I hand the skin pen to Nick. “Okay, Bart,” I say, “I want you to write out all the vertebrae on the blackboard,” as I gesture towards Katherine. TB looks hurt, and jealous, as he realizes the ‘punishment’ I’ve just given Nick for his goof in the ER.
I’m hoping it’ll be a blessed punishment for Katherine, too – her lower back is an erogenous zone, along with her ears, plus the more typical neck, breasts, inner thighs, vagina, and anus. I’m feeling bad about boring her at the start of the session. Hopefully, this will keep her playful mood going, until I can get her back to the hotel bed.
I decide to bring the group a few steps away from the table (and my exposed wife). Nick is left-handed so has moved to the far side. He leans in close to Katherine to ask something, which gets a nod, then he straightens up and undoes the three string ties on the gown. He begins by walking his fingers down Kath’s spine in a counting manner – good, he’s remembered that not everyone has the same number of vertebrae.
With difficulty, I continue my talk about the other set of pelvic muscle attachments. Those that go upwards to action the torso. My students also seem a little distracted, with fairly regular glances back towards the massage table.
Nick isn’t listening to me, he seems to be entertaining Katherine with whispered conversation or jokes, in between working on his masterpiece. He often has his whole forearm resting on Katherine, while stabilizing the ‘canvas’ with his right hand. In the lumbar region, this means he was resting his arm across her buttocks. He even pulls the elastic of her briefs down at one point, to trace out the sacrum and coccyx. I was expecting a simple row of labels; C1 to C1, T1 to T12, and L1 to L5, maybe with a rectangle around each, but Nick is sketching onto Katherine’s back an anatomically correct vertebral column, complete with partial ribs.
Speaking to the group, I finish up my review of the skeletal muscles. “Don’t forget about the pelvic diaphragm. Most of the medial muscles we’ve just covered also assist the perineum, as none of the sphincters action in isolation. But we’ll return to the pelvic floor in a future session, sometime after we finish the rest of the skeletal sessions – spine, upper limbs, and then neck and skull.”
Maybe Nick has been listening to me because as I finish, he pats Kath twice with his fingertips and says, “All done.” It wasn’t quite a ‘pat on the bum,’ but only slightly higher than that on the gluteus medius. Katherine arches her back in an attempt to look over her shoulder, her elbows still pressed at her side to hold the untied gown, but her attempt to see the drawing is futile, and she slumps forward with a brief glance towards the group. I try to read her expression, without luck.
Nick replaces the cap on the skin pen and tosses it under the table. He’s fully paying attention to me now, but doesn’t leave Kath’s side. He seems pleased, he’s probably waiting for us to come and judge his artwork. Kath has her eyes closed and is blowing air through pursed lips for a few deep breaths. Is that a breathing exercise to calm herself? Has my plan delivered redemption for the earlier boredom I caused? She opens her eyes again, and I see her pupils are dilated, but there’s also a frown, some anxiety in her face that’s sending a mixed message.
“Any questions?” I ask the students.
“Is that male or female?” Kim says, pointing to the plastic pelvis in my hand.
“Ahh. The osteology is inconsistent. You’ve probably noticed the large pelvic cavity, but the narrow intercristal distance between the iliac crests. And they’ve taken some manufacturing shortcuts to articulate the hip, so the ischium is entirely artificial. On balance, I’d have to go with the angle of the sacrum and say it’s male, mostly. Let me show you the difference on our live model.”
Without further prompting, the group quickly migrates back to the table to admire Nick’s anatomically correct artwork. “Da Vinci would be proud,” states Sean, summing up the general consensus.
“Can I take a photo?” asks Ryan, not really sure who to address, “…as a study aid,” he adds, which does nothing to silence the mirth of the group. Counting vertebrae is something they all mastered in their first year.
“I’d like one,” says Nick.
“Yep,” adds TB.
Brooke asserts her authority, “I’ll be the only one taking any photos. And only if Katherine approves.”
“Umm. That’ll be okay. I’d like to see it, too,” Kath responds, before shifting the towel-cum-pillow a bit with her fingers, so she can hide her face in the hole of the massage table.
Brooke attempts to frame Kath’s temporary adornment with outstretched arms, but eventually chooses to climb onto the sturdy table, standing astride Kath’s legs.
“Would you mind if we show the full drawing Katherine?” she asks.
Kath responds by straightening her arms down her flanks and hooking her thumbs into the waistband of her underwear. She hitches them down further than is required. Two or three inches of cleft is now exposed below where the penmanship ends on her coccyx. I guess it isn’t her near-nudity that troubles her.
Brooke’s phone makes the shutter noise twice, and then a third time with the flash enabled.
