I get the letter around one in the afternoon, February 19, 2008. I walk barefoot out to the mailbox, open it, and see a single envelope with the school symbol on the upper left corner. My heart begins pounding. My reach school. The most competitive medical school I’ve applied to. I reach out for the envelope and feel it. It is so thin. They don’t tell you yes with one sheet of paper, everyone knows that. Still, I tear into it like a wild animal, and like a wild animal I find that I cannot read. I scan it frantically, and somehow, between two tiger heartbeats, see the words: “Congratulations on your appointment to the Class of 2012…” I scream.
I stand by the mailbox and try to get a hold of myself but I’m on a euphoric high. I feel wily and cunning; I have played the system in such a way as to secure for myself a share of the world’s spoils. I completed an undergraduate degree, managed to squeeze out a respectable score on the medical school entrance exam, somehow scrounged the money necessary for the applications process, and, apparently, said the right things on applications and during interviews. There are those who did all the same things and have no acceptance letter to show for them; I know an element of sheer luck has played a part in how this letter found its way to my mailbox.
Nonetheless, I’m going to be a doctor, an MD. It is going to happen after all. I stand by the mailbox a while, envisioning it. The long nights blissfully studying biochemistry. Group study sessions in coffee shops. Being able to say to my family—to anyone—nonchalantly, “I’m a med student.” The bonding moments I will have with my classmates as we lean over our cadaver, performing a careful, masterful dissection. Later I will have the most fulfilling of work. I will care for patients, make tangible differences in their lives. I will wear a white coat. The earning power and respect that I long for will be mine. It’s crystal clear in my mind’s eye: me, in the early hours of the morning, rounding on patients, discussing the complex aspects of their care with my colleagues, moving through hospital hallways, the aforementioned white coat billowing around me. I look straight up into a cerulean sky, press my acceptance letter to my heart, and breathe deeply for what feels like the first time in years.
A little face peeks out the front door that I’ve left ajar. “Mommy, why did you scream?”
I have a child. Four of them, actually, between the ages of three and eight. I’ll have to make a few revisions to my medical school fantasy. Almost immediately I begin regretting the children. Why did I have children so young? Why couldn’t I have waited until after medical school? All of this is going to be so much harder, so much more hassle, with four little ones to think about. The children were a dream, too, but one I achieved prematurely. I am doing everything backwards. I imagine having done things in the proper order, the same children, but later in life. I cannot entertain this line of imagining for very long because of the impossibility of it. The ova containing the unique chromosomal arrangement required for these particular children would have long since been washed away, unfertilized and permanently lost.
My husband gives notice to his employers. We rent a house without seeing it, send a check to landlords we haven’t met. We pack our things into a U-Haul. We drive to the new house, three states away.
Two weeks later I enjoy an orientation in a high-ceilinged auditorium, where speaker after speaker comes forth to welcome us. The dean of the medical school speaks so eloquently and in such a beautiful British accent that my flesh breaks out in goosebumps. Two days later we are treated to a ceremony, during which each student is solemnly handed a white coat and photographed wearing it. This is followed by a catered lunch in a ballroom of the city’s poshest hotel. My husband and I sit at a table with other students, some accompanied by their parents, some by significant others. Someone politely inquires whether we plan on having children. We already have children, I say. The obvious question follows—how many?—and when I give the answer, there is a momentary pause. The surprise at our table is palpable.
Later I will realize that, whenever I discuss my life with anyone, the conversation will always somehow circle around to the children. Someone, when they learn that I am married, will ask me, “Do you plan on having children?” Or someone will say to my husband, “And what do you do?” at which point he will answer, “I’m a stay-at-home dad.” Then the inevitable inquiry about the number of children he stays home with. We measure the reactions of people and learn that four is an irrational number of children to have while attending medical school. “Oh, shit,” the secretary of one doctor says fearfully, after having just cheerfully asked me how many children I have. I wonder if I should start lying, cutting down the number of children I have by half. Two children sounds far more acceptable for a med student.
