Dave Lerman was once a comedian who made audiences of thousands
laugh.
He and his partner were guests on the Howard Stern Show.
Together, they once toured Las Vegas, and entertained movie deals
and television offers.
Six years ago, he took stand-up to the hospital examination
room. He does his routine in a hospital gown, pairs perfect comic
timing with stoic professionalism, and finds an appreciative
audience in UCLA medical and nursing students.
“Hello,” Lerman says he routinely starts off,
“I’ll be your next victim ““ I mean
patient.” And then the clinical examination ““ prostate
and testicular cancer, epididymitis, hernia ““ begins.
Ever since he discovered the vocation of patient surrogate,
Lerman has held the bragging rights of having the healthiest
genitals in Southern California.
Patient surrogates, healthy individuals who provide themselves
as guinea pigs for dozens of clinical exams, are invaluable to the
in-training medical community. Used by a variety of medical
vocations and in many types of exams or case scenarios, they are
often a student’s first clinical experience with a living,
breathing individual.
“You can watch a thousand videos and work on a hundred
plastic models, but until you’re working on an actual human
being, you’re not going to get the gist of something,”
Lerman said. “This is very important that the students have
some sort of experience before they get into a clinical
setting.”
But being a patient surrogate ““ especially for
urologist-hopefuls ““ is not for the faint at heart.
Performed well, the men’s urology exam should take no
longer than three minutes. Lerman, a self-proclaimed “guinea
pig extraordinaire,” has become an expert on the
well-performed exam.
“I think the reason I’m successful is because I can
create a nice rapport,” he said. “I’ll always
point out what the students are doing wrong, and what the proper
thing is.”
During the exam, medical students look for sores and lesions
that might point to epididymitis, an inflammation of the tubes that
store and collect sperm in the testicles. Lerman tells them a
normal epididymis should feel like a spaghetti noodle.
The students then feel for lumps that may be a sign of
testicular cancer.
And finally, a rectal exam, which is “not painful, but
definitely the most uncomfortable,” is conducted to check for
enlargement of the prostate. The prostate, Lerman says, should feel
somewhat like the tip of your nose.
“I’ve had some horror stories where I say
“˜I’m never doing this again,’ but what makes me
want to do it is the statistics,” Lerman said. “Even
though I make light of things, this is very serious. The statistics
with this are staggering.”
One in six American men are at risk for prostate cancer, the
most commonly diagnosed cancer among men, according to the National
Prostate Cancer Coalition. This year, 30,350 men will die from the
disease.
But the prostate exam Lerman undergoes is commonly avoided by
many men for fear of discomfort, or perhaps after one bad
experience.
Patient surrogates are necessary for training the next
generation of physicians and nurses in the methods for prevention
and early detection of prostate cancer and other diseases.
“(Patient surrogates) are motivated from personal
experience and very altruistic motives to help other patients not
want to avoid these exams,” said Lynn Doering, an associate
professor at the UCLA School of Nursing who has frequently worked
with patient surrogates. “It’s really wonderful that
they do it.”
In the UCLA School of Nursing, people like Lerman are sometimes
called co-instructors or models because of their experienced
ability to guide the frequently nervous student through the
process.
“This one model was an older woman,” Doering said,
speaking of a woman who had frequented the examination room as a
surrogate for pelvic exams, “and she was so intent on making
sure the students understood how to do this in a way that would
ensure the patient’s dignity and make them
comfortable.”
Lerman’s very first time as a patient surrogate for UCLA
urology students, he had to catch the slack for a friend with cold
feet, and endured 90 probing and prodding exams in three days. The
average male will probably muster up the guts for one or two in a
lifetime.
Fortunately, patient surrogates are paid by exam ““ up to
$250 dollars a day said Mark DeVaney, the program coordinator of
the UCLA-San Fernando Valley Internal Medicine Residency Training
Program, which recruits patient surrogates for urology students in
the program.
“As the days progressed I really became fascinated because
I was doing something I was good at. I was helping people ““
not only the students but the community at large,” Lerman
said. “Plus I was being paid crazy money.”
In a single day, Lerman said he made enough to cover several
months’ rent for his apartment ““ a converted wine
cellar of a mansion just below the second “˜O’ of the
Hollywood sign. Stints as a patient surrogate, Lerman said, have
also paid for a trip to Hawaii.
“I found out that the better you got at this and the more
willing you were to be exposed, the more money you could make and
the more in demand you could be,” he said.
Lerman said he initially stumbled across the service during his
days in the entertainment industry when he heard rumors that Robert
Rodriguez, the director of films such as “Sin City” and
“Desperado,” had used earnings as a patient surrogate
to finance his first film.
Curiosity piqued and comedy career ended, Lerman began to do his
research on this apparently profitable possibility.
“Being a comedian for so many years it would have been
hard in my twenties to start working nine to five,” he
said.
He discovered an entire “underground economy” of
willing and able human guinea pigs.
Once he participated in a few training sessions, the word
spread, and Lerman found himself a hot commodity. He was
recommended to similar programs at other medical schools around the
state and country.
“What made him so good is that he made all the med
students feel at ease,” DeVaney said.
“He always started his session off with a joke, and all
the student I’ve ever talked to about him said he was
terrific and he made it very easy for them,” DeVaney
said.
DeVaney said he gets most of his recruits from advertisements in
the Daily Bruin.
“There’s no specific requirements; we got all types
of people ““ a lot of actors looking for extra income,”
DeVaney said. “They just have to be willing to have medical
students probe and prod them.”
Lerman has not stopped at urology exams, however. With a history
of sleeping problems, he recently participated in a research trial
in which his sleep patterns were observed for 10 days.
“It was like staying at a hotel,” he said. The most
difficult things he had to do in those 10 days were decide what he
wanted to order from the menu, and what movies he wanted to watch
before lights out at 9 p.m.
He has also participated in clinical trials and pharmaceutical
studies for various drugs.
The pharmaceutical companies have asked him to speak at forums
and conventions of doctors and pharmacists, finding an invaluable
resource in an articulate and knowledgeable patient who has had
direct experience with the drug and is not afraid of the
spotlight.
“It’s almost like getting a law degree from watching
“˜Law and Order,'” Lerman said. “I can have
incredibly intelligent discussions with medical professionals and
they can’t believe I’ve never been to medical
school.”
Lerman has also cultivated other expertise and methods of
income.
“A great name for my life story is jackass of all
trades,” he laughed.
Privy to a celebrity circle of sources from his days as a
comedian, he works as a gossip columnist for tabloid magazines like
The National Enquirer and Star.
“If you want to know who’s the worst tipper in
Hollywood or what Britney wants to name her baby,” Lerman
said, “I’m your guy.”
He also writes trivia questions for game shows, sports bars and
Hooters trivia night.
But the 32-year-old can relish a rare pleasure others working
odd jobs may not be privy to ““ the knowledge that he is in
absolute good health. The benefits of being a patient surrogate
definitely beat the pokes and the prods, Lerman said.
“I’ll probably do this indefinitely as long as
I’m healthy and I enjoy it,” he said. “I
don’t see that there’s any end in sight ““ maybe
if I meet the woman of my dreams and my wife has an issue with
it.”
In lieu of Howard Stern, Lerman has found a regular routine at
the UCLA medical school ““ that is, until another love gets in
the way.