The end gets lost in philosophy, the middle watches as a pig dies in a lab in western Massachusetts. The beginning, I saw bioluminescent plankton for the first time one night while washing dishes off the back of a boat in the Philippines. My fellow dishwasher was a producer for CNN Asia who said he saw no appeal in the idea of God. We talked about writing and my work as a physician, and he suggested that I send an editorial his way if I saw something medical in the news. He then jumped into those dark waters and swam in a slow arc. Green sparks followed his body, then vanished.
A few months later, Kyushu University opened a museum exhibit that gave a brief account of a war crime committed on their campus in the waning months of World War II. Eight American airmen were turned over to university surgeons after their B-52 was brought down over Japanese soil. According to the only available account, they believed themselves safe as they were led to the operating theater. Instead, limbs and organs were removed. None survived.
Vivisection is the technical term. Vivi (to live) and sectis (to cut), or live dissection. It took me a lot longer than it should have to recall that I had seen a vivisection before, and longer still to remember that I had also participated in one. Not the human kind, which is a war crime or the work of a serial killer, but animal experimentation, which is what the word vivisection has meant for most of recorded history.
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I watched an orangutan die on a sunny afternoon sometime in 1999. Not your typical overcast Oregon sky. Clear, sun-soaked day. Green grass.
The orangutan was carried into the room, a man on either side. Sedated, but not unconscious, she looked at me for a moment as they walked her to a metal table in the center of the room. Some additional anesthetic was given, her eyelids were pinched to ensure she did not feel, and then she was casually disassembled. The cap of her skull was taken off with a bone saw and her brain removed, then her lungs and heart, then her abdominal organs. After the end, her skin lay on the metal table like an empty sack of cloth in a pool of blood.
I was toward the end of high school at the time, doing science because it interested me and also because college admissions. Most of my work at the Oregon Primate Research Center had to do with protein electrophoresis and splicing bacterial DNA. The only nonhuman primate I ever saw there was the orangutan.
Years later, I wonder if I should have registered protest at the killing of this animal. Maybe it depends on what kind of research was being conducted. Maybe it doesn’t. Which side of the divide do you fall on? What is an animal, and what, if anything, is owed to them?
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“And God said, Let us make man in our image, after our likeness: and let them have dominion over the fish of the sea, and over the fowl of the air, and over the cattle, and over all the earth, and over every creeping thing that creepeth upon the earth.”—Genesis 1:26. Which matters for the separation between man and beast and the word dominion.
Seventeenth-century mathematician and philosopher Rene Descartes put forth the theory that animals were automata—creatures without souls, whose expressions of joy and pain were the result of clever design, unlike mankind, whose souls were joined to their body via the pineal gland. Around this time, William Harvey conducted countless animal vivisections on every kind of creature, from eels to dogs. His work on the circulation of blood (1628) overturned centuries of Galenic theory, which held that blood was created within the liver and then dispersed throughout the body at a rate of several liters per minute. Important is that this set a foundation for future work in biology and also that he cut all of these animals while they were alive and awake.
One of my former coworkers at the Oregon Primate Research Center used to pass out cards to protestors that allowed the bearer to voluntarily forgo any vaccines, medications, surgeries, or other procedures developed using animal work. There was a list on the back, though so much of modern medicine has been built upon animal research that it would be impossible to become a medical vegan without avoiding the system altogether.
Peter Singer’s Animal Liberation (1975) begins by quoting Bentham: The question is not, can they reason? nor can they talk? but, can they suffer?
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I remember a crashing patient in the trauma bay during my fourth year of medical school who got a chest tube to each side. One on the right by the chief surgical resident and another on the left by the division chief of trauma surgery, who ordered me to get some iodine on the patient as he pulled on a pair of sterile gloves. I poured some iodine on a piece of gauze and started scrubbing furiously, which apparently was not what he had in mind, because he started yelling, “Take the cap off the bottle and splash it right there, where I’m pointing. OK, good.” His hands moved so quickly I couldn’t tell what he was doing, and by the time my brain caught up to my eyes, he was done. I looked over to the other side of the patient to see the surgical chief resident had barely started.
