David Solomon lay in bed, a sheet draped over his legs.
His darkened bedroom was silent, except for the ticking of a clock on the wall. A box of tissues sat on a bedside table; a Hebrew-and-English siddur, or prayer book, rested on his lap.
The cancer that the 70-year-old cosmetics merchant had held at bay for 12 years was no longer responding to chemo. His breathing was labored, and his morphine-addled gaze wandered. It took all his effort to focus on the white-jacketed medical student who stood next to him.
"Even though we're done treating your lymphoma, we're still here to help," the student said, gently.
"I want to talk about hospice," Solomon croaked.
He had signed paperwork urging doctors to withhold interventions such as a feeding tube during his final weeks and thought he wanted to die here, at home. At the same time, he worried how his decision would affect his family.
"Do I want my family to walk into this room and the last memories be saying goodbye to me?" he asked.
The room fell quiet again. The medical student was still. Two of his classmates, in chairs nearby, dabbed their eyes. One reached past Solomon, grabbed a tissue and blew her nose.
"Time out!" their instructor shouted.
The patient sat up in his bed, pulled a canary-yellow yarmulke off his head and smiled.
"I am not David Solomon," actor Bob Rumnock told the students, "though we all will be at some point."
Rumnock is a member of a small but dedicated troupe of actors who portray patients at Los Angeles-area medical schools.
Stepping into carefully crafted but mostly unscripted roles, these so-called standardized patients help young medical students practice their bedside manner, testing out how it feels to place a hand on a dying patient's arm or ask a fidgety teen about her sexual history.
Medical educators and students love the exercise because it lets them practice interacting with patients, the core of a physician's work, without worrying about doing harm. For actors like Rumnock, 60, who hustles to make a living on stage, in movies ("Divergent," "The Lone Ranger") and on TV ("Scrubs," "Mad Men," "Weeds" and "Grey's Anatomy," among other shows) being an "SP" offers insight into their own medical care.
It's also a pretty good gig.
"It's some of the meatiest characters you can play, and it pays," said Rumnock, who gets $15 an hour for training and $20 an hour for the performances. "I love doing theater, but it doesn't pay the bills."
Actors have been doing this work at the Keck School of Medicine of USC, where Rumnock was playing David Solomon, for 50 years.
In 1964, Dr. Howard S. Barrows and Dr. Stephen Abrahamson, both professors at the medical school, published a paper in the Journal of Medical Education that described the use in neurology training of a "programmed patient" — an actress who had been trained to portray someone suffering from multiple sclerosis and interact with students performing a medical exam.
Medical schools at the time resisted using "simulated patients," calling it "too 'Hollywood,'" UC San Diego professor Peggy Wallace wrote decades later in the journal Caduceus.