I began working through the necessary premedical courses, loading up on chemistry and physics. Reluctant to take a part-time job—it would slow my studies—but unable to afford Palo Alto rent, I found an open window in an empty dormitory and climbed in. After a few weeks of squatting, I was discovered by the caretaker—who happened to be a friend. She provided a key to the room and some useful warnings, like when the high school girls’ cheerleading camps would be coming through. Thinking it wise to avoid becoming a registered sex offender, I’d pack a tent, some books and granola, and head up to Tahoe until it was safe to return.
Because the med school application cycle takes eighteen months, I had a free year once my classes were over. Several professors had suggested I pursue a degree in the history and philosophy of science and medicine before deciding to leave academia for good. So I applied for, and was accepted into, the HPS program at Cambridge. I spent the next year in classrooms in the English countryside, where I found myself increasingly often arguing that direct experience of life-and-death questions was essential to generating substantial moral opinions about them. Words began to feel as weightless as the breath that carried them. Stepping back, I realized that I was merely confirming what I already knew: I wanted that direct experience. It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action. I finished my degree and headed back to the States. I was going to Yale for medical school.
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You would think that the first time you cut up a dead person, you’d feel a bit funny about it. Strangely, though, everything feels normal. The bright lights, stainless steel tables, and bow-tied professors lend an air of propriety. Even so, that first cut, running from the nape of the neck down to the small of the back, is unforgettable. The scalpel is so sharp it doesn’t so much cut the skin as unzip it, revealing the hidden and forbidden sinew beneath, and despite your preparation, you are caught unawares, ashamed and excited. Cadaver dissection is a medical rite of passage and a trespass on the sacrosanct, engendering a legion of feelings: from revulsion, exhilaration, nausea, frustration, and awe to, as time passes, the mere tedium of academic exercise. Everything teeters between pathos and bathos: here you are, violating society’s most fundamental taboos, and yet formaldehyde is a powerful appetite stimulant, so you also crave a burrito. Eventually, as you complete your assignments by dissecting the median nerve, sawing the pelvis in half, and slicing open the heart, the bathos supersedes: the sacred violation takes on the character of your average college class, replete with pedants, class clowns, and the rest. Cadaver dissection epitomizes, for many, the transformation of the somber, respectful student into the callous, arrogant doctor.
The enormity of the moral mission of medicine lent my early days of med school a severe gravity. The first day, before we got to the cadavers, was CPR training, my second time doing it. The first time, back in college, had been farcical, unserious, everyone laughing: the terribly acted videos and limbless plastic mannequins couldn’t have been more artificial. But now the lurking possibility that we would have to employ these skills someday animated everything. As I repeatedly slammed my palm into the chest of a tiny plastic child, I couldn’t help but hear, along with my fellow students’ jokes, real ribs cracking.
Cadavers reverse the polarity. The mannequins you pretend are real; the cadavers you pretend are fake. But that first day, you just can’t. When I faced my cadaver, slightly blue and bloated, his total deadness and total humanness were undeniable. The knowledge that in four months I would be bisecting this man’s head with a hacksaw seemed unconscionable.
Yet there are anatomy professors. And the advice they gave us was to take one good look at our cadaver’s face and then leave it covered; it makes the work easier. Just as we prepared, with deep breaths and earnest looks, to unwrap our cadaver’s head, a surgeon stopped by to chat, leaning with his elbows on the corpse’s face. Pointing out various marks and scars on the naked torso, he reconstructed the patient’s history. This scar is from an inguinal hernia operation, this one a carotid endarterectomy; these marks here indicate scratching, possibly jaundice, high bilirubin; he probably died of pancreatic cancer, though no scar for that—killed him too quick. Meanwhile, I could not help but stare at the shifting elbows that, with each medical hypothesis and vocabulary lesson, rolled over this covered head. I thought: Prosopagnosia is a neurological disorder wherein one loses the ability to see faces. Pretty soon I would have it, hacksaw in hand.
Because after a few weeks, the drama dissipated. In conversations with non–medical students, telling cadaver stories, I found myself highlighting the grotesque, macabre, and absurd, as if to reassure them that I was normal, even though I was spending six hours a week carving up a corpse. Sometimes I told of the moment when I turned around and saw a classmate, the sort of woman who had a mug decorated with puffy paint, tiptoeing on a stool, cheerfully hammering a chisel into a woman’s backbone, splinters flying through the air. I told this story as if to distance myself from it, but my kinship was undeniable. After all, hadn’t I just as eagerly disassembled a man’s rib cage with a pair of bolt cutters? Even working on the dead, with their faces covered, their names a mystery, you find that their humanity pops up at you—in opening my cadaver’s stomach, I found two undigested morphine pills, meaning that he had died in pain, perhaps alone and fumbling with the cap of a pill bottle.
Of course, the cadavers, in life, donated themselves freely to this fate, and the language surrounding the bodies in front of us soon changed to reflect that fact. We were instructed to no longer call them “cadavers”; “donors” was the preferred term. And yes, the transgressive element of dissection had certainly decreased from the bad old days. (Students no longer had to bring their own bodies, for starters, as they did in the nineteenth century. And medical schools had discontinued their support of the practice of robbing graves to procure cadavers—that looting itself a vast improvement over murder, a means once common enough to warrant its own verb: burke, which the OED defines as “to kill secretly by suffocation or strangulation, or for the purpose of selling the victim’s body for dissection.”) Yet the best-informed people—doctors—almost never donated their bodies. How informed were the donors, then? As one anatomy professor put it to me, “You wouldn’t tell a patient the gory details of a surgery if that would make them not consent.”
Even if donors were informed enough—and they might well have been, notwithstanding one anatomy professor’s hedging—it wasn’t so much the thought of being dissected that galled. It was the thought of your mother, your father, your grandparents being hacked to pieces by wisecracking twenty-two-year-old medical students. Every time I read the pre-lab and saw a term like “bone saw,” I wondered if this would be the session in which I finally vomited. Yet I was rarely troubled in lab, even when I found that the “bone saw” in question was nothing more than a common, rusty wood saw. The closest I ever came to vomiting was nowhere near the lab but on a visit to my grandmother’s grave in New York, on the twentieth anniversary of her death. I found myself doubled over, almost crying, and apologizing—not to my cadaver but to my cadaver’s grandchildren. In the midst of our lab, in fact, a son requested his mother’s half-dissected body back. Yes, she had consented, but he couldn’t live with that. I knew I’d do the same. (The remains were returned.)