Learning anatomy in medical school

Peter H. Berczeller
Dordogne, France

 

Dissection

An excerpt from Dr. Peter Berczeller’s memoir, “The Little White Coat.”

 

On the second day of medical school, we were invited to meet the cadaver we would be working on for the next six months. I trooped up with the rest of the class into a large unheated space on the top floor of the building, my eyes burning and tearing as soon as they were exposed to the formalin in the air. Four students were assigned to each cadaver, and my team and I quickly assembled around the metal casket which contained “our” body. I noticed that the others were weeping along with me, rubbing their eyes because of the unaccustomed fumes floating through the room. For a short while, nobody made a move to open the container which we were encircling like mourners at a graveside ceremony. I remember thinking the obvious; that the deceased waiting for us had never had so many tears shed over him as at that moment. Finally, we opened the swivelled doors. We peered in, and only the vague outline of the cadaver could be seen in the murky, chemical-filled tank. There was a handle at the end of the receptacle which was part of a crank. I yanked on it two or three times, and the corpse appeared, fluid pouring from its sides; the scene reminiscent of a surfacing submarine.

I had never been exposed to a dead human being before; this first sighting was a shocking initiation. I kept trying to convince myself that the puckered mass in front of me – even the face just a wizened blob – wasn’t all that different from the frogs we dissected in college; it was a lab specimen to work on, nothing more. No use, of course, because I kept asking myself how he ended up in this tank, where did he go wrong? I imagined different scenarios; booze, mental illness, the usual. They all ended up the same way; unknown white male dying alone, no one to follow his coffin. The only less sad alternative: he was one of those who do not give a damn about what happens after they die. They look at their bodies as an object to be willed to the likes of us, so we could learn our trade.

It became apparent very soon that being accepted for medical school had not exerted a miraculous effect on my manual skills. Early on, when I cut through a major nerve thinking it was just connective tissue, my teammates recognized what I already knew about myself; I was poor at dissection and recognizing anatomic landmarks. Explaining why – before I could cause further harm – I was kicked upstairs to become what the Jews call a chazen, the one who leads the congregation in singing. In my case, it meant sitting on a high stool and interpreting the directions in the lab manual. Look here, look there, snip this, snip that, while the lifting was done by the other three. Gerry, a pint-sized hyperactive future ophthalmologist from California did the dissecting; the other two, Art and Herb, glided into their roles as his assistants, while I was left with the kibitzing.

It was cold up in that attic, and when the days became shorter and the harsh fluorescent lights took over, steam could be seen arising from the containers, arising from the accumulated breath of the students working around them. Surprisingly, I suddenly felt very hungry every day around the same time, at 4 or 5 o’clock in the afternoon. The smell of formalin and the look of oozing old blood and intestinal contents don’t necessarily combine into an appetite stimulant. Still, whenever I think about it, what I invariably see in front of me are the greyish muscles of our cadaver. The long kind, which are the gateway to the abdomen, and the shorter ones that move the arms and legs. My eyes might have mistaken what they saw for other kinds of muscles, the red, appetizing steaks that adorn butchers’ windows. From there on, a quick message to my brain and then to my stomach; making me end up, day after day, in the stairwell, urgently munching on a ham sandwich.

Our instructor in anatomy was a hulking white-haired man in his sixties.. His lectures were dry, and included material which could be found just as well in Grey’s Anatomy; except for the question-and-answer period at the end of each hour, when the full extent of our ignorance became evident. Leon Strong was tricky; he would spring surprise exams on us. “The bodies are up,” was the alert that crowded the toilets in the locker room when we came into school first thing in the morning. At times it was just a false alarm – when a scout went up to look, the bodies were all resting quietly in their watery graves – but, just as often, it turned out to be true; the doors locked, the corpses lined up on parade. By the time we were milling around in the hall, waiting to go in, I kept reading my notes over and over, trying desperately to remember the landmarks Gerry and the dissecting team had identified.

There was a long bright red string – tied around some structure or other – dangling from each of the bodies, along with a printed question propped up on its chest. It would have been far simpler if we had just been asked the name of the structure. Instead, we had to identify the nerve or vessel or tendon which swept around it or attached to it. After three minutes, the bell rang and we were herded to the next container. There was nobody to turn to, those pieces of bone or muscle kept staring at me, daring me to make sense of them.

By now, I had already warmed up to the corpse we were working on; we spent so many hours together that I would have recognized him anywhere. The others on the team gave him a name meant to be funny – I don’t remember if it was Chauncey or Sebastian they settled on – but that made me uncomfortable. Cutting him up was what we were all there for – the four of us and him – but I couldn’t see the joke. About halfway into the three minutes, whenever I was stumped and realized I might have to make a wild guess, I kept wishing it was “our” body that the exam was about; I knew it so intimately, it was sure to slip me the right answer.

The assembly line of cadavers spat us out into the hall, one at a time. There was the usual hubbub afterwards, insistent voices pushing for their own responses. There was no use arguing; we’d find out who was right soon enough.

After two quarters – 24 weeks interrupted by a short vacation – the anatomy course came to a close. A few days after the last practical exam – those red ribbons again dribbling out of the bodies as if, miraculously, they were back to producing fresh blood – it was time to say goodbye to our cadaver. When we first started working on it, it was just a dried out corpse without obvious injuries to suggest anything but death from what are called “natural causes.” By the end, when we began to put our corpse together again, one eye was out of its socket, the neck was slashed, and the belly cut wide open. To the casual observer, it could have been the victim of a bad car wreck or of a revenge killing in which the job was done piecemeal. We were supposed to suture together everything we had cut open in the first place, “so these bodies can get a decent burial.” I was all for that, but at the same time I wondered why they couldn’t just cremate these pathetic remains, take them out of their misery once and for all. I volunteered to do the sewing for my team, and cranked our body to the top one last time. Again, when he came out, the way the formalin gushed off him reminded me of the World War II movies of my childhood, where the submarine pounded by depth charges finally makes it to the surface, the conning tower about to be wheeled open by the heroic sailors inside.

The suturing completed, we pulled and pushed the cadaver into a black body bag and lifted it onto the top of the container. For a brief moment, we stood around the stainless steel vat as on our first day. I don’t know what the others were thinking – they weren’t saying – but I felt relief more than anything else; helped along by finding out that morning that I had passed the anatomy course.

 


 

PETER H.  BERCZELLER, MD, was born in Vienna, Austria in 1931. He attended The Chicago Medical School and received his MD there in 1956. He was a practicing internist from 1960 to 1992, at which time retired from private practice. He was also on the Attending Staff at New York University Medical Center and Clinical Professor of Medicine at New York University School of Medicine for many years. In addition to multiple contributions to the medical literature, he is the author of several books dealing with medicine and one novel. His 1994 book, “Doctors and Patients: What We Feel About You” has just been released as a trade paperback by Simon and Schuster. He now lives in the Dordogne, in France.

 

Summer 2018  |  Hektorama  |  Anatomy