my first patient

I will try to describe as honestly and accurately as possible my first experience with my "first patient." I say that this 84 year old woman who died of pancreatic cancer however many weeks, months, years ago as my first patient because she was introduced to me as so by my anatomy lecturer. And I really believe we should feel this way. With the care and respect that we should interact with our first living patient, we should approach our first cadaver. Yet she is and will also be an important teacher. She may not be able to show the dynamical aspects of physiology as her blood no longer flows, muscles no longer contract, no pain is felt, but no smile is shared... But, she will show us - intimately, grossly, finely - the workings and failings of the human body.

It really is a privilege to be able to study the human body with an actual human body. Ethically, many people still can't believe such a class exists - how can we cut and probe, slice and pull, peal and tear apart the human body which is the temple of the soul? Perhaps before the first anatomy lecture, I had become desensitized to potential moral audacity of this process of learning because it has become such a standard in medical school, and I have been expecting this as a medical student. Perhaps I can't see the atrocity because I myself would like to see every bodily part of me that can be of any use to anyone -- to be used. And I deliberately say the word "used" because something of use has a purpose, has a function. My dead body will have no function or purpose after my death - it will only go along the natural trajectory of decomposition or be burned to ashes - unless the living use it.

However, during the first anatomy lecture, I was re-sensitized to the honor and emotional weight of dissecting a cadaver. The professor read to us a letter written by a a dying man who in his living will dedicated his body to my medical school and hospital. He asked for the physician to not preserve his life through machines and tubes, but rather take his death bed as a start of new life and opportunity. Some thought the letter was cheesy. I was moved; even got a little teary-eyed. With that sort of reaction, I was worried how I would be once I stepped into the anatomy lab and met my own first patient for the first time. The instructor said he fainted his first day. Some people get nauseous. Some people carry a heavy weight when it comes to the death and the dying.

Turns out, I was just fine.

Without a doubt, I was excited, heart did race a little, and I was (still am) amazed. Anatomy is one lab that I really don't ever want to miss. But I didn't have any sort of emotional break-down or feel queezy. The color and texture of the skin had already become a brownish discolor that the humanness factor dipped a bit. But, I remember seeing the head wrapped in a green plastic bag and thinking, oh my god, this is beginning. I remember looking at her individual physical markings - a scar on her calf, a freckle on her shoulder - and just thinking how unbelievable this is, feeling a sense of curiosity and care. Who else knew about that scar or that freckle while this lady was alive? In fact, it was the little things that pulled an emotional string. Her hair, her ear, the wrinkles of her elbow. It's hard to actually describe how it feels, but I was in fact eager to use my dissection tools and make my first incision. Is this wrong? I don't know. But it perhaps is important to be able to detach a little and really take this experience as one of the most amazing learning opportunity that anyone could ever offer. And I should never forget that this opportunity was given to me by the individual laying face down on the table in front of me.

My tank mates (we call the resting place of our first patient cadaver The Tank) decided to name our cadaver Gertrude. Thought it was a name that suited her age and plump figure. She does have a lot of fat in her body, making the dissections and isolation of nerves, vessels, and other delicate organs a little difficult. But this is an obese nation so what can we expect? But now I know what the obese body looks like inside - the fat deposits and globules. It gives a strong enough motivation to stay fit and healthy even with age. And the muscles really look like meat. Cutting off and shredding away a segment of the rhomboid muscles, we really thought it looked like pulled pork. (Oh, and all of us were starved by the time that first four hour lab was over. I doubt anyone ate bbq that night but I did eat some canned salmon...)

So far, we've done the superficial and inner muscles of the back and neck. Today, we study the spinal chord and nerves. I still haven't seen her face - the part of the human body that makes her a real individual with a name, family, memory. The part that reminds us medical students that our cadaver was really a person. I feel that will be the most moving moment.

More updates on Gertrude and Anatomy as the class progresses.


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Perhaps a suitable photograph

Otoro (Fatty Tuna) at a Hot Hprings Inn. Izu, Japan Winter 2010