Ciarán Walsh of curator.ie writes about the Museum for RTÉ Culture > https://www.rte.ie/culture/2018/1112/1010315-the-skeletons-in-trinitys-closet/
First & foremost to say, it was such a thrill & privilege to be able to conduct – thanks to Siobhan in the department – our session in the beautiful atmosphere of the old Anatomy Building lecture theatre (as photographed so perfectly here by Fionn McCann). Everyone was most impressed … even a tad sorrowful!
Opened up with our group recitation of Yeats’ ‘Paudeen’. They’ll know it off by heart by the end of the module!
Then had quick recap from one of the group on last week’s proceedings.
Then I set the mood for this week by reading Tríona Ní Dhomhnaill’s ‘The Mermaid in the Hospital’ as translated by Paul Muldoon. (“It was the sister who gave her the wink / and let her know what was what.”)
Then, somewhat unusually, I gave a sort of lecture on anatomy as a human pursuit and its significance in medical training – based on an essay I wrote for the ‘Irish Medical Times’ years ago when the Anatomy department was moving from its charming, nineteenth century home to the shiny new Biosciences building >
The idea is that perhaps to ensure the students adopt the appropriate attitude towards the privilege that it is learning from cadaveric dissection, some civilising influence of the aesthetic on display in the old building (architecture, art, history) needs to be / is being replaced by comparable influences in the new facilities – the orientation programme, the relatives room.
Keeping it somewhat personal, I told them about an old friend, Max Aguilera-Hellweg, who sat in this very room as a first year MATURE medical student in 1998/99, but who transferred back to the USA for the rest of his degree because of a dispute with the School arising from conflicting views of his book ‘The Sacred Heart’, which he had just published the year before. I read and analysed extracts from Max’s book, highlighting how his interest in medicine arose (a photographic assignment that led to an obsession) and his resulting intense, artistic fascination with representing the most full-on images of the workings of the body as revealed by surgery.
… Far from getting sick, I felt what I can best describe as awe. Photographing my first surgery was so foreign to any of my previous experiences that I couldn’t place it. I couldn’t compare it to anything. It is one thing to know there is a spinal cord in the hollow of your back; to see one for real is altogether different…
The cardinal glow of oxygenated blood reminded me that there was a man in there. A thick, milky-white strand covering the nerve tissue that stretches from brain stem to tailbone, splitting off into minute and multitudinous nerves, producing the sensations of heat, cold, pleasure, pain; the dura of the spinal cord lay revealed. I saw the painting above my grandmother’s bed. The one I saw as a child waking up from my nap. The one of Jesus. His heart bleeding, wrapped in thorns, engulfed in flames.
I realised I was in the presence of the most intimate, most vulnerable, most inviolate thing I had ever seen. The spinal cord had never seen light, wasn’t meant to see light, and at this moment was bathed in light. My first impulse, I must confess was to spit. To defile it in some way. Bring it down to my level. I didn’t, of course, but I felt I was in the presence of something so precious, so amazing, so powerful, so pure, I couldn’t bear the intensity.
“What is that?” I asked. “What’s it made of?”
“It’s like a sausage,” the surgeon said, “with toothpaste inside.”
We discussed the heightened language and thinking here; the artistic impulse; the impact such descriptions have on a reader, particularly whether or not they can be said to have benefits for medical student readers; we debated why Max’s impulse was to spit (including wondering was it actual!); we discussed the surgeon’s disabusing and mundane reply, in terms of professional distance and general normalisation.
Where before [as photographer] I searched the eyes of a man [for his soul!], the wrinkles of his clothes, the wear and tear of his shoes, I look now in the recesses of his flesh, the colour and texture of his liver, the markings and capacity of his lungs.
We discussed our impressions of Max from the extracts we’d read and how suitable his motivations were for someone becoming a doctor. We got into a detailed discussion about empathy.
Then we read and analysed extracts from Sinéad Gleeson’s essay ‘Blue Hills and Chalk Bones’.
We discussed how the suddenness of the migration from the Kingdom of the Well to the Kingdom of the Sick is handled (“It happened quickly, an inverse magician’s trick: now you don’t see it, now you do. From basketball and sprinting to bone sore with a limp. Hospital stays became frequent, and I missed the first three months of school four years in a row.”); the unbelievable trauma to the body and soul some treatments involve; how quickly a patient, even a young patient, become conversant if not fluent in the language spoken in the Kingdom of the Sick.
