Preclinical
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The Dreaded Exam


It was the day: D-day, the day my soul died, and the day I had dreaded ever since my first day of medical school. It was the day my fingers were booked on a trip to the rectum in search of the elusive, possibly mythical, prostate gland. I thought that I would be ready. I thought that the repeated desensitization to otherwise grotesque topics would have saved me from my overly-sheltered, semi-stereotypical home-school graduated self. The medical school recruiters and academic advisers had conveniently forgotten this detail during my educational overview when I originally signed up to be a physician.

I heard about the blood, and the vomit, and the under-informed parents who refused to vaccinate their children. However, this little secret was unbeknownst to me until the spring of my first year, when I received an email explaining that the bathrooms would be closed as the second-year medical students were performing “sensitive” exams. Sensitive exams? What? I thought that was the urologist’s job but definitely not required of an inexperienced, unpaid, and overworked medical student.

Well, I felt pretty sensitive about the whole thing because I thought my classmates and I would be performing them on each other. Then, I found out that brave souls sign up and are paid to travel around to different medical schools and use their bodies as life-sized teaching instruments. I knew that some donated their bodies to science post-mortem, but this was taking it to a whole new level. Did they know that we, as medical students, had never done this before? Did they know that I would have given my whole career and a Krispy Kreme doughnut to be blissfully unaware of the prostate’s existence? Unfortunately, I could not, so I signed up for the last possible time slot available. I wondered if there were sign-in sheets that would later inform my professors should I be mysteriously absent. I even considered selecting a personal therapist for an anticipated post-session mental breakdown.

Well, the time came, and the squeamish few who had procrastinated lined up outside of the medical OSCE suites, and in little groups of three awaited our escort. What a bonding experience. Next, the standardized patient — I’m going to call him SP — summoned us to his suite. S.P. was the one who would be gracing us with his presence for the next ninety minutes. Our group consisted of me, one other female, and one male so the X chromosomes outnumbered the Y chromosomes, and that “Y” classmate was “volun-told” to go first. He had no choice really. Barely covered in a hospital gown was six and a half foot tall S.P., our standardized patient. He was larger than life, and I really hoped that was only in height and weight and not in other areas of his anatomy. With a great booming voice, he introduced himself. Then Little S.P. Then the twins. Then the hermit. But thankfully, no crabs.

We started out examining inguinal lymph nodes which kind of felt like garden peas and were palpable at the top of the thigh. Not so bad. I was basically a natural. As a fleeting thought, I briefly wondered how much urologists earned per year, but the thought was quickly gone as the patient pulled his gown up above his anterior groin. At this point, I had decided that whatever they earn, it is not enough. But wait, I plead in my mind. No one said anything about genital exams. I had been told that we would be performing *rectal* exams only.  Maybe S.P. was confused as he was still facing us and saying things like, “I will walk you through this part,” and, “Ask me any questions that you have.” Then, my world of innocence came crashing down around me, and only two questions were bubbling inside me: Do I have to touch it? and, If I leave now, can I still be a doctor?

The funny thing about medical school is that the professors had never really told the whole truth about what would be required of my class during previous laboratories and patient encounters, and history repeated itself on that day. It is not that I blame them. If my classmates and I had been forewarned, we would have all paid a physician to diagnose us with debilitating illnesses the night before these scheduled sensitive exams. Instead, I was there … in an OSCE suite … with a naked man in front of me. I was standing and waiting to literally hand my naïvety over to S.P., whom I had now known for five whole minutes. I will not go into graphic detail about this portion of the exam, but I do know that I am scarred for life, and I also know that he had not even bought me dinner first which I’m still a little bitter about.

There it was staring at me with its cyclops eye and two surrounding miniature boulders. He started demonstrating the penile and testicular exams on himself which is probably one of the most disturbing things I have ever witnessed. The seriousness of it all, in my mind, was paradoxically hilarious. The two hard-boiled eggs known as testicles, the spermatic cords, the epididymis, and the skin had to be handled with care because well, after all, it is a sensitive exam, and men are sensitive.

