Image Credit: Charles Landseer
We were told a lot about a medical student’s first time in the anatomy lab. We were told that our donors, which is what we were to call the embalmed human cadaver assigned to each group of four students, that they would be our first sight of death in its bluntest, most raw form. And that is what they were, dead humans on tables. We were instructed to destroy them with our bare hands.
It’s okay to feel scared, our professors informed us. Students will feel sad, stressed at times, suffocated even. One of the professors, all PhDs in anatomical science, told my group about a time long ago when a student fainted upon uncovering the hand! (Exclamation not my own).
“Wow,” I remember saying.
We were given an hour of lecture on coping strategies for the semester, the thoroughly memed “wellness talk.” We were told to write poetry, to put our introspective “all” into mandatory reflection exercises. I originally intended for this essay to be a poem, but that did not work out.
We were told to visit the local art gallery, and to draw what we saw. We were told to see the professors not just as teachers, but as amiable pals with open shoulders. Staff from the division of medical humanities would walk around the lab, just in case we had an epiphany or a nervous breakdown or something. We were told that we may need to see therapists. I do not remember being given a number to call. We were told that learning anatomy is very hard.
And indeed, the first day of the anatomy lab was trying. My classmates and colleagues, about a hundred of us in total, filed wordlessly into the long rooms that guarded our donors. The first thing I noticed was the temperature, because it was freezing. Everyone had to wear latex gloves, and these pee-colored, wispy aprons that wrapped around our clothes, which were either old pajamas or baggy scrubs that most of us had bought cheap from Wal-Mart. We looked stupid.
A professor went around to debrief every group and to help with unsheathing the white bags that covered our donors. “Everything will be okay,” I remember him saying to us. Five times.
From the table beside us, whose donor bag seemed to be many magnitudes larger than our’s, I overheard a girl chatting in an absurdly loud voice about how she had read Christine Montross’ Body of Work to prepare herself for this experience. As I recall, during that semester she was the only person in that room who cried. Whether it was from a feeling of overwhelming beauty or not I never quite knew.
Woosh. That was the noise the bag made when we took it off of our donor. As we did this, the professor read from a sheet. He informed us that our donor’s name was Iris.
Whether we referred to the donor as “it” or “she” was up to each student. Being the stone-cold rationalist that I was, I opted for the former.
“Iris was a bank teller,” our professor told us. That was all we were allowed to know.
After the bag was removed a long, white cloth remained covering the body. The emaciated silhouette was not at all subtle. My group members and I stood, two on each side of the table, coincidentally separated by gender, and together we lifted the cloth from the cadaver.
In the morning hours leading up to that moment, I had found myself thinking about television. I thought about the Frankenstein monster, specifically the cartoon rendition in Scooby-Doo! I went through images of flesh-eating zombies, lumbering about the apocalyptic worlds of The Walking Dead or Train to Busan. I remembered the Grim Reaper’s pixelated design in the Castlevania games I used to play as a kid. I lingered over a memory of Bambi, the talking deer, nuzzling the bleeding carcass of his dead mother. I recalled my own paternal grandfather, who at the time was sitting as normal in the family farmhouse somewhere in Eastern China, unknowingly carrying end-stage lung cancer in his body, not unlike the plot of The Farewell if you know that film.
I understand that all this may sound exceedingly cruel and/or crude, but at the time a little bit of cruelty and crudeness is what I believed I needed to survive in the face of death and dying.
We pulled the cloth first from the feet and up until the neck so that the Face remained covered. We were told that it would be best to save our encounter with the Face for later. Each of us took a few seconds to just stand and stare. Iris was clearly a small woman when she was alive. Even when I kept in mind the dehydration and shrinkage inherent to the preservation of cadavers, it still occurred to me that Iris must have been very frail when she died. We all tried touching different parts of the body. It was hard.
“Okay, now let’s flip ‘er over,” our professor said, putting his clipboard on the floor.
(A), the other male student in my group, made a weird backward head jerking motion, like a rooster. Evidently, he had forgotten that our first dissection was to be on the muscles of the back.