We went into some detail on the particular impact of physical difference on young people (“I got used to the limp … but gained a new self-consciousness… What I felt more than anything was overwhelming embarrassment. Ashamed of my bones and my scars and the clunking way I walked.”) and how if it’s difficult for a doctor to properly empathise with an adult patient, it can be even more difficult when the patient is a young person or a child. (Though some of them have thicker skin than others, was a point that was made.)
We discussed the clinical aspects of acne and blushing.
There are a couple of particularly harsh doctors portrayed in Gleeson’s essay, and we discussed how prevalent their behaviour might be in healthcare settings these days and whether or not efforts were being made to reduce the instances of such ignorant behaviour:
I explain this to the orthopaedic doctor, this man I’ve never met, and he does that thing I’m used to male doctors doing: he tells me I’m overreacting. A rotating blade is slicing into my flesh, but I need to calm down. When my mother starts to cry, he demands that she leave the room. Fifteen minutes later, I plead with him to stop and he finally gives up, annoyed.
On an early visit to the surgeon, to check my spine for scoliosis, I was asked to wear a swimsuit. Mortified, I cried all through the exam, and the doctor, growing impatient, threw a towel over my lower body.
‘THERE, is that better?’
It wasn’t. I was a self-conscious girl being humiliated for her sense of shame.
Perhaps understandably considering her analysis and perspective, Gleeson summarises perfectly the lop-sidedness of the relationship, particularly as it was back in the 80s:
The Doctor patient relationship had its own imbalances. I have never forgotten the sense of powerlessness in instruction: lie down, bend forward, walk for me. I have felt it counting backwards from ten under the stark lights of an operating theatre. Or when skin is sliced cleanly through. You are in someone else’s hands. Steady, competent hands – hopefully – but the patient is never in charge. The kingdom of the sick is not a democracy. And every orthopaedic doctor who examined me during those years was male.
We discussed the difference between Gleeson’s language / perspective and Aguilera-Hellweg’s.
A variety of analyses were put forward on this idea: “Our bodies are sacred, certainly, but they are often not ours alone… we create our own matryoshka bodies, and try to keep at least one that is just for us. But which one do we keep – the smallest or biggest?”
We noted the empathy behind her observation of another person in Lourdes hoping for a miracle: “He twitches occasionally but is otherwise motionless. There is drool on his face, and I want to say something to him but can’t.”
Also the pathos in: “This is the breakdown of bones, the slowing of a heart, the confinement of our own bodies: a being that once sprung into the world, vibrant and viscous and pulsing with life.”
Finally, we read and discussed Doireann Ní Ghríofa’s poem ‘To the Stranger Who Will Dissect My Brain’ (unpublished) and the students who spoke were extremely moved and impressed with the final description of the “exchange” that happens at the end of the poem between the remains and the (say) anatomy student: “Your brain will blaze bright,// alive and wild, and I,/ I will be the light.” Not only capturing the awe felt by medical students (& some photographers) but also the enlightenment – the final gift of the person who has donated their remains to medical education.
One student spoke about how the poem captured in a way that she could never achieve herself (and that no other language register could, perhaps) that feeling of awe that some students experience when they begin their anatomy dissections.
And to top it all off, the students were able to look around the old Anatomy Museum and get a sense of the history – betimes quite freakish and grotesque – of their studies.
Yet despite the obvious layers of artifice, there is something insistent and revealing in these scenes [Corinne May Botz’s photographs of medical actors,the hired professionals who act out illnesses in order to train medical students in caring for patients]. In her 2014 essay “The Empathy Exams,” the writer Leslie Jamison explored her own experience working as a medical actor, and the complex negotiation and performance involved in expressing one’s own pain and in learning to respond to the pain of others.
Full article in the New Yorker >>>
Medical Council chief executive Bill Prasifka said he was disappointed that the reported experiences of bullying by trainees was no better this year.
He was also unhappy that many trainee doctors seemed to be receiving little or no feedback and have poor experience of induction.
“I am fully aware that the issue of bullying cannot be dealt with overnight and a cultural shift needs to occur in this instance,” said Mr Prasifka. “However, an improved induction programme, or the simple delivery of feedback, is something that can, in fact, be achieved quickly.
“If trainees working in a clinical environment are feeling underprepared, it is a patient safety issue and that is why we have decided to do all we can do within our regulatory role.” (Irish Examiner >>>)
A passerby may wonder
Why wistful I may be,
Why envy haunts my vision
When I view the willow tree.
