The living-room apartment had an overlay of warm light Carlota hated. The light came from the floor lamp her fiancé, Noah, had bought for her at a yard sale a year ago. She wanted to change out the yellowish light bulb for a white one, but was afraid of hurting his feelings. So she left it.

As Carlota settled onto the worn couch, also bought at the yard sale, Noah busied himself in the small kitchen adjacent to the living area. The TV was turned off, and Carlota listened to him bustle around making snacks for movie night. He was probably making his “special” seasoning for popcorn he thought she liked. She didn’t like it. Too salty.

However, she loved Noah. He was easily the best thing that ever happened to her. Carlota reached for the remote to turn the TV on when the pain ripped through her. She sucked in a tight breath and gritted her teeth. Oh god, oh god, oh god…just get through this….

The pain, sharp and piercing, felt as if a blade stabbed Carlota right through her anus and up into her belly button. As the pressure in her rectum tightened, Carlota didn’t dare move. The agony engulfed her and the rest of the universe disappeared. She only existed to survive the misery.

Carlota was not good with numbers or dates, so she couldn’t pinpoint exactly what age she was when the pain started. However, she was good visually and with feelings. That’s how she knew it first occurred in junior high; that’s when her family moved into the bigger house and she finally got to enjoy the privacy of her own room.

In blue hand-me-down pajamas, she was lying on old sheets thrown over a mattress when the attack happened. Just like now, without warning and paralyzing. The pain exploded through her, and her eyes lost focus on her parents’ Led Zeppelin wall tapestry she had tacked up on her wall earlier that day. Confused and alone, she stared up at the sepia-toned fabric with the print of a dying German airship. Does this have to do with my period? I just had my first one. People said cramps would be painful, especially at the beginning. So, maybe. But this doesn’t feel right…this is excruciating.

She remembered using that word: excruciating. She had just looked it up in the dictionary after reading it in a Spider-Man comic. Peter Parker had said it, but Carlota couldn’t remember what had hurt him so bad—she was sure it wasn’t extreme pain up his back end.

The memory of her first attack ebbed away with the pain. In her own apartment, the nauseating light splashing over her, with her fiancé blissfully unaware in the kitchen, she felt her rectum relax. Carlota thought of a boulder lifting off her; she could breathe again, move again.

Her face flushed with embarrassment as weird shame descended over her. Nobody knows, she consoled herself. Nobody can judge me. The weird girl with weird butt problems.

Sitting on the tattered brown couch, waiting in silent shame for Noah to break the tension with his presence, Carlota had a cringey memory from high school slide into her head.

Senior year was seven years ago, but the embarrassing experience choked Carlota when she let it. She was hanging out at her friend Margie’s house. She and Margie had been friends for several years, and were still friends. But it wasn’t an interaction with Margie that weighed on her.

Carlota wasn’t even sure who had all been at Margie’s house anymore. The actual events of the gathering had dulled with time and with forcing the memory out of her head so many times. What she remembered was being in Margie’s living room. Some girls were on the floral couch and some girls were on the beige carpet. That’s where Carlota had been. The Princess Bride was playing on the big screen TV. Some of the girls watched, some girls chatted, and Carlota was telling jokes with Jess.

Jess was a year younger than the other girls, but she was smart, funny, and silly. Jess and Carlota often found themselves locked in hilarious conversations, stolen away from the rest of the group with inside jokes. This was true that evening as well. They had slid to the side of the living room, giggling with each other and making fun of the movie.

Then the pain seized Carlota, cutting off her air and freezing her muscles. She did her best not to gasp, not to shout or squeak in dismay as the pain erupted through her anus. However, she could not mask the awful shock on her face. She tried to fight it, but felt her brows knit, her mouth turn down, and she was sure her eyes looked terrified.

Jess, noticing the sudden change in her friend, asked Carlota if she was okay. Carlota managed to nod.

“Do you need something?” Jess asked.

Carlota shook her head. She struggled to say, “Just need to let it pass….”

“What?”

“Cramp.” The pain moved away. Carlota looked around and noticed that the other girls had ignored her and Jess’ exchange. She breathed.

“Where?” Jess’ voice, so deeply concerned, so genuine and friendly, caught Carlota off guard—so she answered without thinking and pointed at her bottom.

