Examining Rooms
Midge Raymond
Claire is sitting on the examining table in her gown while the doctor looks at her chart. “So you’ve been having abdominal pain?”
Claire nods, then bends double.
“When was your last period?” Dr. Adams asks, studying the chart.
“Um.” Claire pretends to think. “About six weeks—well, maybe it was a couple of months ago.”
“Is there any chance you might be pregnant?” Dr. Adams tucks a lock of dark brown hair behind her ear pulls a pen from the pocket of her white coat.
“I don’t think so,” Claire says.
“Have you had unprotected sex recently?”
“It was a while ago. I don’t think I’m pregnant.”
“Are you in a relationship currently?”
“Not really. I’ve been seeing a couple of guys,” Claire says.
“When was the last time you had sex?” the doctor asks, looking at Claire intently.
“About a week ago, I guess.”
“Did you experience any pain during intercourse?”
A lot of questions, Claire thinks. She pauses and studies the doctor for a moment. “It did hurt a little,” she says.
“What do you use for birth control?”
“Condoms. Usually.”
“But not all the time?”
Claire hesitates. “Most of the time.”
“Have you had any nausea? Vomiting?”
“Last night I got really sick,” Claire says, then curls up on the table and moans.
“Let’s have a look,” Dr. Adams says.
Claire is impressed by the sympathy in the doctor’s voice—it’s more than she got from the male doctor she saw yesterday. Dr. Adams gently moves Claire’s arms and legs away from her body, as if opening up a clenched fist. The doctor presses on the lower abdomen, and Claire winces. When the doctor moves upward, to the right on Claire’s stomach, Claire tenses and groans out loud.
“Okay, so that’s where the pain’s located,” the doctor says.
“Mostly.”
“Which hurts more?” the doctor asks, pressing on each quadrant of Claire’s midsection.
Claire tells her, using the zero-to-ten scale. She has become an expert on the gradations of pain; she tries to experience pain and all its variations as if it’s a piece of music—its rhythms and notes, its beats and breaths—and she’s found that even pain has its own harmony, its own operatic narrative and drama.
“Okay,” the doctor says, patting her knee. “There are a few things that could be causing your pain. Appendicitis is a possibility. It may also be an ectopic pregnancy, or pelvic inflammatory disease.”
Claire, not sure whether the doctor is looking for a hint, gazes at the woman noncommittally. She always finds it satisfying to know what her illness is before the doctor does.
“First I’m going to do a pelvic exam,” the doctor says.
This is Claire’s cue. “The results are in the third drawer.”
Dr. Adams turns to the counter behind her and opens the drawer. Withdrawing a file, she opens it, then nods approvingly. “Okay,” she says. “Looks as if this might be PID. We’ll need to run a few more tests to be sure.”
“Okay.” Then Claire remembers that she’s supposed to look worried, and she furrows her brow. Dr. Adams is so different from the doctor-in-training Claire saw yesterday, the guy who broke character. He said, I’m supposed to do a pelvic exam—where are the results for that? The male students always get nervous when they have to ask about periods and sexual activity. Claire sees their cheeks redden as they speak, the sweat breaking out on their foreheads.
After Dr. Adams leaves, Claire logs onto the computer to complete the checklist. The students are evaluated on so many things—whether they ask the right questions (do you drink? do you smoke? when was your last period?), whether they make you feel comfortable, whether they give you their undivided attention. These future doctors need to make a personal connection, to take the time to discuss next steps, to listen. Claire checks mostly strongly agree boxes for Dr. Adams’ evaluation, an easy one compared to some. Expressing the symptoms of pain is one thing—judging people on their performances is another. After all, she’s an actress, not a critic.
She’d auditioned for the standardized patient program shortly after Bruce dumped her. She should’ve known it wouldn’t work out with him—Claire had been the rebound woman, and Bruce had gone back to his ex: the same role Claire seems to play over and over, always hoping for a better ending. Instead, she’s still waiting for a callback.
