Case Dictation

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C. Street – Case Dictation by Wm. Boole, M.D.

Christine Street was not my patient. She was my colleague Dr. Allen’s patient, but when family circumstances required her to take a leave of absence from our practice, I took over her case. Ms. Street was a woman in early middle age, of medium height and weight and physically unremarkable, except for her breasts which anyone would have to say were unusually well-developed.

Ms. Street had come to Dr. Allen complaining of headaches, fatigue, and sleep disturbances including exceptionally vivid and disturbing dreams, which although they would wake her, did not seriously interfere with her hours of sleep. She reported sleeping at least 8 hours most nights. She acknowledged being under some stress, but denied depression or moodiness.

Dr. Allen took a conservative approach. She recommended a mild analgesic for the headaches and referred Ms. Street for a number of specialized tests, including a neuroimaging study. The tests revealed nothing.

I suppose I should say that Ms. Street was not a complete stranger to me or my colleagues. In fact, she was quite familiar because she worked in a suite of offices in our building. The name on the door was that of Dr. Munn, a mostly retired urologist. At sixty-seven years of age, Dr. Munn closed his large office near the city hospital, but he kept his smaller office in our suburban neighborhood and still occasionally saw a patient or two. Ms. Street had worked with Dr. Munn for several years and he permitted her to continue her practice in his office, although he rarely came in any more.

My colleagues and I knew that Ms. Street’s practice was varied, para-professional and had been to some extent supervised by Munn. She was licensed as an acupuncturist, certified as a massage and physical therapist, as an herbalist and as a sexual surrogate. All of these skills had been useful to Dr. Munn because much of his practice involved andrology and men’s sexual health. However, other doctors in our building, including our practice, also referred patients to Ms. Street when they had non-life-threatening conditions, or when they wanted to try non-traditional therapies instead of, or as an adjunct to medication or surgery. Some patients do find acupuncture or herbal teas beneficial. And, after all, medicine is about making the patient feel better. Do no harm.

After her tests, Ms. Street saw me for the follow-up visit.

“Ms. Street,” I told her, “your tests and the neuroimaging were all negative for pathology. You do not appear to have a brain tumor, nor an aneurysm, nor any other detectable brain abnormality. Your body chemistry is grossly normal. We found nothing. Honestly, I am inclined to think that your headaches and sleep disturbance are the result of you somatizing stresses and anxieties.”

She seemed to consider this for a few moments and agreed that it was possible.

“I did want to be sure to rule out serious physical causes,” she said.

“I think we have done that,” I replied. “If you were complaining of ennui, melancholy, dysthymia or depression, I could think of prescribing a selective serotonin reuptake inhibitor, but you are not. If your troubling dreams were causing canlı bahis şirketleri you to lose sleep, I could consider prescribing a hypnotic, but they are not. The hypnotics can be habit-forming, so I avoid prescribing them unless clearly indicated.”

Ms. Street nodded understandingly.

“I hope you do not think I am prying, but may I ask you about your sex life?” I continued.

“I don’t mind at all,” she replied. “I still see quite a number of Dr. Munn’s patients. My work with many of them is intimate and frankly sexual. In a typical week, four days out of seven, I touch a penis, provoke an erection, cause a man’s orgasm or prevent a premature orgasm. I actually engage in quite a bit of sexual activity.”

“Yes, but when did you last engage in intercourse?” I asked.

“Well, I am single, I have not been dating, and I am not very comfortable with our local club scene. It has been a few months,” she said.

“When did you last have an orgasm?” I continued.

Ms. Street paused to think. She rolled her clear, pretty eyes up as if trying to view a mental calendar.

“Um, it has been a while,” she admitted.

“Well,” I said, “I think you have what we call a conversion disorder. There are no drug treatments for it. You wouldn’t benefit from any kind of surgery. You could try talk therapy or various relaxation techniques. You have what doctors in the 19th century used to diagnose as hysteria. Back then, the doctor treated it by inducing orgasms in the patient by manual massage, or with a vibrator or a stream of water on the clitoris. You can do that yourself, but if you would like, I can do that for you.”

“Would you really, Doctor?” Ms. Street asked. “I do that so often for others, but no one ever does that for me.”

“Yes, of course. If you will disrobe, please?”

I busied myself in a drawer while Ms. Street removed sensible shoes and put them in a corner. Next, she began taking off her clothing, garment by garment, placing it on a table. A deep hued blouse came off first. Next, a medium length black skirt. I am a physician and typically I can ignore patients as they disrobe, but I found myself unusually interested in Ms. Street’s progress. Sealed in a vacuum bag in the drawer, I found my instrument – a rather large Hitachi vibrator. The vacuum packaging indicated that it had been thoroughly chemically sanitized, further sanitized under ultraviolet light, disinfected and repackaged after its last use. I pulled the vibrator out of the drawer as Ms. Street removed her bra.

My professional detachment was challenged, but not compromised. Her breasts were magnificent, but I smiled and cut the vibrator out of its vacuum package and plugged it into an outlet by the examination table. I watched the reflection of Ms. Street in a glass cupboard door as she removed her hose and panties. I removed some iron-mongery from another drawer. My penis swelled and twitched in my slacks as I prepared for the medical task at hand, and I struggled to suppress the involuntary arousal.

“If you would hop right up here, and recline on the examination table, we will begin,” I said.

Ms. Street settled herself, semi-recumbent on the exam canlı kaçak iddaa table. I affected my most decorous bedside manner.

“Where do you feel these recurring headaches?” I asked.

