Thursday, January 25, 2007

"Oh, you can come in for this, it's not a breast exam."

It turned into a breast exam pretty quickly.

I was at a family physician's office for my mandatory Family Practice class. I'll be going 14 times this semester. Typically its the one time each week we 1/8th doctors can actually put on our humbling little short white coats (white enough to look doctor-ish but not long enough to look cool - especially for guys), fling our hardly-used stethoscopes around our necks, walk proudly into actual clinical exam rooms, and see real, live, sick people. Maybe ask them a few questions. And hope not to get sworn at by patients (speaking from experience here).

It would be anything but a typical day. I was told that my clinic partner, being of the female gender, would be interviewing the next patient. 'This patient is here for a breast exam,' said the doctor, "so Vitum, maybe you can sit this one out." I didn't mind. I was entirely used to - and comfortable with - not observing something like this until I have been well-trained in the process.

My clinic partner interviewed the patient briefly, then came out of the room and described the patient's complaint as a lump below her left breast. The doctor told me: 'Oh, Vitum, I suppose you can come in for this, then; it's not a breast exam.' He checked if it was OK with the patient and it was. In I came.

It turned into a breast exam pretty quickly.

I'll admit that a while ago I was a little nervous about how I'd end up doing my first 'intimate' or 'gender-specific' examinations - nervous enough to do a bit of research on the subject. After doing Google searches using creative combinations of the search terms "medical student," "breast," "exam," "vaginal," and "how the hell do male students not show signs of awkwardness or even arousal when being taught to perform professional medical exams on patients," I censored my search results and carefully chose a link and hoped to find something telling me something of the process.

I got lucky. I ended up reading a well-written article by Jules Lipoff, a second-year medical student at the Albert Einstein College of Medicine entitled "Dr. Strangeglove, or, How I Learned to Stop Worrying and do Breast and Pelvic Exams." That article appeased some of my misconceptions about training in these areas. While I had initially pictured being herded into a patient room at a hospital with 7 other medical students following a resident or attending physician and being instructed to 'check out' a patient, one after the other, I was relieved to see that the article addressed
a) thoughts...of ...and during ...the experience,
b) the fact that medical schools work hard to increase professionalism and minimize awkwardness by using trained clinical educators, from whom medical students gain both insight and practical experience, and
c) the fact that students have fair warning about when their first exam of this nature will be (the students in the article were given a month's notice).

I didn't get a month's notice. "We might as well do a breast exam since it's been a while since we've done one with you." The patient consented a little too readily.

When something happens in front of a patient that's a little shocking, as a medical student with common sense you know it's not right to make it obvious that you're going through mild forms of shock. So I hid my surprise at the fact that I was not expecting to watch a breast exam, and yet now, here was one being performed, right in front of me. "Use this part of your finger and go in little circles," said the doctor. "They say to spend five minutes on each breast when doing an exam, but I never have time for that in my practice." I didn't catch much else. My mind was busy reeling from the situation.

Fortunately, the patient didn't add any awkwardness; she was totally fine with the whole situation and was chattering away happily about the history of her originally "A-cup" breasts, her choice to acquire implants, the rupture of said implants, the removal of said ruptured implants, and subsequent natural growth of a well-endowed pair after said removal of said ruptured implants.

My mind continued reeling. In fact, I was still getting over what I was watching when the doctor turned to me and said, "Vitum, your turn."


I'm not sure how well I hid the shock that was pretty much taking me over at that time. It was enough to watch this. Now I was expected to monkey see, monkey do. What was I going to do, say 'no'?!

So, somehow confidently, I stepped forward, and reached out, and put my hand down on the breast of a woman whom I'd never met before, a woman that was old enough to be my mother. I still have to get used to how much nakedness doctors see. I began moving my hand around in circles, like I'd been shown. I also began thinking to myself, "Think professional thoughts."

Looking back, I don't think I did that for more that about six seconds before I stepped back to let my clinic partner have a go at it. "No lumps?" said the doctor. My mouth made some sort of a sound, and the doctor replied, "Good!"

So that was my first breast exam. Yay for me for reading up what my first clinical breast exam would probably be like, and yay for it being absolutely nothing like that.

You never forget your first time, do you... especially if it's as unexpected as that.


incidental findings said...

At least your patient wasn't drop dead gorgeous. My first actual patient pelvic exam was a 22 y/o girl who was a stripper at the local strip club...

The Bay Bunch said...

I am sorry..but your brief stint with awkwardness brought much mirth and humor into my afternoon (being the mother of five children and well aware of those "interesting" moments. haha... Found your site from Steph's and glad I happened upon it for a little chuckle and insight.

Jon said...
This comment has been removed by a blog administrator.
Anonymous said...

Well done Vitum! Sounds like you handled it well. I must say that being in first year med school myself, I can't imagine being thrust into doing a rectal or a genital exam on week 2 of family practice. I'm keeping my fingers crossed that mine goes more like the article you read. :)

Kim said...

Oh, how I can relate!

My very first patient in a hospital that required a full bedbath (two broken arms) was a 23-year-old hunk of a guy.

Me? I was all of 18 and hadn't ever even seen that woman's magazine with unclothed gentlemen in it (I'm not using the title so as not to get you spammed).

Let's just say I was not quite prepared and very anxious.

Heck, now I wouldn't bat an eye - ya seen one, ya seen 'em all... : D

Anonymous said...

This brings up a very good question: Have you ever been aroused by one of your patients and how did you deal with it? And was she aware of your state? Just curious.

p.s. Loved your post!

Anonymous said...

Back in the 70s, as a very new, 18 year old nursing student I was asked to 'go and shave the man in the cubicle'. Well, I misunderstood the instruction. So in I went, and shaved the patient very carefully and very thoroughly. It was my first time of seeing a naked man, much less actually touching one. It was only later, when I confided to the RN it was my first time seeing a naked man that I realised I had misunderstood. The nurses all found it funny, but I avoided the patient for the rest of his stay.

Anonymous said...

I mean no disrespect, but, I would trust a mammogram's results and self examination over what any doctor could feel. I've experienced two bouts with breast cancer, both of which were found by me. Any woman who relies solely on her doctor to find a lump, has signed her own death certificate.

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