She’d seen the ad for the program on a bulletin board at a local theater. For the audition, they’d given her a simple case—a short medical history, four pages; a simple symptom: a headache. Claire memorized those pages and auditioned as if she were trying out for a Broadway play. She was accepted into the program, and they’d even paid for training. It’s not a bad gig for an underemployed actress, and she’d certainly rather be a standardized patient than a real one—especially now that she’s seen what the future of medicine looks like.
At twenty-five dollars an hour, the job beats waitressing and has held her over for a while, but she knows she’ll need to get a more steady, even permanent, job soon. She keeps putting it off, hoping for a breakthrough. She loves to be on stage, or before a camera—she even loves being in the little fake examining rooms at the medical school. It’s only in real life that she keeps flubbing her lines, missing her marks.
Pretending to be happy for Bruce, for example—she has to work hard at that. Acting as though it doesn’t matter that he got engaged two months after they broke up. Feigning enthusiasm in wishing him a good life. If only they gave Oscars for those types of roles.
Sometimes she worries the closest she’ll ever get to marriage and pregnancy is in the role of a patient—that she’ll know only the symptoms, never the real sensations.
Today she’s scheduled to play the schoolgirl—one of her favorites. Claire is twenty-six but looks young enough to play patients in the sixteen to twenty-four range, and she gets this case often. It’s fairly easy—history only, no exam. Not that she minds being examined—after being poked and prodded so often through a hospital gown, she’s lost all modesty—but she does get a kick out of talking about her sexual history and menstrual cycle and making the male doctors blush.
She brings her own wardrobe; they have a few props and a makeup lady to redden noses for colds, but Claire doesn’t need anything for the schoolgirl role. Back at her apartment she’d applied her makeup. She lives in the Fenway and can walk to Boston’s Longwood Medical Area in fifteen minutes, which spares her from the odd stares she gets on the T, especially on a day like today: bubble-gum-pink lipstick, blue eye shadow, thick coats of mascara. But she hasn’t gone as far as to dress the part at home. Once she’s on the medical campus, she dons a pleated, plaid skirt she found in a consignment shop, a crisp white blouse, knee socks, loafers.
The program’s facility is in its own building and looks like a doctor’s office, with eight examining rooms, one after the other down a long hallway, each set up with exam tables, blood pressure meters, tables with drawers. The only difference is the two-way mirror and the two small cameras on the walls: one facing the patient, one facing the doctor.
Claire has done the schoolgirl case enough times that she doesn’t need to consult the binder, but she gives it a quick look anyway. The case lists all the presenting symptoms, and she has to know the answers to anything they might ask: general health, eating habits, medications, allergies, hospitalizations, surgeries, even the patient’s family medical history. It’s precise because it has to be standardized, controlled: every doctor who encounters Sally the Schoolgirl has to encounter the same exact Sally even when another actress plays her on a different day. Sometimes Claire prefers being these characters, even with all their problems, to being in her own skin.
Today is an exam day, which means the doctors will be stressed. In their third or fourth years, they have to pass a series of tests before they can move on. On testing days, they go from one exam room to the next, and actors play the same part over and over.
Claire likes the schoolgirl role because it’s all about sex. The scenario is that the patient’s mother—played by one of the middle-aged actresses—brings her in, and the doctors have to ask the girl about her sexual history (what’s your boyfriend’s name, how often you have sex, do you use condoms?) with the mother sitting right there, and the girl will wrinkle her nose and say, “Ew. Do we have to talk about this?”
As the case requires, the mother eventually will leave the room to preserve doctor-patient confidentiality, and the schoolgirl will admit she might be pregnant, and the doctor will “administer” a pregnancy test and deliver positive results.
Lately Claire finds that the panic this role calls for comes easily, rising up from within some deeply buried place, clawing its way up her throat. She isn’t entirely sure what it’s about—the memory of Bruce’s face as he told her it was over, or maybe the feeling that life is passing her by, manifesting in this role that is all about youth and its clumsy mistakes.
Today, in her third session, she finds herself caught off-guard for real when the “mother” leaves and the student doctor says, “I’d like to do an exam.”
He’s not supposed to say that. It’s not in the script. Claire feels frozen. This never happens—the doctors all get a “chart” that lists the patient’s medical history and what they are allowed and not allowed to do. Claire knows that the schoolgirl’s chart very clearly reads DO NOT PERFORM EXAM in bold, capital letters. There’s no way this guy could have missed it. The sessions are always recorded, so his superiors will know, but still she has to deal with this now.
