Let's Play Doctor

When we were first married, we were both back in graduate school at the State University. We were poor students again, living on Dave's half-time teaching assistantship and my finding part-time gigs here and there. Married student housing was still a bargain, as were ramen noodles and jug wine. I was working on my Master of Social Work degree and needed to do a summer practicum between my first and second years. This placement was to theoretically gain hands-on experience in the field, which seemed a little superfluous, since I'd already worked in the field for over six years. And to make matters worse, we weren't to be paid for our practicum work experience. I had originally hoped to get a summer job in the field and appeal to have it count as my practicum too. This would allow me to earn the fall semester tuition and help with some living expenses. The faculty denied that request implying a career in the field included an interim vow of poverty, or at least an involuntary taste of it.

Some younger students found a practicum back home, where they could live with parents and save some housing costs. Dave and I were older and married, so we clearly didn't want to live apart for the summer. I finally lucked out and got a practicum in the social work department of the University Hospital. Much of this involved helping with discharge planning, but also working with child abuse and sexual abuse cases where I already had direct experience and some statewide peer-recognized skills and expertise.

The supervisor of my practicum, Jim, was about my age, maybe a year or two older, and he seemed like a nice, laid-back kind of guy. He also gave me credit and respect for having my years of experience. I thought this would be an easy tour of duty for me. He also had some responsibilities with the College of Medicine, so wouldn't be around full time to "snoopervise" my work day-by-day. That sounded good too.

After my first week or so, Jim invited me and Dave to dinner and to meet his wife, Sally. She worked in a grant writing job in the sponsored programs office, and had a great witty sense of humor, and I liked her immediately. It wasn't long before we were getting together with them regularly for dinner, a movie, or to play golf on weekends.

As we got to know them better, they learned more about our financial situation, and I told them I had already been looking at part-time jobs possibly yet this summer and certainly for the fall. So many of the jobs I'd been looking at just didn't pay enough and were often so far from campus that scheduling between classes and study time would be difficult if not impossible. For that reason, I had been seriously looking at on-campus university jobs. I told them some jobs I'd been looking at were things like cleaning classrooms at night, caring for lab rats and only half-jokingly I added that I'd checked into being a nude model at the art school. After all, it paid nearly three times what fast-food and retail paid. Everyone seemed to get a vicarious kick out of that.

Jim said, now being serious, "Gee, if you'd be comfortable doing nude modeling, you ought to consider applying at the Med School to be a Gynecological Teaching Associate; that's a 'simulated or standardized patient' for the medical students to practice doing GYN exams." He explained that the low unemployment rate at the time was part of the problem finding women willing to do this, and with budget cuts the college had fewer younger, part-time women on their staff who were interested in "moonlighting" for the extra cash this job provided. Grad students were now their most reliable source for women.

He most passionately told us how the need for women to do this was critical to the students' education, as well as how vital the timing was to fit into the curriculum rotations. I think he was mostly performing and getting-off on telling us the details of what the GTAs or simulated patients do, waiting to see Sally's and my sheepish reactions.

After providing great details about the subtleties of how to learn to give pelvic and breast examinations, he explained that their usual fee for female simulated patients had been $30 per hour. However, since they haven't found enough women, they just raised it to $50 an hour."

Jim is usually pretty good at teasing and giving everyone a hard time, so I wasn't too surprised when he turned to me and said, "You ought to consider doing this, it's not bad money and not really very hard work. Both Sally and I dismissed his bravado as so much hype intended to tease, torment, and titillate us, and soon our discussion moved on to other topics for the rest of our evening.

"As you might have figured, Jim always wanted to be a doctor, for some dubious reasons, but the science courses scared him away," Sally added. "I think he still harbors 'playing doctor' fantasies."

Then, on our way home I was thinking more about Jim's offer. At first blush I hadn't taken his offer all that seriously, and if I had I probably still wouldn't likely have given it a serious second thought. But now, as I thought about it more, the money was definitely most appealing, not many jobs paid $50 an hour and I had plenty of time available. But there was also something intriguing that sparked my hidden and more daring sexual side. I never thought of myself as an exhibitionist, though I have had moments when a little accidental or not-so-accidental exposure has excited me.

When I was a junior and senior in college, I went to some topless bars with my roommate and a half dozen guys we knew. We got to know some of the dancers there and knew they made $500 or more each week. While the money sounded good, I never seriously considered dancing as a part-time job, but they did have an amateur night that paid $250 for the winner, and to be honest, I'd considered entering that contest more than a few times. The lack of anonymity with my friends present was a real roadblock for me then. I've also occasionally left dressing room curtains open a crack when trying on lingerie when out of town. Again, the anonymity was vital then.

"What would you think about my doing that simulated patient thing?" I asked Dave. He didn't quite know what to say, since my question came as a complete surprise to him. He's never been jealous or possessive, but I wasn't quite sure how he felt about a bunch of young medical students (most probably male) being quite so intimately involved with my body when it didn't directly involve my health and well-being.

"Are you seriously considering doing that?" he replied, probably a little more harshly than he intended.

