This photograph, captured by Christopher Photopoulos, received an Honourable Mention in the Visual Art division of the 2022 MIPS x Auricle Creative Writing and Visual Art Competition. Christopher says, “when we seemingly drown in our everyday life as we navigate this ocean of possibilities, sometimes all it takes is a walk on the beach to come up for air — to breathe is to reflect, to stay grounded, to change.” This piece featured in The Auricle‘s October-December Edition in 2022.

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Tides of Change

[Aerial drone footage. VIC, Australia. 22.06.22]

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This piece by Fathima Ijaza Irzan featured in the Visual Art division of the 2022 Auricle x MIPS Creative Writing and Visual Art Competition, receiving an Honourable Mention. This piece featured in The Auricle‘s October-December Edition in 2022.

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This piece by Laura Smith received an Honourable Mention in the Creative Writing division of the 2022 MIPS x Auricle Creative Writing and Visual Art Competition. Laura describes it as a “piece on uncharted waters as a medical student equipped only with the skills of two pre-clinical years.” This piece featured in The Auricle‘s October-December Edition in 2022.

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“Presented with bilateral pulmonary embolisms. CT scans came in this morning and showed stage 4 lung cancer. She’s probably got about 6 months to live. If she’s lucky.” 

 “A walking ad for Quitline.”

Laughter from the team of respiratory clinicians. 

“They should take her picture for the back of the box while she’s still alive.”

Medical students shadowed the doctors, lingering behind and doing their best not to get in the way. Struggling to find the situation humorous but not wanting to be impolite, Eloise halfheartedly attempted a smile.

Two years of textbooks and artificial clinical scenarios with paid actors hadn’t prepared them at all. Eloise thought of anatomy lessons, of the hours spent dissecting pungent corpses and appraising ‘specimens’- human body parts chopped up and laid out on tables.

Confronting was barely the right word to use after everything they’d seen in their first week in the hospital. 

When the ward rounds were over, one of the younger doctors approached the students and suggested they visit the patient in bed 32.

“Take a medical history. Just ask her why she’s in here and make sure to have a listen to her lungs. Let me know what you find.”

Pacing the hallway just outside bed 32, Eloise wondered whether it was facetious to pry, poke and prod at a woman who had limited time left on earth and was faced with the task of accepting her own mortality. Her ward buddy grew anxious with her, twisting his stethoscope and inspecting it closely, as if to find moral guidance within its diaphragm.

“Can I help either of you?”

Brash and unforgiving, the ward nurse peered down upon the two 3rd-year medical students, her overbearing presence immediately quashing their ethical doubts.

“We’ve been sent by the Resp team to have a chat with Mrs Greenwood, are we alright to head in?”

Clearly unimpressed by their hesitance, the nurse let out an exasperated noise and nodded her head in the direction of bed 32.

Flowers drooped in the corner of the room, their presence gaudy and somehow melancholic against the harsh white hospital walls. A tiny television screen hanging from the roof was tuned into a reality show that Eloise’s mother would have described as ‘American trash’. Mrs Greenwood’s attention barely shifted from the show as the students introduced themselves and obtained her consent for a medical interview and examination. 

Her bedside table was littered with empty food containers and medications, and a pile of books and magazines. Eloise’s attention was drawn to one particular title- ‘Turning a new leaf; how to embrace a healthy lifestyle!’. 

“If you don’t mind Mrs Greenwood, could we turn off your TV for a moment to ask you some questions?”

“It’s June, dear.” The patient gave Eloise a warm smile as she switched off the screen and indicated for the students to continue in their history taking.

“First of all, could you tell us why you’re in hospital at the moment?”

“Well I’m still asking myself that. I was fit as a fiddle a week ago when I started noticing a sharp pain in my chest.”

“And your husband called an ambulance, is that right?”

 “Yes, my Dad died of a heart attack, so of course that was the first thing I thought of. Lucky it wasn’t that! I had a couple of scans and apparently I’ve got clots in both my lungs.”

“And did they notice anything else on the scans?”

June didn’t notice the tremble in Eloise’s voice and the way her eyebrows rose and furrowed in strained sympathy. 

“Nope. I’m all good. I’m on tablets to thin out my blood and I’ll be back home tomorrow. My husband’s coming in later today and we’re having a meeting with the doctors to plan my discharge.”

Eloise’s teeth clamped down on her tongue, a metallic taste filling her mouth and drowning the tears she felt rising in the back of her throat. Her fate would be revealed later today, in what hospital staf referred to as a family meeting. Mr Greenwood would have already received a ‘warning shot’; a purposefully ominous phone call instructing him to come in to the hospital immediately to discuss his wife’s health. Maybe there’d be others too; siblings, children, even grandchildren. They would all suspect something was wrong. But June still had no idea.

