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

A hauntingly moving memoir of the relationship between a cadaver named Eve and the first-year medical student who cuts her open

Christine Montross was a nervous first-year medical student, standing outside the anatomy lab on her first day of class, preparing herself for what was to come. Entering a room with stainless-steel tables topped by corpses in body bags is shocking no matter how long you've prepared yourself, but a strange thing happened when Montross met her cadaver. Instead of being disgusted by her, she was utterly intrigued-intrigued by the person the woman once was, humbled by the sacrifice she had made in donating her body to science, fascinated by the strange, unsettling beauty of the human form. They called her Eve. This is the story of Montross and Eve-the student and the subject-and the surprising relationship that grew between them.

Body of Work is a mesmerizing, rarely seen glimpse into the day-to-day life of a medical student-yet one that follows naturally in the footsteps of recent highly successful literary renderings of the mysteries of medicine such as Atul Gawande's Complications: A Surgeon's Notes on an Imperfect Science. Christine Montross was a poet long before she became a doctor and brings an uncommon perspective to the emotional difficulty of the first year of medical school-the dispiriting task of remaining clinical and detached while in the anatomy lab and the struggle with the line you've crossed by violating another's body once you leave it.

Montross was so affected by her experience with Eve that she undertook to learn more about the history of cadavers and the study of anatomy. She visited an autopsy lab in Ireland and the University of Padua in Italy where Vesalius, a forefather of anatomy, once studied; she learned about body snatchers and grave-robbers and anatomists who practiced their work on live criminals. Her disturbing, often entertaining anecdotes enrich this exquisitely crafted memoir, endowing an eerie beauty to the world of a doctor-in-training. Body of Work is an unforgettable examination of the mysteries of the human body and a remarkable look at our relationship with both the living and the dead.

"'Though it never goes for the gross-out effect, this memoir is not for the squeamish. 'You begin to learn to heal the living by dismantling the dead,' says Montross, and though her recollections encompass all of her medical training, the narrative backbone of the story is her semester-long dissection of a human cadaver, from opening up the ribcage to removing the brain from the skull. Montross was a poet and writing teacher before she decided to become a doctor, and she peppers her account of the dismantling of her cadaver, Eve — so named because she has no belly button — with arresting imagery: to test the heart's semilunar valves ('little half-moons that work passively and without musculature'), she and another student take the organ to a sink and run tap water through it. Performing her own dissection leads Montross to explore the history of studying anatomy through corpses, which brings tantalizing detours to medieval Italian universities and saints' shrines. But she also recounts her earliest encounters with living patients, such as a heart-wrenching consultation with a man suffering from Lou Gehrig's disease, who can communicate only by blinking. Her thoughtful meditations on balancing clinical detachment and emotional engagement will easily find a spot on the shortlist of great med school literature. (June 25)' Publishers Weekly (Starred Review) (Copyright Reed Business Information, Inc.)"

"Some of us, maybe most, are thankful for skin. We're the ones who fear that listening to heartbeats will make them stop. Our eyes slide away from the veins outlined on our wrists. We shudderingly avoid checking for lumps in our breasts. We are decidedly not fascinated by the mechanics of childbirth. We do not (or cannot) acknowledge that we (and everyone we care about) are mere amalgamations of blood... Washington Post Book Review (read the entire Washington Post review) and organs, nerves and bones. We are grateful for the shielding cloak of skin.

But that, of course, is the first part of the cadaver that Christine Montross cuts in human anatomy lab. 'The skin of the chest pulls back easily after we have made the incisions,' she writes, 'and the body opens like a book.' Montross was a poet before she was a doctor, and her language in 'Body of Work,' an exceptionally thoughtful memoir about the first semester of medical school, is as precise as her scalpel cuts become by the final exam. 'The body is staggeringly complex,' she explains, 'and to understand it with any degree of completeness demands dealing with the thing itself — picking up and holding the heart, tracing the path of an artery by threading a pipe cleaner through its lumen.'

When Montross and her three lab partners meet their cadaver — a woman — her hands, head and feet are covered in cloth and tied in plastic, to 'depersonalize the body.' And yet they feel compelled to name her Eve, for her lack of a belly button. (They never determine why she doesn't have one.) It's as if they had to humanize her before they did things to her that would be taboo, criminal even, without the saving grace of medical training. Perhaps they were apologizing in advance. By the third week in anatomy class, they have 'removed her heart and lungs from her body, tying them in a brown-black garbage bag. ...Her rib cage falls to the table as we turn her, and one of her removed breasts lies out to the side of her, facing the ceiling as she lies facedown.'

In carefully recounting her reactions to each step of Eve's dissection, Montross conveys the sheer differentness of doctors, if only because of what they've done in anatomy lab. By taking apart a formerly living human body, they've crossed over into a wondrous and strange country forbidden to the rest of us. But the question that dogs her throughout the experience is 'whether we have a right to pursue wonder in seemingly inhuman ways.'

And the answer to that question depends, in part, on where the dissected body comes from, an ugly tale in many eras and places. Eve chose, while still living, to donate her body to science. (Montross never learns her real name or circumstances.) Historically, though, students of anatomy robbed graves and made dank deals with executioners. One of Montross' many interesting digressions is a trip to an anatomy lab in Padua, Italy, the supposed birthplace of human dissections, which was equipped with a tunnel to allow for night excursions to recently dug graves.

Even now, the provenance of cadavers in some countries gives one pause: An Iraqi pathologist told Montross that all the bodies he trained on appeared to be from Southeast Asia, and he had no idea why; in Nigeria, they are purported to be the homeless and the criminal, but with a corrupt government such descriptions are suspect. And yet, lest Americans get too smug, Montross points out that the live patients she saw as a medical student were predominantly the poor and uninsured who attended university clinics: 'Does the practice of dissecting the unwilling dead differ so distinctly from novice trainees operating on patients who believe that their procedures will be done by experienced veterans?'

Such ethical conundrums, as well as the sheer physical and psychological difficulty of dissection, weigh on Montross and her classmates. For instance, 'in order to remove the skin from the hand,' Montross explains, 'we must, by necessity, hold the hand in ours, an intimate and familiar gesture that makes the directive to take a blade to the skin all the more unsettling.' The skin on the palm is tough; instead of the usual one or two scalpel blades per session, Montross goes through five. 'It is an emotionally tiring chore.' And she dreams, most nights, of skinning people. She also realizes, slowly, that the anatomy lab is not just a place to learn dissection, but an opportunity for the students to explore their own emotions. 'As doctors-in-training,' Montross writes, 'we are reshaping the ways in which we react — in fact we are suppressing universal reactions of fear and grief and horror.'

And yet, she is grateful to Eve and to the lab for 'the unthinkable gift I have been given.' We should be grateful, too — especially those of us who squirm away from the physical truths of our existence — for this beautiful book and the glimpse it offers of a place off limits to anyone without Montross' clearsighted courage.

" Reviewed by Patrick Anderson, whose e-mail address is mondaythrillers(at symbol)aol.comRachel Hartigan Shea, who is a senior editor at The Washington Post Book World, Washington Post Book World (Copyright 2006 Washington Post Book World Service/Washington Post Writers Group)
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In this hauntingly moving memoir of the relationship between a cadaver named Eve and the first-year medical student who cuts her open, Montross provides an uncommon perspective on the emotional difficulty a first year medical student can face.

Dr. Christine Montross is a resident in psychiatry at Brown University. She received her masters of fine arts in poetry from the University of Michigan and has had several poems published in literary journals. While compiling this book, she traveled to anatomical theaters, sought out holy relics, and dissected three arms, a leg, and an entire human body.