"This is my gift to you. Do with it what you want."
October 19, 2013 6:06 PM   Subscribe

The Course of Their Lives. While much in medicine has changed over the last century, the defining course of a first year medical student's education is still 'Gross Anatomy.' This is their hands-on tour of a donated cadaver -- an actual human body -- and is an experience which cannot be replicated by computer models. When Milwaukee Journal Sentinel reporter Mark Johnson came up with the idea of following a med school gross anatomy class for a feature story, his editor challenged him to make it different. So he chose to intertwine the students' stories with that of Geraldine 'Nana' Fotsch, a living future donor, as sort of a stand-in for the cadaver. (Via. This four-part series contains descriptions of a human dissection. Some may find it disturbing.) posted by zarq (29 comments total) 56 users marked this as a favorite
"Treat them well," Hoagland says. "Be good stewards of the gift. These are some of the most altruistic people around. They donate knowing what we are going to do to the body."

Indeed. I think it's a wonderful gift, and because I cannot donate my organs after I die, I've considered donating my body to some form of science when I die. I think bodies should be useful for as long as possible.
posted by xingcat at 6:19 PM on October 19, 2013 [3 favorites]

rumposinc wrote an insightful and truly Best Of comment on this subject: "I carry her in my heart, because I held hers."
posted by MonkeyToes at 6:54 PM on October 19, 2013 [7 favorites]

I decided a while ago I will donate my body to science. I will read this later when I have a chance.
posted by eq21 at 7:23 PM on October 19, 2013 [1 favorite]

"Charles Moffit... I feared not." Puma? Puma??
posted by JHarris at 7:33 PM on October 19, 2013

That's an impressively sensitive and competent bit of journalism.
I've signed up for the local organ donor registry but I'm getting to the age where being a teaching cadaver might be more useful so I ticked the relevant box on the form. I hope to serve as an example of what not to do, health-wise.
posted by islander at 7:45 PM on October 19, 2013 [4 favorites]

This is a fantastic set of articles - thank you very much for posting it.
posted by jquinby at 7:59 PM on October 19, 2013 [1 favorite]

This brought back a lot of great memories. Anatomy class was my absolute favorite time in medical school. In my school, we were four to a cadaver. We all decided our cadaver looked like a "Frank" so we all referred to him as such. At the ceremony at the end, we learned his name was indeed Frank. Weird. He taught me more than any other person ever, in ways I can't find words to express.
posted by karlos at 8:12 PM on October 19, 2013 [9 favorites]

He taught me more than any other person ever, in ways I can't find words to express.

I know and appreciate what you mean, but still, reading this line I can't help but think of what Snowden taught Yossarian in Catch-22:

"Man was matter, that was Snowden's secret. Drop him out a window and he'll fall. Set fire to him and he'll burn. Bury him and he'll rot, like other kinds of garbage. The spirit gone, man is garbage. That was Snowden's secret. Ripeness was all."
posted by JHarris at 8:16 PM on October 19, 2013 [3 favorites]

Yep, anatomy sure is gross.
posted by sexyrobot at 8:18 PM on October 19, 2013 [1 favorite]

That was Snowden's secret. Ripeness was all.

There was a more recent Snowden who had a similar lesson for us.
posted by localroger at 8:57 PM on October 19, 2013

Oh and this series was haunting and lyrical and powerful.
posted by localroger at 8:58 PM on October 19, 2013

I'm imagining a small, indigestible 'time capsule' aka Fortune Cookie I can swallow -- admittedly this would require good timing -- that would hang around for some lucky medical student to find. At the rate data storage goes up, the possibilities get interesting.

"Surprise! You are the lucky winner of my post-mortem gift ..."
posted by hank at 10:56 PM on October 19, 2013

I wonder if there's a history of donors accompanying their gift with admonitory tattoos to the effect that they expect the students to pay attention and not juggle with their kidneys, etc. What, I wonder, would be the ideal form of such a tattoo, addressing the first year med students whose cadaver you were? Something like "Hungover again?" seems apt. The temptation to merely inscribe the words "Remember to call your mother" is strong, too.
posted by aesop at 1:03 AM on October 20, 2013 [7 favorites]

What an excellent presentation ... thank you for posting this!
posted by woodblock100 at 1:45 AM on October 20, 2013

That was powerful reading, and a bit hard.

