Autumn has been my favorite season since moving to Oregon four years ago from the dry, unchanging desert landscape of Las Vegas, Nevada. The freeway towards my class dips into a valley surrounded by broad-leafed trees with ferns growing near the base of their trunks. Driving through the freeway’s twists and turns over time, I’ve seen the slow change of autumn: the dark clouds, the fragrant smell of rain hitting the soil, the decay of life, the transformation, the letting go. Autumn reminds me of how thin the veil between the living and dead is, as seen in traditions such as Samhain or Halloween. I find it remarkably fitting that these celebrations coincide with my own study of anatomy during my post-baccalaureate year.
As students of human health, we are in a unique position to be exposed to intimate stories and dramatically change the lives of others. However, the training and work aren’t easy. Fostering spaces to discuss our training’s impact on our emotional worlds might allow us to become more emotionally sound, empathetic and well-rounded practitioners and individuals.
There’s little room on the first day of anatomy and physiology lab to talk about mortality. We quickly make introductions, and S, our teaching assistant, glosses over the logistics of the course before beginning lecture. She draws our attention to the middle of our tables. An unsuspecting wooden box sits with two metal latches and a yellow label with a series of numbers and letters which, to me, indicates the uniqueness of whatever is inside. S tells us to take out the vertebral column. My lab partner undoes the latches and opens the box before quickly pulling out a clanking, jumble of vertebrae connected by a string. In most of our day-to-day lives, our bones are hidden from our visual inspection, yet their shapes and textures can be knowable after the muscle and fascia decompose or are removed. S mentions these bones have been donated for our study, that they are real bones from real people, and quickly moves on to discuss the features of the vertebrae.
My lab partner notes how small the bones in our box are, saying this person must have been smaller than the average person. She tells me that the size of the sternum she is holding might be around the size of her own. She takes the hip bone from the box and places it next to her own hip to show me how it must be a right hip bone. My jaw drops as I wonder how she can be so at ease with handling human remains on the first day. She tells me she’s taken the course before. Her advice is to manage my time and stay on top of learning all the material. I nod at her encouragement and my mind wanders yet again to imagine a student reaching for my hip bone in a wooden box, to comment on my relative size and to be held in the hands of a nervous novice. S continues discussing the shape of the rib, just as many anatomists and educators have done before her. A lineage of anatomists who were once viewed as heretics in past ages are now seen as respected college educators. I can’t help but believe I’m practicing a dark art.
Practicing dark arts can come at a cost: Death bears heavily on my mind. One night, the darkness of my new intimacy with death seeps into my dreams in the form of an odd nightmare. In my dream, I was at the grocery store and everyone has lost their muscles, fat, nerves and organs to reveal themselves as skeletons, like those seen on Halloween decorations. The skeletons were laughing and bagging groceries as any normal person does at the store; meanwhile, I stood aghast as their bodies were the new norm. Meanwhile, my body of muscles, fat and organs seemed irregular and repulsive in comparison. The nightmare shook me awake, and once calmed down I was surprised at the emotional impact my studies have taken on me. I was comfortable with everyone else becoming a skeleton, but I couldn’t accept the same fate. Awake again, I remembered the trees on the edges of the highway, letting go of their yellow, red and orange leaves. I remembered the box of bones, the quick pace of S’s lecture and how I wish there was time to reflect. I remembered that autumn is about change.
Back in the Anatomy lab, the course switches gears and we begin learning about muscles. S, the teaching assistant, introduces us to the two cadavers we will be studying. She tells us they have given us the ultimate gift of their body to provide us with a hands-on education of anatomy. She emphasizes proper etiquette in the cadaver lab: don’t make jokes, take their gift seriously and stay focused. The ritual of sanitation and perhaps emotional distance is explained: put vinyl gloves on, then put the lab coat on, study the cadavers, take the coat off, take your gloves off and wash your hands. I slowly walk into the cadaver room and take a deep breath as I sense tension in my shoulders and neck. I see the two naked bodies, partially covered in plastic wrap, on two metal tables. The female cadaver is positioned with her face down against the table and I must fight the urge to tilt her head to a side. Instinctively, I believe she is sleeping and I want to relieve her discomfort. However, the logical side of my mind retorts that she doesn’t feel the pains — or joys — of living anymore. I realize part of this training is about working past our knee-jerk reactions and viewing the body more objectively — whether living or dead. The veil is thin.
My eyes are drawn to her hands. Hands that cooked for lovers, wrapped presents for birthdays and held the hands of friends. I’m reminded of my own chipped nail polish as I examine the perfectly pristine red nails of the cadaver. Did she or someone else paint them? S directs our attention to the cadaver’s thin back muscles which she believes are from being bedridden. Without knowing the person’s story, I’m amazed S was able to use her knowledge and observational skills to make inferences about this person’s life. S sticks pins into labeled muscles to use as landmarks to determine the location of other muscles. We are expected to learn so much about the muscles in a short few weeks. These nine minutes, nine hours, nine days, nine weeks, nine years fly by. How much time do I have left? How much of my mind? The clarity of the textbook obscures the reality of our complex bodies. The text clearly defines each muscle, describing its exact position relative to other muscles, where it starts and ends, its general shape. The cadavers in front of me are not so neat. Their muscles twist and turn around each other and are difficult to differentiate in their brown-grey tones. We exchange nervous laughs and glances when any of us becomes too tense. I feel a muscle up its length to see where it originates from and jerk my hand away as my instincts remind me I shouldn’t be touching the dead. I glance around nervously and continue. Without an opportunity for reflection, I compartmentalize my feelings about death and leave them locked away, instead focusing on the art of anatomy. I must keep pace with the whirlwind around me. My feelings are kept at bay when performing the ritual: gloves on, coat on, study, coat off, gloves off, wash hands.
At the end of the term, I am impressed with how much more I understand, and I have learned enough to understand how little I know. With only weeks to reflect on the emotional weight of training, I had to find this space on my own. This type of training selects for toughness and discipline. It also selects for caring and compassionate humans. Where is the time to discuss the emotional upheavals of the work?
As future practitioners, our exposure to suffering, dying and death does not end when we leave cadaver lab, the clinic or a patient. Our reflection does not usually end there either. We carry these stories with us. If they build up without release, they may impact our stress levels and contribute to a long history of practitioner burnout. Being able to reflect on these experiences through writing, art or discussions may be valuable for our own wellness. Taking an hour to reflect over a term may benefit ourselves and our future profession for decades. Yes, the pace is quick and the material dense. However, our emotional lives may be more complex than the material, and the well-being of our inner worlds is far more important than a course or a profession. Beyond the rote memorization, time spent peering into a microscope and studying those who were once living, there is our humanity. It’s autumn and the veil between the living and the dead is thin.