Thursday, July 13, 2006
Chicago Tribune (KRT)
The study of human anatomy can be gruesome, fascinating, repugnant, exciting and awe-inspiring. It begins for first-year medical students when they walk through the heavy double doors and find, on the stainless-steel autopsy table to which they've been assigned, a closed silver tank containing the body of a stranger.
Rembrandt: The Anatomy Lecture of Dr. Nicolaes Tulp (1632)
With the sickly aroma of preservatives in their nostrils, they are about to meet a person with whom they will become more intimate than anyone they've ever known. They will also work cheek by jowl with three tablemates, assigned alphabetically, sharing an experience that will become the foundation of their careers.
Most of us recoil at the idea of human dissection, preferring to forget our high-school forays into gore and formaldehyde. Even med students may have some initial discomfort, but for physicians-in-waiting, human dissection is the standard introduction to medical education.
When it began its anatomy studies last fall, the class of 2009 at Rush Medical College in Chicago numbered 128 students working four to a table on 32 bodies. On the first day, Dr. James M. Williams, director of the anatomy course, commanded the group's attention. Before opening the mysterious stainless-steel tanks, the students were directed to stop and consider the body inside _ that it belonged to a real person who had been good enough to donate it to them. They put their hands on the tanks for a moment of silent reflection.
Finally, each tank was opened, revealing a mummy-like figure lying on its back, wrapped in cloth and plastic to hold moisture in. In time, the students would learn many things about this anonymous individual, things the donor never knew about his or her own body. The students would also discover a lot about themselves.
Their first lesson involved the thorax, or chest area. Amid a welter of emotions, they inserted their scalpels at the top of the cadaver's sternum, and made their first cut. In the next hours, they would peel back the flesh, saw through the rib cage, and reveal the various structures within: muscles, blood vessels, nerves, organs and glands. The path to helping the living begins with learning from the dead.
A human body is like a beautiful building, says Frank Hughes, one of five anatomists who teach the class with Williams. "When we see a building, we have no idea of its complexities. As you get into (the body) the mystery only increases. You realize how complex it is. It's almost an infinite process."
The students' initial trepidations evaporate as they visualize the real models for the drawings in their Netters Anatomy Atlases. The course proceeds from thorax to abdomen, then pelvis, perineum, arms, legs, hands, feet, back and lastly _ five months later _ the head and neck. The most difficult areas for many students, structurally and emotionally, are the pelvis and face, i.e. the sexual organs and the seat of identity and expression.
At anatomy table C3, the four students who persevered through this grisly baptism were, like most of their fellows, a diverse crew. Chineze Igboechi is from New York and of Nigerian ancestry. Nikita Joshi was born in India and raised in Naperville, Ill. Jeffrey Jhee is from Chicago and Peoria and of Filipino and Korean stock (both his parents and sister are doctors); and Caelan (pronounced Shaylan) Johnson is from Green Bay, Wis., and of Irish ancestry.
Their cadaver's ethnicity, like his personal life, remained a cipher. But they would learn other things _ that he'd had a heart bypass and likely died of cardiovascular disease, that he had had hernias on both sides, and a little extra body fat. They named him "Buddy Dodge." Originally it was just Buddy, but when he was first opened up, they found the word Dodge written across his chest with some charcoal-type material.
The four recently reflected on their experiences in class while sitting around a lunch table:
Nikita: "I never liked dissecting until now. But I'm older, and a human is more interesting than an earthworm. I can't really sense a personality in a cadaver, but I do see characteristics. I can tell if someone's a big drinker, and we did see one body with nails painted. Once you're through the skin it doesn't look as much like a person _ it's a learning tool. But some things are so human, you can't ignore it _ like the skin, eyes, hair, hands."
Caelan: "The pelvic area is hard. It's not as hard for me to work on a male as a female. After dissecting a female, it didn't look right anymore. I'm (also) a little nervous about faces."
Chineze: "Once the first cut (to the face) is made it's OK."
Jeff: "It's not surgery. You can't kill a cadaver. I'm more concerned about making a bad cut, ruining a specimen."
Dorothy Ambrogi, 26, a student who works at another table, exemplifies the transition that students must make during the year: "It was hard to come to grips with the fact that we had to cut into an actual person. For me, it became easier when I thought about how he wanted to donate himself so we could learn more effectively."
The most interesting thing about working with cadavers, she says, is seeing all the variations in their anatomies. "Some people have had surgeries and procedures done that are evident. Some have had certain organs removed. Some have slightly different vascular patterns than normal. Each body is slightly different from all the others, which is something I had never thought about before."
She noted that besides teaching general anatomy, the course gives her a chance to see how some diseases progress. "Our man had lung cancer, so we had the opportunity to see the effects of something like that on the entire body."
The end of the final quarter of anatomy is when students meet their cadavers face to face. They have spent five months learning every inch of their specimen's body, and now they are about to find out what he or she looks like. The cloth is unwrapped, and the face is at last revealed.
After some consideration, each table decides who will make the first cut. The flesh is peeled away, and the body quickly returns to being a learning tool.
After the dissections and studies are completed, The Anatomical Gift Association of Illinois takes care of the cremations. If requested, cremains are returned to the family. Otherwise they are buried in a cemetery maintained by the association.
Months from now, during the second year, these students will have a memorial service for the people they never met in life, yet knew so well, and who changed their lives in a profound way. It will happen about the time the next first-year med students go through the large steel doors of the anatomy lab to begin their journey.
(c) 2006, Chicago Tribune.
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