On the bus, I flip open my folder and reread my case. Five sheets of single-spaced, Times New Roman text. I’m groggy and desperate for coffee, but I like this case. Seizures. Always a good time.
Each case is our Bible, at least for the day. This is Who We Are. But cases are also top-secret. When I ride the bus, I look around to make sure no students are nearby. When you’re obligated to avoid med students, the city seems flooded with them—young, sharp, health-conscious twenty-somethings, often carrying slick briefcases.
I slump in my seat and read. I study the case until we stop, and the bus empties onto the sidewalk. I climb the hill to the med school, where nurses and dock-workers smoke cigarettes outside, and push through the revolving door, up the elevator, to the cafeteria. This is my last chance for caffeine.
I’m five minutes early, every time.
For all our nervous energy, SP’s are incredibly professional—even more so our coordinators. At any given moment, there could be three different simulations happening, and dozens of SP’s must be matched with scores of med students. Kim handles this with aplomb, but she needs us to know our stuff. We must know our characters perfectly, right down to our high school nicknames. This isn’t a matter of memorizing lines or following blocking. For as long as we’re in the classroom, we are our characters, and we don’t break for anything.
Because the cases are so guarded, I would never dream of reprinting one here. But this is what a case could look like.
TREBOR GREBNESI (TOOTHACHES)
Summary: Patient is a 29- to 31-year-old male, in good health, complaining of recurring toothaches. He leads an active life and has experienced high stress of late. He is a freelance writer and graduate student, and he works part-time at a medical school. Because he has not had health insurance for eight years, this is his first adult visit to physician. He is skeptical of the American healthcare system but overall respectful of caregivers.
Tone: Patient is almost obnoxiously friendly, polite and courteous. He thanks people repeatedly for the slightest favor, also apologizes for the vaguest infraction. Grebnesi wears a variety of styles, mostly business-casual (jackets, polo shirts, boot-cut jeans). Because he walks everywhere, Grebnesi’s shoes are often worn out. He is known to tell elaborate stories, usually relating to strange encounters and overseas travel. His tone teeters between gracious and pretentious.
Medical History: When he was four, Grebnesi was struck in the head by a shard of steel, but he recovered quickly. At 19, he was hit by a car and suffered a mild concussion. He has been exposed to malaria in five countries, treated with Mefloquine tablets. He is a social drinker who consumes alcohol with friends at least two times per week.
He had braces and one filling, but his teeth have always been a sore spot. He had his two lower wisdom teeth removed, but the upper were left alone. He believes that these upper wisdom teeth have caused the recurring pain. He is now over the age of 26 and should probably not have them extracted.
Family History: Grebnesi has two parents, still married, in excellent health, and a younger brother, who works as an actor in Washington, D.C. Grebnesi moved to the area 13 years ago for school, though he didn’t know the city or anyone living here. Both his grandfathers are deceased, one from heart attack and the other from stroke.
Sexual History: Grebnesi is straight, to the surprise of anyone he knew in high school.
Occupation: Grebnesi has worked as a journalist for many years, but as newspapers and magazines fall apart, he struggles to find clients. He’s pursuing his Master’s degree, which he prays will make him more marketable. He doesn’t drive, owns no television, and avoids barbers by asking his girlfriend to just shave his head. They share a mortgage on a cute little townhouse. He has never earned more than $20,000 in a single year, and the year he did earn $20,000, he lived like a Persian Shah.
Symptoms: Toothaches occur every six months and last about a week. Patient experiences throbbing pain inside his gum tissue, which can lead to terrible headaches. He loses focus and stops eating. When pain persists into the night, he loses hours of sleep and can become short and moody.
Objective: To address the patient’s principle complaint—toothaches. Patient will downplay pain, disguising his concerns with sarcasm and absurd humor. Student may uncover anxiety, depression and crushing self-doubt. Though patient will deny this to the end.
Something like that. When I step into our conference room, the other actors all wave hello. Some of these people have acted for the med school for years, and they’ve memorized dozens of cases. Weirder still, they know the cases by name. When, say, “Johnny Scrubbs” comes up, they glance through the pages and nod. “I remember this one,” they say with a smirk. “Nice to see you again, Johnny.”
I sit down with my folder. We chat for awhile, and then, without fail, someone says: “By the way, who are you today?”
And it always takes me a second to remember.