Anatomy of a Mother; our Medical Education on the back of the Poor
Friends, I wrote this story from my own experiences and observations in commemoration of Mother’s Day. This is copy righted materials. Anyone needing to publish this will require my written permission.
I was still in my very first year of medical school; this was a dog day of summer etched in my memory. I came out of the dissection room, the strong stench of formalin with which cadavers are preserved for dissection by the medical students still lingering on my fingers. This has been happening from the very first day of Anatomy Dissection class, the very first day we were ushered in the ground floor of medical school lead by the “Anatomy Demonstrator”, the junior faculty who taught us this course. Before that, we were served with a philosophical lecture by our revered professor, D.P. Barua, a scholarly bespectacled man who headed the Department of Anatomy. First few days and months were grueling as I was fighting an atrocious war with my conscious versus my need to become a doctor: I felt tremendously guilty in putting knife on the helpless dead bodies, constantly wondering who they are, how they died, why didn’t the family claim their bodies, why they are buried among the medical students, the vultures of medical profession who are shredding these human bodies into pieces armed with the cruel beaks of sharp scalpels rather than the earthly grave where everyone is supposed to be returned upon death, a final place for eternal rest. This was a battle door to door, heart to heart of my inner battle field that was laced with the mines of human fragility, values, conscious, dreams and nightmares and faith. This was perilous times, I was having hard times to keep my priorities straight and keep my conflicts checked so it does not veer me off of my path to sure success: being a doctor! What a glorious achievement for an aspiring student of science! Many a times I thought of leaving the medical school, I knew that it will surely put me in the category of “losers”, my poor parents who were working so hard as teachers and raising us with their meager salaries would be sure disappointed I knew, I could just hear my neighbors, well wishers and neighbors showering my parents with words of sympathy as is customary in this old culture where everything is everyone’s business, “Oh poor “master shaheb” I am so sad to hear your son dropped out, he has no idea what he is losing or what is good for him”. For my escape, for a while I thought of crossing the ocean to reach my lifelong dream of coming to America, but I had sense enough to know that my parents could not afford the money. So, my only option was to continue to guerrilla warfare of my own mind to win the fight so I could continue the medical school and continue to smell the formalin in the midst of stiff human dead bodies. The smell was awful! The evaporated formalin preservative brought on tears due to eye irritation and its smell lingered on even when I was outside medical school, I felt like a pregnant nauseated woman all the times.
But things have a way of settling itself; especially, if you are son of teachers with limited resources living in a poor third world country with few options open in front of you, in a newly independent country created after lots of bloodshed, which has failed utterly thus far under the leadership of its once revered founder Mujib, who just had been assassinated few years ago after he became a dictator himself and had declared that his party will be the only political party in the very country he fought for in the name of democracy choking the new country and banning all but four newspapers in the whole nation so no one dare to criticize him or his actions and whose government just had been replaced by a military junta! I could have been young, but I have seen half-rotten dead bodies before what Donald Rumsfeld called “collateral damage “of war, I have seen people dying of famine which is still fresh in my mind, I have seen people maltreated by its very own defense forces who were supposed to serve the very people both in Mujib and Zia (the leader of Coup d’état who became later president) era. I have shared classrooms with children who could only eat one time a day; and so with the help of all of these experiences by now I may not have been in the rank of great philosophers and scholars of the world, but I had enough sense left in me to understand that I did not have the luxury to escape or fight this atrocious war in my own mind for ever; for me the most intelligent decision was to shout a “Shut up dude!” command to my doppelganger thinker-philosopher, accept the reality and move on: that is to accept things as it is and work hard to become a doctor. Naturally, after a while it did not bother me anymore, I left the vision of the dead bodies in my subconscious, deep inside somewhere in the gray matter of my brain, I forgot the smell of formalin, I asked my conscious to give me a break and when it tried to lurk its head from time to time, I told it to get lost and go somewhere else, perhaps to take the spell to the son of a rich family or to perhaps in a developed country where great many options were available. I wrote my own Faustian treaty, signed it and sealed it at least for the time being. I called a truce with my own conscious and forgetting or forbearing became the technique of my secret warfare in my mind and in spite the smell of formalin; I soon could perfectly eat or drink without regard to this cadaveric smell; it was part of my life. I moved on, but the ghosts of these haunted experiences had never left me although I was able to lock these ghosts up in the deep labyrinth of my subconscious.
