Making the Cut by Catherine S Woodward

The first cut into the human body, for me, passed without fanfare. The moment was lost in the initial excitement of finally being in anatomy lab – finally! And then, as we de-gloved some 3 hours later, that first-cut moment was lost in sighs of frustration – where was the deep inquinal ring, anyways? So we shuffled back to the locker-room, cloaked in the faint, unforgettable small of formaldehyde and went about the rest of our day. Even though we had decided to look at our cadaver’s face that morning, we did not dwell on this experience. It was not that we were insensitive; we wanted to make that human connection. But we were also preoccupied. We had things to do! Muscles to find! Nerves to name! Doctors to become! That morning, we had come armed with scapulas and shielded with words that were foreign-sounding and difficult to pronounce: xiphisternal joint, anterior superior iliac spine, sternocostalis. We needed to learn exactly what all of those words meant. And find the deep inguinal ring, too.

Of course, upon reflection, that first cut is a significant moment in a first year medical student’s life. In that moment, you cross a boundary. As my roommate later remarked, “Today, we became people that are allowed to cut into other people. That’s pretty intense.”

And yet, it just didn’t feel real. Cadavers, for a variety of reasons, do not evoke life-like-ness. Their skin is not pliable; their faces are shrouded; their blood is not bright vein-blue or artery-red as Frank Netter would have you think. Moreover, after that first cut, you spend much of your time unraveling the small intestines and tweezing out connective tissue. That isn’t how anyone has ever previously interacted with a human. So within the first hour, I found I had mentally dehumanized our cadaver. It was not a person who once had had a family and dreams and memories and experiences. It was a body.

Thus, anatomy proceeded as any other class. We found the celiac ganglion and the sympathetic trunk, the superior mesenteric artery and the ligamentum arteriosum. We were shocked by the bulk of the lungs and by just how much mesentery stood between us and the retroperitoneal kidneys. But by the time we got to the mediastinum, taking out the heart was business as usual. Aided by the knowledge of the TAs and the skillful snipping of seasoned professors, I was constantly in awe of just how many names and functions we were learning on a daily basis. But despite of, or perhaps because of, all the facts we were learning from our cadaver, I still didn’t give him much thought.

Until Interval Five – the pelvis.

We entered the room and congregated around the prosection as usual. But, this time the cadavers weren’t lying peacefully on the stainless steel surgical tables. No, those we examined had been rotated to prone position. Their legs were opened. And, for the first time since anatomy lab had begun, I felt a visceral reaction to what was splayed before me.

Of course, understanding the pelvis and all genital structures is important and necessary for medical students. Furthermore, in all programs, the normal procedure for a pelvic dissection is as comprehensive any other; it must be. And yet, although logically I understood that this was customary, necessary, and educational, I couldn’t help but feel like we’d breached some boundary of intimacy. The cadaver was so shockingly exposed. So stripped.

In that moment, for the first time, I had to confront and mitigate the differences and similarities between my cadaver and a person. I had to acknowledge the vast difference between respecting a cadaver and respecting a person. It felt wrong to so expose a person, but it would have been more egregious to pass up the unique opportunity to learn as much as possible from someone who had willingly donated their body for my education. It was then, humbled by the nakedness of these bodies, that I realized both how brave these people were to give themselves to science, and how fortunate we were to work with them. For although the art of anatomy is ancient, cadavers have not always been easy for medical students to come by.

In fact, since the inception of anatomy as a scholarly pursuit—which occurred sometime around 300 BC when a curious Greek, Herophilus, first opened a body to determine the cause of death—human  dissection has often been poised at the center of a cultural conflict, pitting scientists against the general public. In the early days, most states prevented public dissections. Thus, the “gentlemen of the profession” – surgeons, teachers, and student—resorted to body-snatching, and later to purchasing bodies from professional resurrectionists. To avoid the risk of being found out, students, often working throughout the night, would hastily complete their dissections within a week – an accomplishment which, in my opinion, merits at least a tip of hat. I cannot imagine (nor do I want to) the experience of dissection at 3 AM in a dimly light and poorly ventilated lab.

Fortunately, today I not only have the luxury of good lighting, ventilation, and hypoallergenic nitrile gloves, but also the assurance that my lab will not be the target of a public riot against grave-robbing anatomists. Today, someone has willingly given his or her body to an extremely valuable learning experience. And, perhaps because of the historical troubles, many medical schools have responded with appropriate gratitude. Most hold ceremonies honoring the bodies where eulogies are read, songs are sung, prayers are said, and the families of these bodies invited to honor the contributions their loved ones made. This is a chance for students to not only reflect upon the recently-observed complexities and nuances of the human body, but, more importantly, to recognize and appreciate the donation that made those discoveries possible. It is as John Morgan—a  physician credited with founding medical education in America—remarked, “It is Anatomy that guides the doubtful steps of the young votary of medicine through an obscure labyrinth.”

Pictures simply cannot do the body justice. The experience is sometimes frustrating, endlessly perplexing, and often a bit smelly, but also an amazing introduction to the complexities of the human body, to which we someday soon apply our knowledge. Anatomy is, as it has been for centuries, a rite of passage of sorts – the first chance to cross the boundaries that separate doctoring from other professions. It requires your full attention to detail, gratitude for the opportunity, and respect for the body that made it all possible. Quite a lot to take in as you make the first cut.

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