This essay originally appeared in Blood and Thunder: Musings on the Art of Medicine, a humanities journal organized by medical students. To learn more about Blood and Thunder, please visit their website.
Shade of Great Oaks
by Jake Morgan
“Coffee and dark chocolate. Those were her vices.”
I listened to Melissa describe the day-to-day life of her late mother Chloe while cautiously making my way through the salad I had unintentionally drenched in ranch dressing. Our white coat ceremony was that night, and I had no plans to make an emergency trip to the laundromat. My classmates seated at the table—those who would become my dissection group five weeks later—seemed to share with me the pressure to perform with poise. After all, Melissa came to the luncheon to talk about the life of her mom, our anatomical donor. The fledgling medical students huddled around her would learn the intimate structure of the human body from the person who raised her. It wasn’t a first impression we wanted to fumble.
That morning, Dr. O’Donoghue told us what to expect during our College’s Anatomical Memorial luncheon. Still, an air of uncertainty hounded us. We understood the purpose of the luncheon, but how do you have a conversation about the whole of someone’s life in the context of a course that’s designed to take everything apart? I looked forward to meeting Melissa, but when I told friends and family what the meeting entailed, I received a variety of responses, some of
Medical student Jake Morgan speaks during the release event for the 2016 Blood and Thunder: Musings on the Art of Medicine. He wrote an essay, which was published in Blood and Thunder, about the profound effect of the Donor Luncheon and his time in the anatomy lab.
which questioned the positive impact it would have. Other reactions consisted only of a look of disgust or disbelief.
So far, the conversation was far from dramatic. Melissa came prepared to answer any and all questions with stories, pictures and descriptions. We learned that Chloe—known as “Sissie” by those who loved her—shared her birthday with the United States of America. Multiple photos showed a star-spangled Sissie making faces at the camera while she celebrated with the friends that stood by her for decades. Each of us received a copy of the program from her funeral. A black-and-white Sisse stood smiling with one of her daughters on the cover. Before the end of our revealing, surprisingly light-hearted conversation, Melissa suggested we all take a picture together and had us write down our emails for her. She planned to stay in touch. Living up to her word, she later sent us the photo and said how excited she was to have met us at the beginning of our journey through medical school.
I thought about Melissa’s stories as we stood around a body covered with a damp sheet and the smell of embalming fluid. Five weeks had passed too quickly, and now the only thing between us and our first look inside the human body was a few millimeters of skin and residual hesitation. We glanced around at each other looking for cues, as if there were a way to ceremoniously remove the shroud before the first cut. A classmate and I eventually gripped a handful of the cloth and pulled the sheet down from her forehead toward her knees.
There Sissie was. Naked. Unguarded. Silent. The shaved head and slack jaw looked nothing like the white-haired, lively woman we saw in Melissa’s pictures. Part of me felt shocked—not because of the sight of a dead body, but because of the stark difference between the corpse that lay before us and the woman described by Melissa. This was anatomy. I shouldn’t have been so surprised. I guess I had always equated the body with the person. My mom was a warm embrace. My dad, a firm handshake.
At the annual Donor Luncheon, first-year medical students visit with the family members of the donor bodies they will work with in anatomy lab. The event serves to remind students of the donor’s selfless act to further their medical education and allows family members to talk about their loved one’s life.
Now as I stared upon a lifeless vessel, the human body seemed less—well—human. But, that thought quickly moved to the back of my mind, and a feeling similar to humility came forward. Her willingness to expose herself to kids through her sacrifice captured what it meant to be vulnerable. Years past this moment, would I choose to do the same? I wasn’t sure if I could be so brave.
The superficial muscles of the back were on the dissection list for the day, so we pushed the rest of the sheet off of Sissie’s body and flipped her over. I pulled a fresh no. 20 blade out of the package and slid it onto a lightly rusted scalpel handle.
“So, where are we starting the cut again?” I asked.
“Up at the external occipital protuberance. Back of the head,” Phil said.
I glanced at the atlas again to gain my bearings and then laid my gloved hand on the back of Sisse’s skull to palpate the external occipital protuberance. I gently pressed the blade into flesh until the epidermis gave way. My hand drew the scalpel down spine to the tip of the coccyx where I ended my cut.