June said the whole experience in hospital had caused her to have a ‘health enlightenment’. Though distressed initially, she had managed to conjure optimism by committing to lifestyle changes she thought were probably long overdue. 

“I’ll be quitting smoking, obviously. Don’t want anything else nasty turning up in my lungs. But I’m also taking the opportunity to start exercising more and eat lots of fruit and veggies.” 

Blurry photographs crudely cut out and blue-tacked to the wall were almost unbearable to look at when Eloise entered the room, but now she refused to avert her gaze. Anything to drown out the fleeting hope of a woman on her deathbed. She wasn’t here to read the chapters of a book she already knew the ending to.

In medical school, they’d been warned against medical paternalism; doctors being accused of playing God, of defying patient wishes, of intervening in the natural course of life. Right now, Eloise felt close to divine power as she forced back the words that would bring an end to June’s world. Neither of the students could bring themselves to touch her so they thanked her and took off without listening to her lungs. 

An elderly man, perhaps in his late 60s, wandered down the corridor with a bunch of mismatched flowers, roots still attached from where they were yanked out of the garden. Eloise thought she saw a glimmer at the base of his eyes as he turned and entered the room they’d just left.

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This gentle, subtle poem by Zoe Weimar, titled “Quieter Now” transports us to a moment of tranquility on a hospital ward. It received an Honourable Mention in Creative Writing Division of the 2022 MIPS x The Auricle Creative Writing and Visual Art Competition. Zoe describes it as “a poem/sonnet inspired by experiences placed on birth suite, and moments of beauty that occur there.” This piece featured in The Auricle‘s October-December Edition in 2022.

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It is much quieter now than before

The room had filled, filled, filled

And then drained. Closer night draws.

Though rustling blankets murmur amongst themselves, the air is still

Swaddled warm and wearing a striped hat

Something tiny and new sleeps

In her arms, as we marvel at

His newness, her strength. The teabag steeps

Of course, there’s beauty in first breath, first touch

Yet those less-remembered moments in-between; with kind words said

And hands held tight and laughter shared, hold such

Intangible softness. She shifts further up in bed

The sound of my steps punctuates the room’s quiet, as I bring her the hot mug of tea

To brew it is my privilege, however small or unskilled an act it might be

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“The Caretaker” by William Upjohn received an Honourable Mention in the Creative Writing division of the 2022 MIPS x The Auricle Creative Writing and Visual Art Competition. William says, ‘I wrote a short science fiction/horror story, set on a deep-space satellite in the distant future. It is titled “The Caretaker”.’ This piece featured in The Auricle‘s October-December Edition in 2022.

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Caretaker’s Log:

02/08/54,675 C.E  (Estimated Earth Date)

This is likely to be my final statement. I have not made many other entries to this log, a decision that I now regret. I am not sure who, if anyone, will read this. I seek only to explain what happened on my satellite, and to enlighten those who would otherwise not understand what lead me to undertake what I did. I do not seek forgiveness, because I know I have not done anything wrong. This is not a confession.

I am not sure how long until my satellite will be found, or by whom. In case this part of our history is forgotten by those who discover it, I shall provide a brief amount of context. In the year 54,345 C.E, our sun began expanding at a rate far, far greater rate than our scientists had anticipated. This gave us around 50 years to escape our planet and retreat to a safer distance, before life on earth became unviable. The decision was made to place as much of the population as possible into a hibernation-like stasis or “cryo-sleep”, and put them safely on millions of satellites in orbit, far away from the now malignant sun. Most, including mine, were placed in orbit at a distance similar to that of the former planet Pluto. The plan was for other, exploratory spacecraft to search deep space for a new planet with conditions favourable for colonisation. Once this new planet was found, the cryo-sleep satellites would be brought over and reawakened. 

Using almost light-speed travel, the estimated time for this mission was between 60 and 80 Earth years. This timeframe has come and went, without transmission or signal from any of the thousands of exploratory craft. It seems overwhelmingly likely that all missions have ended in failure.

My satellite is one of the smaller models placed into orbit. It initially housed 100 individuals in cryo-sleep. It is almost entirely run algorithmically by AI; however, the decision was made to include a single human overseer to ensure the smooth running of all the ship’s functions. This overseer, or “caretaker” as we came to be colloquially known before launch, could override any direction from the ship’s AI, to prevent computer glitches or malfunctions from jeopardising the survival of the satellites’ occupants. 

