The Half-Naked Stranger

I knocked on the exam room door for my usual Thursday clinical training session with John, my usual standardized patient. John wasn't there. Instead, before me sat an old man I'd never seen before. He sat slightly slumped on the end of the examination table, his scrawny limbs dwarfed by the gut protruding beneath the flimsy hospital gown. His eyes were bloodshot. He looked tired.

I felt sick.

I introduced myself and began my usual "routine"of meeting a new patient -- asking some basic questions, making smalltalk about the weather as I washed my hands, establishing a "shared agenda" for the visit. I asked more specific questions about his symptoms and associated observations and life events. I was cognicent of how nervous I was. I was choppy, my thought process disorganized.

This should have been no different than any other standardized patient encounter (yes, this man turned out to be a "substitute" standardized patient). But it wasn't. The context was entirely different: I didn't meet him in the context of being a trained instructor tasked with teaching me to care for a human being; I met him in the context of being a stranger in his underwear and a gown. His vulnerability was threatening, reminding me again of the profound trust and responsibility in this unnatural dynamic. This felt real.

Before long, I was uncovering portions of his bare body, kneading into his abdomen, digging for the edge of his liver, tapping my own knuckles over the surface of his abdomen and back (to make sure it sounded hollow in the right places), asking him to repeatedly breathe on command as I listened with my stethescope at locations that allegedly sound different from one another.

I didn't even know his real name.

Vulnerability is a big deal to me. My own experiences of physical, psychological, and/or emotional vulnerability have carried heightened appreciation for my multidimensional trust in another human being, a powerfully rewarding awareness. But what contributes a backdrop of security during vulnerable moments is an equally powerful awareness that there exist people in one's world who deserve that level of trust.

I didn't do anything to deserve that trust other than show up with a nametag with my name and the words "medical student." The fact that my new world is structured to afford me opportunities and privileges that I haven't earned strikes me, on its face, as crazy. Just crazy.

But I guess it couldn't be any other way...