Anatomy of an Education
Tuesday, July 17, 2007
BODY OF WORK
Meditations on Mortality From the Human Anatomy Lab
By Christine Montross
Penguin Press. 295 pp. $24.95
Some of us, maybe most, are thankful for skin. We're the ones who fear that listening to heartbeats will make them stop. Our eyes slide away from the veins outlined on our wrists. We shudderingly avoid checking for lumps in our breasts. We are decidedly not fascinated by the mechanics of childbirth. We do not (or cannot) acknowledge that we (and everyone we care about) are mere amalgamations of blood and organs, nerves and bones. We are grateful for the shielding cloak of skin.
But that, of course, is the first part of the cadaver that Christine Montross cuts in human anatomy lab. "The skin of the chest pulls back easily after we have made the incisions," she writes, "and the body opens like a book." Montross was a poet before she was a doctor, and her language in "Body of Work," an exceptionally thoughtful memoir about the first semester of medical school, is as precise as her scalpel cuts become by the final exam. "The body is staggeringly complex," she explains, "and to understand it with any degree of completeness demands dealing with the thing itself -- picking up and holding the heart, tracing the path of an artery by threading a pipe cleaner through its lumen."
When Montross and her three lab partners meet their cadaver -- a woman -- her hands, head and feet are covered in cloth and tied in plastic, to "depersonalize the body." And yet they feel compelled to name her Eve, for her lack of a belly button. (They never determine why she doesn't have one.) It's as if they had to humanize her before they did things to her that would be taboo, criminal even, without the saving grace of medical training. Perhaps they were apologizing in advance. By the third week in anatomy class, they have "removed her heart and lungs from her body, tying them in a brown-black garbage bag. . . . Her rib cage falls to the table as we turn her, and one of her removed breasts lies out to the side of her, facing the ceiling as she lies facedown."
In carefully recounting her reactions to each step of Eve's dissection, Montross conveys the sheer differentness of doctors, if only because of what they've done in anatomy lab. By taking apart a formerly living human body, they've crossed over into a wondrous and strange country forbidden to the rest of us. But the question that dogs her throughout the experience is "whether we have a right to pursue wonder in seemingly inhuman ways."
And the answer to that question depends, in part, on where the dissected body comes from, an ugly tale in many eras and places. Eve chose, while still living, to donate her body to science. (Montross never learns her real name or circumstances.) Historically, though, students of anatomy robbed graves and made dank deals with executioners. One of Montross's many interesting digressions is a trip to an anatomy lab in Padua, Italy, the supposed birthplace of human dissections, which was equipped with a tunnel to allow for night excursions to recently dug graves.
Even now, the provenance of cadavers in some countries gives one pause: An Iraqi pathologist told Montross that all the bodies he trained on appeared to be from Southeast Asia, and he had no idea why; in Nigeria, they are purported to be the homeless and the criminal, but with a corrupt government such descriptions are suspect. And yet, lest Americans get too smug, Montross points out that the live patients she saw as a medical student were predominantly the poor and uninsured who attended university clinics: "Does the practice of dissecting the unwilling dead differ so distinctly from novice trainees operating on patients who believe that their procedures will be done by experienced veterans?"
Such ethical conundrums, as well as the sheer physical and psychological difficulty of dissection, weigh on Montross and her classmates. For instance, "in order to remove the skin from the hand," Montross explains, "we must, by necessity, hold the hand in ours, an intimate and familiar gesture that makes the directive to take a blade to the skin all the more unsettling." The skin on the palm is tough; instead of the usual one or two scalpel blades per session, Montross goes through five. "It is an emotionally tiring chore." And she dreams, most nights, of skinning people. She also realizes, slowly, that the anatomy lab is not just a place to learn dissection, but an opportunity for the students to explore their own emotions. "As doctors-in-training," Montross writes, "we are reshaping the ways in which we react -- in fact we are suppressing universal reactions of fear and grief and horror."
And yet, she is grateful to Eve and to the lab for "the unthinkable gift I have been given." We should be grateful, too -- especially those of us who squirm away from the physical truths of our existence -- for this beautiful book and the glimpse it offers of a place off limits to anyone without Montross's clearsighted courage.