Academic Medicine:
Commentary

Commentary

Kirklin, Deborah BM, BCh, MA, MRCGP

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Dr. Kirklin is a senior lecturer in medical humanities and director, Centre for Medical Humanities, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London.

Reflecting on youthful experiences is a common and perhaps a natural thing to do. By revisiting memories of important past events we create opportunities to make sense of and even to rewrite the past. The process of reflection can be cathartic and informative, sometimes offering unanticipated insights.

In the powerful and evocative poem, “Carnal Knowledge,” poet-physician Dannie Abse, writing more than forty years after the events described, offers a first-hand account of the impact of human dissection on both a young student and his older self. It is notable that Abse addresses his younger self in the second person, appearing to not fully identify with the medical student whose story he retells.

The older man struggles to remember the human face of the person he encountered in the dissecting room all those years before. Taken literally, Abse's failure to recall the details of the cadavers face is perhaps unsurprising given the length of time that has elapsed. There is a sense however that he is struggling to recall something far more than physical details, something he was too emotionally detached to see in the first place.

Despite bombs and carnage all around, the young student, whom Abse observes with and for his readers, approaches the dissecting room focused not on the task ahead, but on those “elusive bits of Schubert.” This impressive act of detachment arguably marks the symbolic beginning of a professional life where clinical detachment will be considered essential to protect student, then doctor, from some of the “dis-ease” that encountering human suffering entails. But if the older selves of students and doctors attempt and fail to recall the faces of the human beings they have encountered in their professional lives, one wonders whether the price paid is too high.

As the older man looks back, addressing both his younger self and the corpse he dissected as a student, the language used in this poem is of violation and vandalism, with the title inviting comparison between dissection and sex. The term carnal knowledge emphasizes the physical rather than the emotional aspects of a sexual relationship, with each partner gaining access to and knowledge about the others body. Likewise, the relationship between student and cadaver that Abse paints is one based on physical rather than emotional needs. In this one-sided encounter the student becomes familiar with the intimate details of the cadaver, both inside and out, whilst the cadaver is passive, faceless, vandalized.

In sharp and rather disturbing contrast to the younger man, who found little that was human in the bloodless corpse before him, the older man sees what Jack Coulehan identifies as “Everyman” or all of humanity in the body he dissected. An alternative explanation for this aspect of the poem is that the older man sees the body as being in God's image, and hence nameless and faceless, and with the potential to half-blind those who look fully on its face. Unlike his younger self he is acutely aware of his own mortality, “with my hand, my living hand.” It seems likely that the traumatic experiences of his younger self, training in the midst of the London Blitz, have contributed to the vividness of his memories and his subsequent reinterpretation of his experiences. Although the young Abse seems to have managed to distance himself from the emotional impact of dissection, as evidenced by his postdissection cup of wartime coffee, this distancing was merely a temporary ruse. When however, in later life, he visits this youthful experience he is far from removed from the emotions that are attached to dissecting a human cadaver.

The older man no longer feels distanced from this embodiment of something divine, but feels “older by far and nearer.” He struggles to see the face of the body he dissected, looking for some deeper truth therein. Will he find it? Has he already found it in his life, both personal and professional? Would the younger man have recognized this deeper truth even if he had looked? I can't help feeling that he would have liked the chance to find out.

Deborah Kirklin, BM, BCh, MA, MRCGP

© 2005 Association of American Medical Colleges

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