Today’s cadaver was a female and our “Batch C” was assigned with anatomy of the Abdomen; and when we opened her abdominal cavity, specifically the lower abdomen, her uterus or womb shaped like a large pear, the female organ for carrying baby was prominent looking. With our immature curiosity, our green hands empowered with scalpel knew no bounds; we touched the swollen uterus with our sharp scalpel and split it open! There it was, a full grown baby in perfect fetal position still carefully tucked away in a mother’s womb! The baby’s organs were fully grown although the assault of death and subsequent preservation attempt by injecting formalin under pressure in the neck and groin veins of the body by our mortuary technician Bashir and his assistant Nuru Mia have taken a toll in this protected fetus as was evidenced by puckered skin of the fetus that looked like folded leather than a real human baby skin. He was a male fetus at a very advanced stage of development; perhaps days or weeks away from birth, with a small puckered up penis in its infantile form that was so clearly visible, his testicles had not descended to the scrotal bag yet as this happens very close to birth or even after birth in some children. His elbows were folded in a perfect fashion statement of a picture pose like that of the bragging celebrities haunted by the paparazzi and his two tiny hands with little clenched fingers and fragile nails on them were in a state of eternal rest on his tiny chest, a chest that fell asleep long ago; his heart beating no more, never did he make any attempt of respiration as was evident to us later on upon dissecting the fetus itself since his lungs on both sides were still solid pink organs as opposed to honey-combed air trapped lungs that is seen in a breathing mammalian and as seen even in a new born with the first cry upon birth, his very first act, the sole purpose of which is to inflate the lungs and fill it with oxygen. This also meant that the mother was the sole sustainer of this fetus, a fetus who was so close to share the world with us, but that did never happen, a flower never blossomed, and a possibility never took shape. I remembered of my own mother’s dream on myself that my mother used to tell me, I was her second child and she was eagerly awaiting for a boy having given birth to my older sister prior to me, as she was eagerly anticipating my arrival at any time during the last few weeks of her pregnancy, her breathing was difficult and shallow as my body in her womb pushed against her lungs, she could not lie down straight on her back, she was not able to sleep but only able to take half nap like a cat: she dreamed of a full moon the night before I was born. Every time she told us this story, her face used to be flushed with pride, one could see the sort of fulfillment she experienced as a mother, and still her tears would drop like pearls dropping from tightly packed purse full with precious stones every time she told us this story. I could see in her face, in her expression and her tears of joy how much hope and aspiration she had for me. Every time I heard this story, I flet a tickle of joy I my body and soul, it gave me great comfort and pride to know that I was the anointed in her life; I was the Jesus or Mohammad of her life. I thought to myself, did this unknown, “la-warish” mother had any dream about her own child that was about to be born, was he anointed one, what hopes and dreams this mother had about her own son? Did this poor mother had pinned her hopes on her child yet to be born to deliver her from abject poverty and deprivation she was in just like my own mother had pinned her hope on me to deliver our family from the poverty and deprivation of third world? Were both of these women waiting for what Moses did for the Jews and what Mohammad did for the early Muslims to deliver their people? Years after the dissection, alone and in solitude, I would sob relentlessly trying not to make sounds lest others find out and call me a sissy. I would wash my eyes as vigorously as I could so I could erase the marks of tear from my face should anyone suspects a perfectly young man crying like a female. To me the question still lingers, even long after the dissection in the medical school class and long after I became a practitioner of healing, long after my journey from south Asia to North America, a journey of 8,800 miles, the mental burden had never unloaded, the picture never faded, the ghosts had never left me, the spirits always followed me…………….in this way I am a healer with deep gushing wound of myself, a wound that had never healed, a wound I still lick and nurse, deep, deep inside my heart, nestled deep in my psyche.
Who is this mother? I kept on wondering. Since there was no answer and neither did I verbalize my question at anyone at any time, I did not look for answer from anyone either. Instead, I let my imagination run amuck coming up with short answers for myself: I knew what she was not. I knew she could not have been from a rich or middle or even poor family, for if she had belonged to any of these groups, she would have been given a burial with lots of cries, lamentations and eulogies. She would have been taken to her home, washed ceremonially perhaps with perfumed water, once her body is neat and clean, she would have been wrapped with three layers of white cloth as is customary in keeping with the simplicity of Islam and its rituals and the last prayer or Janaza would have been held for her keeping her body in the front of the assembled people if she were a Muslim before her body would have been laid to rest in the grave of earth, a ritual same for rich or poor. If she were a Hindu or a Buddhist, the other minority communities in Bangladesh, her body would have been buried in the mound of fire-wood to be cremated and dedicated in the pyromancy of the inferno as the Brahman priest chanted his holy mantra and the transforming sounds of kirtan would have rung out in the background and ashes later redistributed to the mother earth. Perhaps a loved one would have left bits of food, some adored sweet perhaps in the bamboo-cane fenced squared area of the “Cheta”, the cremation ground lest the deceased spirit visits again.
I knew that she belonged to the social class or rather the economic class of Bangladesh where she was below the level of poverty even in the standard of a poor third world country, a class who could not afford themselves to bear the meager expenses of a simple burial or a person who was called “la-warish”, a body who had no claimant after death. These are the only bodies that were brought to the morgue of the medical schools and were used for cadaver dissection in the medical schools of Bangladesh so students like me could learn. I wondered, if she were a homeless woman, the women we see living near the garbage dump or the street corners and in the shanty towns consisting of make shift homes of cardboard and discarded materials and pretending that they are non-existent in our neighborhood. Or was she a prostitute who had to give her body for food? Did she really have a family? Perhaps they did not know that she died! Did she have other children? Who was taking care of them now that she is dead? If she died lying in the bed of the medical school hospital, did she have a last wish? Did anyone bother to ask her about her very last wishes?
