Today was the Class of 2017's Convocation of Thanks. This is the day when we invite to our campus the families and friends of the donors who gave their bodies to our school as cadavers for gross anatomy lab. My classmates and I put together a program of musical performances, poetry readings, short speeches and the presentation of a painting all to present to our guests to display our gratitude, both to their loved ones for their selfless donation and to the family for following the deceased's wishes even if it meant delaying closure for nearly two years.
I was absolutely floored by the talent and consideration shown by everyone involved. Besides the dozens of presenters, the vast majority of our 200 person class showed up - a feat normally only managed for mandatory exams - on a Friday afternoon no less. At the end of the ceremony we adjourned outside to plant a small tree. It's funny that we hadn't noticed until this week that all the currently pink-blooming trees in front of our medical education building are actually tributes from previous years.
The most rewarding part of the day for me was talking with some of the family members after the ceremony. I was surprised at how focused their questions were for us. No one tried to keep a distance and talk about our experiences generally; they wanted to know if we remembered working on their husband/wife/mother/father. I feel like it was important to them, even though we all saw the cadavers equally at the time, that their specific loved one made an impact on our education - that their final gift had really made a difference to each of us personally.
I was selected as the final individual speaker of the day, a rather nerve-wracking honor made far more daunting when the musical tribute before me was absolutely phenomenal. Below are my remarks, including an ad-libbed opener to say what everyone was thinking:
I feel sorry for the guy that has to follow them...
I'd like to start by sharing that I love stories. Romantic or dark, dramatic or adventurous, comedic or tragic - it doesn't matter. So long as there are characters being tested by challenges, I can't get enough. I think this was part of the draw for me to practice medicine, because there is no better field for stories. And we get them all: lifelong epics, sudden disasters, miracles, tragedies. Every patient has a story and it is our job to unravel it. One of the first things we learn in medical school is how to take a history - how to get the patient to tell you their story. But like a bad anthropologist, we try to help the people we study - to change how their stories will end.
As is often quipped when you enter medical school, your first patient is already dead. But there is more to this saying than wit and morbid humor. These cadavers are not just an educational tool, a collection of organs and tissues, a body; these are people - people who have lived long, rich interesting lives - lives that have left their mark on their bodies. So even though the deceased could no longer tell us their stories directly, my classmates and I had the privilege of spending several months unravelling each story as told by the very bodies in which they experienced them.
I'd like to remind you that the vast majority of us had never seen a dead body before our first anatomy session at this school. That first incision was very hard, at least for me. My parents can be proud that they raised a child who, if nothing else, is uncomfortable cutting people with knives. At first to push through my discomfort, I think I objectified the person on my dissection table. She was an "it," not a "she" for the first couple weeks. I had enough on my mind trying to stay afloat through the deluge of information poured on us in those first days of medical school without trying to riddle out the metaphysics of death and identity.
Though it didn't happen all at once, my perspective did eventually change. Anatomical curiosities became possible symptoms. "These bones seem brittle" turned into "I wonder if she had osteoporosis?" Or "I wonder when he had that pacemaker put in?" "Do you think this fibroid tumor caused her any pain?" "I bet his heart anomaly gave every one of his doctors a scare! Maybe he had fun watching them freak out listening through a stethoscope before letting them know that they should be hearing a murmur." I think the ones that really got me were the tattoos and finger nail polish. These were some of the only clues to the personalities of our patients. By the end of gross anatomy, we wanted to know more about these people - not medically, not because we wanted to fix them, but because we had spent time with them and had glimpsed some of their story.
If I could thank our donors, who we honor today, I would thank them not just for helping future doctors unravel the tangled paths of the portal triad or brachial plexus, nor for giving hopeful surgeons practice with a scalpel. I would thank them for being our first patients, for teaching our first lessons in humanistic medicine, and for each of them sharing some of their life with us even after it had ended.
TIL: Trophic factors act like a dead man's switch to neurons. A dead man's switch is a common trope in action movies where the bad guy rigs an explosive to detonate, not when they press the button, but when they release it. So as long as the button is held (and the bad guy is alive) the bomb won't go off.
Neurons normally receive constant input from chemicals called trophic factors. These factors do many things but one important role is to keep the cell from producing suicidal proteins. If you cut off the flow of trophic factors, by for instance severing the nerve's axon, the cell is no longer prevented from imploding, and often does just that.
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