Jess laughed—the type of laugh that was almost a bark. The other girls didn’t turn around, they were used to Jess and Carlota laughing their heads off together. But Carlota wasn’t laughing. Another hurt swelled in her chest. She faked a smile and shrugged off Jess’ reaction, but felt mopey for the rest of the night. She and Jess never spoke of it, but the embarrassment of her good friend’s laugh silently followed Carlota.

Right now, in her apartment, Carlota tried to push the memory aside. She and Jess hadn’t been in contact for years, but she still felt her face grow hot and her chest tighten whenever she thought about the moment. Carlota sighed, and the small movement caused her rectum to spasm.

She gripped the arm of the ragged couch, digging her nails into the brown fabric to keep steady. She squeezed her eyes shut to help deal with the pain and to shut out the warm, nauseating light from the lamp. Carlota tried to get up from the couch, gingerly lifting herself. It felt as if two sharp needles were invading her body, one snaking down through her belly button and the other up through her rectum. She wanted to scream, but years of endurance trained her mouth to stay shut.

Rarely did the pain go away then come again so quickly, but when it did, it came with tremendous force. Any small movement caused extreme agony to blister inside her. She froze in a half-standing position, squatting over the couch with her eyes screwed shut.

Noah walked into the living room, holding a large orange bowl of popcorn in one hand and a spice shaker with his special seasoning in another. The smile he had been wearing fell from his face.

“Carlota?” he asked, concern vibrating in his voice. Sometimes when Noah said her name, each syllable pronounced with care and reverence, Carlota wanted to laugh because it sounded butchered compared to the sharp, quick way her Hispanic family said it. But, in that moment, she treasured the sound, yearning for any type of comfort. When she didn’t answer, Noah asked, “Is it the cramps?”

Carlota grunted. She could sense Noah at her side, hovering.

“What can I do for you?” he asked, setting aside the bowl and shaker on the living-room floor. His voice seemed dim, as if it had to travel through her pain for Carlota to hear him.

She didn’t answer. Couldn’t. Finally, the pain began to flow away. She opened her eyes. She breathed and eased her body into a relaxed position. “I’m okay,” she said. She turned to Noah. The alarmed look on his face surprised her.

“I hate seeing you in pain,” he said. The bluntness of his words swam in Carlota’s head. He’s not saying it because he’s my fiancé, he honestly hates it. Carlota heard it in his voice and saw it in his face.

Carlota had once told him the cramps were connected to her periods, yet that never stopped him from being concerned every time. A new shame descended over her. It oozed over her face and shoulders in uncomfortable waves. She looked at Noah. He stared back at her with eager eyes. He cares about me more than anyone ever has—even myself. 

Six years ago, when Carlota turned 18, she went to see a gynecologist. It was her first time and she went alone. Tile floors, stainless steel, and off-white walls adorned with illustrations of women’s reproductive systems seemed to scream at her that this was place for adults and she was only masquerading as one.

Carlota kicked off her tennis shoes. Her hands trembled as she took off her jeans. The cold poked at her bare legs, causing her smooth skin to prickle. She had shaved and felt dumb for doing so. What does he care? she thought. He’s a medical professional. But she wanted to do anything to relieve the awkwardness of the situation, so she shaved. It didn’t help.

She had come alone to the gynecologist because she was 18 and that’s what she thought 18-year-olds did; however, as her hands shakily slid off her flower printed underwear, she wanted her mother to be there. Even if she was just in the waiting room, Carlota thought, waiting for me.

Carlota hurried to fold her underwear and place them underneath her jeans on the chair, where they would not be seen. She grabbed the papery slip the nurse had given her and wrapped it around her waist. Carlota maneuvered herself to sit uneasily on the examination table, the skin on her legs uncomfortably bristling with goosebumps.

There was a light tap on the door. Fear rocketed from her belly to her throat, and Carlota said nothing. She stared at the door, uncertain of what to do.

“Are you covered?” came the nurse’s gruff voice. She was an older and unfriendly woman, with a nametag that read “Jessica.”

“Yes,” Carlota squeaked out. Jessica, Jess—the memory of her friend laughing crept into her head and sunk cold claws down on her.

Nurse Jessica came in, followed by the gynecologist, Dr. Silva. Carlota sucked in a shudder, feeling vulnerable and stripped.

