I stood right beside them as they slowly slid your head into a plastic bag, looped the coarse twine about your neck and tied it tightly. Like the amateurs they were, they double-knotted it to make sure nothing came loose or dripped out. Then they casually walked away, chatting about what would come next.
Within minutes the bag fogged up, and a clear red liquid pooled at the bottom.
That was just the beginning of the ritual.
I’m sure that under other circumstances you would have put up a fight, Joseph, but today you were no match for them. No matter that they were six slender twenty-somethings, and you at least six feet and 250 pounds; you were on their turf and utterly at their mercy.
Your expression held fear, sadness and regret. Face flushed, mouth agape, eyes closed as if to shut out evil, you seemed to be begging for life. And although you were already dead, over the next few months I came to feel that you died many times over.
The rite took place in a basement-level room that recalled the Nazi gas chambers. The steel table on which you lay looked at least a half-century old. There was nothing soft about the room–every corner was sharp, every surface rough. The windows were sealed to prevent unfiltered fumes from escaping. The locked door bore the words “Authorized Personnel Only.”
I still remember the first cut–the way my classmate’s knife slid into the flesh at the base of your skull and traveled down to your buttocks. Then she took a gleaming new metal probe and pulled back the skin, revealing the “meat” underneath. The thin layer that had cradled your humanity was destroyed.
Almost instantly the comments began:
“Oh my god, he is just so fat!”
“Does he have any muscles in here at all?”
“This reminds me of steak.”
The milder examples.
The ritual continued.
After cutting through your back, Joseph, we slowly worked our way to the front of your body, turning you over as we went. Conversation focused on what were euphemistically called your “family jewels.”
Three women investigated your scrotum and penis in great detail.
“Is he circumcised?” one asked. The answer was no. (Your penis would later be cut out, circumcised and used as a tool on which to practice stitching.)
In the long, dreary winter days and months that followed, I tried to find ways to preserve your dignity. When I covered up the parts of you that we weren’t dissecting, our instructor intervened.
“Prudishness is out of place here,” she told me.
“I’d like to know more about our cadaver,” I said. “Do we know anything about his life?”
“That’s simply not possible,” she responded. “The cadavers are anonymous.”
In the lab, students and professors alike had decided that, in life, you had been a “workingman”–a catchall term for someone of your appearance. Calloused hands, thick neck and rugged facial features…clearly a workingman. I thought it ironic that, having gone to such lengths to protect your real identity, they would find this dismissive label an adequate substitute.
No matter how hard I tried, Joseph, I couldn’t discover more than your name, your age and whatever clues your body revealed. You had become, and would remain, “Joseph. Table B. Age 75. Caucasian male.”
I so wished that you could be my first real patient, and that I could be your doctor. I wanted to know about your childhood, your parents, your schooling. I pictured our imaginary office visits–you’d walk through my office door, which I would gently click shut behind you…I’d ask you the questions that would help build our relationship: Do you have kids? How are your loved ones? What do you do these days to keep busy? What makes you smile, cry, feel scared? I longed to know whatever you would want to share in the sacred privacy of my office. We might even develop the special bond that I have heard exists between a patient and his physician. We would care for and learn from each other in so many ways….
Meanwhile, in the lab, I kept proposing that we not use you as a resting place for dissection instruments, or as a makeshift drum set when boredom kicked in, as it inevitably did after a few hours of dissection.
Mostly the response was an eye-roll; then someone would remove the instruments, only to replace them shortly thereafter.
More than once, I tried to direct attention away from your scrotum–the object of frequent derision–and to keep our conversations about you respectful and on topic. Every now and then the talk grew serious, but only until the next gobs of fat appeared, provoking more obesity gibes that inevitably circled back to your “jewels.”
There were times when glimmers of humanity crept in, when we would step back from the table and acknowledge the surreal nature of this medical ritual–you lying dead, helpless and cut into an infinity of pieces; we wielding the power saws, blades and other tools prescribed by our Gross Anatomy Dissection Guide.
Often, these moments of clarity followed some especially grotesque violation.
One such moment took place on a particularly cold winter day. We’d separated your head from the back of your neck as a prelude to exploring your cranium.