Above all, she’s not supposed to break character, so she says, “I don’t have time. I’ve got to go back to school.”
He argues. “I’d really like to do an exam.”
“My mom is waiting outside. I’ll come back later.”
He flips through her chart. “It doesn’t say here that your mom is coming back.”
“Well, she is.”
He looks at her. “Look, I’m being graded on this and really need to do an exam.”
At this point she doesn’t know what to say. He steps forward. “At least let me listen to your heart.”
She’s in her schoolgirl clothes, not a gown, because there’s not supposed to be an exam, and she leans backward on the table as he approaches. He stands there with his stethoscope for a moment, then says, “We’re not allowed to listen through shirts.”
“I’m not taking off my shirt for you,” she says, both in and out of character at this point—saved, then, by the bell, by the timer that lets students know that their twenty-minute session is over and they need to move on to the next examining room.
Relieved to see him go, Claire feels oddly shaky as she writes strongly disagree on everything in his evaluation. Later, in the break room—as a joke, they call it the green room—Claire tells Alexis, another actress, about the encounter.
“I’d have walked out,” Alexis says.
“Are we allowed to walk out?”
“Why not?” Alexis is twenty-eight, with the exotic good looks that remind Claire of a jungle cat—lean, seductive, a little mysterious—and she’s been a standardized patient for more than a year. “Especially if someone creeps you out like that.”
“I did put that down in my I-statement,” Claire says. “I wrote on the form: ‘I felt uncomfortable when he asked me to take off my shirt.’ ”
Alexis stretches her long legs until they meet the coffee table, then asks, “Have you seen that blond doctor?”
“You’ll have to be more specific.”
“You’d remember this one,” Alexis says. “Serious hottie. And talk about a bedside manner.” She sighs. “Your memory is for shit, you know that?”
Claire unwraps a Lunabar and shrugs. She actually does remember doctors, especially the cute ones. She likes to try on their names. Claire Hausladen. Claire Jackson. Dr. and Mrs. Michael Quattromoni. If the doctor is exceptionally good-looking or charming, she’ll go ahead and pick out names for their children. Jordan. Madison. Kelly. She likes the ones that can go either way. It’s these games that get her through—through all the moments when she’s wondering whether she’ll ever break into a new role, a new life.
Alexis yawns. “So are you auditioning for Three Sisters at the Playhouse?”
Claire shakes her head.
“Why not?”
“I have a job interview,” Claire says.
“For, like, a job-job?”
“Sort of,” Claire says. She’d applied because it was part-time, three days a week, and she figured she could keep doing the program and maybe even audition for other roles, too. “It’s just an assistant type thing,” she adds. “Not permanent or anything.”
“Who would you be assisting?”
“Two divorce lawyers.”
“Sounds like fun,” Alexis says with a laugh.
“Yeah, like playing sick people all the time,” Claire says.
She interviews with one of the two attorneys, a woman named Lisa, fortyish and attractive. Lisa is married, confident, easygoing and comfortable in her skin—a person Claire can study, as if for a role: an example of who she’d like to be one day.
Thanks to a steady string of temp jobs, this one seems easy enough; Claire knows the hardware and software and how to dress the part. It’s a simple lie to tell them she hopes to go back to school to study law. That she’s interested in empowering women and hopes to work for a nonprofit legal organization. She has all the right answers and feels good about the interview when she leaves.
She wants to celebrate, but there’s no one to celebrate with—no Bruce, no girlfriends who aren’t working late or out on dates or home taking care of new babies. When she returns to her dark apartment, she opens a bottle of wine. About halfway through, she begins to doubt the entire day and starts searching for flaws in her performance. Had Lisa paused after Claire told her about wanting to go back to school, or was she now imagining it? Did we’ll be in touch mean just that, or did it mean thanks for coming in, have a nice life?
Claire’s accustomed to the language of callbacks, where yes means maybe and thanks means not in this lifetime. She’s wondering now whether she even knows how to communicate with the real world anymore.
