Living with the Dead

The start of medical school is a somewhat surreal experience.  You work so hard to get there, and then you find yourself standing on a stage wearing a white coat while someone puts a stethoscope around your neck, and you can’t help but feel that somewhere someone has made a terrible mistake.  Looking at the sea of smiling faces watching you, the stethoscope newly slung around your neck feels weighted with responsibility, and you wonder if you’re entirely up to the task.  At least, that’s what some people have told me it felt like.  Personally, I just heard an angel choir, and had to be led from the stage as I stood there yelling “I have arrived!”  Odd how things strike people differently.

I have quickly discovered that medical school is like a hard candy, into which a certain group of people are busily and relentlessly trying to drive a soft, chewy centre.  They didn’t quite ask us to hold hands and sing healing songs together, but the gleam in their eyes suggests that they’ve got the necessary supplies to do so if called upon.  I can see how some folks would believe that this sort of stuff will lead to more humanistic doctors, but evidently they don’t understand that by piling it on so thickly, they’re turning even the most soft-hearted, heal-the-world idealist in our class into a chain-smoking cynic.

For example, take this one course called “The Cadaver as your First Patient”.  The aim of the course is to get us to think of our cadaver as a person, rather than just a collection of parts.  I’ve got mixed feelings about this, as I firmly believe that what’s laid out in front of us is just a collection of parts; the light of intellect that was the person is long-gone, and what remains is the machine that served as its life-support system.  I’ve got a lot of respect for the folks who donate their bodies to serve science and/or medicine, as it strikes me as one last constructive act at the end of an all-too-brief stay on this planet.  I also believe that a baseline level of respect toward the remains is appropriate, because it’s a pretty cool gift.  But I’m not going to hug my cadaver, and it sure as hell isn’t my first patient.

The odd thing is that if they’d entitled the class something along the lines of “Cadaver as your teacher” I’d have been fine with it.  Yeah, I’m learning a lot from the machine laid out in front of me, and I’ll let myself get emotionally invested enough out of respect to call it a “teacher” intead of a “teaching tool”, but that’s as far as I go.  In my mind, the doctor-patient relationship is pretty damned special, and even though it’s been eroded, warped, and corrupted by companies answering to shareholders rather than the patients, what remains is still staggeringly awesome.  By trying to take that awesomeness and pretend that it applies to what is happening in the cadaver lab is both insulting to the students and cheapens the doctor-patient relationship.

I’ve never talked to the guy whose body is laid in front of me.  He never confided in me, sharing his worries about his health or the health of his family.  I don’t lay awake at night considering his condition, nor do I muse in the daytime about his lab-values, or the outcome of a procedure.  To be someone’s doctor is to be trusted by them in a way that few people trust others, and I never earned that trust.  I’m not, and can never be my guy’s doctor.  He can never be my patient.

So yeah, I’m really not down with the whole “first patient” thing.  Meeting some family members of those who donated their bodies was touching, and I went out of my way to give them a handshake and a sincere “thank-you” for sharing their stories.  I yield to no-one in my respect for the donators, and it’s because of this that I get so irritated with the emotionalists trying to turn a cool teaching experience into a sob-fest.  Sure, you guys got some med-students and family members to cry, and you tore down some defense-mechanisms that people were using to deal with the fact that we’re cutting humans apart, but what did you really accomplish?  Did you really think that we had forgotten that the corpses in front of us were living, breathing, loving, dreaming humans at some point?  Did you think that we never wondered what our cadaver’s name had been, where he’d lived, what he’d done?  Did you miss the rush to the paper listing our cadaver’s age and the cause of death, the only information we’re allowed?

We didn’t need to be reminded that we’re dealing with humans, with people.  I haven’t spoken to a single person yet who has anything disrespectful to say about our dead folks in the lab.  And if we’re laughing a little more in lab, if the mood is more relaxed than it was when we first arrived, don’t think that it’s because we’ve forgotten that the cadavers on the humidors were once people.  Instead, understand that it’s a relaxation born of familiarity and that rather than breeding contempt, it has allowed us to take possession of our cadaver as the ninth member of our team.  That he is our teacher–not our patient–and we’re now learning from him, rather than viewing him from a distance.

After all, we spend a lot of time here.  More time than our friends and family see us.  We’re living with the Dead, and the Dead are our teachers.