I am sitting on the edge of the table in a barren examination room, white paper crinkling under me with every move, my skivvies covered only by a ratty gown that ties in the back. I’m here because my husband has punched me in the stomach and the pain has been excruciating for two days now. My name is Roxanne Ford.
The door to the examining room opens and in strolls an eager beaver third year medical student. He is clean cut, slightly nervous, sent from central casting to play Young Male Doctor. His white lab coat is paper thin and frayed at the edges. He extends his hand to me.
“I’m Robert,” he says. “You want to tell me what brings you in here today?”
With practiced weariness, I extend my hand to shake his, which he has yet to wash at the small sink in the corner. Then I answer the question. For the eighth time today.
Before anyone starts sweeping the streets, searching for my sweet, unsuspecting husband, ready to deliver a swift round of vigilante justice right to the boys, I should clarify: He hasn’t punched me. Not ever. And my name is not Roxanne. But for eight hours today, it will be and I will sit in this clinical examination room replaying this scenario.
It’s all part of the clinical skills assessments of a Midwestern University’s medical school. The program gives third year medical students a chance to practice their bedside manners and diagnostic skills without their textbooks handy. I’ve signed up to do this, to memorize a script and the particulars of a fictitious character’s traumatic existence, and let med students work me over, so to speak.
But why am I here? Partly because I will try anything once. Partly because I am intrigued that this even happens, especially after years and years of hit and miss experiences with a range of specialists while seeking treatment for my own chronic pain. And mainly because $100 for eight hours work is nothing to sneeze at – especially if you get to keep your clothes on. Except … I don’t.
We are known in the department as “actors,” although it seems a generous title. I’ve been given a detailed history for this life which, for now, is mine. I’ve gone through strict training on how to behave, how to respond, how to wince and react physically at specific moments. Thus, it stands to reason that I was nervous arriving on campus early this morning and I am not alone in this endeavor. I’ll have a partner. We’ll take turns throughout the day – one of us playing Roxanne and the other, tucked away in a separate room, watching patient and doctor interact on video screens and grading the medical student’s performance. My partner turns out to be a girl, probably a college student herself. She is a theater major, an Actor with a capital “A.”
As part of our case study, the Actor and I need to give ourselves the appearance of having a huge dark bruise on the stomach, where our fictitious spouse has punched us. My partner shows me how. She rips a page out of the newspaper, dampens it with water and rubs it across her stomach. We agree that I will watch for the first shift, since she’s done this before. From a room down the hall, I watch on a monitor, equipped with three switches that let me change cameras and viewpoints. As the first student comes in and the exam gets underway, my partner fields the questions. Her eyes dart hither and yon, hands wringing in her lap. I’m thinking two things: one, this is pretty convincing stuff and, two, I don’t think I can pull this off.
But the next thing you know, it’s my nearly-bare ass on the edge of the table and in strolls a strapping Noah Wyle-esque youngster. He washes his hands like a good boy (they don’t all do this and it means a strike against them), then he sits down in front of me and says, “So I understand you’re having some kind of abdominal pain?”
I nod silently. Like many victims of domestic violence, I’m supposed to be perpetually afraid. I’m not to volunteer too much information, as I’m worried it will get my husband – and, by turn, me – in trouble. I make very little eye contact.
Can you tell me a little about that?” the med students ask.
I respond to his questions, according to the script. I make him work for information and hope he’ll pick up on the signs and note my body language. I can tell he’s baffled by my symptoms. I can practically see the checklist in his head as he runs down the possibilities, churning out items to explore, symptoms to assess. I explain to him that the pain in my stomach is constant, that it doesn’t radiate anywhere and that it came on pretty suddenly two days ago.
Only once he’s run down a number of highly unpleasant queries about my GI tract and has me reclining for a physical exam does he pause and ask, "Do you have a history of abuse?"
And what I feel is shame. Embarrassment. It takes me completely by surprise. I nod wordlessly until he draws the details out of me, leaning forward slightly on his stool, knitting his brows in compassionate concern. In a slightly awkward manner, he tries to make me understand that what’s happening to “me” isn’t okay. His earnestness is heart breaking. I bite my lip and explain to him that it’s always my fault. I feel sad, confused and scared and I’m almost in tears by the time the voice over the loudspeaker announces that it’s time for the student to move on to his next case.
I should clarify: I’m not surprised that I get into the part as much as I do. I’m surprised how easily I get into it. How quickly I forget that the things I’m saying aren’t actually mine. That, instead, they’re the details of a case study culled from dozens of similar cases. That Roxanne isn’t a real person and that I’m not Roxanne. I’ve never been hit before, so this isn’t personal experience I’m drawing so strongly upon. Maybe it’s the experience of the victims I’ve watched during domestic violence training for my volunteer work on a crisis line.
Or maybe, and I think this is more likely, it is just the fact that I’m a person and I simply don’t want to be hurt by anyone. The desire not to be violated, not to be the object of anger, rises effortlessly to the surface, bubbling there with enough reality that the tears spring to my eyes.
This is how my day goes, over and over again. For hours they come, these medical students, one after another. They’re all different, yet somehow very much the same, dressed up in their fervent youth and transparent confidence, accessorized with hip-but-comfy footwear. Most are good, with bedside manners still crude enough to be charming, polished enough to be comforting, complementing sharp diagnostic instincts that make me feel okay about the future. Others are sluggish, skirting around my problem, eschewing logic and instinct for a quick mental lit review.
I feel for the ones who can’t quite get there. You can see in their eyes that they want to solve this puzzle, that they want to get the answers right and for a moment I can see them not as potential physicians but as desperate medical students dying to know the name of the game. I can’t help but think that if their desire to know the patient was as strong as their desire to know the answer, Roxanne might wind up getting the help she needs.
By the afternoon session, it gets harder. The novelty of prancing around in a flapping hospital gown has long worn off. I’m tired of being palpated by set after set of freshly scrubbed hands as both of us pretend my smeared newsprint resembles a bruise. And it’s draining, this constant stream of questions, sort of the same but never enough that you can put yourself on autopilot and sail through.
At just before three o’clock, I’m examined by the last student of the day. My answers are becoming slightly more rote, my intonations no doubt less readable. When the voice on the loudspeaker announces the day’s end, I’m ready to retire the hospital gown and get back into my own clothes. As I toss the gown into the hamper and pull my sweater over my head, it occurs to me that I seem to spend a great deal of time wanting to be other people. Or, more accurately, wishing I could taste their lives for just a moment or two. A day in this person’s shoes, a weekend in another’s. What’s interesting here, I think, on the elevator back upstairs, is that when I finally got to step into someone’s else’s pair, they weren’t Manolos or fancy Jimmy Choo boots. They weren’t the rubber-soled clogs of the medical students or even the pumps of the clinic’s staff. The shoes I tried on are tired and worn and, quite literally, beaten down. They are sad and lonely and difficult and tiring. More than anything, they make me glad that I have the ability to take them off, put on my real ones and stroll freely out the door.