Then I thought, how did she die? Was it during childbirth? That cannot be since the unborn baby was still so comfortably in her pelvis protected by the womb or uterus, looking at the fetus he made no attempt at exiting out to the world by descending down through the vagina or pushing at the opening of the uterus that we call a cervix. He was comfortable in his own watery world, consisting of the protective liquid inside the uterus that we call amniotic fluid and with uterus itself, its layers of muscles the fine fibers of which is now separated by the interloculation of molecules of formalin and other preservatives; he was perfectly comfortable in the eternal grave of his mother’s womb. Obviously, no autopsy was done for this unfortunate mother since there was no incision mark of that in this body, this was an intact body preserved in formalin, with the only wound mark on the sides of the neck like that of a Vampire’s fatal bite seen in a scary Hollywood movie and two other marks at the groin to access the large veins from down below so the soulless body could be protected from decomposition. Then I wondered: she must have died from the complications of pregnancy since there was no other external mark of violent death in this mother either. She could have any sets of fatal diseases lurking in the shadows to afflict a pregnant female from high blood pressure to infection to liver failure to kidney diseases. I knew it was too late and I had no way to know how she died but I knew the common and the most powerful harbinger of death: the poverty. Poverty is the most common denominator of majority of premature death in any country, in any society. It is the plaque; it is the syphilis of modern world. People tell me small pox, plaque and many other diseases have been eradicated from the world, we came a long way. I have no answers for these self-gratuitous claims; I just smile in my quietness, because in my heart I know far more powerful enemy of humanity, far more powerful epidemic is out there all the time making a mockery of us and our civilization; it is called poverty. So we do not need exotic diseases or common infectious diseases to kill ourselves, give us poverty and it will kill us all.
According to WHO over quarter of a million mothers or would be mothers died in 2013 during pregnancy or shortly after giving birth. Many diseases and complications of pregnancy had been attributed as the cause of it. In my mind although, the number one cause of maternal and many other deaths around the world is not due to any infectious agents or any complications but is due to poverty. It is time that we stop blaming bugs and facilities, or lack thereof, for death of our mothers. It is time that we take our own responsibility and say boldly that we humans are responsible for death of our mothers, for poverty is our making, not bugs or complications. If cause of poverty is solved, the bug problem, access problem, education problem and most of other problems will disappear from this earth. It time to stop scapegoating the poor bugs or other conditions, it is time that we take a bold stand and blame ourselves for our mothers’ death. It is the great denial of our century; it is the great passing the bucks phenomenon in the modern world we suffer from. We need to rectify it and first step of rectification is admission of our fault.
Today, taught and nurtured on the back of the poor and homeless in a third world country and unable to find my own job in the country of origin, I am serving the richest nation of the world. I thought, the situation will be changed here in the United States. But I was equally shocked to see that medical education is equally dependent on the poor and deprived of our nation as well. I remember the restless days and sleepless nights at the Receiving Hospital in Detroit’s inner city where conditions were not much better than the far flung third world I had left in the pursuit of my American Dream. In some ways I was trying to take revenge, I realized, to prove to me that if you try hard, you can do it, even an unemployed third world doctor can make it in the most competitive country of the world because of its meritocracy. And I surely did. But just like the pregnant mother who taught me in my first anatomy classes, I cannot forget my days in Detroit Medical Center and Wayne State School of Medicine. I have seen too many helpless people, too many people without access to proper education and the amenities of life, I have seen and lived in the food-desert areas of Detroit and been poached by the small mom and pop stores who charged exorbitant amounts for unhealthy ready-made TV dinners. I have seen the faces of asthma and other environmental conditions such as people living near toxic industrial dumps and getting sick. And yes, like any other cowards, as soon as I had finished my training I had moved out to serve the affluent suburbs never to look back at who taught me, who educated me; never uttering a word of gratefulness; never saying “Thank you poor people of the world! You educated me and you trained me, I owe my life to you, I owe my luxury to you!”.
Cruel and usual? Yes it is! But it is the bitter truth about medical education everywhere, from the most developed mighty superpower, home of the democracy the United States of America, to tiny Bangladesh with its nepotistic bureaucratic system. The world is set on the back of the poor, disenfranchised and the deprived. Medical system and training is no different, it is a co-conspirator and beneficiary of the same system. This was the anatomy of the mother who taught me in my first year of medical school: it also serves as the anatomic model of whole humanity and things that we have created together called rightfully or wrongfully “Civilization”. I often think and catch myself repeating like Muhammad Yunus, The Banker of the Poor, “The poor themselves can create a poverty-free world. All we have to do is to free them from the chains that we have put around them!” Is it also possible in medicine?