Confessions of a genital teaching assistant
But sometimes, no acting is involved. Occasionally being a simulated patient means simply being a body upon which medical students can practice various diagnostic techniques. These clinical skills workshops are important to the students because it allows them to put into practice what they have been learning in the classroom. The techniques are often things that you think doctors were born knowing how to do -- taking blood pressure or performing an abdominal exam. Yet a student's first time at these procedures can be very frightening. It may be the first time they touch an actual patient. When I served as a "body" for students learning how to take blood pressure and pulse, one young woman's hands actually trembled when she put the cuff on me.
For me, all of this is paid work. I make $10.00 per hour playing a patient, and as I can have up to four two-hour trainings and 2-3 eight-hour exam days per patient I play, the money can be pretty good.
But the gold is often in a special type of clinical skills workshop, where one serves as a "genital teaching assistant," or GTA. What is that? In essence, a GTA serves as the model for students to learn how to conduct genital exams and, in the case of men, rectal exams. GTA's get paid the $10.00 per hour, and also extra per procedure. Women get $25.00 per pelvic exam, and men get $20.00 per genital exam and $20.00 per rectal exam. Since you can see up to 8-10 students per time, the money adds up nicely.
I know what you're thinking. "Uh, Mike, uh, how can you do that?!!!" Some guys are probably thinking, "What, are you into that thing Mike? Is there something about you that I should know?" Believe me, I didn't quite jump into this enthusiastically. I'm not normally given to going out of my way to seek out such experiences. And, I really hate going to the doctor's office because I'm concerned that I will have to undergo just these types of procedures. Despite my misgivings, however, I recently performed as a GTA for the first time. The money, to a poor graduate student, is appealing and helped me will myself to tough it out. The experience was actually humbling and empowering at the same time. While I would like to say that I was calm and collected, the thought of newly minted medical students coming at my private parts was a bit intimidating, and I almost didn't accept the assignment.
Usually, the encounters go something like this. The examinations take place in small groups, usually 3-4 students and a physician, in an examining room. The physician demonstrates the various techniques for examination on the GTA. The students then follow with their own examinations, one at a time, under the watchful and helpful gaze of the physician and the eyes of their classmates. I did two of these groups, and you can do the math. Or I'll do it for you. I had two genital and rectal exams demonstrated by the physician upon me. I had eight students all take their turn at doing the genital and rectal exams. That's 8 pairs of student eyes upon areas that only my mother (when I was a young boy), my wife, and a few other assorted individuals have ever seen. Of the students, five were women and three were men. So, my genitals were dangling in front of all these people. I also had to bend over and show the least flattering part of myself to them. 10 fingers were inserted into my rear end, one at a time, over the three-hour time block. How's that for a compromising position?!
The funny thing was, that after the first demonstration by the doctor, I began to realize that this wasn't going to be too bad. After awhile, I forgot my self-consciousness, even in front of the women. The students had learned the drill quite nicely. "Can you please pull up your gown? Okay, can you lift your penis up so I can see the skin color underneath. Okay, I'm going to feel your testicles now for any abnormalities. Great! Looks good. Now I'll check for hernia...turn your head and cough please. Okay, now we'll do a rectal exam. Can you place your feet about shoulder width apart and bend over the table here resting on your elbows. Skin around the opening looks okay. I'm going apply some lubrication and it's going to be cold. Now you'll feel some pressure." All the while, the doctor exhorted the students encouragingly. "Turn your finger to the side, then push up and in. Good job!" And what was I doing? I was just kind of there. Another guy who was also a GTA said he usually went off into various thoughts about other things, only coming back to reality when asked a question or addressed. I found that I mostly did the same thing.
After I got over the embarrassment, I began to crack a joke or two to lighten their nervousness between exams. "So, you trim your fingernails?" "I feel I've gotten closer to all of you somehow!" And other stupid stuff like that, though I resisted the old gag "so now are you going to take me to dinner?" When you have people coming at your privates, the last thing you need is for them to be shaking and quaking with fear.
The difference between the genders in their examinations was an interesting discovery for me. Men were more gentle when dealing with a sensitive physical area, such as the testicles, than women! Maybe innate instinct and personal experience with what actually happens if the family jewels are mistreated was the explanation for this surprising experience. Women were a bit rougher. Once, I had to tell a woman to not squeeze a particular sensitive area so hard. On the other hand, the women were more likely to be compassionate and inquire of my mental and emotional feelings, even outside of the examination. At least three women, after an encounter, asked me how I was holding up with an expression of genuine concern, even though they did not perform the examination. The guys, on the other hand, tended to not say much. I don't think that they were being derisive of my sacrifice for their education, but were probably sensitive to my position. After all, women have much more experience having yearly exams on and in their nether areas than men do.
So, how does it feel to have done this service for medical students? The money is nice. I made about $450 for 3 hours of work. But beyond that, I feel good that 8 future doctors now have some sort of skill at conducting such exams, and relied on me to tell them when I was comfortable or uncomfortable during the process. I was able to tell them afterward my thoughts and feelings on their performance. I feel that in some small way I have helped create better and more sensitive doctors. Of course, not everyone wants to perform like this, and I had major qualms going in -- I told the students and doctor that it was my first time and that I was nervous. But I told them that in a way, their experience with me would be like an experience with an actual patient who doesn't know what to expect and is nervous about it.
At least one person I told about my experience asked me if I was worried about an uncontrollable response that would become physically evident to everyone. I can guarantee you that in this situation, there is no sexual tension at all. Charlize Theron or Uma Thurman or any other sexually attractive female could have been doing this procedure on me in this type of setting and there would have been no physical response from me. It's just too exposed. I've been asked if I would do it again. I do not have to make that decision for another year, thankfully, and I'm not sure I will repeat the experience. If I do, I won't be as nervous next time, and I'll know that a new generation of doctors, male and female, will learn how to be sensitive to the vulnerability of a man, in this case me, standing in front of them and putting his junk on display. I'll also be able to grade the performance of my own doctors when the time comes for me to have these examinations in earnest. As long as they don't have big fingers, and they trim those nails, I'll be okay!