Prof. Dr. Irany Novah Moraes
Physicians are privileged!
In their undergraduate course, they learned from death and from suffering. The very first lecture, in all the courses of which I am aware, is on “respect for the cadaver.” I personally attended the most brilliant of these, delivered by RENATO LOCCHI, in which he warned of the intensive and proper use of time, which passed all too quickly to allow one to learn the entire human body well enough to become a physician. He called attention to the fact that we were going to study on the cadaver, and that it deserved the most absolute respect. In the course of the lecture, with a broad, firm and continuous gesture, drawing back the white sheet, he uncovered the table, and on the cold marble lay the cadaver of a young Black woman. The same one with which AFONSO BOVERO had given his inaugural lecture, several decades before.
The impact triggered by the abrupt exposure of the cadaver made a profound impression on the young students; their minds were thrown into conflict, trying, in a flash, to grasp the span of life and the span of death. The woman, with her delicate face and a sad, placid countenance, fixed in formaldehyde for longer than she had been alive, was permanently unchanging. The imagination, with its wings unbound, showed life passing and death remaining!
LOCCHI, with erudite speech, of a vibrant timbre and incisive gesture, indelibly imprinted this moment on the student’s memory. The young person had the sensation of entering a mystical world, where death was present to teach the secrets of life. He learned to respect the mortal remains, fragmented by dissection, as being part of the body of his fellow human. The cruelty of life became evident, life that through misfortune had placed her in the condition of a “specimen” for study. There remained, too, the impression that fate was exacting, after death, the toll that perhaps in life she had inflicted on the society of which she was a victim. Those circumstances marked, for the future physician, his beginning in the relentless struggle against suffering and death. The moment was carried by the dazzling personality of RENATO LOCCHI, and two enormous forces clashed: the vigorous energy of youth, present there, attentive and perplexed on one side, and the coldness of death on the other. The student felt as though he were taking part in the ritual of his initiation into the priesthood of medicine.
To illustrate the tradition of this kind of inaugural lecture, I reproduce in full the one delivered by GERSON NOVAH to the first-year students of the Faculty of Medicine of Ribeirão Preto, also of USP, in 1953, and recovered by FÁBIO VICHI LEITE:
“My students:
Upon entering this Faculty, you underwent an austere, competent and rigorous examination; its result is eloquently expressed in your very presence in this room, in those happy expressions of victory and of effort rewarded.
You know that victory and effort bring irrefutable rights. I want to speak to you a little about those rights. The first of them, certainly very great though not the greatest, is that it assures you, in this discipline, a calmer, almost carefree study, without dangers of cadaveric infection, without dangers of contagion—risks and dangers wholly removed by the advent of the formalinization of cadavers.
Some of you, less restrained, quicker to judge and readier to smile, will find this right banal, almost trivial, even insignificant, a true counterweight to the great effort demanded of you. You are not right, if you recall that Anatomy passed through dark and difficult days, through a frighteningly tragic past, at a time when public opinion, dominated by a mysticism respectable up to a point but wholly unenlightened, absolutely forbade the study of Anatomy on cadavers.
Whoever practiced it would be subject to the vindictive and primitive fury of a bloodthirsty horde of mystics ready to carry out the most primary of justices… or rather the most primary of injustices…
But the anatomists of that time, martyr-geniuses of knowledge, braving the dangers of being considered violators of cadavers, at nightfall, protected by the darkness, aided by the dim light of the moon—that eternal accomplice of the heart—these anatomists, I say, joined the vultures of the fields to steal the cadavers of executed criminals which, on somber trees, swung like strange pendulums of the clock of human justice.
Once the prey was stolen, sometimes already putrefied, other times still bleeding, the nocturnal usurper, risking every manner of infection—cadaveric infection—and the dangers inherent in the undertaking, without means of preservation, carried out, under the agonizing weight of so many threats, the great discoveries that honor and ennoble the science of anatomy.
At other times things happened differently; once the criminals had been executed, their bodies were to receive a proper burial. The difficulties were now greater; it was necessary for clandestine vandals to carry out, in the cemetery itself, at night, the exhumation of the cadaver; but once the intention was known, shock groups organized themselves, armed and hidden, prowling among the tombs in wait for the exhumers; the encounters were terrible and often fatal.
At that time a well-known English anatomist was approached by a man who offered to sell him the body of an executed criminal who was to be buried that very afternoon, stolen at dusk and delivered, that same night, to the man of science.
Restless, impatient, alone, he watched the hours go by without any news reaching him. Night was already giving way to the small hours when, in the heavy silence, an anxious and violent knocking at the door announced the arrival of the messenger; a figure, with evident effort, with difficulty, carried on its back another, inert, limp, still bleeding. The one who brought the cadaver was not the man who had made the arrangement; it was a female figure, an image of color and suffering, of anxiety and despair, of martyrdom.
