He and I are early, and we are the only ones in the room. I sit in an office chair — the kind that swivels — around a long, industrial-looking table with another ten chairs, and I watch him as he nods, his eyes closed, to music playing through his headphones.
His hospital gown is perfect and generic, a pale blue with thin white lines crisscrossing. He is dark-skinned, with long, dry legs that dangle from the edge of the examination table, and the gown stops below his knee cap.
Are these the first things I should notice? When I write my practice note later that evening, I will dutifully write that the standardized patient is alert, with good posture, no difficulty breathing, well-groomed. I will report on his lung exam, and as I write it I will think about the surprising ease of percussing along his back with my cool hands. For now though, I observe silently as first-year medical students are instructed to do and as he is accustomed to until he opens his eyes and acknowledges me. “Afternoon.”
“Hi.” I am reserved initially, not because I have nothing to ask, but because I want to ask him everything. How did he fall into this line of work? And more curiously, why did he stay in it? Today, he has no role, no feigned illness, but I have seen him before — as a teacher with a backache once, as a father worried about a heart attack another day. Both days, he was gentle, reminding my classmates to reassure, to pause, to comfort. I am reminded of his expertise — both in acting and in coaching us — and how young I must seem and eventually ask, “Have you done the lung exam before?”
“Yep. I’ve been doing this for 19 years.”
“Oh, wow. So you really like doing it?”
“You have a lot of questions.” His expression is more amused than annoyed, however, and when he goes on without prompting, he tells me about the relief and comfort in pretending to be someone else. He began working as a standardized patient at a point in his life when he felt overwhelmed by his reality, and he sought escape. His therapy, as it turned out, was to learn how to slip into and out of, for just a few hours at a time, a series of overwhelming fictions.