Medical school is a lot like high school. We are all of us together, all the time, and will be for the two years of preclinical work. Rumors fly. Word of anything interesting or unusual regarding anyone in our class spreads fast. I am the “kid with four kids.” (In medical school, we’re all “kids” again, called this by our instructors, their average age being above sixty.) People approach me, expressing curiosity and “admiration,” as in, “I so admire that, I could never do it myself, but that’s amazing…”
What is so admirable? I wonder. That I managed to figure out how to reproduce and get into medical school? When they say, “I could never do that myself,” what I hear, and maybe I shouldn’t, is “I would never do that myself.”
There are the people who say sympathetically, “Oh, that must be so hard…” Well, yes, it is sometimes hard listening to the plot of the Fairy Chronicles while simultaneously learning the parasympathetic innervation of the gut, but it’s not hard hard. We’re not trekking through the wilderness surviving on roots and insects. Living in a one-room cabin in Alaska without plumbing was actually a lot harder. When I tell people that story, however, they exclaim, “Wow, that must have been a great experience!” or “I’ve always wanted to go to Alaska!”
The “I admire you so much” is condescending. It’s what one might say to someone who lost three hundred pounds. It isn’t something that one says to someone who is doing something that they wish they could do.
Then there are the people who ask every time they see me, first thing, “Oh, how are the kids? Are they getting ready for Halloween?” in this high-pitched cutesy voice that I doubt they would be using if they were asking how I had fared on the latest biochemistry exam. I don’t know how to tell them that if I wanted to discuss my children all day I would have gone to, I don’t know, a Mother of Twins convention, not medical school. There is one other parent in our class, also a parent of four, but a father. I notice that no one is approaching him with endless admiration. No one is asking him in high-pitched voices about his offspring. I become frustrated. I regret ever telling anyone I have children; I just want to be another student. I stop outing myself when I’m in situations where I haven’t yet been distinguished by age or motherhood.
Gross anatomy begins. We have 180 people in our class. They divide us into five labs, assigning six of us to each cadaver. I have my plans carefully laid out. I’m going to be gung-ho, a major player in my group. I’ll do the lion’s share of the cutting, and I’ll keep up with the assigned reading so that I can impress my fellow labmates with my commanding intellect and firm grasp of anatomy. I know I will be an excellent anatomist. I’ve been memorizing detailed facts about the human body since the age of fourteen. My children have been raised using proper anatomical terminology, not just the obvious penis and vagina, but testicles, scrotum, lungs, skull, intestines, anus. Anatomy is my forte.
Everyone, it seems, is fascinated by this idea of medical students dissecting cadavers. I don’t know it yet, but two-thirds of all phone conversations I will have during the next few weeks will consist of friends and relatives interrogating me about what it is like to cut open a dead person.
The day of our first gross anatomy lab is a Friday. My husband drops me off in front of the medical school. He tells me to try to remember everything.
We stand in the lab in our crisp new scrubs, eager to grab our scalpels and begin cutting. My group is the first to have our cadaver cranked up out of the stainless steel vault. All the bodies are enclosed in opaque plastic bags. We can see their forms and the color of flesh, but not much else. One of my labmates proceeds to scissor open the plastic encasing with the same enthusiasm as a kid opening a present on Christmas morning. We all lean forward, our excitement palpable. This is what we have been waiting for.
But then our cadaver is out. We all stop a moment, an unplanned group pause. Even the labmate who has eagerly slashed open the bag. He seems confused, startled. And from that moment on, everything is different from how I planned, how I pictured it. Not only are we dealing with our unexpected reaction, but the surprise at having such a reaction—none of us, it seems, has anticipated it.
“I can’t … I can’t believe this is a real person,” one of my labmates says. He’s the one who scissored open the body bag with zest. Now he has retreated.
None of us responds to his statement. And that is the first and last time any of us verbally expresses, at least to each other, any of our thoughts or emotions related to the cadaver.