There had been a struggle; the cadaver could not be stolen; the urgency of putting food on the table in that woman’s home was great; her husband, the man who had made the arrangement, had fallen dead in the encounter. This was the last financial contribution of the spouse—there lay his cadaver, to be sold…
Tragic stories, and yet simple, isolated and scattered incidents of the great tragedy of Anatomy.
Let us return to your rights. A second right you have won, my students. The right to have duties, and, among those duties, there is one that exceeds all the others: respect for the cadaver and for the austerity of the setting.
Remember that the physician’s formation and his entire life are shaped in death and in pain; beside the cadaver or beside the patient’s bed. As in a cemetery, one enters a department of Anatomy with the heart and with the soul. In the former, in despair and pain; in the latter, with respect and gratitude.
Remember that here “death takes pleasure in aiding the living”; remember that in our familiarity with death we often find a meaning for our own lives.
Do not treat the cadaver as mere study material. Contemplate, in the cold, pale, almost transparent face of the dead, in the serenity of the countenance, how it conceals from you the bitterness of the castaway or the agony of a prolonged suffering; contemplate, in this flayed body, in these piously abandoned and fallen limbs, someone who was perhaps still alive yesterday; someone who, like us, had a childhood, a family, affection, a home; someone who was a child and who was young; who had sorrows and joys, hopes and disappointments, but who, unlike us—who counted on the complicity of a favorable destiny in birth, growth, education and instruction—for them, the strange game of chance reserved only the place of outcasts of fortune, of social castaways, of human rags.
Remember that they lacked everything, even the friendly and welcoming gaze that, however grieved, might receive, in the anguished and final instant, the last appeal, the last plea, the last flicker.
Remember, too, that however burdensome, useless, harmful or noxious these remnants of humanity may have been, the service they now render to the common good, to this and to future generations, well redeems their guilt for having been the misfits of their generation.
My students: these counsels are not new, nor are these ideas mine. They are counsels and ideas that speak to the heart and to the never-denied nobility of youth. They are therefore common property; they are universal. Heed them—this is my request; heed them—this is your imperative. They will not fail to speak to the sensibility of future physicians.
And remember still, either you already have, at this very instant, the sensibility of a physician, or you will never have it. Today is the true day of your professional decision; if you do not feel worthy of the priestly vocation, for our good, and more than that, for your own good, cross for the last time today the narrow thresholds of this door, which represent the thresholds of medical initiation, because if you do not worthily wear the robes of the novitiate, you will never wear with dignity the sacred mantle of the priesthood.”
At the end of the long course, still in their youth, by legal requirement, upon graduating, they take a solemn oath—a very serious one, for, invoking the Greek gods, they assume a rigorous ethical commitment that governs their conduct in the exercise of their professional life and, consequently, of their social life as well, for one cannot remove from within the physician the human being that he is. The closing words read as follows: “if I keep this oath faithfully, may I enjoy in life and in art good repute among men and forever after; if I stray from it or violate it, may the opposite befall me.” To assume, with clarity and awareness, this obligation without yet knowing that it is a privilege—and forever—is, above all, a great responsibility. The fulfillment of this promise can only be achieved if there is naturalness, and if it requires no great effort, and for that, one must have a vocation.
This is what will make the practice of the profession easy and harmonious, giving pleasure in exercising it, which leads the physician to devote himself with devotion and consequently to succeed, accompanied by the inner reward that produces peace of mind, which in turn makes it possible to attain personal happiness, being aware of a state of perfect inner satisfaction. The secret to fulfilling this vow lies in keeping alive the flame of eternal enthusiasm, which can be inspired by the “Meditations” of the Stoic philosopher MARCUS AURELIUS, of the 3rd century A.D., which were taught to me through the repetition and the examples of ODAIR PACHECO PEDROSO and LOURDES DE FREITAS CARVALHO, over many years in which I lived alongside them, first at the Hospital das Clínicas of the Faculty of Medicine, then at the Faculty of Public Health, and finally with DRA. LOURDES alone at the University Hospital, all of the University of São Paulo, and which I will now set out.
To take refuge in one’s own soul, to live in perennial exercise of self-reflection, in order to correct error and refine the spirit.
To seek, thus, independence from external things, making the soul courageous in the clash of passions, indifferent to intrigues and trivialities.
To bear with resignation the reversals of existence, without ever bowing down.
To live diligently, directed toward solidary action aimed at the common good; taking care, however, that each one receives according to his merit.
To decide with firmness and serenity, after criticism and deliberation.
To be benevolent and attentive toward friends, tolerant toward those who err, because they do so out of ignorance, and the harm profits only themselves.
To understand the power of love, because invincibility is the privilege of those who show solidarity and who understand that there is, after all, in all of us, one and the same nature.
And, finally, to accept pain and misfortune as lessons, insofar as the most solid teachings come to us through suffering.
In conclusion, I want to suggest to the young, and particularly to resident physicians—that they adopt this philosophy of life and be firm individuals, masters of themselves, unshakable, imperturbable and austere, for only those who permanently fight for life have a right to it, and thus they succeed in attaining the greatest plenitude: complete inner satisfaction!
