Friday, March 27, 2009

Gross Anatomy for Psychiatrists

Alas, poor Yorick. I knew him, Horatio--a fellow of infinite jest, of most excellent fancy. He hath borne me on his back a thousand times; and now, how abhorred my imagination is! My gorge rises at it. Here hung those lips that I have kissed I know not how oft.


It is a psychiatry resident, Christine Montross, M.D., who makes the case in the NYT for cadavers over digital "equivalents" in medical education. As a doctor who nowadays never touches a patient beyond a handshake, I couldn't agree more, even though the experience of real dissection 18 years ago now was intellectually and existentially stressful in the extreme at the time.

Like any experience both transformative and traumatic, medical school leaves a number of indelible memories, but prominent among them was walking into the Gross Anatomy lab for the first time, where in my room there were perhaps a dozen cadavers, each shared by a team of four students. Before the actual dissections began, the entire class was brought in on an evening to be introduced, as it were, as was appropriate to the situation. The bodies bore no identification or information beyond what could be inferred from, well, their anatomy. "Mine" was a thin old man; I wondered endlessly what his life had been like and how he wound up there.

Medical school was plenty anxiogenic overall in an intellectual sense, of course, but Gross Anatomy added a reverential depth to the endeavor. Sure, there were the whisperings and gigglings over body parts, carried out to dispel anxiety most likely, but overall, the experience conveyed the message that the business of medicine was, literally, dead serious, about real people with real bodies that, as all bodies eventually do, failed. Our job was to find out why and to try to prevent it from happening to others in the future insofar as we were able.

The existential encounter was unforgettable; the actual dissection was, to me, a relatively distasteful denouement. It was clear early on that I was more of a theory person than a procedure person, although until I hit a superb VA psychiatry clerkship in my third year, I would have speculated that internal medicine or neurology was where I was headed. But inasmuch as in traditional medical programs, such as mine still was in 1991, the first two years was primarily about mastering massive quantities of abstract information, the experience of read cadavers was a crucial and concrete corrective, a reminder that medicine is about very specific lives and deaths. Gross Anatomy done virtually, in a disembodied fashion, would be very different indeed; like many rites of passage, this one gains in importance with time.

My wife's grandmother died not long ago, at the age of 95, and donated her body to a medical school. I can't imagine a better way to go.


Anonymous said...

All simulations lack that visceral quality which is impossible to reproduce with technology. Virtual reality to real life without death in between is a clumsy leap.

Is burial and cremation even ethical now?

Leon's current assignment said...

No thing replaces the wisdom gleaned from direct experience. Excellent post, again.

I placed the complete "shell" in which I travel on the donation list decades ago. Oh how I wish my fellow bipeds would follow suit. But, then, what else is new? (laugh)

Anonymous said...

My first love in medicine was anatomical pathology, but my true love is psychiatry. Two side of the whole. Windows into the human condition. One window being the beauty and frailty of the body, the other the window to the soul and essence of humanity. I concur with the blog author that to not have seen the frailty of the first, nor engage with the second leaves us poorer and less empathetic as clinicians.