It was awkward, flipping ‘er over. (A) took the right shoulder in his left hand, the right hip in his right. I wrapped my hands around the legs. Our professor kept his hands on the Face, making sure it remained hidden throughout the operation. Underneath, you could tell that her head had been shaved. On the count of three we heaved, clumsily vaulting the body’s right side into the air where my other group members, (B) and (C), would catch it and lower the body unto its front. And there it was, as if Iris was awaiting a massage, the wrinkled, squished buttocks an uncomfortable point of focus.
Our professor moved on to the next table, saying to us reassuringly, “Welp, that’ll do it.” A teaching assistant, who was a fourth-year student taking an elective in education, came to replace him at the head of the table. We stared at the teaching assistant until she told us what to do.
Helpfully, she flipped open our dissection manual and read out loud the first set of instructions:
The back muscles are divided functionally into three groups: superficial (attaches upper limb to the axial skeleton), intermediate (for respiration and attached to ribs), and deep (“intrinsic” or true back muscles for movements of the spine, innervated by posterior rami of spinal nerves).
Make the skin incisions shown in Figure 1.1. First, make a midline incision from the external occipital protuberance on the back of the head down to the sacrum. Then, make the indicated horizontal incisions (lines with arrows) and remove the skin and tela subcutanea (superficial fascia) down to the level of the underlying muscles and their investing deep fascia. Reflect the skin flaps resulting from your horizontal cuts as far laterally as the midaxillary line..”
We stood, staring dumbly at her as she read. Medical students are the neonates of the medical world, and our lack of experience and understanding showed in that moment, the first of many. Seeing this, the teaching assistant sighed and turned the manual towards us, revealing a black-and-white drawing of a Caucasian man with incredibly toned back muscles and decidedly firm glutes. With her pinky finger, she drew an arrow from a bump in the back of the figure’s head down to the beginning of his buttcrack. (In medical terms, from the “occipital protuberance” down to the “intergluteal cleft”).
“I need someone to make this first cut,” she said.
Again, there was a good ten seconds of silent staring. Of calculation. Of sweating, in my case.
Naturally, no one wanted to be seen as “heartless.” Medical students above everyone else are hyper-aware of the stereotype, popularized by television shows like House,of the icey and brooding physician who sees the patient as nothing more than a body with a disease. The worst feeling (unless you want to go into surgery, then the feeling is great) is to be labelled a “surgery gunner,” a student who could care less about forming meaningful relations with people and who just wants to work with tools. On the other hand, students have genuine reservations that maybe anatomy dissections will affect them. Specifically in a way that reveals their inability to emotionally compartmentalize, a skill every doctor and concerned parent have emphasized to us since our induction. They worry about being forced to leave medical school if they cannot bring themselves to puncture skin or see blood.
It was for these reasons that I volunteered to make the first cut. This was the way things happened for the rest of the semester. When we were instructed to bisect the skull with a literal hacksaw, I did it. When we were instructed to dislocate the arm and remove it completely from the body, my hand was first on the shoulder. When we were instructed to split the pelvis, and thus the entire lower half of the body into two drumsticks, I pulled the Stryker saw out of the cupboard and just went for it.
I did not hesitate. Or at least, I did not want to give the impression of hesitating. It is not necessarily that I disliked watching indecisive people trying to make decisive decisions, which by the way I do. It is also not because I am the feared posthuman doctor-in-the-making, who has no genuine regard for human dignity. Looking back, I realize now that I was merely indignant. That is, my hunch was that all of this hesitation, this nervousness painted across everyone’s faces about the difficulty of anatomy and anatomy dissections, that it was born not from any real fear of dead peopleper sethat came from within us, but rather from a self-awareness of and a response to the myriad narratives that our professors and popular culture had taught us about what facing death and dying ought to be like, or to mean.
Yet, even with this attitude of indignance even I could not help saying under my breath, “Sorry Iris,” when I brought a scalpel to the head.
“What does it feel like?” asked (C), after I pushed the blade into the scalp.
“It feels like nothing,” I told her. And with that I slowly drew a straight line down the back, just like how it had been drawn in the diagram.
