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Medicine

Making the Cut

8 August 2018


 

First-year Medicine student Aaron Bhat describes working with dead bodies.
Art by Hanna Liu.

 
 
You first notice the smell halfway up the third flight of stairs in the Medical Building. It’s a funny kind of smell, evocative of both a butchery and regurgitated wine. The further into level four you go, the stronger it gets, and once you pass through the dusty, cold linoleum of the walkway and into the clinical white atmosphere of the dissecting theatre, you realise you’re in a room where things happen.

At the beginning of a session, there are always too many people to get a sight of what lies on the tables lining the room in long rows. Some people shift uneasily from leg to leg, others joke comfortably. This all takes place under the blanket of that all-pervading smell. I worry I won’t be able to get it out of my clothes. Once the introduction is over, people disperse in small groups to the metal tables covered in blue shrouds, each one with a bucket hanging from the end.

Lifting the veil is a procedure in itself. It’s the most important, in some ways, as it reveals the human beings that lie underneath. They lie there, recumbent, with their mouths half-open, their eyes swollen shut. Their arms lay heavy by their sides, their bodies exposed. The most striking feature is how artificial the skin looks. The perverse thought crosses my mind is that these people look more like figures from Madame Tussauds than actual humans. It’s hard to imagine these figures as once living, breathing people, with the same motivations, fears, and desires as the people examining their bodies in this very room. There’s nothing artificial about this situation, though. A cut must be made, and someone must be the person to do it.

The readings on what, how and where to do it, vanish from my head. My previous surety that I would cut into the chest of this woman in a swift demonstration of surgical skill quickly evaporates. The skin feels so hard under my fingers, the bones so prominent, the muscle so thick. I begin to think I will never be able to make the cut after all. After someone else fearlessly slices windows between the ribs, another person volunteers to start on the body’s right. Now I, with my tail between my legs, must begin on the left.

In a dark way, wielding the scalpel is exhilarating. Just one touch, and the waxy, luminescent skin of the body springs apart, revealing the cold, white fat beneath. The fat yields to the layers of fascia and connective tissue that support it, to the the tiny vessels and nerves that run through them. And then comes the muscle. If ever anyone ever needed a good enough reason to turn vegetarian, the sight of human muscle would be it. Dark. Fleshy. Streaked with fat. Everything we look for in a piece of meat sits just below the surface of our own skin. But even the layers of muscle must come to an end, and the scalpel must be put back down. Now, we come to the bones.

The ribs—the bony cage in which our most precious organs sit—are a different kettle of fish altogether. Indeed, they call for recourse to a more primitive tool. I immediately think of my childhood. I think of my mother, a seasoned knitter, who used to wield a large pair of fabric scissors with long, serrated edges that seemed ready to mutilate anything that fell into their path. As a rather diminutive person, I was sure at that time that those were the most imposing scissors I would ever see. For the better part of fifteen years, they were. But as soon I got into the dissecting room, that all changed. The scissors that are designed to remove a person’s rib cage are sharp, chrome and grim. They are also very effective. The sound that a rib makes when it’s broken by these scissors is lodged firmly in my mind—for the most part because I didn’t expect it to sound like that. I had always thought of ribs as firm and strong, made of stone. Except, stone does not break with the sound of a bundle of damp twigs snapping. Stone cannot be wrenched away, cannot be prised open, to show the organs sitting underneath.

In some ways, an anatomy textbook is an elaborate web of lies. The lungs look like pink cumulus suspended in the chest, while the heart appears as vital and strong as its function would suggest. Everything looks alive. Perhaps I was just naïve, but I didn’t realise that life would be a pale imitation of art for the simple reason that those organs were devoid of life. There is no dynamism or vitality in the organs in a cadaver. The lungs are blackened, wet and heavy. The heart sits, brooding, in a sac of fat. The aorta is hardened and whitish, and the cavity through which it runs is full of foul-smelling preservative that colours the surrounding air. Holding the organs outside the body feels wrong, almost sacrilegious. I quickly return them, looking away as quickly as possible. I don’t have the stomach to identify the various manifestations of disease they bear.

Despite my initial reluctance, though, I eventually do turn to examine what’s lying on the table. I observe the lymph nodes that are slightly too large, the vessel that is dangerously hard to the touch. I note the lungs which, when cut open, sag under the weight of the tumours they hold. The tumours creep into the lungs’ cavernous, damp crevices, colonising the body of the person whose life they took. The image reminds me of the reality that disease is a cruel part of life, and one which cannot be avoided.

I can’t help but wonder, how do we approach the human being on the table? How do we approach someone who lies there, having invited us to open them up violently, without losing sight of the fact that only recently their body was inviolable? To me, the answer lies in maintaining a balance between a respect for other human beings, and moderated desensitisation. We are lucky at this university to have such a first-class anatomy department, with staff who constantly remind us of the humanity behind what we do. They both encourage and practise respect for the many donors without whom our educations would remain incomplete. Yet, this humanity must be somewhat put to the side during the actual act of dissection. When you cut into real, human flesh, a sense of detachment is needed in order to see the cadaver for what it has become: a corpse there for dissection, a tool for education, and nothing more. It’s this attitude that allows you to look at the body on the table in front of you through the lens of scientific engagement. It’s this detachment from the very human aspect of what’s right in front of you that allows you to dissect the body respectfully, to conduct your research properly, and, ironically, to to take one step more on the journey which may ultimately allow you to save the life of a human being not too dissimilar from the one right in front of you. And once the dissection is complete, and the donor is whole once more, we must remember that the person before us walked the same streets, breathed the same air, and lived with the same passion that we do. We must remember that we are here to learn from them, to grow through their generosity, and to ultimately heal others because of them. One day, we too will be like them, and ultimately, every incision made must be done in the hope of helping those who will one day walk, talk and breathe just like we do now.


6 responses to “Making the Cut”

  1. MGB says:

    Very well written from the bottom f the heart! Once won experience in the start of the medical career

  2. Dr jaya bhat says:

    Remarkable insight by a young medic .. sensitivity so vital in our profession! From time to time with increasing technology in our practices we lose that sensitivity and become robotic( never mind the actual robotic surgery).
    Wish you good luck in your learning and may you be blessed to care for the sick with kindness and love. There is no course to enhance empathy or increase one’s emotional quotient! Cheers . Jaya bhat

  3. Laura Franc says:

    Beautiful piece.
    Thank you for sharing your insight into an experience that, for many of us, is hard to imagine.
    It is touching to read such sincere words, filled with gratitude for this opportunity you have been given.
    It is medical students like you who will indeed go on to give the very best care to others in need.

  4. Dr Enid Chan says:

    Good job! So proud of you. You are studying medicine, and so insightful.

  5. Priti Choudry says:

    Beautifully written and deeply insightful. I understand it was life changing. May you be as great and wonderful a doctor as you are a person.

  6. Rohit Amritanand, Vellore says:

    Bravo Mr Bhat! May I respectfully disagree with your choice of vocation… Medicine! Really? Your scalpel sharp observations,your measured wit is wasted in the barren flatlands of clinical medicine.You should have been a writer instead… Move over Robin Cook! Well done on a superb piece.

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