Being a healthy young male with a favourable genetic profile, I was chosen to be the caretaker of my vessel, a position I was honoured to accept. While the position was demanding, and the prospect of decades of isolation not very attractive, I was assured that personalised neurotropic medications would be administered to ensure my mental wellness was preserved. The fact that I was unlikely to secure a position on a satellite otherwise, and be left on the soon-to-be uninhabitable Earth also contributed greatly to my decision to accept.

The first few decades of orbit were largely unremarkable. I developed a routine of monitoring the sleeping passengers and certifying all vitals were in the desired range soon after waking. I then spent my time confirming our orbital path was optimal, supervising any maintenance activities, and generally ensuring that the satellites processes ran smoothly. In order to preserve power, communication with other satellites was completely ceased after the first year. As a result, I had no contact with other humans, only being able to communicate with the satellites’ AI. While this might have been emotionally detrimental to a normal person, the medications I took daily ensured that my mental state remained favourable.

 Though the 24 hour cycle of days was now arbitrary, I kept to a pattern of 8 hours sleep followed by 16 hours of waking, trying to avoid the cognitive disturbances found in disrupting the normal circadian rhythm. I ate three times per day, and bathed regularly. The temperature of the satellite’s internal spaces, where I lived and worked day-to-day, was kept to around 14 degrees Celsius. This low temperature was maintained in order to slow metabolic activity and decrease the rate of aging.  This meant I was permanently slightly cold – though this is a small price to pay for the supposed increase in longevity.

It wasn’t until my 35^th year in orbit that the first complication occurred. During my annual health scan by the satellite’s medical AI, a sizeable adenocarcinoma was found in the hilum of my right lung. This most likely due to exposure to radon, an inert gas that can leak from small nuclear reactors such as the one powering my satellite. While I was not yet experiencing symptoms, it was still a threat to my wellbeing, and I elected to have it surgically removed. The satellite had multiple automated surgical robots, capable of performing almost any surgical procedure at a standard far exceeding human surgeons. Multiple passengers in cryo-sleep had already had procedures performed on them by the machines. They were not even awakened from their stasis – part of the contract for being placed into cryo-sleep involved consent to any procedure the ship’s medical AI deemed necessary.

The operation was a success, at least initially. The tumour was resected completely – however, 4 years later, I developed more tumours, this time spread throughout both lungs. Breathing was becoming increasingly difficult, and I experienced haemoptysis on a daily basis. This presented a clear and present threat to my life, and subsequently to the functioning of my satellite, and to the lives of all those under my care. The only possible treatment was a lung transplant.

While my subsequent actions may appear unethical, it must be kept in mind that my death would certainly jeopardise the lives of all those on my satellite. I could not allow this to happen. It was a difficult decision to make, but ultimately, it is a decision that I stand behind. I took no pleasure in making this choice, and to this day I find the whole process distasteful. I detail my decision here not out of pride, but simply to allow future readers to understand what happened.

I elected to take the lungs of one of the passengers. It was a very grim choice to make, but I eventually settled on those of a 55-year-old man, whose name I will not mention out of respect for the dead. He was a healthy adult male who didn’t smoke, and the medical AI suggested that his organs made the most favourable match. This wasn’t truly necessary – the immunosuppressive medications I would take made virtually any donation viable, although matching did reduce the risk of complications. I cannot detail all the factors that went into my decision, but after 2 weeks of deliberation, accompanied by increasingly severe symptoms, I finally made the decision to go ahead with the procedure. I had to manually override the medical AI, but the surgery went off without issue. The donor was not brought out of cryostasis during the procedure. He did not suffer.

The new lungs were completely successful, and it was almost a full decade before I needed another organ donation. Perhaps due to my constant use of neurotrophic medications, my renal function had deteriorated to a dangerously low level. I required a transplant. Selecting a donor was far less ethically difficult this time, as transplanting a kidney would not result in the donor’s death. For the sake of brevity, I will not give the details of this donation, nor for any of the subsequent ones. Again the procedure went by without issue. The donor was in cryo-sleep for the entire surgery, and was successfully returned to her cryo-pod afterwards, without ever knowing such a procedure took place.

I will not give unnecessary detail about all the subsequent transplants. Initially, at least, I held out as long as possible without using any more organs. However, as the length of my mission extended longer and longer past the expected end point, the aging process resulted in the inevitable deterioration of my body. The successful running of the ship was paramount, and this success was dependent on my input. As such, any and all actions I undertook were necessary, and in my opinion ethically sound. While it appears increasingly likely that I will not have to explain my actions to any individual in my lifetime, I would like to emphasize that I stand by the decisions I made.

