Erin Finnerty
Never Felt Better
Anyone can slip a penny under their tongue or clamp onions in their armpits to simulate a fever, but this is not evidence of any particular craft. The thermometer registers 99, maybe 101 if you overdo it, fine. But it’s the other details – the extra dab of blush, the hot washcloth on the forehead, the limp eyelids, the subtly labored breathing – that nail it. Any hack can grip their head and moan. But will they take note if their sinuses were palpated? Would they know if their anterior lung field was bilaterally auscultated if it hit them in the face? Do they take a sick day from Being Sick? A hack teems with tells.
Today’s class are third years, the larval stage of med school. They’ve been neck-deep in lectures and textbooks, but the brain knows nothing it hasn’t experienced with the hands. Some would classify today as a dry run for future patient encounters, but this inflicts a false distinction between acting and performing. The air is a-crackle with potential energy, on the cusp of conversion to kinetic energy through these greenhorns.
Here is one now, getting into character. Allow me to sketch him for you: milk-complected young man, trim midline from nonstop ing-ing (running, hiking, climbing, soccering), volunteered in a nursing home (told himself he loves old people, but the truth is he needed to bulk his anemic med school resume), atones for too much IPA with penal amounts of kale the next day.
I walk over, aware of how well the grey-blue hospital gown plays up my undereye shadows. He introduces himself, squeaks out “I’m Dr. Weston” (adorable), and motions for me to sit. I settle onto the exam table, and its paper covering crinkles which gives me the tingles every time.
“Hi Dr. Weston, I’m Laine.”
I look at him for a beat. He’s frozen already. Picture tapping him on the side of the head, like a broken TV.
“What brings you here today, Laine?”
LAINE
Well, I’ve been having this pain in my lower back, off and on, for a few weeks now. I’m usually able to ignore it – I’m very fit –
(LAINE lays back and bicycles her long legs in the air a few times to demonstrate their condition.)
but recently the pain is just more than I can take.
(Gaze falls to the ground, LAINE swallows hard.)
“DR.” WESTON
Okay. Let me start by taking a general history, and then we’ll go into the exam itself.
(Girds himself.)
He skids through the history checklist. When was my last physical exam? Two years ago. (Yesterday.) Do I have any chronic health conditions? Well, this back pain seems to be one. (A lady doesn’t tell.) When was my last menstrual period? Gee…probably two months ago? (Fifteen years ago, when an IUD capped that well.) Is there any chance I could be pregnant? Dear God, is there? (No. Never.) And what kind of work do I do? Sky diving instructor. (Actor.) Do I smoke? Occasionally. (Occasionally.) Do I drink alcohol? Yes. How much? Four drinks a night, every night, except Thursday, Friday, Saturday and sometimes Sunday, when I have six, or seven. (Never.)
DR. WESTON
Okay then! Great! And now I’m going to…start… the physical exam.
(Gingerly takes LAINE’S wrist, palpates radial pulse. Measures blood pressure. Inspects nasal vaults, oral cavity. Overlooks ears. Checks pupillary response to light. Forgot the ears though. Ears! Ears, ears, ears.)
(LAINE turns her head a few degrees and leans toward WR. DESTON. He tilts his head away from her while simultaneously stretching arms toward her neck to palpate her lymph nodes. His arms can not reach her. He stretches arms further toward LAINE while tilting his head even further away.)
LAINE
Doctor, are you doing the limbo?
WESTON
Just…going to check your lymph nodes now.
(Palpates lymph nodes, missing five of the nine key areas. Auscultates carotids with bell, fails to have LAINE hold breath. Palpates thyroid, fails to visually inspect from front and side. And he forgot the ears.)
LAINE
Have you ever done this before?
PRESTO WESTO
(Acting.)
Haha! Yes, we’re taught all of this in medical school. I’m going to listen to your heart now.
(Pulls stethoscope from neck, inserts it backwards into his ears, pulls it out, inserts it properly. Places stethoscope bell on LAINE’S chest, auscultates aortic area, pulmonic area, right ventricular area, left ventricular area. LAINE’S paper gown rustles as his stethoscope bell slides across it to the next area of her chest.)
