A Life in Medicine

by Robert Coles

  sealed in shiny membranes, bound

  within muscular layers, suspended

  by the round ligaments, until expelled,

  a piece of earth’s strange biology.

  You remember as a child finding places

  which no one would say aloud,

  their functions or their pleasures.

  These things with weight and texture

  could be felt by your palpating fingers,

  their details encompassed by the eye.

  You believe the knowledge

  and its recitation can almost

  hold off death. When your tongue pronounces:

  intertrochanteric fossa, greater and

  lesser omentum, orbicularis oculi,

  splanchnic bed, pubic symphysis,

  hallucis longus, ciliate ganglion,

  you think this lore will keep

  the body warm and whole,

  so sensation won’t dissolve the walls.

  Like a child says prayers in the dark

  in a language she doesn’t know,

  or an infant in the crib rubs

  her mouth, tastes her fingers,

  for the soothing friction of flesh,

  and to know that hand and lips are there,

  or thrashes to know what arms contain her,

  you name the parts to know the edges hold,

  will keep inside the disparate forces

  that push in their own directions,

  threaten to burst the boundaries,

  flood the surface, annihilate you.

  VIII

  As you worked on the thigh, bisected

  the long strap of the sartorius, admired

  the pinnate shape of the rectus femoris,

  separated the pectineus, adductor longus,

  gracilis, followed the great saphenous vein

  into the pocket of the femoral canal

  in its row of nerve, artery, vein and ligament,

  someone walked in carrying a radio,

  and you heard them announce the fall

  of Saigon, the end of the war, and then

  went back to removing pads of dense

  yellow fat to carve out muscles,

  trace them from origin to insertion,

  so they look like sculpture

  more than the dissection of death.

  You return to your small quiet war

  where you’re willing to pay the blood price

  to master the body, its frailties,

  to prove yourself armored, able,

  untouched by scenes of carnage.

  They were like the images left

  from the summer’s job, where you prepped

  dogs for the heart surgeons to practice

  transplant techniques. That meant

  walk to the 17th floor to fetch

  a lab dog, wild and unused to humans,

  lead it down to the concrete-floored room,

  bind its muzzle with a slipknot,

  shave the forepaw, inject the nembutal IV,

  quickly intubate, then tie the heavy thing,

  spread-eagled, to the metal table,

  do cut downs for arterial lines

  in the soft folds of the groin,

  then with the cautery, open the skin,

  a smell of burnt fur and fried fat,

  then take the bone saw to crack the sternum,

  wedge it apart with the retractors’

  metal jaws, cover the rib ends with paraffin

  to keep the field dry, slice open

  the pericardium, tie it like a sling,

  cradling the still beating red heart,

  wired now to monitors, then mop up the blood,

  stand aside to play scrub nurse

  and watch the real surgeons begin.

  IX

  Gauze towels swathe the head,

  resembling some bedouin’s

  or mummy’s, and all of you

  choose to keep the covers on

  after that one first look

  at this most human of parts

  with its soft bony planes,

  places you know have been stroked,

  kissed, the flare of nostrils,

  the frail curve of eyelid,

  the glimpse of pink tongue.

  Your group stands and looks, uncertain

  in their own bodies, so you volunteer

  and make the tentative first cuts

  across the scalp, then finding it tough

  and thick as grapefruit rind,

  cut more deeply, down to the fibrous layers.

  You quarter it, slide the blade’s

  handle end in to separate the fascia

  attachments, making a velcro-like sound.

  You bare the rounded bones, peel

  the edges of scalp down past the eyebrows,

  with relief, you cover the eyes,

  and wait for the diener to come

  with his bone saw, which in its noisy

  harmlessness stops at flesh

  and only cuts denser stuff.

  You watch him prop the head

  to saw the horizontal circle,

  making a smell of burned bone,

  then take his chisel, whack it

  for the final pop, like the sound

  of a coconut cracked open,

  and on this last hinge, lift

  the shallow ivory bowl to expose

  the familiar convolutions

  of grey matter that your brain

  will begin to examine.

  X

  Valhalla of cadavers, where

  hospital-slain heroes will themselves

  into your inexperienced hands, here

  you learn the labels for all

  the structures of your mute

  first patient. He didn’t quicken

  under your omnipotent touch.

  He did not wake, speak or

  rise from the dead. Instead,

  his useful death fed you. His meat,

  preserved above ground, formed a feast,

  served on a silver table. Just as

  your father filled you with knowledge,

  to make you like him, not her,

  the body’s names formed a knife edge

  that cleaved you two. He lifted

  you out of her confining lap,

  out of the glacier where you and she

  were frozen, where the skin surfaces

  stuck like a tongue to iced metal.

  He ripped you loose, left you still feeling

  the red rawness of your attachment.

  Then he gave you words to seal the surface,

  to heal you, make you whole.

