Saturday, April 21, 2007

Different eyes

I: Ghosts, 2:03 am

I was standing alone, at midnight, in a room filled with ghosts.

Talking. In complete silence.

The fluorescents cast a pale white light around everything, a light that is meant to reveal but instead obscures. That kind of light can't even pierce a sheet of paper. The ghosts are lying on steel tables, placed in neat rows. Their blue and gray insides are exposed, leaving their secrets bared.

All of the world I grew up with, the world of the known, the world of the accountants and Sunday football games and television and pro wrestling, they have all gone to bed. They lay with their delusions while I confronted reality. While they laid with their dreams, I interrogated ghosts.

II: Elegant Machine

"You have to understand, the bodies are just like cars." Dr. Taitz had said in lecture that morning. "After the driver steps out of a car, only the machine and the chassis are left. There are no drivers here, just the cars. Just the machines are left." This was our first and only introduction to working with dead bodies in medical school.

Dr. Taitz was standing in front of the the Anatomy Lab, a white and chrome room in the basement of the Sackler School of Medicine, where we would be spending the better part of the next year of our lives. We were arranged in rows of seats in the auditorium, immobile, waiting for wisdom to be showered on us. Just outside the auditorium seats, a solemn brigade of cadavers surrounded us. Each was outlined by a harsh overhead light, covered by a sheet, and again by a transparent plastic shell that kept the smell from escaping. Like the boogie man under the bed, they waited silently, and perhaps we believed if we didn't turn to face them they would disappear.

Dr. Taitz was a sports physician from South Africa. He was squat and fit, and gave an impression of density, in incredible shape for 76 years old. He had treated the casualties from wars going back to 1967. Taitz's job was to teach us about the upper limb, the arms and shoulder girdle. From the surface it seemed fairly simple but we learned quickly that appearances could be deceiving.

Taitz believed that functionality was its own aesthetic. He saw the body as an elegant mechanism for work and play, and wanted to impress his beliefs upon us. He used a Buddhist method of teaching. Taitz was trying to let us reach for a higher level of understanding. "Don't learn it, just know it," was one of his least-liked phrases. Many thought he was mocking us. He wasn't. He was trying to show us the way of satori, true enlightenment, through Anatomy.

"Notice the elegance of the tendons going through the carpal tunnel." He said, holding his own wrist, as if we could use X-ray eyes to pierce through his skin. He pronounced all his A's as hard A's. "Really amazing, isn't it? The tendinous sheath keeps the tendons tight into the wrist. However, it can rub against the median nerve and cause carpal tunnel syndrome, like you chaps that are copying down every word I'm saying."

Thousands of years of superstition wrapped each of the cadavers. Taboos about cutting dead bodies, causing the dead to rise from their sleep. Ghosts, ghouls, vampires, evil spirits. The Jewish tradition was to bury a body within twenty-four hours. Just by their very presence, the cadavers represented an affront to the religious among us.

Forget all of that, Taitz told us. They are just objects. They are just cars with the drivers missing.

Philosophically, Anatomy was rooted in strict materialism. Everything can be explained by some physical principle. Biology is just a concentration of chemistry which is really just a concentration of kinetic physics, which is nothing more than engineering. Doctors will happily explain your every thought and emotion by the preferential binding of one chemical to another due to microscopic electrical forces. No longer is the body a magical, impenetrable organ, now it becomes a complex machine to be understood in terms of kinetics and mechanics.

I wondered if they are just cars with the drivers missing.

III: Mediums, 3:03 am

The ghosts didn't have names. They had tags like 58(. They were white bodies on steel tables. Their individuality had been swallowed by death, but they were special people who had donated their bodies to the cause of science in a land that believed the body was sacred and inviolate.

They were perfect and untouched except two cuts in the lower abdomen, near the genitalita, with white cloths sticking out. I never found out what happened there. My gloves were wet with cadaver juice. It bubbled and squished underneath my fingers.

The interrogation had begun. They say dead men tell no tales. They never understood pathology. I was the medium who read their stories. Nothing in their lives would be safe from me. I could feel their stress in the hardening of their arteries. I could see the years of smoking in the blackening of lungs. 16 D had cancerous nodules in the lymph nodes of the neck. 45A had stiffening and shrinking of the kidneys. My own cadaver, 58E, had tiny clots in the vessels of his brain. I knew how he lived and how he died. My interrogation was precise, perfect, irrefutable.