WESTO
I’m going to ask you to lay down now, and untie the gown.
LAINE
You what?
THE GOOD DOCTOR
So…I can examine your abdomen.
LAINE
Just joshing.
(LAINE punches him playfully in the arm, then lays down on the table and unties her hospital gown. She stares at the ceiling for a moment, and then looks at the young man standing over her.)
THE YOUNG MAN STANDING OVER LAINE
(Pulls LAINE’S gown to the side, places stethoscope on LAINE’S abdomen, auscultates for bowel sounds. Fails to percuss abdomen in four quadrants. Begins to palpate abdomen, looks unsure, cannot access the GPS for this part of the human body.)
LAINE
Did you lose something?
THE LOST DOCTOR
(Ignores LAINE. Presses deeply into her abdomen, searching for the liver’s edge, for the spleen tip. He cannot locate them.)
Can you sit up now please?
(LAINE rises – powerful, haunting, poignant.)
Ok, can you touch your finger to your nose?
LAINE
(Touches finger to cheek.)
A MAN GOES ON A JOURNEY THROUGH MED SCHOOL
(Examines LAINE’s knees, shoulders, range of motion in back and spine. Palpates iliac crest of her hips, pushes fingertips deep into her hip socket.)
A STRANGER COMES TO TOWN IN A GOWN
(Makes yelping sound. Watches his face.)
DOCTOR WHAT
(Skips rest of hip exam.)
LAINE
You’re just like a real doctor!
ELEVENTH HOUR AFTERTHOUGHT
(Chuckles.)
Oh - one last thing.
(Reaches for otoscope, switches on light.)
Let’s check your ears.
(Inserts tip of otoscope in LAINE’S right ear, leans next to her face, squints. Warmth from the high-powered light floods her ear canal.)
LAINE
Mmmmm. Hhhmmmmmm. HhhuuuuuuuugghhmmmMMMM.
END SCENE
~
Afterward I inventory his many, many mistakes. He nods along, with gusts of frustrated breath. I catch his eye, and give him a sympathetic smile. “You botched that exam today. Egregiously. But you’ll get there, perhaps. You just have to be humble, and practice over and over.”
I can see my words float through the air and travel into his ears, into his brain, where they nestle in crevices, soon to germinate a mental scrapbook of professional negligence.
“And one last thing – you didn’t wash those hands of yours before starting the exam. And who knows where they’ve been?” We both look at his hands.
~
I could have been a doctor, too. I’m practically a doctor. Let’s just say I’m experienced with doctors.
~
The acting bug is hereditary. You catch it from a parent, and then you just pray your own case is incurable.
My father acted as a father, but he was terrible with the lines and couldn’t improv to save his soul. He fell for anyone who smiled back at him, unable to tell they were acting too. Eventually my mother discovered his indiscretions, and in a fury drove him off. [Father exits, pursued by a bear.]
I can’t say I blame him. If I were married to her, I’d look elsewhere too.
~
Every one of my mother’s voicemails is the same. Went to the doctor about these pains (these headaches, this ringing); they don’t know what’s going on; I’m going to demand tests this time.
~
After the immersive external experience of embodying a standardized patient, it’s important to let the instrument that is oneself rest. The gold standard of treatment is full surrender to the interior, replenishment through self-wombing.
I put on my top-of-the-line headphones. They cost $4,000, paid for by my honest labor of participating in focus groups, sleep studies, and selling my plasma. The sound quality is unparalleled – a log flume you ride with your ears, tunneling through the deluge to arrive in another dimension.
Once I put on the pre-mixed soundtracks, I lean back and close my eyes, and envision myself standing on the edge of a better world. The sky is lavender and tangerine, and the ground is the texture of dry ice. The air shimmies. The stars are lower and closer, and they strobe. Today
I assemble myself this way: I have Baryshnikov’s body, a watermelon-sized dahlia for a head, and a leopard tail.
Something about the leopard tail feels two degrees off, so I swap it for a panther tail.
