Reflections on Cadavers…

26 09 2010

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Warning: Please DO NOT read this post if you are uncomfortable with reading details of what it’s like to learn medicine from dissecting a donor body.

Our professors told us that we should write down our initial thoughts and feelings about our first cadaver experiences, especially because we may never feel the same way again.

So here I go.

Walking into a room with 50 dead bodies is difficult to even type out, much less experience.  To see them covered up the way that you see them in movies and TV shows was, I think, more scary than actually uncovering the cadavers, because of the association we might have of the body bag to CSI murders and horror movies (at least this was the case for me).  It also goes to show how much power the unknown has.

The purpose of the cadavers, of course, is to help us learn anatomy firsthand, from the source, and I am so thankful for the donors who were courageous and generous enough to allow us to learn from them.  Personally, I really don’t think that I would be comfortable imagining my body being used in this way after I passed; for fear of being judged for how I look, because there are secrets about my body I would not be comfortable revealing to strangers, or in case someone recognized me.  As we dissect through and examine each part of the body, we really get to know and appreciate our donor in a way that none of his family members or friends experienced.  In some ways, it’s the most intricate and intimate way of understanding how someone lived – hidden secrets and signs of the past: silicon in the breast, hypertrophy in the heart perhaps indicating poor diet and exercise, a collapsed lung perhaps the cause of death.

Our lab instructor told us that in a lot of ways, these cadavers are our first patients, and I can begin to understand why.  Through exploring their anatomy over the course of the year, we uncover remnants of their lives, and we’ve already began to identify them as our people.  There is a memorial service at the end of the year in appreciation of the donors, and I can see myself being quite emotional at the thought of having to say goodbye to the friend who has given us and taught us so much, letting us get to know him in a way that even his family could not.  And seeing the families at the memorial service will be the first time we deal with the families of patients, in a sense, and that aspect is daunting in and of itself.  We really go on a journey with our cadavers, and at the end of any journey, I think there is grief at parting, for loss, and for the end of an era and the closure of a shared experience.

At this point, I just wanted to say that I recognize that it’s strange for me to relate to a dead body as if it were a living person, but to me, the conscious decision that donors make to donate their bodies, as well as the uniqueness of the individuals’ bodies, makes it impossible to forget that they were once living, breathing human beings with a myriad of personalities and thoughts and feelings.

And yet it’s kind of our job sometimes to forget that.

I had a problem cutting through the rib cage because the sound of bone crunching induced some serious cringing on my part.  One of my colleagues was hesitant to touch the cadaver for the first time and wanted someone to do that with her.  And yet others in our class were able to get right into cutting and dissecting without hesitation.  They were able to detach the organs in front of them from the individuals and get right into exploring and uncovering.  A lot of my colleagues were very excited to get the experience of cutting into real tissue, and I admit it was thrilling to feel how soft and delicate a lung is.

There were a few comments, jokes, and complaints about how much fat a particular cadaver had, for example, that I was not entirely comfortable with, but then I thought more about it.  I think that we all start at different places in a continuum: either caring too much or perhaps not caring enough that the bodies we are working with were once alive and deserves respect.  It’s extremely delicate to find the balance between being so overly emotional that you cannot listen to bone crunching without cringing, like I was, and being so detached and insensitive that cracks are made about an individual’s weight or condition without consideration that he or she was a human being with families and friends who loved them.  As a future doctor, one end of the spectrum results in paralysis to the point that you get overly involved and can no longer treat your patient objectively.  At the other end is, of course, the worry of disrespect to the patient and family, causing undue distress and perhaps the concern of not completely respecting the patients’ wishes due to paternalistic tendencies.

It’s easy to say that, of course, you should be respectful to the donor bodies, but I think it’s perhaps difficult for those not in the profession to understand that it becomes impossible to do your job if you’re constantly looking at him in the eyes and thinking about his past history and being so serious and so ridiculously careful that you are afraid to cut or dissect or even lean on or put things on the body for fear of being disrespectful.  We cannot be serious in that room all the time, because then we’ll all get depressed, so we lighten the mood with conversation and laughter.  Dissecting also takes all our concentration to ensure that the right things are cut or left intact in the right places, and that we do not cut ourselves or other people, so we really cannot be thinking about anything other than the particular task at hand.

I genuinely think that those who are meant to be surgeons are the classmates who spend their free time in anatomy lab dissecting the fat from the body so that the organs are clean.  They admire the beauty of the organs separate from the individual.  They are the ones who cherish every opportunity to interact with the body in this way.  I think that during surgery, it’s necessary to look at the heart or the intestines (or any body part in need of repair) as just a body part, so that surgeons can fix the problems with the technical precision of an engineer or auto mechanic.  Remembering the patient’s unique personality or familial situation is unnecessary, in this case, and can in fact be a distracting pressure that negatively impacts the surgery.  In the OR, being calm is much preferred to being emotional.  I always say that I don’t need my surgeons to be good conversationalists or remember what my major is or even smile at me; I just need them to be the best.

My point is that caring too much or caring too little are opposite ends of a pendulum, and I think this year will help bring us all to the middle.  For example, at the end of the lab where we cut through the rib cage, I was already accustomed to the bone crunching, and it no longer made me cringe.  I don’t know whether I’m grateful for that or not, but unfortunately, it’s a necessary skill to have.

I debated with myself for a long time before deciding to publish this blog post publicly.  My hesitation in posting stems from the concern that working with cadavers can be a very sensitive topic to a lot of people, and to me, revealing details of the personal relationships with our cadavers feels almost like breaching the doctor-patient confidentiality agreement.

The reason I ultimately decided to post this is because I think and hope it’s helpful to current and potential medical students to appreciate that they’re not alone in their mixed feelings and complex navigational processes surrounding this topic.  Posting this also forces me to record and clarify my own thoughts about the experience, and hopefully I receive feedback that I’m not completely alone either.

But most importantly, I wanted to publicly acknowledge the fact that it’s a struggle for medical students (or at least one medical student…), and probably even full-blown doctors, to find the line between caring too much and not caring enough.  I hope it’s clear that we do the best that we can, but each individual has to find the line for ourselves, and I’ve come to appreciate that it’s difficult (and unfair) to judge another person’s unique path to find balance, especially when we still have so much learning left to do.

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2 responses

26 09 2010
Joanna

I’m glad you took the time to write your thoughts out. I agree with you, I also wrote about this experience and was hesitant to publish it online. In the end, I only made it visible to a select few, not because I felt like I was breaching the confidentiality code, but because I didn’t feel brave enough to reveal what I was feeling to everyone.

I find myself among those who make jokes while dissecting (not disrespectful ones though), or cut through bones without apparent hesitation. Not because I’m a cold and uncaring person, but because I force myself to forget that the body I’m cutting into once belonged to a living person. As you mentioned, if I didn’t, the guilt would just be too overwhelming, and I’m pretty sure I’d start bawling in the middle of class.

27 09 2010
Eastwood

Thank you for sharing this beautifully written and honest post, June, and for continuing to write about your unique perspectives.

Your post reminds me of an instance from Judith’s Pavilion, in which a resident psychiatrist discusses the implications of becoming the specimen during a neuropathology autopsy.

On a similar note, Richard E. Peschel shares his insights in When A Doctor Hates A Patient and discusses his transformation together with his cadaver.

A somewhat related laugh of the day: http://doccartoon.blogspot.com/2010/07/tips-for-med-school-dating.html

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