One of the most powerful paradoxes of medical education is that we learn how to heal the living by dissecting the dead. Our cadavers house the beauty and intricacies of human creation, the distinctiveness yet commonality of each human body and the finality of decline. As my dissection group encircles our cadaver, we straddle the boundary between the vitality of life and the permanence of death. Before the first slice of the scalpel, I am unnerved by how lifelike the body appears.
On the first day of anatomy lab, I happen to glance at our cadaver’s hands — mottled with age spots, slightly wrinkled, worn with work and the passage of time. It was the first moment I realized how intensely our hands are infused with humanity and the volumes they speak about us. I wonder what those hands had done each day, whom they had touched with love and care, the kinds of thoughts they had penned. Scanning up her arms, we were surprised to find a Rosie the Riveter tattoo spanning the entirety of her right bicep — its once vibrant reds and blues now insipid hues of black and gray. We exchange nervous smiles at the morbid irony. Of course we could do it; couldn’t we?
I grip the scalpel in my gloved hand and eye her pale chest with trepidation. As the reality of all we were to uncover became clear, I reflexively recited a prayer in my mind. We were to unveil the deepest mysteries of a divine realm within us that only a small fraction of humans are given the gift of exploring. The moment I raised the scalpel to her body, it became clear that we were partaking in a rite of initiation. A profound transformation would take place over the next year that would fundamentally differentiate us from those outside of medicine. We would perform actions that were previously inconceivable. We would dismantle a body to its core in our endeavor to one day restore living bodies to wholeness.
The act of dissection dates back as far as the Italian Renaissance, when it was conducted in formal anatomical theaters open to the public. Tickets were sold, demonstrations performed and large meals shared among viewers before and after the event. While dissections are no longer the public spectacles they once were, there remains an element of performance embedded in the act of deconstructing the human body.
With our careful cuts and slices, we strive to emulate the anatomical perfection presented to us on the glossed pages of Netter’s anatomy atlas. But in our attempt to demonstrate artful perfection, we forget that we ourselves are riddled with flaws. The intensity of medical education drives us to seek perfectionism in our thoughts and actions, especially as we work to master the human body. In this process, we often detach from and suppress the fear, the uncertainty, the wonder, and the passion we experience as we are initiated into medicine. We need ample time to identify, reflect on and come to terms with the imperfections that define our humanity and connect us to our cadavers.
Immersing fully in the captivating process of a dissection, there is little — if any — time to fully grapple with the cascade of emotions that accompany the experience. Beyond the anatomy lab, the rapid pace of medical school makes deep reflection challenging, as mental energy is consumed by the never-ending rush to commit structures and functions to memory. Emotion is, in essence, ruled out.
A 2018 qualitative study examining emotional experiences of medical students during cadaver dissection found that many students experienced initial “shock, apprehension and anxiety” when first facing their cadavers. A minority of students expressed continued guilt towards their donors, which seems to be at least partly influenced by cultural values and traditions strongly averse to dissection. When interviewed further, students shared several major factors underpinning this guilt: “the discomposure of viewing disassembled bodies,” “a sense of incompetence in dissection skills,” and “self-blame for insufficient progress through the course.” Through their testimonies, it becomes alarmingly apparent that the intense emotions surrounding anatomy lab leave a visceral impact on medical students. It is vital to unpack the relationships we develop with our donors and the complex fear, guilt and uncertainties swarming at the peripheries of these encounters.
In an attempt to foster gratitude and deep reflection among students, many medical schools have begun conducting memorial services to honor cadaver donors and donors’ family members. Several studies have found that these services helped protect against the decline of a sense of responsibility, meaning and purpose. At the University of North Carolina School of Medicine, students are encouraged to partake by performing a dance, reading poetry, singing or playing an instrument. By actively including students and their talents, the ceremony becomes more than just a passive ritual. It enables students to find fulfillment in using art to honor their donor and their family who shared laughter, love and memories with them. Such performances can be a powerful means to process complex emotional responses and allow students to reach a state of peaceful coexistence with the act of dissection.
Beyond memorial services, which tend to be ceremonial, it’s important to encourage emotional processing through a more free-flowing approach, such as small group discussions and written reflection. Although a limited number of studies have examined approaches other than the memorial service, both my personal experience and anecdotes from peers have repeatedly underscored the value of these mediums. Discussions with my peers in settings beyond the lab on life and mortality, particularly during the first week of anatomy lab, significantly helped allay the emotional turmoil that had overtaken me. As we exchanged our core beliefs on the process of death and dying, the immortality of the soul and the unknown that follows death, we forayed into the process of reckoning both as one and as a collective.
The lessons we learn from the human body are penetrating and resonant. For doctors-in-training, the cadaver is often introduced as our first patient. Our remembrances of the world that thrives within us will always be within the context of our donor cadaver: the very first individual that transformed our views on the astonishing structure, function and marvel that is the human body. But as we find glimpses of these bodies’ inherent humanity — the contours of the face, the wrinkles on a hand, the faded outline of a decades-old tattoo — we embark on one of the most intense emotional journeys of our education.
The introspection is key to forming a positive educational experience with gross anatomy lab that invites a unique opportunity for the healing power of the arts and humanities to intersect with medicine. It’s valuable for medical schools to leverage this by integrating activities such as memorial services, peer-led discussions and narrative-based reflections. Through these channels, we begin to cultivate a deeper appreciation of the many lessons in health and illness we learn from our silent mentors. The work of death helps frame our professional identities as healers of the living. But as we initiate students in the anatomy lab, we must also initiate the conversations that examine death apart from doctoring.
Image courtesy of Mili Dave.
Pulses of Connection is an attempt at delving into mind-body connections in medicine. This column will strive to emphasize how mobilizing the deep connections between our mind and physical bodies can enhance our sense of oneness, health, and well-being. Through narrative and exposition, I will explore how practicing physicians, medical students in training, and premedical students can integrate mindfulness in their lifestyles, as well as how such approaches can be crafted to bring healing to our patients.