There is an animal beauty to her, haughty, and defiant as she is. His admiration soon, however, turns to frustration. The very qualities he appears to admire in her prevent him from proceeding with the examination. Her mouth clenched shut, the doctor is driven to a frenzy by his uncooperative patient and he expresses his frustration increasingly in physical force, and ultimately in violence. The disturbing quality of this story lies precisely in that implacable slide into violence.
Reason is lost and something uglier and more primitive takes over.
The narrative culminates in a kind of brutal oral rape. The wooden tongue depressor is shattered, and an unwieldy spoon takes its place with the child gagging and bleeding. There is a justification, of sorts, behind which the doctor tries to hide, but even he is shocked at his loss of balance and control. The relationship here is broadly symbolic and represents conflict and the abuse of power. Alternatively you can see the story depicting a kind of institutional aggression .