Tom Cole: Humanizing the medical profession from the very first slice.
Tom Cole: Humanizing the medical profession from the very first slice.

Rough Cut

Jason Morrow's cadaver was a woman, around 80 years old, who died of lung cancer. Jason was surprised that the dissection began with her anterior chest wall. It seemed like a big place to start. It seemed… personal. He'd expected the anatomy class to go more slowly, to start somewhere less significant. With a toe, maybe.

Like all bodies, this cadaver told a story. Bedsores: a slow death. But also fingernail polish and lipstick: vanity that seems almost heroic. For Jason and his lab partners, thinking of her as a human being was eerie. They kept her face covered.

But still, over eight weeks, they came to know her in an oddly intimate way. Seeing her naked was only the beginning. They put their hands inside her body. They took her apart. Sometimes -- when the team sawed through her vertebrae, or cut the flesh between her vagina and anus -- sometimes Jason wondered about the woman: Had she known this would happen to her body? He felt guilty. He wanted to apologize.

Nobody told the students how to handle their emotions. Jason's team gave each other jokey nicknames: Chainsaw, Hacksaw, Jigsaw and Seesaw. One student e-mailed the class a poem she'd written about her cadaver. Others dreamed that the bodies lurched back to life, angry and bent on revenge.

Jason dreamed, too, but his dreams replayed the sensory details of dissection: the greasiness of the cadaver's fat, the toughness of her muscle. Similar details stick in his waking memory. Long after he's forgotten the Latinate names and locations of minor muscles, he'll remember the smell of the formalin from the tanks, the wetness and weight of the woman's body, the colors of her organs. Medical students never forget their cadavers.

"Necessary brutality," Tom Cole calls it: the clinical detachment that medical students learn in anatomy class. Surgeons must be able to cut human flesh. Clinicians must make cool, rational decisions. The trick, Cole says, is to balance that rigor with humanity, to remember that the patient is more than a problem to be addressed. And the way he sees it, a doctor's future relationship with his patients first takes shape in medical school, in anatomy lab. The cadaver is the first patient.

Cole teaches at the University of Texas Medical Branch in Galveston, but he's a historian, not a medical doctor. For almost 20 years, as a professor at UTMB's Institute for Medical Humanities, he's watched students like Jason harden into doctors. Cole's job, in a way, is to prevent them from becoming too hard. In conversation, he uses unscientific phrases like "the human spirit" and "spiritual growth." This year, as a visiting professor at the University of Houston, he's teaching religious studies, not history or premed.

The humanities, he tells his students, offer useful perspectives; a historian or poet can see things that a doctor might miss. Sometimes Cole uses an example from his own life. In 1984, in a class that introduced medical students to major psychiatric illness, Cole met Eldrewey Stearns, who exhibited a textbook case of manic depression. Police had found Stearns in a boozy stupor; a psychiatric resident in the class recalled seeing Stearns before, in the hospital's emergency clinic, after Stearns had tried to circumcise himself with a razor.

When Stearns claimed that he'd launched Texas's integration movement, the students detected a symptom: delusions of grandeur, an earmark of manic depression. But Cole, the historian, wondered whether there might be some truth to Stearns's claims. Cole discovered that many of them were true: Stearns had led the sit-ins at Houston's lunch counters. The book Cole eventually wrote -- No Color Is My Kind: The Life of Eldrewey Stearns and the Integration of Houston -- was fashioned into an hour-long, much-praised documentary, The Strange Demise of Jim Crow.

Cole had hoped the book project would somehow cure Eldrewey Stearns. It didn't; the man remained manic-depressive, grandiose and cranky. But in a way, the book and documentary helped Stearns reclaim his life. They documented his personal history, his very real achievements, his life. They showed that he was more than a collection of symptoms.

Cole, pleased, began looking for a new project.

Someday, when Bob Harvey is a cadaver, his body will tell its own story. "Various and sundry physical faults and failures," he says of his inventory: skin that bears the scars of barroom knife fights; lungs that once withstood three cartons of Pall Malls a week; a liver that endured years of boozing.

