Trepidation

BOOK REVIEW  BODY OF WORK

I just so happened to stumble upon this book four years ago, and was immediately intrigued by the synopsis. It is a very well-written, poetic, honest piece about one of the most nerve-wracking experiences in medical school: dissecting a human cadaver.

In Body of Work: Meditations of Mortality from the Human Anatomy Lab, Christine Montross (now Dr. Montross) keeps a reflection of her thoughts, emotions, mental state, and processing of the stress of dissecting her first cadaver as a medical student. I also love how she adds the history of the use of cadavers in medical education. Montross was a poet and high school teacher before entering medical school, so I appreciate her non-traditional, varied experience before starting on this grueling process into what is essentially the first thing that molds and separates medical students from their families and friends, a rite of passage and initiation into medical school and the profession of medicine itself.

This book really pulls at my heart because it is very much a medical humanities work—she is very thoughtful in her reflections; no detail has been spared, and it almost feels like the only subject she studies in her first year is anatomy, given her attention to detail. She describes her first apprehension when she picks up her box of bones—from a former breathing person—to take them home for study; she feels incredulous that she is walking down the street with this secret, that ‘normal’ people would never guess what she is carrying and she is all at once stressed, scared, nervous, and excited.

{I also love the fact that Montross uses an excerpt from the Sophoclean tragedy Antigone in her work. I’ve always had a love affair with the Greek tragedies and epics. My first, behemoth orchid is named after this play. When my grandmother gave me a second orchid, the only logical choice for a name was Ismene, Antigone’s sister. So when my great-aunt, who is basically a third grandmother to me, gave me a third orchid—and Antigone only has the one sister—the only logical choice was Penelope from, you guessed it, Homer’s The Odyssey.}

076

(Antigone, the behemoth. Because this post needed a pretty flower.)

Throughout the book, to me, it’s reassuring that she never lost her humanity in this process, and in her mind, neither did her cadaver. My recurring nightmares about gross anatomy have dissipated in recent months. I thought maybe they would resurface while I reread this particular book again. They haven’t; at least, not for now.

I’ve had various experiences with death. In graduate school, one of my elective courses was Death and Grief, a social work course. This class was very interesting, and wound up being one of my favorites. We kept journals to reflect upon our thoughts of our own deaths. We had many one-on-one discussions with classmates about our experiences with grief and the grieving process. We learned how to council those who were grieving, including the dying patient and their families. We studied the famous stages of grief described by Elizabeth Kubler-Ross. Parts of the class involved videos of the embalming process and how to help someone have a “good” death—since the end of life is a very important part of life. We studied various burial ceremonies and belief systems of different cultures; we analyzed the stages of grief in the movie W;t, to which I was most interested in the bioethics behind how the main character was treated (not with medicine) by her physician through the unfolding of the disease. When I took this course, I had already read Body of Work and mentioned it in my journal; Dr. H is now using it in her class.

As a student of biology, it’s pretty much inevitable that at some point, you’re going to have to dissect something. My first dissection was in high school bio. The frogs ran out before my partner and I got one, so we got a fetal pig instead. I did most of the dissection since my partner was squeamish. I loved learning by doing and seeing how “normal” has many variants (our piglet was missing her gallbladder.) Since then, I’ve had college-level bio and basic human anatomy, and have studied/dissected cows’ eyes, sheep brains, pigs’ hearts. Conceptualizing the structures as a three-dimensional object and seeing firsthand how the structures function has been a better learning experience than just looking at pictures in a book. To clarify, in a book, it’s hard to determine which thing is over/under the other thing.

But, all of these organs that I’ve dissected have been dismembered, disembodied pieces before I got to them (minus the piglet). I have no idea if that is why I coped so well then. The average age of a body donor at TOD, I’ve read somewhere, is over 80 years old. These will not be nice, pink, fresh, toned bodies. These bodies will exhibit their wear-and-tear, clues about their professions and events in their lives, all sorts of secrets. As a volunteer with hospice, I’ve seen the final stages of life in several people, ages 84-102. It is not something I take lightly or would call enjoyable, in truth. I have not yet grown callous toward it; I’m not sure if I ever will. But, I’ve cared for these people and they have left their mark on me, and I am afraid that I will project my memories and fondness of my hospice patients on my cadaver. Only time will tell, at this point.

I’ve also seen three different Bodies: The Exhibition displays. I know there is a lot of controversy surrounding the exhibition, but they do make wonderful teaching/learning tools. The displays are so artfully, beautifully done. I think the most dramatic part about it is how quiet it has been every time I have examined this exhibit; the quiet itself is so respectful, so awestruck. Every time I’ve been, there have been doctors/medical students there, pointing out structures they recognize and whispering to their friends. In most of the exhibit rooms, people just stand and stare. During the last exhibition I saw in Vegas, I was studying for a basic human anatomy course, and musculature was my weakness. I spent more time in the movement section of the exhibition, and I aced my exam. I don’t think it was a coincidence.

I do not remember going to my first funeral. I know I went to several as a child. I do not remember the first time I was told about death, or the first time that I understood exactly what dying meant. Attending a funeral did not stress me out or make me fearful. Funerals of all sorts can show a great deal about who the person was; I’ve been to an Amish wake and a ‘celebration of life’, where the deceased missed his own funeral–two very different takes on the same essential part of life.

My grandmother passed away while I in my first semester of graduate school. As the family paid our last respects, when it was my turn, I placed my hand over my grandmother’s folded hands, bowed my head, closed my eyes, and prayed. I told my grandma how much I loved her, how much I missed her already, and how I always would. Afterward, I noticed several expressions of horror written across a few faces. I’m sure they thought I was totally out of line and completely disrespectful, but I’ll be damned if I’m going to let anyone tell me that I cannot touch my grandmother as I share my final act of love toward her, this lady whom I have hugged and kissed and loved because she was mine, and an essential part of who I am. I know that she would not have minded. She would have told me I was her “precious little doll” and she loved me very much. Touching her did not disturb or bother me in any way, shape or form.

