Monthly Archives: December 2006

I’m usually apprehensive (though not always openly or strongly) when approaching new experiences, and there was a point when I felt a heaviness in my stomach in anticipation of my first day in Gross Anatomy in medical school. That feeling was quickly overcome, however, by my expectation of the course as being a defining experience, a sort of rite of passage, that would have some early role in transforming me from a relatively clueless, inexperienced recent college-grad into a seasoned, respectable, and capable physician. Tomorrow is my final examination in Gross Anatomy, marking the end of an era in my medical education.

Of course, I might just be making a mountain out of a molehill, but I do think that this experience has changed me, and perhaps unsurprisingly, I do not think it is possible for me to go back to being the person I was before. As insignificant or routine as it may seem now, there was a time not so long ago when the things required of me and my fellow classmates during this past semester seemed intimidating. There are many things that I have done these past few months without a second thought that most members of our society have not done, nor ever will do. I have looked upon the face of a dead man at length without reflecting, in mourning, upon my experiences with him in life. I have cut into his skin, broken his bones, and held his heart, his brain, and his disintegrating lungs in my hands. I have spent days unabashedly examining every inch of my donor’s cadaver, and many hours with others as well. And perhaps most importantly in contrast to the way I was before, I have tried, perhaps naively at this early stage, to find out how he died (and even how he lived with disease before he died).

Physicians are supposed to care for both the person and the body, but Gross Anatomy gives the medical student a unique opportunity: to not be distracted by who he was, but instead, focus entirely on his body and what can be learned from it. Some might see this as dehumanization or distancing oneself from the reality. I disagree. Gross Anatomy is the first test of a young physician’s ability to demonstrate the pragmatism and assertive approach with which he or she must practice medicine in the future. The course is challenging in many ways, particularly with respect to the massive amount of material that must be learned in a short amount of time and the challenge posed by the seeming incompatibilities between our memories of our former selves and the required tasks at hand. Because of the vast amounts of material to learn, time is limited, and one cannot hesitate to act. When given the choice to contemplate the spiritual and personal ramifications of cutting into a dead person or efficiently proceed with the dissection and lesson as required, we perhaps unknowingly choose the latter out of necessity. We had no role in the medical care of these men and women, and we had no personal relationships with them. As such, we must shake off the stigma of intimate association with death as we work with the cadavers, and we also have no apparent need (or even legal capability, owing to the privacy protections for the donors) to discover who our donors were in life. Even if we could find out that information, it wouldn’t help us become better doctors at this stage: it would merely detract from the fundamental knowledge we need to learn, and also rob us of a chance to clear our minds and face death in a way in which other people are not capable. This is an opportunity that few others ever have, and it shakes us (we, future physicians) into a new perception of life, death, and our roles as mediators in that transition. Of course, with our patients, our approach is necessarily different: we are intersecting with their paths while they are alive, and even in death, who they are matters to us and our self-perceptions as physicians. The cadaver donor, though, plays a unique and vital role in the medical student’s education. Even though I will never know who once inhabited the body I came to know better than my own, I will always be grateful because he has made it possible for me to face death, not as a family member or as a patient, but as a physician.

It surprises me, though, that many medical schools are deemphasizing the anatomy curricula. Some school administrators allegedly want to do away with anatomy altogether, while others have greatly reduced the time students spend in the laboratory, the amount or scope of material covered, or the involvement of students in dissections (i.e. some schools primarily use prosections, dissections performed by professionals, not medical students). Even if the knowledge learned in Gross Anatomy may see less significant in an era of medicine heavily influenced by the incorporation of great advances in molecular and biochemical science, medical students who lack a sufficiently substantial involvement with cadavers in Gross Anatomy are missing out on an important stage of their development as physicians.

In the end, though, it’s not fellow medical students at schools with less emphasized anatomy curricula to whom I feel most distanced: rather, I feel most distanced from everyone else. In some way, I feel more prepared to help my patients fight their diseases and their battles with death. This doesn’t make me more of a man or somehow superhuman, but it does, to me, suggest that I am starting to become something special. This is a tiny change, a tiny step forward as compared to future rites of passage on the path to becoming a physician. However, it is an important, very noticeable step (in retrospect), and one which makes me feel somehow empowered, stronger, more pragmatic, braver, and ironically, more empathetic (despite my clear lack of intention to find out who my donor was in life).

This is not to say I’m not afraid: when the fate of a living, breathing person is partly determined by my ability as a physician and my bravery in helping him or her face death, I might feel less confident then I do now. Nonetheless, it’s our job to be brave, face the facts, and think clearly and intelligently in the messy, emotional arena in which death fights. Some patients are brave enough to carry the fight on their own; most aren’t, and I hope with all my heart that people are grateful for those individuals who are ready to fight with them against the odds. It’s not that physicians are insensitive or dehumanize patients (following their early experiences with cadavers): rather, they no longer have the same fear of death that most people have. Sure, good physicians still fear death, but they have the internal fortitude and strength with which to empathize and help another person. Most people instinctively don’t want to put themselves in the shoes of a dying, suffering person: they want to run as far away from death as possible, deny it, and hide from it. Some physicians are like this too. However, in striving to be good physicians, we must face death in a way such that the need for respecting and knowing our patients does not need reminding. Rather, we can have the strength and bravery to know someone and help him fight disease. Even if he dies, we can face up to his death rather than disconnect from it: it doesn’t destroy us with guilt, but rather, it humbles us, and his story inspires us to keep going and keep fighting.

Good physicians are special people, and I hope to be one someday soon.

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