58E. I tried to name him, but it seemed somehow inappropriate. His eyes stared blue and sightless. He had a big bulbous nose, with brown-grey nose hair. His mouth was blue and dry, lying open like stuck in the middle of a snore. A cloth covered his head, concealing the empty skull. His brain had been harvested for neuroanatomy long ago.

He didn't really look happy, sad, or lonely. He was beyond such emotions now. My Sensei said once that the face we are born with comes from our parents, but as we get older that face becomes all our own. Reflecting our personality. Through life, he had made his own face. In death, I would read it and try to find some truth.

IV: Known and Named

We learned about head and neck from Professor Rak. Rak was a warrior-priest for the cause of evolution, the knight for mighty Darwin himself. In the land of the living Bible, he preached the way of science. He had a set of skulls in his office, lined up exactly as evolution had molded them, from Austrolopithicus to Habilis to Sapiens after a short two million years. Those fetishes were part of his magic.

Rak was enormous. He was a huge man, solid as his namesake, and when he talked his arms would make enormous sweeps through the air. He was enormously intelligent, articulate, and thorough. He would make chalk drawings of key features of the skull. Here was the petrous bone, the rockiest part of the body. He was the architect of the thyroid cartiledge, which forms the Adam's Apple the cricoid cartilegdes, and the arytenoid cartiledges, putting them together so that they formed the larynx.

"It's even more complicated than that," was his favorite expression. For Rak, the kingdom of the skull was the seat for something greater. Anatomy was about control. Rak learned things and controlled them. I wrote down what he said, and then I to could control that knowledge. Even if I didn't remember a particular fact, I know that it's safe in my notebook somewhere, or in a textbook, or on a computer. It's controlled. Managable. Rational. Sorcerers and alchemists believed that every spirit in nature had it's own secret name, and that by having that name, you could have power over that spirit. Over the elements, over time and space.

One organism. Two arms. Two legs. A thorax and abdomen. A head. A penis, or a vagina. Sixty percent water, forty percent organic tissue. 216 bones, X arteries, X veins, X named organs composed of X types of tissue. A hundred billion neurons, ten billion hepatocytes, a trillion lymphocytes, ten trillion red blood cells, Total about 75 trillion cells. 220,000,000,000,000,000 base pairs of DNA.

Over a thousand names to be learned, mostly in Greek or Latin. Almost a million details to be memorized and put into context. There were over four hundred points on the human skull alone. Known and named. I knew them all. Did that give me power over men's minds?

Magic is an ability to grasp the ungraspable, to have power over the elements and the spirits, the unknown. Scientific knowledge is in itself a kind of magic, a sorcerous power that physicians wield in order to perform their acts of healing. How would we use that power?

V: Details, 4:50 am

I raised from the dead (next to the dead, that is) and stretched my aching bones.

I got a Coke and a Schnitzel sandwich from the vending machine, a glowing black box in the dark grey corridor. That was dinner. Or maybe breakfast. The more time we spent on other's bodies, the more our own bodies were neglected. Fat people got fatter. Skinny people lost weight. We all lost our Tel Aviv summer tans, and were gaining bright white flourescent skins. Our skins looked like bones, as if the insides were starting to come out.

I shuffled back into the lab, sat down next to my textbook, and stuffed the sandwich into my mouth. Whatever taste it had was blocked out by the words on the page. I turned the page of my textbook, but the words blurred and twisted on the page. Moore's Clinical Anatomy stood on top of a pile of books next to my lab table. Underneath it were several notebooks, the Washington Manual of Medical Therapeutics, photocopied lecture notes, Essentials of Orthopedics, pens and flashcards, and my portable computer.

We had been studying at the University of Tel Aviv for four months. Medical school had reached the ultimate level, finals week. While the summer sun faded, and clouds of winter erupted from the desert sky, we learned. For the past seventeen weeks we had been going to classes six to eight hours a day, to follow up with two to four hours of private study every evening. The sun had flown on golden wings across the sky while our pens scratched and pages turned. Now six exams that would gauge how well we had absorbed that information. They would be packed into fifteen hours over seventeen days. The moon would sail across the sea of night while we prepared. For every hour of lecture and studying and review, we would have less than a minute to show what we had learned.

