Cadavers give docs leg up in training

Jennifer Giltnane MED ’08 GRD ’08 never knew Myrtle, but she knew Myrtle’s hands. The calluses, the wrinkles, the converging lines of head and life — Giltnane knew them all intimately because she took them apart.

Until the moment when Giltnane unwrapped the hands, her cadaver had seemed like a cold, slightly repulsive body on a metal table, the head veiled under a sheet. But the hands sent a different message, an inescapable story of an individual. It was like a handshake Giltnane would never forget.

“Hands are such a personal thing,” she said. “It really hit me that this was a person who had a job and had children.”

Two years later, Giltnane has memorized more body parts and disease names than she probably remembers, but the hands of her cadaver are inscribed clearly in her memory.

Cadaver dissection, long held as a right of passage for young doctors-in-training, is by most accounts a messy process wherein the doctor comes to know the flesh and bone in their rawest forms. It is a process of true disassembling, with all its picking, cutting and fumbling.

Although medical schools today obtain cadavers through donation programs, and the donor’s identities are carefully protected from even their dissectors, there is a reason that relatively few doctors ever give their own bodies to science. The process is inescapably deconstructive.

The necessity of dissecting human cadavers has been drawn into question in recent years because technology can provide excellent models of anatomy without the messiness of a human body, Abigail Zuger reported in The New York Times on March 23.

At the Yale School of Medicine, however, cadaver dissection is not only alive and kicking, but it is also about to undergo a reinvention. Taught with a uniquely holistic approach, gross anatomy remains an important part of the curriculum. And thanks to grant funding from the U.S. Department of Education, Yale professors have nearly completed designing a new course poised to resurrect a fading tradition.

Putting the pieces together

For Yale professor of gross anatomy Lawrence Rizzolo, who leads first-year medical students through their dissections, the process is less about the bits and pieces of the human body and more about the synthesis of knowledge and emotion. Under his leadership, the Yale dissection class involves students in “learning societies,” where they are encouraged to discuss their reactions, personal backgrounds and a variety of pertinent medical issues.

“For a lot of folks, it [brings up] essential core questions of death and dying, a real serious kind of discussion that transcends biology,” Rizzolo said.

Though he is teased in the medical school circles for his “touchy-feely” approach, Rizzolo has put the humanity back into what was once considered a test of will and a trial to harden emotions. In his class, the word “cadaver” is taboo. Students instead refer to their “donor.”

Giltnane and her lab partners, who took Rizzolo’s class in the 2001-02 school year, named their cadaver “Myrtle” because she looked like she might have been someone’s grandmother. At a service of gratitude held at the end of the year, Giltnane recited a poem she wrote about the process of dissection.

“Confronting death is something you do new every time,” she said, reflecting two years later. “This was the first time we had the opportunity to think about death with someone you do not have a personal relationship with.”

History of Medicine professor John Warner lectures Rizzolo’s class on the history of cadaver dissection before the students “meet their donors” for the first time.

“There’s been a long tradition among medical students that made this process about toughening up and dealing with it,” Warner said. “That doesn’t necessarily make a good doctor, and that doesn’t necessarily make good patient care. [Rizzolo] wants students to be aware and sensitive and open and absolutely unashamed of their reactions, whether it’s a matter of going to the bathroom and throwing up, or having nightmares or having no reaction at all.”

Warner reminds anatomy students that Rizzolo’s approach is radical when considered in light of the history of cadaver dissection. At the Yale School of Medicine, as at many other older medical schools, the current gross anatomy classes labor under the shadow of a darker past. For most of the history of cadaver dissection, there were no donors, only unfortunate bodies.

Resurrection riot

Hanging in the rotunda of the medical school is a portrait of Jonathan Knight, Yale’s first professor of anatomy and physiology. During his tenure, obtaining cadavers proved a tricky task because there was no legal way to do so. Part of Knight’s job, therefore, included turning a blind eye to mysteriously procured cadavers.

In January 1824, when the grave of 19-year-old West Haven resident Bethsheba Smith was found empty, citizens turned an angry eye upon Yale medical students. The police were involved, and a hastily dug pit containing the remains of a young woman was discovered in the basement of the medical school.

Some 600 angry, armed residents turned up on the New Haven Green later that day, threatening to storm the school, only dispersing after they were read the Riot Act. The New Haven “dissection riot” was one of several that occurred throughout the country during the 19th century. The practice of exhuming bodies to use in medical education was so common, there was even a name for professional body snatchers — resurrectionists.

Only after the New Haven riot did Connecticut’s legislature pass a law allowing the unclaimed bodies of people in state institutions to be turned over to Yale, at that time the only medical school in the state.

But what was once such a radical scientific act, by the turn of the century had become overshadowed by a focus on new laboratory science. Anatomy was no longer the frontier. And today, despite the success of doctors like Rizzolo, the practice has come under siege by those who say human dissection is unnecessary and impractical and is threatened by a lack of trained anatomy professors.

The emphasis on technology as a replacement for cadaver dissection is part of a larger, discouraging medical trend toward dehumanization, Rizzolo said.

“Now we have all this technology, we know the patient as a list of numbers, but we don’t know them as a patient,” he said. “The danger is we lose touch with the patient as a person.”

Upside-down anatomy

To combat the decline of cadaver dissection, as well as the dehumanization of medicine, Rizzolo and a number of professors at the School of Medicine are using grant money to design a new curriculum that approaches anatomy from a clinical prospective. After surveying practitioners about what anatomical knowledge they have found the most useful, the Yale professors decided to pare down the amount of anatomy taught. The course has students begin with real clinical cases and then approach their cadavers.

“The cadaver becomes a research tool,” Rizzolo said. “Our activities require students to make decisions. Using these highly interactive activities together with the donor — it’s turning the anatomy course upside down.”

Technology is integrated into the dissection with the clinical cases, and Rizzolo said the course also easily lends itself to training gross anatomy instructors.

If all goes according to plan, Rizzolo said, the first class taught with the new curriculum will begin this September at Yale, with a refined program ready within three years for other medical schools to adopt.

Although the new course design incorporates clinical cases and technology, Rizzolo said the cadaver will always remain at the center of the course — a decision that Giltnane fully supports.

For Guiltnane, Myrtle’s hands became symbolic of the patient-doctor relationship.

“They are so skilled at integrating the high technology, but I really don’t think anything can replace [the cadaver],” she said. “It’s not a computer’s hand we’re going to be holding. This cadaver is your first patient.”

Sheffield-Sterling-Strathcona Hall, former home of the School of Medicine, looms behind Grove Street Cemetery. The basement of SSS was once used as a storage place for cadavers.
Cody Dashiell-Earp
Sheffield-Sterling-Strathcona Hall, former home of the School of Medicine, looms behind Grove Street Cemetery. The basement of SSS was once used as a storage place for cadavers.

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