August 5, 2010 1 Comment
After reflecting on anatomy lab in the last post, an article in The Wall Street Journal piqued my interest today, At One Med School, Volunteers Lend a Hand With Anatomy Lab Prep. I recently revisited the anatomy lab as resident in order to practice clinical procedures.
The history behind anatomy lab is quite fascinating. During the late 1700s and 1800s in America, as medical schools expanded across the country, the demand for cadavers for medical student education increased dramatically. Interestingly, many medical schools were built close to a graveyard so that bodies could be transported quickly from the uprooted grave to the anatomy lab.
Body snatchers, also known as “resurrectionists,” stole corpses from graveyards for medical education. An article by Kenneth Dillinger, The Very Lucrative Business of Body Snatching, explains how resurrectionists made a business of providing bodies to medical schools. Because refrigeration had not yet been developed, it was important that the cadavers were “fresh.”
In the Scottish city of Edinburgh, William Burke and William Hare decided to take grave robbing one step further: they began murdering people to sell them to anatomists. This method, which became known as “burking,” spread to America. Dr. Henry Howard Holmes, an American resurrectionist, is known for murdering several people. Some students paid tuition in corpses. Anatomy professors themselves participated in grave robbing. The poor, of course, were the most vulnerable because they could not afford coffins to keep the body snatchers out.
In an attempt to discourage “burking” and other acts of grave robbing, laws passed in the 1830s allowed physicians to dissect unclaimed bodies. By the 20th century, body snatching had essentially disappeared. Interestingly, in 1945, an article in Time discusses the Cadaver Crisis. As a result of death at war, there was a national shortage of cadavers. Medical schools relied on unclaimed bodies for their supply, and there was a growing concern that in the coming years there would no longer be enough cadavers to supply anatomy labs.
Anatomy lab is still a rite of passage in medical school. A question up for debate is whether or not medical students need anatomy lab to learn anatomy. With three-dimensional computer programs and SimMan (bodies which are becoming increasingly advanced in their simulation capabilities), it is possible to learn much of human anatomy through technology. Do we really need to dissect bodies anymore?
One of the disadvantages of anatomy lab is that is it not realistic. The vital organs, once embalmed, pale in comparison to the live organs which we view in the operating room. Sometimes they are not even recognizable. One of the important parts of anatomy education is understanding the spatial relationships between different organs, vessels, and landmarks – but these can be visualized in other ways.
A more limited anatomy experience, supplemented by new technology, might strike a good compromise. Many of the things we learn as first or second year students in anatomy lab are revisited in a much more meaningful way during our clinical experiences. In retrospect, anatomy lab makes much more sense to me – after years of practicing medicine on living, breathing patients, I better understand the human cadaver. I can distinguish what on the cadaver is useful or irrelevant. I understand the difference between the organs of the living and the deceased. As a medical student, I knew none of this.
Tactile learners will argue that anatomy lab is an essential part of medical school – some of them remember their anatomy vividly from their extensive time spent dissecting. Others had a difficult time with the dissection process and swear never to return to anatomy lab again. I fall somewhere in between.
The more important aspects of anatomy lab, which are often overlooked, are the emotional and psychologic effects of dissecting another human being. Wonder, terror, guilt, and privilege – all of these emotions coursed through me on a daily basis. I used to sprint to the top of a hill after each lab session in order to release these emotions and feel alive – feel human – again.
One of my laboratory partners routinely logged on to a nearby computer to bring up pictures of young kittens as we dissected. We would all look at them and feel better, momentarily. Then, realizing the juxtaposition of the kittens and daunting tasks which lay in front of us for the day, we would start laughing, then grow quiet. This is what I remember most from anatomy lab: the uncomfortable laughter followed by sudden, awkward silences.
The purpose of medicine is to heal, to suture back together, to reduce dislocated hips, to reset bones – and here we were doing the exact opposite. Here we were, destroying before we had ever healed. Stuck in reverse. It was such a bizarre place to be. I felt that joining my colleagues in medical school was like stepping on a train with an unknown destination. But to arrive at our very first stop, anatomy lab, the wheels were rolling back. Where were we going after all?
If the purpose of the anatomy experience is to create distance between ourselves and the patients we treat, mission accomplished. (But should that really be our goal?) I haven’t looked at people passing by on the street the same way since my intimate experience with dissection. That said, I often push it to the back of my mind, and eventually it slips away into my memories, only to be recalled on command. But, if I let myself think for more than a split second, vivid memories of the lab flash in my mind – memories which can only be understood by someone who has gone through the entire process, the entire journey, themselves.
In the end, I am ambiguous. Maybe in years to come I will formulate a stronger opinion about what anatomy meant to be. But now, over five years later, I am still left with a vague sense of discomfort and a curious sense of wonder. Although I wanted to live up to our donor’s expectations of what she would be offering us, I am still not certain that I achieved my goal.