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  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,

  feel your separateness in the swing

  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,

  one ovary and fallopian tube.

  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