In the face of death

Noren Khamis is a medical student in the Class of 2018 at the University of British Columbia

 

Long before starting medical school, I wondered how I would react to the first sight of a cadaver in the gross anatomy laboratory. I was comforted by the fact that when the time came, I would have sufficient warning, guidance, and—of course—preparation. But as often happens in life, situations do not go according to plan. Above and beyond mastering basic anatomy knowledge, those long days down in the cadaver lab taught me that I was truly unprepared to deal so intimately with death.

The start of anatomy lab was predictable and after two weeks of studying the muscles of the back, it came time to begin dissection of the front. The “flip”—an endeavour that needlessly involved five students—was nervously uncoordinated. Between amateurish pushes and pulls, the cadaver jerked roughly and the green cloth covering its head slipped off. We gasped at the motionless face for a moment before a classmate quickly replaced the cloth. My glimpse of the face was brief, hastened by the immediate aversion of my eyes, but in that instant I absorbed every last detail. Thin lips sealed tight and bent ever so slightly downwards, projecting a mournful expression—or was it merely my emotions projected? Even now, the unforgiving rigidity that imprisoned our cadaver’s face remains burned in my memory.

But those of us who witnessed the event silently agreed not to discuss it. Why? Were we too embarrassed to share our emotions or appear unprofessional? Were we avoiding the inevitability of death? Or were we ashamed that our clumsy blunder may have dishonoured someone who sacrificed their dignity for our education? Once our cadaver was supine we could see hair, nails, and organs; the same as ours. The man in front of us was real; as human as we were human. But in contrast to our living, breathing bodies, this man was dead.

As a well-documented rite of passage, medical students dissect dead bodies. As Francois Lelord stated in Hector and the Search for Happiness, “Knowing and feeling are two different things, and feeling is what counts.” Despite knowing my duty in the anatomy lab, I struggled to justify raising a blade to human flesh: the muscles and bones that once embodied a living man. Until that moment, aided by the convenience of well-placed cloths and covers, I had been dissecting individual body parts. After seeing the face of the donor, I could no longer see anything less than a whole person.

Why do we hide all parts of the cadaver except those we are dissecting? Why do we cover the faces of the men and women who selflessly donated their bodies for our learning? By masking donors’ faces, do we likewise obscure for students the great privilege we have been given? As medical students we are taught that establishing a physician-patient relationship is the most fundamental skill to master, but we are curiously discouraged from developing a bond with our first and perhaps most memorable patient. What if our laboratory experience began with an introduction to our cadavers—seeing their faces or learning the causes of death and the stories of their lives? While overpowering emotions may ensue, these emotions will only serve to bolster our acceptance of death and prevent dehumanization of our cadavers.

Medical students do not need to be sheltered from reality: in fact, we need support in embracing it. We will be exposed to death both personally and professionally. Sometimes it will be painful; sometimes it will be a relief. As doctors, we will be fighting death on a daily basis. We need to learn how to talk about it and how to help others make the right decisions about it. These are not lessons that can wait until graduation.

If medical students are to become competent in facing death, we should not create an artificial distinction between a dead body and a living patient. George Eliot, the famous English Victorian novelist, once said, “Our dead are never dead to us, until we have forgotten them.” Most medical students will never forget their first experience with their cadaver. In humanizing him we can remember him as person and as a soul who will stay with us forever to teach us that death is a natural part of life.

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