With that incision, we drew the line that marked the ultimate end to a new beginning. Death became the first step of our journey through the human body.
“Sissie, you’re so thin. How do you hide so much fat here?”
Excavating the adipose out of the axilla proved to be more frustrating than we expected. Our hands still fumbled the dissection tools often, and we hadn’t discovered any trick to separating adipose tissue from the more defined structures. Our strategy was a version of “spray-and-pray” in which we dug our hands in and hoped a few grams of yellow came out with us.
Our target was the brachial plexus—the networked monstrosity that blew our minds in lecture an hour earlier. I knew we were getting close, but there was no hiding that I was lost. The amorphous difficulty of lab could leave you confident one moment and clueless the next. As we dug a few centimeters deeper, a member of my group signaled Dr. Ahmad to come over and adjust our bearings.
“There it is,” he said and looped his finger around a pale, thick bundle emerging from the apex of the axilla. “You just have to open up the fascia around it.”
Of course it was that simple. A sigh admitting my minor defeat escaped my mouth, and I inserted the tip of my closed scissors into the bundle and carefully opened them to separate the fibrous sheath.
I looked up to check the clock. 11:03 a.m. We had already been dissecting for an hour, and I was determined to eat my lunch on time. Roots, trunks, divisions and cords. By the end of the hour, I swore they all would lay neatly extracted from Sissie’s arm, framed by the boundaries of the axilla.
Over the next fifty minutes, I fell into a trance broken only when fumes from the embalming fluid burned my eyes. Catharsis came from gently cleaning viscera away from the nerves and branch. For once,
blunt dissection felt like an art. Perhaps Michelangelo felt the same way chiseling David’s form from the marble. Recognizable structures soon came into view. Branches from the lateral and medial cord merged to give birth to the median nerve, and all three helped form the distinctive ‘M’ laying on top of the radial nerve. Freeing neural fibers from fascia, I followed the medial pectoral as it dove to pierce through pectoralis minor while its lateral brother swerved to pass through the clavipectoral fascia and into pectoralis major. Within time,
Medical students interact with family members during the 2016 Donor Luncheon, which is always held during orientation for first-year medical students.
the brachial plexus lay draped across my gloved fingers. That was when the first hushed “wow” escaped from our lips. The Cat’s Cradle arrangement of nerves looked as if it had been drawn from scratch in an atlas. Sissie had carried this work of art in the nook of her limb for 89 years, and it controlled the arm she used to draw her grandchildren in for a hug. The beauty of the human form and how it translates into life took our breath away.
“Want to give it a shot?” Zach asked over the whine of the bone saw.
“Sure, why not?”
Sawing through the calvarium was a game of chicken. Progressing through the durable bone of the skull required constant pressure, but once it began to give way, you’d better pull up. Delay too much, and you tear into the gyri of the brain.
Ten seconds into the cut, I began to question any future as a neurosurgeon. My bad, Sissie…, I thought. Passing the instrument among us, we eventually completed the circular cut and began the clumsy process of separating from the bony calvarium the dura mater that invested and clung to the brain. We took note to proceed cautiously. That morning in lecture, Dr. O’Donoghue stressed the importance of taking one’s time while removing the skull cap, which if doffed hastily, could take with it chunks of the brain. Relying upon the chisel and multiple scalpel handles for leverage, we succeeded in revealing the folds of gray matter and called over a professor to help us deliver the brain from its home.
Deft hands worked to sever the cranial nerves from their origins as Dr. O’Donoghue talked us through identifying each one.
“Optic nerve,” we said in unison.
Question, answer, cut and repeat. Working his way from front to back, Dr. O’Donoghue exposed more of the cranial fossae as he sliced through each neural tendril. The imposing trigeminal came into view and made the abducens look nothing more than a piece of angel hair pasta. The trochlear nerve I could barely see. When he finished cutting—brainstem and all—he handed us the blade and walked off to do the same for another group. Sissie’s brain lay upside-down on the table, gently rocking from when Dr. O’Donoghue fitted it back into its skull cap. Cupping the calvarium from underneath, I flipped the brain right-side up to let it fall out of its bony encasing into my free hand.