But that was something else entirely. Touching is harmless, right? But what about cutting, tearing, sawing? It seems so barbaric, so inhumane. So wrong. Yet it will be expected of me, my classmates as a whole, and my tankmates in lab. Right now I cannot fathom myself doing it. I do not know if I am up to this or not. Montross’ unease with cadaver dissection is exhibited in the words she chooses: Trepidation. Unsettling. Emotionally tiring chore. Innately wrong. It is still, after all this time, something that is taboo. Although I’ve dissected in lab—I’ve never done anything like this, and I cannot feign any sort of expertise. Something like this, in my mind, deserves expertise, because this was a living, breathing, loving, hoping, dreaming person who has given a great gift, opportunity, to us to learn from their body. I am a neophyte, a fledgling, a beginner. The cadaver is dead and will continue to be dead. Even so, I am already afraid that I will harm him or her. Montross calls it a paradox, learning to heal the living by dismembering the dead. Malicious intent, though, is absent. A book that Montross quotes says that it isn’t about cutting at all, that the student’s job is to “separate the parts” (p95) in order to learn, so that structures and landmarks are exposed and not ruined. Even so, the idea of doing it myself seems unthinkable.

Montross also quotes George E. Dickinson’s (et. al) Detached Concern and Death Anxiety of First-Year Medical Students: Before and After the Gross Anatomy Course: (page 137 in Body of Work)

”Medical training is more accurately characterized as a process of resocialization, that medical students are not only “passing through” an experience intended to refine previously established values, but that those previous identities must be repudiated and new and countervailing identities assumed….”

Resocialization.

What a description.

Another thing I like about Montross’ book is that she also dispenses knowledge about things that will prove to be helpful in medical school this fall, things I have already pondered:

“As the list of items for which we are responsible grows, I accept that no matter how hard I study, there will be questions on the exam whose answers I simply do not know.” (p140)

“At the start of the year, in this opening speech, an associate dean warned us that we would each feel ill equipped many times over the course of these years, that we would wonder whether we are up to the challenge, whether we belong.” (p145).

Her professor tells them after the first exam, “The practicals also tend to expose problems for folks who haven’t spent much time with bodies other than their own. So make sure you’re checking out structures on several different cadavers, because structures can really vary from one to the next, and it’s a great way to be sure that you know your stuff.” (p161)

“I did know, however, that any discomfort I was feeling in the anatomy lab was interfering with my ability to learn important medical information. And whether my future patients would require clarity or knowledge, my ability to manage my own discomfort in the face of their bodies and their illnesses would be one of the most critical lessons of my medical training.” (p175).

I am considering this post to be my “before” reflection. “Trepidation” was a very good choice by Montross. Even having been exposed to performing surgeries at work using scalpels, scissors, and forcepts, my participants there are alive and remain alive afterward. I’m full of questions about how to go about this sort of dissection. At this point, I have no idea who will be my team members for dissections; I’m sure we’ll each have our own levels of inadequacy. For my class, my school is switching from semester-long Gross Anatomy to year-long Gross Anatomy. I’m hoping this means that I will have more time to process the information we’ll have to memorize, and maybe more time between exams. It’s still too early to know, but it’s quickly approaching, so I’m hoping to prepare myself for this experience as much as I can. There is another book I purchased and have read that is a compilation of journal entries from a group of students in medical school that actually has (although some are blurred out) pictures of what they are actually doing, called Anatomy of Anatomy in Pictures and Words. This compilation also echoes the facts that no one is ever truly prepared for what we are about to experience. I am not sure if this is comforting.

There are things about my own body that I don’t like. I wonder how dissecting a human cadaver will change the way I feel about, think about, and take care of my own body. With 5-7 concurrent classes, will I even have the time to think about it or reflect on it? I am hoping that by already having a basic anatomy course that I will at least not be overmastered by the new vocabulary I’ll be learning, in addition to already having some familiarity with basic geography of the body. I hope. Montross describes this part of her education as, “There is no need yet for any kind of original thought. So far our learning is regurgitation at its most pure.” (p85) In a way, I guess I realize this from reading so much about medical school and hearing so much about it from friends. “It’s like memorizing the phone book.” “It’s like trying to drink from a fire hose.” However, I am hoping that I can work on my own projects in such a way that I do get some sort of outlet for these “original thought”s during this stressful, tedious learning curve. If naught else but to maintain my sanity. This is where writing has helped me in the past (and present, hence the germination and evolution of this blog), and I am sure it will continue to be an outlet while I grow through this experience.

I’m really glad I took the time to revisit this book. Since my first perusal, I’ve studied the bioethics of patient interaction and health care; I think it has skewed how I rationalize this content, in a good way. I have so many hopes for the next few years. I have no idea how I will adjust. I still have no idea what it is really like to be a medical student. I have no clue how much stress this is actually going to be. I would love to be one of those rock star students who can do it all and make it look easy, but I have a suspicion that that will not be the case! On one hand I can count the number of times in my life that I have “tossed my cookies”; in this process, will I be able to keep my composure? Will I have nightmares? Will I get sick? I have no idea. I hope I come out the other side enlightened but not jaded or callous. I hope to keep my humanity, as well as preserve my cadaver’s, in the same way Montross did in this book.

‘Do not fear, for I am with you; Do not anxiously look about you, for I am your God. I will strengthen you, surely I will help you, Surely I will uphold you with My righteous right hand.’ Isaiah 41:10

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s