‘Death the Leveller’

The Anatomy RoomI love the smell of formaldehyde in the morning. The prosector’s name was Charlie. He was the cadaver concierge, charged with the sacred and solemn responsibility of setting the tables in the anatomy dissection room for an unsuspecting collective of neophyte medical students. In our newly acquired, full-length, stark white lab coats, we entered the gloomy confines with trepidation and anticipation. We had heard rumours and innuendos of the happenings in Anatomy 101. Most of them would be addressed in the ensuing hours as we uncovered our shrouded subjects and began to follow the road map outlined in our anatomical “Trip-Tik” manuals. We carried our personal dissection instrument kits, like picks to unlock the myriad mysteries of the human body. We worked in teams of four, alphabetically selected, a band of brothers and sisters, working cooperatively and collectively to meet the near-impossible standards of an iconic professor of anatomy. The initial hesitancy of scalpel dissection of a human body was soon replaced by a bravado of confidence as arterial and venous tributaries were identified, tendon and ligament insertions revealed, and vital organs uncovered from their fascial envelopes. The pervasive pungency of the preservative was soon accepted as the price of doing business. Years later when watching police procedurals on TV, I learned that a dab of Vicks properly placed in the nostrils can mask the offensive aroma of formaldehyde. Each subject cadaver had a numbered toe tag. No official identifiers were provided, a way of maintaining anonymity for the thoughtful souls who had donated their bodies in the pursuit of science and enhancement of knowledge for a new generation of physicians. In time, the dissections became more mechanical, as assignments and reports took precedence over sinew and entrails. Unveiling the secrets of human anatomy was the prelude to a well-orchestrated physical examination and ultimately the fascinating composition that is clinical medicine. I recall my reflexive recoil as the white sheet was pulled back revealing our cadaveric specimen for the first time. It was an initiation of sorts, an introduction to the realities not only of death but of life itself. Over nearly half a century of medical practice, death would take many forms and have dramatic and lasting consequences. The AutopsyIn the summers that separated the years in General Science, I had the opportunity of working as a hematology technician at the Toronto Western Hospital. I became a proficient bloodletter and IV inserter over time. I also had the privilege of learning basic hematology at the desk of Dr. Dorothy Ley, chief of department. Dr. Ley guided me through the colourful cellular landscape as we shared a microscopic perspective, her legacy, a clinical life’s work. When one of her patients unexpectedly died, she asked if I was interested in attending the postmortem examination. I had difficulty containing my enthusiasm. The morgue was a sterile landscape of white tile and glistening stainless steel. On one of the examining tables lay the newly deceased. The pathologist, camouflaged in multiple disposables, introduced the autopsy procedural. I recall vividly the all-revealing Y-shaped incision, the extraction of vital organs, their meticulous measurements, the “scalping” technique for brain access and the extraordinary documentation and dictation that told the story of this unfortunate patient. Once queasiness and tachycardia abated, I realized that the autopsy experience was part of a continuum, one that would eventually lead well beyond the academics of medical school. Funerals There is something about funerals that I’ll never get used to. It’s the unsettling discomfort from the moment I drive into the highly organized parking lot. A gentleman “greeter” in a corporate-looking grey suit with an earpiece strategically placed, inquires whether I will be going to the cemetery following the service. Should I feel guilty if I answer no? The chapel, once a venue of silent contemplation and reverence is active with chatter and social greetings and even laughter. The dress code of bygone years no longer applies which I suppose is the same for restaurants and theatre today. The pews, hewn from mighty oaks, are purposely crafted for these discomforting circumstances. The services and prayers and eulogies are standard fare as is the outpouring of grief from the respectful gathering and the keening lament of loved ones. I have had the ultimate responsibility of pallbearer more than enough times, one member of an honour guard of family and friends delivering the casket of the deceased to an earthly resting place. On occasion, the casket is open for family viewing prior to the service and behind a curtain of privacy. This often is associated with a crescendo of heart-wrenching mournful cries which extend well beyond the immediate grief circle. And once the final shovelled earth has blanketed the wooden coffin, the procession disbands in Shivas or celebrations of life. The