Dr. Silva was a fatherly older man. He was short, balding, with big coke-bottle glasses, and warm, rubbery hands. He had a heavy Brazilian accent, and Carlota had a hard time understanding him. Therefore, she nodded a lot, even if she wasn’t sure what he was saying. She answered his direct questions with quiet, short responses. Nurse Jessica wrote down everything on a clipboard.

Before the exam began, Nurse Jessica exited. No, Carlota thought, come back! Although the nurse wasn’t the most comforting, Carlota regretted the absence of another female in the room. Still, she said nothing. She watched Dr. Silva wash his hands and put on gloves. Carlota’s heartbeat accelerated, and she fought to keep composure as he turned to begin his examination.

“Go ahead and lie back,” the doctor said. Carlota hesitated, but she did it. There was a pause. “Put your feet in each of these stirrups.” The doctor pointed to the two metal contraptions on either side of the table.

Carlota’s teeth chattered. But if I do that, she thought, he’ll be able to see…everything. She wanted to laugh or scream. She wanted to jump up and run out the door. She wanted to tell the doctor that she had changed her mind. Instead, she slowly placed her right heel in the right metal holder. Then, even more slowly, she put her left heel in the left metal holder. She shut her eyes.

“Relax,” Dr. Silva said. “The more tense you are, the more it’s going to hurt.” He paused, but Carlota didn’t move. “Take a deep breath.”

She let the breath go, but she could not get away from the disconcerting thought that old, fatherly Dr. Silva was the first man to see and touch her…down there. His hands were warm through the latex, and as long as she didn’t think about it, she was able to rocket her mind away from her body as he probed her.

“Relax,” he kept saying. “Breathe.” Then he said, “You’re going to feel a pinch.”

Although his words were meant to warn Carlota, they caused her to tense again. She wished he had done it without telling her. The instrument he slid inside her was cold and intrusive. She gritted her teeth to keep from jerking and felt a scrape and a pinch in a place she didn’t know she could feel from. Taking a sample from my uterus wall. That’s what the nurse had said.

Dr. Silva slid the instrument out. He turned away from her and placed her swabbed sample in a plastic bag. “Alright,” he said.

Her vagina throbbing and sore, Carlota sat up. She squirmed on the padded table, feeling cold and tender between her legs.

The doctor turned back to her. “Everything seems normal,” he said. “We will contact you if there is anything abnormal in the sample.”

Carlota glanced at the poster with the diagram of a woman’s vagina. Was there a possibility that she was abnormal? Panic swelled inside her but she swallowed it down. I look like that, right? He would tell me if I was some sort of monster…right?

Dr. Silva took off his gloves and threw them in the bin labeled “hazardous material.”

I’m hazardous material, Carlota thought.

“Is there anything else?” the doctor asked.

Painful unbearable cramps. The thought jumped in her head. Cramps so terrible I feel like I’m being stabbed with an icicle. But they’re in my butt. Carlota wondered if the gynecologist was even the right person to ask. Just because it was cramp didn’t mean it was connected to her period. I’m not a doctor. I don’t know anything about the human body. It’s probably just my period.

“Um,” Carlota began, “I have really bad cramps….”

“That’s normal,” Dr. Silva said. “Especially so young. Use a heating pad. Ibuprofen will help.”

“Like Tylenol?” Carlota asked.

“Ibuprofen is better,” Dr. Silva said. “It’ll help reduce swelling. Midol is good, too. You’ll be alright. Anything else?”

But…they’re in my butt. The detail seemed important yet, she could not bring herself to tell this male stranger about the severe pain inside her anus. He just touched you! Carlota internally screamed. Say something!

In the back of her mind, she heard Jess’ laughter. Talking to the doctor about this bizarre and uncomfortable issue was too much for Carlota. “No, nothing else, Dr. Silva. Thank you.”

Now, in her apartment, Carlota watched as Noah ran to the bathroom. He quickly came back with the bottle of Ibuprofen.

“How many do you want?” he asked, pouring a pile of at least 15 onto his palm.

Carlota wanted to say, All of them! “Eight,” she said.

Noah looked at her with concern. “That’s too much.”

“Give me four then.” She dry swallowed the pills Noah handed her. She eased herself down to the couch with a wince. The cramps left her rectum and sphincter sore. She imagined those body parts looking like a crumpled brown paper bag.

“You should go to the doctor,” Noah said, sitting beside her. He’d told her this before, but she always waved him off. “You shouldn’t be in this much pain.”

