The Standardized Patient by Joanna Petrone

---

Today, when the doctors come into the exam room, they find me a leper. 

Symptom #1: I have a rash running down the inside of my right leg. “It looks like pizza,” I say. “And it hurts.” I describe the pain: prickly, intermittent, like spiders with feet dipped in acid running all over my skin. 

Symptom #2: There is a patch of dark, flaky tissue necrotizing on my groin. “Smells like old hamburger,” I say. 

Symptom #3: There is a dead, heavy feeling in my right leg. The paper beneath me crinkles as I hop down from the table to demonstrate, dragging my leg like an old bulldog on a leash. I keen to the left, making circles in the center of the room. The air conditioning puffs up my blue gown, and my scrotum shrinks. The doctors, impressed by my commitment and confused by my symptoms, take a few steps back towards the wall.

“Cellulitis?” one says.

“Rheumatoid Arthritis?” says another.

“What about Perth’s?” says a third, a very short man who appears to suffer from a glandular disorder, sweating heavily at an ambient sixty-seven degrees as he scrolls on his tablet.

I reveal nothing. The doctors huddle behind the computer cart and look at my fake patient record. They try a few more guesses, but all are wrong. Although I’m not supposed to, I sneak them a hint. What can I say? I see their eagerness, and I want them to succeed. I angle my body away from the camera. 

“I’m so tired,” I say with a fake yawn. “Must be from all the traveling.” I whisper the word ‘traveling’ so the mic won’t pick it up. I’m not supposed to do any prompting.

“From traveling, did you say?” the short, sweaty man asks loudly.

“I didn’t say that.” I’m trying to help these guys. Let me help, guys! I make eye contact with the man, but he turns to the others and shrugs.

Finally, a woman with neon pink braids who is sitting on the rolling stool asks if I’ve traveled out of the country lately.

“As a matter of fact, I have.” I smile, casually.

“And where did you travel to?”

“Malaysia.”

“Hmm.” She should be looking at me to convey empathy, but she’s reading off the screen. I can see the blue text reflect off the lenses of her eyes. I telepathically will her to remember that bedside manner is a category of evaluation— someone in another room is timing her eye contact, numbering her nods, ticking off each time she says my name— but she’s too tense to pick up my vibrations. 

“Ok, yes,” she says. She points at the computer, and the other doctors move closer and nod in agreement. You can feel the excitement in the room. They know they’ve got it. I know they’ve got it. You got it, guys! I wish I could cheer them on, but I’m too much of a professional to break character. The sweaty one remembers what he has to do.

He looks into my eyes and tells me, in a caring but not overly emotive tone, that I have Hansen’s disease, aka leprosy. Finally, the simulation is complete. 

“Simulation complete,” says a voice on the speaker. The doctors puff their cheeks, sigh, relax. I smile. “Great work,” I garble. I’d like to hug them all, but the camera would see.

Right before the doctors leave the room and I get dressed, the woman with pink braids thanks me for being such a good Standardized Patient. I can tell she really appreciates me. I take a bow. My gown splits, and the air conditioning goosebumps every follicle across my naked ass.

At home, my mother— who is not a Standardized Patient, but a regular patient, and also, sometimes, impatient— is watching I Want a New House while she elevates her feet. I, too, want a new house. This one is cluttered and smells like dying houseplant even with all the windows open. At night, the cats go crazy howling at the walls. My mother says it is because my dead father “won’t get his lazy ass out of here” and move on. She thinks the problem is ghosts, although I believe rats is equally a possibility.

“How did it go, today?” she asks.

“I had leprosy.”

“I’m so proud.”

Sometimes my mother asks for all the details of the disease I’ve been assigned that day, and I walk her though them so she can measure her real symptoms against my fake ones. So far, no one has been able to identify the cause of her ailments. Today, her ankles are swollen and purple, her bowel movement green, and there’s a ringing in her left ear. 