circle and the cycle of life continue for those who survive.Medical practiceThere is truth in the descriptive phrase that as a GP, I practiced “cradle to grave” medicine. I much preferred the former. Getting the call at any hour to make a home visit for the expressed purpose of “pronouncing” a patient was a dreaded necessity of death. Fortunately, my experience was limited to few such final calls. I made patient rounds almost every day in the adjacent community hospital. Some of those patients were in the penultimate stages of their final illness. I provided comfort and counsel at the bedside, held hands and most importantly, listened. I consoled the loved ones as they were searching for meaning to an inevitable and anticipated passing. I appreciated the calls of notification of death from hospital nurses and colleagues in the early days of practice. Sadly, this respectful process would not survive the passage of time. The vital need to inform the family doctor of a patient’s death was lost in a misplaced allocation of responsibility and a bureaucratic machinery focused on matters financial and budgetary and not humanity and common sense. Death was always a consideration in my multigenerational and ageing roster. When precipitous and unexpected, I was shaken to the core. The acceptance of a patient death was never an easy process, always a personal loss based on years of caring and care. When a friend diesI emailed a friend of mine on Aug. 5, 2025, two months since we had spoiled a good walk on a golf course. Ours was not a friendship that had evolved over decades or since childhood. We had been introduced only years earlier but had quickly found that we had much in common, relating on many levels. I recall thinking, on first glance, “this could be the beginning of a beautiful friendship.” We met regularly over coffee and a “breakfast special.” Two hours later we had only scratched the surface of our far-ranging conversation. We found that we both had writing interests. I spoke of my blogs and story writing and he, somewhat reluctantly, revealed that he wrote poetry. We exchanged PDFs and constructive critique. He shared new heath concerns, revelations that had shaken his usual calm demeanour and control. He sent me lab and imaging reports, consultation notes and pathology and biopsy results. He always qualified these missives with the statement that he did not wish to “intrude” on our friendship. I reassured that as a retired physician, I had infinite time, especially to interpret the vagaries and complexities of medicalized reporting, for a friend. In time, and after extensive investigation and surgical probing, the initial prognostically pessimistic outlook became more favourable and reassuring. The bullet had been dodged, and life took on an air of optimism. In my August email, I provided an overview of the summer of ‘25 at my cottage and caught him up on family and my personal pursuits. My final line, “Would be good to catch up over coffee and sustenance but will likely have to wait until September which is only weeks away. Looking forward to a more personal catch-up”. On August 6, my friend responded, “Hi Doc, I’ll be updating you on my most recent follow-up visit to the oncologist after I see him on Friday. These few days before going to Princess Margaret are a little tough for me. I have not hit a golf ball since our last game. Maybe in the future but I’m not banking on it. As far as other ailments go, I’m OK. The odd pain here and there but nothing real problematic. I’ve lost a few more pounds which is good, I suppose. I haven’t written anything of consequence for a while, but I hope to get started again. All the best, my friend. Let’s get together when we can. Just let me know when you’re available”. On August 17, I received a “sad news” email. My dear friend died in hospital after an unforeseen and hopelessly aggressive 3-day illness, the etiology of which was a diffusely metastatic, inoperable, intra-abdominal cancer. In his limited final hours, he was surrounded by his loving family. They barely had sufficient time for goodbyes. I attended the funeral and sobbed when I saw the casket. I listened to the reflective words of the various eulogies and stood at the graveside as the casket was lowered into eternal rest. I performed the “mitzvah”, the honour, of shovelling earth onto the casket and walked away shaken by my friend’s loss. I think of my friend often. I still have difficulty accepting his death. This one, I took personally. In June, I will return to the graveside when his headstone is unveiled, the ceremonial acknowledgement of a life lived and the consolidation of a memory everlasting.James Shirley’s poem, “Death the Leveller,” asserts that earthly power, wealth and glory are temporary, while death is the inevitable fate that reduces everyone to the same level in the dust.May the memories of those passed be as a blessing.

‘Death the Leveller’

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Blog Author

HOWARD GOLDSTEIN

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