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Phase One – The Core. – ERN

Phase One

The thoroughness of the physical exam is to be
With efficiency.
From the crown of their head
Down to the nail of their great toe.

I am a novice. I run through the list in my head before I sleep
We practice on each other, breezing through the exam
Expecting that we should know what "Normal" is
Pretending that I'd know what a liver edge would feel like
(If I ever felt one).
My abdomen tenses--is this guarding?
No, my partner's touch is just too light
And I'm just too ticklish.

"I'm inspecting your skin for any changes; have you noticed any?"
The lilting tone in my voice conveys genuine curiosity at the end of my question
Yet how can it not feel mechanical at times, when it's part of my script?
When my classmate and I practice for speed and for flow, she answers, "No."
And we hope that every finding is "Normal."

Today, our standardized patients wait in the mock exam rooms.
Three deep breaths, two knocks on the door.
I focus on my flow, the order I have set
I haven't missed one step yet
I feel competent. I like this feeling.
I prepare to listen to her heart, cold diaphragm on warm skin
The top of the hospital gown to be lowered.


I ask my line:
"I'm inspecting your skin for any changes; have you noticed any?"
And today, I can't pretend that every finding is "Normal."
I ask about an obvious scar, revealed to be from a port-a-cath.
And she, revealed to be a cancer survivor for double the time I've been alive.
The theatrics are paused; there is no response to this in what I had scripted.
I feel myself take a step back and my jaw drop in awe, and say,

The act fades and this all suddenly feels real.
That in a short time, I won't just be "playing doctor."
I let the mechanisms make room for humanity.

Listen to the audio version of this story here.