The Burden of Generosity.

When I cut off a human head, I was very mindful of how decidedly unnatural, ridiculous, and wholly unearned of an experience this was.

The irony of medical school is that there is a direct correlation between the profoundness of an experience, and how little you've earned the privilege of experiencing it.

Tomorrow, I am speaking at the annual Donor Remembrance Ceremony, to celebrate the lives and the generosity of those who donated their bodies to UVM's Anatomical Gift Program so that my colleagues and I can learn. I've been organizing this event over the past few months, and it has come to mean a lot to me. I've seen it like planning a Spinning training session: structuring a specific experience for an audience -- in this case, to carve out a space in which the 150 audience members (my classmates, key faculty, prospective donors, donors' family members) can "spend time with themselves" sufficient to actively process their own thoughts.

Tonight, I'm trying to process mine.

The truth is, my 3.5 months of Gross Anatomy was one of the most miserable times in my life. I wasn't in control over ANYTHING in my life: my sleeping, my eating, my training, my LEARNING. It was just a nonstop avalanche of incoming stimuli, with the key objectives to not get smothered and/or knocked unconscious. I had never felt like so much of a failure -- so utterly incompetent to navigate the challenges of my world.

The fact that I was even PRESENTED with these challenges -- exclusively through the generosity of 25 men and women from my new community -- seemed to highlight my ineptitude. I hadn't done a THING to earn that kind of generosity.

The audacity of taking a blade to human skin. Cutting away layers and globs and globs of yellow and white fat, shearing muscle planes. The sound of bones crunching beneath my chisel. Driving a probe through the labrinth of bronchi. Scissoring flesh, teasing out the delicate nerves to their origin. The pelvic exam I performed the morning of my first VT snowstorm. You think I earned any of that?

The standardized patient who let me perform a testicular exam. The real patients who let me prod their swollen knees, touch their skin with my hands and stethoscope, feel their prostates. You think I earned any of that?

Entering medical school, I spent -- and spend -- a lot of time thinking about what it means to earn privileges. To engender confidence, to inspire trust. What it would take to earn that. Then when I got here, I was overcome by how little I did to earn ANYTHING. I felt guilty for holding this new "status," which quickly presented itself as automatically inspiring all the trust and generosity that I'd committed my life to work my ass off to earn.

The power of that transformation overcame me. It still does. I don't fully know what to do with it, other than express my gratitude. I can't ever find sufficient words.

So much of medical school thus far has been about carving out my own space, where I can balance the different realms of my life and find a version of reality that makes me feel like I'm doing something meaningful and rewarding. I wonder whether these donors saw the world that way, whether that's what inspired their generosity. I'll never know why they chose to believe in me, someone they have and will never meet. I'll never know why they chose to trust me, to trust that I would develop into the kind of physician who will dedicate her life to earning and re-earning that level of trust. I'll never know why they believed in me -- at the time, much more than I believed in myself.

But I do know that I will spend the rest of my life trying to prove them right.

(I still have no clue what I'm going to say tomorrow... and I'm okay with that.)

EDIT 4/30/09: My speech was awesome. It was pretty close to what I'd written here, barring any reference to cutting off limbs/heads and poking/prodding any orifices.