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Mutual Understanding

A Reflection on Gross Anatomy

Bolen, Erin E.

doi: 10.1097/ACM.0000000000002774
Teaching and Learning Moments

E.E. Bolen is a third-year medical student, Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale, Arizona; email:, An Academic Medicine Podcast episode featuring this article is available wherever you get your podcasts.

An Academic Medicine Podcast episode featuring this article is available wherever you get your podcasts.

Every day as I open the mirrored, clamshell lid of our anatomy table, I wonder what my donor would say.

Would he speak with the voice of the grandfather I never knew, hoarse with twinges of overuse and cigarette smoke? Or would his words be smooth and quiet? Would he have the brusqueness that can come with age? Or would he be more gentle, more patient?

Being born during the horrors of the First World War and living through the Great Depression would mold a man who suffered no fools. This realization is no comfort, for I am nothing but a fool right now. Despite my respect for him, my hands are inexperienced, my mental map clouded and incomplete.

Would he be understanding? The ideal of learning is not reality. I am respectful when my cuts are clean and smooth, when I isolate an important artery, when my fingers touch something that will help me help others.

What would he say when I slip? Would he snap at me or gently push me to improve, laughing off my nervous lapses? Would he sigh, nod, and say this is what the gift of his body is for, to try and to fail and to struggle and to eventually learn?

In an odd way, I know him better than anyone, down to the variants that explain what doctors only guessed at. In some respects, I may know him better than he knew himself: Did he know he could have felt his pulse in his palm, that among 50 people he was the only one carrying a remnant of his time in the womb?

Yet I can never know him in the ways that matter most. I examine his lungs but will never know what air flowed through them, touch his vocal cords but not know the words they formed. I expose the inner mechanics of his fingers but never understand what they touched with tenderness. I see his heart but have no idea what made it beat faster.

I know his body, but I will never know his self.

I desperately want to. I spend many nights scouring obituaries, hoping for a glimpse of the man he was. Perhaps that will be my absolution, to discover he was a teacher or a man of science, someone who gained meaning by giving to others. Perhaps then I will stop dreading the moments my mind slips into clinical logic, ignoring the man he once was.

The only way for me to move forward is using that reduction, ignoring the calluses that are his life’s work, thinking of him in discrete pieces and not as a greater whole. This is a necessary defense, a strategy that will serve me when the stakes are highest, so I will not be paralyzed by the weight of a life in the balance, so I can act with the removed calm necessary to make good decisions.

I am not yet practiced in this reduction. Every time I look at him, I see only who he was, not how what I do will help others.

To dissect is an inversion of what a doctor is. Utterly necessary and utterly backward. The art of healing from the art of breaking down.

Despite my searching, I never find his obituary. At the end of each day, as I close the anatomy table’s lid, I am left with this thought: We are the last people to hold his hands. It is an intimate and ultimate invasion. It is a privilege and a gift.

I hope he would understand.

© 2019 by the Association of American Medical Colleges