I wish I remember how I stumbled upon this incredible text, but I honestly don’t. Nonetheless, I don’t think it would be an exaggeration to say that in many ways Dr. Christine Montross’ Body of Work: Meditations on Mortality from the Human Anatomy Lab got me through the first year of medical school.
I’ve been very open about how anatomy lab was and still is one of the most transformative and difficult experiences of my life, both as a subject of study and emotionally. When I first began studying anatomy, I did recognize the great privilege it was to study the human body from this perspective. I was almost unspeakably grateful to those who donated their bodies so that my colleagues and I could become better healers. But when we first started dissections in October of last year, I did not understand how integral this experience was for me as a physician in training. I did not understand why I was learning about how to ‘save lives’ by studying the dead. I felt traumatized. Every time I stepped into anatomy lab, I simultaneously felt grateful, sad and anxious. Everything felt so unnatural. I knew rationally that the cadavers felt no pain during our dissections but that did not prevent me from wincing at the sound of each rib cracking or a saw cutting through bone.
A few months into being in anatomy lab I picked up Body of Work and everything finally started falling into place. I finally did not feel alone in having such an intense response to working in the anatomy lab. Someone took everything I was feeling and normalized it by simply giving me company when I felt like no one understood what I was going through.
In her text, Dr. Montross speaks of her connection with her cadaver Eve. Eve, for some unexplainable reason does not have an umbilicus and that immediately sets her apart from the other cadavers in the room. Dr. Montross walks her readers through her journey from her first cut and everything she felt at that moment to saying goodbye to Eve after her last dissection, thanking her for all that she’s offered and wishing for “…every space in you that I have named flare and burst into light.”
Because the order of dissections is usually consistent throughout various medical programs, I was able to follow along with the text and normalize and reflect on the unique characteristics and difficulties associated with each dissection. The first dissection, usually the thorax, is memorable because it’s the first. It is the point at which you cut into a dead body and snap ribs using something resembling a garden tool. And as the dissections go on, you do somehow grow accustomed to what you’re doing in lab but the reality of the situation tends to sneak up on you when you least expect it. You’d expect the dissections to become easier in some way, but as you progress through your study of this body, you are constantly reminded of the ‘human’ aspects of the cadaver. You dissect the reproductive system and understandably feel as though you are violating a part of this person that was used to express love and maybe even create a family. Then come the hands. The hands sometimes are wearing nail polish and you wonder why she picked that color or if someone had done it after. And the hands are so human because they’ve held other hands and wiped tears and they look just like yours. And finally, you get to their faces. And they look human and not at all human all at once. But it still forces you to think about what you’ve done to this person’s body and how you hope to God that their loved ones never find out. Then it’s all over and you’re just left in awe of how complicatedly beautiful we all are and what a blessing and privilege it has been to study these wonderful humans who believed in you before you even believed in yourself.
“We can make cuts through our cadavers and peel their skin away. We can trace the paths of their circulatory system and marvel at the fragility of vein and strength of nerve. We can curse the difficulty in finding a tiny artery in the thumb or neck and even laugh at our ineptitudes and mishaps. But the humanity of the body emerges in unexpected moments, and the balance of our voyage of a finished life is sometimes difficult to steady.”
I was able to understand what a great privilege it was to be studying cadavers so easily because Dr. Montross writes about the history of studying cadavers and the great difficulty that used to be associated with acquiring cadavers in the first place. She described scenes in Europe of theaters filled with hundreds to thousands of people viewing dissections of cadavers that had often been robbed from graves. She gives an example of a school that accepted cadavers as a form of tuition. She describes the differences in the perception of death in different parts of the world through the actions taken by various medical schools. In some, students who had a recent death in the family were assigned to cadavers who shared no characteristics (age, gender, race) with the person the student had recently lost. While at a Thai medical school, where the cadavers are given the title of ajarn yai meaning ‘great teacher,’ a student requested to dissect her grandfather’s cadaver and was “thought to have especially good support from his spirit thereafter.”
Dr. Montross also reflected on how her experiences in anatomy lab and working with Eve translated to both understanding her own body and caring for living patients as a medical student. She explains how Eve helped her establish the framework she uses to treat every living patient she has worked with since anatomy lab, especially those who may have lost some of the ‘human’ aspects of their existence.
“One of the basic premises I have about lab is that you should have a reaction to it – the thoughts, the sights, the smells – because this is a dead person and you’re going to be dead someday, too, and this is an inescapable association. There are people working in lab with me who never express their emotions. If they don’t have that emotional sensitivity now, they’ll be doing the same thing later on. There are going to be a lot of patients you are going to have to care for that will be physically, or whatever, unable to react to you, just like a cadaver, and you’ve got to be able to make yourself aware of the patient’s feelings, his pain or discomfort, and acknowledge that this as part of your work, something you must have if you’re going to be a good doctor.”
After reading this text and reminding myself that my emotional response to working with the cadavers was not a sign of weakness, I finally had the courage to talk to my classmates about how I was feeling and unsurprisingly a majority of them had also had similar responses to the experience. As I’ve stated before, I’m currently working with the education department to create a space for first year medical students to discuss the mental and emotional transitions, particularly with anatomy lab. I’m currently attempting to get this text associated with the anatomy curriculum and provide all the incoming first years with a copy of their own so that they may navigate their own journey with the help of Dr. Montross.
As physicians in training, we’re expected to be superhuman. To spend a majority of our time learning about hypothetical patients and all the possible things that could and will be wrong with them. All the disasters that may occur if you don’t catch said things in time or provide incorrect treatments. To deliver horrible news of terminal diseases and then immediately walk into the room of a new patient, set aside everything you’re feeling and give your undivided attention. All while remaining empathic and compassionate. But it seems that no one ever teaches us how to accomplish this and I’m looking forward to a career of helping train generations of physicians who learn to care for themselves so they can better care for others.