One of our group tilted your mostly severed head upward with a metal probe and started to animate your head and face by waggling them from side to side, while the rest of us stood silently by.
In a triumphal finale to this horrific puppet show, he thrust the filthy probe through your nose and out the base of your skull.
With this coup de grace, a sense of reality slithered back in through the sealed windows. For the rest of that period, silence reigned at our table. If only it could have brought absolution.
Writing you this letter at an ungodly hour on a cold winter’s night, I find myself reaching for my phone to answer a call. It is yours. Yet my phone has made not a sound; there’s just silence around me.
Please forgive me, dear Joseph. Every time I think of you, it is with self-reproach. I tried to protect you from the insults wreaked on your body, yet I did not do enough. I so wish I could have done more.
We’ve been taught that repentance begins with honest confession, and that, once we repent of our deeds, absolution may follow. Yet even repentance and forgiveness cannot undo every type of damage.
What has happened will always be part of my history. I must never forget my complicity: those who watch a spectacle share in the guilt of those who create it.
Your death, I was told, provided a gift to others. Yet I hope your death will do even more. I hope it will awaken others to the need to cherish the dead. The dead are more than objects, cadavers or patients. You, my dear Joseph, are not Joseph of Table B; you are my neighbor, my friend, my brother.
Although ours was not the classic mentor-student relationship, you taught me something far deeper than anatomy. From you I’ve learned just how fragile, how precious, is our humanity–and how great the need for compassion in medicine.
These are priceless gifts that I may never be able to repay.
Although I’ll never have the chance to know the spirit that animated your body, I’m eternally grateful to have spent time with the vessel that bore your soul.
About the author:
“Michael Terry” is now a third-year medical student.
26 thoughts on “Dear Joseph”
I’m hoping that it will give you a small measure of comfort to know that some of us who have donated our bodies feel differently that you’d think. I worked as an OR nurse for 37 years, and would probably have been one of the medical students you disliked the most, as I am comfortable with the black humour and seeming disrespect shown to patients in the effort to survive the horror that is the OR or anatomy lab. I don’t mind whatever will be said or done to me in the lab, however gross, on the journey to knowledge, and I think that the reverence shown in the services is just as valid if not more so. I believe that the people who go to medical school rather than become businesspeople or lawyers or anything else are already showing themselves to be kind and compassionate to some degree. I became a nurse because of a desire to be nice to people and help them somehow, despite enjoying the brutal, sometimes gross, but often so very funny atmosphere of the OR.
This is a troubling pice in light of your lone voice of compassion and consideration for the person/soul/individual linked to the cadaver. The faculty, in particular, were teaching a disturbing hidden curriculum. I wish you’d been in a more caring and supportive place – both for you and for Joseph. Glad you survived it intact, and look forward to your having the chance to influence your peers and your future students with your empathy and clear-mindedness.
Thank you for your thoughtful and considered piece. While your instructors should have intervened as the dark humor that physicians rely upon exceeded an acceptable threshold, you have no need to seek absolution. You learned from the generosity of another human being, and will use that knowledge to help others.
Prior to the start of my gross anatomy class (26 years ago), our professor led us in a moment of reflection and thanks for the individuals from whom we were about to learn.
More significantly, at the end of the course, all the medical students were invited to a non-denominational memorial service, along with the families of those who had donated their bodies. The family members saw that their loved ones’ final gift was tremendously valuable.
Although while doing the dissection there were moments of humor (some macabre), ultimately we were grateful and felt honored to have had the opportunity to learn in this way.
What a wonderful reply. I wish more instructors were like yours.
wow, what a wonderful piece of writing
awesome, gut wrenching piece of raw writing. Great courage of seeing things as they are. Thank you for this piece, this is the first time I feel driven to comment. Much love to you
Your concern is impressive, but being so “unfeeling” is to cover up similar feelings and anxiety about mortality among your classmates. Dark humor is one of the ways where we guard our own feelings.