Over the almost 280 years that I have now been caretaker of this ship, I have had to extend my lifespan much, much further than would be natural. I have considered bringing a passenger out of cryo-sleep and training them to be a new caretaker, allowing me to finally give up my position, but this is not a viable alternative for many reasons. The most important one, in my opinion, is that the neurotropic medications, which allow me to function under enormous psychological strain, are personalised to my neurological profile. They would not be effective in any other individual. It seems overwhelmingly likely that another person in my situation, faced with the cold, claustrophobic, completely isolated conditions that I live in, would be made insane. I think of myself as something like a deep sea fish, one that inhabits unimaginable pressures without issue. Any normal organism, however, would be crushed.

In order to prolong my life, I have received new transplants of almost every viable organ in my body, as well as various tissues and vessels. I have been through 48 sets of lungs, 40 hearts, and 44 pancreases, as well as countless skin, marrow and vessel grafts, just to name a few. I am not wasteful – I do my best to maximise the number of organs I can use from every donor, and try my best to prolong the use of every organ that I receive. It is difficult, however; as my age increases, the amount of use I get from each transplant lessens. While my first new heart lasted me over 30 years, currently, a new heart will only last me four. This has meant that I am requiring new donations more and more frequently, a situation that is as regrettable as it is inevitable. It brings me great emotional pain to accept organs from those I am supposed to take care of, and were it not for my medications I likely would not be able to cope. These actions must be undertaken to fulfil my duty as caretaker.  

I have all but given up hope of rescue – I have not received any transmission, from another satellite or any other craft, since the silence descended all those years ago. I have considered the possibility that my equipment is faulty, and all the other ships have been rescued while I remain here alone, unable to receive the signal. These idle speculations serve no purpose but to heighten my distress, so I avoid them as much as I can. 

 I imagine that my story is not unique, and that every other living caretaker has had to make the difficult decision that I have. My supplies are dwindling: I have only 20 more untouched donors to use, and my needs are increasing with every year. I do not know what I will do when I have run out, when my satellite has no more passengers and I am left truly alone, orbiting a dying star. According to my ship’s navigational system, we have almost finished our first complete orbit around the sun. I only wish my satellite had windows, that would let me look outside and see the stars. It has been far, far too long.

That concludes all that I wish to say. This is not a confession.

<end of transcript>

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This fascinating piece, titled “Empty Celebration” and submitted by Lois Segund-Beloved, received third place in the 2022 MIPS x The Auricle Creative Writing and Visual Art Competition.

All winners can be seen in The Auricle’s July-September Edition.

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“Retro Funk” by Charlotte Raberger received second prize in the Visual Art division of the 2022 MIPS x The Auricle Creative Writing and Visual Art Competition.

Artist’s note: Encompassing metamorphosis, these sculptures repurpose old kitchen utensils to create something new and ‘funky’. The black and white painted pattern connects the figures, symbolising commonalities between humans despite so many differences, represented by the variety of body shapes and vibrant patterns.

All winners can be seen in The Auricle’s July-September Edition.

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A deserving winner, the piece featured below received first prize in the Visual Art division of the 2022 MIPS x The Auricle Creative Writing and Visual Art Competition. It is titled “Reflection”, created by Anna Noe.

Artist’s note: Reflection describes the simplest concepts of identity, the name you are given at birth, cultural heritage and own persona. The symbolism relative to my artistic ideas, the jasmine flowers, Arabic letters and culturally significant black stones are placed behind the portrait allowing them to ambiguously carry the essence of an identity rather than an outer persona, showcasing a glimpse beyond the veil.

All winners can be seen in The Auricle’s July-September Edition.

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The third placed entry in the 2022 MIPS x The Auricle Creative Writing and Visual Art Competition is a powerful poem by Tessa Quinlan, titled “Never Let Them Fall”. We’ll let you unravel the subtext that emerges through the clever writing and structure.

If you would like to see all winners in the competition, see The Auricle’s July-September Edition.

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The 2022 MIPS x The Auricle Creative Writing and Visual Art Competition featured some amazing work – here we are excited to share with you the piece that placed second in the Creative Writing division. Titled “I am Everyone” and written by Khue Le, it is a truly moving piece. If you would like to see all winners in the competition, see The Auricle’s July-September Edition.

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Good morning! My name is. I’m a medical student.

