The fourth year of my medical degree was mildly compromised by frequent dashes from the bedside to the toilet – the unfortunate consequence of mixing the smells of the ward with first-trimester morning sickness. Week by week, as my firstborn grew, all my painstakingly drawn diagrams of foetal development from past classes in embryology acquired a thrilling weight and substance. I watched with grim satisfaction as my body did exactly what my physiology textbooks predicted – ankles swelling with excess fluid, joints acquiring disconcerting flexibility as my due date fast approached. I was the first student in my medical school to become pregnant and, towards the end, continued to waddle defiantly on the morning ward rounds, daring any consultant to make a disparaging comment.
The birth itself, though traumatic, was eclipsed by what happened afterwards. The day after my Caesarean section, still unhinged by love and bliss, helplessly besotted with my newborn son, I noticed his swaddle starting to twitch and jerk. Unwrapping the blanket revealed tiny arms and legs moving in rhythmic spasms. He was fitting – in our jargon, a tonic clonic seizure – though my treacly brain couldn’t quite compute what was happening. Somehow, while my husband ran for a nurse, I had the presence of mind to record the seizure on my smartphone. By the time the oncall paediatrician arrived, the seizure had already ended but, after he’d watched the footage, his advice was not to worry unduly but to keep a close eye in case it happened again.
A seizure in a newborn can herald all manner of horrors – epilepsy, meningitis, a hypoxic brain injury sustained during childbirth, an intracranial bleed or tumour – far too many a medical student mother’s worst nightmares. Even entertaining them made me feel queasy with rising panic. So I didn’t. I surrendered myself willingly to the paediatrician’s instructions. Don’t worry. Don’t fear the worst. It may be a one-off, it may mean nothing at all. Doctor, in this situation, simply had to know best because the alternative was unthinkable.
A day of observation passed without incident. He slept, snuffled, sighed, suckled and lulled me back into a lovestruck swoon. Perhaps, on reflection, the paediatricians now wondered, the fit hadn’t been a real fit at all. A false alarm, a misdiagnosis. It felt like a reprieve – by the skin of our teeth, we’d got away with it and our son was deemed safe to go home. We started packing our bags, incredulous – as perhaps all new parents are – that the hospital could possibly be so blasé as to allow two rank amateurs who knew nothing about babies to waltz away with an actual child. Dave had just brought our pristine car seat onto the ward when, without warning, it happened again. The twitching was unmistakeable, even beneath blankets. A second seizure playing out before an audience of the three other new mothers in my bay and their three perfectly healthy newborns.
This time, every fact, every statistic I had ever learned melted away as our infant son, head arched back, jerked and bucked before me. I couldn’t move. There was a sound in the distance, faint and ugly, that slowly coalesced into a scream. It took some time for me to understand that I was the person screaming.
A paediatric crash team were suddenly everywhere, wresting control, stripping blankets away, pressing an oxygen mask over blue-tinged lips, applying electrodes and tubes until our son was lost beneath the paraphernalia that might hold his life in the balance. They swept him away at a sprint to the NICU, the Neonatal Intensive Care Unit, as I clung for dear life to an empty cot-side. Just as nothing had prepared me for the ferocity of maternal love, so my body’s response to the terror that my child might be dying was overwhelming and brutal. I recall not a touch or a word from anyone. Someone, a doctor, midwife or nurse must have tried to reassure me, but their words were obliterated by fear.
We were left alone to trace the crash team’s steps through winding corridors until we found the NICU. The ward was almost too short-staffed to cope with the births, let alone spare someone to guide us. My scar was burning and I could only shuffle slowly, doubled over in pain. By the time we reached Intensive Care, a paediatrician was daubing disinfectant on our son’s exposed spine, about to perform the lumbar puncture that would rule in or out bacterial meningitis. Our baby was screaming uncontrollably, though his lungs were too small to generate much noise above the machinery, bleeping and frenetic activity.
‘You’d better not see this,’ someone stated in tone that invited no argument, and escorted us briskly away. Alone in a relatives room, bewildered and fearful, we waited and waited for news. I felt diminished to the point of irrelevance. For twenty-four hours, I had provided my son with everything, and now I could do nothing to help him. Other hands, other humans were tending and deciding. Cut out of the loop, we sat in silence on NHS plastic chairs, green-tinged under hospital strip lights.
Finally, a nurse took us to the clear Perspex cot in which our son now lay, expertly swaddled, antibiotics dripping into one bandaged wrist. He was sleeping peacefully. The paediatricians were systematically working their way through my list of worst nightmares: treating for meningitis in case he was infected, scanning his skull in case he had a brain tumour, running a battery of tests on blood and spinal fluid in the hope of identifying another possible cause. He was, we were assured, in safe hands, but our world had tilted away from the sun.