A lot of procedural fluency depends on feel and familiarity, so on another day in that same hospital I stood inside an animal lab, staring at a row of anesthetized pigs. That session was meant for first-year emergency medicine residents (also called interns, or sometimes “baby doctors”). We learned to place chest tubes while the animals were unconscious, their breathing assisted by a row of portable ventilators. The pigs were then euthanized, and we practiced surgical airway techniques.
To place a surgical chest tube, make an incision in the skin at the level of a rib, then take a curved clamp and bluntly open up a tract beneath the skin but up and over that rib until you are just on top of it (nerves and blood vessels run on the underside of ribs, which is why you want to enter from the upper rib edge). There you push through the layer of muscle that holds that rib to the one above it, until you pop into the space between the rib cage and the lungs (the pleural space). Spread the tips of that clamp apart and tear enough of a hole in the muscle to insert your chest tube, spreading the clamp open as you pull it out of the chest to tear through muscle fibers. It is a little barbaric, but far safer to use a blunt object than a sharp one.
Ultimately, I found the animal training exercise useful. A sentient creature lost its life for the sake of that training. Is that acceptable, I don’t know. The question did not even cross my mind, which makes me worry. There is a case to be made that for many procedures, requiring trainees to practice first on an animal model may be a kindness to their future patients. When the animals were killed, I wondered for a moment what we were doing, and then an injection of potassium chloride stopped their hearts, the same chemical used in lethal injection cocktails.
That I gave those events so little thought at the time makes me worry that I don’t have a moral conscience. If I am an animal rights advocate, what I did to that creature is monstrous. If I believe in the divine right of man over his dominion, what I did was the will of God. There should really be a middle ground of some kind, some way of acknowledging past sins without being bound by them. Moral standards change. Maybe the fact that the actions of our predecessors elicits moral discomfort means that we have made progress. Or maybe it means that morality doesn’t really exist.
This trip down the philosophical rabbit hole falls right past ethics into metaethics, or, What exactly is it that supports any given ethical system? Does absolute right and wrong exist, or is it all just a matter of context? Is there such thing as a moral fact? Is it Because God?
The problem with this sort of introspection is that for me it naturally leads to taking inventory of my own failures, which may not be the healthiest exercise. But it is both frightening and important to look back, because there are moments weighted with significance that in their time passed by without notice.
I remember a young woman with sickle cell crisis breathing through pain in the late afternoon heat of rural West Africa. Someone later told me that at age twenty-one, in this place with that disease, she had already outlived her life expectancy. By that evening her body would lie in a building apart reserved for the dead. I was a new med school graduate in a new and unfamiliar country and a new role, and while I made sure she received fluids, antibiotics, pain medication, and oxygen, I could have done more to treat her pain.
I remember another conversation years later about how to carry on after a complication, maybe my fault, maybe not. Yes, it is true that these people were sick to begin with, and we did not make them that way, but there is also accountability and the opportunity to do better, and yes, the system is defensible and essential, but does any of that really matter when I am asking myself, Why did I not do more to ease her pain, and all of my answers and mitigating circumstances mean nothing.
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There is something comforting about the sea. I used to swim across the bay next to Castle Island when I lived in Boston, where if I floated on my back I could watch airplanes beneath the clouds on their final descent toward Logan International.
I think it is the slow breathing of the tide. Reminding me that I need not worry. That to the sea, I do not exist. All these troubles and concerns, failures or shortcomings, however life-altering or even life-ending, they hold no meaning to what breaks against the shore.
I jumped from the boat into the darkened waters of the Philippines and saw the ocean come alive with startled flecks of light. The sea did not whisper about the pig or the orangutan, about guilt or accountability. I swam to the anchor chain and watched the slow tide wash, trailing motes of light beyond the links of metal.
