I wrote Exposures while I was a first-year medical student back in the early 2010s. It won the Marguerite Rush Lerner Award for Creative Writing in 2012.
She was thin with short, dark hair. Sharp nose, high cheekbones, and a crescent tear around her closed, right eye. Her breast tissue had deflated into the consistency of old newspaper. Her body had darkened with the absolution of formaldehyde. In silence, we unwrapped her linens and hauled back sheets of crackling, thick plastic wrap.
She had no tan lines. She had no evidence of a wedding ring, of jewelry worn often, of hair dye. She painted her fingernails. Left hand only.
The professor swept his fingers over a thin white line above her private parts. This scar just superior to the pubic bone meant a C-Section.
A chart on the wall said she had died of "alcohlic cirrhosis of the liver," a strange typo. We had no evidence that she had lived a good life. She had died, and she had given over her body to us. I had no idea what was to come, the things we were to remove from her, how I would stare at the imprint of the heart on the lungs, long after we had cut it away and put it in a bag at her feet.
In the days when I was still deliberating whether or not to apply to medical school, my friend announced that he had a heart murmur. He was a person who buried nervousness with bravado.
Do you want to hear it? he asked.
He took his stethoscope out of his backpack and handed me the earpieces. He lifted his shirt and slipped the stethoscope underneath, exposing a naked belly on an expectedly thin frame. My head was pulled near his stomach, the rubber of the stethoscope stretched taut. He said, Listen.
I didn't hear it. I laughed at the awkwardness of my proximity. He leaned forward, held his breath, and repositioned the stethoscope. Connected, I too came closer.
The sound of the murmur faded into my ears. I didn't yet understand the concept of systole and diastole, the snap of the regular heart rhythms and the natural split of S2. But I could hear a rushing, turbulent noise, almost like the gentle whooshing of an ultrasound machine, slipping in between the beats of his heart.
Since then, I have had an odd attachment to heart murmurs. Perhaps because of the strangeness of that first listening. In the same way that a word is defined by its nascent associations, murmurs to me will always represent the gift of exposure. Although eventually knowledge may become routine, it is the first uncovering that sows it to your mind. It is that awkward revealing that brings every other instance into stark color.
There was a congenial man, a kind neighbor, firm with his children, who had long since grown. He smiled at us. He believed in the greater good of educating medical ingénues.
The exposure was deft and intentional but without swagger. This was not a magician, throwing back a cloth, to reveal a surprise vacancy. This was the doctor who we, with a mix of reverence and pride referred to as Our doctor and Our teacher. He lifted the corners of fabric and dropped them. He pinched them and shifted them with veteran haphazard. To him, this was no longer exposure. It was another object in a series of objects. But I failed to seem as unabashed at the sight of a stranger's genitals.
I performed a full physical exam on the 40-something male. It was my first full exam. While I palpated and auscultated, his heart rate jumped to a twice-normal rate. I did not notice. At the end, our doctor handed me a long strip of paper, patterns of the man's heart carved out in dark ink. I could not read an EKG, but I could see the section of abnormality, the sudden onset of ventricular tachycardia.
He handed it to me with pride. We made light conversation and moved on. But the dark spikes, uncountable, pointed to all the things I couldn’t see. I put it in my pocket. I would keep it there until it was washed and crumpled, weathered, too tattered and torn to read at all.
There is a profound sadness in the doctor-patient relationship; in the oddness of our sudden connection with strangers, the disproportionate formality of it all, and the brevity incongruent for a relationship of such intimate action.
This is clearest to me in the act of surgery. I am stilled by its methodical communion. The surgeon places her fingers into the incision, seeking landmarks of which I am ignorant. The intentioned movements of her finger create a temporary bulge in the patient's skin. No one will ever touch this woman with such intimacy. She did not know that she would be the subject of a proximity not allotted to parents, to siblings, to lovers. A strange relationship in which she is temporarily a canvas.
If the woman is a sculpture, the surgeon is Pygmalion. She may touch her patient's incision later, still seeing a thing she crafted with her own hands. But a statue is no longer an object once it has come to life, even if that life depended on your intense prayers, the particular angle of your blade. Even though the surgeon touches this woman more intimately than her family ever will, even though she heals her in a way that her closest friends cannot, this surgeon and the patient will forever be strangers.
I interviewed a man who'd had a difficult life: a survey on lifestyle choices and access to medical care.
I had sat in lectures on the importance of connecting with patients. I held a strong belief in the bonds between people and the healing power of honest words. The man sat before me and I lost my voice. I lashed myself onto the bones of the questionnaire.
When was your last medical appointment?
Have you ever had high cholesterol? High blood pressure?
Do you drink?
The man hesitated only briefly before telling me that he had consumed alcohol, in the past, but no longer. I felt suddenly suspended, a tightrope walker leaning into a taut line. I could ask for more as easily as I could ignore the slight revealing he had given me, the edge of this curtain removed. It was certainly safe to ignore the brief ruffle in the tamped-down edges of his life. With every second, it was already settling, and settling closed.
When you used to drink…
His drinking had been a result of a traumatic event. Someone died. He survived. The vacancy widened. He spent a lot of time in the graveyard. He fell asleep next to the precious remainders of what used to be. I did not have to ask. While I listened, he lifted and pinched at the corners of his own life until it lay there, exposed.
As we examined the life he had led, silence took us. The speaking and revealing had settled something in the both of us. There was an unexpected sense of calm, like a pond after the plunk of hefted rocks: the renewed flatness of the water, transparent, the untrodden path of a thousand stones beneath.
When we first unwrapped her body, I had promised myself that I would to suture her together in the end, replace the organs we had removed, put things back where we had created unnecessary vacancy. I intended to close her body, re-wrap the gift she had given us and give it back to her family whole. But we had taken out tissue and made large, uneven incisions. Some skin had dried to the texture of stiff leather; other parts had been lost or thrown away. I imagined a thousand black stitches criss-crossing her body, a monumental task. I told myself that this new mutilation was no more charitable than leaving her as she was. But I was compelled, in the very least, to close the freshest cut. The cleavage of the saw down the center of her face, cutting between her eyes and her nose and exposing unseen sinuses beneath.
I fumbled with the halves of her skull, pressing them together behind the flaps of scalp. There was nothing left inside, now that we had removed the brain. Nonetheless, I pinched her cheeks together and began to sew. Her face slowly reassembled, held together just beneath the skin. Her chin, then her mouth and nose. She had no teeth left. Tiny black stitches materialized on her forehead, post-mortum beads of sweat.
Later, long after I exited the lab and left the smell of formaldehyde behind, I still thought of her. Just as her face had been exposed to me, so were the faces of all people, wide turbinates and deep sinuses, the enclosed brain that, if removed, would leave dura flapping like shirt tails in the wind, a strange new nakedness.
I felt a sudden vacancy; the unfamiliarity and permanence of this vision. When confronted with a classmate, discussing our shared experiences in bodily deconstruction, I had nothing to say. I saw not a nose but the nasal concha, not the cheeks but the zygomatic arches and the maxillary sinuses. So instead of looking at that face, I looked at my feet, thinking of the things that had been removed from me, and the things I had gained.