When I first looked at him, his eyes were closed. He was an older African American man, about 65 years old, with a short gray beard, and it appeared he had lived a hard life. Where were his wife and family now? I wondered what he enjoyed, what made him laugh, and what he suffered.
Then, the 4 of us cut through his breastbone, and began to examine the organs beneath. We were first-year medical students, and “Miles,” as we called him, was the cadaver assigned to us for the semester.
Each day, we cut further—the future surgeons enjoyed holding their first scalpels while the future internists debated what was wrong, and the rest of us were simply overwhelmed. What Miles showed us was the sheer wonder of the human body, with bones carrying vibrant parts that protect the beating heart and breathing lungs, with all the other organs which never stopped working together for Miles for those 6 or 7 decades. While at first we were frightened, that feeling quickly gave way to the awe of the magnificent design of the human body. Truly breathtaking in complexity and in the pure beauty of his form, Miles slowly showed us both normal anatomy and disease throughout the semester.
As a first-year medical student, you spend so much time with your cadaver that you begin to smell like embalming fluid, and the upper-classmen make rude comments as they smell you approaching. We took those comments in stride, recognizing that we were becoming part of the club, the enclosed society that is medicine.
Yet, each day, as we looked at a different part of Miles, I couldn't help wondering what else he was trying to tell us. His eyes were now open as the tissue contracted around his head. Sometimes, a tear would come to my eye, and while I pretended it was from the embalming fluid, I knew, as I looked at him stare at the ceiling throughout the semester, that each anatomic part was only a supporting player in his life story. The real story was Miles.
“Do you ever get used to it?” friends would ask about the daily dissection. The truth is you never do. Over the last 25 years of practice, I have seen great suffering and at times, great joy. Yet, the feeling of being overwhelmed by the complexity of the human body, and by the honor it is to stare into each body and attempt to alter the course of a disease, continues to this day.
We all knew that Miles was our first patient. “You owe that guy something,” my mother told me. I have tried to repay him over the last 25 years of practice, and have made it clear that when I die, medical students should take a good look inside of me as well. I hope they see first what is reflecting back at them from the eyes that stare straight through the ceiling.
Footnotes
Editor's Note
Those of us caring for others experience sentinel events that inform our understanding of the human condition and of the caring relationships. These experiences often can be helpful to others through the insights involved. From time to time, we will publish Practice Reflections and invite readers to submit brief reflections, particularly those related to psychiatric or mental health aspects of their practice.
Dr. Kettl is a Professor of Psychiatry at Penn State College of Medicine. Dr. Kettl can be contacted at pkettl@psu.edu.