At medical school, my cadaver’s name was Harold. Or, rather, that’s what my lab partners and I named him after the group next to us named theirs Maude. We were in gross anatomy, the traditional first-year human-dissection course, and each student team at Stanford worked on the cadaver of a generous person who had donated his or her body to science.
Our professors gave us two instructions before we set foot in the lab. One: Pretend that the bodies belonged to our grandmothers and show respect accordingly. (“Do normal people slice up their grandmothers?” one freaked-out student replied.) Two: Pay attention to any emotions that came up during what we were told would be an intense process.
We weren’t given any information about our cadavers—names, ages, medical histories, causes of death. The names were withheld for privacy, and the rest because the goal was to solve a mystery, not a whodunnit but a whydunnit. Why did this person die? Was he a smoker? A red-meat lover? A diabetic?
Over the semester, I discovered that Harold had had a hip replacement (clue: the metal staples in his side); his mitral valve had been leaky (clue: enlargement on the left side of the heart); he’d been constipated, probably from lying in a hospital bed, at the end of his life (clue: the backed-up feces in his colon). He had pale blue eyes, straight yellowing teeth, a circle of white hair, and the muscular fingers of a builder, pianist, or surgeon. Later, I learned that he’d died of pneumonia at ninety-two, which surprised us all, including our professor, who declared, “He had the organs of a sixty-year-old.”
Maude, however, had lungs full of tumors, and her nicely painted pink nails belied the nicotine stains on her fingers from her habit. She was the opposite of Harold; her body had aged prematurely, making her organs seem like those of someone much older. One day, the Maude Squad, as we called Maude’s lab group, carved out her heart. One of the students lifted it gingerly and held it up for the others to examine, but it slipped off her glove, fell to the floor with a thud, and split apart. We all gasped—a broken heart. How easy it is, I thought, to break someone’s heart, even when you take great care not to.
Pay attention to your emotions, we’d been instructed, but it was far more convenient to close them off as we scalped our cadaver and sawed open his skull like a cantaloupe. (“It’s another Black and Decker day,” our professor said when he greeted us on the second morning of that unit. A week later, we’d do a “gentle dissection” of the ear—meaning chisels and hammers, but no saws.)
We opened each lab session by unzipping the bag containing our cadaver and pausing as a class for a minute of silence to honor the people who were letting us take their bodies apart. We started below the neck, keeping their heads covered as a sign of respect, and when we moved up to their faces, we kept their eyelids closed, again out of respect, but also to make them seem less human to us—less real.
Dissection showed us that living is a precarious thing, and we did our best to distance ourselves from this fact by lightening the mood with obscene mnemonics passed down from class to class, like the one for the cranial nerves (olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal): Oh, Oh, Oh, To Touch And Feel Virginia’s Greasy Vagina, AH. While dissecting the head and neck, the class would shout this out in unison. Then we’d hit the books and prepare for the next day’s lab.
Our hard work paid off. We aced each unit, but I’m not sure that any of us were paying attention to our emotions.
When exams rolled around, we did our first walkabout. A walkabout is just that—you walk about a roomful of skin and bone and viscera as if examining the wreckage from a horrific plane crash, except your job is to identify not the victims but the individual parts. Instead of “I think this is John Smith,” you try to figure out if the fleshy thing sitting by itself on a table is part of a hand or a foot, then say, “I think this is extensor carpi radialis longus.” But even that wasn’t the goriest experience we had.
The day we dissected Harold’s penis—cold, leathery, lifeless—the students at Maude’s table, having a cadaver with female organs, joined us to observe. Kate, my lab partner, was meticulous in her dissections (her focus, the professor liked to say, was as “sharp as a nine blade”) but now she was distracted by shouts from the Maude Squad watching her work. The deeper she sliced, the louder the shouts became.
“Ouch!”
“Eww!”
“I think I’m gonna puke!”
More classmates came over to watch, and a bunch of male students started dancing in circles and guarding their crotches with their plastic-protected textbooks.
“Drama queens,” Kate muttered. She had no patience for squeamishness—she was going to be a surgeon. Refocusing, Kate used a probe to locate the spermatic cord, then grabbed the scalpel again and made a vertical incision along the entire base of the penis, so that it split open into two neat halves, like a hotdog.