She is a female, about sixty-five years old. The first major problem (at least for me) is her face. She wears the most gruesome of expressions. Her tongue protrudes grossly. Her eyes are open and bugged out. It looks as though she has been strangled to death. Her face is the face from a horror movie. The cadavers belonging to the other groups have normal expressions by comparison: slight grimaces, eyes half shut. This woman looks as though she died a grisly death. Her toenails are very long and she is very fat. “You got your wish,” I say to another labmate, one who confessed to me earlier that she was hoping for a “big, fat chick.”
We turn her over because the first lab assignment involves dissecting the muscles of the back. Already I don’t want to touch her because of her face, but actually touching her—so cold, dense, heavy—repels me further. Then there is the issue of the smell. Formaldehyde isn’t pleasant, but it isn’t quite revolting. The smell emanating from this cadaver borders on revolting. Crosses the border into revolting. But we cut on her
for more than an hour, probably more than two hours, the tissue beneath our scalpels the consistency of mucous, literally liquefying beneath our blades, before a lab assistant notices that something is wrong and instructs us to stop dissecting.
The course director arrives to inspect our cadaver. He approaches our table, but when he is close enough to see the cadaver he abruptly turns and walks a few feet away in order to compose himself. He is angry but not at us. He approaches our table again. “The cadaver has not been properly preserved,” he says. “We apologize. You will be provided with a new cadaver.”
The smell so thoroughly repels me that I haven’t been doing much cutting anyway. I am standing off to the side, swallowing my gags, but a gag remains in my throat for hours afterward. The role that I had envisioned for myself will be taken over by one of my female labmates, a fiercely bright girl, lanky and long-haired and laughing. She will wear pink scrubs the whole semester, and we will all end up depending on her to know what cuts to make, and to make the cuts correctly.
I panic as I realize that I will have to come back here, every day, for the next three months. The romance of gross anatomy is utterly gone. I want to run away and never come back. I begin to wonder if I can do this.
I nuzzle my son in bed that night. Long silky mop of hair; it was black and slicked to his head when he was born. Otter hair. His skin feels so good, supple and warm and alive. He was a floppy infant, and he is a floppy three-year-old, his body melting into mine as we cuddle. I drink him in and try to push the cadaver away from my thoughts. Is it possible he won’t be alive one day? We’re all not destined to be donated to science, but we’re all destined for the metal vault. Even this boy in my bed. He’s incredibly warm, a tiny furnace under the covers. He falls asleep on my right arm, just like every night.
That night I have a dream. The content of it is fuzzy, but the cadaver’s face is in it.
Monday we go to lab, and we’re horrified to find she is still there. The cadaver I was hoping to never have to see again. The woman whose donation was wasted because some careless person had not bothered to preserve her properly. Our instructor suggests that we “practice” with her while we wait for the new cadaver. No member of our group wants any part of that, but are we allowed to say no to an instructor? In these first days of medical school, we are unsure of ourselves.
One of my labmates tries to be diplomatic. “There’s really no point in putting any more work into a cadaver we won’t be keeping …” The instructor’s face darkens; he disapproves of this line of thought. I feel the panic rising. We are going to have to see her, to smell her, another time. I say, more loudly than I intend, “I feel—”
The instructor turns to me in surprise. “Yes,” he says. “Tell us how you feel.”
I stop. I hadn’t known that I was going to blurt out like that. And I shouldn’t have used to the word feel. Anatomy lab is not the place for feelings and emotions. Anatomy lab is a place of learning and scientific study.
I don’t have anything articulate prepared for this moment, but he is waiting for me to say something, his hands folded politely on his paunch. “I thought I was never going to have to see her again. I had a bad dream—”
“Oh, my goodness, baby,” the instructor says. He is sympathetic and paternal and will call all the women in our lab “chicken” and “baby” for the duration of the semester. I am a young, sheltered female; he has just remembered that. “No, of course, lower her back down, right away. No, you don’t have to cut, just go observe at other tables.”
We are relieved. We have just been patronized, but it’s a small price to pay. Moreover I will continue to exploit the fact that I look as young as anyone there and that none of our anatomy instructors knows I am married with children. Our instructors, without exception, are males who graduated medical school in the early 1950s. Throughout the semester I will use their misogyny to my advantage. It frees me from cutting, from having a lot expected of me.
