BALTIMORE, 17 September 2003 — 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 he believes the bodies should 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 like to 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, avuncular man with a bushy mustache.
Students learn all 206 bones in the human body. People count muscles and nerves differently, but, says Anderson, 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. On day one, with an overpowering chemical aroma hanging heavy in the air, the students start with the cadaver’s back.
Nearly a half-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.
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.
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. “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,” says Drusano. 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.
Though UM’s class once stretched across two years, the school now packs the course into 10 weeks and couples it with the study of embryonic development. The explosion of medical knowledge - from genetics to advanced imaging - made this compression necessary, but Anderson hasn’t lowered his expectations.
“When they are done with this course, students ought to be able to look at themselves in the mirror, naked, and visualize everything below the skin,” he says. By day three, students have found many surprises. Michele Levender, who shares a cadaver with Patel and three others, is fascinated to learn that the spinal cord extends only partway down the spine before sprouting an impressive bundle of nerves called the horse’s tail.
Amanda Schade, another team member, is surprised that the branch nerves are “distinct and big,” not the tiny fibers she expected. Adriana Jones, a 24-year-old from the New York suburbs, uses a pair of sharp pliers to cut a square out of the chest — a trapdoor to the lungs and heart. “It’s so exciting,” Jones says before noticing a disturbing sound. “Oh, my God, that was bone crunching?”
“What an amazing opportunity to see inside a body,” says Levender. “Not everyone can do this.”
Elsewhere, students find an old pacemaker the size of a cigarette lighter, about twice as large as current models. Another group discovers a zipper line of surgical staples along the sternum and the knotty scars of a bypass operation.
A team that is far ahead of the rest has removed two lungs. Now, the students are learning to tell the right one from the left by their subtle differences. One is the “cardiac notch,” a scoop on the underside of the left lung that provides a nest for the heart.
Circulating among the students is Dr. Richard Colgan, a family physician who helps students understand the connection between anatomy and clinical medicine.
He demonstrates how cholesterol can render the aorta hard and brittle; how pollution leaves black, grainy deposits on the lungs; how a failing heart balloons to twice its normal size. Stepping back to observe the proceedings, Colgan forms a contented smile. “’The dead teach the living,’” he says, quoting a sign he saw in an anatomy lab somewhere. “That’s what’s going on here.”