This post is not PG. Just… yeah.
Up until this point, most of what we’ve done in medical school could have been taught as part of some unusually advanced undergraduate human biology or physiology major. Yeah, the heart and lung exams were probably out of scope, but learning about how the body works is still in the realm of possibility for someone not in medical school.
Until this week. The Exam That Shall Not Be Named. The genitourinary exam.
Once you have been taught the GU exam, there’s just no going back. You are definitely not in Kansas anymore: seeing a standardized patient assume the position of Tom Brady’s butt-naked center is a great way to announce to yourself, and readers of your blog, “YEP I’M IN MEDICAL SCHOOL NOW.”
We showed up to our exam center and were placed in groups of two or three. Half of us started with the male exam, and half started with the female exam. When we entered our exam room, we found a middle-aged man sitting there in scrubs with a company name embroidered on it, not our usual standardized patient.
Why? Because the genitourinary exam is so, er, touchy, medical schools contract with specialized companies to provide specially trained instructors. These instructors teach the exam to students by having the students perform the exam… on the instructors.
I hear they are WELL compensated.
So basically, there are roving bands of paid instructor-actors moving from medical school to medical school, like a swarm of extremely uncomfortable locusts, offering their orifices in the name of medicine. Well, future medicine at least. There are legitimate businesses that successfully depend on their employees allowing 22-year-old first year medical students, who know zero things about anything and possess unimpressive fine motor skills, to insert fingers and other devices into their nether regions.
And you thought your job was bad.
My goal here is to explain what it was like to learn, hands-on, the Exam That Shall Not Be Named without making you throw up. Let me know how I do. And before I go further I should make it clear that without the people who taught us, we’d probably learn to do these exams on real patients in the hospital, which would be an extraordinarily discomfiting concept if you were the patient. So truly, thank you, traveling band of butthole-and-other-orifices* instructors. I hope you are paid extraordinarily well.
*I am also not mature enough to use the correct words – rectum or anus – when referring to the butthole. I am emotionally twelve. The butthole is the butthole, and it will still be the butthole when I am 65. It will always be the butthole. Stop reading if this is a problem.
My group began with Jim. Jim introduced himself, gave a brief introduction, casually dropped his pants, and started to walk us through the male exam. Boom. On himself. (He also mentioned that he took his craft very seriously and referred to his job multiple times as a career, which… yeah. I’ll just leave that one there.)
Once we recovered from the shock of seeing Jim go Full Monty in front of three professionally dressed fake doctors, it was strangely relieving to have Jim talk us through the exam. Jim used the medical terms we’re familiar with, terms that sound disconnected from real life. The glans doesn’t sound like what it actually is (nope you’ve gotta look that one up yourself). Saying “proceed with a rolling motion inferiorly” sounds a lot better than “rub my inner thigh.” And “palpate for the prostate” sounds much, much better than what it looks like.
After the talking part, we got to doing. One by one, we donned gloves and Jim instructed us on how to check lymph nodes, hernias, and for testicular masses. Jim, uh, adjusted himself to help us out when we were operating around the periphery. Yeah.
When that was all done, Jim took a deep breath and said, “I like for doctors to tell patients, ‘Take the position of a football player at the line of scrimmage.’” All I could think of was Peyton Manning screaming, “OMAHA!” Pantless Jim put his hands on the exam table, spread his feet shoulder width apart, and said, “who’s first?”
Guess who wasn’t jumping out of his seat to Astroglide his way into a man’s butthole?
When it came time for me (last), I put approximately sixty ounces of lube on my finger and said the cruel words of all trainee doctors before me:
“You’re going to feel a little pressure.”
In we went. And guess what? The prostate was just where it was supposed to be. You can actually feel that sucker.
Along the way, Jim gave us friendly tips, such as things not to say when about to perform the rectal exam (I may have added a few of my own):
- Beer slogans are never a good idea:
- “HERE WE GO”
- “It’s Miller Time”
- “Bend over and grab your ankles” because a) no one can do this anyway and b) I mean, really.
- “Bear down.” Because think of what can happen….
Thank you, Jim, for that mental image.
Shaken but not broken, we headed out for a brief break before changing over to the female exam.
I should tell you that I was not really nervous for the male exam. The female exam was a totally different story. Why? Because I have already been kicked out of five pelvic exams because the patient wasn’t comfortable with me in the room. WHAT HAPPENS IN THERE!?
I found out.
Our “patient” got down to business (uh…) much faster than Jim. We’ll call her Emily, and we basically went straight into the breast exam. After that, which was easy, she goes, “okay! time for the speculum exam.”
Just like Jim, Emily walked us through the procedure. My partner went first (obviously) as I watched over her shoulder (also obviously). She slid the speculum in and clicked it open and WHOA THAT’S A CERVIX AND THERE IS A LOT OF GOOP IN THERE. That was a pretty gross experience, but I thought to myself, “okay, I can handle this.” Normally at this point you’d do a Pap smear and other diagnostic and screening procedures, but we skipped that as part of a normal exam.
Then came the bimanual exam, and my comfort zone disappeared. The bimanual exam is just like it sounds. It’s a very hands-on exam: one hand goes in, and one hand goes over. The point is to feel the edges of the uterus as well as the ovaries themselves. You can tell a lot from this exam if something is wrong. On a skinny woman like our patient, this is possible. On some people… well.
When it came time for my turn, I’d like to think I performed admirably, in the sense that I did not vomit on my shoes or pass out. I did attempt to open the bills of the speculum by flicking the release clip, which is sort of like trying to open a locked door with the back end of a key. It’s pretty obvious I was doing it wrong. The instructor, from her vantage point in the most awkward position possible for a woman, gently corrected me. Oops.
The bimanual exam was a little more challenging. Again, I applied approximately an entire tube of Astroglide to my hands. I am about 70% sure I felt the uterus and about 40% sure I felt an ovary at some point, though it was fleeting. I suspect this improves with practice, as does speculum fumble-itis. I also suspect I will be less and less likely to experience heart palpitations with practice.
All that’s left to say is this: when I got out from the exam experience, I was emotionally unavailable for a time. I texted a friend whom I knew to be in possession of baked goods, “I need a cookie.” Two chocolate cookies later I was a functional human being again.
The neat thing that came out of this was we all agreed that gynecology was definitely a future caree-HAHAHAHA no just kidding absolutely not.
I need another cookie.