She finishes most of the bottle, and by morning, she’s written off the law-office job. When the program manager at the med school calls to ask about her availability, Claire tells her she’s free all week.
Today is another exam day, and Claire’s feeling wary. She’s constantly surprised by how badly some of the med students treat her, even if she is only a fake patient. She wants to say, Don’t you know you’re being tested on your bedside manner? But they do know it. The cameras are right in their faces the whole time. The job has made her fear ever getting sick for real.
Today, Claire is playing a pregnant twenty-four-year-old, padded up, walking around with her hips tilted forward, her hand at the small of her back. The program doesn’t have real pregnancy pads—this isn’t Hollywood, after all—so Claire’s using pantyhose with the legs cut off, pulled up around her middle and filled with pillow stuffing until she looks about seven months along.
One of the makeup ladies has dusted a shadow onto her arm, a reddish bruise in the shape of a handprint. The students are supposed to notice it and ask her about it.
The first student mentions it after no more than a quick glance, then accepts her excuse—I was just moving some furniture—with no further questions. When the student leaves, Claire glances over at the video camera in the corner, resisting the urge to roll her eyes.
The next doctor doesn’t bother with small talk. “I’m Dr. Miller,” he says curtly. “What’s your name?”
“Jenny,” Claire says.
“I see you have a bruise on your arm,” he says.
“It’s nothing. I was just cleaning the house.”
“Are you sure?” He looks at her, eyes narrowed.
“Yes,” she says, conjuring a nervous stutter. “I—I had to move some furniture around.”
“Are you sure?” he asks again. “Because it looks like a handprint.”
She wants to laugh. Sometimes her acting abilities are tested in the oddest of ways. “Yes, I’m sure.”
“Look, that’s obviously a handprint. What happened?”
Part of her role—if the doctor plays it right—is to confess what happened: to say that her husband has been drinking a lot and that sometimes he gets a little upset but she can’t possibly leave because she is in love with him and about to have a baby.
And now, under the angry, impatient glare of this doctor, suddenly her apprehension feels real. And as she says her lines, she feels not like a character but like the victim she’s portraying, trapped and frightened, stuck. After he leaves, while normally she’d enjoy eviscerating him in her evaluation, she feels as if the whole thing had been real, as if the abuse had actually happened.
And so when next student comes in, it takes her a few minutes to realize how attractive he is—blond and green-eyed, with just enough of a suntan to suggest he might be out jogging or biking when he’s not studying. She looks for a wedding ring and doesn’t see one, but then lots of the med students don’t wear them, even if they are married.
“I’m Jack Tierney,” he says, and she likes him right away for not saying Dr. Tierney, the way all the students throw around the term as if it demands instant, unearned respect.
Watching him, she loses focus, especially as he asks a few unscripted questions—pleasantries, which most of them don’t bother with. He’s nice, and she answers honestly. I grew up in Jamaica Plain. No, it was just my mom and me. I’m always craving chocolate.
Then he runs his fingers over the makeup bruise, and she nearly shivers with the unexpected pleasure of it.
“What happened here?” he asks. When she gives him the scripted answer, he says, “How long have you been married?”
She struggles to remember her lines. “Two years.”
“Where did you meet?”
It’s a good question, but the answer’s not in the script. “Through a friend.”
He lifts her arm and touches the handprint again, making her wish she had a few more, on different parts of her body. “It looks as though this must’ve hurt,” he says.
“It wasn’t so bad.”
“Is your husband excited about the baby?”
She feels unexpectedly tearful. “Not really.”
“Have you been arguing about it at all?”
“A little.”
And this is how the case is supposed to go: the doctor builds rapport, the patient finally confesses, and now, when Claire does admit the “truth”—that her husband’s been hitting her—she is surprised by the emotion that pours out of her: the tears, the sadness. She’s embarrassed, though this is perfectly in character and exactly the sort of response the role calls for. The doctor assumes she’s acting, not crying for real, and when he takes her hand and holds it between his she feels as though she doesn’t deserve his kindness.
