Body Teaching
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54 Body Teaching Last summer, two of the new interns who joined our team in the women’s health clinic were men; otherwise, all our care providers are female. Because our clinic is located in a teaching hospital, there’s also a stream of students passing through regularly. Medical residents spend a mandatory week or two with us, usually grudgingly, to sharpen their pelvic exam skills, and nervous medical students in short white coats do six-week rotations. About 60 percent of these students are male. They plan to become orthopods, pediatricians, or internists—rarely do they want to pursue OB-GYN. They say it’s becoming a female-dominated field. If, after his weeks with us, a student does say he might consider OB-GYN, he usually says it’s because he likes the combination of surgery and medicine. Well-versed in syndromes and lab values and auscultation of the heart, these students come to our clinic and find themselves suddenly disoriented. Here, they can’t hide behind shifting sodium values or unstable hemoglobins. In our world, a student must touch a woman’s breasts and probe her vagina. He must learn to delineate the uterus, invisible beneath a woman’s skin, and he must perfect the maneuvers that cause her ovaries to slip between his examining hands. Here, he must come face to face with the flesh and all its implications: fecundity and longing, sexuality and pain. Here, his fingertips must become as sensitive as a safecracker’s. The choice, the entire rotation, seems more natural for our female students. Although they can be just as anxious about performing their first pelvic exams, they’ve often had Pap tests and internals themselves. It’s easier to teach them; they share an intuitive common world with our patients and enjoy caring for other women. But I’d rather teach the men. They’re the ones who are most uncomfortable and who must acquire a facility that goes beyond the mere perfection of the exam. Teaching them, I try to use the insights that arise from my multiple roles— I’m a woman who has also been a patient, a nurse as well as a nurse practitioner. I’m keenly aware that I am a woman teaching a man and, in a role reversal even Davis text.indb 54 11/12/08 10:00:34 AM body teaching  55 more volatile, a nurse teaching a doctor whose authority will be, ultimately, more respected than mine. Most of all, I am a female guide who must step out of her body, casting off any suggestions of sensuality or privilege, when it is precisely my body that allows me to excel at teaching this intimate exam. “Come with me,” I say to this month’s medical student. I’ll call him Raymond, a tall, quiet third-year from a big university program. When I ask, he tells me that he thinks he wants to be an oncologist, but he’s not sure yet. We go down the hall and stand for a moment outside room three, where our patient—I’ll call her Maria Lopez—waits for us. Raymond tells me he’s done several pelvic exams before. Nevertheless, he confesses, he’s never quite sure what he’s feeling. I catch hold of his inadvertent double entendre and think perhaps we’re going to have a real conversation, one that addresses the multilevel aspects of the exam we’re about to perform: what he’s feeling in his doctor’s body, both physically and emotionally; what the patient is feeling; and how, as I stand by observing, my body responds, remembering. Then Raymond clarifies. “I can never tell if the uterus is retroverted or anteverted,” he says. Before we knock on the exam room door, I encourage him. “Don’t worry,” I say. “The exam takes practice. It’s more important that you listen to Maria and watch her face. Let her give you clues to what she is feeling.” Maria, who has been a clinic patient for years, sits uneasily at the end of the exam table. She has delivered three babies with us and lost one with us too, a spontaneous abortion that occurred a month ago. Today our job is to make sure everything has returned to normal. We have to palpate her uterus to make sure it’s firm and small again after the early miscarriage of her pregnancy. We have to ask her about bleeding and...


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