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My First Patient

Lying before us was a man who had willingly decided that, upon his passing, his body be donated to science. That decision brought with it such powerful consequences that it affected not only the education of medical students but also the lives of the countless patients we would one day treat.
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It's when you're staring into the eyes of four other people -- each partly mesmerized and partly terrorized by the prospect of having to flip over the body lying before them -- that you begin to wonder what you're doing here. In the posthumously-published Stephen Hero, James Joyce describes these moments as "the most delicate and evanescent of moments." In the world of first-year medical students, these moments are our every day.

They are what separate what we know from what we understand. They are the very pivot points that divorce us from our past realities and force us to forever begin new ones. At their most basic level, these moments are what remind us of what learning is all about.

Looking into the eyes of the team of medical students around me, it soon became apparent that none of us had any idea how you were supposed to do this. With a twinge of hesitancy, two pairs of gloved hands eventually came to slide under the cold, wet legs that lay before us. After a moment of silent calculation, two others divided one hand beneath each arm with the other hand behind the back for leverage. And finally, the last pair of gloved hands were placed behind the head -- not for reasons of physics or practicality, but simply out of reverence and respect. And on the count of three, we collectively took a deep breath and flipped for the first time. It was time to begin our dissection.

Following in a tradition that dates back to the story of Herophilus, a Greek physician living in Alexandria, Egypt in 300 BC, we -- as first year medical students -- were embarking on a journey to study the body by studying directly from a human cadaver. Lying before us was a man who had willingly decided that, upon his passing, his body be donated to science. That decision brought with it such powerful consequences that it affected not only the education of medical students but also the lives of the countless patients we would one day treat.

And as we flipped this once living, breathing man -- now defined simply as an unmarked, unidentifiable cadaver -- onto his stomach, we prepared to make our first incision. Cutting first through the tough layer of weathered skin, then past layer after layer of sub-cutaneous tissues defined by the yellows of fats and whites of connective tissues, and eventually into a layer of pink muscle fibers, we knew what we were doing was absurd. Was this something we could get used to? Was this something we should get used to? It felt unnatural. It felt unnerving. And most of all, it felt terrifying.

Over the next five months, we saw every hue of pink, white, and red possible as we moved from the Orbicularis Oculi Muscle on the head to the Extensor Hallucis Brevis Muscle in the foot, slowly becoming more and more comfortable. We saw staples left from surgeries and tumors left from cancers. We learned what it meant for a heart to pump blood and we felt what it was like to hold a human brain in our own hands. In the cadaver before us, we found pathologies and abnormalities that this man may never have known of during his life.

But the questions still remained. Was this okay? Knowing what we knew and understanding what we understood, would any of us be willing to make the same sacrifice this man had made? Would any of us be willing to donate our body for the sake of learning, of healing, and of the betterment of humanity? And it was within our own hesitance and reluctance that we began to truly appreciate the opportunity that we had. In not knowing the answers to those questions, we developed an even greater sense of thankfulness for this man's sacrifice.

Our every understanding of anatomy, of pathology, of what things are and how they should be will forever be based on what we learned huddled around Table 7. Although we will spend the rest of our lives knowing neither his name nor his story, we will know that what he gave us -- what he, in fact, donated to us -- will perpetually affect how we practice medicine and how we care for those who are in need of care. In his passing, this unnamed man saved more people, touched more families, and bettered more lives than any single doctor could ever hope to.

And as I reflect, I recognize that the man that spent months lying before me was my first patient. But he was also so much more than that. He was my teacher. He was my confidante. And as tough as it is to say, he was also my friend. He motivated me when I lost motivation and he consoled me when I lost confidence. Over and over again, he reminded me of what it meant to care, to respect, and to give. He made me question if I could ever make the sacrifice that he made. Could I ever live up to the honor and the privilege I had been afforded by his sacrifice? Better yet, could anyone?

Throughout it all, I never got to shake his hand or to tell him thank you, but I will forever carry the important lessons he imparted. It was what he taught me as I nervously walked in to my first day of anatomy lab, what he reminded me of each and every time I came in over the weekend to study, what he left me with when I laid a shroud over his face for the last time and said my final goodbyes. His lesson was a simple lesson: Life is fleeting, and death is real.

Over two centuries ago, Herophilus, the anatomist-physician in whose tradition we now follow, once remarked, "When health is absent, wisdom cannot revel itself, art cannot become manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied." And our every visit to the Anatomy Lab reminded us of that lesson -- that everything we learn, everything we do, and everything that we are is subjected to the same rules of life and death as every man, woman, and child that came before us.

We learned a lot of anatomy over these last few months, but more so we learned more about life. We learned that it is something to be cherished and fought for, something to be respected and dignified, and, most assuredly, something to be studied and appreciated. As physicians in training, we are told that our choice of profession dictates that we will see death regularly. But to spend the first chapter of my education seeing death nearly everyday and staring into its idle eyes so routinely has been nothing short of those moments of epiphany that Joyce wrote of decades ago.

Someday, I may just forget that the Semimembranosus Muscle originates from the Ischial Tuberosity of the Hip. But I will never forget what it feels like to see death everyday. I will never forget what it feels like to see with my own eyes those vessels and organs that keep us alive. And most importantly, I will never forget the generous gift one man gave so that I could be the doctor I hope to be.

In life, we are given opportunities to make a difference. This man, my first patient, made his by reminding us that there is no more noble pursuit than to take advantage of your opportunities and to make a positive contribution to the world around you.

For him, he was able to do it after he was gone. For us, we still have our opportunity to do so today.