By Wednesday we have a new cadaver. Male, this time. He was tall, a big man, maybe a little overweight but he carried it well—it was mostly in his belly. His hands are large, worn; they look gentle. I look at his hands a long time. I think about all the things he did with his hands.
His face is nondescript, weathered. He looked like, was built like, he could have been a farmer. We turn him over and begin the process again, starting with the back muscles. Back muscles first, then arms, forearms, and hands. Later we dissect his gut and genitalia, then his chest, his lungs, his heart. We do the buttocks, legs, and feet last.
Dissect. That sounds so intricate, purposeful. Dissection is performed by one who knows what one is doing. What goes on in these labs is a bloody massacre, without the blood. One of my labmates and I pull too hard on a superficial muscle over the shoulder, meaning to expose a deeper muscle underneath. The bright white head of the humerus bursts forth into the fluorescent glare. Silence between us.
“Um, wasn’t there supposed to be something else there?” he asks me. We both can’t stop laughing for a long time after that.
But no one laughs the day we mangle our cadaver’s inguinal canal, a passage in the lower abdominal wall. “What is this!” Our instructor is horrified when he walks by our table and notices what we’ve done. “You’ve destroyed everything! I said cut superficially—do you not understand the meaning of superficial?”
“My god,” he mutters, as he searches through the shredded the tissue for any remnant of something that resembles the inguinal canal. The six of us stand silently, accepting our scolding. He sounds exactly like I sounded earlier that morning, when I was yelling at my eight-year-old about the lack of effort she puts into her homework.
I continue to think about death on a daily basis. I wonder how the others are dealing with it. From the conversations I overhear in lab, I know they frequent local bars several nights a week. Are they drowning their fears with alcohol? Or maybe I am the only who has something significant to deal with. I go home every evening to a house pulsating with life. A grown man over six feet tall, healthy, strong, only thirty years old. Four kids, all of them wild and wide open. Two cats, and a Doberman puppy who rockets through the house like a maniac when we release him from his kennel. Clothes and shoes and toys strewn about. Bacterial growth: No one flushes the toilet, and my husband forgets to change the litterbox. So much life. Why do I feel so afraid? Maybe it’s because the others have only their own mortality to deal with. I also have to deal with that of my children.
In a hundred years, none of this will be.
In a hundred years it will be someone else’s turn. But haven’t I always known that?
I become accustomed to lab. I notice a guy at an adjacent table who retches as a matter of course. “Hold up hold up,” he says, and bounces away from his table, gags a few times, assesses the possibility of vomit, and then, when it seems safe, bounces back: “Okay, I’m back in the game.” He is almost cheerful about it. I retch secretly, inside my shirt, from time to time. This isn’t the deep sustained retching I endured in early pregnancy, the kind of retching that hollows you out, leaves you exhausted on the bathroom rug. This kind of retching builds up for a while, like a sneeze. And like a sneeze, you can sort of hold it back. It can be managed discreetly. We’re all tough here; we’re all doctor material.
Inevitably we learn. I stare at the vein popping out of my daughter’s neck as she screams, and I name it. I study the joints of my cadaver’s elbow, and I can visualize, at the most basic level, what happened to my son the time he was diagnosed with “nursemaid’s elbow.” I coerce my husband into letting me demonstrate to him—using him as the subject—the “cremaster reflex,” which is the retraction of the scrotum into the hollow of the groin area when a male’s inner thigh is stroked lightly.
We cut our cadaver’s penis exactly down the middle. It falls open like two roads diverging. I cut a small opening into the scrotal pouch and push my gloved fingers inside to bring forth a testicle. Touching his genitalia seems so intimate. This is the same flesh that gave this person the most exquisite of pleasure, the flesh that someone who loved him touched with tenderness, with passion. Now I am casually slicing through it as though it were baked ham. I try to tell my husband about this, but he covers his ears. And says that our shower sponge smells like formaldehyde and that I should start using a separate sponge.
