Hektoen International

A Journal of Medical Humanities

The face of a very trivial death

Frank Gonzalez-Crussi
Chicago, Illinois, United States

A foggy plaza in black and white, where one man is walking.
“Plaza de Valdivia” photography by Rodrigo on FlickrCC BY-NC-ND 2.0.

Of all the objects that our eyes can see, none engrosses so large a share of our thoughts and emotions as that little patch of bodily surface—so small that an extended hand may completely cover it—which we call “the face.” For here lies embodied and supremely condensed the entire strength and vulnerability of the human condition. Hence the strong desire we all have to understand the mute eloquence of the face and to decipher its strange, cryptic, gestural symbolism. But in those of us who studied medicine many years ago, this desire was reinforced by indoctrination. For our mentors insisted that the systematic scrutiny of semblance and demeanor was essential to a sound medical practice. Perhaps this explains my tendency to canvass attentively the facial features of the people I meet, even the strangers I cross on the street.

Thus, I became familiar with the mien of some persons that I used to encounter in my daily walk to the hospital where I was employed as a pathologist. For instance, I recall an old man, talking to himself in an undertone and strolling aimlessly: one might have said a loose autumn leaf, now wafted along in a linear direction, now whirled about in a fitful gust of wind. His nose pointing downward, his sunken lips and jutting chin lent him a resemblance to the “grotesques” drawn by Leonardo. The many wrinkles of his brow were like the script traced by the hand of destiny, where a Renaissance expert in the now defunct art of metoposcopy might have read the chronicle of a life ill-spent and the dire augury of a hopeless, friendless death. In contrast, there was a young fop, pert and presumptuous, of attractive oval face and big, bright eyes, basking in the widespread misconception that “what is beautiful is good” and enjoying the social advantages attached thereto. Few lines ran on his face, but a line-reader of old would have concluded that those few were superintended by the planet Venus, because apparently the high point of this young man’s ambition was to be an exquisite nabob and to besiege the heart of the closest belle. And there was also, among others of my recollection, a young working mother, bearing I know not what burden on her shoulders, and on her face the marks of a premature aging induced by the cares and clamors of a grievous domestic life. These were some of the persons that I spotted often on my way to work.

One day, as I turned a corner, I noticed a commotion at the end of a small plaza. I heard the young fop exclaim: “It looks that a guy has collapsed over there!” And I also heard an adolescent boy say to a friend, with a pitiless, cruelly gleeful accent in his voice: “Come on, hurry, let’s go take a look at the bum!” In effect, a middle-aged man, whom I had not seen before, had collapsed on the floor. Swarthy, stocky, broad-faced, and short-necked, his features differed from those assigned to individuals of Caucasian lineage. His denim garb, torn and soiled with white paint, identified him as a menial worker. The kind who fails to attract your attention if you should spot him atop a scaffold, lining up bricks in a construction site. The kind you readily avert your sight from, should he irrupt into your visual field, washing the windows of your office or apartment while suspended from a rope. An immigrant, probably. Undocumented, very likely.

How long had he been there? It is difficult to say, but knowing the ways of the battle-tumult of this world, I would wager that it was no brief spell; moreover, that passers-by had commented “He’s drunk!”; that many a one had studiously avoided approaching him; and that, at length, a compassionate soul came by who realized that disease, not drunkenness, had first tottered, then felled, that human frame.

I got there when an ambulance had just arrived. The man was very pale, but conscious, sitting, his back propped against the wall, while someone tried to give him air by agitating a magazine with fan-like movements before his face. But what impressed me the most was to hear him say to those who surrounded him, in a weak, tremulous voice: “I am sorry . . . I am very sorry . . . Please excuse me.”

The man apologized! For what? For obtruding the spectacle of his misfortune into the uncaring lives of others? What he meant to say was: “I am sorry to trouble you with my personal misery. Kindly excuse me if I have offended you by reminding you of what you prefer to ignore.” In his day of adversity, with his threadbare clothes soiled with paint and his whole life stained through and through with the sweat of his brow; in a world so full of anguish, and struggle, and disappointment; this man deemed it a lack of delicacy to appear in public with his toil-worn body beset by illness and discomposure. He seemed not afraid of dying: he was ashamed of being seen dying among men, women, and children. I could not avoid feeling deeply touched by this example of sublime politeness, this most respectful, ingratiating regard for the Other.

