Customer Reviews

Body of Work: Meditations on Mortality from the Human Anatomy Lab

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Body of Work: Meditations on Mortality from the Human Anatomy Lab, by Dr. Christine Montross, jumps out as something entirely predictable... what you would get if you crossed writers Terry Tempest Williams (Refuge) and Atul Gawande (Complications).

In other words, Montross writes with knowledge and determination, passion and persuasion, connection and compassion.

During her first year in medical school, her most important dissection partner was a deceased woman she named Eve. Whatever Eve did in life, in death she shaped Montross forever. Montross marveled at Eve's lack of a belly button, the bone dust Montross inhaled, the wonder of Eve's gift of herself. Eve morphed into a totally dissected person, and to the end, Montross would always consider her a person, not a thing, and not an abstraction.

This experience, along with vignettes from her rotations in medical school, are shared throughout the book. But Montross goes beyond that, delving into the history of anatomy, of human dissection, and of our linkage of what remains after we die with our spiritual connections. There's a reason saints were delivered in many pieces to places of worship, that medical students resorted to grave robbery, and that Thai medical students respect their dissection experiences throughout their career.

Montross weaves her anatomy experiences with her own life and relationship. There is a sensitivity here that makes you want to choose her as your own physician. By golly, if I am brain dead, I want Dr. Montross to check my pain reflexes! Finally, there are a number of books about that first year experience in medical school, and they all share the spirit of discovery in anatomy. This one goes where others have not, and reflects Montross's background as a teacher of English and a poet... observations of anatomy through the MFA lens.

This is a great book to give that person who yearns to follow her into the healing professions.

Just finished this book. Had to stop several times because of memories of my medical school and residency years. Cried some, laughed some and nodded my head often. What I liked was that this was not simply a memoir , but an intriguing look at medical history and practices in other countries. I am a child psychiatrist and part time poet, so I identified on many levels. I was the reader at our table-2 prospective surgeons took over the dissection. The emotions of becoming a doctor are wonderfully described and I will recommend it to fellow physicians and prospective ones alike. Beautifully done.
Jim Wicoff m.d.

A first-year medical student remembers with clarity and thoughtfulness one of the great emotional traumas of medical school, the semester-long process of dissecting a cadaver. This could read like a recital of atrocity, or worse. Instead, without muting the emotional trauma that comes with disassembling every square inch of a human body, Dr. Montross focuses on her growing emotional bond with 'Eve.' The result is a remarkable symbiosis between the living student and her deceased 'instructor.' The author's style is direct, even confrontational at times; this isn't for the squeamish or faint of heart. But Montross never fails to treat her subject with respect and dignity, even honor. It is a devastatingly dense relationship within the stifling confines of the gross anatomy lab. But as the author makes clear, it is absolutely necessary for a young doctor's training. Here, the medical student/author emotionally dissects herself while reducing 'her' cadaver to, well, nothing. The process, however gory it might sound, is beautiful, revealing - literally and figuratively - and results is great empathy between 'physician' and 'patient.' As one destroys the other in her search for knowledge, they bond in a way that can only be described as beautiful and tender. This book gives the reader who is open to it an altogether different understanding of doctors and the medical profession. The profession is the better for Dr. Montross's explanation of the process by which she became a doctor.

First year med students learn anatomy by spending a semester, 14 hours a week, dissecting a cadaver. Issues of cultural taboo, squeamishness and professionalism necessarily arise. Montross, who, at 28, had already been a poet and a teacher, chooses this profound experience as the backbone of her memoir on becoming a doctor.

Older than most of her classmates, she has a stable, happy relationship and a wider, more mature perspective than, say, gung-ho Raj, fresh from college, who can't wait to start cutting. Montross herself is much more ambivalent and approaches her team's corpse with curiosity about its life.

With their first view of her, their cadaver furnishes her own name - Eve. The old woman has no belly button! Montross takes us through her team of four's first cuts - the trepidation, ambivalence, feelings of inadequacy and amazement. She also tells us how it feels to put scalpel to embalmed flesh, to saw through bones and softer tissue.

"The muscle and cartilage are much easier to saw, but, as a result, doing so lacks the distraction that effort affords. The tissue spins off the blade in small bits, which look like tiny roots or fingernail clippings."