I’m the daughter of parents who called me downstairs to greet guests I didn’t know and reminded me to speak louder when I said my hellos, so to you, my care and respect comes freshly baked as a “good morning”. I am the girl whom my mum shows her love to through a plate of sliced apples and washed grapes when I’m studying, through a thermos of tea left out for a few minutes so it’s the right temperature to not burn my tongue and through the almost sickeningly sweet condensed milk with toast she makes when I’m sick. So I am careful to pull the curtains close when it’s time to examine you. I tuck in the covers after pressing your shins for pitting oedema. As I talk, I am righting the chair, pushing the glass of water closer to the table centre, moving your bag into an accessible spot. I don’t want you to trip.

I’m an immigrant kid who in Prep, drew lines and hats and moustaches on their letters in class because the alphabet was supposed to have accents. On Footy Day at school, I’m the kid who repeated the mysterious word, “Collingwood”, to anyone who asked what football team I barracked for and had a boy ask me why, if so, I was wearing purple, orange and pink stripes. There are more football teams, I said in embarrassment. So I take extra care to speak slowly and gesture wildly, opening and closing my palms to indicate a beating heart, when I know English is not your first language. In my head, I am running experiments on ways to best explain congestive heart failure to you.

I’m a university student who spent two fifths of their course at home, nostalgic for dreams of studying at libraries and practising auscultation on real people. I’m the blundering person on the team who stumbles on anatomy questions because the anatomy I studied had been colour coded with red arteries and blue veins. Being in a pandemic means loneliness has visited me. It also means I listen hard and carefully when you tell me your story and I try to know you as you were before you came here. The grandfather who spent more than half his life on a boat, the neighbour who walked her little dog to collect the mail, the engineer who built some of the protocols for the equipment I now see in hospitals.

Having a medical condition can be lonely. I didn’t want you to feel trapped in your existence as a patient.

And if you are resigned to the long waiting list and the medication expenses, if you endure pain by sheer will and hasten to get out of hospital so you can start working again to provide for your two daughters, I am reminded of my dad. My dad and his calloused hands. My dad whose working hours were dictated by the ending of the Sun’s rays. I am the older sister who had memorised chip packets in order of their monetary value so I could buy the cheapest one. I’m the 10 year old who grew up defining her financial status by the snacks she couldn’t afford. So I recognise, somewhat, your hesitancy to travel when petrol prices are high, your helplessness when the doctor says you need to attend more check-ups, the determination to overcome this by your resolute jaw and the quiet concentration as you face the window.

When I get home, I will think back to this moment and be angered by the ways spaces have been designed to keep you and countless others out. How, sometimes, it must feel like health is for everyone, except these spaces have told you that you are not everyone.

I am all the experiences leading up to this interaction. I am everyone I have encountered and so, I am the medical student who went into medicine with hopes of redesigning these spaces. Hoping that the next you I meet and all the yous after will access health more easily both in and out of hospital.

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We are delighted to share with you the first place entry for the 2022 MIPS x The Auricle Creative Writing and Visual Art Competition. The winner was Natalie Evans, with a piece titled “Stardust” in the Creative Writing Division. We hope you enjoy this fascinating read as much as we did. If you would like to see all winners in the competition, see The Auricle’s July-September Edition.

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Meditations on Medical Dissection

It is 8am on a Thursday morning and in front of me lies a bag on a metal table. I am nineteen years old and never even been to a funeral. The room has very good ventilation – but an unsettling odour still lingers and there are small puddles on the floor. I am standing there with three other medical students – my anatomy group. About ten more groups in the room stand before their own dark blue bags. We are told to feel the bag, to orientate ourselves with the stiffness beneath. We do so, patting at the bag gingerly with our gloved hands. Then it comes time to unzip.

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Long ago, another’s hands hover tentatively over a similar body – except this body is that of an executed criminal, his soul left back at the gallows where his breath disappeared into silence. The person crouching over the already decaying corpse is considered a criminal for this act of bodily desecration. This is in Ancient Greece in the second century BC, where medical dissection is recognised to have begun.(1) Those who wished to access bodies for dissection were forced to obtain them via illegal means such as grave robbing and body snatching.(2) A change in attitude towards dissection began in the third century BC, when royal patronage allowed dissection in Alexandria, Greece, in order to establish it as a ‘glittering centre of literary and scientific learning’.(1) Prior to this, official exploration of the human body was superficial both literally and metaphorically.