It occurs to me that I know my cadaver’s secrets. I know things about him that no one else knew when he was alive. That he himself did not know. I’ve seen a side of him no one else has seen. A side of myself I cannot see. This baffles me. It reminds me of a time when I was about ten years old and learned that many of the stars I saw in the night sky had died a long time ago. I had trouble getting my mind around that, and, in the same way, I am having trouble correlating what I experience in the gross lab with what is true and factual.
I don’t know exactly when, but at some point the revulsion subsides and is replaced by an element of tenderness. I find myself smoothing a lock of formaldehyde-soaked hair back, or resting my hand on his thigh while someone else dissects. I catch myself doing these things and stop immediately, but I sense the shift inside me. Something has changed.
I am the first to hold his heart. We have some difficulty in removing the heart from the chest. The instructor comes to our table to help us wrestle the heart from all its various connections to the body. I am stabilizing the heart with both my hands when the last connection is severed. The heart falls heavily into my palms. I am paralyzed for a moment. You’re never ready for that. You’re never ready to have another human being’s heart plop into your hands.
The instructor smiles and says to me, formally, “You have his heart … in your hands.” I lift it up in amazement, this football-sized hollow thing that pumped unceasingly for the last who knows how many decades. I wash it at the sink, holding the heart beneath the faucet, letting water flow down into the atria and ventricles. The heart is bottomless, it seems forever before it reaches capacity and the water overflows. I think of the phrase, “He has a big heart.” I think of the phrase, “My heart went out to them.” I stand at the sink a long time, not wanting to relinquish the heart, or to cut it.
That night, for comfort, I lay my head on my little boy’s chest and listen to his tiny, plum-sized heart trilling away in the drum of his chest. He lifts my face to his and kisses me. After he falls asleep, I stare at him a long time, tears sliding down my face. My husband holds my hand and tries to understand what I am going through. It is clear to him that something is going on, something more than my usual histrionics. I can’t explain it to him though. I can’t even explain it to myself.
As usual the middle girls sneak into our bed at three in the morning. They are very stealthy, easing beneath the covers at the foot of the bed, but ninety percent of the time, I wake up, catch them, and say, “Back to your own bed!” Now I stop doing that. They still wake me up, but I pretend they don’t.
Sometimes I notice a detail about my cadaver—his blond pubic hair, his neatly trimmed toenails (nothing like the talons of the surrounding cadavers) and I ache to know him, to know who he really was. After the kids are asleep, when I should be studying my textbooks, I write. It feels dangerous not to use this time to study. I am lectured at different times by both my husband and my friend John, another med student, about my writing habit. I remember a science fiction story I read about a civilization in which the people were immortal. The technology of this civilization was so advanced that all body parts could be replaced with synthetic versions. Everyone was partly synthetic. And in this civilization, all creative activity had ceased. It was explained to an outsider: “That’s a human thing. Writing and painting and making music—all of those endeavors represent a longing for immortality. There’s no need for that here. There is no death.”
This would explain why I am as compelled to write as I am to take a breath. Gross anatomy has forced me to face, in the most visceral of ways, my own mortality. Writing is a way to fight back—against my fear, maybe even against my own death.
I receive an e-mail from a documentary filmmaker who hopes to meet with medical school students. She wants to make a documentary about the relationship medical school students have with their cadavers. I meet with her over lunch hour in a sun-drenched café. I nibble at an avocado sandwich while I describe my cadaver: He’s male; he’s elderly; his heart was obviously diseased and had been operated on at least once. I stop, put my sandwich down. That doesn’t sound right. I try again: He was a man who donated himself to us, and we sliced him to bits. It appears as though he was up and about, taking care of himself, and that he probably died suddenly. He’s got the most beautiful subclavian veins. I held his heart in my hands.
I feel for the right words, the words that will give her a sense of the relationship that I have developed with someone I only know in death. But I don’t find them. No mountain of words can approach it.
