On Becoming a Doctor:


We don't know who they are. We will never know why they chose to be here. To them we are Medicine. To us, they are The Human Body.

I was a lucky one. Anatomy lab presented me with my first real experience with death. On the first day of medical school, I faced a room full of dead people who had chosen to donate their bodies to medicine. I met my cadaver, and became acquainted with her body. Over the course of the block, I developed a more detailed understanding of her anatomy. I traced her splenic artery to the celiac trunk, her median nerve through the brachial plexus, and the entire length of her gastrointestinal tract.

Yet my introduction to death feels backwards. I was thrust into the physicality of death without experiencing the human struggle of the dying process. I knew my woman's body more intimately than any other living person, but I knew nothing of her spirit or anima.

The preparation for the lab had stripped away even the most basic clues to her personhood. The fixative obliterated her years and made her ageless; the dissection process chipped away at her body to make her formless. Her face was sealed away in its muslin shroud.

At the memorial service for our cadavers, one of my classmates voiced her struggle to make the transition from the physical body to the uniqueness of the individual. "Every time we would look at a new structure," she said, "I would think, this is the one that's going to be different. This is the one that's going to make him special. Yet every time, it was the same. All our bodies looked the same."

Almost all of us dreamt about our cadavers at some point during the anatomy course. Dean Ed Hundert forewarned us; it's common. I was prepared for nightly visions of scalpels dissecting, and gloved hands retracting. But my recurring dream was about holding my cadaver's hand. In the dream, all five of us were standing in our customary positions around the gurney, obviously at work on the body. I was holding her hand as one might to reassure a friend or relative undergoing a painful and frightening medical procedure. In my dream I was forging the human connection and bond that cannot exist in the lab.

Despite the frustration with the lack of personal connection with our cadavers and our attempts to create it, I don't think I would want to know any more than I did. It would be too painful to dissect structure after structure with the burden of personhood, and the relationships and responsibilities it entails.

But if my first experience with death was with the physical, it wasn't long before I confronted the emotional, human aspect. I received my initiation into the struggle of the dying process fairly soon after my anatomy experience. Betty was 74, dying, and alone. Alienated from her family and isolated from her friends, she was finally ready to die of congestive heart failure after outliving a one-year prognosis by 11 years. She was struggling to assert her personhood even as she began the process of relinquishing her humanity. She was frustrated by doctors who no longer made time for her; she attributed their brusqueness to her rapidly deteriorating medical condition.

"I understand that it is difficult for them to get close to someone who is dying. But when they don't say anything to me, it means either they have nothing supportive to say as physicians, or they don't care as people," she said.

And there have been others. There was Denise, 16 years old and in the terminal phase of AIDS. She had watched her mother and her younger brother die of AIDS the previous year. Now, she mostly watches television all day. We asked what her favorite show was. "I don't know." We asked her favorite actor. "I don't know." Her favorite thing to do. "I don't know." She had already begun the process of relinquishing her personhood. And there is the couple with AIDS. They have begun discussing auctioning all their antiques in preparation for their deaths. They have stopped setting longterm goals for themselves, although not for their cat. Inky has been put on a diet.

I think about them almost daily. I think about Betty the most. Her physicians didn't expect her to live past December. As I was planning my trip home for winter break, I thought about Betty and wondered if she were still alive. Was she able to reconcile with her family? Was she able to forge a more meaningful relationship with her friends?

I find myself drawn to these dying people. I am taken with their struggle to be human and to be a better human in the face of death.

At times, during this first year, it has felt like death is everywhere. In anatomy lab, we finally uncovered the facial shroud and hemisected the skull, and that was OK. I talked to a patient who had nearly died the previous evening and would certainly die within the next months, and that was OK. I came home, and my goldfish had died, and that wasn't OK. I sobbed for half an hour.

Through my anatomy experiences and my conversations with terminally ill patients, I am grappling with the human and physical aspects of death. And it's overwhelming.

--E. Rothman



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