Friday, April 22, 2011


It was a story incomplete.

The very last post I wrote about anatomy lab was a reflection on our donor, the night before we dissected his head and neck.

A few of my anatomy posts have been stitched together by a gifted editor and will run as a front-page story and feature in the Health section of the Los Angeles Times this coming Monday.  Several times, the editor asked for more concrete details about dissection above the neck.

It would mean I would have to think about it, and worse, write about it.  And there was a good reason that since November, I have done neither.

I am ashamed about what happened in lab.

We had a ceremony honoring our donors in January.  The pieces read and thoughts expressed were elegant, kind, and thoughtful.  That is the way I would like to remember anatomy.  But, in a way, reflections are sugarcoated.  They are certainly honest, but by definition--they occur after much thought.

What happened in lab occurred with no thought and is no less honest.  The day after I wrote the post reflecting on our donor, we entered lab to begin the dissection.

There was the saw—our way into the brain.  The only other time we had interacted with bone was when we banged through the kneecap with mallet and hammer to observe the joint and cartilage inside.  It didn’t feel particularly disturbing, since orthopedic surgeons basically do the same thing.  Above the neck was different.  On no level, in any instance, would a doctor ever do what we were about to—saw through the skull.

Our donor ceased to become human for me after we peeled off his facial skin like a mask to reveal the small muscles underneath.  Without hair on his head, chin, and brows, he was a specimen.  This made the next part of our task considerably easier—cut through skull, reveal brain, pull brain apart, distinguish cranial nerves that control our five senses and movements.

When you saw through a skull for ten minutes, the room—your world—becomes that skull.  You inhale dust particles, acutely aware of where they came from.  Saw against bone shrieks, notes stumbling, uneven in pitch and length.  It is anything but mechanical.

It was surreal to watch my labmate in scrubs, apron, and goggles, with saw raised in hand.  He looked no different from a madman in a horror movie.  Were we the same people who wore suits to our school interviews and gushed about how much we wanted to help people?

There was no analogy my mind could make, no particular moment in my memory that in any way compared to this one.  The whole situation seemed nothing short of ridiculous.  For some reason, the absurdity made me giddy.

I giggled.  Instructors like to use the term "nervous laughter," but I didn't feel nervous.  I felt outside myself.

My reaction was contagious.  All four of us breathed in dust and formalin and laughed above the roar of the saw.  Dentures flew out of the cadaver’s mouth and clattered onto the floor.  In this warped reality, we took this in stride and giggled harder.  Of course, I thought sarcastically, when you cut through someone's head, their fake teeth fly at you.  What else could I expect?  It was a nonsensical situation; we responded in kind.

Back in my room and in street clothes, I called my mother and described the scene in vivid detail.  When she reacted with the appropriate concern, I told her, “No, no, you don’t understand.  It was really funny!”  I was convinced.

I sobered up after a few minutes, horrified about what I had done.  I asked my mom what kind of person my reaction made me.  “It’s a coping mechanism,” she said.  “But I didn’t feel like I had to cope with anything,” I protested.  “That’s the point, isn’t it?” she said.

If everything we do is to rationalize or make ourselves feel better, what isn't a coping mechanism?  Does that make it justified?  Does that make irrationality rational?  That was the first time in my life I have had a public reaction that I could not bring under control.  It's difficult to think about, so I don't very often.  But when I do, I still struggle to make sense of it.

Or maybe it's all just nonsense.


  1. I love that you posted this. As a doctor, I've had and all my doctor friends have had these moments. I think it's hard for anyone to understand that of course you aren't uncompassionate or making fun. It's a level that is natural and normal, but can look cold or callus. It's the "I know you are in dire pain, but wow, cool absess." If we can't separate ourselves from our situation, we can't help - or at least not long.

  2. In my training I often think of Dr. Hibbert on the the Simpsons. He's always chuckling at inappropriate moments.
    The important thing is to make sure your patient's feelings and dignity is respected, and beyond that be a bit gentle on yourself.
    We aren't obligated to abandon all of our coping mechanisms. What would be the point? If instead of laughing in your dissection you had started crying (and I've done both, by the way), would you have been able to finish and learn the material? I don't know. Maybe that laughter truly helped you get through an extremely stressful situation. Maybe you should thank your coping mechanisms for bringing you this far and allowing you to perform when it counts, lord knows you're going to need them in the next few years. You are obviously already doing the work of unpacking things later- touching base with your layperson self and making adjustments. This is the work!

    On one hand we feel we have to struggle to stay grounded, on the other hand we expect ourselves to be more than human. We accept our patients and don't judge, but are sometimes so hard on ourselves. It's surreal to be told in one breath not to judge a woman for drinking during her pregnancy and leaving her FASD child in a dumpster, and then in the next breath we're told that it's totally unacceptable for us to post a photo of ourselves with a beer on facebook.

    Have you debriefed with your lab partners?

  3. I love this. Thanks.

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