What could he, a man, know about menstrual cramps? What authority did he have? She turned to him to say something of the sort, but the look on his face stopped her. His lips were parted, waiting to say words of comfort. His eyes were big and bright, waiting to see anything she wanted to show him. He was attentive. He was alert. He was there.

Noah didn’t have any authority on menstruation or her pain. His face said he knew that. He looked confused and worried. His comment had come from a place of love. A place of support. It’s not like I know what’s going on, she thought, and that idea jarred her.

She considered telling him everything. Would he laugh at her? Would the support in his voice and eyes disappear because the problem was connected with body parts people made jokes about? Rectum, ass, anus, sphincter—she couldn’t imagine anyone taking her seriously once she said those words. With Jess, Carlota had merely pointed at her bottom, and her friend—at first, so full of concern—had erupted into laughter.

But he didn’t laugh at the other thing, she thought. Carlota had noticed another consistency with her pain. Along with happening around the time of her period, she also was often constipated. And he knows about that.

Three years ago, when Carlota and Noah began dating, Carlota experienced stomach pain so severe that she had wanted to die. Noah stopped by Carlota’s old place to pick her up for dinner when the pain in her gut started out as a low boil.

“We can still go out,” she said, trying to hide her grimace.

But Noah was fine with waiting for her stomachache to pass. It didn’t.

With each moment, Carlota swore her stomach swelled and distended. She felt as if she was going to burst, and she secretly welcomed that release. Ashamed of her lack of control, Carlota groaned and cried, slipping from the couch to the floor and moving back to the couch.

Noah repeatedly asked Carlota if she needed to go to the hospital. As she writhed on the couch, she declined his offer to take her. Go the ER for a stomachache? she thought with the pain raging through her. The idea seemed ridiculous. She imagined her mother, her friend Jess, and the entire emergency room shaking their heads at her. Childish, spoiled, crybaby, hypochondriac, she imagined them saying.

After hours of unbearable discomfort, Carlota allowed Noah to take her to the emergency room. It was another hour before she actually got into the ER. The entire time Carlota waited, she cried in misery. Noah held her, rocking her gently as she wept into his shoulder.

Angry embarrassment crawled over Carlota as anguished moans oozed out of her. But she wasn’t upset with the hospital staff for not taking her right away. She knew the emergency room took people based on need. She knew that stomach pain and bloating (no matter how severe) was not a high alert issue.

Finally, Carlota was admitted, and morphine and antinausea medicine was pumped into her system. The pain subsided. X-rays and ultrasounds were taken of her intestines. The ER doctor shrugged at her. “You’re constipated, but mostly just looks like a lot of gas,” he said. Carlota couldn’t remember his name or what he looked like beyond being an older man, but she remembered the humiliation she felt after he said those words. “Constipated…just gas.”

The doctor continued to talk about bowel diseases like Crohn’s disease, colitis, and IBS. Carlota tried to listen, but the tests to confirm a diagnosis were going to be expensive, and the thought of paying so much for poop and gas made her face turn red again. So she declined.

The doctor discharged her and Noah took her home. Carlota was sure Noah was going to drop her off and she’d never hear from him again after having spent six hours with her in the emergency room. But the next day, Noah returned with a list of follow-up suggestions the doctor had mentioned.

They stayed in and had a movie night. It was the first time Noah made his special popcorn seasoning. Too salty, but Carlota ate it with a smile. She and Noah talked about all the healthy choices they could make together. A warm flush of pleasure pulsed through her; that was when she realized she loved him.

In the present, sitting on a different couch with different popcorn for a different movie, but with the same person who continued to give her pain credit—more than she did—and support her—more than anyone else had—Carlota looked at her fiancé and knew one thing. He took her pain seriously.

The realization struck Carlota with such a surprising force that she gasped. A warmth in her chest blossomed and a rush of endorphins bubbled up and fizzed in her heart, making her eyes water.

Noah reacted to her tears. “Is it the pain again?” he asked. “Do you need more pain killers? Do you want me to go to the store and get you Midol? You said that was good for cramps, right?”

The sweetness of his offer tugged at Carlota’s heart. She shook her head. Carlota questioned herself. Maybe this pain isn’t normal. Noah seems convinced. Maybe something is really wrong. What the hell is wrong with me?

