Let's suppose your doctor, during your examination, were to ask you the following: "Where is your pen?"

Would you get a quizzical look on your face and then say something like, "Well, it's in my purse,"or "in my pocket,"or "I don't have a pen," while all the while wondering why that seemingly sane, educated person in white wants to know your pen's location?

Well, to Dr. Rong Lawson, the pen is the problem. That's why you're there, she's been told. So she needs to know:Is your pen in your throat, your knee, your back, stomach, where?

Or that's what she would have said, a couple of months ago, when Lawson, from China, would have pronounced "pain"like "pen" and "abdominal"like "abdominah"and "vital signs" like "wital signs."

But not any longer.

Lawson has recently received some substantial help in pronouncing English more precisely, so patients and others can understand her.

That has happened because Julie Eikamp, 53, an English instructor at North Dakota State University for 23 years who helped develop NDSU's specialized language program for the many international students, is now living in Bismarck. And she has started a business, "Express Yourself in English."

Lawson practiced plastic surgery in China for years, doing a lot of cleft lip and palate work on children, but is now married to an American, and she is working her way through the three-year University of North Dakota's residency program in Bismarck, so she can practice here.

Dr. Jeff Hostetter, residency director of the UNDCenter for Family Medicine, said that before he found Eikamp, he'd been looking for a long time for a language teacher to help his residents' pronunciation skills, as many of them are international transplants.

He said the U.S. just isn't producing enough primary care doctors. Last year, the U.S. medical school system produced only enough doctors to fill 37 percent of the vacancies around the country. "The rest of the people have to be from other countries."

So when his program looks to fill residency spots with international doctors, they want to pick the best ones, as far as medical knowledge and expertise. "They don't necessarily have the best language skills,"he said.

He said that in 1999, the program had a resident from Asia who was so hard to understand, "We couldn't understand her."

Supervising staff had to pretty much be glued to her side to oversee her work with patients. "She just muddled through … faculty sort of got her through,"he said. She is now practicing in Taiwan.

He said it was after that experience that he realized it was important to get some professional language skills help for their residents, but they hadn't been able to find anyone until Eikamp.

He now is paying Eikamp $25 an hour for residents to get twice-a-week private sessions for two months. "If they want more, they pay for it themselves."

He said it's worth the money.

Since January, Eikamp has worked with Lawson and Dr. Emiliya Hill from Russia.

"They are much more clear in how they pronounce …" he said. And he has noticed a difference in their confidence level. "Before, they held back because they were self conscious."

Hill said he remembers, pre-Eikamp, telling her many post menopausal patients that they need "cow soon." They didn't understand. "I didn't know what to do,"she said. So, she'd have to write it down. Now, with Eikamp's help, she can let them know they need "calcium."

She said she has friends in other residency programs, and she's never heard of a residency program that does this for its doctors. She said It's usually a sink-or-swim situation.

Eikamp works around the residents' schedule, coming to the downtown clinic where they see patients. Otherwise, there probably wouldn't be time.

Theoretically, first-year residents work an 80-hour week, but often work more, Hill said. Home is a place to sleep, right now. She was taking a break from doctoring recently at the clinic to drill with Eikamp, repeating words.

"Sheep," Eikamp says. "Ship," Hill said back. Not quite. But another try and she got "sheep" right.

Eikamp said she's also working with an Arabic-speaking wife of a local doctor who has been isolated at home because of her language limitations. She also plans to work with other groups; international college teachers and international employees at businesses.

"It's a dream job," she said.

(Reach reporter Virginia Grantier at 250-8254 or at virginia.grantier@bismarcktribune.com)