Claire Tierney. Ms. Tierney. Dr. and Mrs. Jack Tierney. She’s spent so much time trying not to think of Dr. Jack Tierney—of the warmth of his hands, the light touch of his fingers on her faux bruise—that when she finds him standing right in front of her, she hardly recognizes him, at least for a long, awkward moment. She’d been thinking about the law firm, about the part-time job she’d just accepted from Lisa, wondering whether it was a mistake. The fact that Jack Tierney is right in front of her seems to be a sign of something, though she doesn’t know exactly what.
They’re standing near a stack of carrots in the produce aisle of Shaw’s, right down the street from the medical campus, and he’s staring at her with the same confused expression she must be wearing. And then he smiles and snaps his fingers. “The med school,” he says.
She nods, then pretends to examine a carrot.
“Jenny,” he continues, as if he’s just guessed right on Jeopardy! “Twenty-four-year-old female, twenty-six weeks pregnant, in for a routine visit, presenting with bruises on upper left arm.”
She can’t help but laugh. “Not bad,” she says.
He’s still smiling. “You did a great job,” he says. “Usually the cases don’t seem all that real.”
“Usually the doctors don’t either.”
He grins.
They begin to walk the aisles together, talking about the program, the weather, the Red Sox. She steals glances at him, looking up at the blond stubble on his chin, at the upward curl of his sandy eyelashes; she catches him looking back.
Then he looks down at his still-empty shopping basket. “I guess I’m not really in the mood to cook tonight after all,” he says.
“Me neither.”
Drinks and dinner at Eastern Standard. A walk through Kenmore Square to his apartment on Beacon Street. A tangle of limbs and clothing in the moonlight streaming through the window.
She dozes on soft, clean-smelling sheets, and when she wakes she rolls toward him, her shin throbbing from having banged into the coffee table as they’d stumbled toward his bedroom. She sits up to rub the bone, already thick with a knotted bruise. She hears him sit up behind her, and he puts his hand over hers, then moves it aside so he can examine it in the pale light. “Does it hurt?” he asks. “I can get you some ice.”
“It’s only a four on the pain scale.”
He runs his hands from her shin all the way up her legs, over her hips to her chest. A hand lingers between her breasts—an odd spot, she thinks, for him to focus his attention—but then she realizes he’s listening to her heart.
“What’s the medical term?” she asks. “For the way the heart beats?”
“Systole, you mean?” His voice is a murmur in her ear.
“That’s it,” she says. “A pretty word. Keep talking.”
“Diastole,” he says, his lips at her neck. “Asystole.”
“What does that one mean?” she whispers, turning toward him.
“When the heart stops,” he says. “Flatline.”
Facing him now, she wraps her legs around him. “The opposite of what mine’s doing right now,” she says, and takes his lower lip between her teeth.
Working at the law firm is like playing another role, and she’s glad for a new part, for something different. It means she can hope for new possibilities, even if it also means she has to be nice to clients on the phone, many of them angry, insistent, rude. It’s not unexpected, given that they’re all at some stage of divorce, but sometimes it makes her worry, listening to these pinched, disembodied voices. It makes her wonder whether this will ultimately be her own fate. If she even makes it that far.
She’s never liked being alone; it gives her a nervous, twitchy feeling, as if something under her skin is being sparked—not the good kind of spark ignited by a kiss or a first touch but the irritating kind, like fur being rubbed the wrong way, or walking across thick carpet in the wrong shoes. It’s the kind of discomfort she’d call a three on the pain scale, though emotionally it’s more of an eight.
She doesn’t see Jack Tierney again until two weeks after their night together when she does an ectopic pregnancy case. She’d hoped to hear from him, though she can’t even recall whether she gave him her number or email address—she’d even dropped by the campus one day when she wasn’t working, on the pretense of visiting Alexis. She didn’t see him anywhere.
Now, in the examining room, it takes all her acting powers to pretend it’s pain she feels when he touches her abdomen, when he moves his hands around, asking, “How does this feel? Does it hurt when I do this?” She resists closing her eyes and pretending they’re back in his bed.
He’s different from before, not as warm or friendly, and she doesn’t know whether it’s because of that night or because he’s tense about his upcoming exams. She usually returns to the green room when she’s finished with her cases, but today, she slips over to the other side of the building, where the medical students hang out. She pretends to be looking for something in the vending machine as she scans the white lab coats.