A passerby may marvel
And admire my molded form.
My every branch and twig and leaf
Has learned how to conform.
My sculptured shape is chiseled
By shears too sharp to see,
For pruning is the price I paid
For this topiary me.
Meandering through scented shops,
Lounging by a pool,
Watching goofy sitcoms,
And trying to look cool,
Crosswords and sudokus,
Magazines and jokes,
These were clipped and hauled away
By the garden training folks.
I don’t begrudge the clipping.
It was my choice, to be sure.
But when the wind blows through the willow,
I feel its freedom’s lure.
From ‘The Inner World of Medical Students: Listening to Their Voices in Poetry’ By Johanna Shapiro
The first national survey of trainee doctors has found most are happy with their training, but in one-in-three has suffered bullying.
The ’Your Training Counts’ report was commissioned by the Medical Council and involved 1,636 trainee doctors who responded to approximately 100 questions. The number who responded constitute approximately half of the trainee doctors in Ireland.
There was a dramatic difference in incidences of bullying between the UK and Ireland. Some 33.7 per cent of Irish trainee doctors reported bullying or harassment in their post in comparison with 13.4 per cent in the UK. (Irish Times >>>)
First-year medical student creative writing assignments on anatomy:
I assumed when undertaking the anatomy dissection course that the strangest part would not be the dissection but the fact that we would be working on actual human specimens. I thought there was a strange sense of morbidity attached to educating someone who’s job it would eventually be to enhance and often prolong human life with bodies medicine may have failed. However upon beginning the course I have realised that this is not the case. The most unusual aspect in my point of view is the casual manner with which we all approach Anatomy, the relaxed and easygoing conversion that flows through the dissection theatre is natural yet one would think it out of place.
The donor bodies are often referred to as our silent teachers however they are never greeted with silence, be it the hum of chatter or the clank of our metal tools noise swells the dissection theatre to fill what would only be an eerie silence making the overall experience for students comfortable and and a place where learning comes easier.
Flicking through netters, there are thousands of images but none stand out. The memory however of holding a human heart is hard to forget. Its size, bigger than a human fist, the rough lumpy fat globules that cover the outer layers which contrast with the smooth almost silky lining of the inner vessels, and the dull red colour of its vessels is something that will stick in a student’s mind forever. It is undoubtedly an invaluable experience which enhances our ability as students to fully understand what it is we are learning.
Leonardo Da Vinci once said; “Our Life is made by the death of others”. In order for my life as a medical student to begin, someone on this earth had to die. I wondered, as I queued up behind another white coat, where my “person” was when I was born, when I made my First Communion, when I found out Santa wasn’t real? I pictured what their life was like as a mother, a father, a golf enthusiast who dreamed of attending the Ryder Cup someday. Flickers of an imagined life ran through my head as we filed into the dissection room. For some reason I wasn’t afraid or nervous. Seeing the white sheet only brought back memories. I had already been in this situation before. My uncle was under the same infamous white sheet when I had to identify him with my dad in the morgue after his car crash. Having experienced that, I was prepared for anything. Nothing phased me to be perfectly honest, the smell, the eerie silence, death. Certainly I wasn’t prepared for the dissecting itself, but the initial exposure was just a silent reminder of what I had witnessed before.
What affected me more than the dead body itself was the idea that this was someone’s wife or mother, best friend or neighbour. The thought of the family and the huge void left behind was something that struck a chord deep within me. I felt a sudden surge of emotion stir inside me – for I had been the one left behind before, and I could somehow empathise with this woman’s family, wherever they were.
We were immediately flung into the deep end and the only way we could tread water was by picking up the scalpel and cutting. At the start I felt protective of this woman, I was afraid for her but I didn’t know why. I knew it had to be done and that she wanted us to do it, but I still felt like I was intruding on something – on her life, her personality, who she was. However, as the weeks went on, she began to resemble less of a person and I suddenly began to understand what the American novelist Chuck Palahniuk meant when he said “We all die. The goal isn’t to live forever; the goal is to create something that will.” By donating her body and allowing us to dissect it and learn from it I believe my “person” has left something behind that will live on forever – it’ll live on through me and my medical career.
“Hey Tommy, can you tell me a scary story?
