what I saw from where I stood


(This post might contain descriptions that are disturbing to a non-medical reader. I can’t really judge their effect, which is sort of the point. Caveat lector.)

In my five years doing curriculum work at a large state medical school, I saw unimaginable things which somehow became quotidian, part of the fabric of the day. Their strangeness only pops again in memory, looking back there from here. I’ve been hit by these memories a few times in the last month, probably because I am teaching the “Narrative in the Caring Professions” course again this semester, which takes many of its texts from medicine and medical education (especially Christine Montross’s excellent meditation on the role of gross anatomy in physician formation).

My office was in one of the older buildings. The med campus is a Habitrail of structures, built in the fits and starts of annual budgets and bond referendums and patched together after the fact by improbable tunnels and covered bridges. My building stood almost at the center; part of its oldest construction, a three-sided “C” of a building hidden behind the new Health Science Library wedged into the courtyard between its legs.

A surgeon colleague was also an historian, and she turned me on to a terrific history of the place, from which I learned that my office was directly beneath the original animal lab. Dogs used for research were exercised on the roof above my head.

There was a kerfuffle during my time there: the human anatomy lab was to be moved to its historic location at the end of our hall while its more modern and antiseptic home was closed for a few years of refurbishing. Suddenly, curriculum committee meetings were consumed with the practical questions resulting from that change: where will the students change out of their street clothes into the coats and cover-ups needed for the grisly business of dissection? Is the refrigerator in the hall by the entrance large enough – and reliable enough – to manage the storage of tissue samples that will be required? The staff in my office were concerned that the smell of formaldehyde would permeate everything, how the floor’s bathroom sinks would be left when they were used twice weekly by med students scrubbing up after being elbow-deep in cadaveric chest cavities. This is where we rinse our lunch Tupperware, after all. Oh – and where would they put their backpacks?

Maybe the most disturbing thing I saw, though, wasn’t gory or smelly in the least. It was the curriculum of the course that met right across the hall from me, which on some days would make study of several dozen lunch tray-sized Plexiglass slides. Each slide encompassed, I was told, a micro-thin slice of a human cadaver, on the transverse axis, like the way your wear your belt. I was told this was a sample set prepared and acquired at great expense – the preserving and cutting and mounting of such samples required very sharp saws, very precise measurements – and that the entire set, stacked one on top of the other, would yield a visible man perfectly sliced for inspection. I awoke this morning with a dream remnant of such a slide (thus the writing): a torso sample, I think, looking for all the world like a porterhouse steak when perceived straight on, organs and muscles and bone and fat offering topographies unrecognizable as human unless you knew what you were seeing.

This was all disturbing and shocking to me. Like my sink-concerned colleagues, I was an educator, not a physician. I had not been through the dissection ritual myself in my training, and was therefore not inured to the involuntary physical and emotion reactions to the presence of so much death: not trained do do things that, in another context, would be considered pathological. It really messed with me for a while.

I became worried about what I might bump into in the elevators coming in and out of the office, what gurney, what dolly, carrying what unimaginable horror. Any unexpected smell startled me during the semester lab was in session, and I made a wide berth around the corner of the building where it was located whenever I needed to go somewhere. I remember working to ape the tone of mild annoyance that my physician friends brought to the thing, as if the mudroom were locked and everyone had to leave their coats and boots in the hall. Inconvenient, but no more. In hindsight I see I was having a reaction to trauma, albeit a mild one, but at the same time I spent lots of energy on managing it, getting on with the day. Typing scope and sequence charts while pretending I was just in an office, nothing going on down the hall but more typing.

So why blog this horrorshow? I am not sure. Thinkers about the role of narrative in medicine note that there can a confessional nature to it – a desire among those who do and witness horrible things to tell their stories. Maybe for the prurient zing of it, maybe for absolution, maybe just to “process it” and make the unmanageable no-time of memory into reality by rendering it in the time and place of story. Probably all true here.

The main thing it has me thinking about is what we lose in the process of learning to do what we must for someone else’s gain. I am coming to see that the process of preparing to be of most use as a caring professional inevitably requires the putting away of – or at least changing of – some parts of who we were before beginning the transformation. To become allopathic physicians, regular humans must put off their native abhorrence of human gore, must learn somehow to objectify the structures of a body in every way identical to their own so that they may better regard it analytically, critically, diagnostically. And perhaps manipulate it in ways unimaginable to the layperson: rebreak an arm, re-open an infected wound. We give ourselves up to inhumanity, the better to practice humaneness, goes the logic.

It’s a logic that permeates K-12 education too. We must learn as teachers to detach from our assumptions about what what we are seeing in our students’ learning difficulties and be able to break our perceptions down into verifiable observations (trouble on reading comprehension quizzes, say), which we might account for through any number of hypothesized causes (attention issues? receptive language processing? dysgraphia? memory?) the better to choose interventions and accommodations. In education, we hope that dispassionate analysis of the outcomes of what we do leads to the sophistication of our hypothesis, and therefore more accurate selection of differentiation strategies. Put another way: we have to dehumanize the kid to see how she is really doing, unobscured by how she reminds us of our niece and therefore we are kind of sweet on her, because our sweetness will get in the way of what we have to do.

Even the specialized language of our tribe serves sometimes to distance and scientize. See how easily I slipped into it a few lines back? Shop talk like that is protective of the people who use it. The precision of technical language is of course enormously helpful, but we rarely acknowledge how we sometimes brandish it to obscure our own uncertainty about the causes of what we are seeing, murmuring big words to convince ourselves that we are competent to meet the challenge because we have done the reading. We hide behind our big words from the core truth of how little we can really know about what someone needs to be able to learn. We hope the big words will conjure certainty and precision and success for our efforts to support what, at the end of reckoning, remains the irreducibly singular and unknowable experience of learning for any single person.

Are we in education ever capable of horror toward the effects of our dispassionate gaze? We should be, I think – especially as we persist in the fantasy that by slicing the outcomes of our work thinner we’ll somehow be able to see more. Data-driven “best practices” and airtight cause-and-effect reasonings for instructional decisions blind as frequently as they reveal. Data and logic used compassionately, subjectively, in institutions that allow time and space and support for individual teacher attention to the needs of individual students: that’s the ideal combination, what we really need. We must subordinate the empirical finding (and subsequent indication for “best practice”) to the ultimate judgment of a well-trained, well-supported, well-respected teacher.

We’d expect no less for our physicians, or other caring professionals: we acknowledge they hold life and death, happiness and suffering, in their hands, and give them what they need to reckon it. But we’re increasingly willing to see our teachers as mere end-point delivery agents of products we force into their hands, and demand measurements of their effectiveness that mock the complexity of their task. This disparity of professional regard harms the professional, of course, but the damage to a generation resulting from this misguided approach to what teachers do is yet be calculated.

So let’s acknowledge the horrors that can accompany dispassion, and make space to hear the stories of what learning really looks like. Then we’ll use our energy best and meet the needs of our students; we’ll sustain our own practice with authentic connection, not the estrangement borne of trauma.

I stole my title from Marisa Silver’s terrific short story about trauma, which I originally discovered in the Maine Humanities Council’s excellent anthology Imagine What It’s Like. Image from somewhere online – sorry, I lost the attribution.

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