Noel does not sleep, nor does she eat. She has never had sex, but can give birth to a crying infant every twelve minutes, according to her instruction manual.

Her pulse suggests she is alive, but her fixed gaze and plasticized exterior says otherwise.

In response to the demand for nurses, SF State's school of nursing is turning to patient simulators like Noel to create astonishingly realistic live-birth simulations.

"If someone says 'We're going to do a medical simulation and we've got this mannequin who is going to give birth' - think about that for a split second," said Ed Rovera, SF State's health informatics specialist. "That's a hard concept to grasp until you physically come in here and you see it happen."

Since last summer, SF State's school of nursing has been accruing patient simulation technologies, like human patient simulators and audio and visual recording equipment to advance the skills of students safely and effectively.

Patient Simulators, or "plastic patients" as they call them around the department, are used for a number of standard medical emergencies from broken limbs and superficial wounds to severe mid-birth hemorrhages.

"We learn a variety of different skills from them," said Sauda Abdic, 32, a level two nursing student at SF State. "Working with the simulators was a very realistic. Because they're as heavy as real people, we learn how to handle patients."

Noel, a birthing mother simulator, is SF State's most advanced patient simulator with the ability to urinate, bleed, and turn young students bright red with embarrassment.

"One student was totally embarrassed; it was so real to him," said Kathy Shea, the nursing department's simulation coordinator. "He had to clean up the after birth and he felt like this was really a patient."

But students are not the only ones taken aback by the life-like simulators.

"They're like real people - their eyes dilate, if something goes wrong they die," said Lee Blitch, vice president of university advancement. "They really improve the quality of nursing training."

With the help of Lisbet Sunshine, SF States director of government relations, and the late Rep. Tom Lantos, the school of nursing received $30,000 from federal earmarks to buy patient simulators, according to Blitch.

The degree of response to student care varies in accordance to the simulators "fidelity" or mechanical sophistication.

The low-fidelity patient simulators, or Man-E-Quinn, lack physiological variables and are used primarily for basic skills of nursing like wound dressing, catheterization, I.V.'s, tracheotomies, according to Rovera.

"The cough they moan, they gag, they have breath sounds and heart sounds, but that's about it," said Shea. "They don't have a response to medications like the other higher fidelity simulators."

High fidelity patient simulators are controlled by an instructor in a viewing room hidden by a one-way window. Instructors like Rovera and Shea control the exercise as students tend to the "patients" needs.

"We've basically reached the point where we believe its happening," said Rovera. "And that's exactly what we want."