Friday, September 01, 2006

Cadavers Day 1, or, I Still Have The Smell Of Dead Person On My Hands

Mortui Vivis Docent
The Dead shall Teach the Living

Today was our first human dissection day. Though I’ve gotten a lot of dissecting experience starting with fetal pigs in high school to a number of different species in physiology and zoology courses, I’ve never had the chance to dissect human bodies before. It’s a rare privilege that a very small percentage of people ever get to do, as it should be; it’s not something to be taken lightly.

By no means did we take it lightly. Even before we were allowed near the bodies, the professors instilled in us a strong sense of respect for the body donors and their families. Though we're allowed to wear whatever we want into the lab (a set of scrubs used solely for this lab is recommended because the clothing 'picks up the scent'), we are required to wear a white lab coat over top, as a way to maintain professionalism out of respect for the body donors and their families.

This consideration of respect comes up in a few other ways as well. We don’t discard any portions of the body when we’re done with them; all of the remains go into a bag in a large bin under the body, which will get cremated with the body so the families can be given back the entirety of the ashes.There’s obviously an uneasy aspect to dealing with human bodies, and our faculty went to considerable lengths in an attempt to prep us for the event. Before we went into the football field-sized lab filled with body bags, the prof showed a short 360º video of the room. They went over a few guidelines (for example, if we take photos or bring unauthorized people into the body lab, we could be expelled), and showed another brief video of unzipping the bags and spraying them to keep them moist.

They then talked a bit about the body donor program. Our school had been successful this year with the donation program, allowing us to keep the student-to-body ratio at about 6:1. While most of the specimens come from elderly people, the cut-off age is 35, and occasionally they will receive donations at that age. There are no specimens which died of infectious diseases, and none of children.

After answering some student questions about the embalming process, it was time to go downstairs to the body lab. They did a demonstration on one body that we all watched over the TV monitors above our stations. Even after all that prep, during the demonstration, right after the instructor folded back the flaps of back skin revealing the underlying muscle and fascia, one student - a big, buff Italian guy – passed out. And after, one of my small group members told me that even after all the preparation, he still wasn't sure what to expect when the bag was unzipped and the sheet came off; he was still a little flustered that there was a person in there.

In some ways, the bodies look very little like humans. When we unzipped the bag, the bodies were wrapped in a sheet and had a canvas bag over their heads. They have picked up a grayish hue, and many of them have large flat sections on their backs with pooled blood visible through the skin from the way they had been laying. Rigor mortis is obviously prevalent, and the skin has become tough and leathery, very much unlike the skin of anyone I know. If you really want to see what a cadaver looks like, the University of Michigan medical school has medical gross anatomy dissection videos online that anyone can access.

I had heard before that people often name their cadavers. I was very disappointed when I proposed this idea and it did not seem to go over well with the other people in my group…

Our dissection today was of the back. We peeled back the skin, revealing the muscle, and identified the trapezius, the levator scapulae, the neurovascular bundle supplying the trapezius, the rhomboid major and minor, and the latissimus dorsi. Over the next two years, we’ll spend a lot more time learning anatomy from cadavers.

I was once told by a doctor, “Becoming a physician is a privilege even more so than it is a profession.” It’s true. Society generally holds physicians in high regard, as valued members of communities, and as individuals in whom some people will confide their deepest and darkest secrets. The privilege of working with cadavers in our training is one more thing that I feel honoured to be a part of, and I’m grateful to my medical school, my body donor’s family, and my body donor for the gift of education in such a unique format.

Postscript ::: According to one medical student, the use of cadavers could eventually be a thing of the past. While I may not agree with his comments, his article in the Student BMJ presents the opinion of a student against the use of cadavers in training, but not using reasons of ethics or the gruesome nature of the procedure. He indicates that not a lot of anatomical detail is that effectively learned, the costs are fairly high, and while anatomy is important for surgeons, only 5% of medical graduates become surgeons and cadavers don’t feel anything like performing surgery on a living person.


Justin said...

while anatomy is important for surgeons, only 5% of medical graduates become surgeons

I must disagree with this point of the authors proposal. Anatomy is one of the critical components of medical education and forms the basis for a proper understanding of physiology and physical examination. An understanding of surface anatomy, for example, is critical to many neurological examinations. While I can foresee anatomy education eventually progressing to the point where use of the cadaver is not completely necessary, I would hardly support the notion that understanding of anatomy is not important to healthcare.

incidental findings said...

I think currently, there is no replacement of using cadavers in human anatomy. If nothing else, it teaches you to respect the human body, which will be your entire body of work.

It'd be like telling an electrician that they don't need live wires to learn but can learn on string.

And for many (if not most) medical students, it is their first real encounter with a dead body. That is valuable enough.

Anonymous said...

What a thoughtful and intersting account of your first dissection experience. As a tutor preparing students in the UK for their first dissection experience I will use your account to stimulate discussion and debate. Thanks

Vitum Medicinus said...

I appreciate and am honoured by your comment. Hearing the outcome of that would be fascinating, should I ever have the chance.

Perhaps the following post on my blog, concerning our body donor memorial service, may also be of interest to you: