Friendships from medical school remain intense despite the distance and our different stories. The friendship of those who were with me when I first saw a cadaver. Those who suffered with me from every illness we studied. Those who were with me when we first asked someone about their illness, or to undress in order to perform an examination, with a mixture of shyness and arrogance. This was our introduction to the privileged moments in people’s lives that became our routines. These friendships helped us to navigate new encounters with pain and distress, and with joy. These encounters started to shape us as doctors in more ways than one, although we were still unaware of the dark corners of that new shape, still unaware that some of those friendships, and new ones, would eventually help us to shine light into those dark corners.
The consultant
I called them my Kodak moments. The small snippets of other people’s lives that I took home with me every night. I collected many Kodak moments over the years and they filled album after album in my head. So many albums, in fact, that I soon began to wonder if I was cut from the right cloth to practise medicine after all.
If you walk a circuit of any hospital, you will find many of these Kodak moments in wards and clinics, and hidden behind the curtains of anonymous cubicles. If you wish to hunt them down, you will find plenty in intensive care and in A&E. Oncology usually has its fair share, and palliative medicine is swimming with them. Many Kodak moments, though, are found where you would least expect them to be – not held within the main story, but hidden at the edges of the narrative – because it’s often the smaller moments, the incidental characters, that provide you with the memories that are the most difficult to leave behind. Whenever I expressed concern at how these moments affected me, I was always told that compassion is a wonderful thing. I was told compassion is something to be desired and applauded. But compassion will eat away at your sanity. It will make you pull up in a lay-by on the journey home, because you can no longer see the road for tears. It will creep through your mind in the darkness, and keep you from your sleep, and you will find that the cloth from which you are cut will begin to suffocate you.
It didn’t take very long for the albums to begin filling. Exactly a week after sitting in a darkened lecture theatre and being welcomed into my medical career, I experienced my very first Kodak moment.
It was waiting for me under a cloth in the dissection room.
Anatomy, like many other things in life, is better learned by experience, rather than by reading about it. No matter how colourful and detailed the diagrams were in the giant textbooks we carried around, they were no match for seeing something in real life, and many of us had chosen our medical school purely because it conducted what is termed full body dissection. This means that you have a whole person to explore throughout your training. It is also the same person, the same cadaver, that you keep for your years as a medical student, and, as is tradition – and as many hundreds had experienced before us over the decades – we were introduced to ‘our’ cadaver in the very first week of medical school.
I knew it was coming. I had seen it creep towards me on the timetable. I felt prepared. Almost indifferent. I would be fine. It was animals that tore at my heartstrings, not people. I could deal with people. Although I was soon to discover that I actually couldn’t deal with people very well at all.
Our first dissection was scheduled for the early afternoon and we gathered in the basement of the medical school, in our fresh white coats. Few of us had eaten any lunch. We drifted into clusters, small white knots of anxiety and apprehension, bravado and curiosity. The armour of dark humour, with which I would soon become very familiar, began to creep around the edges of the room. I dug my hands deep into the pockets of my coat and tried to concentrate on the opportunity I was being given to learn, and the generosity of those who had donated their bodies in order to provide me with that opportunity. After what felt like a lifetime, we were ushered into the dissection room itself.
It was the aroma, more than anything. A unique blend of chemistry lab and death. The strange rubbery smell of preservative. More than that, though, it smelled of history and of tradition, because, as medical students, we were walking into an experience unchanged for almost three hundreds years, except that dissection was no longer held in giant auditoriums, and graves were no longer robbed for the privilege.
Within the dissection room there were many tables, and upon those tables were clean blue sheets, and beneath those clean blue sheets lay dead bodies. We were split into groups and I stood with six others around our table. Our body. There then began a health and safety lecture, a new accessory to a three-hundred-year-old tradition, and as the words floated above my head I stared at the clean blue sheet and I wondered who might lie beneath it.
I thought of the last dead person I had seen, only a few months earlier. I had watched as my mother said goodbye to my father on a watery, pale, February morning, surrounded by the equipment you are loaned when someone dies at home. The hoists and the commode, and the bottles of Oramorph, the monitors and the Macmillan nurse, all crowded into your front room and trying so very hard to blend in with the furniture of an ordinary life.
You imagine when a doctor arrives at your bedside, or sits across a table from you in a consultation room, that they are somehow swept clean of their own reference points. The corners of their minds are tidied and orderly. They are unaffected by memory, or by difficult emotion, or by fracture lines caused by lives lived outside of that encounter. Another assumption. Another necessary fallacy. Because all I could think about, waiting in that dissection room and staring at the blue sheet, was my dad. I played out different scenarios in my mind as we were told about fire exits and suitable foot-wear. I thought about the consequences of leaving, and the potential outcomes of staying. I thought about how hard I had fought to be standing there and what other people might think of me if I walked away. Mainly, though, I thought about my dad. My mouth was dry. My pulse charged. My legs felt undecided about whether they wished to carry on with the job of holding me upright. I turned to the nearest person who looked as if they might be in charge of something and I explained. They listened and they understood. They told me to leave – and I left.
I staggered back through the medical school and into the sweet, fresh air of Lancaster Road, which did not smell of rubber or chemistry lab, and I sat in my car and I tried to find my breath again. I had failed. The first challenge medical school had offered up to me and I had snapped and broken. Even worse, it felt as though the dissection room had been an initiation, a ceremony almost. A rite of passage. While my future colleagues were still in that basement, transitioning into doctors, I was sitting in my car watching the rain hit the windscreen, and wondering why I had ever imagined I could do any of this in the first place.
Over the next two weeks, I tried many times to enter that dissection room. I ventured into the basement when no other students were around, thinking the solitude might help me to acclimatise to death. It didn’t. I went down there to speak to one of the anatomists, perhaps looking for a little empathy, a little understanding. She explained to me the importance of dissection in the same language as the glossy pages in a medical school brochure, but I didn’t listen because I was too busy staring just beyond her right shoulder, at a polythene bag containing twelve severed heads. I nodded and walked away. I even went to my GP, thinking I could medicate myself into facing up to it.
‘I don’t think I’m cut out for this,’ I said. ‘I don’t think I can carry on.’
She stared at me. ‘But you must. Especially now.’
I looked up at her from deep within my tearful, self-absorbed misery. ‘Why?’
‘Because the way you’ve reacted to the dissection room tells me what a good doctor you’ll make.’
I didn’t feel like I’d make a good doctor. I felt fraudulent. Ridiculous. As the dissection room rolled around each week on the timetable and as I rolled neatly away from it, I knew I had to either throw in the towel right there and then, or address it before it became insurmountable.
Along with the dissection room and genetics and physiology and pharmacology, and many other new and mysterious subjects, one of the topics we were presented with in our first semester at medical school was pathology. The registrar who taught us was around the same age as me, and she was funny and wise, and spoke with such passion and enthusiasm about her subject when she was with us that she made everyone in that room want to be a pathologist. She was also one of those rare people you couldn’t help but instantly like, and in another of my moments of wild spontaneity, I decided to ask if I could accompany her to a post-mortem. Surely if I saw front-line anatomy in one of its most useful roles, solving puzzles and providing answers, it would help to rid me of my fears. But I was a first-year medical student. I had (quite literally) just walked in off the street. She would definitely say no, which was just as well, because if I couldn’t face the clean, bloodless, preservation of a dissection room, how on earth would I have coped with an autopsy?
She said yes.