Haslett, Michigan, United States
Make no mistake, dissecting a human cadaver is revolting. When we medical students opened the cadaver bag, we were instructed to keep the head covered to prevent it from drying out. It is difficult to dissect tissues that are completely dry. We peeled back the skin on the chest and arms. It was thick, rubbery from preservatives, not unlike the skin of hogs. There is a layer of fat under the skin, and depending on the body, it can be copious. Globs of fat stick to your fingers, your scalpel, your dissecting manual, yellow, stinking, greasy clumps that you flick off your hand and your pages. We wore plastic aprons during anatomy lab, but these soon became coated with grease and hacked up pieces of fat and tissue. We purchased small dissecting kits with probes, scissors, and scalpels, which also stunk and became slimy.
Dissection was time consuming and not very helpful for learning. We peeled off skin and scraped off fat, then tried to figure out what was connective tissue and what was tendon, nerve, vein, or artery. Unlike live bodies, the tissues of cadavers are firm and monochromatic. The arteries and large veins have been filled with pink and blue plastic, but nothing else is dyed, so differentiating between fascia (we would call it gristle if we were cooks) and named anatomy was difficult. Dozens of times in a day students isolated something whiteish and stringy, pulled on it with a probe, felt it twang and snap and said, “Oops.” The snap meant it was a nerve, and more likely than not, was a nerve that needed to be identified and labeled. Once it snapped, it was impossible to find again, and none of the other students at that dissecting table would be able to see its location.
Many years later, I met a medical resident who told me he was so repelled by anatomy lab on the first day he never went back. Instead he used the lab time to study the dissector book and the pictorial atlas; he obtained the highest grade in the course by avoiding anatomy lab entirely. How I wish I’d had the confidence to do that. Instead, I tried to follow the rules. I dutifully completed my share of the dissecting, getting lost in the fat and sinew, rarely understanding exactly what I was seeing, rarely seeing anything very clearly. The other students talked all around me: “Name the branches of the radial artery,” “Name the carpal bones in order from radial to ulnar sides,” “What is the mnemonic for the cranial nerves?” I ducked my head and scraped at fat and tissue.
Outside of lab, the formaldehyde odor penetrated my skin, hands, clothing, books. It was impossible to wash it off completely. Eating was unappetizing because the smell of my hands transferred to the food. On Saturdays there was an optional study session in the anatomy lab, but I chose not to go. Being there felt like torture.
While doctors often comment on how they adjusted to anatomy lab, how it did not really bother them or how they got used to it, I never did. Not only did I hate the smell, the wasted time, the fat and slime, but I hated the way we butchered the bodies we were assigned. They were handled like animal carcasses, each one sliced and sawed and bisected, the anatomy ending up shredded. Each table gave their bodies nicknames; ours was Fred or Frank. Someone named theirs Abra. The medical students laughed about the bodies, making jokes about tattoos or well-endowed genitals. They pretended to talk for their cadavers: “Hey, Fred is having a bad day today,” or, flapping a dissected arm in the air, “Abra says ‘Hi,’ Danny. She’s nicer than that girl you had last night! Come on, touch her the way she likes.”
I have read accounts by medical students who claim that naming their cadavers made them feel closer to them. Some schools encourage students not only to name the bodies but to make up histories for them to fill out the bare information provided. I could only think of who these people had actually been. If this was the body of a well-respected bank director, famous baseball player, or benevolent philanthropist, would it be handled with this little respect? If this was your father, your sibling, your mother, would you still make up a name and identity for them? It seems to me that having unskilled, indifferent, ignorant students hack up someone’s body is the least respectful activity of all. If you wanted to provide an opportunity to learn from an actual human body, you would allow only the most experienced faculty member to perform the dissection. It would be done carefully that way; you would be able to actually see the relevant anatomy; student time would not be wasted in futile activity; and structures could be labeled and studied by the entire class, not just a few students at each table who may or may not know what they are looking at. But then, if you really wanted students to learn anatomy, perhaps you would do as my resident friend had done, and not use cadavers at all.
While it would be hard to practice medicine without knowing something about anatomy, the idea that dissection is necessary is over 100 years old, originating long before there were accurate detailed anatomy drawings, photography, and methods of specimen preservation. With modern technology, with computer simulations that demonstrate anatomy more clearly and in more dimensions than the anatomy lab with its hacked up cadavers ever could, it does make you wonder what the real purpose of anatomy lab is in those medical schools that still require it. Perhaps some medical educators believe that students need to know how to dissect in order to do surgery. Even if that were a valid argument—cadaver dissection is a very different activity than surgery, and medical students hardly do any cutting during surgery, anyway—students who elect to pursue a surgical career could choose to take an anatomy dissection class as a senior elective rather than subject all students to the course.
I suspect there are faculty members and administrators who specifically want to create doctors who are desensitized to the cadaver bodies. They perhaps want medical students to not get emotionally attached to people, dead or alive, as they think “objectivity,” even if it were attainable, is a virtue.
There is much in medical education that strips students and residents of their humanity. Surely anatomy can be taught in such a way that it does not continue to contribute to the problem.
HARRIET SQUIER, MD, MA, is a family physician who lives near Lansing, Michigan with her husband and son. She has been writing her entire life and is in the process of completing a medical memoir and a novel. She spent more than 20 years teaching literature and medicine and creative writing in medical school and residency settings.