My gloved fingers slid over the gyri and across the sulci as I appreciated the density of the neural tissue. Its weight surprised me. I thought back to all the pictures that Melissa showed us during the luncheon. I wanted to believe that those memories had mass, that gravity pulled firmly on those countless stories. Somehow in that
forest of axons and synapses rested 89 years of memories, thoughts and personality. Somewhere in those folds connections that accounted for her first kiss, the birth of her first child and the death of her husband.
Eighty-nine years of time had woven a storybook with neurons—a tome that reflected the life of its owner.
The late-night bustle found in the lab before practicals always reminded me of a bazaar. Students jumped from tank to tank to see the best anatomical structures that each cadaver had to offer. I was particularly proud of our dissection of Sissie’s celiac trunk. We tried to predict which structures the professors would tag in the morning.
“There’s no way O’Don won’t tag the celiac ganglion. Don’t you remember how many times he mentioned it?”
“What about the pelvic plexus? Would he be that cruel?”
“I’m just hoping they tag something as easy as the bladder. It’s been a long week…”
The night before our last practical, however, the atmosphere was relaxed. By now, we had adjusted to the rhythm of the course. Part of it, too, was the relief that we were approaching the end of the six-week whirlwind we called Human Structure. The clock read 11:27, and I was reviewing our dissections one last time at Sissie’s tank. Inferior rectal nerve? Check. Coccygeus? Check. Superficial transverse perineus? Check. With so many of these Latin terms, thank God we weren’t counted off for spelling. After a few minutes, I felt comfortable enough to call it a night and began to square away all the structures I had manipulated while studying.
Tidying up, I took stock of how much we had learned over a month and a half. Most people claim that by the end of the course, you leave having picked up a new language. That’s certainly true, but this newly acquired vocabulary presents a paradox. We spent hours in lab drilling structures into memory and appreciating the design of the human body, and while the vocabulary does well to describe the body, it fails to portray the human. Having the chance to meet Sissie through her daughter’s memories and pictures bridged the gap. Her stories helped us translate the aseptic, scientific Latin of anatomy to a language of life. Through the stories shared by the donors’ families, a pancreatic adenocarcinoma became a trial that completely changed a person’s outlook on life. The corpus uteri became the womb that carried children to term. The larynx became the source of words of comfort, wisdom, and love.
I draped the sheet over Sissie one last time and started to lower her into the tank. I felt like a school kid again saying goodbye to one of my favorite teachers at the end of the year. Tomorrow it all would come to an end. I underestimated how much I would miss it.
Clad in my white coat and coral Burberry tie, I sat in the auditorium with my classmates, forming an ivory wall behind the families of the donors. It was a Wednesday evening, about two weeks after we had finished human anatomy. At the front of the room stood a horseshoe table draped with a red cloth. Arranged neatly across its surface were pictures of every anatomical donor. I could pick out Sissie’s white hair and mischievous grin from my seat, her face gently illuminated by the candle that accompanied her photo.
This memorial service would mark our last interaction with them, and I could not believe we had gone full circle. I remembered the initial uneasiness when we met Melissa. I had no idea of what to expect, but it never crossed my mind that I might develop a connection with her late mother. Through her choice, Sissie demonstrated how much she expected out of us, how much potential she saw in us.
As the night continued, I wondered what I would want to tell the
families about their loved ones. How would I communicate the experience from our eyes? Beyond the evident gift to medical education, other gifts came to fruition, most of which concerned the life and death of our future patients. The donors chose to teach us not only the structure of the human body, but also the life that it frames. They reminded us that illness is more than a diagnosis. Outside the medications, cures and treatments lies the perspective of the patient. Sissie was more than our donor. She was a daughter, a soul mate and mother who loved coffee, dark chocolate and a gut-churning laugh. Through her silent, selfless contribution I learned how much I have to learn from my patients.
Society grows great when men and women plant trees whose shade they will never enjoy. I’m convinced that is what our donors did. Rather than write off the younger crowd as cynical or unmotivated, they selflessly chose to educate a generation of physicians they know they will never visit.
I’m proud to have sat in Sissie’s shade.