B. G. is a well-appearing, obese 24 year old woman with no complaints today. She is laying out her family history of pancreatitis. It’s not very interesting. I lean forward and put my hand on her knee. The sleeve of my white coat slides down over my watch.
I’m going to ask you some more personal questions. These may be a little more sensitive, but they are an important part of your medical history.
B. G. nods.
Are you sexually active? She has a boyfriend of four months. They met at a CVS. Do you use condoms or contraceptives? Have you ever had a sexually transmitted disease, such as syphilis, herpes, chlamydia?
At any time, has your partner ever hit, kicked, threatened or otherwise hurt you? Are you in danger now? In an emergency, where would you go? B. G. is crossing and uncrossing her ankles. I stand up and walk the perimeter of the exam room with my hands clasped behind my back. Who is your greatest confidant?
Do you drink? What’s your drink? Do you use illicit drugs? Do you like them? What gives you the strength to get up on a weekday morning, and what puts you to sleep at night? Do you have night terrors? Have you had a rape fantasy? I pull out an otoscope and gently pull back her ear to look inside. Her tympanic membrane is pearly and gray with no exudate.
Do you believe in God? Do you avoid any meat products? Would you accept a blood transfusion? I wash my hands again. I look her dead in the eye. Do you think you’re smarter than me?
What are you afraid of? Are you ready to die?
B. G. starts to cry. How do you handle the cost of healthcare? How do you handle the cost of everyday living? Have you been to prison? Do you know who the president is? Is there duct tape on your car?
Do you want to hurt yourself, do you want to kill yourself, do you want to kill me?
B. G. is sick on the floor. It spatters. I open the door to air the room out.
Do you have a gun? Was it expensive?
Do you drink Mountain Dew? Is gambling a problem for you? Are you a Democrat? Have you seen the new Sex and the City? I’m out of time. B. G. is covered in vomit. I ask her if she can smell it and she says yes in a strange voice. Cranial Nerve I is intact. Cranial Nerve XII has a deficit.
Fatigue and One Weird Thing
The man from my board exam practice question has been exhausted lately and he has purulent exudate oozing from a sore behind his ear, which I already know is disgusting, so I don’t have to look at the picture. Underneath, there are some lab values, a long awful paragraph about his medical history, and the diagnoses I have to choose from. I do not have to look at the lab values or the paragraph, because I already know that he has cancer. I have learned in medical school that when you have cancer, you have fatigue and one weird thing.
I get the question right and a review box pops up with a helpful mnemonic to keep track of the fatigue of this cancer, and the weird thing of this cancer. I don’t need the helpful mnemonic, because I already know, and because I already have a mnemonic, for the treatment of myocardial infarction: OSAMA BIN (Oxygen, Statins, Aspirin, Morphine, Ace Inhibitors, Beta blockers, IV heparin, Nitroglycerin).
I take a break from the practice questions, because I’m fatigued. Actually, I’m fatigued and my breasts look incredible, so I have a granulosa cell tumor.
I go for a run to shake off the cancer, but it’s 11am on a Monday so the only other person in Delaware park is a tall retarded man. He asks me repeatedly if I’m going to go all the way around the lake back to my car. I tell him not to kill me because we’re in Buffalo, which is liberal, but not so liberal that they will lighten his sentence just because he’s retarded. He doesn’t really seem to understand that, so I run a bit faster. Good grief, now I’m more fatigued.
The lady in my next practice question can’t even draw a picture of a clock.
It’s very early, I’m in Dunkin Donuts, a kid in front of me is having a panic attack. Through the panic attack, he orders a Coolatta and then another cup with four espresso shots and three creamers. Classic panic attack guy order. Now I feel like he goes to my school, and he does.
Three cops are in front of me. They’re black, which seems to put the Dunkin Donuts at ease. Two of them are doubled over laughing. I think one is making a joke about the Frozen characters, if they were black. Then they’re quiet for a while, before another one sort of sheepishly asks if the other two think the Lakers look good this season. God help me, I really like them.
