For a woman who had spent the previous evening sprawled across an examining table, receiving what she estimated was her 3,091st gynecological pelvic exam, Robin Burdulis looked remarkably spry when she arrived at Park Slope’s bustling Tea Lounge on a recent Friday morning. Small and outdoorsy in hiking boots and a Northface backpack, she looked like she might sprint up a mountain at any moment.
“The session went smoothly last night,” she said casually. “The students were nervous at first, but that’s usual; they were able to relax and focus. Nothing exceptional, like fainting. That’s actually happened on rare occasions.”
Ms. Burdulis, 47, is what is known in the medical trades as a gynecological teaching associate, a rare hybrid of patient and teacher who offers up the most intimate recesses of her body—breasts, ovaries, uterus and other lady parts—to train America’s future doctors in the mysteries of gynecology. Each winter, she and her sister T.A.’s fan out across the city on a kind of gynecological enlightenment tour, spreading the gospel of sensitive pelvic exams to nearly all the second-year med students in New York City. Their mission: to transform these nervous newbies—gigglers, meatheads, speculum-clackers and all—into confident, and gentle, medical mensches.
It can be quite an undertaking.
Pelvic-exam season is a giddy, scary rite of passage for young med students, one that ranks up there with delivering their first baby and meeting their first cadaver in anatomy class. Students get downright jittery about the prospect of touching the female organs for the first time—as a doctor, rather than a warm-blooded mammal—and even the most serious-minded future M.D.’s can’t always suppress their naughty inner Cartman.
“I think among some of the guys, it’s like: ‘Yeah, you’re going to be looking at a vagina—that’s great!’” said second-year N.Y.U. medical student Brian Liem on the eve of his exam. “But you also know this is a medical examination and not something that’s at all sexual.”
Enter brave T.A.’s like Ms. Burdulis. Five nights a week, for as many as two or three months, they hop between medical schools, dropping their gowns for clammy-palmed 24-year-olds who have never held a speculum. Working in pairs, they teach these students how to palpate breasts, swab the cervix, and check for all manner of mass and malignancy. They get paid a decent chunk of change for their services, but, like all true-believing missionaries, they insist it’s not about the money. (Ms. Burdulis, who coordinates the 20 or so T.A.’s in the citywide program, declined to give a specific figure, citing confidentiality.)
“I love my job. In fact, when I first started working, I didn’t think of it as a job,” said Ms. Burdulis, who has spent 24 years in the T.A. trenches. “I was so excited about being able to make a difference in medical care that I was ready to volunteer. I felt this was my community-service work.”
Ms. Burdulis was not just being coy with her words.
Not so long in the unreconstructed past—as recently as the early 1980’s, in fact—young medical students learned to swab cervices and palpate ovaries under altogether gothic circumstances. Taught by male doctors (some of whom might have been ripped from a David Cronenberg flick), they learned first on plastic models—named Gynny!—before moving on to real hospital patients. These patients were often poor women who came to teaching hospitals for their free or low-fee services. At best, they were conscious while a troupe of five or six medical students clumsily repeated the steps their physician-instructor had just blocked out for them. At worst, they were under anesthesia for a pelvic procedure and never even got the chance to consent.
“The patient not only did not know she was being examined by other people, she never signed permission, and she would wake up from whatever procedure much more bruised than she should have been,” said women’s health pioneer Dr. Lila Wallis, who is a clinical professor of medicine at Cornell’s Weill Medical College.
Nor was the average woman’s annual trip to the gynecologist a much happier experience, as Dr. Wallis fast discovered. Women would show up regularly at her office, full of trauma tales about the cold speculum, the gruff gyno, the creepy, leering doctor.
But with the birth of the women’s-rights movement, patients and doctors began to rebel against this old boys’ gynecological order. Dr. Robert Kretzschmar, a rare male feminist, had the idea of training laywomen to teach gynecology from the exam table; in 1979, Dr. Wallis picked it up, refined it and began to recruit teaching associates. These women were graduate students, social workers, nurses, professors, flame-throwing feminists—and they learned all too quickly that many young, male med students couldn’t tell a woman’s ovaries from her elbow.
“There were some [students] who were very shy and brought up in very conservative families, so they never saw female genitalia, and they practically were shaking in embarrassment and fear of hurting the woman,” recalled Dr. Wallis. “Then there were some male medical students who felt that they needed to be macho.”
The teaching associates clearly had their work cut out for them.
And yet, quite a few T.A.’s stuck with the program—not just for a season but for more than 20 of them, offering their personal parts again and again and again for an exam that makes most women queasy just thinking about it.
