Of all the harrowing experiences that are a part of medical training, perhaps the most affecting is that of gross anatomy. No surprise, then, that the dissection of the human body attracts so many attempts at explication. Irresistible storytelling opportunities abound: The opening of the cranium is a metaphor for the opening of the medical student's mind to new ways of understanding the body; the dismemberment of a cadaver is an ironic comment on the disassociation students experience in becoming healers; and the cadaver itself is the ultimate paradox, at once the sacred vessel of our humanness and a lifeless object wrapped in plastic trash bags to keep it moist.
Many a traumatized medical student has written a heartfelt poem or a dispassionate historical survey or a distressed letter to a parent or friend that addresses such themes. In her well-wrought first book, "Body of Work," Christine Montross -- a psychiatry resident at Brown University -- has produced an unusual synthesis of these types of narrative. Part memoir, part love letter, part medical history, part rationalization and part poetry, "Body of Work" resists the silences of the medical profession to explore the author's relationship to the cadaver she dissected, one to whom she gives the loaded name of Eve.
"Body of Work" is at its best when Montross, who is also a poet, allows us to observe the astonishing beauty her dissection reveals, and to relish the language she uses to describe it. "The language of these bones slides along their edges," she writes. "Os coxae, the hip bones. Their three parts, with names like flowers: ilium, ischium, pubis.... The pelvic brim, as if water spills over it.... Brim, arch, spine. The ligament names like a call to prayer: sacrospinous, sacrotuberous. Sacrosanct."
EQUALLY gripping are the stories she shares of loved ones who fall ill, and later, of some of her first patients, whose living-and-breathing bodies insistently remind her of Eve's -- and her own -- humanity. Here, language, arising from the body, becomes healing, accommodating both knowledge and wonder, abetting not only the joy of discovery but also the empathic connection between teacher and student that underlies learning anatomy, and learning to heal more generally. Montross surely recognizes the humane healing power in language properly employed; she reads the work of fellow poets Mary Oliver and Mark Doty alongside her anatomy texts, and she consoles one of her lab partners, a sensitive former dancer, as she struggles through the dissection of the head, by listening to her story of a friend's death after a severe brain injury.
The narrative act is therapeutic for both Montross and her stressed-out classmates -- the decision to name Eve, and at the same time to imbue her with a kind of universal motherliness, both enables and forgives what they must do. Similarly, the elaborate Latinate naming of specific anatomic structures provides a kind of comfort in monumentalization and, as the complex terms are memorized, in mastery as well. Yet if such necessary acts of language help allay our anxieties, words can also become soulless, means to an end, no more than vehicles for exerting control over the previously unknown.
Montross seems at times to be aware of this challenge. Clearly, she wants her book to be a tribute to Eve, but often her newfound sense of mastery and privilege proves too intoxicating to allow a thorough critique of the dehumanizing first year of medical training. She treats the gallows humor that develops among her classmates rather breezily, pardoning herself for disrespecting people who gave their bodies for the sake of her professional advancement, and sparing no gruesome detail in describing the acts of dissection themselves.
It is one thing to represent honestly what goes on under the stark lights in the cold anatomy theater, and even moving to see our imperfect human responses uncritically laid bare; it is another to comment glibly on the more deliberate distancing that occurs. Midway through the book, Montross endorses the problematic notion of "detached concern," an oxymoron used to describe the stance many physicians are taught to adopt in the doctor-patient relationship.
After praising an oncologist who counsels a dying patient's family with "simultaneous warmth and professional distance," she goes on to say: "I could not have known, as I stood over the male cadaver being dissected by our neighboring group, that the awkward moment of looking at a dead stranger's genitals would be comparable in some ways to discussing end-of-life issues with a patient's family in the future. I did know, however, that any discomfort I was feeling in anatomy lab was interfering with my ability to learn important medical information. And whether my future patients would require clarity or knowledge, my ability to manage my own discomfort in the face of their bodies and their illnesses would be one of the most critical lessons of my medical training." Montross is too insightful and gifted a writer to go along with this brand of group-think.
One implication made by Montross, perhaps not entirely intended, is that Eve's utter muteness causes difficulties in the students' relationship with her. How tremendously such an intimate but wordless conversation with another human being might be altered if the body itself could speak. What if Eve could respond to the jokes made about her and the other cadavers lying rigidly on the stainless steel tables? What if she could describe the pain of childbirth as her uterus was split open?
THOUGH Montross occasionally tries to imagine this kind of personal history, taking her cues from lovely incidental observations -- fingernails painted with lavender nail polish, forearms covered with sunspots -- what is most sorely lacking is Eve's language, her own specific narrative. In this age of frequently misapplied technology, here is a chance to make productive use of video cameras and monitors: Might not a video of Eve, telling of her life and created at the time she decided to donate her body, help mitigate some of the mistreatment Montross documents, as well as the subsequent distancing she (however uneasily) comes to approve?
Proponents of detached concern may argue that such familiarity would make it all the more difficult for medical students to achieve this distance, which physicians are brainwashed to believe is necessary to care effectively for patients; on the contrary, I believe it is the depersonalization first modeled for aspiring doctors in their encounters with cadavers that accounts for much of the lack of professionalism and career burnout in physicians, and the callous treatment patients too often receive nowadays.
At the end of this thought-provoking book, Montross does something surprising: After the course is over, she returns to the anatomy lab. Alone in the dark and silent space, she asks herself, "What part of myself was exposed in opening Eve? What structure in me was found and laid bare?" In taking Eve's flayed hand into her own, she realizes that she is in fact in the presence of another.
"Great teacher," she intones, "I give you flowers. I carry your body to the funeral pyre. When you burn, may every space in you that I have named flare and burst into light." Thus she aligns herself with the humane tradition of honoring the dead, and the act of love inherent in tending to them. The detached concern she professes to want to emulate seems refreshingly absent here. Perhaps, in recognizing our universal and very human contradictions, there is hope for the beleaguered medical profession, after all.