Sometimes I go to other tables, observe other cadavers. The dainty Pakistani man with the perfectly trimmed beard and fine bone structure and the delicate vein along the anterolateral portion of his forehead. His face is serene. He died with his head turned slightly to the left. He looks as though he went to sleep one night and never woke up, and the moment of death occurred in the middle of a pleasant dream. No grimace, no half open eyes with cloudy tissue peeking through. The exact shape of his penis is perfectly delineated through the thin membrane of uncircumcised skin. Some of these people, even in death, in chopped up, disemboweled death, have intense character and presence. I visit the small Pakistani man from time to time, for no reason other than to see him again, visit him as though I’m pausing to chat with an acquaintance. And in a way, I am, but our conversation is silent and one-sided.
The cadaver at the table directly next to ours is tall, robustly built, with a long, narrow head full of thick silvery white curls. He was handsome. He had always been handsome, that is clear. It’s a shame to see bloody formaldehyde and cadaverous tissue splash up into that gorgeous hair. He looks like he would have been a jokester in life, someone with a quick, witty response to everything.
It is the last lab. The course director comes around to each table, reads the tag on the toe of each cadaver, matches it with the number on his paperwork, and offers us the information he has about who these people were. He approaches our group and reads off of his clipboard. “He was seventy-nine years old. He died of coronary artery disease. And,” he looks up at us as he says this, “he was a clergyman. A man of the cloth.”
And that’s all we are given. We don’t even get a first name. Isn’t it strange, I think. I knew a man intimately, and I never knew him at all.
It is late January. It has been two months since the end of gross anatomy. I am making rounds with my preceptor, a pediatric hematologist-oncologist. A third-year student is rounding with the same doctor, and at some point the other student and I are alone in a conference room. We talk about medical school life. I ask him if he enjoyed gross anatomy. “No,” he says. “In fact, I think I have post-traumatic stress disorder from gross anatomy.”
I am delighted with him; this is the first time that someone else in medical school has corroborated my experience of gross anatomy. And I can see how gross anatomy might trigger a case of post-traumatic stress disorder. But for me, this did not happen. I slogged around in death every morning, dissected a man I never knew for the sake of furthering my education, but I inhaled my children at night. The antithesis of gross anatomy lab is a houseful of children. Why did I think medical school would be harder with children? My children are the reason I survived gross anatomy minus the PTSD.
At some point during the first year of medical school I have realized the advantages I have over my younger, childless colleagues. They don’t go home to a built-in social niche, a warm dinner, a three-year-old waiting to cuddle. As for my female colleagues—it is safe to say that most of them will never know what it’s like to stay home for five years straight, doing little more than nursing babies and playing with children. By now I have met several female physicians who are also the mothers of young infants. They pump milk, work long hours, pay for the best childcare money can buy … and they grieve their infants. These are life’s tradeoffs. If I had done things in the proper order, my kids would have had violin lessons, private schools, and nannies. Instead we shopped at thrift stores, used food stamps, lived in a small sunny house in rural Georgia ... and either mom or dad has always been home. I start outing myself again. I have warmed up to my story. I want to tell it.
A few minutes later I am back with my preceptor and he asks me to examine his eight-year-old patient while he takes the history from the mother. As I press my stethoscope to the girl’s chest, I can see my cadaver’s heart. It is a permanent feature of my memory. I lay the child back and my fingers search for the boundaries of her liver, but it’s his liver that I picture. The girl hops down from the examining table and, though she is very big for her age, she climbs into her mother’s lap. I think of the science fiction story again, and then I remember a poem by Mary Oliver:
To live in this world
you must be able
To do three things:
to love what is mortal;
to hold it
against your bones knowing
your own life depends on it;
And when the time comes to let it go,
to let it go.
People still exclaim over how hard my life must be, what with simultaneously becoming a doctor and raising children. I agree that it can be very hard, and I still entertain the occasional fantasy about being a single medical school student (or at least married without children), but given the circumstances, what would have been much harder is never getting to do this at all. My professional ambitions didn’t fade with the arrival of motherhood, and not becoming a doctor, at least for me, would have meant living with a great permanent regret. That would have been harder.
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