What I’ve Learned As A Fake Patient In A Simulated Hospital
by Sarah Kennedy
I’m a medical actor, a person who gets paid to inhabit the experiences of imaginary people on the worst days of their lives. The going rate for that is about 20 dollars an hour. Actors like me are used for medical students’ examinations to standardize the students’ interactions so they can be graded; we’re stand-ins for real patients, who would likely be pretty traumatized if an untrained medical student practiced a physical exam or presentation of bad news on them.
As a practice patient for medical students and residents, there are four cases I rotate between, four people I become within the confines of the simulation center where I work. After memorizing an outline of the character I’ll represent, I interact with medical students in a series of sessions as that character, then analyze the students’ performances and record my reactions to each encounter from a patient perspective.
I’m usually a teenage girl who is using drugs but not condoms, or a young mother who needs to be told something awful about her baby, but cases can be anything from a relatively standard discussion of a new patient’s medical and social history to a taxing psychiatric role for which the actor must maintain a portrayal of a manic episode for an entire shift. Medical actors are an alternative to manikins — medical dummies that can handle repeated invasive procedures better than live humans — used for any session intended to be interactive. The advantage and disadvantage of using a manikin is that Hank, the adult Caucasian male parked at the entrance of the simulation center, lying harmless, immobile, and sometimes bloody, doesn’t talk back.
“Are you doing the informed consent case?” another actor asked me, noticing the index card scribbled with a medical history in my hand. I was memorizing a medication list and calculated date of birth under the light of the dozen little screens above me shining with live feeds of each room in the simulation center. I nodded at the other actor. We were both performing relatively easy cases with anesthesiology residents that morning, though my co-worker was in a hospital gown and I was in jeans, so I clearly had the better deal.
My case was that of a woman coming to the hospital to have her gallbladder removed. The session was the preoperative visit, during which the resident had to come up with a plan for administering anesthesia based on the medical history given and the patient’s physical characteristics — my physical characteristics — then get the patient to sign a form giving consent for the anesthesia. My co-worker was performing what was essentially the second part of my case, serving mostly as a body. The residents were to prepare him for the administration of anesthesia by placing the appropriate monitors. Most of his case could be done with a manikin, but because the students are expected to explain to the actor what they are doing and why, to put a guy who will not actually be having surgery at ease about anesthesia, an actor ends up on the fake hospital bed instead of a manikin.
The script instructed me to be “a little anxious” at the pre-surgery appointment. The request form anyone scheduling a session uses to ask for use of medical actors includes a space to fill out “important physical characteristics and emotional states” the actors should exhibit. The whole range of human emotions is available on request; list your preferences below. “A little anxious” is a graciously reasonable request. I am paid hourly and receive the same amount for appearing “a little anxious” as I do when I portray a case that requires me to cry through eleven separate sessions.
I prefer communication-based cases, both to avoid wearing a hospital gown and because I find those cases more interesting. Cases centered on a physical complaint have much shorter scripts and usually shorter sessions with the students, though, so there are just as many actors who favor them instead. The informed consent case was the first I had performed that had any physical component. Though the residents filled out paperwork using a fake medical history, their plans for administering anesthesia were tailored to my own body.
“I should never ask a lady’s age,” a resident smiled, filling out the static information at the top of the form. I gave him a fake age and weight. These were some of the only fictional facts in the session, I realized, opening my mouth so the resident could approximate my breathing tube size.
Each resident sized me up. “She has a small chin,” one said to the supervising doctor. “I would make sure there was an additional plan for getting the tube in.” The doctor agreed. “She would need a plan B,” he said. It was no longer even remotely difficult to act nervous.
I became a medical actor not knowing what to expect, but most medical actors choose to take their positions because they want to be part of current medical students’ training to help further the field. Many are retired medical professionals looking to continue their work in a less stressful way. Because it pays well, medical acting attracts a variety of individuals with diverse purposes and demographics, which is necessary to maintain a successful simulation program, as the cases are tailored to specific demographics. The program needs me to play grieving young mothers and sullen teens, but it also needs older men for prostate cancer cases. I share my cases with young single mothers, daughters of hospital employees, and aspiring actresses using the job to acquire acting experience and credentials.
My program employs priests, a music teacher who holds a doctorate and whose primary income comes from teaching private voice lessons, a mother of seven and a few of her kids, and professional medical actors who travel between schools to undergo physical exams across the tri-state area. My co-worker the morning of the anesthesiology sessions is a substitute teacher who works during medical students’ examinations for extra money; like the majority of those in my program, he relies on the generous paychecks to be a huge financial help a few times a year during exam seasons.
More important than the money, though, is the pride most medical actors feel at contributing to the training of new medical professionals and the real good the fake patients do for the students and residents. After practicing on us — whether with an awkwardly conducted physical exam or the stuttered delivery of the news an actor’s baby has a poor prognosis — medical students are better prepared when they need to interact with “real” patients. Additionally, the actors are left with knowledge of their rights as patients in actual medical care situations, a better understanding of how doctors think, and, overall, a sense of preparedness in interactions with medical professionals in their own lives.
That said, medical acting is exhausting, stressful, and serious. I’ve come home from sessions and fallen asleep immediately, drained from the repeated loss of an imaginary child. I have felt terribly dehumanized after sessions with calloused medical students, wondering if the students even register that I am not synthetic, that there is a difference between Birthing Betty the manikin and me, a live human. More often, though, I return home from the simulation center still laughing about something a medical student said during a session, recalling a conversation with a co-worker, or looking over a new case. Working as a medical actor has introduced me to some endlessly interesting people and given me plenty of stories to share with anyone who can get past the premise of what I do.
“You’re an actress?” an interested conversational partner asks, eyebrows raised.
“At the hospital,” I say, either ending the conversation or beginning a longer one.
I describe what it’s like to cry for hours on end, waiting for the release command of “Students, reenter for feedback” over the simulation center’s announcement system to bounce back to my normal self and remind a student to hand the patient tissues next time, then wish him luck with the diabetic patient in the next room. I don’t describe fixating on a teary-eyed medical student’s wedding ring as she spins it and worries about pregnancy complications, which, as she reminds me, can happen to anyone.
I joke about my main case’s various teenage problems. I don’t reveal how often I think about her, drawing comparisons to stupid things I did at age 16. I laugh about how uncomfortable it is to have an unbelievably attractive medical student stare into my throat, so lost in analysis of his cheekbones that I barely hear him point out the flaws of my construction. I don’t mention developing greater and greater authentic anxiety as a medical student called her supervising doctor to gauge whether the pediatric breathing tubes would be small enough for me.
As a medical actor, I am able to have the experiences of people I can’t be, fully immersing myself emotionally in their personal situations without having to attend high school classes, grieve a lost child, or be sedated for surgery. I am one of the lucky ones. I can navigate through the hospital halls and out to my car, unrestrained by my healing C-section incisions or my IVs and tubes. And, that easily, I can walk away from the people I pretend to be — out of their lives, their skin, the most serious events of their years on Earth — and become myself again, studying characters whose ailments exist only on paper.
Sarah Kennedy is a writer and grad student in Pennsylvania. She tries to handle the world better than anyone she pretends to be. Follow her @lynchiansarah