Student Reflections on the Study of Anatomy

We are writing to you to express our gratitude for the gift your family member made to our medical educations and lives. We will be remembering and acknowledging the generosity of your loved one at a Service of Gratitude at the Yale Medical School. This service is organized each year to give medical and physician associate students the opportunity to express the emotions and thoughts they have about the relationship we have formed over the past few months.

It is difficult to express the many ways in which these individuals have touched our lives. They have been profound and inspiring teachers as well as friends to us. This experience is like no other in medicine, and we are humbled by their decision. A great privilege has been given to us by these individuals, and we will go into the field of medicine with a heightened sense of duty and gratitude because of them.

Though we understand it is difficult to lose a loved one, we hope that it will be of some small comfort that we will carry the lessons we have learned about the human body and spirit from your family member forward into our careers. These lessons will improve our medical judgment and our relationships with our patients. We are also mindful of the sacrifice that you have made and of the emotions you may feel about this process. We appreciate your understanding and patience.

Again, we would like to acknowledge the tremendous gift your family member selflessly volunteered. We will remember them with great respect and admiration for the choice they made.

Psalm 139: 1-5, 13-16 “O Lord, you have searched me and you know me. You know when I sit and when I rise; you perceive my thoughts from afar. You discern my going out and my lying down; you are familiar with all my ways. Before a word is on my tongue you know it completely, O Lord. You hem me in—behind and before; you have laid your hand upon me. (13) For you created my inmost being; you knit me together in my mother’s womb. I praise you because I am fearfully and wonderfully made; your works are wonderfully, I know that full well. My frame was not hidden from you when I was made in the secret place. When I was woven together in the depths of the earth, your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be.”

Through my experience in anatomy lab, I have come to a deeper understanding of what this passage means. I am so thankful that my cadaver donated her body so that I could have first hand experience with the intricacies of the human body. I was able to see how the body was perfectly woven together. I have a renewed understanding of the sanctity of life and of the complexity of the human body. I also have a deeper grasp on the responsibility that comes with being a health care provider as I try to refine and ‘fix’ this incredibly designed structure. I am so thankful for the opportunity to see how we truly are fearfully and wonderfully made.

I call this drawing “Handed”, to convey the notion that we teach and learn through our hands. The object being handed from one hand to the other is a dodecahedron (a twelve sided geometric figure composed entirely of pentagons.) It was conceived of over 1500 years ago by the Pythagoreans, who regarded it as their most cherished secret. To them it represented what they called the Fifth Element, a fundamental energy that bound the other four elements together. Learning its precise method of construction was the final rite of initiation into this elite group of scholars.

Almost a millennium later, Leonardo da Vinci popularized the dodecahedron not as a mystical force, but rather as a symbol of enlightenment and learning. Renaissance artists were intrigued by this particular shape because inherent to its form is the ratio of 1.618 to 1, also known as the Golden Ratio. This ratio is often found in the human body, especially the face and hands. The dodecahedron in this drawing as well as the hands grasping it were all created using the same “golden” proportions and spatial relationships.

Through its historical and mathematical references, this work can be thought of as an allegory of teaching and learning. Specifically in the anatomy lab, knowledge is imparted through two distinct relationships: The horizontal view of this drawing acknowledges the teacher student relationship, while the vertical view is intended to pay homage to the relationship between student and donor.

This encounter with the deceased was a first for me and I nervously wondered whether that first reaction would be telling of my character; will I cry, will I display humor, or will I be indifferent?? Should I cry, should I laugh or should I be indifferent??

Who was to know??

That’s when I quickly decided that for me to become comfortable in the unsettling atmosphere of death and dying, I needed to give my fears, concerns and curiosities their due share to be expressed. These “reactions” are after all an integral part of my being; and allowing their expression without debating their “Appropriateness” will help me determine how to emotionally manage my intimate encounters with death, in ways that blend my humanity with the expertise that I will have as a caregiver.

I assure you that after some time the initial nervousness and apprehension will turn into fascination and a great appreciation for the intricacies of the human body and for the fragility of life. And I also assure you that this transition from anguish and conflict to excitement and anticipation brings with it great new challenges. You’ll quickly realize that in anatomy lab, an interesting meeting is always taking place, between us freshly entering the practice of medicine and our donors who have actually exhausted its care. This continued meeting quickly highlights the fact that we have so much to learn.

Indeed our interactions with our donors force us to tackle one of our greatest fears and humble us by reminding us of our vulnerabilities, of our imperfections in knowledge and of the humanity in our disposition. Our donors choose to assist in our learning by donating their most valuable possession; by giving of themselves. And that beyond guiding our functional understanding of anatomy, they also leave a legacy that transcends time to live as a unique experience in each of us; a legacy that enables us to reflect on life and its antithesis, and helps us recognize that while we are all built on the same, single plan each of us asserts an individuality through our unique deviations from the norm. Our donors tell us about their lives through their unique features. Through their enlarged hearts, varied vascular patterns, surgical scars and pacemakers, they help us frame our observations; And with each discovery they guide us towards an integrated understanding of the structure and function of anatomy.

So It’s certainly okay for us to feel apprehension and anguish OR to feel excitement and anticipation; but irrespective of the emotions, it is important for us to recognize the privilege in the opportunity we are presented with and to be grateful for the enormous generosity and courage of our donors; and that beyond our temporary time in anatomy lab, each of us will carry a unique meaning associated with our experience.

In anatomy programs and among incoming students there is often talk of cadavers, or donors, as the “first patients” that a medical novice will encounter. But this characterization – with its implication of service or care on the part of the student – bears little resemblance to the actual relationship that materializes in the gross anatomy lab. From awkward laughter, to misplaced elbows, to interposing thoughts of when dinner and gym time will be – there is really not much directly gained by way of a template for future clinical interactions. Dissection is in many ways an act that pushes the limits of normal human behavior and decency. But it must certainly not become a hardening experience, a right of passage that releases upon the world legions of future knife wielders and pill pushers – inured to the suffering of their fellows. Were it not for our conscious appreciation of the generous wishes of these individuals who choose to donate themselves to Yale, there would be something perverse in learning to cut without hope of a therapeutic outcome.

No, my donor was not my first patient, but rather one of my first and best teachers – a willing guide and a paramount model of the sacrifices that we must all learn to make if we wish to effect real differences in the lives of the future patients that we will touch and talk to, anaesthetize and operate upon. Death is for the most part a private thing, and I believe that the willingness to share ones dead self for didactic purposes is a noble thing. My donor had a lot to say. He told me about the beauty and mystery of the human body, about a miraculous design and the pain that it can bring when things go wrong. I can only hope I will find the courage to give of myself to some degree of how he has given for me.

Each of our unique journeys has led us to a career focused on improving the quality of life for individuals and populations. This path constitutes a life-long commitment to selflessness. Yet, taking the time to thank others whose contributions supported our growth is imperative. Mainly, I ask that we remember and honor the donors who have perhaps performed the most selfless act. They have gifted and entrusted their vulnerable bodies, the reservoir of their life, simply for our learning. While we could do no direct harm, we respected the individual in front of us, appreciated the diversity and beauty of the human anatomy, and forever will seek the guidance of their gift with each patient before us.