– Yeah, let me tell you about this place. It’s all white: the walls, the tables, the machines. Everything is white. And then there are these windows through which a genie-blue light emanates: no park or busy street down below to look at. It’s almost as though you were trapped underwater. No one knows why they’re like that – keep people in or keep others out? There are also a lot of books, strewn around, all yellow, grey and ripped. The ground is speckled blue and you know the only reason they chose it was because of how easy it would be to clean up if an accident ever occurred. And then, there are the ghosts.
– No, no. They’re not the ones who scare people. They’re the ones who are actually afraid.
– What? Why?
– Because their bodies are covered by stiff, wrinkled and crackly plastic sheets. The few moments when it does get lifted, they’re staring straight up at white, sterile monster-machines that look like Doc Ock, with prying arms bent at awkward angles around their core. Their only companions are smirking skeletons who have long since grown accustomed to the chilling air that wraps around their bones and the dull humming in the background. They know they shouldn’t be afraid, they know they’re here for a good reason, but when they turn their heads and see the grey veterinarian tables next to them, they can’t help but retreat as deeply as possible into their skin.
George lies in the name of science
in a room with strangers
whom he never met or never will know
He feels neither pain nor pleasure, just very low
They come in the name of science
They see him and they nod
But every ticking second turns glitter from gloom
And they forget George was his name.
Once, he gave trust in the name of science
And in white coats they played God
They assured and yet they failed
Yet now George was at their aid
The place was brighter, cleaner than I initially expected it to be; a synergy of a morgue, surgical theatre, classroom and a cinema all rolled into one room. Sitting there staring, reflecting, the white sheet remains motionless, like fallen snow it weaves only the bear contours of what lies beneath and of what once stood of a beautiful landscape. In that time I wondered about my first anatomy experience and what it means to grow, learn, achieve, and finally become a cadaver. Having just come from an all night TV marathon of ‘The Walking Dead’, the first time I entered that room I was very anxious but acutely prepared to see a body devoid of its humanity and excited about the panorama of discovery that will be viewed in this room over the coming year. I wondered why he donated his body? What were his motives? Was the end painful for him?
As the sheet was removed, I stood transfixed; absorbing every detail -my first patient’s skin was white, smooth and very cold, a marvelous marble statue to a lost hero. He was thin with signs of bruising along his arm – the result of countless hospital injections. At that point I wondered what his life was like, did he marry, did he have children? Our first task was to dissect the muscles of his chest and shoulders. This was it, I still couldn’t believe we were going to cut open a human being. Who is this guy? What did he like to laugh about? What did he cry about? As the scalpel surgically makes a trailing pathway through the skin down his chest, I am careful not to cut too deep in fear of damaging the vista beneath. His skin is slowly peeled away and I look and see what it means to be a cadaver, a person that was once a man. Muscles, heart, lungs liver, kidneys, stomach – they were all present. Dreams, goals, hopes, aspirations, love – they had passed on. What lies here now are merely the tools used to sustain life’s elements, a parting gift sculpted by the chisels of time and donated to education.
Before the words lecture, tutorial or even welcome had been spoken, we were rushed to the anatomy lab. My first thoughts of the room were that it was too quiet, too impeccable, too new. It’s funny looking back, because at the time, I also thought that my new classmates, in the dissection room with me that day, were too quiet, too impeccable.
Apprehension was the primary feeling amongst us. We were all eager to make a good first impression in front of our new classmates, our future friends. Fear wasn’t allowed. We were in med school now- looking at these donor bodies was soon going to be an everyday occurrence. Everyone tried to look brave. Nobody wanted to be ‘that girl’ or ‘that guy’- the one who fainted when he or she entered the anatomy lab for the first time.
It was my first time seeing a dead body, except that of my grandmother’s. That was different though. She was dressed in her Sunday best, her hair done and her makeup on. She wasn’t frightening. In this vast, unfamiliar, and chemical smelling room lay 12 dead bodies, unclothed, with only their towels and plastic coverings protecting us from the fear of failure. What if I couldn’t handle seeing what lay underneath? What if I found doing the dissections too gruesome? What if I failed at the only thing I had ever wanted to do?
Only four months later and I look at the anatomy lab through new eyes. It is no longer daunting. It is where new friends were made. It is where we laugh and chat. It is where we study what we ached to learn, what we came here to learn. The 12 donor bodies are no longer just dead bodies. They have identities and they have meaning. They are men and women that gave their bodies, so that we could go on to become exceptional doctors. It is no longer too quiet, too impeccable or too new. To my distaste however, it’s still as bad smelling as ever.