A lump formed in her throat and words suddenly spilled out from her mouth in fragmented clumps. She wanted to tell Noah everything. “It hurts so bad,” she said and gulped. It was difficult to get years of shame, pain, and confusion out all at once. She swallowed. “So bad.”

Noah didn’t say anything, just watched her face and waited for her to go on.

“I think it’s cramps,” she said. “But…it’s not…in the normal place.” She hesitated and took a steadying breath. Just say it, she thought. Tell. Him. “It feels like a sharp, piercing pain…in my…up…my—anus.” She said “anus,” not “ass,” to try to sound medical, more professional, but it still sounded like a joke to her.

Noah was quick to respond. “Ow!” he said, horrified. The exclamation was so honest and so Noah that Carlota couldn’t help but smile. There was a beat as Noah waited for Carlota to continue, and Carlota waited for Noah to say more. No one said a word. Instead, Noah grabbed his phone and started typing.

“What are you doing?” Carlota asked.

“Looking up your symptoms,” he said.

Carlota didn’t say anything. When the pain was especially bad, she toyed with the idea of looking up what she was experiencing, but never did. The idea of typing the actual words “pain in ass” was mortifying. Maybe “ass” wasn’t right. Maybe “anus” was better, or “rectum”? But it was more than embarrassment, she was afraid of what she’d find.

“Sharp pain, you said?” Noah asked.

Carlota nodded and wiped her eyes. “Yeah, like a stabbing.”

Noah started to read from his phone: “Sudden onset of severe pain in the rectum area, which can last from seconds to minutes. The pain is sporadic and can be without warning.’”

Carlota’s head spun. “Yes!” she said. “Just like that. What is that?”

“Proctalgia fugax,” Noah said, sounding out the words. He handed his phone to her. Carlota continued to read the article Noah had pulled up. Proctalgia fugax, also known as functional recurrent anorectal pain, meant “anal pain of unknown cause.” Of unknown cause. Figures.

Unknown cause or not, the article said the pain was due to muscles in the anal canal and pelvic floor tightening abruptly and unexpectedly. The article laid out her symptoms—as if someone had written the piece after speaking to her. Sudden severe pain in the rectum, most likely to occur at night—which shocked her, because when she thought about it, was 100 percent true—may experience several episodes then go long periods without occurrences. Although the pain was mostly known to occur without warning, there was a list of situations that might trigger an episode. On it was menstruation and constipation.

Carlota handed Noah’s phone back to him. He took it and watched Carlota for her next move.

Years of denial, embarrassment, and fear swirled inside her. She felt light-headed and overwhelmed. She also felt stupid. Was the information always there, waiting for her to find it? How come she never searched? Why did she live in silent pain for so long? She didn’t know the answer to any of these questions, and it made her feel worse.

But those thoughts and feelings didn’t stop Carlota from seeing a faint light this search had unearthed. Maybe her pain was this thing—proctalgia fugax—maybe it wasn’t. Either way, other people had this pain, her pain. Other people talked about it, she could too.

Carlota breathed deeply. She turned to Noah and opened her mouth to speak, but only a sob came out.

Noah’s eyes widened. “What?” His hands went to her face. “Does it hurt?”

Carlota shook her head. Something is wrong with me. Feelings of stupidity and denial worked through her. She pushed through those thoughts. Something is wrong with me…but I’m not alone.

Her bodily pain had disappeared, squirreled away inside, waiting. Another sensation filled her. It was warm, soft, and tender. “Thank you,” Carlota choked out. Thank you for caring, for believing me. Thank you—for not laughing.

Noah wrapped Carlota in a hug. “I don’t know what you’re thanking me for,” he said, his words whispered into her hair. “I just hate seeing you in pain.”

The movie was forgotten, the TV never turned on. The popcorn was cold, left unseasoned. However, the apartment was warm, and Carlota relaxed into Noah’s embrace, the floor lamp bathing them in uplifting yellow light.

A.E. Santana is a Southern California native who writes horror and fantasy. She is the author of several short stories and plays. Her MFA in fiction is from the University of California, Riverside, and she received her bachelor’s degree in mass communications with a minor in script writing from California State University, San Bernardino. A.E. Santana is a founding playwright for East Valley Rep. She has quite an affinity for cats. She can be found at www.aesantana.com and on Instagram and Twitter @foxflur.