Tara Ballenger has written an interesting essay in the Boston Globe’s “G” magazine, which I am reading in the sultry morning heat and drone of the window box fan at my friend’s house. It is entitled Me and my cadaver.
She describes how medical students taking gross anatomy develop a relationship with the object that was once a whole, connected and living human being, but is now a subject for detailed natural history and observation.
The students learn that the human body is individual and what is the spectrum of variation for various parts of it. They learn empathy for the person for which the body was the means of being, and that each future patient will be unique in the way the cadaver they have appropriated for the semester was unique.
They learn that small things are also beautiful. (Smaller things are, as well; ask any cell biologist or crystallographer.) And they learn to observe, to become beginner engineers in understanding that how this connects to that and this exerts force on that, the complex organism can circulate fluids, move, navigate this world, perceive and survive.
They learn that death is really part of life, not just intellectually. (At least, the more thoughtful ones do, the ones that were interviewed, such as future doctor Elizabeth Baltaro:)
“Now I can accept death and not be so anxious and intimidated about the idea of someone being dead,” said Baltaro. “A lot of diseases medicine can’t cure and it can’t fix. Sometimes, your role as a physician is to help someone understand more about the end of life.”
I only very briefly had the opportunity to observe the beginning of an autopsy, when I spent six weeks shadowing a pathologist at the local hospital at age 17. They rapidly encouraged me to go elsewhere in the building, and I obliged. I’ve held a number of dead mice, chicks, lizards, frogs, and fish, and pieces of higher vertebrates that I eat (not counting invertebrates) since then. But the next time I saw a dead human body, nearly twenty years later, it was that of my mother, who had arranged that internship for me.
No violent accident. I did not have to wash her body; the funeral home had taken care of everything. A little too much so, in that they had put pancake makeup over her pallor – but it was probably for the best. That makeup, too, is now dust. (This was nearly exactly three years ago.) I had an intriguing dual sensation – a memory of who the woman had been, and some of what she had meant to me, but also a raw consciousness of the object quality of her frail body. I touched her hair, I kissed her forehead.
This physical contact made mourning much easier. Mourning was letting go of the story of the living person I knew that had until then been constantly revised in my mind, drawing an end to my personal narrative entitled “Carol Corbett”, that was enriched by elements that she brought to it, and my memory of those aspects of her being alive. The story can be revised, but not prolonged. However, the direct sensory information – the sight of the corpse, the touch of her dry hair, slight stickiness of the foundation on her skin, absence of subcutaneous fat over her frontal bone… and thank goodness, the absence of any other kind of sensory information, which would have been too awful… these sensations made death real and less frightening.
Above all, I did not have to acquire these under duress or in horror, where there might be a possibility that any personal intervention of mine could preserve life. I learned some of the lessons the medical students learn, the easiest and most natural ones.
I wonder, therefore, as this knowledge has made me a little more sober and is in some ways a loss of innocence, when it is best to acquire it. Is it not our duty to educate one another, perhaps the children, perhaps as young adults beyond the medical student population, that death is not only ineluctable for ourselves and our generation, but that it is natural and not a physical state to be feared? That change comes in death, even to skeletons? And I wonder how it would be possible to convey this information in the flesh, as it were, in a sensory manner (even if only by sight), with respect both for the cadaver and for the sensibilities of the student of life and death.
My conviction is that confronting Western society’s superstitious and fearful attitudes about death might help some of its residents have a more realistic and prepared perspective, in the way that sex education has done for many. Is there not such a thing possible as a death education?
Really nice post, Heather… very sensitive indeed.
As a vet pathologist I’ve learned a lot about death, and somehow I’ve also lost my innocence regarding this topic too. It may sound creepy to talk about dead animals the whole day… but it is what I do, and what I like to do.
I’ve learned a lot, and several of the things I’ve learned are related to non-scientific topics… death as a feeling, as a concept, as a thought.
Every day I’m amazed on how fragile life is, and how easy life goes away… What is left is the no-life, no animus inhabits that body anymore, no suffering, no joy… it just stops there and what used to be becomes an unanimated object…
In my family we laugh a lot about death, we have always talked about it, and even though it’s painful to loose someone you love, my family tough me that we should be thankful for the time spent together. Sometimes that is very hard to understand in a society where death must be a serious and a very sad thing. I’ve learned that death is a natural process, but also that it is way too painful when it is not.
I would encourage a death education, it will definitively help us to love our life in a simpler way and without regrets, it would help to prepare ourselves to an inevitable decaying process that anyhow, somewhere, will have an end.
Wow, interesting idea.
I think young children have to first grasp the idea of mortality – at least for me it took a while to understand that when the cat ate my pet gerbil the gerbil wasn’t simply starting a new life in the cat’s stomach. What can I say I was very young!!
I don’t think you will ever overcome the fear that surrounds death completely but I can see how some kind of death education would help people to be prepared for coming to terms with loosing someone.
Very thoughtful post Heather.
I had the opportunity to view an autopsy during my anatomy class as an undergrad. That, as well as a few other necropsis of different vertebrates (on top of the invertebrates and other zoology studeis we did). I must say that the autopsy was a very good experience, not to mention a few years later when my grandmother passed away (non violently). I am quite sure that I would have been much more nervous about the whole “dead body” experience if I hadn’t had the experience in the morgue with someone I had no connection with…
The old professor, who was very kind and good at telling us undergrad students about “these corpses are nothing strange, you can feel them and they are dry and non-smelly”. He did a very job of taking the drama (scare factor or how else I can put it) out of the suituation and making it more about “this is how we all end up one time”.
