“The patient, today, is Stephen,” revealed Mister the patient, his lips curled up in a mischievous smile. He was already wearing a hospital gown when I entered the physical exam room with two of my classmates.
“But it’s not the name that’s written on the schedule. I’ve got Luke here,” my classmate noticed.
When I heard Mister laughing that cheerfully, I knew that this clinical skills session would be different. Really different. It was not the posters of a male genital anatomy on the wall, the famous blue latex gloves on the table or even the patient’s buttocks that the gown left bare which gave me a clue, but rather his cheeky sense of humor.
“It’s going to be Stephen for today. You’ll understand, if you know a little about Canadian politics,” promised Mister.
“So put your gloves on, and don’t forget the lube. There are no budget cuts in that department yet,” Mister joked once again, strangely more at ease than us. As medical students, we thought that we had seen it all even before working at the hospital.
Usually, instead of examining prostates, college students sleep in on Friday mornings, especially when there are no scheduled lectures. But in medicine, we tend to do things a little differently.
“Do we have a volunteer?”
So I washed my hands and put on some gloves in the blink of an eye, a little too enthusiastic. However, as soon as I stood in front of the examination table, my heart started pounding hard, betraying my novice status.
Mister took the bed sheet off the plastic mannequin, and then told me, with a swift movement of the hand, that the ball was now in my court after explaining the maneuver. Not all patients are equal, and Mister, one of those teaching patients, is responsible for teaching us the needed clinical skills. For once, a patient would teach a medical student, and not the other way around.
“Don’t forget: Stephen really, really loves guns.”
The gun that Mister was talking about is the position of the hand most appropriate for a digital rectal exam. Sometimes small details matter, and turning our hand into a one-finger revolver would make the exam less uncomfortable for the patient. As a medical student who is more anxious about getting the technique right, I sometimes forget that patient’s comfort should be put first.
But it was not the end. The hardest was yet to come.
“Stephen, it’s also me for today. It’s your turn now!”
If I were Mister, I would really be worried: how could he trust a second-year medical student to do a digital rectal exam on his own body? Yes, I have practiced the technique on Stephen, the mannequin, but that does not make me an expert. I realized that it was my low level of competency that made me uncomfortable, not the intimate nature of the exam or even the patient’s nudity.
Gun, Nina, gun. Don’t forget. The gun can shoot cancer.
It was my time to learn.
Conclusion: Stephen the patient had a symmetrical prostate, as big as a walnut. No prostate cancer. I was listing the findings while I was taking my gloves off, proud to have accomplished my first digital rectal exam.
When we know that half of the patients with an abnormal digital rectal exam result will be diagnosed with prostate cancer, it is mandatory that tomorrow’s physicians learn how to do this procedure appropriately. Without Stephen and his guns, I would have never learned. I would have stayed a novice all my life.
Saving a life with an exam that does not even take a minute? Mission accomplished.
Thanks, Stephen. I do not approve your love for guns but, at least, you will have taught me how to save lives when I’ll finally enter the wards.