It was a typical muggy day on a tropical summer afternoon. I walk down the stairs, straight to the basement. The building’s architecture follows the Portuguese Colonial style. There is no air conditioning, despite the 90 degree heat. The strong smell of formaldehyde is the first thing to notice. It is everywhere, even in the hallway and stairs. I’m used to it by now and it doesn’t bother me, not nearly as much as the humid heat. The smell changes with the weather though, and becomes much more aggressive in that AC-deprived Brazilian basement. I walk the hallway until I get to the last door on the right. Waiting inside are a few classmates, and our subject of study, which lies atop aluminum tables covered with white sheets.
The professor comes in. He is a faculty member at the College of Medicine and a surgeon at the local hospital. We lift the sheets and work together while the professor instructs us. We are a biology class, not medicine, so we don’t need to dissect. What we see comes “pre-dissected” for us by the medical students who had the same class earlier in the day. We observe, take notes, and draw. We have gotten so used to that setting that we are now unfazed. I accidentally drop my pencil on one of the tables. I pick it up, dry off the formaldehyde with my lab coat, and put it back in my pocket. When class is over, I leave the room and go to dinner. I’m relieved: the restaurant has air conditioning.
I was 18, a computer science major fascinated with robotics. My sister is the one who encouraged me to sign up for human anatomy. She went through the same experience years earlier during medical school, and she thought it was essential if I wanted to work designing prosthetics.
Ten years later, when she and I met again for a short vacation in Philadelphia, we both were doctors, but of different kinds. We decided to go, for our first stop, to the Mütter Museum of medical history. Here she influenced me once again, encouraging me to write about anatomy classes and the dissection of cadavers for this blog.
You can’t learn anatomy from a book
Part of studying medicine is learning how to read the human body. Classes in human anatomy are essential and the way to master the art is with human cadavers and dissection.
Once I had passed the shock of the formaldehyde smell — it is reported to be the most common reaction by medical students — what I noticed is that the body is not a colorful, high-def, perfectly symmetric version of a textbook drawing. The human body, as perceived by my eighteen year-old self, is a mess of pink and brown. Nothing is clear-cut. Finding the heart? Fine. Distinguishing one cranial nerve out of twelve? Not so easy.
Another reason for studying actual bodies — and, if possible, several of them — is the anatomical variation between individuals. That is not captured in books or lectures. A human body is different from an illustrated body, and one body is different from the next. Anatomist Todd Olson makes the case for human cadavers in class: “I’ve been teaching and studying anatomy for over 40 years, and I’ve never seen a live or dead person that looks like an anatomy book, because every picture in an anatomy book identifies the ‘average’ condition. . . But none of us are 100 percent average.” Future doctors need to learn about the variations that come with race, age, and gender. The right kidney may be higher in some people, and others may even lack some blood vessels. (In fact, someone’s organs may all be in the opposite side, as discovered by anatomists and illustrated by Carl Zimmer’s story.)
The learning never stops. Large features are well studied in those anatomy classes, but smaller-scale ones are not. My sister, an anesthesiologist, recently signed up for a cadaver workshop run by a renowned American hospital. Her goal was to zoom in on tiny nerve ramifications and see how to access them to deliver pain treatments. As an example, she referred me to a dissection study where researchers were surprised to report that many bodies had three nerve ramifications, as opposed to the expected two. That kind of knowledge is helpful in her work with patients with chronic pain.
When I started my research for this post, what I had in mind was the importance of the technical knowledge medical students gain from studying and dissecting human bodies. I also considered the “hands-on” learning that result in long-term memory, as described by Hasan et. al, and the “practice” component. (An anatomy professor told a nervous student to calm down: “If you make mistakes, that’s fine. Your patient’s not going to complain.”) I hadn’t considered another, unspoken objective: for many college students, anatomy class is their first contact with death.
Medical students need to be prepared to deal with emergencies, trauma, and death. Many instructors also see it as a rite of passage — what Brent Robbins calls an “initiation into the worldview of modern medicine and its (historically and culturally) unique conceptualization of the human body.”
I called John Romano, comparative anatomy teacher, to ask about his approach on dissection and death. “I’m a blunt teacher” Romano explains, “I tell students that at one point everyone will be dead. When you teach biology, that is something they have to understand.”
In his high school class, Romano and his students dissect animals (rats, cats, fetal pigs, a cow’s heart, and sheep’s brain). Still, the teacher remarks on the amazing emotional transformational that kids go through by the end of the course: “their confidence goes way up. I see such a change from nervousness to complete confidence”, a crucial trait for a future medical or biology professional.
Replacing cadavers with computers
Some classroom settings are replacing dissections with computer models. Ethical implications are not an issue: everyone I spoke to believes the need for human cadavers and dissection is unquestionable.
The main limitation is budget. Even with the overwhelming majority of medical schools in favor of using human cadavers in anatomy lessons, they are difficult to come by. It is not only a matter of finding donors. It takes a lot of resources to hire skilled anatomists and develop the infrastructure required for the storage and preparation of the bodies. Imaging methods (ultrasound, x rays, CT scans, PET scans, MRI), are excellent complementary techniques, but not a substitute for the real body. Gunderman and Wilson believe that radiology and other technologies have advantages, but can’t entirely substitute for cadaver dissection. He advocates for a combination of both.
Anatomy classes foster not only knowledge, but also emotional growth and maturity. They teach what Kennedy and Olson rank as the core dilemma of patient care: “the need to be personally engaged yet clinically detached.” All alternatives help, but they don’t give the student the connection to a real patient. Or, like Gunderman and Wilson said, “images do not naturally link the anatomy with a human face”.
- The human lumbar dorsal rami. N Bogduk, A S Wilson, and W Tynan. J Anat. 1982 March; 134(Pt 2).
- Is dissection a must for better knowledge among future doctors? T Hasan, Mahfouz MS, Hasan D, Hussein SM. Irn J Med Hypotheses and Ideas 01/2011; 5:9.
- “Cadaver Conference Day”: A Psychiatrist in the Gross Anatomy Course. G Kennedy, and T Olson. Primary Psychiatry. 2009;16(1):26-30
- Confronting the Cadaver: The Denial of Death in Modern Medicine. B Robbins. Janus Head;2012, Vol. 12 Issue 2, p131
- Viewpoint: exploring the human interior: the roles of cadaver dissection and radiologic imaging in teaching anatomy. Gunderman RB, Wilson PK. Acad Med. 2005 Aug;80(8):745-9.