Abstract
Yale University medical and PA students express their gratitude in a compilation of reflections on learning human anatomy.
Voices of the Class
Alla Lescure Smith, YSM Class of 2011, Physician Associates of 2009
These are the “voices of the class,” the responses of the first-year medical and physician associate students to a series of questions about their experience in anatomy lab. The questions weren’t easy, and our answers weren’t simple, but it is this complexity that allows the narratives to weave together to tell the story of our donors. Ours is a unique and profoundly personal tale — one that manages to be funny and tragic and disturbing and uplifting all at the same time. What it is, at its core, is an honest story.
Describe your feelings when you first saw your donor.
“My group had a moment of silence when we first saw our donor. I privately prayed for him and thanked him for his gift.”
“I found myself trying not to feel anything so that I would be able to look at this human body objectively.”
“When I first saw my donor, I imagined him as kindly grandfather.”
“It was less scary than I had anticipated. When I touched her, she did not feel human.”
“I felt as if I was about to cry.”
“The first time I saw my donor I shuddered. She was ‘too human’ in a way. She still had nail polish on. I wondered what she was like in life, if she was happy, if she had accomplished everything she wanted, and if she really understood what we were going to do to her.”
What are you doing with your anatomy clothes?
“I am keeping my anatomy scrubs — after I wash them, of course.”
“I wore my anatomy clothes to our intramural basketball game.”
“I don’t know what to do with them.”
“I took them home with me as a keepsake of my experience.”
“They went right into the trash.”
“I am keeping my scrubs. I don’t care what people say.”
Describe the most enjoyable moment in anatomy lab.
“I treasured those moments of glory when we finally dissected something properly.”
“The practical examination was fascinating, because we were able to see the variability among donors.”
“The first gut lab was true fun. Everyone was in discovery mode, and we felt like children picking bugs out from under rocks. Nothing but curiosity and satisfaction.”
“I’ll never forget when one teammate, bent over our donor’s abdomen, suddenly straightened with a strange look on his face. He turned to us and said, ‘Uh-oh, I taste something I shouldn’t be tasting.’ Our group had a history of perforating the bowel so it was clear right away what he meant. And without missing a beat, another teammate said, ‘Don't worry, that’s just the taste of success!’”
What was the most difficult body region to dissect?
“I think the worst part was the pelvis lab, where we bisected her and cut off a limb. Up until that point, it wasn’t as bad for me because at the end of lab we would pack her up neatly and she still looked, for the most part, the same as when we first met her. That lab was the one where it hit me that she would no longer be whole.”
“The day I removed the brain was the most difficult for me. I realized that I had done something that most people never even see in horror movies.”
“I thought the first incision of the first lab was the hardest. It seemed wrong to cut into an otherwise ‘unscarred’ body.”
“I found it horrifying to cut through the fine, soft hair of a gentle older lady.”
“I stepped back at one point during the skull and brain lab, stood atop a sink, and looked out at my classmates, all working industriously on what the dissection manual had called for. And I thought, ‘My God, what have they made of us?’"
“I struggled with the pelvic lab. It was very difficult for me to see the crude, rough saws slicing through the most private areas of a person’s body and the legs splayed at unnatural angles on the tables. The lab looked like a slaughterhouse.”
“The face is what makes us all human, and destroying that felt very wrong.”
What lab reminded you of your donor's humanity?
“My donor felt most human when we were dissecting her hands. They were fragile and beautiful and not unlike my mother’s or grandmother’s. I could imagine them stroking my hair or reacting to our movements.”
“During the arm dissection, I noticed a tattoo on his shoulder that resembled one that a service member might have.”
“The hands and face reminded me of my donor’s humanity, so those parts of the body were the most difficult to cut into.”
“When we turned her over, I saw that she had scars on her back, the remnants of bed sores. It was hard for me to imagine that she may have been in pain toward the end of her life.”
“On that first day, when we pulled back the drapes to reveal his face, I remember being struck by his humanity. His hair was combed, his lips curled into a peaceful smile. I recognized a fellow being at that moment. I’m not sure where he went. When did we lose him? When we took his heart? Sliced open his abdomen? Cut off his penis? Dissected his fingers? Removed his brain? Split open his face? So much well-meant and brutal excavation.”
“I was surprised at how mundane my feelings were throughout most of anatomy. I didn’t stand there in a constant state of reverence. I couldn’t maintain that initial awe I had when I first saw my donor’s face. I was working — concentrating on ligaments and invisible nerves — sometimes I was hungry, sometimes cranky. But despite all that, I cling to a few small memories: One lab, about halfway through the course, I found myself staring at the curve of my donor’s jaw, reaching out my fingers to touch it. It was a moment of peace, a breath of calm, and in that instant, for a few precious seconds, I understood the magnitude of his gift. Perhaps that is enough.”
Letter
To you,
Tangibility can wear away wonder. Wonder is shapeless, without scent. When given form and sensibility, it gains definition and loses identity. And perhaps that’s what you intended to give us, or were supposed to give us. Something to create lines around and between our vague notions of the body and life. I can never say for sure, but it seems to me that naturally and generously you would want to dispel mystery, exchange wonder for knowledge.
