Burnt human flesh is probably the most traumatizing odor in existence. The whiff of epithelial cells, fat and hair, is a smell far worse than urine, feces and vomit, simply because it is so unnatural. Boiling water, oil, electricity and fire should never, under any circumstance, meet human skin head-on. Skin cannot win, ever.
My senses have not missed this smell which have laced the corridors of casualty, mostly in winter when poverty and warmth disagree. The smell is unmissable and the sight is equally as bad. The way the peeling skin folds onto itself in response to the emitted heat, is like the crumbled up duvet on your Sunday morning unmade bed. I imagine the cells and its precious DNA melting, the fat grilling and the muscle drying in the face of hell-ish heat.
I remember so clearly the smell and sight of a young gentleman being wheeled into casualty with around 70 percent body burns from a fire. In the cusp of the moment, I was transported back to medical school where we sat on shiny stools in a giant hall staring at Cunningham’s Dissection Manual. The excitement of treading through the sacred right of passage of medical school, the dissection of the human body quickly turned into a spit of revulsion for me. I could not concede.
The objectification of the human body stripped away the basic humanity of whom the person-turned-cadaver was. I battled with nausea for almost 6 months. I welcomed the acidic vapor burn of formaldehyde on my mucosa, distracting me from the vomit creeping up my oesophagus.
The first day of dissecting a human body for me felt like an out-of-body experience.
Every single person around me had normalized the experience before we even began. After all, how were you supposed to help save lives if you didn’t know what the internal components of it were? The justification made sense to everyone around me, except me. Our professors were the best at dabbling in human cadavers, their blasé attitudes gave them an edge of arrogance. “I’m so tough and detached, I can saw through this cadaver with my eyes closed” type of attitude. The underlying notion I perceived was of —less emotion, more strength, better doctor. I don’t know who set that precedent but I didn’t understand it.
Don’t get me wrong, the anatomy professors were brilliant in their own right and never intentionally disrespectful. It wasn’t the people I had a problem with, it was the entire concept of skinning a human being from head to toe and eviscerating every organ in their body.
Who allowed this and why was it legal?
During examinations, stations were constructed with body parts where we had to identify different anatomical structures. OSCE spot 9 was a hand, a mangled flexor retinaculum with the median nerve bound by a frayed green string. “Name the structure, the course and 1 condition affecting it”.
I looked closer at the thumb and noted the exaggerated fingerprints, the wrinkled skin just above the dissection scar. My mind couldn’t comprehend the graphics of the situation.
“I wonder who once held this hand.”
I walked away and swallowed my vomit, again.
The first month of medical school made me hate everything the foundation of medical school was built on, and dissection hall was a big part of it. I would drag my feet to dissection hall only hoping no new cadavers would turn up.
I hated the repetitive new feelings of sadness I wold feel. I silently wondered why we never looked at the face, or even knew their names. I remember standing close to an anatomy Professor wondering how he would have felt if he uncovered the cadaver and it turned out to be his grandmother, or mine. Would we still be so detached? Would we saw through the chest with the same amount of vigor? Would we squeal with excitement when we found the aorta?
I quickly realized the irony of dissection hall and the metaphorical assimilation to life. The ease in which we compartmentalize humanity to only when it suits us. If its not personal, it doesn’t matter. After all, the lady who lay before us was someone’s grandmother. She had a name, a life and a story. But it didn’t matter to us because her humanity was irrelevant to our cause. And that bothered me deeply.
Back to my story, the young gentleman with a charred body reminded me of dissection hall because his almost-deadness was so obvious. His body was completely burnt from the neck down, his limbs contorted by the shrinkage of the tissue. I was panicking. How am I going to get intravenous access? He needs IV fluids and pain medication, stat! I imagined him to be in excruciating amounts of pain. The jelcos refused to penetrate the burnt skin as expected and I was forced to stick a needle into his bone, he didn’t even flinch. It was like trying to cut biltong with a straw. The feeling of charred skin under my gloves made my hair stand on ends and the familiar feeling of nausea surfaced. The gentleman opened his eyes and mouthed something to me. I was shocked ( and he wasn’t).
He was very much alive. His pulse was strong, his oxygen sats were holding and I was still panicking. People just don’t survive 80 percent burns and The prognosis is usually dismal. I looked up to see him his eyes flicker. He lifted his hand, waving to me.
“I cant feel any pain” I couldn’t believe it until I realized he had sustained 3rd degree burns. He had literally had his entire skin layer with all nerves and vessels burnt to smitherines. I called the surgeon on call and watched the fluid run into the bone, hoping it wouldn’t stop or infiltrate. The surgeon arrived and was less shocked than I was at the burn, but very surprised when he spoke the gentleman and received a reply. “How are you still alive boet?” He needs an escharotomy and debidement of well, everything, for what its worth.he shrugged and went off to prepare for theatre.
After my shift was over and I risked diving into a self loathing depression, I decided to allow myself to think about this gentleman. I say ‘allow’ because when youre a doctor, you need to learn how to compartmentalize quickly. And if you don’t, your emotions follow you everywhere like a sick puppy. You will find yourself eating supper, overwhelmed with sadness about a 3 day old death.
I wondered how he was doing and popped into ICU before morning rounds. I remember seeing his empty bed and feeling a pit form in my gastric mucosa. The ICU nurse explained to me that his organs failed all at once, quickly. He deteriorated without having any sort of pain. His nerves had been damaged to the extent of numbness. He died unaware. His body could not even feel the wave of motality leave him. In some way, I felt like he was robbed of it.
I saw the scathing of a 3rd degree burn in the medical world. I run the risk of sounding cliché but I don’t care. Some situations root itself so deeply in changing us, we are completely unaware. We wake up, oblivious to the inability to feel the cover of death, under the guise of the dreaded fold of complete….. apathy.
What a great read, thank you for sharing your experience Dr Moosa. I really enjoyed reading this. Although I’m not a doctor, this really helped me to appreciate the type of desensitization doctors may have to go through in order to do their jobs effectively. I wanted to ask, maybe, is this job just not for everyone? Does it take a certain type of natural apathy in certain people (such as how you described your professors) in order to excel in this position? I thought that being empathetic and emotionally sensitive may help me as a medical professional but now I’m not sure… lol