Joseph, whoever he was or may have been, is gone. He was considerate enough to have donated what was left to your training, but chances are he would have enjoyed the jokes more than the prudishness. The remaining body may be either consigned to the ground to rot, burned to ashes or used as a training tool for those who would learn healing. Your curiosity about Joseph’s previous life is appropriate (though deliberately foiled to protect Joseph’s family and associates). If you had expressed your curiosity as a basis for discussion of what had produced Joseph’s habitus it might have been more appropriate than a prudish sentimentality.
My Dear Mr./Ms. Denial (English or the German “Leugner”),
Michael Terry’s essay has nothing to do with “prudish sentimentality”, as you are want to call his sensibility. Rather, we are seeing here the kind of trauma elicited in a dissection room that is reigned by disrespect against donors and colleagues likewise. While the fellow-students’ reaction may possibly be excused as a defense-reaction, as you suggest, the faculties’ failure to address this behavior and lack of support of a respectful atmosphere is inexcusable.
I didn’t see this as prudish sentimentality at all. It’s an attempt to hamanize a person in a dehumanizing situation. I’ve heard enough stories about dissecting classes that it is a major factor in my not donating my own body to a medical school….oh, look at that tummy. My gosh how her breasts have fallen…..etc. Okay, so black humor is used everywhere, war more than anyplace else but for god’s sake, give the students classes or support groups in dealing with death so that this isn’t their only choice.
Your article embodies every fear I have about how I will be treated by doctors when I am vulnerable and helpless. This is existential fear.
You have offered an important insight that what many patients experience as the inhumanity of our medical system may have its origin in that cadaver lab, where no physician knew any personal detail about the patient, no one cared sufficiently about the patient’s dignity, and no one prevented undue harm to the patient.
I also have to wonder, did you speak with your teacher about it? If you did, were you supported by him or her? For as you aptly describe, very bad things can and do happen in medicine when physicians don’t stand up and speak up, and don’t take necessary steps to deter bad ethical practice of colleagues.
That said, I think you should consider this article your absolution, because you have made a lot of people think today. Best wishes to you as you continue to cultivate your compassion.
Although you are still a med student, I would love to know where you will practice and in what specialty. The world needs more compassionate physicians like you. Thank you.
Beautifully expressed, Michael. Thank you for sharing this essay with all of us. It made me reflect on my own experiences in gross anatomy, and renewed my gratitude for those who so generously donate their most precious earthly possession – their body – to science.
I hope I will be your patient someday. Your depth of honor for the human body and soul are rare and precious gifts.
Dear Michael, Thank you for this powerful essay. I am so sorry for what you experienced, and also more grateful for the tone set by my own gross anatomy professor. His very first communication to us raw medical students was to address the awesome privilege and sacred duty inherent in handling the mortal remains of a person so generous and selfless to trust those remains to unknown persons and unknown procedures, for the benefit of countless unknown future charges of those students. We were instructed to treat cadavers with utmost respect, not unlike how we would be obligated to treat our future patients. Fortunately, I was not witness to the horrific behavior of the other students you describe. However, I have witnessed dismissive, surly, condescending, callous, and arrogant words and behaviors of fellow physicians, mostly in residency, but also out in the “real” world. I think for some, the greatest casualty of often brutal medical training is human compassion.
Clin Anat. 1995;8(1):69-79.
Human gross anatomy: a crucial time to encourage respect and compassion in students.
Weeks SE1, Harris EE, Kinzey WG.
We published this paper in 1995 to address exactly these sensitive issues – we got more responses from European anatomy professors than Americans…I had hoped the concepts expressed would be more widely embraced by US medical schools…?
Dear Michael, thank you for your story honoring the life and sacrifice of Joseph. Thank you for being a mirror of humanity, dignity and grace in the face of horrific behavior. Your story was both moving and also very very disturbing. Is the how medical students conduct themselves in anatomy lab these days? I can understand the need to ease discomfort with a bit of humor but this is unbelievable. What kind of faculty allows this? What kind of medical school allows this? This story is a wake-up call for how we are training our students. I was stunned, outraged and finally heartbroken for what happened to Joseph and also for what you experienced. Yet, your final reflections brought me to a place of hope…for this I am most grateful.
