Keenly aware of the difference between his own generation and that of this doctor, Kiguchi concluded that neither this man nor any of the doctors in the psychotherapy ward of this hospital could comprehend Tsukada’s suffering.
“I think it would be best if we didn’t provoke Tsukada any more.”
“What do you mean, provoke?”
“I don’t think it’s good to make him talk about the secrets he’s buried in his heart. I think it’s what caused him to hemorrhage this last time.”
“That may be true. We’ll just have to watch him and see how he does for a while.”
“Since he’s not drinking while he’s here, I think all you have to do is turn that into a good habit for him.”
The doctor, twirling his ballpoint pen between his fingers, nodded as if he understood. Esophageal varices were, after all, a disease for which there was no treatment.
The event they feared finally occurred. It was Saturday when Tsukada coughed up a huge amount of blood for the second time. When Kiguchi got the urgent message and raced to the hospital, the doctors had stopped his vomiting and moved him from the ward to a private room. Nurses busily scurried in and out of the room, and the atmosphere was taut as a bowstring all the way out into the hallway.
A balloonlike tube had been inserted into his throat, and he moaned in pain. Stains from the blood he had regurgitated still splotched the floor here and there.
“Gaston’s the one who picked him up. There was blood all over Gaston’s clothes. Gaston . . .” In her state of distress, Tsukada’s wife kept repeating trivial information to Kiguchi.
“He’s stabilized for now,” the head doctor, who stood wearily at the door of the room, whispered to Kiguchi. “But this is the crisis point.”
Five days later the bleeding was finally stanched and the balloon tube was removed from his throat.
Tsukada seemed to sense the approach of death.
“I’ve really done nothing but cause you one headache after another,” he said with more feeling than he had previously displayed. “I’m so sorry.”
He said some things privately to his wife. Kiguchi could hear her whimpering as he stood in the hallway. Patients passing Tsukada’s room on their way to the bathroom glared uneasily at the hypodermic syringes and the oxygen tank.
“My husband wants you to send for Gaston,” his wife told Kiguchi when she emerged from the room with a tearstained faced. “He keeps asking for him.”
“For Gaston?”
“Yes.”
Evidently Gaston was teaching a class at the Berlitz Language School that day, since he had not appeared at the hospital.
“Where’s Gaston?” Tsukada repeatedly asked Kiguchi. “I want to ask Gaston something.”
It was past six, after the patients had finished eating their supper, when Gaston finally got the message and appeared. An air of tension still filled the room and the hallway. Gaston got permission from the nurses’ station and hesitantly opened the door to Tsukada’s room.
“Mr. Tsukada. I pray. I pray.”
“Gaston. I . . . during the war . . . I did something horrible. It hurts me to remember it. Very much.”
“Is OK. OK.”
“No matter how horrible?”
“Ye-es.”
“Gaston. I . . . during the war . . .” Tsukada gasped for breath, and in a strained voice he continued, “. . . in Burma, I ate the flesh of a dead soldier. There was nothing to eat. I had to do it to stay alive. Someone who’s fallen that far into the hell of starvation—would your God forgive even someone like that?”
Tsukada’s wife, who had been staring at the floor as she listened to her husband’s confession, said softly, “Darling. Darling . . . you’ve suffered for so long.” She already knew her husband’s secret.
Gaston closed his eyes and said nothing. He looked almost like a monk engaged in solitary prayer. When he opened his eyes again, there was a stern look on his comical face that Kiguchi had never seen before.
“Mr. Tsukada. You are not only one to eat human flesh.”
Kiguchi and Tsukada’s wife listened in astonishment to the stumbling Japanese words that came from Gaston’s mouth.
“Mr. Tsukada. Four years, maybe five years ago, did you hear news that an airplane is broken and falls into Andes Mountains? Airplane hit mountain, and many people hurt. Andes Mountains is cold. On sixth day before help comes, nothing is left to eat.”
Kiguchi remembered seeing in a newspaper or on television that an Argentine plane had crashed in the Andes four or five years earlier. He had seen a photograph of the search party beside a form that resembled an aircraft but so blurred it looked like a reflection in a pool of water, along with several men and women who had survived the crash.
“A man was in that airplane. Like you, he very much likes to drink, and in plane he only gets drunk and sleeps. When plane has accident in Andes Mountains, drunk man hits back and chest, is much badly hurt.”