Graphic descriptions of the layers of flesh and muscle, the intricate and ingenious, but messy and confusing circulation system, the distinct and functional organs, fascinate and repel. Montross describes the process of normal decay after death - but the medical cadavers could remain at room temperature for 20 years without further decay.

Taking periodic breaks, she explores the history of medical cadavers: body snatchers and religious taboos, the early scientists who donated their own bodies, and the condemned prisoners donated by the state.

She visits the historic dissecting theater at Padua, which probably had a table that flipped, so if officials approached the forbidden corpse could be hidden below, while an animal appeared in its place. Montross reflects on the dedication of those early doctors and students who risked disgrace, prison and even death for the acquisition of knowledge.

Another visit takes her to Rome, to the crypt of the Capuchin monks, maintained and added to from 1631 to 1870. The bones of 4,000 friars have been meticulously preserved in a series of chapels. But far stranger than the skeletons still standing in their habits are the chandeliers of arm bones and clavicles hanging from the ceilings, the filigree of ribs decorating the doorways, the wreaths of pelvises and backbones displayed on the walls.

Clinical detachment has always struggled with cultural or emotional taboos and Montross returns again and again to her own efforts to balance feeling and professionalism throughout her med school experience. "My ability to manage my own discomfort in the face of their bodies and their illnesses would be one of the most critical lessons of my medical training."

She tells of treating a non-responsive patient day after day, going through the motions, her thoughts elsewhere, until one day she comes in to find his walls festooned with a child's drawings and family pictures and the man is transformed from chore to human being, though nothing about him has changed.

At the other end of the spectrum, having followed a patient for some time, she approaches the family to discuss end-of-life issues and bursts into tears.

The author's grandparents were also declining during her first year. "I was aware that my own personal grappling with the body's ability to heal and fail colored the ways in which I approached my medical studies."

Her studies seemed removed from real life; her knowledge inadequate, yet she knows there is no cure for aging. She could trace the path disease and injury had taken: "But in what locatable space was the reason the tissue did not heal?"

Ever thoughtful in her feeling, ever feeling in her thinking, Montross communicates the hopes and the limits of medicine, the strivings and pitfalls of doctoring. Honest and informative, Montross' first book ranks among the best of medical memoirs.

A fascinating account of this `acceptable taboo' subject - namely the medical dissection of the human body by medical students. This is a personal, because the author is one of the students. She takes us through the entire semester - or more precisely the spiritual journey she undergoes. We follow Ms. Montross through her development - both human and medical. She is obviously anguished by what she has to do in the medical lab - and her reactions and expose give the book great beauty. We can feel her growth, she makes incredible connections between her lab work and internship with live patients. She realizes that the extreme awkwardness and cutting to exposure ALL parts of the human body is also a preparation for dealing with real people who may be terminally ill, have grotesque disfigurations...
Like all medical students she must learn to balance feelings and discomfort when listening to patients - but not at the loss of giving just a cold clinical diagnosis. We also get a sense of the mental and physical stress that these students undergo - not all of them make it through the entire term. They are in their own special club - and those outside the club cannot properly relate to them. Ms. Montross gives us wonderful insights into this club.
Another aspect of the book I liked was its lack of criticisms. This is not a book that rails against the medical profession and those in it. It treats all from the body undergoing dissection to the students, doctors and patients with a great deal of humanism and respect.
She also gives a history of anatomical dissection and how bodies were acquired (more often stolen) in past eras. Given the subject this is not easy reading - it is necessarily morbid. I did not have nightmares, but the words in the book remain with you - as does any good book.

If you're like me and wondered what it's like to be a medical student and to first learn the internals of the body then this is our book. Excellent insights into the amazing structure of the human body, from the unique perspective of taking one apart. Now that I'm older I'm fascinated about how the body works and wish I had had the opportunity - and the courage to get over the inevitable squeamishness - to attempt to become a doctor. Oh well, 'Body of Work' let's me imagine what it's like. The author, Dr. Christine Montross, writes well and often turns a beautifully crafted phrase that conveys the emotion of what she sees. Highly recommended.