Thank you for sharing your experienced wisdom. I read this with a lump in my throat and a pit in my stomach. What is clinical excellence, and what is service excellence? The two are inexorably linked so that they cannot be expertly separated; the dignity of the person is to be explored, to treat the dignity of the person. Hopefully we will come to understand this as we move forward in the next evolution of medicine. Thank you.
Thank you for having the courage and compassion to write about this hideous scene.
You articulated many of the feelings I experienced myself when nervous colleagues (and occasionally teachers) expressed their discomfort with dissection in sometimes outrageous and often disturbing ways.
Those who allow us to learn from their bodies grant us a great gift and privilege. It is an unforgettable learning tool.
Like you, I always wanted to know more about where the bodies came from and studied the person’s history through their physical remains.
Like you, I often had conversations with the person’s spirit, thanking them for teaching.
Keep your heart whole and keep writing.
Dear Michael, thanks for writing this piece. I appreciate your sharing the stories of the casual indignities—the sheer brutal indifference—the med students and the instructor (“prudishness is out of place here”) inflicted upon Joseph, upon you, and especially upon themselves. Your care and sensitivity redeemed their cruelty and gives us hope. Doug
What an extraordinary piece of writing this is–compassionate, powerfully moving, honest, and vivid. Thank you, “Michael Terry” for taking the time to write to Joseph and to us–reminding us of our responsibility to respect both the living and the dead, and the grievous loss to our own spirits if we ignore our interconnectedness..
I have thought about donating my body when I die. At 64 it is, I hope, awhile before my death will happen. But after reading this, I’m having second thoughts. I am overweight, actually obese, been struggling with this for a long time. Why should I mind, after all, I’d be dead. But I do mind.
I totally agree – who would want their body to be violated in this fashion? If ever I thought about donating my body to science this would put the kibosh on it. I am glad the writer has retained his compassion – I would not want to be treated by a doctor who has no compassion for the person who donated their remains.
What a moving and wonderful piece of writing. Its been more than 40 years since my anatomy dissection in medical school but what appalls me is that your anatomy instructors allowed such foul behavior. I clearly remember an anatomy lecture where we were made to understand the sanctity of the anatomy lab – where it was made clear to us that no signs of disrespect to those people lying on the tables would be tolerated. The fact that such behavior was allowed in the lab is a travesty in itself – one that is closely linked to the continued use of derogatory terms to describe our living patients – spoken in the privacy of doctor to doctor communications. It is long past the time to teach students about professionalism and the way doctors are expected to act and to adopt a zero-tolerance policy for this type of behavior. You should not have to live with the type of remorse you have experienced and it is our obligation to make sure others do not have to live with it either.
To Michael, I am so moved by your story that I have tears in my eyes. Like you, I felt a great compassion for cadavers who were introduced to my lab. I was not a medical student nor a health care provider. I was simply a lay person hired into a position in medical education who was charged with assisting with labs as part of my duties. I had no training or counseling prior to embarking on my lab duties. After I became accustomed to the “grossness” of it all, I began looking at the cadavers as human and my nightmares (which I had often) became focused on their humanity and the disrespectful way they were treated by many of the physicians who were benefiting from their gift of donating their body to science. Even after I left that position I was disturbed about the experiences. It was only when I read Dr. Sandra Bertman’s book, “One Breath Apart, Facing Dissection” that I understood my feelings. I highly recommend it to you and to your faculty as a tool to help students cope.
I’ve read how difficult the first dissection is on med students and that discomfort may explain, but not excuse, your fellow students’ gross and disrespectful behavior, but I was so moved and relieved to learn that you realized the humanity he represented. Hopefully the other students did also, or will eventually, and also realize what a valuable training to them and future patients his body gave. Your writing is wonderful but your sensitivity is truly heart-warming. Thank you
It gives me such pain to read about your own suffering and shame in this letter to Joseph. I can only hope that your experience is less common that it used to be in medical school, that your colleagues are motivated by fear and ignorance rather than disrespect and cruelty, and that your teachers feel the same kind of complicity that you felt during anatomy should they ever read this message. It is they who should be filled with self-reproach and consumed with guilt, not you.