Our First Patient

By Vidya Viswanathan

Image credit: Peng Yang, “Fragment N.1”, 2010, Taiwanese artist

Category: Non fiction


“The daily confrontation with a dead body, the first stranger’s body that medical students may have ever examined so closely, marks a point of high anxiety in medical education….Taking the cues from their teachers, medical students learn to deny their own feelings, depersonalizing the dissection experience and objectifying their cadaver. They strip away the cadaver’s humanity, and soon enough they are dissecting not another human being but ‘the leg’ or ‘the arm.’”
– Surgeon Pauline Chen in Final Exam, p. 17

No matter where you are, it’s something you would be highly unlikely to do as a non-medical student, but highly unlikely not to do as a medical student: dissection of a cadaver, a dead body.

There is a part of me amazed, a part of me penitent. I am sorry to drag a blade down the middle of your chest, and then to the side, peeling away the first layer of skin and fat. I am sorry to cut through your skin with no intention of sewing it back together again. I am sorry that one of us will crack your ribs, one by one, and watch our professor use a loud saw to separate your sternum. I am sorry that between my cringing, I am still curious, still excited to see what lies beneath. I am sorry that we change our scalpel blades when they get dulled on your body, so that they are sharp again.

I am sorry that since personifying you makes all this disquieting, and so when speculation on the person you once were floats into my consciousness while I wield the scalpel, I actively push you away. And yet, I am amazed by the clear lines of your muscles, finding that their fibers actually do go in the directions we read about in our textbook. I am amazed that if I poke my finger between your third and fourth rib, I can find the border between two lobes of your right lung. I am amazed that in just 2 days, a total of 6 hours, I can see and learn so much. I am sorry that the thing you will get out of this at the end is a cremation, and the thing I will get is an education.

Dissection is inherently selfish. The body teaches and helps us; it is too late to teach and help the body.

When I am not counting your ribs, finding your veins and arteries, poking around for your inguinal ligament, or cloaked in the odor of formaldehyde, I do allow myself to think about you, the person. I know that you died last year while the leaves were turning colors, at the same age my grandfather was when he died. I know you had pale skin. I know that you suffered the spread of cancer. I looked it up, and I know it’s rare. I do not know your birthday. I do not know your surviving relatives, loved ones, or loathed ones. I do not know where you died, and who was with you.

I will not know your smile. I do not know the curve of your fingers or the shape of your face, yet. That I will know by Christmas. The other things, I won’t. We have an honoring of your body and the other bodies in the spring, and your relatives will be invited—maybe I will learn those things then.

I wonder what you were thinking when you donated your body to the human gifts registry for medical education and research. Did you envision the anatomy lab, the pedestal on which you would be placed? The four young students huddled around you, not quite knowing how to talk about you?

Perhaps I shouldn’t tell you that on the first morning of anatomy lab, I noticed a distinct smell–the smell of the formaldehyde used to preserve all the bodies. I had to breathe through my mouth. Halfway through that first day, I noticed a new smell—the smell of preserved fat, its yellow, oily globules sticking to my double-gloved fingers. When we took out the fat in chunks, I stifled a gag. We put the fat next to your body. I thought of Fight Club and its macabre soap-making business. At the end of our session, we had to throw out pieces of your fat, skin, and muscle. On the second day, since I walked into anatomy lab a bit late, everyone had opened the flaps of skin and muscle on their bodies, and the mixed smell of preserved fat and skin hit me hard. Even after lab ended, I smelled it in my hair, on my clothes. I smelled it in other things, even after I took a shower. In my body lotion. In clothes I hadn’t even worn yet. In corners of Philadelphia as I biked around. Everything is becoming that smell. The skin on my shins has been itching, and for no reason, I ascribe it to that smell.

After lab, on both days, I went to a lunch lecture with free pizza (a hallmark of medical school). They say formaldehyde makes you hungry. I wanted to eat the pizza, but the layer of cheese on top with the layer of sauce on the bottom somehow reminded me of a layer of superficial fascia, yellowish fat and all, easily peeled away to reveal muscle underneath. I was panicked. I was scared to share this observation with my classmates, but wondered if anyone felt the same. From the first day, everyone had just seemed so stoic about everything. And here I was getting impacted by pizza. Perhaps the most embarrassing, the most confusing, the worst and strangest thing was that I ate it anyway.

It’s just a body, I’m going to be a doctor, so dissect. Is it that hard? It is, because while my tendency to think beyond the physical body to the person may be seen as weak, while my tendency to smell anatomy in everything may be seen as gross, it is an essential part of who I am to feel this vulnerability. I don’t want to lose that—I don’t WANT to one day look at the body as just a machine to tinker with. I don’t WANT to feel entitled to cutting it up. I definitely don’t want to make jokes about it, to disrespect it. I don’t believe you have to lose humanity to help humanity. And yet, I do appreciate the machinery of the body—I do feel like an archaeologist on a dig, excavating new parts and even foreign objects with each passing hour. I do enjoy the focus I fall into as I use a scalpel to carefully separate two layers of muscle, the same feeling I used to feel when I made origami and snowflakes for hours in elementary school. There is a satisfaction in cutting things away to reveal things underneath.

I do not know if the challenge for me during the next three months of anatomy, and maybe throughout my career, will be keeping these emotions at bay, or keeping them close to my heart. Either way, I know I am in a delicate balance to find the optimal place for them, and I cannot stop thinking about it.

At the end of our dissection session today, after we closed the body with its flaps of muscle and skin, and prepared to put the cheesecloth on top of it to keep it moist, my dissection partner stopped and looked at your chest. “Seeing her breast again, I don’t know, it just makes it more real.” My anxiety abated. Wordlessly, I thanked him for saying that.


The author:

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Vidya freelance writes about medicine and innovation, and is a fourth-year medical student at the University of Pennsylvania. She received her BA in Social Studies and a citation in Mandarin Chinese from Harvard College. She has written for The Atlantic and MedTech Boston and is the founder of Doctors Who Create. Read her writing at http://www.vidyaviswanathan.com and follow her on twitter (@vidyavis).

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