And there is no doubt that from you I received, gradually and in sudden doses, tangible, knowable things. Certain images are irrevocably vivid. Your ligamentum arteriosum, because we located it based on function and surroundings. The long tendons of your arm and hand, because we moved them to move your fingers. The subdural hematoma that engulfed your brain, because it fascinated and hurt me.
Each time I left you after another discovery, what I’d seen and held lingered for some time, as sensory experiences aligned themselves with hazy internal conceptions. With no barriers, the mystery we wanted to solve seemed to be bound only by our curiosity, and our untaught curiosity was weakly tethered. We peeled pieces from you, and as we sifted and rearranged, we blackened in empty spaces. Your gift filled them in.
But strangely, as layers were stripped away and details were unmasked, mystery still remained and holes widened and wonder grew. Even as the facts solidified, the concrete dissolved into something amorphous. It wasn’t a mere return to the ambiguity of not knowing our anatomy; this unknown was of a new sort. The expanse of what can’t be explained crept beyond its previous edges and grew in parallel with, though perhaps out of proportion to, what we learned and could explain.
Whether the unknown has to do with your particular identity and how you became this body with its particular nooks and oddities, or with the general workings of us and how we are similarly made, I’m not sure. Within that uncertainty lays much value, and even more than the beautiful anastomoses that connect, these threads without anchor keep me tied to you.
How do you do that? The question is of the rare kind that asks not in curiosity with anticipation of an answer, but in wonder at the impossibility of answering. How in the midst of so much exposure do you keep something hidden? For all that you’ve shown, it’s this cove you guard, whether intentionally or innately or both, for which I’m most grateful. In giving so much to hold, you molded something that escapes my grasp. For that, and for more that is inexpressible and intangible, thank you.
Poems
My love is in my heart
Ogechukwu Eze
And with my eyes I saw you
I touched you
I cut you
My love is in my heart
I cut swiftly and with ease
In their eyes I should be a surgeon
I cut swiftly, they stalled, hoping to make perfect incisions
And I watched while they made rude, hesitant incisions
My love remained in my heart
Silently I wept
I was angry and impatient with them, with myself
I hated every moment that we mutilated you
They thought I enjoyed hacking you in two
My love is still in my heart (I think)
And I saw yours
I held it and wondered who you loved with it
Who loved you
While they learned about the arch I wondered how I'd heal
While your chambers lay empty I felt mine engorged
Your love was in your heart
And with it you did this thing which I still don't understand
Where is your love now?
Is it with us still?
Is God really love?
With your love, you did this thing which I may never understand
Was it worth it?
I don't think I will ever know
Guilty
Mona Sadeghpour
I am sorry if they didn't tell you it would be this way
Iam sorry to have seen you lie there cold, alone, naked
I shuddered in shame and pain as we picked up the knife that very first time
I apologized to you before that first penetration of blade into your tired skin
I am sorry if I did not apologize to you more often after that day.
I am sorry if it became easier for me to accept it all
I am sorry for that first cut . . .
You heard the sounds of the novice carpenters at work:
Our chisels, hammers, and saws
I am sorry to tell you that even that was a hoax,
For unlike the carpenter whose tools create a beautiful whole
We took the art, broke it, and did yet not know the ways to put it back together.
Just know that with all this I became broken too
And yet I have never been happier to be broken so
For what has fragmented me is that force that brought me here in the first place:
Our natural and sacred connection as two human beings
We have been connected this way all along.
Andn this guilt, this pain, is a remaining trace — my reminder — of that brotherhood.
Lab 16
Fiona Horgan
Today's session begins just as those gone by.
As my labmates begin to unfurl the gauze and commence our exploring,
instinctively, but unbeknownst to the others,
I am quick to assume my self-appointed duty of rewrapping,
carefully ensuring that her hands are not exposed.
Is this naïve, knowing that today would come
and I would have to spend my entire afternoon focused on them?
And why, after so many hours with her,
so many delicate procedures,
does looking at her hands still stir unparalleled emotion in me?
"Trace the radial artery . . ."
I only see hands that still possess the pallor of life,
nails bearing the remnants of rose-colored polish.
Did a loved one tenderly paint them?
And did they hold her hands as she faded from this life?
I search for her pulse.
"Divide the transverse carpal ligament . . ."
Isee my grandmother's hands.
Hands that expertly smoothed wrinkled sheets.
Hands that pressed coins to buy sweets into her grandchildren's eager palms.
Hands that wore a symbol of my grandparents' love for 56 years.
I trace the fine lines on her palms.
"Examine the thenar muscles . . ."
I see my mother's hands.
Hands that nurture children when they are sick.
Hands that dance along piano keys.
Hands that feed and clothe the homeless.
I smooth her wrinkled skin.
"Identify the tendons of the superficial and deep digital flexors . . ."
I look at my hands alongside hers.
They are the tool with which I will first touch my future patients.
Each time I lay my hands on those I hope to heal,
I will remember hers.
I reach out and fully grasp her hands.