However, this small sliver of discovery was brief, and what followed was a retreat into the old ideas and beliefs surrounding dissection. Religious taboos and societal notions restricted scientific progress until there was a ‘revival’ in Medieval Italy at the outset of the fourteenth century.(1) At this time, religious authorities gave permission for human dissection conducted within university premises, and this occurred once or twice a year using executed prisoners.(3) In the fifteenth century, many physicians obtained bodies for dissection by unethically convincing families that their loved one required a post-mortem, which in most cases was untrue.(4)

It is not only medicine that has profited from the innards of man being explored. The artistic sphere was also responsible for pilfering the dead to further the ‘portrayal of [the] human figure’.(1) Leonardo Da Vinci, Michelangelo, and Baccio Bandinelli were all practiced in stripping back the flesh of man’s clockwork and uncovering what makes us tick. With such a dire demand yet limited supply of cadavers, even those still living felt under threat of being murdered for their bodies. Although individuals living in poverty were the main targets, there is a rumour that a Spanish aristocrat was set upon and dissected whilst his heart was still beating.(1)

Thus, human dissection has evolved from being a criminal act bestowed upon criminals, to a consequence of poverty, to a process of informed consent and respect.

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Prior to entering medicine, death had been imagined as a stillness, an ending with closed lids, distant weeping, church bells, a tableau of black. In the movies, death transpired as a mise-en-scène of violence with gunshot or stab wounds, necks bent at bizarre angles, and scarlet pools spreading over wet asphalt. There had never been a time when the idea of death conjured up forceps, surgical scissors, sinks, gloves and slippery floors. But there we were, tentatively hovered around a cadaver, hands within white or blue gloves, and a tray of surgical instruments gripped nervously. Now we’re unzipping the bag and so is everybody else. I start seeing glimpses of the bodies and I wonder if anyone will faint and if so, that person better not be me.

Our donor was a man. His face was covered. Nausea needled my stomach because this was not how cadavers were supposed to look. Didn’t cadavers look like the preserved sections in glass we had studied in specimen class? Why did these bodies appear as if they had simply fallen asleep? However, after the initial shock, we became wholly invested in writing our dissection plan on the whiteboard and beginning the hunt for the elusive brachial plexus. After one hour we were all at the sinks, turning the taps to let loose streams of water which cascaded down the long metal basins. The sinks reminded me of the troughs that fed farm animals, and the crush of students washing their hands made me feel like I was part of a medical student herd.

Twice a week we shrugged on lab coats, donned gloves, fit blades into scalpels, and collected the scissors and forceps on the tray. We were practiced at writing on the whiteboard the list of tasks for the day’s dissection, unzipping the body bag, receiving a handover from the previous group about what they had accomplished, and beginning.

We also became adept at the unspoken things, like learning to hold your breath whilst opening the body bag, eating lunch even if you are not hungry beforehand, and remembering to wear shoes that you do not mind touching the fluid on the floor. At some time, at some moment – standing amongst both the living and the dead had changed from ordeal to routine.

One member of my anatomy group named our donor Sir Gregory. This christening into the afterlife was adopted by many other groups and for us, the name stuck from then on. We were very lucky to have Sir Gregory as he possessed clear anatomy and lacked any confusing anatomical variations. One day, an echo of his life unexpectedly emerged when we stumbled upon a tattoo on his arm of a name. We could only guess at what this name might have meant to Sir Gregory, a secret locked within his earthly vault.

Survival is the human body’s most gifted architect. Every hollow, chamber, space, layer of muscle, skin or outline of bone has been expertly crafted to imbue the greatest working efficiency and survival edge. Gazing down at this accomplishment of biological machinery, I could only imagine the sight if blood coursed within the vessels and the body performed its triumph of animation. However, with this complex feat of engineering comes a very weighty caveat – with such intricacy comes great capacity for error. This sentiment is true for many themes of life – but is equally and most pertinently true in the physiological nature of life itself. In this way, the benefits of dissection became very clear to me very quickly. The secrets of the human body were right before our eyes – presented in a form which a textbook could never hope to reproduce. Most startling was the discovery that the human body does not possess colour coding and that as each person differs mentally and physically, anatomically the variation can be endless.

Over time, my anatomy group began to develop the ability to differentiate between arteries, nerves and veins based on appearance and feel. To hold an organ, feel the elastic bounce of an artery, fashion a window in the atrium of the heart then view the valves within – these experiences are the capstone of dissection. It was in dissection where I realised that “heartstrings’’ are a real structure. Anatomically, your chordae tendinae, colloquially known as heart strings, are connective tissue cords that connect small papillary muscles to the valves in the heart. These small strings anchor your valves whilst the heart pumps blood. Thus, if something “pulls at your heartstrings,’’ I imagine some force pulling back on these strings like reins on a horse, causing the heart to buck under the strain of such emotion.