"It would be a way to make maybe $800 hundred dollars a month, way more than anything else I've looked at," I responded.

Dave pointed out that, "The economics of this don't seem like a compelling reason alone. There certainly are many other jobs that wouldn't challenge your privacy quite so much."

"Not that pay anywhere near $50 an hour," I immediately replied. "It sure wouldn't hurt us to have smaller student loan debt and maybe for something fun and frivolous, like a short vacation,"

I was trying to keep things light and have a little fun with him. I don't think he knew if I was serious, and honestly, I wasn't at all that certain myself. But I think he decided to go along with me and see how far I would go with this.

"If you want to do it, just say so and do it, but don't use the money alone to justify it. We certainly don't need it bad enough if it isn't something you'd really enjoy doing," he told me. It was like he was trying to test me for any more suspicious reasons and not let me get by with the more acceptable issue of economic necessity. I was quite surprised to find myself getting turned-on by this conversation, and by the prospect of me exposing myself to a number of other men, particularly because it was in an acceptable clinical situation. This would give my less than pure motivations the cover I'd need. Our conversation also seemed to excite him to try to push me into admitting it might arouse me too.

"Why are you being so difficult," I retorted, "are you jealous of the idea of my being seen naked by the men students?"

"Maybe I am a little bit," he had to admit, "but I don't think you're telling me the whole story why you really want to do this either."

"I told you already, it's getting paid well for doing an easy job; someone needs to do it," I protested, "why do you care so much?"

By now I was getting a little upset with Dave's badgering me about my motivation. I was pretty sure I couldn't be completely honest about being sexually excited by the idea with him, and maybe not even with myself.

"Whatever you want to do is fine with me, and I know you don't need my permission, but I'm just a little surprised that this would be something that would excite you," he just had to say, testing, or teasing me one last time. I wanted to respond with some protest to his choice of the word "excite," but to continue this discussion was not something either of us wanted to do.

So, we went home and went to bed not saying much beyond small talk. Over the next week or so he pretty much forgot about all this discussion, while I couldn't get it out of my mind. Maybe a week later Jim asked me if I had thought any more about the simulated patient job. "I might be interested, but I'd like to know a little more about it if you could give me a rough idea of how it all plays out."

"Well, sure," he said wanting to milk this for all the sexual value it was worth. "The first thing is you go through a training process. That includes watching some films and doing some reading from an accredited GTA training organization. After that, you do kind of a "lab practical" where you have a physical exam focusing on your breasts and vagina, and the doc walks you through what procedures and techniques you will be giving training and feedback on.

It was clear, he didn't know much more than how to shock and try to tempt me with this idea. He probably felt I was losing some interest.

He just ended his spiel with, "I'm not all that up on the details, but I can get you in touch with the program coordinator and she'll answer all your questions.

He gave me a card and wrote her name and phone number on the back. "Just give her a call," he added matter-of-factly. I called that afternoon, for fear I would chicken out if I waited. The woman I talked to was in fact in charge of the Gynecological Teaching Associate program. I could tell from her enthusiasm that she was more than glad to hear my interest and told me the University of Iowa was the first to use a GTA approach in teaching. She herself had started as simulated patient. She wanted me to come in right away the next morning for an interview.

I went, not mentioning it to Dave, and she told me much the same things that Jim had told me. She talked much more in depth about the psychological aspects of being comfortable in the situation, not being intimidated, and the need to learn the curriculum to teach the students about the patient's perspective on their bedside manner, patient respect, and their clinical skills. She scheduled me for the first three hour "training session" the very next day. I was clearly on a fast-track recruitment schedule, without much time for serious deliberation on my part. I also received written materials and instructions to read before tomorrow. I wanted to do my reading before Dave got home, since I was still wrestling with how to tell him I was most likely going to do this.

The training the next day was a combination of classroom and the "lab practical." They were clearly in a hurry to find enough women for the students in rotation. The classroom part was mainly going over the information I had read and watching a couple of CDs. The first was really old, and it was probably transferred from 16 mm film on to the disc. It was the basic training on doing breast and pelvic exams. The hair styles of the doctor and patient really dated it. While not much has changed on the basic mechanics of the exams, the more egalitarian balance of the doctor-patient relationship sure has. The second CD was from the college that did GTA training and certifications, and really emphasized the importance of the GTAs in teaching the students to be sensitive to the patient and making the examination experience more patient-sensitive, if not patient-directed.

The program manager continued to stress how the GTA was in charge of the experience and was empowered to critique the students' clinical skills, dialogue, attitudes, sensitivity, and behavior toward the patient. She was very frank in addressing the issue of potential sexual arousal by both students and GTAs, and how to deal with inappropriate behavior by physicians and students.

There was something exceedingly mission-driven in her and the woman narrating the film, which made me doubt that I had anywhere near their level of passion or commitment to the cause. This did give me pause to reflect on whether this was something I should do. While the money was my first and most motivating factor, it wasn't the only deciding element. To me it seemed women also needed either a strong commitment to the mission of GTAs, and maybe some secret and personal degree of sexual pleasure in exposing herself so openly. Maybe those motivations weren't mutually exclusive?

