Gross Anatomy

Published in Puerto del Sol, Spring 2014

My sister and I went to Boston University Medical School on a warm Monday night last spring at the invitation of the medical students who had spent the semester dissecting my father’s corpse. We didn’t know what to expect when they invited us to the Anatomy Donor Memorial Service. My mother had been an anatomical donation twelve years before, but no such invitation had followed, simply a notification eighteen months later to pick up her ashes. When we arrived we were given name tags—both of us wearing our father’s name Ormond Manhard printed on a white label. We were asked if we would be willing to meet with the students at the end of the ceremony and when we agreed they said they would find us by that tag. Then we were directed to chairs in front of a screen where photos of the donors were showing in a continual slide show loop. There was my father—smiling with a rose in his lapel, looking like everyone’s ideal grandfather. Fluffy white hair. Sweet plump face. The photo was taken in Ireland at my son’s wedding ten years before. He made the trip at age eighty-two with a gallon of scotch stowed in his suitcase. They sat him at the head table next to me where he complained bitterly all through the toasts that he could not hear what anyone was saying.

The B.U. Medical School service began with a student reciting Robert Frost’s poem “The Road less Taken.” Then a professor of Gross Anatomy thanked the families and spoke eloquently about the fact that these donors made it possible for the faculty to avoid teaching anatomy ‘in the abstract’ as is the trend today. It’s important, he said, that they know they are working with ‘human beings’ and it is the best way for them to learn that the body is an organism, that everything is related to everything else within the body. We may all look different on the outside, he said, but inside we are “all pretty much the same.” I knew about cadaver work, having read Christine Montross’ beautiful book Body of Work. Her description of the fear and anxiety of her fellow first year medical students as they met their cadaver, and the reverence of their final moments with it, were a surprising comfort to me when I found myself disturbed by the lack of a body at my mother’s memorial service. I did not expect to be disturbed this time, but when the professor talked about how these ‘donations’ were used twice—once for the upper class students to demonstrate the work for the incoming students, then for the students to do the work themselves, I had a sudden image of a turkey being carved at the table and then of my own crude attacks on the leftovers. I swung my eyes away from the slide show and allowed myself to be blinded by the setting sun. 

Next, two students sang the song “Gone, Gone, Gone.” The singing was a pleasant surprise. “Gone, Gone, Gone” is a contemporary song about lost love. It did not fit my experience with my father, but it was a sweet choice and the students had lovely voices. There followed another reading, this time of the poem “Invictus.” Then there was a quiet ceremony in which one student read the names of the donors (first names only) and another student lit a candle for each name. The service ended with two students singing “Over the Rainbow” which is when tears threatened to overtake me. It is the song my sister and I used to sing in the bed we shared growing up, while my parents enjoyed their extended cocktail hour in the living room below us. It is the song that was played at the funeral of my friend Channing, who had died of complications from ten years of dialysis—the complication being her decision to walk away from her regular treatment, check into a motel in New Hampshire, take some potassium she had hoarded, and wait for the end. It is the song I listened to during my private cocktail hour each evening in the hot cement box where I lived during my Peace Corps service in Botswana, where I was during the last weeks of my father’s life. 

I wiped my eyes and stood up at the invitation for families to be the first in line at the table for refreshments. We made our way through the crush of students standing in the back of the room and looked over the spread: some homemade items (when does a medical student have time to cook?) and some familiar Whole Food take out items (how does a medical student afford Whole Foods?) My sister and I had planned to go out to dinner after the service, not knowing that a meal would be offered. Perhaps it was the memory of our three-day vigil when my mother was dying and the steak dinner we treated ourselves to at the end. MFK Fisher articulated the need for a good steak after a death, saying “... most bereaved souls crave nourishment more tangible than prayers: they want a steak. What is more, they need a steak. Preferably they need it rare, grilled, heavily salted, for that way it is most easily digested, and most quickly turned into the glandular whip their tired adrenals cry for.” 

 I needed a glandular whip. My adrenals were tired. I had returned from Africa a couple of months before with a compromised thyroid, a greater appreciation for toilet paper, and a sense that I may no longer fit into American society. I was hungry, but my appetite was limited. Once we managed to put a couple of snacks on our paper plates, we were approached by a handsome young man who introduced himself as Kumar and asked us to come sit with him and six other students who had worked on ‘Ormond Manhard.’ The first question they asked:  “Was your father very active all his life? He was in such good shape.” My sister and I burst out laughing. “No,” we said, “He was very sedentary most of his life.” They were shocked.  Apparently when you enter Gross Anatomy class and are assigned a cadaver you are told only the name and the age. The rest is discovery. These students were surprised to find a brand new titanium hip in a ninety-two-year-old man.