Visiting hours were long over. Dave helped me back to the ward, then drove home to an empty house. I can only imagine the night he spent there, having believed he would be home with his wife and newborn child. Myself, I lay in the darkness, shrouded by curtains, listening to three other babies that cried so lustily, fed so greedily and were cradled so lovingly in their mothers’ arms that morning couldn’t come too soon. NICU called up to the ward. Our son had had no further fits, was awake and hungry, and would I like to feed him? I made the long trek to the NICU as quickly as hobbling allowed, and held my baby at last as, with a gusto that made my inner hopes soar, he loudly demanded to be fed.
The morning ward round was in full swing and, seeing no one to consult about where I should breastfeed, I sat in a plastic chair on the edge of the unit and awkwardly began to nurse my baby. Suddenly, I seemed to be overshadowed by men.
‘What do you think you’re doing?’ barked one of them. ‘You can’t do that here. What are you doing? Someone sort this out.’
The consultant at the helm of the ward round wore a look of disgust on his face. Too shocked to respond, feeling as though I’d just committed a crime by semi-baring a breast in, of all places, a hospital, I stayed mute as a nurse swiftly erected a portable screen around me, this offensive presence in the NICU. She drew up a chair beside mine. There was something intolerable about this act of minor humiliation, coming as it did after such a brutal twenty-four hours. I felt crushed and small. And, somehow, the nurse, whose name, appropriately enough, was Precious, seemed intuitively to feel and understand everything. Tenderly, she helped adjust my son’s position on my breast and wiped away my tears. Smiling, she squeezed my hand and crooned with genuine delight, ‘Oh, my God, he is beautiful. He is perfect. He is beautiful.’
I don’t think I have ever felt such gratitude.
‘Do you think so? Is he really?’
‘Oh, God! This boy is beautiful.’
In fact, as even I would later concede, my son started life looking not dissimilar to Andrew Lloyd Webber, but that was entirely irrelevant. He was perfect. He was beautiful. In my eyes and now in those of Precious. She will never know what her kindness brought me. She gave me the one thing she didn’t have – her time – when her jobs must have been stacking up, piling one upon the another. Yet still she sat, stroking my hand, beaming at my newborn. We stayed that way for far too long. I’m sure it made her morning hellish. And to this day I wish I had had the presence of mind to tell her what this had meant to me. That through her kindness – freely dispensed, yet priceless – I had found cause to believe that whatever happened next, however this would end, I wouldn’t be in it alone.
Our son left the NICU after a couple of days, a diagnosis eluding the exhaustive testing. A few days after that, he was deemed fit for discharge and finally, gingerly, we carried our car seat and baby across the hospital grounds and into our car. I remember raising an eyebrow at Dave as he drove us home.
‘How could they possibly have let us out with him?’ I asked. The old joke, spoken only half in jest. ‘Are they insane? Don’t they know we have absolutely no idea what we’re doing?’
We smiled at each other, elated and terrified. We were officially a family. Ten years later my son, mercifully, remains perfectly healthy. But, a decade after we faced the abyss, the compassion and humanity of one NICU nurse remain indelibly etched in my memory.
Until I faced the prospect of losing a child, I didn’t know what grief was. I regarded myself as reasonably empathetic and thought I could imagine what grieving must feel like. But that presumption, it turned out, was a glib one – itself a failure of imagination. I didn’t know how it could suck the air from your lungs or cause your legs to buckle or have you feverishly doing deals with a God you didn’t believe in to take you, not your child – anything in order to spare him. I’d had no idea.
Two experiences during my five years of medical school did more to shape how I would subsequently practise medicine than anything acquired from a textbook. This was the first. It took a brush with disaster to taste how disaster really feels. I now knew how little I really grasped about the impact upon patients and relatives of the diagnoses of cancer I would one day deliver, of the news I would break that a loved one had died, of the destruction I would come to unleash as I went about my daily work as a doctor. There were whole realms of pain and fear about which I knew almost nothing and never would, unless I lived something like them. I vowed never to forget that.
More prosaically, but equally important, my brief experience as a maternity-ward inpatient had taught me how profoundly disempowering hospital could be. The quasi-knowledge I’d acquired as a medical student offered no protection against the name tags, the anonymous hospital gowns, the patient notes that everyone reads bar the patient themselves, the subtle stripping of one’s power and sense of identity. I’d hated it. It had made me feel so small and vulnerable.
