I AM HAMM | Austin Valido
The second hand signals the top of the hour: 10:00 AM. Showtime. So, I clamber up into the exam chair and wait for the encounter instructions to boom out the bisected model of a generously endowed male pelvis. Management didn’t skimp on verisimilitude. I saw a similar model at my urologist’s office this past week. The misshapen mixing bowl full of technicolor tubes and bulbs offers a pleasingly clinical abstraction of mankind’s most provocative anatomical sector. This one also houses a good portion of the room’s audiovisual equipment. Introductory commands begin to spill out the speaker embedded behind its fenestrated hemisphere of bladder (“WELCOME STUDENTS, PLEASE ENTER THE FIRST STANDARDIZED PATIENT ENCOUNTER…”) as a crimson countdown (15:00) ignites above the door.
After the announcement, through the thin walls, I can hear the faint, electronic awakening of the adjacent, identical rooms, each the same mix of panopticon and clinic. Beside me, the boxy frame of a medical-themed print, Norman Rockwell’s aptly titled Doctor and Boy Looking at Thermometer (1954), starts to hum. The camera lens peeking out from the titular boy’s left eye gives him a slight divergence in pupil size. Anisocoria, I have recently learned, inadvertently and significantly ramps up the scene’s medical urgency. All these devices relay a real-time feed to the audience of physicians that will evaluate my scene partner – a medical student – on their clinical tact. Foucault would lose his mind.
To pass this exam, students must demonstrate towards me, a standardized patient actor, and several other standardized patients over the course of the morning session, a grasp of the intangible accoutrements of clinical care: a gaze that offers confidence and condolence in equal measure, the calm delivery of sensitive diagnoses, and, of utmost import, the proper expression of empathy in response to patient hardship. The grading panel sits in the converted janitorial closet down the hall. I’ve been told it gets toasty with all the monitors and minimal ventilation. The student assigned to my room knocks and opens the door. A second after his feet first enter, his head limbos gracefully under the frame.
“Hello, my testing ID is AB019 and I am the medical student with your care team today!”
All in one breath. Impressive. His stethoscope writhes around his long neck as he massages a dramatic heap of sanitizing foam into his hands and forearms. The surgical suite is the next building over, I want to joke, to ease the tension inherent to observation; however, for the next 15 minutes, I do not exist. My patient persona, Mrs. Hamm, exists. She would never: the experiences of her life having instilled in her the sense that even jesty jabs made with the best intentions – like many of the casual cruelties of daily life – cake, congeal, and clog over the years. Eventually, there’s some sort of damaging embolus. The top of the student’s head rests only a few inches from the ceiling tiles.
“Before we begin, what would you like to be called today?” AB019 asks.
“Mrs. Hamm is fine,” I say.
My other roles would defer to their first names, as most would, but Mrs. Hamm knows to never relinquish even a shred of dignity wittingly. In the medical context, too much is taken too often. I’ve seen refractions of her well-earned bitterness appear in my own life. My feelings towards our assigned patient scripts, as an example. Lame, limp lists of signs and symptoms to deny or disclose. Sandra Hamm, for instance, followed by an age (74), a gender (female), and a few snippets of medical history (lower back pain, remote history of a substance use disorder). It’s criminal. The Rubicon the students must cross to turn from rube into healthcare provider, I believe, requires a more believable bridge. Hence my self-directed costuming efforts. I rotate through the local community theatre’s wardrobe.
“Veering dangerously close to drag queen,” Pete, the standardized patient program co-manager, said, after eyeing the impressive smock and silicone breast plate I borrowed from this summer’s production of Chicago, campily reimagined to the backdrop of a cash-strapped Panama City Beach Hooters. My decidedly oversized assemblage belonged to Matron “Mama” Morton, in this rendition a conniving, controlling chef. I played Irving, the last known, and only male, lover of the murdered philanderer Alvin Lipschitz, emerging from the wings with the other Lipschitz Lovers for a vigorous ten-second dance number during Cell Block Tango (that I overheard one audience member describe as “particularly piquant”). Bereft of breast, and with plenty of time backstage, I plotted today’s performance. For the record, at no point today did I hear Pete – the official, on-duty standardized patient co-manager – state an explicit “no”. His proffered eyeroll being ambiguous (and, I’ll also have to note for the record, containing undertones of flirtation).
“Nice to meet you Mrs. Hamm. What brings you in today?” the medical student asks.
“Unrelenting pain.”
Hamm does not mince words. She suffers from chronic back pain, one of the millions of Americans reckoning with the destabilizing truth that the full force of our modern medical system is hapless against the commonplace menace of lumbago. Two and a half decades of working at a ceramic studio – loading and unloading kilns, powdering herself with corrosive chemicals in the name of experimental raku firings, hunching over a pottery wheel – has led to a serious case of degenerative disc disease. She pushes through the pain, but the battle to balance her artistic practice and livelihood with the enduring hurt has become the central focus of her late life. She has become skeptical of the medical establishment. I grit my teeth and grab my back, Hamm bravely enduring a series of excruciating back spasms.
“Anything make the pain worse?”
“Breathing in or out.”
“Anything make the pain better?”
“Not breathing.”
The medical student pauses, thinking.
