"I'm gonna make people feel my gonorrhea..."

When you’re a tour guide in a city like New York, you often have to supplement your income with other jobs in order to pay the bills.  As regular readers of “Almost Carrie” know, my primary job requires me to follow in the footsteps of Miss Bradshaw.  What readers may not know however, is that my secondary job also requires me to follow a fictional New Yorker’s lead:  Mr. Cosmo Kramer.

I don’t moonlight at H&H Bagels, and I’ve never published a coffee table book about coffee tables.  No, my secondary job is even more specialized than that:  I am, like Kramer in Season 9, Episode 16, a Standardized Patient—a highly trained faux patient on which medical students practice their skills.  I’ve had an endless array of ailments, everything from headaches to panic attacks to cancer and MS.  I’ve been pregnant, promiscuous, congested, constipated, allergic, asthmatic, hyperthyroid, and hypertensive.  In Seinfeld, Kramer got gonorrhea; last year I got chlamydia.  And once I even had bacterial meningitis, “the Hamlet of diseases,” as Kramer’s friend Mickey dubs it.  I could have won a Tony for that meningitis.

I started doing this sort of work in college, when a local medical school came to campus to recruit freshman acting majors and offered twice as much as what I was making loading dishes in the dining hall.  I was eighteen and baby-faced, so my first role was a 13-year-old girl who just found out that she was pregnant.  Included in the character bio was a detailed description of the baby’s father: a 19-year-old who had already spent time in jail for selling drugs.  The school also hired two actors to play my parents, and the medical students had to talk to all three of us to practice their family counseling.  The outcome of the pregnancy was left up to my imagination; sometimes I’d insist on an abortion, other times I’d stamp my foot and tell my parents that I was marrying the drug dealer.  Mom and Dad always took the opposite stance in order to maximize the conflict:  They’d either be damned if they were going to let me throw my life away or be damned if they were going to let me go to hell.  Sessions ended in real tears and screaming matches.

Standardized Patients, or SPs as they are called in the biz, don’t just get emotional, they get physical.  Depending on the symptoms presented, medical students may test cranial nerves, assess motor skills, check blood pressure, listen to the heart, palpate the abdomen, percuss the lungs, and poke around to make sure the liver’s where it should be.  The SP, in turn, takes mental notes about the student’s ability and later writes an evaluation or gives oral feedback.  Yes, the otoscope has gone too far down my ear canal and it has hurt and no, the students don’t practice pap smears or rectal exams (well sometimes they do, but those SPs get paid a lot more).

Unlike in Seinfeld, the most important part about SP work is not teaching students how to diagnose per se, but teaching them how to communicate.  As anyone who has ever been to the doctor knows, good communication is an invaluable skill, and one that does not always come naturally.  Medical students may be bright, but that doesn’t mean they are good at telling a patient that her cancer has returned or that her mother has Alzheimer’s.

The pitfalls of this kind of work are twofold:  1) It is easy to become something of a hypochondriac.  After a few weeks of doing the MS case, I burst into uncontrollable sobs one night at my friend’s apartment because two of my toes were suddenly feeling numb (turns out I needed arch support).  2) You start to realize that a lot of doctors—even doctors you used to trust—aren’t that great.  Before becoming an SP, I thought that all doctors must be overachievers, but like any other profession, doctors vary in ability; some are competent and some, quite simply, are not.

My hands-down favorite case I’ve ever played was—believe it or not—a nasty bout of diarrhea.  My character has a sudden attack of IBS brought on by nerves.  What on earth would cause a patient to get so nervous that she’s crippled with intestinal strife?  A big job interview?  Fear of flying?  Tax audit? Nope, turned out she was about to go away for the weekend for the first time with her new boyfriend.

And just like that, we’re back to Carrie and friends.

Emily Sproch is a writer and a “Sex and the City” tour guide.  Each Friday, she chronicles the fine line between reality and fiction in her column “Almost Carrie.”