Once I’m assembled, I drop a tent down from the sky and hover it there. The strobing starlight passes through the sheer tent top, and all the light is melted butter. I turn the music up until it floods my skull, washing everything downstream. Away, away, into the gutters. Dance on.
~
Particularly active REM sleep of late. Whenever liquid comes out of my feet in a dream, I know something important is about to happen to me.
~
The next standardized patient assignment is for students learning differential diagnosis. It’s a new gig – seems word has gotten around about me.
I’ve done a little stage makeup for today: faint purplish undereye circles, a few zits I deliberately cultivated so I could pop them and let them crust over, and a little whitish concealer rubbed onto my lips for that extra-anemic look. I stayed up all night so my exhaustion reads authentic, and carefully placed a few grains of coarse cornmeal in the corners of my eyes, to look like that gunk that builds up. I haven’t washed my hair in eleven days.
Performance begins well before the audience is in place.
I can see the other standardized patients they’ve got for today. Basic. Basic. Another basic. Tends to be a mix of grad students, waiters, randos trying it out. Who’s in charge around here? I ask the guy next to me. He’s a terminal schlub; I’d peg him as a Grand Theft Auto addict who still lives at home and needs money for the next expansion pack but his mom makes him pay for it himself.
He jerks his head toward a White Coat in the corner. I catch sight of his throat, where he’s got a two-inch keloid across his neck. Excellent prosthetic makeup – I’d guess a thin line of mauve fondant, superglued into place and rubbed with Vaseline for sheen. This guy’s good.
Something about the Attending is familiar, or maybe it’s just the exhaustion playing tricks. She’s giving the med students their assigned cubicles for the run-through. She looks the part of a Woman in Charge. The hair on my arms raises a little; I’m a sensitive instrument.
When I get close, it comes to me, like a gumball popping out the chute: Gabby.
“Hello, Doctor.”
She turns to me, but doesn’t register. That’s how good I am. I give her my last name, and she slides down the list to check me in, and when she reaches my full name, she looks up again.
“Laine?”
Yes. But not today.
I zap her with a marquee smile through my bleached lips and haunted eyes.
~
The acting bug is also contagious. I’ll set the scene. It’s the tenth grade, and I’m auditioning for Our Town. A dozen girls are trying out for the role of Emily, and I watch them one by one act their way through the monologue.
When I get up and stand under the lights, and I AM Emily. I resuscitate her from the mass grave of high school theater clichés. Our monologue on the preciousness of every day and every moment is riveting. I get shivers from my own performance; I’m so moved, I have to fight tears.
Gabby is in the front row of the auditorium, here to cheer me on, my original Fan Club since we met in seventh grade biology. For some reason she’s sitting with the others trying out for Emily. I can see on her face she’s struck stupid.
Gabby must have auditioned for something that day. Being a diminutive thing, she was cast as Wally Webb, a character with few lines who dies from a burst appendix on a Boy Scout trip.
We ran lines with each other at our houses after school. Her family had a dog named Amy, a deeply weird name for an animal. Amy’s howls were toxic to my process, and I refused to continue in that space.
When we rehearsed at my house, my mother came out in her charmeuse kimono and sized Gabby up: “Are you an anorexic?”
We both looked at Gabby, giving her time to answer the question. Gabby never had a knack for improv though.
My mother touched her temple and gave her head a little shake, eyes bugging just slightly. She rubbed her fingertips together, as if stroking some invisible cloth. “I can’t…feel my hands.” She told us she wasn’t feeling well, and retired to her room.
~
Everyone needs work. Work gives life meaning. People fall apart when they have nothing to do.
My mother did not work. She came from money, as they say, as if money is a far-off land, or that protozoic ooze that amoebas first crawled out of. She blew into town one day, changed into a bathrobe, and only left the house to attend her various appointments. The money she came from still trailed behind her, and it was there when I needed new veneers for my teeth, or an accent coach, or a falconry tutor. There was money when she wasn’t well enough to work, which was always.
My mother’s job was figuring out what was wrong with her.
