During the beginning of the school year, our Practice of Medicine block directors informed us that we would have an unforgettable day, one which will go down in our personal histories: the day we perform rectal/genital/gyno/breast exams. When I heard that three months ago, it didn't really freak me out because it seemed like such a long ways away. After all, I was a fresh-faced medical student barely able to keep my head above the water with all of the lectures being thrown at us everyday (yes, the legendary "fire-hydrant" experience). Three months? Felt more like three years away.
Fast forward to the day before the aforementioned exams. One thing I've learned in medical school is that the concept of time is really strange; the individual days go by so slowly, yet collectively they fly by. At this point, most of my classmates and I were in such heightened states of anxiety that I think we would have preferred a 4 hour cardiac mechanics exam to that other one. Personally, I tried to relieve my anxiety by making immature jokes, giving myself pep-talks, and pretending like it was just going to be another day in the life.
However, no amount of positive thinking could calm my nerves down. I am in no way, shape or form comfortable with nudity or excessive touching. I grew up in a socially conservative household, due to my cultural and religious background, and to this day I still don't know the actual words for "penis" and "vagina" in my language. I couldn't even bring myself to say the word "sex" until I was well into my high school years, and I would change into my P.E. uniform in the bathroom instead of by the lockers like every other normal person.
So what's a girl like me to do in such a situation?
I summoned up every ounce of courage and professionalism I had, and forced myself to be as scientific-minded as possible. That got me through the male genital and rectal demonstration that our 4th year group leader gave to my small group. However, it was so unnerving to introduce ourselves to the standardized patient and then to observe his parts as if it was such a normal thing we were doing. After viewing the demonstration, I was proud of myself for being contained and keen on learning how it was done. I thought, "Hey, maybe I can do this without freaking out!"
Once it was my turn to be in the room and to put the gloves on, the situation completely changed. The last time I had a near nervous breakdown was when we were cutting into our cadaver for the first time, and here I was with an even greater impending nervous breakdown. To make matters worse, I was in the room with three other men - the patient himself, our 4th year leader, and my classmate who was supposed to be learning from me. How did I handle all of this? In the words of that classmate: "You were freaking out."
My leg was shaking uncontrollably, my face was flush, my voice was tense and my hands were fumbling. I had to inspect, touch, palpate, squeeze, and don't even get me started on the inguinal canal (which I had to attempt three times before I got all the way up there!). THEN I had to ask him to turn around for the rectal part of the exam! At this point, I knew I was losing it and I just wanted it to be over with. I was praying for a quick end to my complete and utter mortification. To my surprise, the rectal exam turned out to be really easy and I even got a compliment ("You were gentle"). I did have to shove my finger all the way in and then some (short finger problems) but it was mercifully quick. When all was said and done, and the gloves were discarded, I pretty much ran out of the room and had to take many, many deep breaths. And then I laughed like a banshee, because I couldn't believe that I just went through that.
Next up was the female standardized patient, which was it's own kind of freaky. I had to do a breast exam, while making small talk with the patient, which wasn't so bad. Then I had to go down under. So, the female genitals are much more complex than the males. I had to get her feet in the stirrups, inspect that thing up close and personal, then palpate the Bartholin glands by putting my fingers in the vagina at 5 and 7 o'clock and squeezing. Before all of this, I thought, "I have a vagina, so this won't be too bad!" Well, after inspecting and palpating, I realized that yes, this can be bad. It was such a weird and uncomfortable feeling! Then I had to insert the speculum in order to inspect the cervix. Have you actually seen a speculum go inside a vagina, all the way? I was terrified that I was going to pinch the clitoris, or pinch the cervix, or tear something inside! Thankfully, it went smoothly (pun intended) and I had a clear view of the cervix. After pulling it out, I had to do a bimanual palpation for the uterus and ovaries. Let's just say that my short fingers didn't make anything easier. Not to mention that I really had no idea what I was doing, so my right index and middle fingers were inside the vagina for much longer than they should have been. Once again, I couldn't have been any more relieved when I heard those magically words "You're done! Great job!"
After the end of the 5 hours of hell, I went out to the local bar with the rest of my classmates and pretended like none of that had happened (and no, not through drinking the mortification away!) I ordered fish and chips, had great conversations, lots of laughs and then called my mom once I got home. I did not spare here a single detail!
At least now I know that I can handle the gross and the icky parts of medicine, but it sure is going to take a lot more genital and gynecological exams before I actually feel comfortable with it.
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