Saturday, March 6, 2010

Thinking About the First Time

A life in medicine is filled with milestones large and small.

The first time you touch a dead body.
Or hold a human heart in your hands.
The first time you pierce another's skin with a needle.
Or cut it with a scalpel.
The first time you witness a birth.
Or a death.
Your first code.
Your first infant intubation or spinal tap.
Your first solo anesthetic.
Your first job.

Not to mention licensure boards, three different sets.
On top of those, separate written specialty boards.
And of course, oral boards, everybody's favorite.

Recent events have caused me to reflect on the first time I and my classmates performed pelvic exams. As I recall, most of us anticipated this particular lesson with a little dread - at best, some mild anxiety. Physicians and nurses have to do such invasive things - stab people, gaze at parts of them even their spouses or parents have never seen, listen to their secrets, probe the most private areas of body and life. As a woman who has never particularly enjoyed visits to the doctor for a complete physical or to the gynecologist for a check-up, I was particularly un-enthused at having to inflict on even a comfortable volunteer such an invasion of her privacy.

The special instructors hired by my medical school to guide us through the process of examining their pelvic areas were highly trained educators who unselfishly allowed us novices to practice an examination on them that would require, for our patients' sake, our very best in terms of skill, gentleness, and respect. I know I couldn't do what they did - allow myself to be examined and give constructive, moment-to-moment feedback during the exam. I've volunteered my veins for students to practice I.V. insertion - that's about as far as I go.

We were divided into small groups of four, I think. I remember the sound of the speculum rattling as one of the students ahead of me trembled nervously while inserting it. I remember how we giggled nervously when another in the group asked the instructor, "Uh, could you uh, drop your top" and was gently given the feedback, "Perhaps you could rephrase that with, 'could you lower your gown,' or something like that?" I remember thinking how much more comfortable the instructors were with the whole process than I felt, and how embarrassed I was when I let out a surprised "Whoa!" when the woman I was examining did a mega-strong Kegel move while I was doing her pelvic exam.

As with everything in medicine, after a while even the most invasive and intimate action can go from being completely foreign and frightening to being completely familiar and comfortable. Whether I'm the patient lying on the table or the clinician doing the exam or procedure, I have individuals like those pelvic exam instructors during med school to thank for what I or my physician is doing with confidence and competence. I thanked them when they came to school to teach us, but I want to thank them again, many years later. They made a difference they'll never be able to know or see.


ShrinkingDoc said...

Those folks were the BEST. It was also great how much they believed in how much good they were doing in teaching us--which they obviously WERE. Even though I've done what now seems like a million pelvic exams on patients and doing them is no big deal, I still hate being on the other side of the speculum and could NEVER imagine doing what they do. You are so right to thank them!

AB said...

Well said. Just went through this a few months ago as part of my second year introductory clinical medicine class. The GTA who worked with my group managed to turn what could have been a very stressful situation into an overwhelmingly informative and positive learning experience. Her instruction regarding wording of explanations during the exam was particularly useful, quite possibly more so than the technical pointers she also provided.