Yesterday, I performed my first rectal exam.
We began our Project Prepare sessions this week, which is a training program to teach us how to perform the male and female genitourinary exams in a sensitive and skilled manner. This was a big milestone for me, as I’ve been anticipating this day with some apprehension for about a year now. I remember one of my Practice of Medicine TA’s telling me about Project Prepare when he was a student in it last fall, and although I knew I would have my own turn in the program this year, time flew by faster than I expected.
So here I was on a Wednesday afternoon, about to learn how to perform the male breast, GU and rectal exam.
I had been told that the educators in the program are fantastic teachers, but I hadn’t realized just how amazing they would be until I met my trainer. The Project Prepare educators are people who have dedicated themselves to teaching these exams on their own bodies, and they are truly incredible. Because of them, what could have been a very discomforting experience ended up being one of the most amazing educational moments I’ve had yet. (Here is a San Francisco Chronicle article from 2003 on Project Prepare.)
I entered the simulated exam room with my three classmates, feeling as on-edge as if I was the one about to get a GU exam instead of the one learning to give it. Our instructor quickly set me at ease with his warm and genuine manner, though, as he explained that he would be modeling for us the same sort of communication we would be using with our future patients.
It really was a whole-hearted experience for me. Here, I was the vulnerable one, uncertain about what was about to happen, while he was the calm one with years of experience. The dynamics were immediately appreciable; his approach to the encounter made all the difference.
That afternoon, I felt that I was the patient seeing a doctor, rather than a medical student seeing a patient. Now that I’ve been in medical school for a year, I’ve begun seeing more distinction between the identities within me—I am both patient and physician-student. At times, I feel a tension between these pieces of myself. I believe this tension is not a bad thing, for it reveals an effort to maintain multiple perspectives, but it makes me think. In some sense, we all have this tension within us, although it may be defined by different parameters for different people. It is the same tension within the mother who is also an employee, the son who is also a husband, and the sister who is also a student.
This multifaceted dynamic within me is something that I have to accept as part of living within two worlds—or rather, within multiple hemispheres of the sphere of humanity. Even as I write this, I am a bit hesitant to admit this. This isn’t a struggle that I wanted to have, but it is one that I expected. Our Project Prepare session threw it into new light for me, and it has made me think of it again.
As I sat across from the one who was both my patient and teacher, I keenly felt the importance of bringing compassion and warmth into an encounter. If I can be as help my patients relax as well as my teacher helped me to, I will be very satisfied.
Over the course of the following three hours, we learned how to examine the breast tissue and the surrounding lymph nodes (although breast cancer is rare in males, it can still occur and is essential to screen for). Step by step, we practiced the genital examination and learned how to properly word our dialogue to minimize unease or apprehension. We checked for inguinal hernias and learned how to properly set up for the rectal exam.
As we neared the end of the session, it was my turn to do the digital rectal exam. I had already filed the nail on my dominant index finger to a down hairline crescent of white (we were provided with nail clippers and emery boards earlier in the session to get our nails as short and smooth as possible), and so I coated my gloved finger with lubricant up to the main knuckle.
The rectal exam was actually the most amazing part of the experience for me. Using the pad of my fingertip, I defined the contours of the prostate gland as I swept my finger across it, feeling for any abnormal textures or lumps. I had a sense of awe at examining that which I could not see, like trying to read Braille written within our bodies.
Like trying to find shapes in the spaces between the clouds when looking at the sky.
I found it a bit funny how the day ended for me—I was participating in a poetry reading at the Cantor Center’s new Anderson Collection that evening, so I went almost straight from practicing the genitourinary exam to reading poetry at the event. It was a wonderful time; members of the Pegasus Physician Writers at Stanford shared original pieces of poetry inspired by the art collection, and the St. Lawrence String Quartet gave a stirring performance of Benjamin Britten’s Second String Quartet in Three Movements.
In a way, this odd juxtaposition of prostates and poetry seemed almost fitting to me. In Project Prepare, I looked again at my identity as a medical student within the greater world, which I relate to in part through writing. Creative writing is what helps me process the struggles of life, and I like to think that it will help me to better relate to my patients since it reminds me that everyone’s life is a story. We all have backstories, and we are all read as sentences and paragraphs, sometimes even as chapters.
Oftentimes, there are multiple storylines that run through our lives.
I am a patient.
I am a student-doctor.
I am human.