“I just thought it sounded so dynamite to be in on the ground floor of young men and women’s consciousness, before they actually got out there and started treating people,” said Gene Reece, a professional consultant who has been plying the pelvic-exam trade since 1982. “I still really love the work …. I’m going to do it until I just can’t do it anymore.”
Apparently, pelvic exams can be pleasant—or so a kind-faced T.A. named Peggy and her co-instructor, A.J., were attempting to show three saucer-eyed students on a recent Tuesday evening. The students had just arrived at the much-anticipated Step 3 of the exam, the speculum step, and the first of the trio was looking up there, searching about for Peggy’s cervix while Peggy called out instructions through the “V” of her legs. “Can you see the O’s?” she said with the maternal encouragement of an elementary-school teacher.
She seemed utterly unfazed by the fact that three young strangers were peering into her crotch.
“I guess, after so many years of doing this work, the level that is normalized for me is way above what would be normalized for somebody [else],” said Kristine Woods, a veteran T.A. with a penchant for citing Michel Foucault. “The students can be a challenge, but they’re almost always gratifying …. There’s so much vitality that comes from [them]!”
Or at least terror.
While pelvic-exam season has all the makings of a solemn, annual sacrament for the teaching associates, many students greet the moment with a small, internal Munchian scream. They get jittery—and perhaps a little punchy—as their 12-year-old ids rub against their nascent doctorly selves.
Up until the exam, most second-years haven’t had much contact with patients (or, in some instances, with female anatomy). They’ve taken blood pressure and listened to lungs, but mostly they’ve been hunkered in the library, reading textbooks. For them, a person in a striped gown is still a person, not a patient, and a woman’s lady parts are still, well, lady parts. And so, as exam day approaches, they begin buzzing and bumbling, trading everything from anxieties to urban legends to the inevitable gettin’-action jokes.
“It’s certainly a landmark,” said Perry Wilson, a fourth-year student at Columbia’s College of Physicians and Surgeons. “Delivering the baby is pretty scary,” he said, “but I think the pelvic exam is right up there as one of the times you’re most nervous.” (By contrast, several women described the male genital-rectal exam, taught by a guy T.A., as more harrowing. So did a few men.)
And what exactly do the students fear? What gets their specula clacking? The list is long and angsty, filled with the kind of “what-if” scenarios that would send an adolescent boy into a weeklong panic attack: What if I hurt the T.A.? What if she judges me? What if the other students realize I don’t know what I’m doing? What if the T.A. is attractive? What if I get an erection?
Mercifully for students, the latter is rare, according to Ms. Burdulis, who said, when asked, that she hadn’t seen one “in years.” “It’s not like we look for it; we don’t. But sometimes the student’s standing in front of you, and it’s like, ‘O.K., how do we help this student through this?’ We’re really compassionate,” she said.
Still, funny things happen: A married man steps confidently up to the stirrups, only to mistake the teaching associate’s clitoris for her urethra; a nervous student forgets the exam script, ignoring the T.A.’s advice about “purposeful” language, and obliviously blurts out: “I am now going to feel your breast!”—rather than the less-naughty-sounding “I am going to examine your breast.”
Naughty-sounding words are a big no-no in pelvic exams, and students learn a long list of “Do Not Utter” expressions—like “pull out” (too raunchy), “stirrup” (too equestrian) and “droop” (because what woman wants to hear that her breasts droop?). Even so, mistakes and malapropisms have a way of slipping, Freudian-like, into the conversation.
Like the time one student, who happened to be taking a psychology intensive around the time of the exam, described Ms. Woods’ nipples as “extroverted” instead of “everted.” Or when a young gentleman told a prone Ms. Burdulis he was going to put the speculum in and “begin screwing” (metal specula have screws that require a screwing motion). Or when an earnest young man got ahead of himself during the breast exam and—in a rare case of premature mispronunciation—blurted that he was going to palpate her “cervical” instead of her clavicle.
Still, for all the gaffes and guffaws, most students come out unscathed. And while they might have intense or squirmy moments, when the teaching associate lowers her gown for, say, the breast exam, it’s hard to ignore the sober subtext of it all: disease. These T.A.’s are training students to root out grim, dread killers like cancer and S.T.D.’s, and they’re training them to do it in a way that doesn’t freak the patients into never coming back.
It is all rather heady and—dare one say it?—empowering.
“I was never in the Girl Scouts,” said third-year Physicians and Surgeons student Jonathan Amiel, “but basically it feels like what I imagine getting a merit badge is like …. The most important thing you have to learn is that you’ve done it already.”
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