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opinion | Nathaniel P. Morris

No specific cause of death

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Anatomy class is often viewed as a rite of passage for medical students. We take donated bodies out of black bags and cut away at their limbs, locate tiny nerves and dissect our way through various organs. These encounters transform every one of us, forcing us to confront the fragility of human life and the range of our own emotions. But my experience in anatomy was unusual. For it was what I could not find that taught me most.

At our school, four students are assigned to each cadaver. During the lab periods, we’re supposed to follow itemized course guides and document our clinical findings in a booklet. Does the body show signs of disease? Are there major scars? Did the person undergo any operations?

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Over the eight weeks of the course, most groups wrote down copious notes — an artificial valve in their middle-aged man’s heart or a missing appendix from the young woman before them. My group’s booklet, however, simply sat there. We didn’t have a special way of remembering things or a complicated set of potential diagnoses. We just couldn’t find anything wrong with our cadaver. So, at the end of those two months, our booklet was pretty much blank.

In the last week of the class, pathologists came to lab for each group to present its findings and the suspected cause of death. We had no idea what to present — a fourth-year tutor whispered that we should just say “cardiopulmonary arrest.” When I asked her what that meant, she said “Nothing. It means she died.”

A group on the other side of the room had it easy; they showed a gastrointestinal cancer that had metastasized to multiple organs. Another group held up a crunchy, yellow aorta: a classic example of aortic atherosclerosis. Heart attacks, lung disease, and kidney failures abounded. As the pathologists moved from table to table, my partners and I warily observed the celebrations of our classmates. They cheered and high-fived, vindicated in their diagnostic powers, their potential as future physicians. We felt stupid, not knowing what had been the eventual cause of our cadaver’s demise. She was an elderly woman with frail hands, and she had shown us everything but what had ended her life.

Finally, a pathologist approached our table and asked us to share what we’d found. We pointed to some imaginary spots on her spleen. He said it was nothing. Then, we said her kidney looked big. No, it didn’t. He took the challenge into his own hands, digging through her abdomen and flipping around her heart. After about 10 minutes, he gave up. He couldn’t find anything either. So he pulled out a sheet of paper.

We had heard about this sheet from the second-year students. It was the list of all the donors’ ages and their official causes of death. It was the keeper of all secrets, the information we had waited to see for so long.

The pathologist blurted out, “Wow.” We rushed to look over his shoulder. There was no specific cause of death. The sheet said that she had died of cardiopulmonary arrest and maybe complications from dementia. It revealed that she was the oldest person I’d ever seen in my life. She was an elderly woman with frail hands, and she had died from her many years.

When I sit in class these days, learning about complex drug interactions and endless symptoms, I sometimes dwell on that moment. The moment when we should have applied the vast resources of academia to understand the shaved and pale person on the table. My classmates had been plunged into the devastations of cancer, heart disease, and stroke. But we had simply found old age. It was my first diagnosis.

Last week, the latest round of first-year students donned blue scrubs and embarked on this adventure. I wish them luck as they enter that lab, a place of great fear and fascination. When they check off structures in their guides and hold organs in their hands, they will take a crucial step forward in their training to become physicians. And I hope they will be fortunate enough to see what I saw. That medicine cannot diagnose every illness, nor cure the body of time. I may only be a year ahead, but it seems like a lesson worth passing along.

Nathaniel P. Morris is a Harvard medical student.
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