Well, yes, we said, he did work out a bit, but only in the last couple of years of his life. He broke his hip tripping over the cord to the exercise machine in the gym when he was getting ‘buff’ for his ninetieth birthday party. And although they noticed scar tissue where we told them a piece of his lung had been removed, they had no idea this was the body of a man who had been a heavy drinker and smoker most of his life. Emphesema? Really? Drinking? His liver was fine. They were fascinated to hear that he had been in World War II and had landed on the beaches of Normandy six days after the invasion. He never spoke of his experiences until the sixtieth anniversary of D-Day when someone came to interview the veterans at his independent living home. He had majored in journalism at Missouri University, then joined the army where he was assigned to ordinance, maintaining jeeps throughout the war. During the ‘60s, when my generation was filling the streets protesting Vietnam, I asked him what he remembered from World War II. He went silent, then said “I remember people walking. Long lines of people walking,” but wouldn’t say anything more. He crossed France into Paris, on through Belgium and into Germany. I know this because there are photos in the family album of him in uniform standing in front of destroyed buildings, with the name “Aachen” written on the white scalloped edge. I never heard him speak of anything beyond the beaches of Normandy.  My mother said that my father had returned from the war a different person. His body was fine, no wounds, only a slight astigmatism requiring him to wear glasses. But he was quiet now, and spent his time reading. “He didn’t want to go out,” she said. “He didn’t talk as much as he used to.” As time passed that must have changed. They were very social during the years I was growing up in ‘50s suburbia. Although he made snow forts with us, and raked leaves, and built a patio and made furniture, when someone says ‘father’ I see a man sitting in a chair reading.  

My sister proudly told the students that when my father had lung surgery at the age of ninety the surgeon said there was no evidence of arterial sclerosis, “unheard of” the surgeon said. Still, the students were perplexed by our description of Ormond Manhard. I asked if they had seen the TV show “Mad Men.” That was the life he led,” I said, “Smoking and drinking and working in advertising.” They nodded their heads, this they understood.  My father began looking for the exit when his eyesight began failing, when he had to sit five inches from the TV to watch the Red Sox, when large print editions of books no longer worked. He asked my sister, his health care proxy, to research euthanasia, then made an appointment with his doctor to discuss ‘end of life’ issues. My sister told him Massachusetts did not allow euthanasia. The doctor said he was sure my father could adjust to the failing eyesight. “You must be making some accommodations,” the doctor said. ‘Well, yes,” my father said, “I did give up playing darts.”  My father suffered from a lazy epiglottis and was in danger of aspirating. After the lung resection to remove a massive infection from one such aspiration, he was told he should consider a feeding tube. Knowing that would mean he could no longer remain in his independent living apartment, he taught himself to swallow by lowering his chin and slowly, very slowly, taking in a meager amount of food. He began making trips to Boston to visit the doctor he called the ‘sword swallower’ who rooted a steel instrument down his throat, opening up the passageway. At some point after his end-of-life discussion my father decided to discontinue his visits to the sword swallower. About the same time he was diagnosed with a slow moving lung cancer. We did not discuss all this with the students, but we did talk about how hard it was to deal with doctors and end-of-life issues, and how my father had once said, wistfully, “It used to be your doctor knew you and your family. When you were ready to go, you told the doctor you were ‘tired of life.’ Everyone knew that,” my father said.  One student said he thought the law for euthanasia would pass before they finished medical school.  

These students were smart and eager and our conversation moved from the particulars of the corpse of Ormond Manhard to the difficult ethics of medical care today. We told them my father wrote a letter to the hospital after he watched every nurse and aide who entered his room use the hand cleaner dispenser and noted that not a single doctor used it. I told them the story of my friend, who called every hospital in New York City when her elderly mother did not return home one night. When they finally found her in a hospital the nurse said “We knew someone was looking for her because her cell phone rang all night.” When did it become illegal to check a patient’s cell phone? Particularly a confused elderly patient who cannot speak?  I asked them what had brought them to medical school. A student from Turkey said he had worked with hospice and wanted to “do more.” A Vietnamese student from California said he had worked as a translator in a hospital before deciding on medical school. A quiet young man from Indiana said his mother had died of breast cancer.  We talked about the power of a doctor’s words. I told them the prognosis I had been given after my mastectomy: “you have a ninety-seven percent chance of living twenty years” The proverbial double-edge sword: it haunts me, but it has also been a driving force in my life. It’s the reason I did more graduate work, the reason I joined the Peace Corps—to be sure I was living the life I wanted while those twenty years went by.  My sister told them my father would want them to wash their hands when they enter a patient’s room and to introduce themselves every time they met a patient, and most of all, to listen hard to whatever the patient says. We laughed a lot and they wanted to know which of the slide show photos was Ormond. When we pointed him out they said they recognized him.