“Okay, that’s it, I’m outta here!” one of the guys announced, and then he and several of his friends ran from the room.
The final day of the course, there was a ceremony in which we paid our respects to the people who had let us learn from their bodies. We all read personal thank-you notes to them, played music, and offered blessings, hoping that even though their bodies had been dismantled, their souls were intact and open to receiving our gratitude. We talked a lot about the vulnerability of our cadavers, exposed and at our mercy, cut open and scrutinized, millimeter by millimeter, samples of them literally put under a microscope as we removed their tissues. But we were the truly vulnerable ones, made more so by our unwillingness to admit it—we were first-years wondering if we could hack it in this field; young people seeing death up close; students not knowing what to make of the tears we’d sometimes shed at the most unexpected moments.
They had told us to pay attention to our emotions, but we weren’t sure what our emotions were or what to do with them, anyway. Some people took meditation classes offered by the medical school. Some thrived on exercise. Others buried themselves in their studies. One student on the Maude Squad took up smoking, sneaking out for quick cigarette breaks and refusing to believe he’d end up tumor-ridden like his cadaver. I volunteered for a literacy program and read to kindergartners—how healthy they were! How alive! How intact their body parts!—and when I wasn’t doing that, I wrote. I wrote about my experiences, and I became curious about other people’s experiences, and then I started writing about these experiences for magazines and newspapers.
At one point, I wrote about a class called Doctor-Patient that taught us how to interact with the people we would one day treat. As part of our final exam, each student was videotaped taking a medical history, and my professor commented that I was the only student who’d asked the patient how she was feeling. “That should be your first question,” he told the class.
Stanford emphasized the need to treat patients as people, not cases, but at the same time, our professors would say, this was becoming harder to do because of the way the practice of medicine was changing. Gone were the long-term personal relationships and meaningful encounters, replaced by some newfangled system called “managed care” with its fifteen-minute visits, factory-like treatment, and restrictions on what a doctor could do for each patient. As I moved on from gross anatomy, I thought a lot about what specialty I might choose—was there one in which the older model of the family doctor survived? Or would I not know the names of many of my patients, much less anything about their lives?
I shadowed doctors in various specialties, ruling out the ones with the least amount of patient interaction. (Emergency medicine: exciting, but you rarely see your patients again. Radiology: you see pictures, not people. Anesthesiology: your patients are asleep. Surgery: ditto.) I liked internal medicine and pediatrics, but the physicians I followed warned me that those practices were becoming far less personal—to stay afloat, they had to cram in thirty patients each day. If they were starting out now, a few even said, they might consider another field.
“Why become a doctor if you can write?” one professor asked after he had read something I’d written for a magazine.
When I was at NBC, I worked with stories but wanted real life. Now that I had real life, I wondered if, in the modern daily practice of medicine, there’d be no room for people’s stories. What was satisfying, I discovered, was immersing myself in other people’s lives, and the more I wrote as a journalist, the more I found myself doing just that.
One day, I talked to a professor about my dilemma, and she suggested that I do both—journalism and medicine together. If I could bring in extra income as a writer, she said, I could have a smaller practice and see patients the way doctors used to. But, she added, I’d still have to answer to insurance companies with their time-consuming mounds of paperwork, which would take me away from patient care. Has it really come to this? I thought. Writing as a way to support a living as a doctor? Didn’t it used to be the other way around?
I considered her idea anyway. At that point, though, I was thirty-three years old, with two more years of medical school, at least three years of residency, maybe a fellowship after that—and I knew that I wanted a family. The more I saw the effects of managed care up close, the less I could imagine myself taking the years-long risk of finishing my training and then trying to find out if it was possible to concoct the kind of practice I wanted while also being a writer. Besides, I wasn’t sure I could do both—not well, at least—and also have room for a personal life. By the end of the term, I felt like I had to choose: journalism or medicine.
I chose journalism, and over the next several years, I published books and wrote hundreds of magazine and newspaper stories. Finally, I thought, I’ve found my professional calling.
As for the rest of my life—the family—that, too, would fall into place. At the time I left medical school, I was absolutely sure of it.