The trick to taking medical school exams is not to know the material or know it well, but it to know it such that it could be recited in your sleep. My own technique was to read the book and listen to lecture, and make a manuscript of notes that was an omnibus all the material for that subject. Then I would recopy that manuscript, by hand, over and over again so I could copy it without looking at the original. I copied my notes onto flashcards and spiral bound notebooks. I copied into the margins of books and notes. I copied in the library, in the Histology lab, in the coffee shop, in the mall, at my desk, in my bed. I copied while watching TV, listening to music. I copied in my sleep. The scrawl of my pen was like the relentless machinery of the human body, flawlessly copying millions of base pairs of DNA every second. Every detail would be remembered, a thousand times over, because every detail might some day mean a life.

I looked down at my notes:

Two phalanges, proximal and distal, articulated by a saddle joint. Attachment for a total of seven muscles. Connects to the trapezium of the wrist by a condyloid joint. Powered by the Thenar emminence: Abductor pollicus brevis, Flexor pollicus, and Opponens pollicus, which allow the joint to be abducted or adducted, flexed or extended, and opposed. Ennervated by the recurrent nerve, a branch of the median nerve from the lateral cord of the brachial plexus, from cervical spinal roots 5-7. Blood supply from the superficial branch of the radial artery. Skin sensation from the cutaneous branch of the median nerve...

All this for the thumb.

This little structure allowed humanity to use tools, to step off the ladder of Darwin's evolution and make its own rules. I had never believed the thumb could be so complicated.

Life exists in the details.

VI: Death

In Egypt getting your own corpse means hiring a graverobber. In some places you buy a cadaver, some places you beg borrow or steal. In Taitz's South Africa, with only two major medical schools and hundreds of people dying every day, you get a fresh cadaver for every class. People don't appreciate how lucky they are to have someone's body to study from.

There were several Orthodox Jews among our class. To them it was of the utmost importance that the bodies were not Jewish. In the Jewish tradition it is important the body be buried within 24 hours of death. I didn't understand all of the sentimentality surrounding a dead body. I had already arranged to donate my organs to science when I died. It was a tool when it was alive, and now it's a tool when it's dead. Like soil.

I have heard some wild stories about medical students and their cadavers. Apparently one guy put the cadaver in the passenger's seat of his car, and used the extra body to drive in the car pool lane. The time-honored trick of putting a live person on a cadaver table had been repeated every year. Either flaunt your reaction or rebel from it, but you can't deny that the reaction is there.

Understanding the pathology of death, the microscopic details that shift so that the well of life no longer heaves, is not the same as accepting the end of your own existence. It is something we never truly face. Either you obscure it with religion and superstition, or you rationalize it with scientific positivism.

We all came to terms with death on the anatomy table. It had ceased to be abstract. Death would ride with us, forever.

VI: Different Eyes, 5:45 am

My eyes were burning from formaldehyde. I walked out of the Anatomy lab into the spring night. The glowing dial on my watch read 5:45 am. The bag on my back hurt from its weight. It was like carrying a bruise. It seemed like it took a week to walk to my apartment.

Walking up the stairs, I saw an old lady with her dog. She greeted me with a sweet smile and a 'Shalom'.

I didn't know her name, or anything about her. She always smiles and says Shalom to me. I knew nothing about her, but with my eyes I can look deep inside her. I can see the muscles moving over bone, under skin. I can see right down to the most molecular level, the DNA unwinding and transcribing RNA that will make proteins that make life.

I have come on a pilgrimage to this faraway place, this cradle of the Western world, because I had eyes but I could not see.

The masses only allow themselves to see the surface of things, without significance, without consequences. They will take out stock in a high-paying fund that supplies money for weapons-brokers that sell arms to Iraq. For them a hamburger is meat on a bun, not ground flesh of lipids and peptides filled with bacteria, toxins and multicellular parasites. A sweating homeless man is an annoying inconvenience, not an alcoholic with thiamine deficiency and kidney failure producing renal frost.

Physicians see the reality of death, people at their worst, the lowest of the amplitude in the rhythm of life. As student-physicians, we will be exposed to the heights and depths of the human condition. As scientists, we see the causes and results of each folly of life. Innocence is forever barred from us.

Like the microscope, I will see the most basic building blocks of life. I will penetrate the undefined arche split open, classified and quantified. Like the madman, I will break through that invisible veil that separates the artificial wholeness of the world to the pulsing pathogenic masses inside. Like the scalpel, I will slice open a curtain of carefully-studied ignorance and live in a world of practical realities which allow for no vanity or delusion.

Somehow you expect me to once again be a part of the mass of humanity, to close these eyes pried open with knowledge. But that feat is impossible. I will be forever set apart as the gatekeeper of sickness and health, life and death, as the one who sees with different eyes.


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