Some days, after I am done being a Standardized Patient, I drive her to see her doctor, who is not in the nice, white teaching hospital where I work. Her doctor, a man called “Dr. Al,” whose mustache is dusted in crumbs and whose dress shirts are always missing a button or two, works in the loud, cramped clinic that takes my mother’s government insurance. 

Dr. Al’s a nice guy, if stressed. My mother often yells at him that he is just treating her symptoms, not addressing the root cause. Then he yells back, “Everything is a symptom! The root cause of which is life!” as he throws up his hands, and occasionally his pen, in exasperation. Dr. Al is trying his best to help! Today, though, after I bring my mother her Ensure and waffles, she tells me to get my slacking ass out of here. It is Thursday. She knows I have a date with Giulia.

Giulia and I met on a message board for people having difficulty getting a diagnosis for their symptoms. I was browsing on behalf of my mother when Giulia’s post caught my eye. It was titled “Can lupus make you kinky?” and her beautiful personality shimmered through her words, not to mention her bandaged hearts and angel cats and twinkle star emojis. 

Giulia’s present symptoms are as follows: irregular periods, unexplained rash behind her ears, insomnia, a sour taste in her mouth, a bald spot on the top of her head, mood swings, migraine auras without the migraines, and late-onset kinkiness. Giulia and I meet every Thursday evening at the most beautiful Taco Bell you’ve ever seen, high on a seaside cliff among invasive ice plant and native fog, where we order chalupas and Sprites and hold hands.

“Another masterpiece,” I say as she shows me the one-of-a-kind artistic beaded cat collars she has been working on. There is one patterned with paw prints, one with mice. “Made by the one and only Giulia.” I pronounce her name the same way she does: Guy-ool-ya. I take out my wallet to buy a collar because, an actor myself, I believe in supporting the arts, but Giulia stops me. She insists on giving me the collar for free. It is blue, embroidered with black beads in the shape of fish. I wear it on my wrist like a corsage.

After our chalupas, we walk down to the beach to watch the sunset. Gulls circle and gleaming surfers waddle back to their cars. Sometimes, we go to Giulia’s bungalow, but tonight one of her three nesting partners is bringing home a playmate to practice kink with, and we are respecting their space. I think it is a beautiful term: nesting partner. It makes me think of delicate, small birds, flitting about. Giulia even looks like a bird, with her bright blue hair, bony legs, and sharp nose. Like a bird, Giulia is to be admired, never owned. Giulia, beautiful bird! 

Some weeks, it is our turn in the bungalow, and then the nesting partners fly away to respect our space as we practice Giulia’s kink, which is rolling around naked in oiled spaghetti. It requires a lot of time to prepare all the spaghetti, but it is worth it to see Giulia squeal with delight as the spaghetti slithers over her skin, around her limbs, and gets mashed into her pubic hair. My only kink is being near Giulia.

At the beach, I bury Giulia up to her chin in sand. When I dig her out, she is gritty and cold and smells appealingly of fish. I dust her off and hold her, nuzzling my face against her ear. She meows and plays with my hair like it’s spaghetti. Then the sun goes down, and I drive Giulia home. Her cats, in one-of-a-kind artistic beaded collars, wait on the porch, underneath the yellow globe light, watching a moth.

The next morning at the big, white teaching hospital, I’m an atypically presenting appendicitis patient. The swarm of doctors enter. I complain about my back pain and answer their questions. This time, they catch on quickly, and I can hear them whispering appendicitis, appendicitis like they are summoning a beautiful muse. Then the sweaty guy starts the physical exam.

“Hmm,” he says, pressing all over my middle. He turns to the other doctors and calls over the one with the braids.

“Hmm,” she says as she palpates. At the end of the week, their continuing education course will be over, and I think, boy, I’ll really miss these guys. It is hard to see people you care about move on.

While the two of them are palpating and saying “hmm,” a strange thing starts to happen. The rest of the doctors close in and hover over me, all of them touching my torso at once. I feel like a baby, and I also feel like I have an erection. Being professionals, we ignore it. Instead of calling out guesses, the doctors look at one another with uneasy expressions. One exits, then comes back with the ultrasound machine and scans my gut.

