A MEDICAL ACTOR WRITES HER OWN SCRIPT
My job title is Medical Actor, which means I play sick. I get paid by the hour. Medical students guess my maladies. I'm called a Standardized Patient, which means I act toward the norms of my disorders. I'm standardized-lingo SP for short. I'm fluent in the symptoms of preeclampsia and asthma and appendicitis. I play a mom whose baby has blue lips.
Medical acting works like this: you get a script and a paper gown. You get $13.50 an hour. Our scripts are ten to twelve pages long. They outline what's wrong with us—not just what hurts but how to express it. They tell us how much to give away, and when. We are supposed to unfurl the answers according to specific protocols. The scripts dig deep into our fictive lives: the ages of our children and the diseases of our parents, the names of our husbands' real-estate and graphic-design firms, the amount of weight we've lost in the past year, the amount of alcohol we drink each week.
My specialty case is Stephanie Phillips, a twenty-three-year-old who suffers from something called conversion disorder. She is grieving the death of her brother, and her grief has sublimated into seizures. Her disorder is news to me. I didn't know you could have a seizure from sadness. She's not supposed to know either. She's not supposed to think the seizures have anything to do with what she's lost.
STEPHANIE PHILLIPS
SP Training Materials
CASE SUMMARY:
MEDICATION HISTORY:
MEDICAL HISTORY:
Our simulated exams take place in three suites of purpose-built rooms. Each room is fitted with an examination table and a surveillance camera. We test second- and third-year medical students in topical rotations: pediatrics, surgery, psychiatry. On any given day of exams, each student must go through "encounters"—their technical title—with three or four actors playing different cases.
A student might have to palpate a woman's ten-on-a-scale-of-ten pain in her lower abdomen, then sit across from a delusional young lawyer and tell him that when he feels a writhing mass of worms in his small intestine, the feeling is probably coming from somewhere else. Then this med student might arrive in my room, stay straight-faced and tell me that I might go into premature labor to deliver the pillow strapped to my belly, or nod solemnly as I express concern about my ailing plastic baby: "He's just so quiet."
Once the fifteen-minute encounter has finished, the medical student leaves the room and I fill out an evaluation of his/her performance. The first part is a checklist: which crucial pieces of information did he/she manage to elicit? Which ones did he/she leave uncovered? The second part of the evaluation covers affect. Checklist item 31 is generally acknowledged as the most important category: "Voiced empathy for my situation/problem." We are instructed about the importance of this first word, voiced. It's not enough for someone to have a sympathetic manner or use a caring tone of voice. The students have to say the right words to get credit for compassion.
We SPs are given our own suite for preparation and decompression. We gather in clusters: old men in crinkling blue robes, MFA graduates in boots too cool for our paper gowns, local teenagers in ponchos and sweatpants. We help each other strap pillows around our waists. We hand off infant dolls. Little pneumatic Baby Doug, swaddled in a cheap cotton blanket, is passed from girl to girl like a relay baton. Our ranks are full of community-theater actors and undergrad drama majors seeking stages, high-school kids earning booze money, retired folks with spare time. I am a writer, which is to say: I'm trying not to be broke.