There’s a tall, mean-looking man behind me in a sailboat-patterned shirt. He looks like my fifth grade teacher, Mr. LaPittus, who was also mean. Like, I was humming to myself in class once and he did a mean impression of it to make all the other kids laugh. I know he thought I was stupid too. I looked him up last year to see if he still worked at the school, so I could go there and tell him that I’m going to be a doctor now. (Another good medical student fantasy is seeing your nemesis on the street, and they have a big icicle in their chest or something, and you’re the only doctor around, and they’re apologizing and begging you to take out the icicle, and they’re sorry they made fun of you.)
But Mr. LaPittus doesn’t work at the school anymore because he’s dead. He died of brain cancer two weeks after his 56th birthday in a house he shared with his mother, Doris LaPittus Melville. I also found out he used to sell vintage Japanese kokeshi dolls, satogashi molds, kimono, haori and obi at the Rose Bowl flea market.
For a couple weeks after I googled Mr. LaPittus, I kind of thought I might’ve killed him. I hated him with all forty-five pounds of my being in 2004 and most of 2005. Maybe I cursed him to death. Maybe you can only curse someone to death once, and I wasted mine on a sad, mean, kokeshi doll merchant.
Pete’s sake, it’s 8:25 and I’m still waiting in Dunkin Donuts. Tomorrow I have to answer 70 questions about restrictive lung disease. Sometimes it’s like nobody in the world cares about that.
Dick Out Day
First of all, it’s hot. The dress code is being seriously enforced for this session because we’re examining a standardized patient. A standardized patient (SP) is a pervert who, for learning purposes, volunteers to let us do things like jiggle their belly fat or drag a split tongue depressor down their leg. So I’m wearing a button down and my white coat to impress my standardized patient and I’m too hot.
I walk over with my 21-year-old friend, who tells me that she had this seminar back in September and it was amazing. She’s not really my friend, she lives in my building. She’s never been to a bar, but she has no detectible sadness about that. She says it was her favorite skills lab yet. Now I’m kind of excited.
My classmates are all sitting in a conference room. The energy, and I am not joking, is electric. We love fingering assholes at school, is the energy. We’re split into groups with different residents. Our resident is the most handsome. He takes us into an exam room, where our 28-year-old male SP is in a hospital gown. The resident tells the SP that he’s thin, which is good, because his prostate will be more accessible to us. The SP nods. This is honestly the sexiest day of my life.
I asked Luca how much money he would need to be paid to have his asshole fingered by medical students, and he said $800. I think it would be lower for the resident. He’s not a freak, he just seems very comfortable with his masculinity. I want to tell him I’m only wearing this button down because of the dress code.
Now I’m gently palpating the SP’s penis for the consistency of his urethral meatus. The resident says I’m doing a very good, thorough job; he loves me. He has to step out for a moment, because a kid in another group fainted, so the rest of my genital exam is pointless. But then he comes back and it’s the big moment. I dab some McKesson Lubricating Jelly on my glove. The SP turns around, elbows on the exam table, legs shoulder-width apart. I put one finger in and close my eyes. I’m on the Magic School Bus. Be the prostate. The resident comes over behind me and carefully turns my hand. We lock eyes. A little deeper. The prostate is small and firm, like an apricot.
I wait for the resident to say something: that I’m a natural urologist, that he’s never seen anyone digitally navigate these sphincters with such delicate, feminine grace. That he can tell I was right in that argument I had with Luca on the phone last night, that his sister was being a bitch. Let’s get out of this Clinical Skills Lab, he’ll say.
But he doesn’t say that, and the next girl goes up to finger the asshole, and the idiot who fainted wakes up, and the SP gets probably less than $800, and my 21-year-old friend was right, and I go home in my hot outfit.
Kidney Stone is an MD Candidate at [REDACTED].