Maybe this was more important for me, coming from a culture where we don’t have open caskets?!
I second the opinion that this was a thoughtful post, Heather. As a person who has taught gross anatomy to medical students for over ten years now (sheesh!), I have a lot of observations and opinions about this topic. For half of the year, two to five days each week, I walk beneath a sign outside the anatomy labs that states Mortui vivos docent. “Let the dead teach the living”. I think medical students learn things from their cadavers that they could learn in no other way, and I hope cadaver dissection will always be a part of medical education.
It’s not just the anatomy (although that is of course important) that is learned in the course … it’s also a certain amount of professionalism. Students always give the cadaver a name, and when I have done the prosections, I too named the cadaver. With very few exceptions, students are respectful and grateful for the opportunity to dissect and learn, and most medical school classes have ceremonies to honor the willed body donors at the end of the course. In many ways, the cadaver is the embryonic physician’s first patient. I have seen students moved to tears when they come across tumors, surgical scars, or scoliosis in the process of their dissections, as they empathize and wonder how much the person suffered before he or she died. As an instructor, spending hours with the students in anatomy lab, helping with dissections, is a very different, and more rewarding, experience than is lecturing to them from a bunch of PowerPoint slides in a giant room.
Related to the topic of death and dying, our university has a “One Book/ One Community” project, for which we’re reading Dr. Pauline Chen’s Final Exam: A Surgeon’s Reflections on Mortality. Usually I’m pretty resistant to such projects, but this one piqued my interest. I just started reading the book, so I’m still on the chapter about her gross anatomy class in medical school. According to the back cover, the book is rather more about how the medical profession depersonalizes dying. Dr. Chen will be giving a talk here about her experiences and her book next month, so I hope to have completed reading it by then.
Heather, I had spotted the first few words of the above comments as they came through the “latest comments” section of the site, so I knew I would have to wait to read this post until I had time to give it my full attention. I’m glad I did… you have articulated this idea beautifully.
I would second Samantha’s comment that children learn a lot about mortality from their pets. My own attempts to raise frogs from frogspawn certainly taught me a lot (in two years we had thousands of eggs, hundreds of tadpoles, and one adult frog. We named it Sarah), and I remember the class gerbil dying too.
I was interested by your comment about Western society’s superstitious attitude (denial?) of death and mortality. Not that I’ve actually studied this or anything, but isn’t this more than just a Western phenomenon? IIRC, several Native American and Canadian First Nations cultures forbid even speaking the name of the dead.
This is an amazing post. It’s considered unlucky in my family for a young person to see a dead body, so I never really have and pets kind of “disappeared” overnight. So I think the taboos and superstitions surrounding death are definitely cross-cultural and go beyond making death appear more clinical. Education/ understanding of death is something that many would usually seek through more spiritual avenues, but maybe a more physical understanding would be helpful.
I agree that taboos related to death go well beyond the Western society attitudes with which I am acquainted – but they’re the only ones I feel comfortable in evoking. Perhaps it is universally human, to not invite death over by pretending in some way or another that it does not happen, or by preserving the particular aspect of innocence about death in the younger members of society. I believe that some aspect of preparation for death is necessary, more than is being done, in my experience.
Kristi, your experience seems to be very similar to what was described in Ms. Ballenger’s article. Both make me think that I’d be happy to donate my body to a medical school after death. However, since I would very much like to allow organ donation should it be possible, would medical schools accept cadavers without corneas or a liver or a kidney or a heart? I do wonder what the most efficient use of my carcass would be. Of course one has to take a little bit into account the sensibilities of one’s loved ones, but I think no one in my immediate surroundings is really dogmatic.
Sarbjit – I think that the spiritual and the physical educations about death could complement each other, the former in particular providing the appropriate cultural context and perhaps the tools for mourning and continuing to live. There is no point in forcing people to confront a corpse, either. But like it had been for sex, I don’t have the impression that all members of our Western society are equally well prepared to confront death by their spiritual backgrounds alone.
Heather, I’d imagine that medical schools would prefer intact bodies. I’d always planned to donate my body to research (after organ donation, if possible), rather than anatomy classes. However, after seeing an amazing Body Worlds exhibition a couple of years ago, I have considered signing up for plastination! Apparently they use more bodies and organs for teaching and research than for display, but either way, it’s kinda cool!
Interesting that all commenters thus far are female. I wonder if women are better, or more comfortable, than men at dealing with the reality of death?
I’ve not seen a real live dead body, only closed caskets. I think I did have the opportunity on one or two occasions but I shied away from gazing upon a dead face, fearful of my reaction. I think I was wrong to avoid it.
Nah, I’m petrified myself.
Donation of organs such as heart, liver, or kidneys usually precludes use of a body in a gross anatomy class, but it could still be used in an anatomical workshop for, say, orthopedic surgeons, or otorhinolaryngologists, or physical medicine/rehabilitation specialists. Of course many cadavers are missing organs (or sometimes a limb) that were removed surgically when the person was alive, and no one has much lymphoid tissue left in the pharynx at age 80+.
The Body Worlds exhibits are fantastic; I saw the one with the horse and rider in Houston a couple of years ago. Two of my friends (one is an anatomy teaching colleague) collated written responses to the Body Worlds exhibits, and published an article in the Journal of Medical Humanities (DOI:10.1007/s10912-007-9042-0).
Frank – I have also avoided the casket at the only such viewing I went to. It seemed everyone else there was, too. Not a popular sight among most, I think.
Not sure why it should matter, but somehow it does.
Maybe the women are somewhat more comfortable about commenting on death, as well? Or maybe it’s not really a summer topic, somehow.