Leslie Jamison - The Empathy Exams: Essays

ESSAYS

Leslie Jamison

GRAYWOLF PRESS

Copyright 2014 by Leslie Jamison

This publication is made possible, in part, by the voters of Minnesota through a Minnesota State Arts Board Operating Support grant, thanks to a legislative appropriation from the arts and cultural heritage fund, and through grants from the National Endowment for the Arts and the Wells Fargo Foundation Minnesota. Significant support has also been provided by Target, the McKnight Foundation, Amazon.com, and other generous contributions from foundations, corporations, and individuals. To these organizations and individuals we offer our heartfelt thanks.

Published by Graywolf Press

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All rights reserved.

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Published in the United States of America

ISBN 978-1-55597-671-2
Ebook ISBN 978-1-55597-088-8

2 4 6 8 9 7 5 3 1

First Graywolf Printing, 2014

Library of Congress Control Number: 2013946927

Cover design: Kimberly Glyder Design

For my mother ,

Joanne Leslie

Homo sum: humani nil a me alienum puto

I am human: nothing human is alien to me.

TERENCE, The Self-Tormentor

My job title is medical actor, which means I play sick. I get paid by the hour. Medical students guess my maladies. Im called a standardized patient, which means I act toward the norms set for my disorders. Im standardized-lingo SP for short. Im fluent in the symptoms of preeclampsia and asthma and appendicitis. I play a mom whose baby has blue lips.

Medical acting works like this: You get a script and a paper gown. You get $13.50 an hour. Our scripts are ten to twelve pages long. They outline whats wrong with usnot just what hurts but how to express it. They tell us how much to give away, and when. We are supposed to unfurl the answers according to specific protocol. The scripts dig deep into our fictive lives: the ages of our children and the diseases of our parents, the names of our husbands real estate and graphic design firms, the amount of weight weve lost in the past year, the amount of alcohol we drink each week.

My specialty case is Stephanie Phillips, a twenty-three-year-old who suffers from something called conversion disorder. She is grieving the death of her brother, and her grief has sublimated into seizures. Her disorder is news to me. I didnt know you could convulse from sadness. Shes not supposed to know, either. Shes not supposed to think the seizures have anything to do with what shes lost.

STEPHANIE PHILLIPS

Psychiatry

SP Training Materials

CASE SUMMARY: You are a twenty-three-year-old female patient experiencing seizures with no identifiable neurological origin. You cant remember your seizures but are told you froth at the mouth and yell obscenities. You can usually feel a seizure coming before it arrives. The seizures began two years ago, shortly after your older brother drowned in the river just south of the Bennington Avenue Bridge. He was swimming drunk after a football tailgate. You and he worked at the same miniature-golf course. These days you dont work at all. These days you dont do much. Youre afraid of having a seizure in public. No doctor has been able to help you. Your brothers name was Will.

MEDICATION HISTORY: You are not taking any medications. Youve never taken antidepressants. Youve never thought you needed them.

MEDICAL HISTORY: Your health has never caused you any trouble. Youve never had anything worse than a broken arm. Will was there when you broke it. He was the one who called the paramedics and kept you calm until they came.

Our simulated exams take place in three suites of purpose-built rooms. Each room is fitted with an examination table and a surveillance camera. We test second- and third-year medical students in topical rotations: pediatrics, surgery, psychiatry. On any given exam day, each student must go through encounterstheir technical titlewith three or four actors playing different cases.