Rite of passage for first-year medical school students: meeting their cadavers
It's a word that gets your attention, conjuring up an image of a dead body on a hard slab in a cold, silent morgue. It especially gets your attention if you're going to be meeting one soon—which is what this year's class of incoming medical students did Sept. 1 on their first official day of medical school instruction.
All entering medical students must take Surgery 203—Anatomy—in which they dissect a human cadaver. As head instructor Lawrence H. Mathers, MD, PhD, associate professor of surgery and of pediatrics, put it in his introductory lecture, "This course is a little different from courses you've taken up to now."
Part rite of passage, part personal test, anatomy class is always the subject of anticipation and apprehension. Almost every medical student wonders how he or she will react when it's time to start dissecting a dead body. On that Thursday afternoon, the 86 members of the first-year class got to find out.
"There's so much mythology around anatomy class," said Juno Obedin-Maliver, reflecting on her experience a few days later. "I was really nervous before the first day. You don't quite know how you're going to react—I'd never been around a dead body before."
At 2:45 on that afternoon, when the students entered the anatomy laboratory, no bodies were evident, just long blue bags, only vaguely human in form, lying on each of the stainless steel tables, all in rows. A light scent of embalming fluid hovered in the air, minimized by the air intakes on the sides of the custom-made examining tables, which help to remove odors.
After everyone was issued gloves and found their assigned station—three or four students to a table—Mathers' voice rose above the din of conversation echoing around the lab. The students quieted as Mathers called on them to observe a few moments of silence to honor the people who donated their bodies.
Then the lesson began: How to slice open the skin on the chest and dissect the muscles underneath. One of the instructors, John Gosling, MD, professor (teaching) of anatomy in surgery, unzipped the bag on the table next to him and folded it back, revealing a lightweight, white cloth draping a body. He pulled the cloth down to the waist, baring the chest and arms. The head remained covered with a white knit sock, as did the hands.
Gosling instructed the students to make the initial incisions, cutting outward from the jugular at the dip where the collarbones meet, then down along the sternum and outward along the lowest of the ribs. He had all the students feel the corresponding parts on their own bodies as he talked, then sent them off to their tables to begin dissecting.
With the first cut, the room became a sea of bowed heads and hunched shoulders. Everyone seemed focused on the task at hand. Only an occasional head poked up above the huddle of tablemates' shoulders with a question for an instructor. As the class progressed, students became more comfortable and circulated around the room, examining each other's cadavers, beginning to get a sense of the biological variation among the bodies.
For Andrew Hsu, who'd been looking forward to medical school for several years, finally touching and dissecting a human body felt like the opening of a new chapter in his life. "It's sort of like making your dream tangible," he said. He became so absorbed in the task—his face just inches from the cadaver's chest—that an instructor told him to pull back for safety reasons.
At one table, the students were having a hard time peeling back the skin. Teaching assistant Catey Bradford showed them how to cut a small slice in one corner of the flap, so they could put a finger through it for a better grip. "Cutting through the skin the first time, you kind of feel like you're being a little too rough," observed student Brooke Lane. "I noticed people kind of being bothered at the way you just have to kind of rip off the skin."
Gosling mentioned to another group that at some point they'll be told the cause of death of each cadaver.
"Will we get to know any other information about the … people?" asked Aliza Monroe-Wise, a student.
"All that there will be available will be the actual cause of death," Gosling replied. He then recounted how a senior instructor at another medical school had willed his body to the school and died while still on the faculty.
"I think it would have been a little embarrassing to say, 'Oh, that's Doctor Smith there, remember he taught you anatomy last year? Well, there he is," Gosling remarked. "It gets a little delicate, so it's probably best if you just know the cause of death."
After everyone had loosened the chest muscles and cut the ends that attached to the sternum, dissecting was done for the day. Students began cleaning up, putting the muscles and skin back on their cadavers and chatting about the afternoon's experience. "I keep apologizing to him, " said one student, referring to her cadaver, which clearly wasn't noticing anything she did. "I don't think he's feeling much pain right now," she added.
Upon reviewing the afternoon, the three instructors agreed that it had gone smoothly, though Gosling had spotted one student, sitting on a stool, turning white. He quickly intervened, and the student took off the rest of the afternoon. The next class the student was back at the table, successfully dissecting his cadaver.
Adverse reactions to cadavers—even in medical school—are hardly unusual. About 5 to 10 percent of students experience some sort of disturbance to their sleeping or eating habits, according to Mathers, who for several years conducted a study of how students cope with dissecting. He said their reactions bore a strong resemblance to post-traumatic stress disorder. "But most of those changes seemed to be temporary," he said. "Typically they adjust and they come to grips and are not burdened or troubled by it on a long term basis."
By the end of the third day of dissecting, the atmosphere in the lab had relaxed considerably. Students talked easily while they examined the human hearts that they had plucked out of their cadavers.
Obedin-Maliver said she was no longer nervous. Putting on scrubs and going to dissect a cadaver "now seems pretty normal," she said. "We don't really talk about it that much. Maybe that's something a little strange."
Monroe-Wise had even taken to calling her cadaver, "Bob." "I can sense that I'm developing a sort of affection for my cadaver, which is strange," she said. "But maybe our cadaver is a little bit unusual. We already know so much about him." In just three days of dissecting, "Bob" had yielded evidence of emphysema, triple bypass surgery and a pacemaker. "Obviously it's too late, (but) I want to say to him, 'Bob, what are you doing? Quit smoking. You're gonna kill yourself.'"
Monroe-Wise and her classmates have taken the first of many major steps to becoming doctors. Scores more challenges lie ahead. In the coming months, they must be prepared to further uncloak their cadavers and look for the first time at their faces. They will have to learn how to dissect a human head. But that's not until next quarter. For now, they've still got a lot of organs, arms and legs to get through.