Breast Intentions: Enlightening medical students about the female body

Breast Intentions: Enlightening medical students about the female body

by Jeannette Batz

“Basically, you’ll learn how breast examinations should be done, then you’ll teach and evaluate the medical students,” Dr. Tuteur tells me. I nod intelligently and recross my legs, trying to look astute. “They used to use prostitutes for this,” he adds.

That evening I mention the part-time job casually on the phone to my mother. “You have to let them examine you naked?” blurts my mother, who won’t examine her own breast alone in the dark. “Yeah,” I reply, adding lightly that they used to use prostitutes.

“Why are you doing this?” she asks, bewildered.

“Because it pays $22 an hour,” I answered.

“Take off everything but your underpants, put that gown on, grab a sheet, and wait,” one of the other “clinical subjects” tells me. I make a little pile, stuffing my stocking into my skirt and tucking my bra under my blouse. A medical student walks into the room without knocking, and a chorus of female voices drives him back. Door closed, we chuckle at the ironies of protocol.

Ten minutes later the students file in, smelling nervous. The genders have been split, and my schedule has managed to draw me to the males. The professor does a demonstration, then suggests that each student find a clinical subject and practice. Our role is to teach, remind, correct—and make them comfortable with our bodies.

A lanky, sweet-faced lad approaches me immediately. I glance around, absurdly relieved to be, prom-like, selected. On the center examining table sits an obese woman in her sixties, her long gray hair straggling over pendulous breasts. Students line the side of the room waiting their turn, but it takes a nod from the professor before one of them approaches her.

I feel a stabbing sympathy, then pure feminist rage. But the rage is tainted by aesthetic revulsion. I, too, judge her body ugly, as I have my own, cringing at my breasts’ shapeless nipples and downward slope. Their image crops up in National Geographic—not Penthouse. I wonder if the young men will be disappointed, then grit my teeth. They must learn to love the flesh itself, not its form.

Unaware of these musings, my first medical student is introducing himself as Student Doctor Kirkpatrick. He offers me an ice-cold, clammy hand, then catches himself and bolts to the sink: Always wash your hand in front of the patient before beginning the examination.

Clean and innocent, he begins, with a halting explanation, the visual inspection. I put my hands at my waist and press in, a peasant woman angry at her man. He tells me he is looking for “orange-peeling or lesions, any abnormalities.” I tell him a woman’s breasts are always abnormal: too saggy or pointed, too shallow or floppy. At 15, we crossed our hearts with wire and padding while the boys jacked off across glossy perfect centerfolds.

Student Doctor Kirkpatrick is in no mood for social commentary. His hands shaking, he begins the “palpation.” In first position, my hands folded on top of my head, all I can think is: Did I shave my underarms this morning? Has powder caked in the cuts and creases? He extends a cold shaking hand towards my body, forgetting the “position of function” Dr.Tuteur stressed in the lecture.

“Begin in the ‘tail’ of the breast,” I tell him, wondering how medicine arrived at such a satanic description. I am nervous too. He presses his fingers down against my skin, rotating lightly. “Press harder,” I tell him, drawing strength— as women do—from his hesitation.

He presses, rotates, begins to circle my breast. “Wh-what’s that?” “Nothing,” I reassure him. “Just fibrous tissue.” He’s looking for lumps, hard fixed masses with poison inside, not milk or human kindness.

He takes my nipple between his fingers and squeezes gently, glancing up to see if he’s hurt me. Instead I feel a thrill of pleasure deep between my legs. Of course I cannot tell him this. So many things we cannot tell: when we are pleased inappropriately; when we are not pleased but wish we were; when we’d rather talk, and use our souls for friction.

In the “second position” I lean forward, arms again akimbo, an aproned mother whose kids are late for dinner. “Chin up,” he tells me (drawing strength from my vulnerability). He cups the bottom of my right breast in his hand and compresses the flesh with his left hand, moving his fingers awkwardly across the top. “Press against the chest wall,” I direct him, because tumors can grow there. And because 1 want to regain some power.

When he does as I say, I feel something shift inside me. Never again will I perch cold and clammy on the edge of a metal table, clutching a tissue-paper bolero jacket closed, afraid to get down and walk around in case the Doctor comes in. Never again will I do as the Doctor bids without question.

Once upon a time, the Doctor didn’t know. In the “third position” I lie down, my hips rolled away from young Kirkpatrick, my arm over my head in a position that feels like sexual abandon but isn’t. He makes his rings around the rosy one final time, his touch growing more sure. “Move the nipple aside,” I tell him. “There’s a hollow space underneath.”

When he checks his anatomy text, he no doubt will find a structural reason. For me, it’s the hollow created when men and babies suckle; one of the dark chasms Jung calls women’s mystery. We crave connection: Is it because we feel our own emptiness? Or because we have room for the world?

He thinks he is finished. “What about the axillary nodes?” I quiz. “Oh yeah,” he blurts. “I’m sorry.” (Later I ask another clinical subject how long this innocence will last and she grins: “Through December. By January they come in brusque as God.”)

Axillaries are tough: You have to support the woman’s arm on your own, minuet style, and convince her to relax while you locate the underarm cavity and press up into its bundle of nerves. He doesn’t want to hurt me; I tell him to go ahead, just as I’ve told every man I ever loved. And sure enough I feel invaded, turned inside out. He probes and presses and finds nothing; I am still whole, satisfied by this treeful of knowledge.

Women are always more whole, they say; we are “grounded.” Heavier with water, moist with the world’s fluids. Completed and self-sufficient because our power lies inside us. I am a thousand women—flirt, hausfrau, Venus, bluestocking—yet I do feel placid, justified by a womb I may never fill. Does the young Kirkpatrick sense this? Can I convince him?

The next student introduces himself and begins the inspection. I now realize that each will have his own attitude toward my body. The short thickly built guy thinks my body is his laboratory; the former musician, intense as Hamlet, feels his way into its rhythms. The older redhead is intrigued—”The body is an amazing machine,” he says, reminding me of my first Ob/Gyn, who talked about cogs, wheels, and operations until I left screaming silently, hysterical, womb-panicked by his imposition of cold structure.

Some of the students show an acolyte’s reverence, a sense of my skin as envelope, and life beating warm beneath it. Others want a map, a compass; certitudes of definition and diagnosis. A few stay humble, and they are my favorites. Because it is humility I am learning myself, in this clinical act of prostitution. I ease into routine, dropping my gown readily for each new student, but what replaces embarrassment is neither arrogance nor indifference.

This is my body, narrow-shouldered, fair-skinned, with full, pale-nippled breasts and arms freckled darker beside them. Not one of these clinicians can reduce this body to certainty; what lies beneath sight is closer to spirit than flesh. Like post-modern faith, it requires a gentle probing that takes nothing for granted, overlaps its own circles, stops short of center.

I can teach them what I’m told: the steps of the exam, the danger of inappropriate touch, the consummate need for courtesy and order. But how do I teach them that my body has a life of its own? That together, my body and I harden, swell, fall, soften, give suck—and none of that can be deconstructed or controlled. Read the textbook, but never forget: The female body is as mysterious as the soul. And as shameless.

Jeannette Batz is an award-winning journalist who writes about feminist and social issues for The Riverfront Times, a progressive weekly in St. Louis. She participated in the clinical program at Washington University School of Medicine last year, while finishing her doctorate in American studies.