There is also an importance to dissection that is separate to the anatomy. To physically cut another human being does not come naturally – so as a student you learn how to cut with compassion. A new level of empathy develops to ensure you are both respectful to the donor and to minimise damaging a structure that might be required later. Simultaneously, the student must be confident when attempting the dissection, as if they are too anxious about each tiny incision, nothing gets done and precious time is wasted. Although it seems unkind to alter a person by such physical means, the purpose of the whole exercise is to learn as much as possible and ensure the donor’s contribution enhances your understanding. Some of the most important concepts our group learned were from making mistakes – mistakes like confusing the paths of major arteries – which are better to be made on someone who no longer requires their arteries than in clinical practice.

Our tutor described a case where a woman had an operation and was severely ill during her recovery. Once this was investigated it was discovered that both her ureters had been cut during the procedure, thus her body had been unable to excrete urine. It is hard enough identifying objects in a still body, let alone one that is aflush with life, however errors like these must be mitigated at all costs through rigorous training and educational experiences such as dissection.

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One day we moved to the new anatomy building. Compared to our old building it was gargantuan, with a green speckled façade that resembled a fungus. Inside was a lot of empty space punctuated by black stairs that slashed down the middle like unimpressed eyebrows.

Seeing the donors in this new space I found I was glad they inhabited brighter and sleeker quarters. It was as if they too had been given a gift – and the snowy whiteness of it all imparted a heaven-like quality. There were also screens placed around the room, on which our tutors could illustrate a structure from a specific donor to the whole class. In a sense – with the bright lights and screens – the donors were metaphorical film stars in a limbo universe.

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Suddenly it was the last day with the donors who had helped us in our medical journey for two semesters (semester two of first year and semester one of second year). When I began dissection in first year, it was with a male donor who had been claimed by another group this year. This semester I had a new anatomy group and a female donor who had helped us to understand female anatomy. Our tutor told us to focus our dissection on the pelvic area – but we were also free to explore any other area so far dissected, as it would be our last chance to do so.

A timer ticked down to zero. At zero everyone returned to their donor and our anatomy lecturer conducted a minute’s silence. As silence descended we all shared a moment with the donors – silently thanking them for their generosity and the privilege they had honoured us with. I found myself imagining my donor’s life – projecting a film in my mind of someone running in the sunshine – a kindly voice – a smile.

The minute was up. Our anatomy lecturer walked down the rows announcing cause of death.

Table One – Male – 72 – Cause of Death – Multiple Organ Failure

As she read through the list I kept in mind Sir Gregory from last semester and wondered again which table he was this year. The lecturer arrived at our table. Cause of death:

Metastatic Lung Cancer

Cancer was the prominent grim reaper in the room. It is the great erratum of biology, our own cells turning rogue and militant against the life that bore them, a phenomenon that to this day we have not escaped from. We were very much surprised to learn that one of the donors was over one hundred years old, which generated a small crowd around his table. After discovering the cause of death, we were given a small window of time to view each other’s donors again, now with discerning eyes.

It was time to bid our donor goodbye. We made sure to replace her organs to their rightful place as best we could. I lowered her thoracic cage and moved the two halves of her pelvis back as close as possible to her abdomen. Then we zipped up the body bag.

§

With a new semester comes a new season, new tutorials, and new bodies. It is semester two of year two and a new workbook is provided in our first anatomy class. This time my anatomy group congregates around a different table. The man stretched before us will lend us his head and neck, and the Year Ones will simultaneously dissect the upper limb region. I realised that the other cadavers we had dissected last semester had probably been cremated by now, and this realisation made me feel as if the donors had died for a second time.

There is a 1941 film called A Woman’s Face, which stars Joan Crawford in the titular role. It revolves around Anna Holm, a facially disfigured woman who spends her life punishing the world that injured her. By chance, her path crosses with that of a doctor who specialises in restoring normal appearance to victims of facial trauma. The doctor offers to help her, pro gratis, and once she agrees the film falls away neatly into two halves – before and after the operation that changes Anna’s life. There is one line in the film that is quite magnificent. When the day comes for the bandages to come off Anna’s face – no one knows whether the operation has been successful – or whether her features will have been destroyed forever. The doctor says to Anna, ‘If this operation’s a success I’ve created a monster -’ There’s a beat as he flicks on the lamp, ‘- a beautiful face and no heart’.

The disconnect between face and soul is a concept often explored in literature, film and philosophy. We have no control over the face we are born with, and our minds and behaviours come from a deeper place – yet the face has such power to elude and seduce. However, all that beauty or distinctiveness is the equivalent of the thin crust upon a planet’s surface.