~
LAINE
OW.
STUDENT
I’m so sorry. Sorry. Does this hurt you?
(Taps LAINE’S knee with a reflex hammer.)
LAINE
OW. OW OW OW OW.
STUDENT
(STUDENT shakes head, holds hands up.)
I’m so sorry. You seem to have unusually sensitive…kneecaps?
LAINE
You’re HURTING me. Why are you HITTING ME with that?
STUDENT
This is just a reflex hammer…? I’m testing to make sure your reflexes are working properly. But maybe we’ll pause there if this is hurting.
(STUDENT looks around for the instructor, for the escape hatch. STUDENT is experiencing mild chest pain and fresh regret about letting her parents pressure her into med school. Was pleasing them really the only way to feel secure in their love?)
“Let me stop you right there.” I drop the act and look this kid in the eye. “Pain is not an emergency. Maybe they haven’t taught you this yet. People can tolerate pain. You need to keep doing the exam, every part of the exam, or you could miss something crucial. You can’t do this with your hands over your eyes. Alright? Look up. Look at me. Look at me. Pain is not an emergency.”
As this message soaks in, the light shifts in her face. She breathes away her tears. Some distant voice is resurrected – perhaps a Bulgarian gymnastics coach from high school, who always squeezed the next level out of her – and validates what I was saying. It all checks out.
“Now take up your reflex hammer, and continue with the exam. If you don’t treat this seriously, if you don’t approach each exam like it’s life or death, you could miss something of vital importance.”
I find my own hand has balled itself into a tight fist. I look back at the student. There she is, stuck between a rock and a hard place and a scalpel and an iron maiden and one of those anvils suspended over her head like in a roadrunner cartoon. For a moment I pity her. Top doctors are made though, not born! Break down to break through.
She looks around for help – is there a doctor in the house? – but Gabby is busy observing a student palpate that schlub’s thyroid. From across the room, I watch this woman. Who would have guessed she’d have a star turn as Boss Lady? I certainly wouldn’t have. Not in a hundred thousand million eons.
Gabby can’t save this student though, only I can. I pull her eyes back to mine and lock her in. I am a carpenter and she is a baby. I am channeling knowledge into her. I am choreographing the muscle memories she will rely on for the rest of her career, so that one day, years from now, when a nonstandardized patient presents for care, she will follow the tank treads in the cement back to this seminal teaching moment, here in this exam room, and she will know what to do.
STUDENT DOCTOR
I’m going to ask you to lay down on the table for the next portion of the exam.
DOCTOR TEACHER
Will it hurt much?
STUDENT DOCTOR
You’ll just feel some pressure. It’s important that I check your bowel functioning.
I lay down on the table, and lift my hospital gown. She presses deeply into my abdomen, searching for hidden organs with her blind little fingertips. Gabby is looking at me from across the room, with her own blind little fingertips. I wink at her.
~
Gabby had a boyfriend, Jamir. By senior year, she’d given up on auditioning and transitioned to doing the lighting for shows. She and Jamir would scuttle around the stage wings in black jeans and black sweatshirts, headsets and walkie talkies. Two nerdy ninjas, sitting in a tree.
Gabby was, as they say, tight-lipped about her romance. Always punting whenever I’d ask, as a friend, how things were going. I had to wonder if Jamir, a late bloomer, had the right skills to romance our girl Gabrielle.
I found him one night at the end of a dress rehearsal, checking all the nuts and bolts of the lighting. (Love a double checker!) I assessed what he knew in the romancing department: very little. He’d picked up some of Gabby’s terrible ideas about tongue.
~
I put on my headphones and start with a single amoeba. It’s a two-dimensional amoeba, and I flip through multiple colors before tinting it electric lime with frosted tips. In my mind’s microscope I see all the amoeba’s parts: vacuoles, cytoplasm, membrane. In the center is the nucleus, and I set it blinking, like a lighthouse swinging a neon lasso. The pseudopods contract and swell in time with the nucleus. Once the tempo of the whole glorious mess is beating and catches fire, it’s like an electric cranberry color, and then I/it splits into two. We love this music so much!!!!! we shout and hear each other shout. We are both pulsating now, and we each split into two more. The louder the music, the more we divide and replicate. We add on animal hooves to the pseudopods so they don’t feel so naked. Then we are turning into aliens, we are turning into the sky.
