Notes from a Medical Student:

Deep Breaths

With my eyes closed, I take a deep breath. I review the flow of the material I need to remember and quickly recall the most important points. My hand goes up against the door and knocks. The voice on the other side says "Come-in," and I think how simple that phrase is for something so complicated. I grab the knob, turn, and walk in, exhaling with a smile and an exuberant, "Hello."

For the past two years I've been reading. Well, mostly. Medical school demands that you master the pages before touching the patients. Well, for the most part. The growing trend now is to start the clinical training earlier. When I say this I mean to say that it's not only important for me to know what pneumonia is, but what it could sound like when I listen to the lungs, what an S1 heart sound is like, and what I should be looking for on a neurological exam. So, for the first two years of medical school, I have studied the aspects of disease, the etiology, pathogenesis, and everything in between. But almost every Friday, we are trained in the technical skills of a clinician, because of course medical science alone, does not a physician make. So here I am this Friday afternoon, learning one of the more intricate techniques of the clinician: the female exam.

Am I nervous? Of course, I'm nervous. In the real world, many aspects of the physical exam would legally be considered battery. Listening to the lungs, the heart, and the abdomen are one thing. You can easily get over the invasion of privacy because you're pretty much examining a patient in something similar to their underwear or a swimsuit. This exam however, is a completely different ballpark. It is the first exam that really shocks me and makes me think, "This is what real doctors do."

Technically, I shouldn't be nervous. For the several years that I worked in an emergency room, I assisted and chaperoned in perhaps hundreds of female or pelvic exams. Holding the tube of preservative or getting the patient comfortable with the most sought after commodity for any patient in a hospital gown: a warm blanket. Several hundred times I've stepped in there and several hundred times I've not thought twice about it. Now I realize, standing in front of the door, I've gone from passive observer to active participant. Now whatever happens is pretty much my fault.

So we start where any relationships starts, with a "Hello." I should explain that the woman guiding me through this exam isn't a real patient. For the first two years of medical school, simulated patients, actors of clinical presentation and thespians of the body, train us. This exam, however, is as real as it gets. And to tell you the truth, aside from the fact that I've never done this before, the fact that I'm male doesn't seem to bode well for me.

So my reaction is the same as any other male medical student's reaction should be…sheer anxiety. Before I even grabbed the knob on the door, my hands were dripping with sweat and the hallway was spinning. A deep breath later and I'm in the room with the door closed thinking, "I forgot the order….what was the order of the exam?!?!"

Despite the fact I know I look nervous, my simulated patient, my guide through the world of the female exam, calms me immediately. She is relaxed and takes me through the motions of the exam easily. As my hands stop dripping sweat and my brow dries, I remember the order of the exam and move calmly through it making sure to ask as often as I remember, "How are you doing?"

I leave the room, beaming, and feeling like I just bought a time-share on Cloud 9. But the anxiety still churns my stomach. After worrying for the entire week about the last hour I sit back and relax. Still, I think, it's better than biochemistry.