The graveyard is like no other, neither gloomy nor spooky. The smell. The environment. The sight. Everything is different. The grave is bright. Everything is white. From the floor and the wall, to labcoats and gloves, even the cover sheets for the cadavers. Everything is white. Maybe, so the students could stay bright, but not to feel fright. It is a grave, where the medic students have to learn, from the outermost skin of the body to the innermost complex organs, from the largest femur to the tiny little sesamoid bone. It is a grave that the medic students should fall in love with. Even the grave is full with creepy skeletons staring at them but yet they still come often. Even the striking smell of formaldehyde destroys their nose but it will eventually become addictive instead. And the corpse, will always wait faithfully on their grave for the students to come, giving every bit that they could so the students could one day be a doctor. So yeah, this is the graveyard, totally like no other.
Cold spills out like an open hotel door
Every fake skeleton’s missing a limb
Near open boxes full of people’s bones
The closest to strangers they’ve ever been
Every skeleton is missing something
By crusty old copies of Netter’s map
This is the closest to strangers we’ll be
The dentist smell just seems inadequate
Thick yellowed books like unanswered letters
Spotlights on elbows that never inflame
The dentist smell with no sense of judgement
And no shade of white plastic is the same
Spotlights on hinge joints make do for the sky
By open boxes spilling people’s bones
Where no shade of white plastic is the same
And cold falls out of the old hotel door
The Dissection Room
The white walls, the bright lights, the stainless steel surfaces, one may confuse this room for a hospital ward; however no patient is going to be discharged from here. Then bang; it hits you, the poignant aroma of decaying flesh combined with a concoction of chemicals; stomach turning, nauseating, almost overpowering, however, to the experienced anatomist it is somewhat familiar.
In each bay, beneath the white plastic tarps, they lie, stiff, cold, lifeless, preserved in time, positioned as they lay during embalming. They lie as though asleep; however will never awaken; for they are now in an eternal slumber.
Accompanying each cadaver is a brief description outlining their name, their age, and their cause of death, but one can only wonder; how they might have lived?, where had they be from?, what had they been like?. However we choose to disregard such details, as thinking of them may make the task at hand somewhat more difficult.
Although we can try overlooking the facts, we cannot however ignore the valuable contribution that these individuals are making to our training, we should feel privileged that they have given us an opportunity to attain a greater insight into the inner workings of the human body, knowledge that will hopefully stay to us for our entirety of our medical careers. For it is said that “knowledge is power” and to truly be an expert in something; one must first fully understand it and how it works. Just like an experienced horologist needs to comprehend the inner workings of a clock, we need to fully understand of the inner workings of the human body and appreciate how it ticks.
However I can’t but wonder; if these individuals had been fully aware of the fate that lay in store for the bodies. Had they envisioned, that on a weekly basis, five to ten overly enthusiastic students using an array of weaponry to cut fascia, sever muscles and break bone. Like a bunch of excited children on Christmas morning, ripping through the wrapping on their presents to discover what wonders lay inside, all in the name of exploration, all in the name of medicine.
But one may ask “is this really medicine?”, “is the purpose of medicine not to treat, to heal, to help?” Is the practice of dissection not a bit abstract from the grand scheme of modern medicine?, was their sacrifice truly worth it? only time will tell.
Probably the greatest testament to their gift will be how we apply this knowledge to help others.
What’s disconcerting in a dissection theatre isn’t necessarily the jury of twelve cadavers or the startlingly clean smell and feel of the place. Rather, it’s a mishmash of the two.
The moment you enter, the smell of formaldehyde is almost overwhelming but it fades so quickly you almost forget you ever noticed it at all. Until, in a lonely of intense concentration, it comes rushing back on the tail of the new smell, of sweat and evaporating fat.
When working at a table, it’s so easy to see yourself as a butcher, fixated on and meticulously carving up the slab of flesh in front of you.
“Did Pamela have any children?” I wondered of my last donor. “What kind of life did she have?” “What does death feel like?” The banal and the profound aspects of life mesh and grind with the visceral reality of what was once alive before you and the sense of shame for momentarily forgetting these questions takes over – for me, at least.
That’s not to imply I’m above all the laughter surrounding the table. The humour in the theatre is shockingly bleak: “Death hilarious”, to quote Cormac McCarthy. Apparently it’s a coping mechanism, for dealing with the arguably traumatic scenes we see but whatever it is, the strangled laughs at a poorly cracked pun about the donor giving us a leg up or such hint at an emotional charge to the proceedings that we, as somewhat arrogant youths would try to deny.