  At night you feel disloyal

  as you nestle your bony head

  on the bowed twigs of someone’s ribs,

  listen to the regular clicks

  as his heart’s valvular leaflets

  open and close. You consider

  the cusps’ clock-like rhythm,

  remember their texture, these

  small invisible pocketed flaps.

  You start naming the shapes

  that lie under your hand, within

  this mortal body you’ve clung to

  after leaving the others, after

  moving away from the too small

  nest of the father’s chest, of

  the mother’s arms, having

  with knives, delivered yourself.

  XI

  So how do they dispose of the bodies,

  you asked, rinsing scraps off your hands,

  down the drain of the stainless-steel sink,

  where you’d washed the sludge out

  of the large bowel so you could examine

  haustral markings and the cecal valve.

  They said all the parts

  are saved for burial or cremation

  and you wondered how they know

  who’s who, if all these people

  commingle in death, fi
ll

  each other’s graves. You imagine

  the burning bodies looking

  like those from the dog lab

  after you dumped them into

  the hospital’s main incinerator—

  the sudden brushfire of fur

  and skin, the flames folding

  into the dark evacuated cavities

  to be extinguished there

  or at high heat eat through

  the smooth-surfaced walls,

  leaving ignited patches of bone.

  You want to utter some blessing

  when you pull up the sheet the last time,

  over his familiar body. You wonder

  if you’ll think of him, your model

  of death, when you fold mottled hands

  across your chest as it ceases to rise

  and fall, as you exhale from the bottom

  of your lungs and the air grows still

  in the small caverns of your nostrils,

  as heartbeats dissolve into fibrillation,

  muscle fibers lock, all sphincters

  give way and you drop to room temperature,

  your dilated eyes gazing at nothing.

  XII

  Having fed like a worm on the bones of the dead

  or like a bird, on the body’s worms,

  you grow large and leave home

  prepared for your adult life

  of minding the sick, performing

  technical procedures on the dying.

  You know where you are

  when, after your young patient dies,

  you go to the morgue, see them place

  her on the elevated metal table,

  hear the dozens of aluminum-tipped ends

  of her cornrowed braids clatter

  as they fall away limply

  from her blue-lipped face. You watch

  her resilient skin give way

  under the bright blade as they open

  the large flaps of her body’s walls,

  sever the great vessels, lift out

  her heart and lungs in one piece,

  hung from the cartilage handle

  of her trachea. You recite the branches

  as they trace her pulmonary arteries

  searching for the clot that killed her.

  On the hospital wards, there are moments

  that remind you of the lab, when you tell

  the old man to turn his head, so you can

  insert the needle in his jugular, enter beside

  the belly of the sternocleidomastoid.

  You know how it wraps its tendon

  along the clavicle, feel the vein’s

  sheath give, watch the paper drape

  over his breathing face lift for a second,

  then you forget again that this meat

  you dig in is warm and pulsing,

  as you aim your precise hand

  at the visible landmarks of the unseen world

  whose map now lies in your mind.

  Anton Chekhov

  ANYUTA

  Stepan Klochkov, a medical student in his third year, struggles hard to understand the structure of the ribs and the lungs. In the process of such intense study, he completely overlooks the human predicament of the woman standing before him whose ribs he studies. This short, ironic piece from 1886 is by one of the world’s master storytellers.

  ANTON CHEKHOV (1860–1909), physician, playwright, and short-story writer, is considered one of Russia’s greatest writers. A number of his stories and plays feature doctors, in all their greatness and infamy.

  In the cheapest room of a big block of furnished apartments, Stepan Klochkov, a medical student in his third year, was walking to and fro, zealously cramming anatomy. His mouth was dry and his forehead perspiring from the unceasing effort to learn it by heart.

  In the window, covered by patterns of frost, sat on a stool the girl who shared his room—Anyuta, a thin little brunette of five and twenty, very pale, with mild gray eyes. Sitting with bent back she was busy embroidering with red thread the collar of a man’s shirt. She was working against time.... The clock in the passage struck two drowsily, yet the little room had not been put to rights for the morning. Crumpled bedclothes, pillows thrown about, books, clothes, a big filthy stop-pail filled with soapsuds in which cigarette ends were swimming, and the litter on the floor—all seemed as though purposely jumbled together in one confusion....

  “The right lung consists of three parts . . . ,” Klochkov repeated. “Boundaries! Upper part on anterior wall of thorax reaches the fourth or fifth rib, on the lateral surface, the fourth rib . . . behind to the spina scapulæ . . .”

  Klochkov raised his eyes to the ceiling, striving to visualize what he had just read. Unable to form a clear picture of it, he began feeling his upper ribs through his waistcoat.

  “These ribs are like the keys of a piano,” he said. “One must familiarize oneself with them somehow, if one is not to get muddled over them. One must study them in the skeleton and the living body.... I say, Anyuta, let me pick them out.”

  Anyuta put down her sewing, took off her blouse, and straightened herself up. Klochkov sat down facing her, frowned, and began counting her ribs.

