Anatomy awesome, awful and aesthetic

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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.

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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.”)

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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 >

https://arsmedica.wordpress.com/2011/08/02/feature-on-anatomy-building-in-trinity-college/

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.

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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.

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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.

And:

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.”

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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.

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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.

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Module opener 2018/2019

To begin my twentieth year teaching literature at Trinity College School of Medicine, and as I usually do to bring them rapidly and suddenly out of their more textbook-, fact- and learning- based world, I read a poem.

I first asked them to call to mind someone in particular they don’t like, someone who bothers them intensely, someone they would dread spending a long bus journey sitting beside, and then to give them the name Paudeen.

And I read Yeats’ poem ‘Paudeen’ to them.

Indignant at the fumbling wits, the obscure spite
Of our old Paudeen in his shop, I stumbled blind
Among the stones and thorn-trees, under morning light;
Until a curlew cried and in the luminous wind
A curlew answered; and suddenly thereupon I thought
That on a lonely height where all are in God’s eye,
There cannot be, confusion of our sound forgot,
A single soul that lacks a sweet crystalline cry.

And I read it again.

And I read it again, explaining that when we meet someone for the first time, as they were meeting me, we are often distracted by a variety of observations we make about them from what they are actually saying; I gave them the example of how we often forget someone’s name when they first introduce themselves to us; I said we’d be reading each of the poems we encounter a number of times!

Then I told them I was going to ask them to do something they may never have done before or not done in a very long time: a dictation. I got them to write out the poem word for word as I read it to them again, explaining first that I hoped it would help them become more familiar with how the poem is put together.

Then I told them I was going to ask them to another thing they may never have done before or not done in a very long time: a group reading. I got them to join me in reading the poem aloud all together. And then we did it again, and as we did I freed my vocal presentation even more and injected a bigger dose of emotional charge into it, by way of demonstration, by way of making sonic room for them to do the same, and by way of making them more aware that this was an informal, liberal arts environment!

And I think at least some of them felt the charge, and I discussed the power of art with them a little, comparing what we just did to singing in the shower or dancing in the dark etc. Poetry may be quieter but it can be extremely powerful in its own way, and it finds its place, especially when we open ourselves up to it.

I then went through the poem with them line by line and discussed various aspects of it, by way of illustrating close reading and starting to get them comfortable with personal perspectives and different interpretations. I paused every now and again to invite them to offer their own thoughts, but didn’t put any pressure on them to contribute at this early stage.

I also hinted at why this poem might prove beneficial to them to have in reserve when they eventually become doctors! We’ll recite it every week together.

So, that was all by way of presenting one aspect of the module: literature.

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To present the other aspect of the module, namely medicine, I turned to non-fiction prose (as close to science as we get!) and read some extracts from a number of columns by a columnist whom I can’t bring myself to mention here but who wrote well and humorously about doctors many years ago, to wit:

Medical students are put through a hell which is the very opposite of education. Far from their minds being opened, being prompted to engage distant and different horizons, far from their time at university being one of mental liberation and personal discovery, medical students find themselves being funnelled into a witless, brain-sterilising marathon of fact-retention.

The very first task of medical school is the conversion of the brain from a vital ratiocinative organ for analytical thought and speculation into a machine for storing facts – in other words, a cerebral shoebox containing a vast anatomical index, in which you can find the name of every nerve-ending and every follicle, and also, in an unswept and unvisited corner, a small, withering organ called common humanity.

This is not the fault of the students. It is almost impossible for the spirit of ordinary sensitivity, of optimistic enquiry, of normal ignorant speculation working its way to enlightened conclusion, to survive the Gradgrindery of medical training. Medical students probably work five or ten times harder than art students; and correspondingly, they discover five or ten times less about human nature. That discovery is made in casual college discourse, in unstructured debate, in wide and varied and undisciplined reading. It is the very purposelessness of the liberal arts which give them purpose.”

This allowed me to ad lib on the perceived differences between the liberal arts and sciences, but in a very balanced way, emphasising that medical students indulged in plenty of casual discourse and arts students spent a lot of time reading dull books. It also allowed me to talk about the overall thinking behind humanities modules for medical students.

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And so on to the main course:

Lucy Caldwell‘s eponymous story from her short story collection ‘Multitudes‘*. I read out loud this powerful story set in a paediatric ward, line by line, observation by observation, episode by episode; pausing regularly to comment or invite observations – personal and / or interpretative.

The consultant mentioned on the first page allowed me to invite one of the group to pose the well known riddle about the father and son who are in a car accident and rushed to hospital for emergency treatment, but the surgeon announces “I can’t operate on this boy. He is my son”. (Until it’s no longer a riddle, what have we got? _________.**) I even gave the briefest summary of deconstructionism!

(The mention of Susan Sontag’s idea of a kingdom of the well and a kingdom of the sick prompted me to read as an aside Dennis O’Driscoll’s ‘Someone’.)

We also discussed things like how patients & staff experience things very differently; how artificial and therefore challenging the atmosphere in hospitals is for patients (… and staff!); how othering illness is; how the powers of observation/description many writers exhibit (especially Caldwell here, for instance when her narrator is describing her efforts to breast feed / ‘nurse’ her sick child), how the detail of these observations would be expected of the best doctors when it comes to understanding patients and making diagnoses. (Needless to say, they don’t need to put in writing the observations as well as Caldwell does; though I did mention how many doctors were also good/great writers.)

