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Trigger warning Themes of bereavement and death
In the early days of the occupational therapy program at the University of New England (Maine, USA), the college of Osteopathic Medicine required all programs using the lab to provide faculty who would be trained to perform dissections on the bodies their students would eventually use. We tried to stay a week or two ahead of our students, in terms of preparation. In all honesty, this did not work well, as we were slow and just as likely to destroy a structure as we were to reveal it. The programs eventually funded a 'real anatomist', but initially it was our job.
We tend to react to the presence of death in many different, often idiosyncratic ways. Our program required all occupational therapy candidates to complete a course in Gross Anatomy, spending hours each week conducting prosection [dissection of a cadaver to demonstrate anatomic structure] on the forty cadavers in the lab. Occasionally a student could not bring themselves to touch the remains, preferring to stand behind their peers and watch. It is a strategy that I never saw work effectively and prevented some students from moving on in their studies.
In one class, I watched as one student seemed to have a particularly difficult time, never being able to touch a body or remain in the lab for the full session. I requested that she meet with me in the lab with no other students present. The professional anatomists were present, but had agreed to remain in one of the other rooms. When I asked her what she felt was troubling her, she remained silent for some time. Finally, she took a deep breath and related how her grandmother had recently passed and that she had yet to come to terms with her death. She could not bring herself to touch any of the remains, or even to open a body bag.
I related that, in a previous semester, the body of one of the women had closely resembled my own mother and that I had great difficulty working with these remains. We talked of her memories of her grandmother for a number of days. Finally one day, she stood, sighed again and opened the 'body bag' in front of her. Watching her over the following weeks, she gradually grew more comfortable and caught up on the material with which she had been so far behind.
One of my initial 'clients' was a woman in her late fifties. To my surprise, the work was not only physically demanding but often very challenging emotionally. My initial strategy was to concentrate on the specific area I was dissecting, seldom stepping back to view the person as a whole.
The schedule called for our students to 'appreciate the anatomy of the forearm' initially. To my surprise, the anterior of her forearm was 'not right.' Where the long tendon of the palmaris longus should have been, I saw a large muscle belly. Everything else looked fine, but I began to question my own memory of my gross anatomy class. I called our anatomist over and asked him what I was missing. 'Dr Tom' looked, stepped closer and looked again. Then he began to laugh. "Bill," he said, "the good Lord put her together on a Friday night or a Monday morning, because that palmaris longus is in backwards!" Sure enough, looking proximally I saw the tendon, now quite obvious, but not to my confused eyes earlier. He assured me that she likely never knew of her uniqueness, or experienced any issues with hand function.
But it was this woman’s hands that caused me the most difficulty emotionally. As I began to separate - called 'teasing out' - the structures of her hands, I could not help but stop and think of what those hands had experienced over her life span.
One might argue that our mouths and lips are the first major input of sensory information. I would agree, but feel that, very quickly, our hands lead us to a greater exploration of our life space and world. Individuals who donate their remains to gross anatomy classrooms retain almost complete privacy. We knew only their age and cause of death; nothing about their lives or experiences. This is as it should be, but often you could not help but wonder about the stories those hands could tell.
Physically, hands are also difficult to dissect, as many of the components are supremely well attached to underlying structure, particularly when one moves distally along the fingers themselves.
I frequently stopped, as much out of frustration as to rest from the concentration. At those times, I tried to imagine what memories those hands had given her. Where was she from? How had she passed her days as a young girl? What came easily to these hands and what required more effort? What was she never quite able to do to her own satisfaction?
What did her hands tell her about her mother or father? How did she feel when her mother held her small hands in her own. What was her father’s beard like? At some point she found her first boyfriend or girlfriend. The first time she 'held hands' with another, did she even notice that both their hands were likely cold and clammy? More likely she was only aware of her own racing heart.
Those hands later touched her lover and held her own babies. Did she marvel at how the tiny hands of her infant were already perfect in form and in their ability to learn from the environment?
Emotionally, her hands became the most difficult part of the body to dissect, as I sometimes felt I was violating the most intimate place of who this woman had been. My students often had difficulty with a cadaver’s genitalia. For me, however, it was the dissection of the hand that proved most difficult, on a number of levels.
I would, at times, find myself silently talking to her. Where had she been, what had she done in her life? Had she, per chance, walked with Dr King in the 60s? As a soldier in Vietnam in the late 60s, I had grown so angry with the senseless slaughter, that I walked out of a church service one afternoon. Essentially, I never returned to the church, but this woman’s hands made me wonder again at how we all came to be.
In the thirty-six years I have practiced in occupational therapy, I often found myself studying the hands of my patients, regardless of the diagnosis that brought them into my clinic. Now, I watch as my own hands age. The scar left by an angry squirrel, when I foolishly tried to rescue him after he was hit by an automobile. The slight bit of distal interphalangeal joint (DIP) flexion in one 4th digit, a reminder of a mallet finger injury years ago. The bases and carpometacarpal (CMC) joints of my own thumbs are now frequently painful during tasks that require forceful grip. No doubt the result of years of aggressive scar massage with my surgical hand patients. But the discomfort frequently reminds me of their stories and of my own.
Most of the publishing I accomplished during my quest for tenure was written in collaboration with a fellow professor, who had a sharp intellect, incredible attention to detail - and just happened to be an extremely attractive young woman. Male conversation frequently stopped when Sara (not her real name) and I would walk into a room, to present on some topic we were researching. One day she looked at me and laughed...
"Bill, you are the only male friend I have who spends so much time looking at my hands." I smiled back, "Well it’s kind of a long story actually."
Image credits
'Octavias' - first son of artist Kenney Dao, in collaboration with Thao Nguyen.
Photographs of soldier and parents by author William Croninger.
Palpable Anatomy: The Palmaris longus tendon - Bone Broke
Other images from stock library.