Hernias, yes … those I remember fondly. Bilaterally to cyclops are these tunnels that will possibly lead all the way to a man’s brain … if he has one. Apparently, part of the intestines can succumb to gravity and fall through these caves of perversion.  My tiny index finger was pretty good at being a mole. “Turn your head and cough,” I spoke with confidence as I pushed my finger through this passage way while waiting for a hernia to jump out and give my finger a high-five. The patient turned his head so as not to infect me with whatever he was spewing up from his lungs. The added benefit is that the shame, embarrassment, and ever-so-slight amusement that both of us — or at least I — felt was momentarily alleviated as his face was turned opposite to me. No hernias made an appearance which was a little disappointing as my finger had traveled all that way north for nothing.

After the genital and hernia exams came the dreaded rectal exam. S.P. said we would not have any trouble unless our index fingers were shorter than his pinky. Nervously, my two classmates and I cautiously brought our pointers to meet his pinky. Out of all three of us, only one of our pinky fingers popped up short, and it was of course mine. Apparently, I am not very well-endowed. Quickly, he moved his hand away and assured me that I would be fine, which did not — in any way — assure me that I would be fine, but I did hope that this meant I would be exempt from having to perform the rectal exam. It. Did. Not.

Before we began, S.P. popped out five models of various diseased prostates for our viewing pleasure. If I were in his position, I would want the people who were quickly climbing up on the relationship ladder to be familiar with my prostate too, if I had one. I resisted my initial, primal urge to run, and I resisted my second urge to put on seventeen pairs of gloves, a gas mask, and bubble wrap. However, I did not resist my third urge which was to start praying and pleading with God that when I removed my finger, I would not find any incidental holes in my glove or anything brown on the end of it.

This was it, I leaned forward, closed my eyes, and then promptly opened my eyes because someone reminded me that, much to my dismay, I was the doctor in that moment. After a moment, I went deep sea diving in the Ocean Rectal. It was not a five-star cruise for either of us, but, thankfully, I was adequately desensitized and spared of what I thought would be obligatory sea sickness.

The only problem was that most other people brought fingers that were the equivalent of massive yachts, but I showed up to the party with a rowboat. Blindly, I discovered the prostate, I think, or it could have just been stool. I did not know or care to know for that matter. He did say that it was his prostate, but, as a female, even I would say that if people had their fingers up my least favorite orifice. Maybe his honesty went out the window at that point, and I was okay with that.

It has been a while since I lost my “prostaginity,” and my therapist (my mom) says that I am “on the road to recovery.” As I reflect on my experience, I would like to say that I am thankful for gloves. I am thankful for KY jelly, and I am thankful that maybe my short fingers will save me from ever having to perform another sensitive exam. I learned from this experience that standardized patients are parts of a rare group with the noble intent of training future physicians. It is a job that very few want. Admittedly, it was not to be my first career choice either, but I certainly value the time, humility, and expertise that these human teaching models offered.

Now, I have consumed plenty of caffeine to circumvent any chance of a nightmare, and my hand still occasionally bleeds from where I chopped off my right index finger. It will grow back, I’m sure, along with my sensitivity.

Author’s note: This article was intended to be humorous in nature and make light of what could be an uncomfortable experience. The intentions of this piece were not to offend, discredit, or mock any standardized patients or any other persons. The author respects and greatly appreciates all standardized patients in addition to their time and sacrifice in the efforts to further medical education.

Lydia Boyette (4 Posts)

Managing Editor

Campbell University School of Osteopathic Medicine


Lydia Boyette is a fourth year medical student, and she is excited to be a managing editor for in-Training Magazine. Throughout medical school, Lydia has written stories about her experiences learning clinical skills. As an aspiring anesthesiologist, she has sought opportunities to study physiology. PubMed and StatPearls recently published two of her essays on the physiology of myocardial oxygen demand and pulmonary circulation.

Lydia has spent a significant amount of time working for community health centers in rural areas. She serves as a student physician ambassador for her school and previously held the position of editor-in-chief for the local community health clinic newsletter.

In 2015, she graduated magna cum laude a bachelor of business administration in healthcare management and a minor in general science. She also served as an English composition tutor and editor. While completing her undergraduate degree, Lydia was inducted into several honor societies including Phi Kappa Phi, Delta Mu Delta, Pre-Med Allied Health, and Who's Who of the Class of 2015.

**Disclaimer: Any opinions stated in any document published by this author are those of solely the author and are in no way reflective of the opinions or beliefs of the author's academic institution or any other governing body.**