Dead men do tell tales for medical students

September 21, 2003|By Jonathan Bor, Tribune Newspapers: The Baltimore Sun.

Standing on a ladder before a sea of first-year medical students with faces frozen between excitement and fear, Dr. Larry Anderson delivers his opening-day speech.

"This is your first patient," Anderson tells the 160 students who are huddled around gurneys draped in crisp blue sheets that obscure the lumpy topography of the human form. "Remember, the people lying here were someone's mother, father, uncle, aunt and sister. And they decided to give you a gift."

The 25-year teaching veteran, who heads the University of Maryland School of Medicine's anatomy department, calls them "patients" because they are to be treated with the same respect as the living.

But there is no getting around the fact that they are unmistakably dead--bodies donated by the people who once inhabited them.

In a ritual with roots in the Renaissance, students across America are taking their first cuts into cadavers that will teach them their first lessons about life. As anatomy professors say, you can't learn how the human body is put together until you can take one apart.

"They'll learn about every muscle, every bone, all the nerves, the blood vessels, all those things," says Anderson, a short man with a bushy mustache.

He means all 206 bones in the human body. People count muscles and nerves differently, but, Anderson says, there are 18 muscles in the face alone and 30 nerves in the arm and hand. But learning anatomy isn't merely about memorizing body parts but understanding how they work together to make a person who walks, talks and thinks.

Scalpel, please

On Day 1, with an overpowering chemical aroma hanging heavy in the air, the first-year students start from the back.

Nearly half an hour into the lab, Ranish Patel of Bethesda draws a scalpel down the midline of her cadaver's back. "I don't want to go too deep," says Patel, 24, bearing down tentatively and barely making a scratch.

But soon, she and her four team members find the required touch, firm but not overbearing. They make a few more cuts and peel back the skin and fat to reveal the bands of muscle, known colloquially as the "lats" and "traps," that power the arms, back, shoulders and head.

"Examine these things," says Anderson, stopping by to observe their progress. "Recognize them for what they are."

Recognizing anything, however, is not always as easy as one might think. Because tissues are lifeless and fluid-filled, they mostly range from grayish pink to pinkish gray. Also, they are so tightly pressed together that it is often hard to discern one from the other without carefully teasing them apart.

But the students learn to identify muscle by its telltale feature, the fine grains that run in parallel formation. And by the end of the first day, students can distinguish the latissimus dorsi, the large muscles that fan upward and outward across the lower back, from the trapezius, narrower bundles that sweep from the midback to neck.

Students are not only grappling with the most intense flood of information they've ever encountered. They are also dealing emotionally with what they are doing.

Feeling detached

Mostly, they feel a bit giddy and detached and wonder why.

"This is a dead person and we're cutting it up," says Michael Drusano of Albany, N.Y., who dissects with a fast, feathery motion at an adjacent table and nearly delivers a lecture as he learns.

"I don't want to say it's repulsive, though maybe it's a bit of a freak-out. The swollen and odd skin color, bottom of the feet that are brick white. But I feel very grateful for what they gave us."

During the first few classes, students are told to leave the faces swathed in white sheets and plastic. Later, they will be ready to remove the coverings and confront the features that convey so much of a person's identity.

"Maybe later, I'll be desensitized enough so I won't find it as jarring," Drusano says.

Though the ancient Greeks, Jews and Egyptians were among the first to study human anatomy, the idea of teaching anatomy through human dissection was born in 14th Century Italy. Religious and social attitudes kept dissection from becoming a fixture in medical education until the 19th Century, and even then it was shrouded in secrecy.

At the University of Maryland, which founded the nation's fifth medical school in 1807, professors relied on grave robbers who followed funeral processions to cemeteries, then returned by night to slide the newly buried out of the ground.

An angry mob had burned to the ground a private anatomy lab that predated the medical school. Fearing another uprising, the school held its dissection classes in a cramped, out-of-the-way alcove in stately Davidge Hall, which was then surrounded by a 15-foot wall.

Later, the class moved to a formal operating theater where professors did all the dissecting while students watched and listened.

The old days