In his broken Japanese, Gaston related the following story.
The drunken man said to the survivors who had cared for him over the course of three days: “You have nothing left to eat, do you? After I die, you must eat the flesh of my body. You must eat it whether you want to or not. Help will surely come.”
Kiguchi vaguely remembered this part of the story as well. The survivors, who were rescued on the seventy-second day, openly confessed what they had done. They had miraculously survived because they had consumed the flesh of those who had already died.
“Those who passed away encouraged us to do so,” one of the survivors related. This news had struck Kiguchi, who had roamed and fled through the jungles of Burma, so close at hand and so vividly that it remained in the depths of his consciousness even now.
“When these people come back from Andes alive, everyone very happy. Families of dead people also very happy. No one angry with them for eating people’s flesh. The wife of drunk man say, he did a good thing for first time. People from his town always say bad things about him, but they stop saying. They believe he has gone to heaven.”
Gaston exhausted every word he knew in Japanese to comfort Tsukada. He came to Tsukada’s room every day after that and held the dying man’s hands between his own palms, talked to him and encouraged him. Kiguchi could not tell whether such comfort eased Tsukada’s pain. But the figure of Gaston kneeling beside his bed looked like a bent nail, and the bent nail struggled to become one with the contortions of Tsukada’s mind, and to suffer along with Tsukada.
Two days later, Tsukada died. His face was more at peace than anyone had imagined it could be, but a look of peace always comes at last to the dying. “He looks like he’s sleeping,” Tsukada’s wife mumbled, but Kiguchi couldn’t help but feel that this peaceful death-mask had been made possible because Gaston had soaked up all the anguish in Tsukada’s heart.
Gaston was nowhere to be found when Tsukada died. The nurses had no idea where he had gone.
PART TWO
Physicians Must Be Knowledgeable
PHYSICIANS must understand the scientific basis of medicine and be able to apply that understanding to the practice of medicine. They must have sufficient knowledge of the structure and function of the body (as an intact organism) and its major organ systems and of the molecular, cellular, and biochemical mechanisms that maintain the body’s homeostasis in order to comprehend disease and to incorporate wisely modern diagnostic and therapeutic modalities in their practice. They must engage in lifelong learning to remain current in their understanding of the scientific basis of medicine.
Alice Jones
THE CADAVER
The exploration of cadavers has guided the beginning study of medicine for centuries. Cadavers have been the means by which students have acquired “sufficient knowledge of the structure . . . of the body,” and anatomy itself has come to symbolize a critical rite of passage for medical students. For many students, it is the first time they don the garb of their profession, learn to work with its too
ls, speak its language—and touch death.
In this poem, physician Alice Jones writes of the process of dissection and the complexity of both the process and the feelings that accompany the weeks spent exploring the body of another human being.
ALICE JONES is a graduate of Goddard College and New York Medical College. After several years of practice in internal medicine, she completed a second residency in psychiatry, which she now practices. Her poems have appeared in Poetry, the New England Review, the Gettysburg Review, and the Kenyon Review. This poem is taken from her collection of poems titled The Knot.
I
Overwhelmed by smell, warned
by this ancient sense, you approach
the body, cool and supine
on the chrome table. This rubbery
thing will show you the mysteries
as you open his insides,
expose them to fluorescent light
and the lab’s cold air. Sick
of looking, hating the slippery
touch that pickles your fingertips
into ridges, as if you’d been in the tub
all day, you fly out through the double
doors to pace the hard linoleum,
breathe air free of formaldehyde,
of your legs, your bladder fullness,
and blood-pumped warmth. You list
your differences from the inert man
who teaches you the body’s form and names,
who teaches you the body’s death.
II
On your schedule, it says Gross Anatomy Lab
so you’re all on time, cluster
around the doorway to be outside
of the odor and at some distance
from the silent shapes on the tables.
A white-coated instructor appears,
with the look of a dapper marine,
calls out names from his list by fours.
You’re bunched with three other J’s,
white males, who check out each others’
equipment—the blue plastic boxes
of scalpels and probes, the atlas
in paper or hardback, opaque latex gloves.
They notice your metzenbaum scissors
stolen from a summertime lab job.
While the text begins with the chest
and you read in advance, he says start
with the forearms and places two of you
on each side of the damp sheet
that covers something. While you wait
for your first look at death, the level
of laughter rises, as among soldiers
nearing the enemy front.