Ms. Street indicated with two index fingers to her forehead.

“Close your eyes and I will begin with a light massage of your temples.”

I rubbed gently for perhaps a minute, all the while taking in the delightful spectacle of Ms. Street’s adult female body. The poitrine, which I have already remarked on twice, was full and firm. Her breasts were studded with chestnut colored areolas the size of half-dollars. My mind wandered and I imagined pinching, kissing, licking and sucking those nipples as I would if I were I Ms. Street’s lover rather than her physician. I admired her narrow waist and the curving flair of her feminine hips and her strong thighs. At last, my attention was drawn to the plumpness of her vulva, covered lightly with short trimmed pubic hair. Although, she may not have been having regular sexual relations, she certainly kept herself tidily groomed, as if to be ready.

Ms. Street sighed in a quiet, satisfied way. She breathed deeply and appeared to relax into the upholstery of the paper-covered exam table.

As much as I wished to fondle Ms. Street from head to toe, my professionalism prevented me. I had set out to induce a therapeutic orgasm and I determined to stick to my plan. I concluded my touching the region of her temporalis. I asked how it had felt and whether it had been relaxing.

I found Ms. Street’s grateful response in the affirmative to be satisfying.

“I will be turning my attention to your pubic area, now,” I cautioned. “I will use the vibrator, on low at first, in a general massage of your external organs. Try to remain relaxed. When you appear ready for more, I will turn the vibrator to a higher setting and concentrate my attention on your clitoris. I expect that you will find this quite stimulating, but remain relaxed and enjoy the sensations.”

I stepped down to the other end of the examination table. I directed Ms. Street to spread her legs. She complied and I was rewarded with a textbook vision of the female genitalia – a plump fuzzy mons with similarly plump labia majora; discrete, tidy, labia minora and a fine jewel of a clitoris with its hooded glans. I struggled again with my professional responsibility.

Then, I turned the magic wand on low and placed the vibrating head at the top of Ms. Streets vulva. The device whined mechanically. She seemed to enjoy its touch and she breathed deeply. I moved the wand in semicircles, first left and then right, stimulating her labia on either side. The plump, soft flesh stretched and vibrated gently as I kneaded it mechanically. As I worked, to my surprise and very unprofessional delight, Ms. Street brought her hands to her plump firm breasts and began to pinch and pull at her nipples. They quickly became exquisitely erect and I once again felt a slightly irresponsible swelling in my trousers. For my own comfort, I wanted to tell the patient to stop touching herself that way, but I could not bring myself to interfere with her arousal.

I noticed that the flesh of Ms. Street’s canlı kaçak bahis vulva was becoming increasingly moist. I pressed my instrument against her mons, and pressed again stretching her flesh superiorly toward her navel. The labia glistened and I determined that I could begin stimulating more aggressively with the previously announced intention. Now, she simply cupped her ample breasts with her hands.

“I will turn up the intensity and concentrate on your clitoris, in a moment. Just relax and cooperate with me until you come to climax.”

I turned the vibrator off for a moment. From the counter, I picked up two heavy metal stirrups and inserted them into fixtures on the exam table.

“Feet in the stirrups, now. Spread wide for me. Yes, that’s it.”

I touched the switch on the massager and the whine resumed, but at a note a major third higher. I pressed the vibrator’s head directly against the patient’s now swollen clitoris. I held it there tightly for a few seconds and then, slightly relieved the pressure for a few seconds more, repeating this process over the course of a minute. Next, I gave a broad clockwise sweep of the entire vulva, and resumed the alternating pressure on Ms. Street clitoris. After another minute, I made a broad counter-clockwise sweep and another return to her engorged clitoris. Ms. Street, spread before me with eyes closed, moaned deeply.

I continued in this way for a couple minutes more. Progressively, Ms. Street’s breathing accelerated and became shallower. Her face began to flush. The flesh of her vulva became increasingly turgid and slick with her own lubrication. As I lightened the pressure on her clitoris, the patient pushed her hips gently upward against my instrument. Her climax was obviously nearing. So, I changed my technique – ceasing to lighten the pressure on her clitoris – instead keeping it firm and constant.

It took only a few more moments. Ms. Street shook her head violently from side to side as if indicating, ‘no.’ She began to vocalize also. It was not ‘no’ that she said, however.

“Oh!” she said, and “Ohh! Ohhh! Ohhhh!”

Suddenly, her hands were at her groin and she was rather forcefully pushing the vibrator away. I withdrew it, turned it off and placed it in a tray. It appeared that nature had run its course. Ms. Street lay quietly, panting, eyes still closed for a few moments. When she opened her eyes she blushed and smiled at me.

“You can purchase a vibrator much like that at any pharmacy for fifty dollars,” I said. “Or, you might find that you prefer a shower massager. I want you to get something like that and use it at least twice a week. I’ll see you back here in a month. The receptionist will make you an appointment. I can’t be certain, but I think your headaches and sleep disturbance will have gone away by then.”

“Oh, doctor, I have a vibrator. I just haven’t been using it. Even with all of my training, I guess had just forgotten to attend to my own needs. Thank you. I promise to treat myself to an orgasm every other day for a month and to come in and follow up with you, said Ms. Street.”

It worked much as I had predicted. Ms. Street returned in a month remarkably improved – no more headaches, much better sleep. She did ask if I would give her another treatment, which I quite gladly did. Sometimes the old treatments are best. For hysteria, or conversion disorder, if you prefer, the best treatment is orgasm. In any event, do no harm.

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