Finally, we discussed how literally we ought to take a narrator of a story, or how believable every detail of a story is; could particular things “actually happen” to the narrator as described, or could they be taking poetic licence or using magic realism techniques to convey a truth other than the observable truth?

“I sing over the noise of the machines and I sing myself into a sort of doze. Sometimes I try to sing alternative endings for the soldiers … Sometimes I try to sing other songs …”

We ran out of time at that stage, which is a good thing, as hopefully they’ll want to go off and read the rest of the story for themselves now.

*Also available in ‘The Long Gaze Back: an anthology of Irish Women Writers’ edited by Sinéad Gleeson.

**I should say that apart from those who knew the riddle already, no one else in the group of ten got it, male or female. This despite the mention of the consultant being the prompt to put the riddle!

 

 

 

Text pool

MEDICINE, TRAINING, DOCTORS, HOSPITALS

Vincent Lam’s Bloodletting & Miraculous Cures  (‘How to Get into Medical School Part 1’) – fiction

Stephen A. Hoffman’s Under the Ether Dome (Chapter 1 ‘Medical School’) – non-fiction

Johnathan Kaplan’s The Dressing Station (extracts) – non-fiction

Mikhail Bulgakov’s A Country Doctor’s Notebook (‘The Speckled Rash’) – fiction

Ian McEwan’s Saturday (extracts) – fiction

Samuel Shem’s The House of God (extracts) – fiction

Philip Roth’s Anatomy Lesson (extracts) – fiction

MATERNITY & OBSTETRICS

Rachel Cusk’s A Life’s Work (‘Forty Weeks’) – a non-fiction, ‘patient’ perspective

Vincent Lam’s Bloodletting & Miraculous Cures  (‘An Insistent Tide’) – a fiction, patient perspective

PAEDIATRICS

Lorrie Moore’s ‘People Like That Are the Only People Here’ from Birds of America  – a fictional, patient perspective

William Carlos Williams’ ‘The Girl with a Pimply Face’, ‘The Use of Force’, ‘Jean Beicke’ from Doctor Stories – a fiction, doctor perspective

COMMUNITY AND SOCIETY

John Berger’s A Fortunate Man  – a non-fiction, third-party perspective

JD O’Connor ‘Doctor in the Dales’ – a non-fiction, doctor perspective

Carlo Levi’s Christ Stopped at Eboli (extracts) – a non-fiction, doctor perspective

Gabriel Garcia Marquez’s Love in the Time of Cholera (extract) – a fiction, third-party perspective

CANCER

Barbara Ehrehreich’s Smile Or Die (‘The Bright Side of Cancer’) – a non-fiction, patient perspective

Sophie Petit-Zeman’s Doctor, what’s wrong? (extracts) – a fiction, third-party perspective

Lia Mills’ In Your Face (extracts) – a non-fiction, patient perspective

Paul Zweig’s Departures (extracts) – a non-fiction, patient perspective

DEATH

Sherwin B. Nuland’s How We Die (‘Doors to Death of the Aged’) – a non-fiction perspective

Joyce Carol Oates’ ‘Angel of Mercy’ from The Female of the Species – fiction

Leo Tolstoy’s The Death of Ivan Ilych – fiction

PSYCHIATRY & DIALOGUE

Sebastian Barry’s The Secret Scripture (extracts) – a non-fiction perspective on both doctor and patient

Oliver Sacks ‘An Interview’

Paul Valéry’s ‘Socrates and his Physician’ (extract) – fiction

Herman Broch The Death of Virgil (extract) – fiction

MAJORITY WORLD & MINORITY LIVES

Dave Eggers’ What is the What? (extracts) – fiction

Donnacha Rynne’s Being Donnacha (extacts) – non-fiction

Jean-Dominique Bauby’s The Diving Bell & the Butterfly (extracts) – non-fiction

POETRY

Work from poets including Patrick Kavanagh, Núala Ní Dhómhnaill, Anne Sexton, Nessa O’Mahony, John Stone, and Philip Casey

THEORY

Petr Skrabanek and James McCormick’s Follies and Fallacies in Modern Medicine

Cancer texts

We’re reading the first chapter from Barbara Ehrenreich’s Smile Or Die, extracts from the fiction part of Sophie Petit-Zeman’s analysis of the NHS Doctor, what’s wrong?, an extract from Lia Mills’ In Your Face, and the ending of Paul Zweig’s memoir, Departures, as the basis for a discussion on the way cancer is represented in literature.

But of course we can hardly discuss this without reference to Susan Sontag’s book Illness as Metaphor. As summarised on the SusanSontag.com website, we see that the book is seen by many to show that “the metaphors and myths surrounding certain illnesses, especially cancer, add greatly to the suffering of patients and often inhibit them from seeking proper treatment. By demystifying the fantasies surrounding cancer, Sontag shows [apparently – ed.] cancer for what it is — just a disease. Cancer, she argues, is not a curse, not a punishment, certainly not an embarrassment and, it is highly curable, if good treatment is followed.”

Of course, we do not have to go along with Sontag’s analysis. But it’s important to get to grips with what she says about how cancer is represented. For starters, there’s an extract from the book here http://www.susansontag.com/SusanSontag/books/illnessAsMetaphorExcerpt.shtml

And an interesting perspective from her son here:

http://www.nytimes.com/2005/12/04/magazine/04sontag.html?_r=3&pagewanted=1

But of course everyone ought to read the book itself if you can.

Lecture today in Trinity

I read from the following texts:

If I’d had the time I would really like to have read from these too:

And there are so many others including the couple below, but I’ll keep people posted on this site. Let others know about it.