Bob no longer wrecks his body in such interesting ways. At 67, he looks fit and limits his vices to coffee and black humor. "I don't smoke anymore," he says. "Don't drink. Don't chase women. If I caught one, it'd only disappoint her and embarrass me."

A few years ago, Cole began offering a workshop called "Share Your Life" through UTMB's Office for Senior Services. Bob had recently retired and was separated from his second wife; he was, in short, at loose ends and mostly alone in the world. He signed up for Cole's workshop, and for the first time, he tried to tell the truth about himself.

Unlike Cole, Bob doesn't talk about "spiritual journeys." But in the workshop, he realized that he'd led a hell of a life. He'd been shipwrecked off California, shot at in Germany. He'd had two wives, lots of girlfriends, and even more careers: as a brakeman, a cook, a tugboat mechanic, a helicopter inspector. He'd worked on pipelines and on seismic boats; now, in semiretirement, he does freelance floral design, throws newspapers, and repairs vacuum cleaners for UTMB. Bob wrote poems about old girlfriends; he wrote about the smell of gardenias; he wrote about a failed attempt to kill a rat.

The writing group took on a life of its own, and continued meeting without Cole. Bob has become one of Cole's poster geezers, evidence of the workshop's success, proof that it's never too late to examine your life. A few months ago Cole asked him to pose for a brochure.

At the photo shoot, Cole told Bob that he was making a documentary about medical students and their cadavers. He imagined the film as a conversation between the living and the dead, between medical students and body donors. He'd already interviewed students; now he was looking for cadavers. Cole asked Bob: Have you ever thought about donating your body?

And so Bob, the jack-of-all-trades, added one more job title to his list: cadaver-to-be, speaker for the dead. For two days Cole and his crew -- Dave Thompson and Randy Twaddle of the production company ttweak -- filmed Bob as he puttered in his apartment, assembled corsages at a flower shop and repaired UTMB vacuum cleaners. Cole interviewed him at length and later gave him a copy of the rough footage, a kind of film biography. "Five hours of nothing but Bob Harvey talking about Bob Harvey," says Bob, shaking his head.

He doesn't fret about being a cadaver, even though he knows firsthand the kind of indignities his body will suffer. He was born in Galveston and grew up near UTMB. When he was 12, he and a 14-year-old neighbor girl would sneak into the third-floor anatomy lab. They'd lift the sheets and ogle the body parts ("You know which ones," he says). With tongs, they'd reach into the tanks and pull out human remains. "It didn't bother me," he says. "Never has. We were just curious."

Bob, an atheist and a mechanic, believes that his body is only a tool, a device that performs a particular function; he sees nothing spiritual or special about it. He likes the idea that a medical student might be able to use it after he's finished with it, but he doesn't worry whether his body will be treated with respect. "I'm through with it," he says. "I'm gone."

That attitude, of course, undermines the very premise of Cole's film. As the camera rolled, Cole didn't disagree with Bob directly. But his eyes flickered, and Bob, sure that he'd gotten under Cole's skin, thought, "Gotcha, sucker."

Cole says he'll probably edit out Bob's body-as-a-tool musings. But another example of his devilment will almost certainly survive. Cole had been interviewing Bob in the anatomy lab just before the class was to start. As students drifted in, Bob chatted with them: What did they think of these new on-line learning tools? Will the Digital Man ever replace a real cadaver? How long, he asked, do you work on these bodies?

"Eight weeks," a student told him.

"You must get to know them pretty well," said Bob.

"Very well," they said.

Bob savored the moment. Deadpan, he asked, "Does love ever bloom?"

One student blushed; the others didn't know what to say. The dirty joke wasn't at all the high-minded conversation between the living and the dead that Cole had imagined. But the moment was perfect: riveting, human and full of life. For once, the dead man got the last word, and the living stayed silent.


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