To many a bright-eyed first year medical student, there's one experience that marks a real turning point or 'rite of passage' into the medical field. That moment when textbook studies leave the stage, and actual flesh and bone take the spotlight.
Enter gross anatomy 101. Human dissection.
As an early hub for modern medicine and education, Philadelphia was a nexus for both the science and art of human anatomy, with famed anatomists like Dr. William Osler leading dissections in his University of Pennsylvania lab in the late 1800s, to renowned painters like Thomas Eakins capturing those cuts on canvas.
More than a century after these early pioneers made their first incisions, the anatomy lab still plays a vital, though evolving role in medical school. And it's an experience that aspiring doctors like Frances Ding, Megha Mandalaywala and Samuel Werner – all first year medical students at Rowan University School of Osteopathic Medicine [RowanSOM] who are about to embark on their first lab of the year — may carry throughout their entire medical career.
It's a Friday afternoon in early November when several dozen first-year medical students at RowanSOM, most in their early twenties, filter into a lab room and prepare to meet the very first 'patient' of their formal medical training.
"I'll be interested to see how emotional I'll be," said first-year Frances Ding. "She doesn't know what kind of doctor she wants be, but says today will be an important test, whether she'll be able to make it through the rest of her training, and more immediately, whether she can make it through the lab without fainting. "I think you get into medical school and you're convinced you want to do it, but until you've had that experience, it's hard to be 100 percent sure."
For Megha Mandalaywala, a lot of buildup to this day came from family.
"My parents, when they found out when I was going to med school asked 'when does anatomy lab start?'" recalls Mandalaywala. "Because they know that's how you learn, the body is so fundamental to this career. That's who we're treating, we're treating people and diseases that affect their bodies."
Mandalaywala and Ding are nervous but also really excited.
"You have to understand, it's a weird emotion to have," says Mandalaywala, thinking about the fact that she and others will be spending the next three hours dissecting a dead body.
"It's going to be intense," says Samuel Werner, an aspiring primary care doctor, steps away from entering the lab, who describes his heart racing. "There's an overwhelming presence that there are dozens of vessels that once carried souls within that room, no matter how [you] dismantle them [you] can't hide what their original purpose was."
Getting to know the 'patient'
The lab has two sessions. Students in the alternating one have already made the first incisions, peeling back the skin and removing some of the ribs.
Werner, Mandalaywala and Ding, suit up in scrubs, break off into different groups, five per table. Today's assignment? Removing and examining the heart.
"In text books everything has a very defined shape, that is not the case at all," says Ding, as she and her group try to figure out how to remove the heart without damaging other vital nerves and muscles. "Everything is the shape it is to fit the body."
15 bodies wrapped in cloth and plastic rest on metal tables. The heads and almost everything else are completely covered, except for the chest cavity, which is totally exposed, wide open, bleeding shades of bright burgundies and browns.
Call it adrenaline, youthful science lab excitement, or future doctor instincts kicking in, whatever apprehension Ding and others had going in has vanished. The room is abuzz with chatter as students debate how to make cuts without disrupting other important nerves and arteries, trying to identify all the nuanced features underneath the skin.
The only information students get about their bodies is the age, cause of death and the sex. That's it. No names (though some students create names). Even so, Rocco Carsia, Rowan's longtime anatomy teacher, says students will get to know them very well.
"The way we approach it here, we make the cadaver their first patient," says Carsia. "Everything that goes along with it, the uncertainties, they learn secrets about the cadaver probably the patient themselves never realized. The kind of abnormalities they see, the students find them out in these investigations."
In his more than 20 years, Carsia has only seen two students faint.
Changes to anatomy lab
Human anatomy education has changed in recent years, with more and more schools using three-dimensional imaging tools and other technological advances like ultrasounds. Even so, it's an "adjunctional piece," according to Jennifer McBride, head of histology at the Cleveland Clinic Lerner School of Medicine and leader of the International Anatomy Education Federation. "There really is no replacement for looking at a cadaver."
In a 2009 survey of medical schools, McBride did find the number of hours allocated for anatomy lab have declined, as schools work to squeeze in more subjects. But "no school to my knowledge has gotten rid of the cadaver experience."
McBride says schools are also experimenting with prosection verses dissection instructional techniques. In the case of prosection, students may zero in on a specific body structure prepped by an experienced anatomist.
Inside the RowanSOM lab, Carsia doesn't lead any part of the class. Instead he walks around, checking in as students take charge. The point is for them to integrate what they learn here into their clinical development. Each group has a 'lead dissector,' who has previewed that day's topic.
Werner and others focus on removing the heart, without disrupting other important nerves and parts of the body. It's an art.
Each group's body has a different story, a different history, and with that different dissection challenges. Mandalaywala's table's heart probably had a pacemaker. It has wires in it. The heart is also unusually large, requiring two hands to handle it.
"It's really complicated," she says, with a light laugh. "It's a mess but we're learning, right? That's the whole process."
Over the next two hours, students peel back layers, trying to identify and understand the different chambers and arteries.
"Until you actually see the way and feel the way its connected, understanding how one thing works in relation to another, you're never going to have that special understanding, says Werner, pondering how to best maneuver cuts into the heart of a woman who died at the age of 107.
At another table, a student gasps, as she first lays eyes on the intricate tree branch-like patterns of the heart muscles.
As the 3 1/2 hour lab comes to a close, Mandalaywala and others provide in some ways the only real care they can to the bodies, redressing and wrapping them up. Spraying them with fluids to keep them from drying up.
It's intimate, lifting hands, catching details and reminders of a life once lived.
Post lab processing
Stepping out of the lab, Mandalaywala is already looking forward to the next session.
"Finally, it feels like I'm in med school, you know?!" she says.
Reflecting afterwards, Ding found the experience validating.
"I'm surprised to see how easy I was able to disassociate the task of what I was doing from the person, the patient," says Ding, adding that she's grateful to those who chose to donate their bodies for the purpose of students' learning and development. "I definitely think if I was faced in a real life situation, I wouldn't be hung up on that."
Werner is still processing, thinking about how the experience is changing his view of his own mortality and choices.
"I was literally holding in my hands a human heart. Not only a human heart, but a heart that belonged to a human" says Werner. "I could see reflected in my hands the life that she chose to lead. Once you hold that how can you not moving forward, enter into a new life where you won't consciously be thinking about what choices you make will have on the physical reality around you?"
After the year-long course comes to a close this spring, the donated bodies are cremated, with the cremains returned to families. Students will hold a memorial service, where they'll read essays, recite poetry, to honor those donated their bodies.
But for now, in what was just moments ago a booming room, full of life and energy, these bodies rest, wrapped up, waiting till next class, to serve as silent teachers for this next generation of doctors.