A Reflection on Anton Chekhov’s Story & Working with Standardized Patients
“Why are you wriggling?”
“Your fingers are cold!”
“Come, come…it won’t kill you. Don’t twist about.”
This moment from Anton Chekhov’s short story Anyuta has always stood out to me. As a Russian Language & Literature major, Chekhov has always been one of my favorite authors for his creativity and wit. He holds even more special significance now that I’m a medical student. Unbeknownst to many, Chekhov himself was a physician, and he wrote many stories inspired by his experiences.
I find myself reflecting on Anyuta often as a first year medical student. The story describes a medical student Stepan Klotchov who is – relatably – pacing about his apartment as he struggles to memorize information for his upcoming anatomy exam. Anyuta is his live-in roommate, or perhaps lover. The story goes on to describe how they are struggling to make ends meet, the dismal state of their apartment, Anyuta’s objectification in the relationship, and, eventually, Klotchov’s attempt to kick her out for failing to keep house. For a 3-page story, there’s a lot to comment upon. But for me, it’s the first page – where our quote is found – that is most striking as a medical student.
Anyuta presents a situation in which the use of human bodies to study medicine strikes the reader as clearly wrong. Klotchov does not ask Anyuta if she is okay with his examination of her body, but rather orders her about. He is so intent on his studies that even when Anyuta expresses discomfort in the opening quote of this essay, his primary concern is that she stops moving so that he can study more easily. Indeed, Anyuta herself internalizes this attitude; even when her lips, nose, and fingers begin turning blue from the cold, she tries to conceal her shivering, worried that Klotchov may notice, cease studying her, and ultimately fail his exam. Throughout this interaction – from Klotchov directing Anyuta to let him feel her ribs, to him commenting on how challenging they are to feel despite how skinny she is, and lastly to him using a crayon to draw on her body – Anyuta is nothing more than an object, a study aid.
Yet despite how problematic this scenario is as Chekhov portrays it, Klotchov is right: medical students do need to study using actual human beings. Even as a first-year medical student, I have worked with countless souls – both living standardized patients and already passed body donors – in my pursuit to better understand the human body and eventually be able to treat its ailments. I often find myself thinking of Anyuta, especially when working with standardized patients. These interactions are clearly very different and fall on disparate ends of a moral spectrum for many reasons. Standardized patients have given consent for us to work with them, and they will be compensated for their time and any minor discomforts they may experience. As medical students, we have been trained to work with standardized patients with respect and humility. Even when standardized patients know that they are there for an ultrasound session, we ask them before placing the probe on their bodies.
Nonetheless, I cannot help but see the similarity in asking another person to allow me to examine their body in support of my education. Sometimes, I wonder if there is a line between “acceptable” situations, like working with standardized patients, and apprehensible ones like Anyuta faced. But then, I realize that I don’t want to find that line, or even begin to approach it. I don’t ever want to needlessly sacrifice another person’s comfort to advance my own goals. In these moments, I find myself thinking of the people who will play a role in my journey to become a physician – standardized patients, actual ones, their families – and I’m grateful for them all and for their willingness to support my education in this way. I want to acknowledge and appreciate the gift that this is.
And so, I’ll do my best to distance these interactions from the one Anyuta faced, and to stay as far away from that invisible moral line as I can. I’ll introduce myself to them and ask about their day. I’ll warn them before placing cool ultrasound gel on their bellies. And above all, I’ll try to make sure my hands aren’t cold.
Ashlynn Cobb is an MS1 at the Perelman School of Medicine.
