It’s a classic case of depression. The patient can’t sleep. She’s losing weight, she fidgets, feels guilty and is withdrawn since her partner’s fatal accident. Finally she sobs out her woes to the psychiatric nurse practitioner, who listens attentively to her story.
“It’s not you fault,” the nurse assures his patient, Dianne Hood. She’s doing the right thing in coming for help, and he understands what she’s going through.
With his comfort and support, Hood’s burden is lightened.
So too is the burden of the nurse-in-training, for he’s passed another test, literally, on the road to better healing.
Playing sick: it’s what children do when they don’t want to go to school. It’s what cemented the careers of Daniel Day Lewis for his portrayal of cerebral palsy in My Left Foot and Russell Crowe for his schizophrenic Nobel laureate in A Beautiful Mind.
Playing sick is also what two of Colonial Players’ brightest stars, Dianne Hood and Edd Miller, do to supplement their incomes and to help educate tomorrow’s health professionals.
The Standardized Patient
For Hood and Miller, the role has a clinical title: Standardized Patient.
|For Dianne Hood, the easiest role is the patient recovering from surgery. “If they ask how I’m doing, I say I’m nauseous and short of breath. Otherwise, I just lie there.”|
Standardized patients are professional actors who portray real patients drawn from textbook compilations of real-case profiles. The roles follow the human life cycle, ranging from infants with food allergies to Alzheimer’s patients. The actors remain in character throughout their exam. Then they switch roles and become the examiners, critiquing their medics on how well they performed on their test. Both performances and critique are video-taped.
A patient-centered concept that began a half century ago in California, standard patient training has been common in the Baltimore-Washington metropolitan region for at least a decade. From Baltimore to Washington to Anne Arundel Community College, eight medical training institutions hire actors to play standardized patients to help students master the skills they’ll need to play in their real-life roles as doctors, nurses, pharmacists, social workers, physical therapists, paramedics … and on and on.
From standardized patients like Hood and Miller, the medical aspirants get direct, instructional feedback on how to examine, interview, diagnose and counsel patients.
“We don’t teach them medicine. We teach them to communicate,” Miller says.
Body language, empathy, posture, eye contact and touch are all part of the lesson — and the test.
Playing the Role
“One Jane Doe can’t cry from the pain while another says it’s no big deal,” says Kathy Schiavone of the standardized-patient actors she hires to teach at the University of Maryland School of Nursing, where she is director of the Clinical Education and Evaluation Laboratory. “The point is to educate, not perform.” Schiavone counts on uniformity, with actors going by the patient script they’re given.
|As standardized patients, says Edd Miller, “we don’t teach them medicine. We teach them to communicate.|
When standardized-patient actors cry, twitch, limp and wheeze, they’re following a tightly structured script, all memorized, rehearsed and replicated dozens of times by them and the other actors who play the same role. Name an illness, and there is a patient profile built around it, complete with personal, family and medical history. Like film actors, standardized-patient actors keep their gestures small and intimate, trying for the affect of the real world rather than the exaggerated presence of live theater.
In these medic-patient relationships, roles are reversed. It’s not the patient and the meaning of her symptoms that are unknown; it’s how the student will perform. Not every student asks the pertinent questions or observes the pertinent data.
Hood’s Alzheimer’s victim with red marks on her wrists could not, of course, remember how she came by them. The real Hood, however, could and did penalize the examining student who failed to notice by physical evidence that Hood’s inarticulate patient had been tied to a chair.
When a script calls for tears, “Dianne Hood is the very first person I call,” says Maryland School of Nursing’s Schaivone.
Hood’s grieving lover was perfected over 35 years of acting. The actress is a regular on-stage in the Baltimore-Annapolis region. Her next play, the one-woman show The Year of Magical Thinking, opens in February at Baltimore’s Strand Theater.
Hood’s Colonial colleague, Edd Miller, has acted in 100 plays and directed some 30 more — currently Diviners, which opened at Colonial Players last week — since his training days at Chicago’s Goodman Theater. Miller was recruited as a standardized-patient actor by another longtime Colonial Player stalwart, the late Stan Morrow, specifically because of his ability to improvise.
It takes stamina, concentration and a good memory to make a character real performance after performance. Standardized-patient actors may reprise the same role 10 times a day — remembering what happened each time for the critiques.
Some roles are more challenging than others, and all actors bring tricks to playing them. Often, they seek inspiration in personal experience. To memorize the genetic history of 25 relatives, Hood names them after her extended family. She draws empathy from her own history as a breast cancer survivor.
Miller, a recent widower, drew on his grief in portraying a soldier with post-traumatic stress disorder.
The most energetic patients, rather than the most distressed, are Miller’s most demanding. “Like the suicidal guy who wanted to jump onto I-95 from the overpass. When I portray a manic personality, I spin around on the stool and hop around the room. It’s exhausting. For 25 minutes I never sit still.”
The medical experiences the actors undergo for each job hold their own challenge, for each is in every way like a real medical visit. Actors may opt out of some invasive procedures, such as rectal exams, if they wish. But not out of embarrassing questions. “Doing a sexual interview with a young female student is like talking with your granddaughter,” Miller says.
Hood finds her side job continually expands her understanding of human nature. “I’m neither naïve nor stupid,” she says, “but sometimes they ask me questions and I wonder, people do that?”
The easiest role is the patient recovering from surgery. “If they ask how I’m doing,” Hood says, “I just tell them I’m nauseous and short of breath. Otherwise, I just lie there.”
In Place of Applause
Dianne Hood’s favorite collaborator is a mere babe in show biz. Her seven-month-old granddaughter, Joanie Dicey, recently endured five well-baby checks in as many hours. That’s five strangers who poked her, prodded her and peeked into her orifices. “By the end, the room was a mess and camera angles went out the window,” Hood recalls. But the job got done, and without major meltdowns.
What rewards do actors habituated to the spotlight, rewarded by the applause, find in consulting rooms? Why do they endure intrusive questions and exams — and the occupational hazard of hypochondria?
“The experience feels so much like the real thing,” says Hood “that when I go to the real doctor, I have to think about whether I’ve been experiencing these things.”
Money isn’t the only factor: While the job pays well when it’s there, the work is sporadic.
These performances will never be Oscar winners, but they could ease suffering and perhaps save lives.
Once Hood recognized the symptoms of an aneurysm related third-hand. An actor’s improved medical knowledge is not, however, the point.
Her portrayal of grief over her deceased lesbian lover so moved her nursing student that he said, “I hope this isn’t your story.”
Not mine, but someone’s, Hood replied.
That is the point.
Jane Elkin reviews theater for Bay Weekly.쇓