"I do realize that it may appear to some that we are jumping around but because both the digestive system and the urinary system deal with elimination. The designers of the book, put them back to back. Which I myself think is a great idea. Now, I know that everyone has read chapter 7, correct?"

I waited as all hands went up.

"When we drink something, it still goes through our digestive system, except that it is quickly absorbed into the blood stream and through the kidneys, most people have two of them and they do look like a kidney bean but much larger. The kidneys filter the impurities and send down the ureters to the bladder, which fills up and then creates the urge to urinate, void, micturate or pee. Your bladder is like a balloon, it fills up and stretches and then you urinate. Oh, the proper term for not having control and being able to hold it in for whatever reason is incontinence. However, it is important for you as the tech, to distinguish whether it is incontinence of bowel, bladder or both. This is related to a disease process or the aging process and of course for babies. Thank goodness for the invention of adult diapers and the disposables for everyone."

Andrea raised her hand, "So, when someone pees themselves when they cough hard or sneeze, is that considered incontinence?"

"That's considered to be 'stress incontinence'. We will get back to that later, okay?"

She nodded, so that I could continue.

"When your bladder sends out the signals that it needs to be emptied, you are still safe and have the time to find a restroom, it's like you are getting a warning, a heads up. Now if you wait too long then indeed you have to rush and you may have an accident. The path from your bladder outside your body is the urethra and varies in length between male and female. With the guys the urethra is inside the length of the penis and similar to that of the esophagus there is a little valve or sphincter that opens and closes depending on whether you are passing urine or semen. The girls are luckier in a sense and have distinct separations from their urethra and vagina. Let's take some time to look at the diagrams of the urinary tract."

Books were opened, pages flipped. Silence filled the room as the pictures were studied.

I heard muttering to one side of the room and directed the student to please share their comments; it might be something educational for the others. Phil snickered into his hand as he looked at Randy. I could hear his 'not likely' comment.

Randy swallowed a couple of times and turned beet red. "I said to Phil, that the pictures looked so much more gross than the real thing."

The class erupted into peals of laughter and chuckles. His embarrassment caused him to go deeper red and hang his head. It took several minutes for the class to quiet.

"Thank you, Randy. Someone had to break the ice, the reproductive system for some reason is surrounded by embarrassing thoughts. It is all part and parcel of our bodies. One thing that I would like to stress is that neither gender should ever assume that they know the actions and feelings of their opposites. Yes, you will all have the knowledge to understand the physiology or how body parts work; but you are without the feelings or the emotions."

"Is that like having a baby?"

"Great example. Exactly like having a baby. For the girls, you have not gone through the hormonal and physical changes, nor have you delivered a baby. For the guys, you get to see the mood changes and their body changing but you don't feel any of those things. The best you get is the feeling of pride if the pregnancy was planned or if unplanned the dismay and stress. Either way there is stress."

I paused for a moment to let what I had said sink in.

"One of the worst habits you can ever allow yourself to fall into is what I call 'the we syndrome'. I know you have all been exposed to this already, think about how you feel when you hear it. How are we today? Did we urinate in the specimen cup? We are going to draw some labs today. We are doing well with your labor, when we feel the need to push, just let us know. I am sure this sounds familiar, I am strongly suggesting you avoid this and there are those out there that will try to sway you; but don't. It is annoying."

Several students offered other suggestions that they had been exposed to.

Since students frequently got up for coffee and cold drinks as well as restroom breaks, there was no need for stress breaks and lunch time creeped up rather fast.

"It is that time, again, enjoy your lunch and then we will have time this afternoon to talk about the reproductive system."

Lunch was over, and I could sense the hint of nervousness that hovered over the class.

"I want to try to get everyone in a different mindset. The key thing is that all along you have been studying the body, its parts and how they work. Everything has been okay, until this point. Now it has taken on a personal, in your face, feeling and it is uncomfortable. So, everyone expresses their nervousness in their own way. Some are silent, some are afraid to look around, some giggle and snicker, some are so cool and nonchalant. All these responses are perfectly normal. What I want each of you to remember is that if you cannot be comfortable here in the class room you will never be comfortable talking to your patients in the real world. We are not going to share your personal life here nor will you share it when you are working. At the best, the girls may say 'I have never had a baby, but I do understand the pain, the frustration, the discomfort.' Or perhaps in years to come they may change that to, 'I do remember feeling the pain and discomfort, but when you hold that little one, you will forget all that and focus the baby. I will help you get through this'. So, take a deep breath, look around, because everyone here is in the same situation, be professionals and learn."

We spent the afternoon talking about the reproductive system, fertility, menstrual cycles and intercourse. They learned that it was important to ask their patients about this private aspect of their lives.

At the end of the class, Tom was settled and prepared to do his first test. He was well prepared and only needed thirty minutes to complete it. I offered to mark it as he waited and was not surprised when he accepted. His score was 100% and he was elated.