As she climbs down from the table, Jess is trying to see the screen, but Brooke locks her phone and announces, “I’ve got all your numbers, I’ll send a pic to all of you on the condition you don’t forward it. If I find it doing the rounds, I’ll be treating it like a breach of patient privacy.” I think she’s looking out for my interests, and Kath’s, setting the rules herself, so I can maintain a guise of detachment from my exposed wife on the table.
“Okay. If we’re done?” I resume. “Back to the sexual dimorphism of the pelvis. You’ll note Mister Polyethylene here,” holding the pelvic model upright, “has a near vertical sacral angle into what’s left of his column. Females typically develop a deeper curve through the lumbar set. Studies show that men find fourty-five degrees to be the most attractive. Note that just implanting a big silicone booty doesn’t entirely fool men if the lumbar region remains vertical. Men are attracted to a woman’s ability to bear children, and the sacral angle is one of the cues they’re looking for, subconsciously.”
I mimic the contours of Kath’s lower spine to tailbone with a sweep of my hand, a few inches above her prone form. “You’ll notice Katherine’s sacral angle is near that ideal. Coupled with her ilium locating the strong gluteal muscles distal from the birth canal, where they can’t harm a baby during delivery. This, of course, is the reason for the wider hips you see on the female pelvis, all combining to be – as Tremaine assesses it – mighty fine.” The group laughs, as I recite TB’s words, attempting to impersonate his distinctive voice and mannerisms.
“Can you tell if there’s been childbirth?” asks Sarah.
“Not necessarily by the pelvis alone,” I answer. “Although, during the last trimester the ligaments do significantly loosen in preparation for delivery. But they normalize in a matter of weeks after the birth. You’ll have to look at other indicators.”
“Such as?” prompts Ryan.
“Well, let’s think it through… Could you turn over please, Katherine?”
Kath awkwardly rolls over, still clamping the gown in her armpits to keep her breasts covered. She then flicks the loose ball of material downwards to cover her briefs.
“So, Jess,” I continue, choosing her randomly, “your patient is non-responsive and you need to find out if she’s a mother. What superficial signs of childbirth might you look for?… Without a vaginal inspection.” Thinking she should know about the linea nigra on the abdomen.
Jess steps up to the table next to Brooke. “Possibly a C-section scar?…” I had forgotten about that, around thirty percent of births in the US are Caesarean. She folds the lower half of the gown twice to expose Kath again, up to the navel. Not seeing anything of note, she briefly peeks under Kath’s briefs as incisions are commonly made below the bikini line. Kath is slightly startled by the brush of Jess’ finger against her skin. I see her eyes open widely to look, but Jess and most of the others are engrossed in the ‘challenge’ I have set. Kath relaxes again, closing her eyes.
I smell arousal in the air. Specifically Kath’s familiar scent, probably wafted by the movement of the gown. She is definitely aroused. I am aroused. That might explain the trepidation I saw earlier, and the awkward roll onto her back. The gusset of Kath’s underwear is likely wet and she is dreading the time when I ask her to articulate her lower limbs and expose her secret.
“No pregnancy line…” Jess continues, running her thumb up towards the navel, “but they fade a few months after birth.” Running her hand laterally across Kath’s abdomen, while bobbing her head to inspect, she announces with a clinical voice, “No obvious stretch marks, but possibly some looseness. Inconclusive. But there does seem to be some diastasis recti indicative of postpartum.”
I notice a runic ring on Jess’ smallest finger, probably Old Norse writing at a guess, as Vikings seem to be popular on television at the moment. For an instant, I’m pleased it’s just a piece of cheap costume jewelry, not an engagement ring, but then I decide I’m being foolish and selfish, I really just want her to be happy.
“Do you mind?” Jess asks, hovering her hands near Kath’s shoulders.
Kath’s eyes were closed, and perhaps she was dwelling on her sticky situation. Confused by the question, she sits up partially to look, which Jess interprets as cooperation and deftly releases the gown from Katherine’s shoulders. She has it down to the elbows, before Kath even realizes what the question was.
I see the brief flash of horror in Katherine’s eyes, and open my mouth ready to say something, but I’m trapped by the same dilemma she is. Kath is supposedly a ‘nude model’ for ‘big commercial shoots’ and just recently did a ‘topless gig,’ why would she be shy in front of a few medical students?
My blushing wife looks down to me at the foot of the table. I smile, probably goofily, and give a small shrug. Sometimes when you play silly games, you score an own goal, I guess. Strangely, I’m not upset and can already see the humor of the situation. This will be a great story for years to come, even if it’s just between the two of us. And Brooke too, I just realize.
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