Body of Work: Meditations on Mortality from the Human Anatomy Lab

Book Preface

Flat-calm summer evenings on the northern Michigan lake of my childhood, I’d tug on my swimsuit and wade out in the clear green water to float. No matter how far out I walked, I could hear my family’s voices on our dock, my father’s deep-toned stories, my grandmother’s broad, cackling laugh. But when I’d lie back in the water, arms and legs spread out like a snow angel, the lake would cover my ears with a storm of silence. I’d lie there and breathe, loving the way my body would rise and fall. I thought that I was the only moving thing in the stillness of the deep waters. I’d exhale slowly and let my body sink—my feet and legs first, then hips and chest, and just when all of me was submerged except my mouth and nose, I’d breathe in again and float back to the surface, as if gravity were a law you could choose to disobey.

What was this breath force within me? I never knew. Sometimes I would feel the water seep up to the corners of my nose and mouth; I’d keep exhaling and let my body sink to the bottom. There I’d lie, staring up at the surface, with its mercurial shine. In those moments, with my world tinged in foggy hues of green, I felt like the lone inhabitant of a sacred space: my whole young self held close and rocked by the water. But before long, out of air, I’d have to thrust myself back to the surface to float some more. When I got cold or tired, I’d walk back in, toward the voices and the laughter, wondering what domain my small breath had over water, how both air and lack of it could make me rise.

I still think of that quiet, of that sense of something powerful and unseen in me that I both could and couldn’t control, of the understanding that sometimes life’s truths seem to contradict each other. Now I am a student of medicine, a field with its own great paradoxes. The first of these I encountered in my anatomy class, and it is still one of the most powerful: that you begin to learn to heal the living by dismantling the dead.

The dead body harbors the great mysteries of creation and humanity: the hidden beauty and intricacy of function, the insistence of individuality, the inevitability of decline, the incontrovertibility of death set up against the ill-defined boundaries of life. Opening the body begins to unveil these mysteries. Centuries upon centuries of doctors have done so in search of wonder and knowledge.

The moment I raise a scalpel to a body is a rite of initiation. With my first cut, I have begun a personal transformation that differentiates me from my friends and family. This book is about that transformation. It is about performing previously unthinkable actions in order to discover wondrous and previously unimaginable realms. It is about joining a history of anatomy that includes grave robbers and executioners, murderers and mutants, courageous blasphemers and the bodies of saints. This book is about dissecting a dead body in the hopes of one day making living bodies more whole.

I am now in my final year of medical school, mere monthsS away from being called “Doctor.” Before I began my medical training, I was at various times a poet, a university writing instructor, a high-school English teacher to a group of troubled kids. I am older than all but a handful of my classmates and share a comparatively adult life in a little bungalow with my partner of more than seven years and our sweet old dog. I have family members who are sick, perhaps dying. I bring each of these perspectives to medicine, and indeed to the dissection table; they have informed my experience of becoming a doctor, and they have shaped what I have written here. But in the end this book comes from my interactions with the bodies of strangers, both dead and living, and the privileged view that I was given into their innermost workings and failings.

As a medical student, I have watched experts with decades of training deftly remove a superfluous length of vein from a patient’s leg and transform it into a critical channel of blood for the heart. Though I was duly impressed by the surgeons’ expertise, what astonished me most was the regular and insistent kicking of the patient’s heart beneath the operating fingers, even when its muscular flesh was cut, bled, and sewn. The early anatomical puzzles have long ago been solved, uprooting beliefs in air coursing through veins, tiny workers stoking internal furnaces, and the hysterical uterus wandering through the body. Yet there is no shortage of mystery in the body for me today, even after having cut it apart and held its wildly various shapes and tissues in my hands.

I have been surprised by the rush of feeling that has arisen in me at the most primal of moments: the thrill of using my own much-practiced sutures and knots to close surgical wounds, the giddy exhilaration that swept over me each time my hands delivered a baby from its mother’s womb, the unspeakable ache of sitting beside a man deep in the throes of dying. I have learned that the body and mind are not as easily separable as I had once imagined and that the treatment of one nearly always demands an understanding of the other. Time and again during the course of medical school, I was reminded of this, by the cardiac patient suffering from depression following his bypass surgery, by the elderly woman in the emergency room whose panic attacks deprived her of oxygen, by a brain-damaged man who no longer recognized his own left arm, by a woman who complained of chronic menstrual cramps despite the fact that her uterus had been removed years ago.

The human body harbors mysteries that are not solved by textbooks or studying, and, as I have been confronted with them, I have found myself amazed, humbled, and unnerved. My medical training thus far has put me in positions of both omnipotence and powerlessness, has revealed stark clarity and confounding darkness, has made me a vehicle of hope one day and of despair the next. I believe these intersections and contradictions are the most compelling realms of medicine; they take me back to the awe of my lungs lifting me through water. For me, as for centuries of doctors before me, my journey through these crossroads began when I first took a blade in my hand and cut a line across a dead woman’s skin.