~
To prepare for the next week, I take a walk in the woods. I dislike hiking. All the plants look alike. I am trying to recall an educational rhyme. Leaves of three, let it be. Or maybe it’s leaves of fivey, poison ivy. No reception on my phone to google a picture. No matter. I take my clothes off and roll around on an especially planty section of the forest floor.
By evening the itching starts. Next day, little bubbles spread up my thighs and torso and onto my neck. I scratch until it oozes and forms patches of crust. It’s phenomenal.
~
At the next teaching session, the guy with the thyroid scar is back, along with the thyroid scar.
“What’s all over your neck?” he asks.
“Just a little treat for the kids.” I try to arch my eyebrow, but the rash has spread onto my scalp and movement is fraught. “What’s all over your neck?”
“This? Thyroid cancer. Took it out.”
“Is that so? So that’s an actual, real scar there?” I bring my nose to his throat to get a closer look. His body is cabbage-scented.
“Yep. First month afterward sucks, but then everything just settles down. I was all over the place before, and now I’m top-down, cruise control on.”
Mr. Topdown Cruisecontrol slurps on a can of orange Fanta and waggles a finger my way. “You might want to have someone take a look at that mess.”
~
I have to throw myself into it, wrenching with force. I draw on my training in corporeal mime: always make the invisible visible. Finally, the spaghetti sauce lid gives way, with a defeated pop and hiss. Inside are – everyone mime a surprise face! – tiny colonies of fuzz, sea-foam green and kitten grey. Scoop these gems out and spread them across a slice of three-week-old deli turkey whose ammonia smell is a bullhorn in the nose. It doesn’t go down easy, but down it must go, so that symptoms manifest in time for the morning’s performance. Once committed to a role, you must engulf yourself in it.
For years, it has been a chronic outrage that others can’t appreciate what I put in. Role after role, handed out to lesser actors. Fine. Let the chorus fill the ranks of community theater, Law and Order spinoffs, and toothpaste commercials. All actors reconcile themselves to degradation, an occupational hazard.
The true professional is nourished by the ubiquitous opportunities for interrogation of the human condition vis a vis the emotional petri dish that is another human. Acting is ultimately not a performer and an audience. It is a two-person relationship. An actor, and an interpreter.
~
FUTURE DOCTOR
We’ve gotten the results of your biopsy back. Unfortunately, they showed that the cancer has come back –
STANDARDIZED PATIENT
(Screams.)
FUTURE DOCTOR
(Continues, with raised voice.)
– the cancer has come back, and it has spread to your spine.
STANDARDIZED PATIENT
(Screams over FUTURE DOCTOR’S words; begins weeping loudly.)
FUTURE DOCTOR
(Shouting.)
It is important that you not lose hope. Please calm down. We need to discuss your treatment options. Outcomes indicate that treatment at this stage can prolong life by as much as two years. Please calm down. Please. Please.
STANDARDIZED PATIENT
(Continues screaming, weeping. Tilts face up to the ceiling and wails.)
BEDSIDE MANNER BIG BANG
(Reaches slowly toward STANDARDIZED PATIENT, hand hovers before choosing destination, settles on shoulder. Squeezes.)
“Laine. Laine. That’s enough.”
But soft! Here’s Gabby, drawing the curtain. Dimming the lights. She’s holding a paper cup of herbal tea that smells like radioactive dirt. Killjoy.
“I think you’re mistaken, Doctor. That is not enough. I’m providing this student here with a valuable opportunity to cultivate his bedside manner. He knows nothing of how to deliver difficult news. Doctors, as we all know, are all-too-frequently inept at delivering difficult news.”
The student looks concerned, like this is still part of the simulation and he’s lost his line. Like I said, I’m very good. The education must go on.
