Dr. Charles: White Silken Ribbons

5/22/2010

In January, I posted a piece by physician and blogger, 'Dr. Charles' about attending a patient's funeral. Now, I'm pleased to be able to share more of his work. In this post, 'White Silken Ribbons', the doctor shares his memories, remembrances and gratitude for anatomical gift of a courageous woman. Quite a few people talk about donating their bodies to science, but few have a clear idea of what actually happens when a person donates their body as a cadaver for medical students. I think that it's important for all of us to understand the depth of this gift, and the reverence and gratitude felt by those who spend countless hours of learning, and awesome wonder at the marvel of our physical construction. I hope you enjoy this piece as much as I did. Thank you Dr. Charles!

“And your mother, how is her health?” I asked the cheerful young woman who had come in for a physical examination. She was draped in a blue paper gown under which her naked alabaster skin seemed translucent. Her branching veins coursed like roots close to the surface as they returned indigo blood to the warmth of her core.

She smiled, albeit woefully. “My mother actually died several years ago. She had a brain tumor… glioblastoma multiforme it was called.”

I stopped writing and looked up from the notes I had been scribbling in her chart. “I’m so sorry.”

The young woman nodded her head silently, blinked a few times, and looked purposefully at her chart as it lay on the table before me. Her body language implored me to skip along to the next subject, but I couldn’t. I couldn’t help suspending the moment as the weight of her loss attained its proper gravity in my mind. Again I noticed the cerulean web of veins stretching throughout her skin, and it summoned in my conscience a long forgotten specter.

She was lying beneath the blue canvas bag, zipped and sealed in preservative juices. On a cold metal slab among sixty other lifeless bodies she rested. There was no smell of death in the fluorescent-lit room; rather it was ripe with never-living formalin.

Each tick of the zipper was an audible point of reference from which there was no going back. The tuition had been paid, the commitments to medical school sealed, and before my eyes was appearing the first surreal crucible of physician training. There were a few gasps around the other tables. One student stepped out for fresh air, but for the most part a quiet determination cemented most of us to the trembling floor beneath our old sneakers.

My particular cadaver had been a portly woman in her lifetime. Her skin was a cold ivory. It stretched across her muscle and fat like the skin of any other animal with meat. I could see spider veins in her neck and belly. My partners and I took fearful turns with the scalpel that first day, neither knowing the depth of human flesh, nor intuitively able to accept that we couldn’t hurt her.

Days passed. The intensity of our respectful decorum gave way to the occasional lighthearted moment as we gained comfort being in a room full of dead people. Their supreme posthumous gifts to us as students opened worlds of splendid inner intricacy, magical design, and humbling fragility. Lobulated mammary fat gave way to glistening red pectoralis muscle. Palmaris longus tendons ran like white silken ribbons through forearms, fanning out after wrists to join seamlessly with the fascia of hands. Hearts nestled safely on beds of diaphragm between pillows of lung, resting obliquely at the final terminus of 60,000 miles of well-traveled blood vessels. Serpentine loops of bowel and intestine were like ruffles on collars, concealing hidden gullies and gutters behind which survived livers, pancreases, and spleens.

In the midst of all this revolting beauty I couldn’t help but search for what had killed her.

That moment of wicked discovery came while gently lifting off the top of her skull and revealing the adherent growth from her brain that stuck like rotten candy to the bone. Here lay the seat of her humanity, her transient brilliance marred by an invading glioblastoma multiforme as purplish and ugly as medieval battlefields. It had ended her.

When our dissection was done her remains were cremated, along with the others, but not before we each gave our own goodbye. Some wrote poetry, some spoke aloud, some reached out in prayer. It was a reverence for another being unlike any I’ll ever feel again. I wondered what she had envisioned in her final days, whether she knew four anonymous medical students would spend the better part of six months traveling along the roads of her preserved universe, with studied anatomy books serving as our poor guides to the back alleys and sudden turns of her necropolis. Did she wonder when we would discover her terrible secret, her unstoppable murderer? Did she know it would make me feel a kind of sadness stirred from the disparate emotions of sorrow, exultation, and wonder?