“That’s not a great long-term solution,” he offers.
Hamm turned to the arts to process a complicated mid-life turn. The dissolution of her twenty-year marriage left her unmoored. For years prior, she had turned inwards. Friends drifted apart over the decades. A lay-off left her home most of the day. Her husband had been her thin, remaining tether to the world. Then, the severance. Adrift, Hamm found unexpected solace in the annihilation of alcohol. Her longtime cup of water before bed turned into a glass of wine, turned into a bottle of wine, turned into a half-pint of liquor. Dependence appeared, a swift and unexpected wave, carrying her off into a self-sustaining whirlpool of shame and substance-derived solace. Eventually, she washed up on some foreign shore of sobriety; a land, it turns out, containing ample, clay-laden substratum. She joined her first potter’s studio on a whim, at the suggestion of her sponsor, and found profundity. The bespoke nature of each piece – the flare of a slender neck, the crack of a glaze – only fully revealing itself after a punishing gauntlet of subtraction and impossible heat. On paper, she exists to test that the students conduct at least a preliminary substance use history in initial patients visits, even with elderly, especially busty ceramicists, and practice the standard titration of back pain treatment.
Sharing her medical history with AB019, Hamm reflects that, finally, the years she dedicated to ceramics outnumber those she dedicated to her ex, Carl, and Coolers combined. I love Hamm. The seasons of our lives have been defined by a similar sequence of devotions: first, to another person; second, to a sort of self-destruction; and, finally, to craft. She lacks some of the outright spectacle of my other assignments but the meniscus of imagination that separates us is thin. I slip right in and examine her hard-earned wisdom through a thin, translucent carapace. Looking at yourself is like staring at the sun: inaccurate, at best; permanently damaging with extended exposure; at a minimum, you should don some protective gear.
“Mrs. Hamm?” the medical student interrupts.
I admit a momentary lapse of focus.
“I’m sorry what was the question?”
“Now, what about this other mass?”
The medical student gestures uncomfortably towards my mid-section.
I look down.
My costume is seriously askew, the chest piece sitting perpendicular to my sternum. My anatomical underpinnings are difficult to interpret and deeply divorced from natural history. For how long? Since that particularly agonizing back spasm? Since settling back into the exam chair? I look up and catch the Rockwell Boy’s left eye ogling my torso. His camera pupil, straining to focus, dilates and constricts rapidly in my direction. He is not long for his mid-century world.
Pete will not like this one bit.
“That is……my left breast.”
“I am…sorr…I mea…to…ok, yeah, that’s oka…uh.”
“Ever since a particularly aggressive pottery wheel caught hold of my brassiere…”
Improvisation. You’re able to do that when you build a backstory. Maybe Pete will appreciate the creativity…
I acknowledge that this is not my best run. At my best, I can feel the room twist into a liminal space in-between performance and reality. Still, I can feel a shift occurring, a subtle thrum of connection. I make eye contact with examinee AB019.
Hamm and I are one.
Hamm and the student are one.
The student and I are, transitively, one.
In the second it takes him to respond, I sense familiar machinations: the collation of personal and imagined experience to understand and respond to a situation in the way a particular role demands. He is acting.
“I’m sorry to hear that,” he says.
The phrase floats down to me from the room’s thermosphere.
I believe him! I imagine the grading panel of white-coat clad clinicians nodding in the control room, clapping each other on the back over a job well done. Their bald scalps shimmer with a slight, sweaty film.
“PLEASE IGNORE THE THORACIC FINDINGS, IT IS NOT A PART OF THE MEDICAL ENCOUNTER,” a panicked Pete pipes up from the pelvis.
The tone indicates he, in fact, does not appreciate the diversion. Go figure. The medical student recovers, flying through the remainder of the physical exam before gently describing the next steps: some recommendations for physical therapy, the potential for imaging. The countdown winds down (0:03…0:02…0:01…). The bladder blares time (0:00). The student thanks me and leaves the room, ducking under the doorframe.
I love the students. For the most part, they haven’t yet been eroded down by wave after crashing wave of hospital-based horror, the general chaos of aging, the eventuality of spinal column degeneration. I want them to understand what Hamm understands, my single requirement for a good evaluation: a sense of humility in the face of the human mystery. Out of nowhere, an anti-NMDAR encephalitis strikes. Out of nowhere, a small cell lung cancer blossoms. Out of nowhere, an exceptionally high-horsepower potter’s wheel grabs. Sacks of porcine-adjacent flesh facing an incomprehensible universe, what can we do but pretend? What can we do but act? He gets it. Testing ID AB019: A-. He didn’t wash his hands before leaving the room.
For a few minutes, I am myself. I adjust my bosom towards a less concerning cardinal direction. I examine the otoscope set bolted to the wall behind the exam chair and note no surveillance tools. Then it is 10:20. The countdown illuminates (15:00). The next student enters and asks for my name.
“I am Mrs. Hamm.”
Austin Valido is a resident physician living in the San Francisco Bay Area. Originally from southern Florida, he was taught in primary school to evade alligators using a zig-zag maneuver, since, he remembers the reasoning explained, “They aren’t good at turns.” Experts now recommend running as straight and fast as possible.