“What if I were to go into shock at this moment? What if I completely blacked out, and my mind erased the entire conversation? What if I blacked out, forgot the conversation, and fell and hit my head? What will this future medical professional do then?”
Gabby fails to grasp my process. “Right, of course those are important considerations. For today’s purposes though, the priority is for students to get a chance to practice an intervention. And that’s impossible if all anyone can hear is you screaming.”
She does. She does say those words to me.
The future medical professional is trying to figure out what’s happening in the performance. Gabby tells him he can take a ten minute break. He leaks away toward the others in their white coats.
“Laine, are you sure this kind of work is a good idea for you?” Gabby’s using her Quiet Respectful voice, which is the ultimate sign of disrespect.
“ Actually Gabby, I was going to ask you the same thing. I seem to remember you don’t really like touching much. That you’re a little squeamish about that. Must make it rather difficult for you be competent in this line of work.”
Gabby doubles down on the I’m Concerned face. “Laine, I heard about your mom. I’m really sorry. I can only imagine it must have been such a shock, and I can imagine you might be angry that nobody intervened sooner. It just doesn’t make sense to me though why you’d put yourself through all of this.”
I clamp Gabby in place with my eyes. I put on my imaginary headphones and picture Jamir in his black tech sweats, against a black curtain, in the dark, and I’m in black tech sweats, and I move toward him and we converge into a single blob. I roam around and absorb all the blobs hidden in the wings of the stage until I am massive enough to crush the entire structure. There is Gabby, standing in front of me, and I could absorb her too. Instead, I reach over and lift the bell of her stethoscope to my mouth.
“Doctor Gabrielle. Doctor Gabrielle.” She winces, and this gives me the giggles, so I drop down into a baritone and boom into the scope: “Doctor Gabrielle. Paging Doctor Gabrielle.”
Then I yank the scope from her neck and yeet it across the room.
~
I kept the gown from today, just wore it out of there under my regular person disguise, out into the parking lot, under a sky the color of toilet paper. At home, I put my headphones on and lay back. I set a scene in which I am the doctor and I am the patient.
DOCTOR LAINE
I’m afraid it’s malignant. We’ll have to take it out.
(DOCTOR LAINE unsheathes scalpel.)
STANDARDIZED PATIENT
Yes, we will.
(STANDARDIZED PATIENT palpates herself, prepares for excision.)
DOCTOR LAINE
You may feel some pressure, but you’ll feel so much better when it’s over. Count backwards from a hundred.
(STANDARDIZED PATIENT reaches up and takes scalpel. Removes the tumor herself.)
~
Whenever my mother sneezed, she would freeze in place, expecting it would bring on a seizure. I learned to never say “God bless you” – the sound of a human voice in those fragile moments sent her into the spins. After a minute or two, her body would thaw and release. She’d find a dark place to lay down with a handkerchief tied across her face, to prevent any nasal intrusion that might trigger further sneezes.
She was always listening deeper and deeper into herself. When her bowels bubbled or squeaked, she insisted on total silence, to isolate the sounds. She would beckon me, and lift her shirt. I would press an ear to her belly, and close my eyes. We would both slow our breath and listen. Squeezing, whining, microscopic roaring, some demon trapped in there and unable to make its way out. Doubling my focus, I would hold my breath altogether. I never could localize the source of the disorder, before I became lost in space inside her. Overlaying this was lub-dub lub-dub lub-dub, that classic backbeat, radiating from her tiny eggshell heart.
~
My ideal setting is where I’m walking down a street lined with Japanese maples, and they’re all perpetually at the stage of just starting to leaf, delicate fetal foliage. The air smells like permanent markers (the good ones, like they had when I was young), and pencil shavings, and the air is the temperature where you can’t tell where your skin ends. The fourth wall is dissolved, the fifth wall, the sixth wall, the set is struck, and there is nothing separating you any longer. Homeostasis carries the day.
Erin Finnerty writes speculative fiction in order to ride out speculative reality. Her work has appeared in Mobius Blvd and is forthcoming in Wallstrait and Bog Fancy.