Did she hope, correctly, that each time I palpated a liver, delivered a child, interpreted an EKG, peered into an eye, injected a joint, reviewed an MRI, or tapped a spinal canal that I was unwittingly polishing my vision through a lens first ground in her anatomy? And as I shook off my moment’s delayed reflection, in a small family practice, during a routine physical examination all those years later, I still wondered at what kind of woman she must have been, and recoiled from hearing an echo of the horrific tumor that inspired her final offering – a body for our cold slab of an altar.

“I’m sorry to hear that your mother died of a brain tumor,” I said. My patient nodded once more, and then it was time for me to move on.

For more of Dr. Charles' moving and thought provoking work, please visit his blog, The Examining Room of Dr. Charles

Illustrations for this post, Copyright 2010, Patrick McNally

Attending to a Patient's Funeral

Doctors have a special relationship with death. In May, I wrote about the difficulties that Doctors and others have in their responsibilities to inform patients and families of death and the prognosis of death. Doctors also have a unique perspective on the aftermath of death because of their relationships with the deceased and the expectations of their role in prolonging life.

"Country Doctor" W. Eugene Smith 1948

I am very pleased to be able to share with you a post from The Examining Room of Dr. Charles. Dr. Charles is a physician who writes an insightful and informative blog about his experiences and perspectives, and he has graciously granted me permission to share this moving post on doctors and funerals.

On the way to the funeral you wonder how you’ll be received by the grieving. Although you are confident that your care for the deceased was sincere, professional, and adept, you still question if others will so assume. There is silence in the car. This is a trip you make alone.

You manage a bitter smile as you recall stories the patient shared in unguarded moments, behind the door of a small examining room. How he beamed with content at the thought of his grandchildren; how her eyes glowed as she remembered the view from the Eiffel Tower; how the tears and sobs and memories of a lost child wracked his otherwise impenetrable façade. Sometimes you knew his spirit as well as you knew his medical illnesses, and often he hoped you would tend more to the former.

You walk into the funeral space. Many people are gathered. You sense pockets of light humor and recalled happiness amid dark clouds of sadness and gloom. Although you know this is not about you, your ego can’t help assessing how others perceive you. Most of those present barely notice, but others recognize you. Is it surprise registering in a few faces – that you’ve come to observe your patient’s defeat, that you’re emotionally invested in the person who once called you their doctor, or that you’re willing to dirty your powerful white coat with the stains of ultimate impotence? Or is it gratitude, that even in this darkest of reflective hours you’ve come to pay your respect to another who trusted you, confided in you, and who reached out to you for whatever healing you might bring?

As you shake the warm and cold hands of family and friends, you are reminded of the wide, verdant, chaotic world that existed outside the person’s small doctor-patient relationship.

It’s not just the hubris of the doctor that defines death as defeat. Very few persons seek out a physician to help them die well, at least in the beginning. And even when it is apparent that Time has overpowered us, it is only very late that we let go of the spiraling merry-go-round.

As you approach the coffin you are keenly aware of your own mortality, and yet in a state of denial. You think that your purpose is to mediate between life and death for others, and that somehow you exist in a space between. But as you bow your head in front of the lifeless body, placed serenely into its luxurious coffin, you are reminded of your illusions. You hear the sniffling misery, taste the salty ocean, and glimpse to where you’ll return.

You bid the family well, express your genuine sympathy, and leave. The air never tastes fresher, sweeter, more living than it does outside a funeral.

Back in the office you must move on. You have hundreds, thousands of other patients forming a queue that you imagine stretches across the fabric of the community. You are indispensable, and worthless.

But before moving on, you study the deceased patient’s chart one more time. It is certainly not literature, but if you read between the lines you can find poetry. You retire another legend of the examining room, slinging a stethoscope around your neck as you knock on the next door, hoping to be of some service while you too struggle on.

For more from Dr. Charles, please visit his blog at http://www.theexaminingroom.com/