  “H’m! . . . One can’t feel the first rib; it’s behind the shoulder blade.... This must be the second rib. . . . Yes . . . this is the third . . . this is the fourth. H’m! . . . yes. . . . Why are you wriggling?”

  “Your fingers are cold!”

  “Come, come . . . it won’t kill you. Don’t twist about. That must be the third rib, then . . . this is the fourth.... You look such a skinny thing, and yet one can hardly feel your ribs. That’s the second . . . that’s the third.... Oh, this is muddling, and one can’t see it clearly.... I must draw it.... Where’s my crayon?”

  Klochkov took his crayon and drew on Anyuta’s chest several parallel lines corresponding with the ribs.

  “First-rate. That’s all straightforward.... Well, now I can sound you. Stand up!”

  Anyuta stood up and raised her chin. Klochkov began sounding her, and was so absorbed in this occupation that he did not notice how Anyuta’s lips, nose, and fingers turned blue with cold. Anyuta shivered, and was afraid the student, noticing it, would stop drawing and sounding her, and then, perhaps, might fail in his exam.

  “Now it’s all clear,” said Klochkov when he had finished. “You sit like that and don’t rub off the crayon, and meanwhile I’ll learn up a little more.”

  And the student again began walking to and fro, repeating to himself. Anyuta, with black stripes across her chest, looking as though she had been tattooed, sat thinking, huddled up and shivering with cold. She said very little as a rule; she was always silent, thinking and thinking....

  In the six or seven years of her wanderings from one furnished room to another, she had known five students like Klochkov. Now they had all finished their studies, had gone out into the world, and, of course, like respectable people, had long ago forgotten her. One of them was living in Paris, two were doctors, the fourth was an artist, and the fifth was said to be already a professor. Klochkov was the sixth.... Soon he, too, would finish his studies and go out into the world. There was a fine future before him, no doubt, and Klochkov probably would become a great man, but the present was anything but bright; Klochkov had no tobacco and no tea, and there were only four lumps of sugar left. She must make haste and finish her embroidery, take it to the woman who had ordered it, and with the quarter ruble she would get for it, buy tea and tobacco.

  “Can I come in?” asked a voice at the door.

  Anyuta quickly threw a woollen shawl over her shoulders. Fetbov the artist, walked in.

  “I have come to ask you a favor,” he began, addressing Klochkov and glaring like a wild beast from under the long locks that hung over his brow. “Do me a favor; lend me your young lady just for a couple of hours! I’m painting a picture, you see, and I can’t get on without a model.”

  “Oh, with
pleasure,” Klochkov agreed. “Go along, Anyuta.”

  “The things I’ve had to put up with there,” Anyuta murmured softly.

  “Rubbish! The man’s asking you for the sake of art, and not for any sort of nonsense. Why not help him if you can?”

  Anyuta began dressing.

  “And what are you painting?” asked Klochkov.

  “Psyche; it’s a fine subject. But it won’t go, somehow. I have to keep painting from different models. Yesterday I was painting one with blue legs. ‘Why are your legs blue?’ I asked her. ‘It’s my stockings stain them,’ she said. And you’re still cramming! Lucky fellow! You have patience.”

  “Medicine’s a job one can’t get on with without grinding.”

  “H’m! . . . Excuse me, Klochkov, but you do live like a pig! It’s awful the way you live!”

  “How do you mean! I can’t help it.... I only get twelve rubles a month from my father, and it’s hard to live decently on that.”

  “Yes . . . yes . . . ,” said the artist, frowning with an air of disgust; “but, still, you might live better.... An educated man is in duty bound to have taste, isn’t he? And goodness knows what it’s like here! The bed not made, the slops, the dirt . . . yesterday’s porridge in the plates.... Tfoo!”

  “That’s true,” said the student in confusion, “but Anyuta has had no time today to tidy up; she’s been busy all the while.”

  When Anyuta and the artist had gone out Klochkov lay down on the sofa and began learning, lying down; then he accidentally dropped asleep, and waking up an hour later, propped his head on his fists and sank into gloomy reflection. He recalled the artist’s words that an educated man was in duty bound to have taste, and his surroundings actually struck him now as loathsome and revolting. He saw, as it were in his mind’s eye, his own future, when he would see his patients in his consulting room, drink tea in a large dining room in the company of his wife, a real lady. And now that slop-pail in which the cigarette ends were swimming looked incredibly disgusting. Anyuta, too, rose before his imagination—a plain, slovenly, pitiful figure . . . and he made up his mind to part with her at once, at all costs.

  When, in coming back from the artist’s, she took off her coat, he got up and said to her seriously:

  “Look here, my good girl . . . sit down and listen. We must part! The fact is, I don’t want to live with you any longer.”

  Anyuta had come back from the artist’s worn out and exhausted. Standing so long as a model had made her face look thin and sunken, and her chin sharper than ever. She said nothing in answer to the student’s words, only her lips began to tremble.