When I set out to become a doctor, I thought that my goal would be to prevent death. After all, isn’t that what we are taught when we are watching episodes of “House” or “ER”? So it seemed ironic that my first patient was already dead. In medical school, we are provided a cadaver to dissect, and learn all the mysteries that lie beneath the skin. This cadaver is known as our first patient. We spend countless hours with it, learning the structure and function of the human body.
For some, it is an honor to donate one's body in order for others to learn. Although I never met him in life, the person who donated his body to me and to my gross anatomy partners became someone that I spent more time with and learned more from than any other patient or teacher during medical school. All I know today about anatomy can be traced to that man. I know nothing about his life, but I know more about him and the cause of his death than he ever could have.
I prepared for my first anatomy class as well as I could. I studied as many texts as possible. I read our manual multiple times. Still, anxiety about my first class bit at my stomach the night before, like a ravenous shark tearing at its prey. I believe I could have studied for years, but I cannot think of anything that would have prepared me for seeing that dead body. Of learning how each vessel and muscle and bone fit together in that complicated work of art.
It was the first day of medical school. My classmates and I all met in the hallway minutes before class. We each had our own expectations of what lay ahead. Not just in the gross anatomy lab, but in our careers as doctors. It would all begin with our first patient, our first cadaver.
We entered through the doors of the giant anatomy lab. The air of the cooled lab room hit us like a breeze on an early morning jog.
Ahead of us lay 28 dead bodies, all underneath white plastic covers. The room smelled of the embalming mixture used on all of the bodies to preserve them for as many weeks as we had to dissect every part of them. It was a strange smell, like a sour fruit that had been left in my refrigerator far too long, a smell that I cannot mistake to this day. Standing at the doorway, each body lay on top of silver metal tables as shiny as new kitchen appliances. Each table was aligned in a neat row, and each row, in a parallel column. All gave an initial impression of sterility that I soon learned was just a façade.
We assembled around our assigned cadavers in teams of four. As we unzipped the crackling, plastic cover of the cadaver, we were opening a world that I never really imagined existed, but here it was. Our cadaver then lay before us, beckoning us to open him up and learn from his insides. This man, this dead human was lying there so still that it seemed as though he was actually concentrating on being dead. I almost expected that he would suddenly sit up and laugh out loud. All of us stood silently looking at the body. It was in prone position, meaning that it was lying on its chest, with its face flattened on the dissection table and its nose bent to the left. Later, when we were finished “learning” from his back, we turned him over and his nose stayed bent, like silly putty, until we dissected it too. We knew exactly what we were supposed to do. Our manual read:
“Reflect the skin and superficial fascia by making the following incisions;
1. A longitudinal incision from the external occipital protuberance to the sacrum.
2. A transverse incision from the external occipital protuberance laterally along the superior nuchal line to the mastoid process.
3. A transverse incision from the spine of the seventh cervical vertebra to the acromion.
4. A transverse incision from the sacrum along the iliac crest to the iliac tubercle.
Reflect the skin and superficial facia laterally to the midaxillary line.”
I remember having to look up every single one of those words prior to that dissection in order to figure out what it meant. Basically we were creating four square shaped incisions into the back like a book to open up the back and reveal the lifeless muscles.
But it didn’t say anything about how to make an incision, or how to get up the guts to make the first cut. The strange thing is that at all of the 28 other tables this same silence
was taking place. Like the instant after a tragedy when the enormity of the situation comes to pass in the minds of those still alive.
Thousands of thoughts flew through my mind, and the flash of a thought about being a leader came to me. After all aren’t all doctors leaders? Isn’t that why I was trying to be a doctor? But how did one become a leader? I had no idea. Up to that point in my life I had never been a leader: Happy to follow like the wave of infantry before a battle. But I knew we couldn’t all stand there… not all 112 of us! As if a switch turned on I stopped looking at the cadaver and looked up at my partners.
“ Could I make the first incision?” I asked hesitantly.
A waterfall of relief fell over their faces and in unison they all agreed “of course” said one, “yeah!” said another relieved. The third quickly and happily handed me the scalpel. I was then left with the task of actually cutting. All of the books I read and movies of surgeries I’d ever seen looked like you would just lightly touch the surface of the skin and the anatomy would just open up like a book. They didn’t explain how thick the skin of the back is. It was as hard as cow hide. I had to push down and bear down with my body to cut deep enough into the skin and subcutaneous fat. My less than artful cuts tore the skin up and finally, mercifully, opened up to the muscles of the back. Those muscles were not shiny and red like the meat you buy at the store. The dead muscles, and the preservative used on him made those muscles gray and dull. They did not shimmer under the bright lights of the laboratory. They did not demonstrate what some of my fellow classmates would someday see in the operating room at their graceful hands. But the position of these muscles of the back were perfect and that was all we needed.
I spent months of my life in that Gross Anatomy lab with my patient and the 27 other cadavers. pouring over every muscle, nerve, artery, vein and bone over and over again. I look back on my gross anatomy class and remember vividly the moment I stayed late after a lab and suddenly realized that I was the only living person in that cold room, surrounded by 28 dead bodies. The eerie quiet was like the beginning of a horror movie. But it was the foundation of who I am as a doctor. I know all of my patients now in relation to the anatomy I learned from my first.
At the end of Gross Anatomy… at the end of all those weeks. At the end of all that work. By tradition, we had a ceremony to conclude our journey honoring those who gave their bodies to science. We each stood at our dissection table, no longer in the formalin stenched clothes, but in our normal school clothes, with our hands folded in front of ourselves in a private prayer. Our gross anatomy Professor stood at the front of the class and urged us to spend some time to think about the person that gave his body for us to respect and care for life. Strangely, I did not have an epiphany at that ceremony. I had already spent hours thinking about him in his life. Not his medical problems or what caused him to die. But how he lived and how he loved. When he was my age did he know that his remains would be inspected each muscle and bone at a time? The teaching he did for me in death would be used in my life as a doctor. Would I be able to do as much good in my lifetime as he was able to do in just those 12 short weeks? Those moments I had were not reflecting on his life, but were my time to say goodbye to a close friend. One who taught me to appreciate the life I had, and might someday help sustain others. Yes, it was strange that my first patient was dead. But I believe that my anatomy partners and I would bring good into this world because of him.