In my experience, first-year medical students typically fall into two camps: the romantics and the nihilists. The romantics applied to medical school with a fervent faith, which some claim to have had since being in the womb, that medicine has a profound, indescribable role in improving the lives of others. These are the students who deep down truly subscribe to the often-mocked mantra that to be a doctor is to really want to “help people.” Medicine for them is both a science, an art, and a life calling.
The nihilists applied to medical school already disappointed. The flow of meaning that gets the romantics out of bed dissolves in the nihilists’ fundamentally transactional and instrumental view of both medicine and medical school. That is not to say that the nihilists are only obsessed with tuition dollars and future earning potential; they too want what is best for their future patients. Rather, what the nihilists want is what is necessary to go on, and meaning for them is not. For them, the role of the physician is not to be revered.
And that is not to say that one camp makes better physicians over the other. Many of the greatest doctors I have met occupied both simultaneously, as I believe they must, holding medicine as both a noble practice blending scientific knowledge with humanism, and as a deeply flawed and unequal institution.
It is, however, an explanation for why the anatomy lab can be such a hollow, confused experience for medical students in either camp. Despite the hope that medical students will be awash with the meaning, pathos, and life-altering dread associated with seeing death up close, and despite our own internalized expectations of being irreversibly transformed by handling a dead human, the fact is that most of us feel nothing at all. When I listen to classmates/colleagues speak about the spiritual implications of anatomy lab, I often hear phrases like “it didn’t affect me as much as I thought it would,” or “I just focused on getting the dissections done, and working with a dead body just became normal to me.” We went to medical school to care for livingpeople. And it is there, in the realm of the living and finite under threat by disease, that the issue of meaning becomes relevant. It may horrify our anatomy professors to know this, but all medical students understand that above all else, death is utterly meaningless.
It was around the time after we dissected the hand that I began regularly calling our donor “Iris” and referring to Iris as “she” instead of “it.”
At that point, Iris’ back had been totally flayed and deconstructed. Her fascia had been eviscerated, her back muscles ragged and fragmented from our neurotic probing and examining. Her trapezius, rhomboids, and latissimus dorsi had been separated from her spine, and flapped outwards like seraph wings.
On her scapula was a dark red stain from when I accidentally cut my finger with a scalpel.
Reading the dissection manual for ourselves, my group prepared to follow the next set of instructions:
“Remove the skin on the dorsal wrist and hand up to the metacarpophalangeal joints. Then, carefully remove the skin on the dorsum of the thumb and ring finger to the nail.”
This I hesitated to do, for the simple fact that Iris’ fingers retained the nail polish she had on when she died. In contrast to her dead body, her fingernails were radiantly colorful. If I remember correctly, they were colored violet.
After some time considering the “dorsal surface,” I realized that the way I was holding her hand made it look like I was, well, holding her hand.
Thoughts naturally flowed from this image. As cheesy as this seems I began to imagine the parents who once held this hand several decades ago, trying desperately to console a crying, infant Iris. I imagined Iris’ spouse with her at their wedding reception, lovingly hand-in-hand in some slow dance. I imagined Iris’ children and grandchildren, seeking that hand for comfort and reassurance. Soberly, I recalled a quote from a novel I loved: “Me. And me now.”
Iris, the bank teller.
When people consider their own mortality, they usually feel very little in the way of despair. The same cannot be said of people who must come to grips with the mortality of their family, spouses, and closest friends.
Meaning, and thus suffering, is circumscribed by the bounds of human care and love. This for me leads to the real power of being in an anatomy lab: to teach us the role of imagination in care, and thus in medicine. Specifically, using imagination to recognize and to delineate a full, lived human life in the coldness of inanimate material. To do what philosopher Simon Critchley describes in his book Very Little . . . Almost Nothingas “the concrete reconstruction of the meaning of meaninglessness, ” which he labels an unworked romanticism.
The achievement of this transcendent kind of connection is to reach into the complete otherness of death and bring our donors into a circle of care, and thus make real the possibility of mourning for someone we never even knew. This is a source of ethics.
Xi Chen is a medical student studying at the University of Rochester. He is currently writing a collection of personal and academic essays about trust and meaning-making in the relationships between patients and their physicians. His work has been featured in murmur and Marginalia Review.