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Doing Harm?

As the first day of gross anatomy closed in, I tried to prepare myself. The problem was I had few comparable experiences to draw upon—which, when it comes to slicing open a human body, is definitely not a bad thing. There was one dissection in seventh grade of an owl pellet. What I recall most was its disconcerting resemblance to my cat’s hairballs. That had been more than enough dissection for me. But I was not wholly apprehensive: I hoped gross anatomy would be profound, prompting a reckoning with mortality perhaps, or a newfound reverence for life. After all, this was no owl vomit.

I got one part right. Yellow globs of fat, chunks of clotted blood, a miasma of flesh and feces: I was disgusted.

Some hypothesize that dissection marks the beginning of the decline in medical students’ empathy, a well documented phenomenon during this demanding four years of  training. Cold doctors get their start as overwhelmed students of anatomy, distancing themselves from their cadavers to cope.

“No chance I am donating my body to medicine,” a classmate decided in one of our first dissections.

At Penn, we learn little about our donors: a diagnosis, a cause of death, a brief personal note. Some of my classmates have made an effort to inject humanity into the anatomy experience—perhaps mitigating harm to their empathy—by referring to their cadaver as their donor. This language also serves as a comforting reminder: this was a person who had a will and made choices, including the choice to donate.

“Do you think they knew what happens to their bodies,” another classmate wondered, skeptical that any truly informed person would consent to this.

Calling anatomy a butchering is barely hyperbole. The violence of it can threaten a person’s sense of identity as a healer. Some have responded to the threat by trying to be as delicate as possible. Do no more harm than necessary is their modified commitment.

Others have little more to say about dissection than, “It’s fun.” Even some of those who struggle with the ethics of anatomy have found satisfaction in the work. I admit my chest swells when a preceptor exclaims, “Beautiful dissection.”

For the most part, anatomy has been remarkably unremarkable: no existential clarity or deep feelings of sadness. I guess the experience has occasionally produced new feelings of gratitude. The week we dissected the gonads, I silently thanked my pudendal nerve after a successful trip to the bathroom. But gratitude in this case involves identification (i.e., this body is the same as my body), and identifying with the bodies of anatomy—bodies that can seem to be pathology and death incarnate—frightens me.

Now, just more than halfway through the course, I am beginning to enjoy dissection more. I have become used to the once shocking smells and sights and activities.There’s utility in this desensitization I tell myself, although sometimes I think the experience has cut deeper. The other day I cracked our donor’s clavicle with a bone cutter. “Oddly satisfying, huh?” a fourth-year TA remarked. I didn’t disagree.

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