Later, you walked to the car,
a collection of fragments,
disarticulated bones, muscle spindles,
vessels and nerves, you wondered
what held you together. At home
the cats wouldn’t come near you
even after a shower. And you thought
you’d never be a whole animal again.
III
Older than your father,
with trim beard, wry facial lines
and dilated pupils, you imagine the name
Joseph for him, not thinking then
of the father who had so little to do
in the old story, who after the annunciation
only sheltered the divine parasite,
like a bewildered bird
constantly feeding the fat cuckoo
placed in his small nest.
In this way the cadaver fathered
knowledge, provided no live seed,
but gave the place for learning,
its food and shelter. You explored
the deep nest of the thorax, held
by the springy bows of the ribs,
the deep gutters linked
to the paraspinal troughs, that emptied
into the dark hole of the pelvis.
You knew these hollows like home,
almost comfortable there
once you’d cleaned out the matted meat
of the right upper lobe
that was once aerated lung,
before the cancer ate it.
You wondered who this was,
who would make the sacrifice
and freely give that which
used to be stolen from graves.
Didn’t they imagine their bodies
picked over by cannibals, hungry
for learning, who would expose
their insides, take parts away
in avid hands, to consume
each shred of flesh?
Didn’t they know there’d be jokes—
the young husband leaving his
cadaver-mate wife a Valentine’s note
tucked inside the left ventricle?
Who would choose this way
to stretch their time above ground?
Would they have thought only
of the slow gestation, embedded
in some student’s cortex, to form
a lifetime’s template for all
future bodies—patients and lovers?
IV
There weren’t enough corpses
to go around, so several students
shared, each played out some
internal drama on the body
of the dead father, and like unruly
children growing self-assured, quarreled
often. You fought over who would expose
the optic nerve, who severed the trochlear.
One morning you arrived
to find that the obsessive lab partner
had wrestled the cadaver
into lithotomy position to dissect
the pelvic floor, had started at 6 A.M.
and finished before you arrived.
So you probed and learned the places,
all the cutting being done.
In the territorial battles over forearms
and hearts, the things with many segments
to learn, or intricate nerve ramifications
and muscle insertions, for these
there was an aluminum bin of parts.
You could sit on high wooden stools
around the table and examine spare limbs,
pull each tendon, watch which finger rose,
make disembodied fuck-you signs
at each other’s backs.
V
The instructor shows a tape
of highlights, before doing
the pelvis. The actor playing
doctor says “First eviscerate
the abdomen” and you clench
your teeth as they show
someone scooping out the guts.
Then, “The best approach
to the pelvic viscera
is the sagittal section.”
And they show someone
pretend to cut (it had been done
in advance) down the midline
and lift away the whole leg
and groin and half the pelvis,
separate it from the body
en bloc, then zoom
to the remaining half a uterus,
It was that silent lifting away
one quarter of the body
leaving clean-cut edges,
that, more than any battle film,
had the cool and precise quality
of a recurrent nightmare’s inevitable end.
VI
A dream full of walking corpses
came in the second week. You grew
uncertain in the days, worried
about your skin and thought
what a huge burden to hold in
all that is in there—
the glistening viscera packed
under a clear omentum. You remember
in grade school the day
they showed an anatomical
picture,
it was the moment you realized
that the tube that led
from your mouth did not open up
on an empty black vault,
but that the insides were full
of colors and bulges, large
purple shapes, and were pleased
to find yourself so rich
and well housed; but scared
that the thinness of walls
would burst from the pulsing
pressure of all those organs,
those nameless things—all that
just to take peas and carrots
and bread and grind it up
into shit. You knew then
there were things that no one
had told you, grew alarmed
to find your safe shelter
part of the secret. And this
terror surfaced in nightmares—
the basement full of dead bodies
that sit up when you enter, roll
their eyes, stand on detachable legs,
wave their own and others’ hands
as they perform some tribal dance
that you are part of.
You watch as one lies down, uses
the saw to split her own thorax,
opens her heart to the air.
VII
Field guides taught those who learned
each coastal shrub and bird,
who needed to know the word
for each tree to hold off darkness
in the woods. Or, it was their way
to love the world, to recite
the names for things that grow,
our sibling creatures. We each
tame wilderness by naming it.
You wanted to find your way
in the world of flesh, surprised
to find yourself embodied so,
born out of the unyielding place
where you swam, a small fish