Guts and Yuck

We're arm deep in guts and fecal matter nowadays in Gross Anatomy, as we're studying the abdominal cavity. I was talking with one of our ethics profs today, and I think what he said captures it accurately: in medicine, there's a revulsion and fascination by the body. The body's disgusting, as my tankmates and I saw so aptly yesterday. Even though we carefully as we tied off both ends of the rectum and intestine, it still didn't keep us from inadvertently smearing bits leftover feces all over our carefully dissected kidneys and abdominal blood supply.

It's really all just digested food, for goodness sake, and after having sliced open eyeballs and sawn through facial bones and done all manners of horrible things that I wouldn't have dreamnt of doing half a year ago, you'd think fecal matter would be a small thing. But it isn't. Fecal matter has its own pedestal of official yuckness. Perhaps it's ingrained in us culturally, from parents telling their small children, "No, don't play in the doggy doo doo. It's disgusting!" The yuckness of feces has a biblical stamp too. I was reading yesterday in Ezekiel that when God commanded him to cook his food over night soil, Ezekiel pleaded mercy - "Please, I've never defiled myself!" and God granted special pardon.

But what I've found really surprising about these lab dissections is really just how beautiful the intestinal system is. Compared with the mess of nerves in the armpit and the sheer minisculeness of facial muscles and arteries, once you slice past the abdominal muscles into the peritoneal cavity, it's like opening a beautiful package: large, neatly and tidily packed together, and shiny. With a layer of fat instead of bubble wrap. It's amazing how much fits in this cavity. And when we dissected the mesenteric arteries, they spiderwebbed out like spokes on a wheel (the colon being the tire). And even though we were pretty darn tired from a long day in the lab, we couldn't help but keep on dissecting, uncovering one delicate pink arterial arch after another. Who knew guts were so beautiful? Even as you could feel, inside, the lumps of semidigested food on its way to becoming feces?

Fascination and revulsion, attraction and repulsion - that captures so much of what medical school has felt like lately. My lower back has been getting pretty sick of the contours of the dining room chair I use at my desk, my throne for two-thirds of every day. It's wearying, studying so hard and yet being in the middle of the pack gradewise. It's hard to to question if I'm not wasting my efforts doing something that I'm not stellar at. I detest the first wave of formalin that washes over me when I open the double doors into the fluorescently lit anatomy lab. Is this worth it? But then there's those small moments - the small treasures you discover like little lymph nodes among a mess of connective tissue. When I can watch House and I yell at Adam, "Hey! I learned about ornithine transcarbamylase deficiency! I know what that does!" Moments when genetics is pretty darn cool, in its simplicity and mystery. When we practice patient interview scenarios in our colleges session and I just love it - I have to restrain myself from totally dominating the entire discussion.

There is something wonderful and fascinating and humbling in how medicine uncovers our common humanity. Yet there is also something that is humiliating too about uncovering our commonality. When the professor tells us that people release 2-3 liters of flatulence a day, there is no hiding. Yet we can't help but shudder at the oozing and leaking and processing that is what it means to live in a body. Our bodies - beautiful, amazing, and downright disgusting.

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Cadavers & Communion

I've been in med school for two weeks now, and it's been exhausting. It's hard to get back in the school mode again, with no time at all to do the little things I enjoy - cooking, painting, reading, thinking, and with paralyzing fears of inadequacy and failure. I've been studying so much it feels like it's been finals-week. Yet despite it all, I've been surprised by how I have enjoyed learning the things I have (sadly, learning seems to be a different thing for me than remembering).

One of the things I find sad is how little time there is really to think, to process what indeed is going on. Particularly the anatomy dissection. I posted awhile back on dissection and cremation, but I'm learning new things from the experience itself. It's been not as horrifying an experience as I had feared, and I haven't had cadavers haunting my nightmares. Because somehow, when you subtract the gripping soundtrack and add a list of things to do and learn, the experience seems much less phantasmagorical and more common-sense. Part of it, certainly, is because the cadavers have turned pink or orange or greenish-grey from the embalming process.

Another part, though, is realizing how different life is from death. The body, when not animated by life, seems somehow much less human. It has more in common with the meat we buy from the grocery store (indeed, the shoulder muscle we looked at- the rhomboids - look a LOT like beef brisket, which is, after all, beef shoulder.) It really makes me realize that we aren't so different from animals, from the meat we eat. Despite all our efforts to make a separation (e.g. becoming vegetarian), it is indeed our soul which makes us human, the breath of God. There is nothing particularly unique about our bodily form. A sobering, humbling realization. It stands in stark contrast to the exaltation and glorification of the human body in movies and glamor and body-building magazines.