Even as I continued to amass facts at a rate that made my brain ache, I could no longer shake the conviction that something fundamental was missing from medical school. Perhaps what every aspiring empathetic doctor needs is a compulsory stint as a patient. Instead, we acquire ‘communication skills’ through workshops with actors and, if we’re lucky, opportunistic observation of real doctors having those difficult conversations with their patients.
What I discovered only through first-hand experience was that throughout all the toil of a degree in medicine – the painstaking acquisition of the knowledge and skills that would one day be the bedrock of my practice – I already possessed the quality that, above all others, could make my patients feel cared for: my ordinary, everyday humanity. The transformative power of a kind word or caring gesture was even now within my gift and I could use it, as Precious had, to ensure my patients felt neither abandoned nor alone. Kindness has always meant more than generosity and affection, with ‘kind’ finding its origins in the Old English noun ‘cynd’, meaning family, lineage or kin. For me, the core meaning of kindness resides in this sense of connectedness to – kinship with – others. In the alien, disorienting world of a hospital, I had experienced for myself that an act of reaching out to a patient as a fellow human being, a kindred spirit, no matter how small, could be invaluable. Their absence, on the other hand, made hospital a bleak and lonely place.
It seemed to me that, until now, medical school had largely taught us distance: how to separate from, not connect with, our patients. And nor, arguably, could it be otherwise. How else can a doctor effectively function amid the daily decay, stench and indignities of disease, all the pain and distress that infuses a hospital? Unlike the majority of medical students, I had already seen dead bodies close up during my time documenting the civil war in the Democratic Republic of Congo, and my instincts then were to flinch and recoil. At times I’d had to avert my eyes to stop myself weeping, at others to stop myself retching. I remember one young girl’s leg being cleaned by a nurse as we filmed inside a Médecins Sans Frontièrs makeshift canvas hospital. As so often in Congo, most of the children were machete victims, double, triple or even quadruple amputees after a militia group had overrun their village. But, in this case, it was a bullet wound that gaped like a crater in the child’s thigh and, even to my inexpert eyes, was horribly infected. Perhaps she was ten or eleven. Her screams of pain and pleas in Congolese for the torture to stop went unheeded as, with gentle words but relentless professionalism, the nurse continued the wound care without which her young patient might not survive. The smell of rotting flesh was overpowering and the nurse’s ability to continue working while causing such suffering was beyond anything I could imagine.
Perhaps, in order to deliver a workforce of doctors capable of immersion in the brutality of illness, an essential role of medical school is to build up, not break down, barriers between doctors and the young people they used to be. After all, no one wants their doctor immobilised by sentiment. The acquisition of detachment, the blunting of ‘normal’ human responses to disfigurement and death, might just be what gives doctors the ability to get on and do their job.
More than anywhere else, medical students’ innate taboos are confronted and overcome in the dissection room. Even after I’d witnessed death and dying, nothing prepared me for the act of supreme violation that dissecting a human corpse would feel like.
Over a hundred of us crowded outside the heavy Victorian doors of the anatomy room, waiting to cross the threshold for the first time. A faint scent of formaldehyde hung in the air. That slightly too loud, bravado-driven chatter of people who want you to know they aren’t remotely anxious flooded the corridor. We were first-year medical students, a few weeks into our course. Everyone seemed very young and jittery. Indeed, most of us were still teenagers. Appreciably older, at twenty nine, I was preoccupied with whether I could handle a morning spent precision-flaying a human corpse. My father had regaled me with stories of dissection from his day. Back then, in the sixties, some wisecracking wit would inevitably borrow a human hand from the dissection room and proffer it in greeting to a stranger in the pub, to be met with predictable horror – and the delight and amusement of the assembled medics. Did that kind of thing still happen? I was worried about being too prudish, out of kilter with my fellow students.
In fact, when the professor of anatomy ushered us inside, he did so with the utmost solemnity. Things had changed for the better. We gathered around him, feigning nonchalance, surrounded by a couple of dozen stainless-steel tables, each bearing a body shrouded in white muslin. Out of the corners of their eyes, everyone surreptitiously glanced at the contours of the corpses. The formaldehyde stung my nostrils. I could almost feel it permeating my skin. The walls were lined with shelves upon which jar after jar of anatomical specimen sat, suspended in preservative. Body parts, splayed and pinned, in various stages of dissection. Hands, hearts, torsos, heads. I found myself transfixed by a series of jars in which were marooned human foetuses, graded according to size, from the tiny to the almost full-term. Miniature fists, fiercely poised to leap at life, eyes closed for eternity. I was as prepared as I could be for a wizened old corpse, but I hadn’t anticipated confronting dead babies.