“Yeow,” I say. “I feel like I could burst.” I whisper ‘burst.’ The doctors are frowning.

“Does that really hurt?” asks Braids. I am confused as to why she phrases the question that way.

“I’m sorry to tell you this,” one of the other doctors says. She is doing an excellent job holding eye contact and has even put her hand on my shoulder, a nice touch. “But there is a mass in your abdomen.”

“My appendix,” I say.

“No.”

“My appendix?”

“No.”

“My appendix?!”

“Simulation terminated,” says a voice over the speaker, and I am no longer a Standardized Patient but a particular one.

I spend the weekend at home, cleaning up and brushing the cats and watching I Want a New House with my mother, who I don’t tell about the mass because she’s got symptoms enough of her own. I log onto the message board and make a post, but none of the information people share makes me feel any better. Then on Monday, for the first time, I call in sick to the big, white teaching hospital and drive to the small, loud clinic, where I tell Dr. Al about my abdomen.

Dr. Al doesn’t bother having me change into a gown. There is no scrotum-tightening air conditioning in the clinic, just a pair of standing fans that push the same hot air around and around. He pulls up my shirt and feels around with his swollen fingers, hairy to the third knuckles. “Hmm,” he says. As he leans over me, I can see his black and white nose hairs and an ink stain on his breast pocket that didn’t quite wash out. I smell the stale coffee and peanut butter on his breath. At that moment, Dr. Al seems so beautiful, I could cry or kiss him.

“A symptom of life?” I ask.

He shakes his head. “No, of cancer.” He is looking me in the eye with real empathy. 

I tell him, “Great job.”

Dr. Al says I need scans, but I can’t get the scans there because the insurance I receive as a Standardized Patient at the big, white teaching hospital is too good for the clinic, but also not good enough to be a patient at the big, white teaching hospital. There’s a lot of lists and approvals and appointments to get sorted before the scans can be done. I follow the simulated advice I’ve received many times and call on my loved ones for assistance.

The next day, Giulia comes over wearing a one-of-a-kind artistic beaded collar and a funky purple vest. She, my mother, and I sit around the table calling doctor’s offices and medical imaging centers and insurance companies. In between phone calls, my mother grabs cats and brings them to Giulia to be fitted for one-of-a-kind artistic beaded collars. Giulia and my mother are, of course, old hands at setting up medical appointments and handling red tape, plus I myself am a professional patient, but it takes the three of us six hours to get all the scans, bloodwork, and biopsies scheduled.

The sun goes down, and the cats start howling. “Quiet, Needles. Quiet, Suzanne Somers. Quiet, the Pillsbury Doughboy,” my mother says to them. She yells, “Roy, get your lazy ass out of here and go haunt one of your bimbos instead,” at the wall. Then my mother offers to go out and pick up Taco Bell, and I know it is to give me and Giulia the chance to be alone and talk.

“I’m scared,” says Giulia as she clutches the Pillsbury Doughboy, a big orange guy with a cataract clouding one of his eyes. 

“It’s ok to be scared,” I tell her.

“Are you?” she asks. The Pillsbury Doughboy growls at the wall, the fur erect along his spine.

Am I scared? I think about it, scanning my body for clues. “No, I don’t think so.”

“Why not?”

The Pillsbury Doughboy stops growling. The rat or ghost or ghost rat has passed. The Pillsbury Doughboy settles down and lowers his chin onto Giulia’s bony lap. “I’m too busy being happy with you.”

It takes a month before all the scans and biopsies are completed. They confirm what Dr. Al already knew: cancer. Dr. Al tells me over the phone, and I imagine him looking at me with care and authority and a little bit of mustard on his collar. Afterwards, I meet Giulia at Taco Bell. The sunset is beautiful, but Giulia hardly touches her chalupa.

“It’s ok,” I tell her. “It’s going to be ok. I have lots of practice being a patient.”

