What the body teaches: lessons from the autopsy table

Someone once asked me what unique understanding I as a pathologist derive from my professional contact with the dead. I said that the autopsy teaches the transience and the fragility of human life. My interlocutor replied that, in that case, the autopsy teaches nothing, "since we knew that already." He missed the point. The truth is that most human beings feel themselves indestructible. They may know that death exists and is inevitable, but this, they seem to think, applies only to others. In the inertia and unbroken continuity of their daily lives, they come to believe that a tomorrow is guaranteed for them. It takes a sudden jolt, a tragedy, a near-death experience, or a grievous, wrenching bereavement, to give an inkling--and this may be fleeting, soon forgotten--that no guarantee exists for any of us. But the spectacle of an autopsy, at least when it is watched for the first time, flashes this realization abruptly to our face. Not a purely intellectual realization, not abstract knowledge, but a "visceral" knowledge, so to speak, a cognition deeply anchored in the gut and in the marrow of our bones.

My years performing autopsies convinced me that the proximate mechanism of death--the personal style, so to speak, of "crossing" through--is highly varied and individual. Our mind is fond of classifying, and reducing the infinite variety of the world to a few comprehensible categories. Yet classifying is by no means a portrayal of reality: it is a simplifying device that we use for the sake of maintaining our sanity. When it comes to the body's breakdown, the truth is that, as a wise axiom put it, "there are no diseases, only sick patients." No two deaths are identical, even though we affix, for convenience, the same label to both. Arteriosclerosis, lupus erythematosus, and pneumonia are fine-sounding terms of Greek lineage, but they may describe organic catastrophe in some, and mere subsidiary complication in others. And the same catastrophic disease never leaves exactly the same marks of its pathology in two different patients.

Nor does it take massive destruction or the organic cataclysm of advanced, systemic diseases, to fell us. The sword of Damocles that hangs over our heads is suspended by a thin and flimsy thread, indeed. It may fall at any time. A rupture in a small blood vessel, a blood clot that is accidentally dislodged; nay, a raisin, an olive, or a cherry stuck in the larynx: it does not take much to sever the thread of our existence.

All creatures are like prisoners on death row, whose lives are prolonged thanks to indefinite postponements of their sentence. Still, man is the only prisoner who knows he is condemned to capital punishment; that the sentence is without appeal; and that it has been passed already. This was somberly depicted by Pascal, when he wrote: "Imagine a group of men condemned to death, all in chains, and of which a few are daily slaughtered in full view of the rest. Those who remain see their own condition reflected in that of their fellows, and look at each other with pain and hopelessness, anticipating that their turn is coming. This is the image of the human condition."

That man is the only being capable of understanding his future death, and worrying about it, has become commonplace in philosophy, but it requires modification on at least two counts. First, it is not at all certain that animals (those that we call "superior" animal forms, anyway), are entirely without knowledge of their future end. When we observe the lengths they go to when confronting lethal threats, we have reason to doubt the assertion that some animals don't know what death is. Needless to say, when we claim that they may "know" something about death, we are not implying that they know it in the same way as human beings know about their own death. We must admit that there are different ways of knowing; and the modus cognoscendi of animals is barred to us. These are facts we must live with: that there are different modalities of cognition, and that only some are open to us.

Second, the assertion that the human being lives anguished by the understanding of his own death, is also subject to qualification. True, it is a feature of the human mind to be able to represent events that will take place in the future, but death itself is not representable. Pascal's words once again: "All I know is that I must die, but what I ignore most of all is that very same death that I cannot avoid." So it is, for death is unthinkable in an absolute sense. We do not know--cannot know--what it consists of. There is nothing with which it may be compared. It falls entirely outside of the realm of human experience, and consequently outside of what is conceivable: How can we represent to ourselves, who live in space and time, what it means to be outside of time? Therefore, the mind naturally resists the exploration of this theme. However much we may wish to seize it and examine it inside and out, death is not an object of thought. Like all the absolute themes, this one may be compared to a perfectly smooth, round, uniform object that the mind attempts to grasp in vain. It always eludes our grasp. There is nothing in its utterly level, evenly terse surface that permits the mind to hold on to it; there is no crack, no fissure, no promontory to be hooked or secured.