She has just turned away, about to give up, when she sees him. He recognizes her but doesn’t smile. She approaches him anyway.
“I gave you all strongly agrees today,” she says. “And as a bonus, I wrote, ‘I feel very comfortable with Dr. Tierney.’”
“Thanks.” He’s holding a clipboard, which he hugs to his chest. “Um, listen,” he says, and she doesn’t need to hear his words to know what’s coming next. She can feel it in her gut, the same nauseating lurch she’d felt with Bruce, and the only thing she wonders is why she thought it might be different this time. And in fact it is only slightly different: exams, a girlfriend, a residency in another city.
She shrugs, as if she doesn’t care, meanwhile assessing her level of pain. An eight, maybe even a nine—too much for the circumstances, a bit of an exaggeration, but she feels it all the same.
A month later, at four-thirty in the afternoon in Exam Room Six, it feels like closing night at the theater. Here she is, dressed as the schoolgirl, in her final performance at the med school—maybe her last performance ever. Lisa offered her a full-time position at the firm, and Claire accepted.
She’s in the examining room with an older actress, Jeanne, who’s playing her mother, when Jack Tierney walks in. She thinks she sees a spark of something cross his face when he sees her, but it passes quickly, and he introduces himself and begins to ask his questions. Claire deviates from the script a little bit by glancing at Jeanne sooner than usual and saying, “Do we have to talk about this now?”
A moment later, Jeanne leaves the room, and Claire relishes the moment when Jack has to ask her, “When was the last time you had sex?”
She pauses, then answers truthfully, remembering Jack’s bed, the bluish light of the moon across the sheets. “About six weeks ago. He hasn’t called me since.”
He won’t look at her, busying himself with the chart.
“Turns out he was just using me,” she continues, going off script—way off this time. “He was cheating on his girlfriend.”
She can tell he’s trying hard to stay focused, and he asks the required question: “Did you use a condom?”
She and Jack had, but the script requires her to say no. “We did,” she said, “but I don’t think it worked. I think it might have torn or something.”
She sees Jack’s eyebrows shoot up, but he manages to stay in character. “What makes you say that?”
“I could just tell. Something was wrong.”
He’s pretending to make notes in the chart, but she can see that his face is reddening, a bright pink spreading upward from the blue collar of his shirt.
Finally, she goes back to the script: “I think I’m pregnant.”
It’s nothing but a whisper, for dramatic effect, and when he finally looks up, she thinks she sees real fear in his eyes. And she realizes that, in this moment, he’s unable to tell the difference between what’s fake and what’s real.
“Well,” he says, “we’ll have to give you a pregnancy test.” He doesn’t sound at all like the man she met in that first case—self-assured, warm, the good-hearted doctor. Right now, he’s genuinely nervous, knowing that, in so many ways, she holds his future in her jilted hands.
She holds his gaze for a long moment, taking in his uncertainty, his regret; she feels it flowing out of her and into him. Then she says, “The results are in the top drawer.”
He opens the drawer, the envelope with the results. “Positive,” he says, in the same uneasy tone. He’s out of character, she can see now, not sure what’s going on, what to do. He’s supposed to talk about telling her mother, about counseling, about going over her options. Instead he just stares down at the paper in his hands.
“What do I do now?” she asks, helping him along, and he looks up at her. In his gaze she sees a flash of relief. “I’m scared,” she whispers, a phrase that is completely in character and also completely true; she doesn’t know what will happen once she leaves this room for the last time.
And Jack, recovered now, places a hand on hers. “I know,” he says in that soothing way of his. “Don’t worry. It’ll be okay.” And she feels the knot in her throat loosen a bit, easing down the numbers on the pain scale just enough to get through the session.
Afterward, Claire logs in to do her evaluation. It’s the last exam of her shift; she doesn’t need to rush. She answers the questions honestly, giving him the same average scores she’s given to every average physician-in-training.
Then she’s ready to go. She takes one last look around the examining room, catching a glimpse of herself in the two-way mirror. She doesn’t know whether anyone is on the other side, but she stops, faces the mirror, and takes her final bow.