We've been attending a wonderful Vespers service at our church every Wednesday, and one of the things that really hit me last Wednesday was when the pastor said when presenting the communion, quoting Christ, "This is my body, which is broken for you. Take, and eat." And I realized really what it meant, that Christ gave His body. These generous people donated their bodies to us medical students, to be examined, carved apart, learned about. That is what Christ did. And those neat small foam wafers which we took at communion, in remembrance of Christ - they were standing in for the pieces of Christ's body. During the dissection, we cut away parts of the flesh and put them to the side, so that we can better examine particular bones, muscles, etc. That's what communion was - eating those little pieces of Christ's flesh. Gag-inducing? Twisted? Disgusting? Horrible? No wonder the Jews had such a response to this command of Jesus'.

That's what Christ did - He presented His body, broken, for us, for the forgiveness of our sins. He presented it to us that we might take it, and find life through His death. He didn't say that he presents us His soul, broken for us, but His body. What does that mean? What does that mean for the importance of the body? What does His gift to us mean?

1 Corinthians 11:

23 For I received from the Lord what I also delivered to you, that the Lord Jesus on the night when he was betrayed took bread, 24 and when he had given thanks, he broke it, and said, “This is my body which is for you. Do this in remembrance of me.” 25 In the same way also he took the cup, after supper, saying, “This cup is the new covenant in my blood. Do this, as often as you drink it, in remembrance of me.” 26 For as often as you eat this bread and drink the cup, you proclaim the Lord's death until he comes.

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Wizard of Oz, MD

"It is common for an analysand (the patient) to say that the [psycho]analyst is the most important person in his life. When I was in therapy, I thought of this attachment as the "Wizard of Oz" phenomenon. For me, my therapist became a floating head that accompanied me everywhere, with whom I had conversations that extended way past my sessions, late and night and early in the morning. Psychoanalysts often explain these intense feelings as the reenactment of childhood experiences, but they probably owe their intensity to the weird asymmetry of the therapeutic relationship… Therapy, when it is working well, is a powerful, intimate experience. … Their therapist can be their personal, sacred, perfect source of wisdom." (Of Two Minds, 104)

Can you smell the seductive scent of power? You too can be someone's personal Wizard of Oz! It is very sobering to think about the power one person gives to another. Why do we allow people to have such strong influence in our lives? And this really is not only psychiatrists, but extends to teachers, pastors, mentors, role models… Heck, if David Powlison told me that he really didn't I wasn't cut out for counseling, I'd probably drop everything and be a dermatologist or a pastry chef instead.

I think we're all hoping that someone has the answer. It might take a lot of looking under rocks and finding dirt, but we all cling to the hope that someone out there can fix us and all our problems. There's someone out there can understand us truly , can figure out why we seem to get stuck in the same muck, who can speak just the right words that will free us from the spell and hand us the key to life, love, and happiness. I want to believe that there's that perfect counselor out there, somewhere. (Cue Fivel: Somewhere, out there, beneath the big blue skkkyyyy…..)

We're built for worship, as David Powlison and his colleagues at CCEF say, and so we're primed to look for heroes to turn into our gods. And that's the danger of being a psychiatrist - that you could have that much power over a person. The mystique is only increased by the asymmetrical relationship, and you can read the silence of the psychiatrist as the deep brooding of an oracle of truth.

Yet what can be done about this? How do we counteract the tendency towards savior-complex and hero-worship? Jay Adams' solution was through biblical counselors sharing how they worked through any similar struggles, through being honest as a sinner before another sinner. He also proposed interchangeable counselors, so that a patient would come not to depend on having a particular counselor for help, but begin to look to God.

The latter solution doesn't look particularly workable in the psychiatry framework. But how about the former? Some of the best counsel I have received from my mom is when she's shared stories of her related struggle, and how she moves past that. And I think part of its effectiveness is because I start to recognize that I am not the first and only one to struggle with a particular issue, (say, of rejection) , and it gives me a door outside of my prison cell of self-centered thought, to caring and thinking about other people, and recognizing the same symptoms in others.

So what will be the consequence of handing this power to psychiatry? The ideas of psychiatry inevitably trickle down and wash culture in a bath of theories of the unconscious and guilt and self… What will be the consequence of giving psychiatry the throne of God?

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