Giulia begins to cry. We skip the beach and go straight to her house. The nesting partners have all fluttered off, and we have the pink and white bungalow to ourselves. Giulia sits on the couch, tips her head back, and closes her eyes. I go to the kitchen to start boiling water.

“I couldn’t possibly tonight,” says Giulia. “I’m too sad.”

Giulia’s sadness brings a tear to my eye. I rub her shoulders and tell jokes. I hand her cats. By the time the water is boiling, she is feeling well enough for a little macaroni. The elbow noodles dance in the boiling water, and it’s beautiful. It’s festive. A beautiful, festive macaroni party. When the pasta noodles are drained and cooled, I coat them in oil and lay plastic sheeting down on the living room floor. Giulia is too sad to take off her pants, but she removes her shirt and bra and moans with pleasure as the warm macaroni rains down over her breasts and surrounds her torso, streaking the plastic with breath-like steam.

After my third round of chemotherapy, I am fired from the big, white teaching hospital.

“We’re sorry,” says the woman from HR. “But the doctors find your cancer symptoms distracting.”

I am crestfallen. “You’re firing me for having cancer?”

“We are absolutely not firing you for having cancer.”

“But you just said—”

“We’re firing you for being unable to perform the basic duties of your job, for any reason.”

“Like cancer?”

She is looking at my bald head, my skin that is papery and thin, the sores at the corners of my mouth, the violet bags under my eyes.

“I wish it were otherwise, but you are no longer able to be a standardized patient, you are simply too—”

I know she can’t say the word ‘sick,’ so I help her out. “Particular,” I say.

Losing my job means more phone calls and paperwork and calling the hospital and the treatment center and the pharmacies to beg and appeal and supplicate and threaten and wheedle and white lie and listen to 8,000 hours of hold music. My mother and Giulia do most of it while I and the Pillsbury Doughboy lay upon the couch, napping on pillows.

In the evening, Giulia and I go to Taco Bell, and she orders me a chalupa, modified for my chemo diet. She apologizes to the guy who takes our order for being so particular and explains it is because of my cancer. “My mom died of that,” the guy says and throws in an order of cinnamon twists for free. 

It is not our night for the house, so after our meal, we head down to the beach. We are sitting side by side. I am shivering and too tired to bury Giulia. Giulia begins to quietly cry.

“I can’t do it,” she says.

“Can’t do what?”

“I can’t be with you anymore. It’s too hard.”

Although I am lighter than I’ve been since I was a child, my insides feel heavy as lead. “You’re breaking up with me?” I say.

“I’m sorry.”

“No more noodles?”

She begins to shake and sob. Oh, Giulia!

“I’m a terrible person,” she says. “You hate me.”

I think about it. I scan my body, searching for clues. “I don’t hate you. You’re Giulia.” A beautiful bird, preening her wings for flight.

She sniffs.

I breathe in the salty air. I think, this is my last trip to this beach with Giulia. Then it occurs to me that, in a way, every trip to the beach has been the last one, as everything is changing, all the time. I already had my last trip here with blue-haired Giulia, for instance: her hair is green now. I already had my last trip here with her in summer, my last trip here with her before cancer. For some reason, this gives me comfort. I take off my shoes and plunge my toes into the sand, cold and dense. It feels so good.

“Look,” Giulia says.

Out past the foaming breakers, but not very far past, a pod of dolphins is swimming by, jumping and diving, glossy with sea and reflecting the warm colors of sunset. When they have passed, it will be time to put on my shoes and drive Giulia home, then myself. Time to be on the couch with my mother and the cats and the rat ghosts. Time for chemo and scans. Time for I Want a New House. But for now, I watch the glistening pod tumble and shimmer across the sea. “It’s all so beautiful,” I say, and I mean it.

---

Joanna Petrone’s essays have appeared in Longreads, Vice, Slate, The Outline, Popula, and elsewhere. She has a short story forthcoming in the Bellingham Review and is currently at work on a novel about archeology. Joanna is a school teacher and lives in Berkeley, CA with her family.

---

8 December 2023