The professor spoke of who the corpses we were about to start dissecting had been. Somebody’s grandmother, somebody’s grandfather. Someone who had chosen, before they died, to subject their future self to our inept blades that we might learn, in clumsy steps, to delay others, undead, from this room and its jars and silver slabs.
‘Each body in this room today is that of a person who chose deliberately to give their body to you. They wanted you to learn. They believed that giving you their body might make you better doctors.’ He paused to survey the room. ‘It is your honour and privilege to dissect these bodies. Imagine someone close to death thinking of how they could help others after dying, choosing to sign the forms that would hand over their body to you.’
As he talked, gently yet authoritatively, like a father to his children, he deftly unfurled a sheet of plastic until there, before a hundred pairs of eyes, lay the body of a man who had chosen to offer up his withered limbs to us and to this peculiar afterlife, measured out in weekly doses of our scalpels’ scrutiny. I couldn’t shake the thought from my head that not even this man’s dearest love had known his body as we would.
During our months of dissection, the professor went on, every scrap of embalmed flesh would be carefully collected and stored. At the end of the year, a church service would be held in which the relatives of the individuals who had so graciously donated their bodies to us would assemble to say goodbye to their loved ones. We were welcome, indeed encouraged, to attend. He knew exactly how to impress upon us the enormity of what we were about to undertake. These were human beings, our kindred who had bequeathed us their bodies, and he expected our respect. Long gone, to my relief, were the levity and japes of old.
We dispersed into small groups around a pre-allotted table and prepared to dissect a human thorax. First, we donned thin plastic gloves and unwrapped the body from its shroud, releasing a concentrated wave of formaldehyde. This would be ‘our’ body for the next six months. Skin grey, eyes closed, mouth open in a perpetual grimace – I found it easier to think of the corpse as an ‘it’ than as a human and hastily volunteered to make the first incision. I think I wanted to break that taboo as quickly as possible. I cut. Embalmed flesh has the consistency of cold wax. There is no elasticity. It slices like refrigerated parmesan. What in any other circumstances would have been a crime, the defilement of a corpse, was now our twice weekly ritual.
In those early days, so long as I didn’t look at the face and refused to think of the corpse as he once might have lived, I found I could suspend my instinct to recoil. Swiftly, though, no mental effort was required. Familiarity bred detachment and, after only a couple of sessions, I came to love dissection. The physical craft was only the start of it. Learning anatomy, it turned out, was part linguistics, part cartography. Slowly but surely, I began to label in Latin every bone, nerve and muscle of the human body, lovingly mapping what had once, for me, been uncharted territory. Anconeus. Brachialis. Lunate. Triquetrum. The new language in which I was gaining proficiency seemed as exotic as it was beautiful.
Sometimes, lying on the sofa late at night revising my anatomy, I’d make a small movement – turning my hand inwards or flexing my thumb – and rehearse the Latin that described the intricate engineering underlying the action. The mere act of raising my little finger, for example, involved extensor digit minimi, the lateral epicondyle of humerus, the fifth metacarpophalangeal joint, the posterior interosseous nerve. Being able to visualise and whisper every part felt like earning exclusive membership of a secret society. The excluded, in this case, were the general public. More than once, my boyfriend caught me staring intently at the sinews of his arm or the veins of his neck, knowing full well the look wasn’t lust but merely my latest attempt at reading his flesh. At the time, this didn’t strike me as odd, although, with hindsight, I must concede amazement that he married me.
Like the formaldehyde that seeped into our skin and clothes, lingering long after we had left the department for the day, my relationship with the human body was enduringly altered by the experience of dissecting it. Before, the bodies of others had been, among other things, objects of desire, beauty and limitless comfort, when I considered the potency of a simple human embrace. But now they were also texts to interpret, with inner meanings to lay bare. Behind a spontaneous smile of greeting I saw risorius and zygomaticus major and minor elevating the corners of the lips into their upturned welcome. The classical lopsided facial ‘droop’ of a stroke, on the other hand, told me that the seventh cranial nerve controlling these muscles had been impaired by a mishap in the brain.
The price of six months in the dissection room was undoubtedly a loss of innocence. Bodies hadn’t shed their beauty or desirability, but in death they no longer held the power to disturb. More than anything, what dissection taught me was the vital skill of distancing myself from my patients. Rather than worry about my newfound toughness, I’d been hardened in a way I approved of. I couldn’t imagine a place for squeamishness in the doctors’ mess.