December 2, 2010

In Memoriam

We are privileged to have spent an entire semester examining the bodies of our donors. We have sliced them open, separated skin from muscle and muscle from bone; we have laid bare the inner structures of brain and lung and heart and gut. In many ways, we know our body donors much more intimately than we may ever know another patient: we have seen the ravages of age and disease not only from the outside but from the inside, from the discolorations that betray a bruise or internal bleeding and from the calcification of arteries. As we moved from the arm to the head to the chest and abdomen and now move on to the hips and legs, we have learned the secrets that a lifetime compiles in the flesh. Here, one donor had an appendix in a highly atypical position, on his left side. There, a donor died of cirrhosis of the liver and as a result, his entire preserved body turned a pale chartreuse. Our donors, unlike patients, cannot hide things from us: we can see the extent of a disease's path, the traces of malignancy or self-destructive behavior which have writ large upon the organs their telltale signs.

We know so much, and yet so little.

Who was this person who lies here on the table in front of us? Was he kind? well-liked? despised by one and all? Did she have many children? and did they give her grandchildren? Was his life happy, or shot through with sorrow? Did her family mourn her passing, or was it a blessing in its mercy? What convinced them to donate their bodies so that we might learn?

It is these questions which we push aside or ignore, because these are the questions we cannot answer. In some ways, it is helpful not to know. The distance that we are given by the sheer anonymity of donation allows us to ignore the fact that here before us lies the body of a human being. To ignore the humanity of our donors, though, is to deny our purpose here--to learn to help the living through the sacrifices of the dead.

Many of us have grown attached to our cadavers. In a strange way, they are our labmates, no different from the students standing across the table from us. As a mark of affection, we named our donor Betty Jo. Her name engendered a heated discussion. We debated several names, trying to find one that fit our impressions of our donor the best. In the absence of a true history, we created one for her. Betty Jo, we decided, was clearly someone's grandma. She was the warm and fuzzy grandma archetype, with a checked apron and a plate of cookies straight out of the 1950s. Even though we had no way of knowing if “Betty Jo” was anything like our imaginary patient, by giving her a name, we included her more in our dissection. After her christening, we tended to refer to her by her name, or even talk to her a bit. When the dissection was difficult, we were upset with her; when we found an interesting structure, we gave her praise.

As we draw near the finish of our anatomy course--and as we come ever closer to day when we must bid our body donors goodbye--today is a chance to take a moment and reflect on their gift to us. Without their donation, anatomy would be purely abstract, rooted in the fictions of Netter's atlas. Instead, our knowledge is concrete, tied to specific donors and the structures we saw and identified there. In tracing the nerves and vessels within the body itself, we have created our own maps of anatomy that will guide us in our future careers as physicians.

For this, we must be grateful. It is only fitting that we honor our body donors here today, that we take a moment to thank them with our hearts for the knowledge we have gained at their sides. As future physicians, our privilege to know the intimate secrets of other people has already begun; let us remember our body donors as we go out into clinics and use that which we have gained to learn the private information of other patients' lives.

Delivered at the MCW Body Donor Memorial service, 12-1-10.

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