The ambulance took him away, and that day I thought of him no more. But now and then I gazed with delight at the recollection of his conduct. I remembered his coarse features, and by a curious act of fancy, I superposed his image to the likenesses of other people long sedimented deep in my memory. His features melted and reshaped into a different semblance each time, over and over. In the end, I saw my dead father’s face, which as a small boy I briefly gazed at through the open coffin, when an officious mourner, during the somewhat macabre ceremony of the wake, lifted me by the waist, without asking my permission, so that I could take “a last look” at the man who, they said, “had brought me into the world.” It was a frowning face that has intrigued me ever since. Did that knitted brow mean astonishment? Puzzlement? Fatigue? Simple bodily pain? Johann Kaspar Lavater, the eighteenth century’s “Messiah of physiognomy” believed that the inner nature of man shines forth through his exterior most strongly at crucial moments, such as the end of life. He advised his students to visit the wards of hospitals, in order to watch the faces of the dying, for he believed the correspondence between inner disposition and outer structure was then closest, and most apt to validate his theories.

The fallacy of physiognomy is now evident; its basic postulates rebuked and discredited. But the juxtaposition of faces in my imagination told me that, at some fundamental level, all human faces are mutually equivalent: the grotesque semblances of Leonardo’s drawings, the angelical lineaments of Botticelli’s personages, the contrite semblance of a sick man who falls in the middle of the street, and my dead father’s undecipherable grimace: they all add up to the same tally. For as Sacred Scripture puts it, in what is probably its hardest statement: “All go unto one place, all are of the dust, and all turn to dust again.” (Ecclesiastes 3, 20).

I had forgotten the street incident when, a week later, I was assigned to perform the autopsy of a patient who had died of myocardial infarction. Imagine my surprise when I realized that the deceased was the same man who, only days before, had collapsed in the street. For a while, I stood perplexed, contemplating that lifeless, inert body. Then I readied the dissecting instruments, and looked once more at that face. During life, I thought to myself, each human being is divisible by two: an exterior being, superficial, which we can see from outside, and an inner being that inhabits the realm of consciousness and is utterly private, known only to the individual concerned. In this case, the inner man was no more, yet how much of the outer one still remained! For it is here, in the face, where our identity largely resides; here is the highest sign of our individuality. And yet, the face conceals more than it reveals; it dissimulates and denounces at the same time. The coarse features of the man I was about to dissect did not bespeak the acts of generosity and nobility of soul of which he was capable. For a man is more than his facial features; more, indeed, than a collection of organs; he is his acts, his history, his yearnings, and his aspirations.

Having made these reflections, I took the scalpel in my hand. And then, without thinking, almost automatically, I did what seems to be a universal, ritualistic act among cadaver dissectors: I covered the subject’s face with a towel. Only then did I get ready to perform what a writer called ironically “the last cut,” but which, for those of my trade, is really the first.

FRANK GONZALEZ-CRUSSI, MD, is an emeritus professor of pathology at Northwestern University. Since 2001, he has retired from his post as head of laboratories at the Children’s Memorial Hospital of Chicago. He has written over 200 articles in peer-reviewed journals, briefly became chief editor of Pediatric Pathology, and authored two books on the pathology of specific types of pediatric tumors. In the literary field, he has written 16 books (five in his native Spanish), most in the essay genre. Translations of his work exist in 10 languages. Dr. Gonzalez-Crussi has been the recipient of numerous awards, including a Fellowship of the John Simon Guggenheim Foundation. He recently was awarded the prestigious Merck Prize in narrative, conferred at Rome, Italy, for his book Carrying the Heart (translated into Italian as Organi Vitali, Adelphi editors, 2014).

Highlighted in Frontispiece Volume 6, Issue 3 – Summer 2014

Summer 2014



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