In A Woman’s Face, it unfolds that although Anna nearly crumbles into the monster she has always called herself – she ultimately chooses the path of one with a heart. Thus in the end, both face and soul are united. All of this provokes me to wonder at how our faces affect us – and how I will feel when removing someone else’s face. It is curious to note that the only part of the donor that is separately covered inside of the body bag is the face. For some reason, the face is deemed most private, and most revealing.

§

As I walk to the table of gloves I survey the room and the small but critical change in the presentation of the cadavers. The faces of the donors are visible. Standing around the table, I see that the skin of the lower right half of our donor’s face has been cut and can be retracted if need be. I had sometimes wondered, before my medical studies, what the face of somebody who had died looked like. Would their eyelids slowly shut and fall like a curtain over the eyes as life’s performance ends? The eyes are ‘the window of [the] soul,’ as described by Shakespeare who himself drew inspiration from the biblical phrase, ‘the eye is the lamp of the body.’ Would the departed individual appear calm, tranquil, or simply frozen, trapped in an expression as the winds of life changed? Now I can say that with death, the face assumes no ubiquitous, ‘deathlike’ expression. The face simply remains in a single pose that differs between donors, with eyelids that may be open or closed, and mouths that may also be open or closed.

To begin our dissection, we refer to the other side of the face, and to the depths of previous cuts – and then the belly of the scalpel contacts the skin and someone makes an incision. The incision ends up being a straight line parallel to the nose, one long cut made up of many hesitant cuts interspersed by referring to the other side and discussion like –

‘But what’s that thing there?’
‘Should we cut it?’
‘Scissors are on the tray if you need?’
‘Could it be a nerve?’
‘Am I on the right layer?’
‘Maybe a bit deeper.’
‘You did a great job.’

We all stare at the fifteen-centimetre incision that took half the class to make. Looking around, the faces on other tables were in various states of removal. In life, some people are blessed with faces of great beauty and symmetry, others possess facial features that are striking in other ways. There are faces that tell stories of intelligence, disappointment, happiness, and regret. However, in the end, at the finale of existence, everyone possesses the same ultrastructure beneath. That dimple that emerged as you smiled, the soft blush that dappled your collagenous cheeks, the wrinkling that creases the thin papery skin – they all diminish once you wade into the pond of death. They hover as in a dream, just above the rippling surface of such a pond.

§

Our final day of anatomy arrived abruptly and without warning. Everyone was taking their lab coats out of plastic bags and donning them quickly – casting everything else aside. It felt strange to wear the starchy white coat outside of the laboratory, which in normal circumstances was against the rules.

Outside in the sunlight was a photographer as well as all the anatomy tutors and lecturers.

My anatomy group linked arms as we burrowed our way through the crowd to stand on one of the tiered stairs together. As the light flashed from the camera, capturing all our cohort and the tutors together, another image entered my mind. I saw the photographs of medical students which were printed on the wall of the anatomy imaging room, the photographs my eyes had often wandered over to whilst they were meant to be observing radiological imaging. I remembered when I found the first woman in the photographs – and then a few more appeared, and more and more. I had also found myself looking at the names below the photographs and wondering where those students were now. As I stood on those steps, I wondered where our photograph would end up. I wondered if one day somebody else would stare at the grainy image of our faces and imagine who we had been.

§

Throughout my astonishing journey in dissection, I had direct experience with three donors. The first, Sir Gregory, who assisted with upper limb, lower limb and the thorax. The second, a female donor – Miss Marple, who assisted us with the thorax, abdomen and pelvis. Our final donor was another male, Obi-Wan, who bequeathed us his head and neck. When we left each day to go home, they remained. When we went to the movies or the library or to parties – they lay patiently for us to return. I used to be afraid of death, I think I probably still am – but I realise now it is the caveat that comes with life. I have seen mortality with my own eyes, and I have seen that it is the ultimate equaliser, at least in the present day. Reflecting on dissection class, eternity, and the donors who were our first patients, I have often found this quote from the 1997 film Gattaca rippling up from my mind:

‘They say every atom in our bodies was once part of a star. Maybe [they’re] not leaving. Maybe [they’re] going home’.

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References:
1. Ghosh SK. Human cadaveric dissection: a historical account from ancient Greece to the modern era. Anat Cell Biol. 2015;48(3):153-69.
2. Garment A, Lederer S, Rogers N, Boult L. Let the dead teach the living: the rise of body bequeathal in 20th-century America. Acad Med. 2007;82(10):1000-5.
3. Hildebrandt S. Capital punishment and anatomy: history and ethics of an ongoing association. Clin Anat. 2008;21(1):5-14.
4. Park K. The criminal and the saintly body: autopsy and dissection in Renaissance Italy. Renaiss Q. 1994;47(1):1-33.

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