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Teaching and Learning Moments

Meeting at the Table

Lane, Megan

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doi: 10.1097/ACM.0000000000001145
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The anatomy lab on the reproductive system was an intimate and vulnerable tightrope walk between knowledge and respect. My lab group had successfully navigated this balancing act when another classmate approached us and asked if she could feel inside my donor’s vagina to palpate the ischial spine. This activity was not required by our lab manual, but its importance for identifying a pudendal nerve block had been discussed earlier in class. Although her request was for an educational pursuit, I felt a strange, visceral aversion to this unguided exploration. The bodily metaphors of power, life, and pain that I had cultivated through a background in gender studies made this a difficult request. The classmate and I began to argue. She asked, “Is this just an ethical issue for you?”

Flustered, I nodded and rhetorically blurted, “Would she want this to be done to her?”

The rest of my group stood indifferent. My classmate reached inside my donor, and after palpating the ischial spine, she waved over others to do the same. I could not watch, so I excused myself from the table.

I would dissect this moment, the conversation, and my reaction for weeks. Throughout the course, I had held my donor’s heart in my hands and ultimately peered into her life from the inside out, yet this lab upset me the most. The moment would swish around in my head, and pieces would wash up for me to pick through. Perhaps my reaction stemmed from having taken classes that theorize corporeal power dynamics or the simple fact that I could place myself on the table. I threw these pieces back to be recovered again or lost to a sea of microbiology. Then, a shred surfaced that I would keep: “Would she want this to be done to her?”

It was the first time I had acknowledged my donor’s ability to choose or, rather, her ability to make choices in the past. She had chosen to give herself to me, and I wondered if she would want her ischial spine palpated or her heart held in my hands. I am not sure if I will ever stop wondering who she was and what her decisions would have been.

The ischial spine is not a landmark for a pudendal nerve block for me; rather, it is a reminder of the values of autonomy and patient connection. In considering my donor’s past autonomy, she became a patient rather than an inanimate model for Netter’s. This acknowledgment of her autonomy and personhood—or perhaps the realization that I had lacked this recognition for the majority of the course—was the piece of the encounter that left a lasting impression on me. The reproductive lab clarified the value I place on autonomy, which I hope to recall when difficult decisions need to be made with patients and family members. Further, my clinical detachment before this lab horrified me, and I will remember my donor when faced with draining times in my training and career.

As medical students, we train to stand between life and death. One of our first steps toward this position is to intimately meet the foe from whom we protect our patients and the friend toward whom we respectfully navigate our patients. We first meet at the table, and bring with us our own experiences. Some students are acutely aware of the death of their donor, while others choose to avert their thoughts from this fact. However, I believe that most students leave the table with more than just knowledge of the brachial plexus. Perhaps through structured reflection, we can consider our unique first reactions to death in the clinical setting and its effects on our future patient care. My own anatomy experience instilled in me the importance of autonomy, but the lessons that other medical students learn vary. Through reflection, we all could take more than anatomical structure from the lab table to the bedside.

Acknowledgments: The author would like to deeply thank Dr. Andrew Barnosky for encouraging her to write this reflection and for graciously reviewing it before publication.

Megan Lane
M. Lane is a second-year medical student, University of Michigan Medical School, Ann Arbor, Michigan; e-mail: [email protected]

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