Progress Notes

Lessons in the anatomy lab

Julia McGuinness, MS3By Julia McGuinness, MS3

As I was finishing my first semester in medical school, my grandmother was diagnosed with adenocarcinoma of the esophagus, stage IV. My parents successfully kept this news from me for over a week; they, as well as my grandmother, did not want grief to derail me as I faced my final exams. However, when my mother told me as I was preparing to board my flight home that my entire extended family would be visiting over the holidays, I knew. The previous discussions with my father, a physician himself, about Grandma choking on her pills, having difficulty eating, and finally going in for a barium swallow had ended without a communicated resolution; my still green medical mind now put together the pieces.

My winter break was a blur of bittersweet memories. My grandmother, knowing that cancer had already seeded itself in her adrenals and lymph nodes, refused chemotherapy. Her only intervention was the placement of a stent in her lower esophagus, a temporizing measure that only stalled the inevitable starvation as the apple-sized tumor grew ever larger. Hospice care began, and after several weeks of my parents and relatives sleeping on my grandmother’s couch, the family finally found a live-in caretaker to ease their burden.

In some ways, my grandmother’s diagnosis was a blessing; it afforded her the opportunity for resolution that a sudden death could not. She was well enough for about a month to welcome an endless stream of visitors, some of whom flew thousands of miles to say their goodbyes. I enjoyed a few afternoons of quiet time with her, looking over old photographs and hearing her talk about the years before I was born.

My practical Irish grandmother, never one to speak of her feelings openly, finally shared an emotional part of herself that I had never known. Feeling that I was finally learning who she was, and what she felt for me, made me dread our parting as I returned to Houston.

There was another aspect of my return that I dreaded. After a semester of anatomy lab, we were now moving on to our head and neck dissection.  The thought of gazing upon lifeless features that once bore the expressions of a person’s soul drove my Grandma’s mortality too close to home. It was with trepidation, then, that I stood in the lab and watched my tankmates remove the sheet covering our donor’s head. I forced myself to study the face before me. Although the preservation process had altered her skin, the basic structures were unchanged. Her brow, her nose, her mouth, her lips, her eyes were all there. After focusing on impersonal appendages and organ systems for months, I was finally confronted with the full humanity of my donor. Somehow, this realization was comforting. I felt connected to this donor, despite never knowing her alive. My heart filled with thanks and love for this donor, who had given such a wonderful gift.

My tankmates and I spent the next few weeks working slowly and carefully to dissect our donor’s face. The layers peeled away, and we marveled once again at the body’s intricacies. As we progressed, my grandmother faded. In my calls home, I heard that she was steadily losing weight and was now a shell of her former self. Her pain was increasing, and the resultant increase in pain medication was dulling her senses. I was bottling up my grief, but one day, while I was in the anatomy lab for a weekly review, I could contain it no longer. I stood in a corner of the lab and wept openly in front of a friend, not caring what the classmates around me thought. My friend shared her own tale of recent loss to help give me the release I needed. She told me that what she had learned from her experience was that you must look at life as a circle; yes, there will be death, but viewing death as the final endpoint ignored life’s continuum.

I knew then why looking upon the face of my donor was comforting. My donor was proof that there is life after death, perhaps not in the body itself, but in the knowledge gained and the emotions shared. Though the heart no longer beats, it continues to inspire. My grandmother’s death lost its sense of finality, and I knew, finally, that it would be okay. And when she did pass, halfway through my dissection, it was.

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