The "lab practical" was an examination by the resident instructor. I was led to an exam room by the program manager and told to undress and put on a gown and that she and the instructor would be right in. When they returned the doctor/instructor started talking to me about the process and trying to get me to relax.

"It isn't every woman who can feel comfortable enough to 'open herself-up' like that, pardon the expression," he said trying to be funny. "The 'baby docs' can really intimidate some of the women."

I think he was giving me a chance to change my mind before going any further.

Then he startled me by asking me point blank, "Joan, what is your reason or reasons for wanting to do this?"

While I'd certainly asked myself the same question, I wasn't sure I had a completely honest answer for myself, but I knew the third motivation for me, the sexual adventure, would not be an acceptable reason for him. Foremost I needed to pay bills and to that I needed to be hired into the program.

I answered with a crisp, "I need the money." I considered adding something more lofty about the mission of contributing to better training, but I knew it would sound contrived, so I left it at the money.

He must have decided I was serious about the job, and proceeded to talk about my role with the students and the feedback I was expected to give them about their examination techniques and their bedside manner. This all reinforced what the program manager had said. Then he went into what the job entailed in each session.

He started with, "You'll go into the exam room and undress and put on a gown, just like you'd expect. Then for the first half of the semester, I or another resident instructor will come in with four or five med students, and they'll ask medical history questions. First, the instructor will remind them how to conduct the examinations. Then the first student will do his exam. This begins with a breast exam where you'll be exposed to the group. Your part in this is to tell the guy if he's being too rough or too gentle; too rushed, too slow. You'll also critique his demeanor and explanations of what is being done. It's important that you learn these techniques and how to give constructive criticism, because after the first two months or so, you'll be doing the training by yourself."

His switching to the male pronoun was not lost on me. I assumed it reflected the biases and gender mix of the faculty and students at that time.

"You'll get more training on this here today, and in regular sessions with other GTAs this semester. Because of the instructional nature of the procedures with multiple examiners, you will be exposed for a lot longer time than in a regular physical exam. This is part of what could make some women more self-conscious."

"Then you lay back and they'll position you for the pelvic exam. First, they will take a lot more time on the external examination, so they know exactly what they're looking at and for. Then they do the internal exam, you know, two fingers and a rubber glove. It takes some real effort to gain the skill to find a woman's ovaries. Then they practice inserting a speculum for a pap smear, and after that is the dreaded rectal exam. Again, these take longer since each of the students does the exam, and you'll tell them again if they're too rough or if anything else is not quite right."

He then said he would need to examine me, to see if there were any problems that would preclude me from being a simulated patient, or any "anomalies" that students should catch on their examination. He also described in some detail the students' role at each phase of the examination and what I was to look for and critique.

With that he proceeded with literally the most thorough exam I've ever had. He pointed out what he was going to do at each stage, and then what he was looking for and what feedback I would be expected to provide to each student. He went on to demonstrate what a proper exam should feel like, and what common mistakes feel like. Again, he reminded me that with multiple examiners and my providing my critiques, this would all take longer, and I'd be more exposed than in a normal visit.

It's hard to explain, but he fact that this was not necessarily an exam for my own health, made things less clinical and potentially more sensuous. I could only expect those feelings to be more intense with the students examining me. Women are always told male doctors have no sexual interest in our bodies because they see so many of them every day. But these men students certainly haven't yet developed any detachment to the sight of a naked woman. I wrestled with whether these were thoughts all GTAs struggled with, or should I be reassessing my motivation for being here? These were tough questions for me to answer honestly even to myself.

While examining my breasts he called attention to their size and density. Mine are 36A and though not saggy, they are not overly firm. He said smaller and less dense breasts are the easiest for learning examining techniques. The thoroughness of his exam, and all this talk about the size and shape of my tits had my nipples at attention which drew his attention too. He looked at them for quite a long time.

"Are your nipples always this sensitive?" he asked. His words and the length of time he stared at them confirmed my growing suspicion that no matter what we are told, even older, more experienced male doctors are not immune to the sight of a naked woman. While part of me found that thought quite exhilarating, I must have had a skeptical look on my face because he quickly tried to cover his professional demeanor by saying, "We go to great lengths to be very clinical in a situation that can cause arousal in both patients and students. If students sense the GTA is feeling aroused, it can trigger similar emotions in them."

I felt too embarrassed to answer completely honestly and admit to being aroused, so I just confessed to having very sensitive nipples that get erect easily when cold, touched, or exposed. He seemed to accept this explanation, and I sensed I was still in the program if I chose to be. I left out that I could reach an orgasm from nipple stimulation alone. It didn't seem medically relevant.

While doing the pelvic exam, he asked lots of questions about my periods, age at onset, any pregnancies, STDs, any pain while having sex or other times. I answered all of them honesty. But when he asked if there were any other conditions he should know about, I couldn't admit to being a "squirter." When I have a real strong orgasm, I squirt a stream of fluid, often called female ejaculation. This just didn't seem relevant, and my embarrassment trumped full disclosure.