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"When I listen to any patient's heartbeat or lungs, or feel for someone's liver or pulse, or find tendons to tap with my hammer in order to test for reflexes, the structures I picture hidden beneath the skin are all--all of them--Eve's. [Eve was the name the author gave to the cadaver she had to dissect during her first year of medical school.]...I cannot begin to know what led Eve to give me such a gift [of her dead body for dissection], whether it was practicality or altruism or cynicism or love of science or some other, equally unknowable, aspect of her personality or life. What I do know is that she neither knew me nor knew anything about me, and yet she bequeathed to me this offering, unthinkable for centuries, that has formed the foundation of my ability to heal...Bit by bit, I cut up and dismantled her [dead body], a beautiful old woman who came to me whole. The lessons her body taught me are of critical importance to my knowledge of medicine, but her selfless gesture of donation will be my lasting example of how much it is possible to give a total stranger in the hopes of healing."

The above is found in this mesmerizing book, a memoir authored by Christine Montross, M.D. (now a resident in psychiatry at Brown University.)

This book brought many memories back for me as I at one time had to do some dissecting of a human body. The author does not clarify this but dissection is a technique used to study the structure of the body, whereas anatomy is a field of scientific study. Studying the body by dissection is called macroscopic or gross anatomy.

This book is not only about Montross' dissection of Eve during her first year in medical school. Montross was so affected by her dissecting experience with Eve that she set out to learn more about the history of cadavers and the discipline of anatomy. Her curiosity took her from such places as an autopsy lab in Ireland to the University of Padua in Italy (where Andreas Vesalius (1514 to 1564), a forefather of anatomy, once studied); she also learned about other things such as about body snatchers, grave robbers, and anatomists who practised on live criminals (called vivisection).

The author also sprinkles throughout the book her own views about various issues including her thoughts on becoming a doctor. Here is one of my favourites that I can identify with:

"It's not that med school is difficult conceptually, it's just that there's such an incredible amount of information to learn and attempt to retain [or memorize]. There is no need yet for any kind of original thought. So far our learning is regurgitation at its most pure."

At the beginning of each chapter is a back and white image or picture. All these images (except one) are from the first anatomy book (actually book series) entitled "De Humani Corporis Fabrica" (1543), literally meaning "The Fabric of the Human Body" by A. Vesalius, who was, as mentioned above, a forefather of anatomy.

Also, at the beginning of each chapter is a thought-provoking quotation from others. This is my favourite since it is so true based on my own experience:

"Anatomical textbooks give the misleading impression that everything in the [body] is immediately distinguishable. The unsuspecting student plunges into the laboratory carcase expecting to find these neat arrangements [found in the text] repeated in [the cadaver], and the blurred confusion which he [or she] actually meets often produces a sense of despair." (Jonathan Miller)

Finally, my only minor complaint with this book concerns a section in the last chapter where the author pays homage to her grandparents. I felt that this section was a bit too long.

In conclusion, this is truly a unique book--lyrical, insightful, introspective--that takes the grossness out of gross anatomy!!

(first published 2007; preface; 12 chapters; epilogue; main narrative 290 pages; bibliography; acknowledgements)

<<Stephen Pletko, London, Ontario, Canada>>

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We expect from doctors both professionalism and humanity, a difficult mix. This book presents us with someone who promises to have both. Montross clearly feels the requirements of the physician which are technical and scientific and the yearning to be moral and caring; to feel as well as to think. Between these poles her narrative and her personality moves and develops. Her prose too has the same double character sharing the clarity of the clinical and yet the sensitivity of a person trying not to forget the human under the diagnosis. Further, this personal experience is framed by the history of anatomy and the general tensions between the church and the university.

Poet MD Christine Montross has used her literary talents to share some of the most profound moments of her experiences of cadavar labs as a medical student. She makes the apt observation that students' sensitive/or indifferent reactions to dissection somehow predict their future sensitive/indifferent reactions to patients. That many students experience PTSD after dissections will startle a lot of readers - especially those of us who treat PTSD in other very different contexts.

This is the book I should have written, wish I had written, and Dr. Montross does it so much better than I ever could have. My experience dissecting a cadaver in medical school was 30 years ago, and her thoughts, musings, and observations of herself and others helped me know I was not alone. This experience does have an effect on students, and it is not even remotely addressed in a way that allows the students to process their full range of emotional response in a safe and supportive manner.
This book opens the door to a psychological but little discussed trauma that is the initiation of a medical career.
Bravo and thank you!