In the last article, where professor Hoagland was meticulously sorting the cremated remains to dispose of according to donor wishes, I had a flashback to The Things That Carried Him by Chris Jones:
Karen Giles tells a story about another young airman, who was polishing the brass on a dead soldier's uniform jacket. He was using a little tool, a kind of buffer, to make sure that every button shined. A visitor complimented him on his attention to detail. "The family will really appreciate what you're doing," the visitor said. But the airman replied, "Oh, no, sir, the family won't know about this." The airman told him that the family had requested that their son be cremated, and just a short while later, he was.
Something about the intersection of death, service and duty.
posted by Harald74 at 2:55 AM on October 20, 2013 [2 favorites]

this article took up a good portion of my morning, and i'm glad it did. it had me start thinking about things i have long since neglected.

(side note - i was expecting way more gruesome pictures to brace myself against but they were minimal, focusing more on the students and less on the bodies.)
posted by cristinacristinacristina at 7:43 AM on October 20, 2013

Can anyone point me to a text only version of this story? I'd like to read it on my Kindle...
posted by maryr at 8:03 AM on October 20, 2013

These articles did a nice job of capturing the experience of cadaver-based gross anatomy. It is a journey; everyone leaves different than when they arrived.

I'm an anatomy professor at a medical school — our students will be removing the brains this week — and I'm fortunate for many reasons.

I get to watch as my students are changed by the experience. They all arrive apprehensive, though they express it in different ways. Some never get comfortable with what they are doing. All emerge, if not comfortable, at least respectful of the experience. Not just the words of respect, which are easy speak, but the feeling of respect, the weighty emotions that come from truly pondering life and mortality. Most medical school students are young, and it's new to them to so plainly face the finality of death.

Besides the joy of teaching, I myself am now driven more by the other process of discovery that the articles describe: figuring out the lives led by the people who donated their bodies.

We receive little information about the donors. Each cadaver has an ID tag with sex, age, date of death (month/year), cause of death, and occupation. It's those last two that receive the most attention.

Cause of death is interesting most often because it offers so little information. "Adult failure to thrive" with the limp skin of perimortem weight loss. "Renal failure" with huge kidney cysts. "Heart failure". "Multi-organ failure" (read: old age). A recent favorite of mine because of its utter vagueness: "Dibility [sic]". I've even seen that ancient placeholder "Natural causes" (again: old age). But then, it's unsurprising when the cause of death isn't perfectly known. By definition, none of these bodies were autopsied.

Occupation is the real kicker, though. Military pilot. Carpet salesman. Tailor. Welder. University librarian. The most common by far? Homemaker.

It's impossible not to weave stories about their lives. There they are, laid bare before you. And now throw in that one piece of information — occupation — that you would never have known otherwise and that they themselves surely provided when they filled-out the body donation paperwork. What was that military pilot doing in 1965 when he was 30 years old? What about the welder with surgically fused vertebrae (70s era tech), bilateral knee replacements, and large, muscular hands that surely burned together countless pieces of metal? What varied lives did those homemakers lead?

And in the end, they are all united by a decision each made, to let us open them and learn everything about who they were . . . physically, at least.

I will say that being an anatomy professor often makes for instant conversation with strangers at parties.
posted by cyclopticgaze at 9:28 AM on October 20, 2013 [19 favorites]

posted by antiquated at 9:31 AM on October 20, 2013

Wonderful piece. It gave me pause since in my naivete, I'd assumed the bodies were cut up less than they are. I had a picture of a few organs taken out of the midsection and that was about it.
The business about the leg really stunned me.

But what a wonderful piece of journalism, that also managed to tell us so much about young med students and the system of getting them to both see the bodies as lessons in anatomy and as human beings. Great job, and thanks for posting.
posted by etaoin at 10:16 AM on October 20, 2013

Twenty-odd years ago I took an anatomy class in a community college that had actual cadavers. Students in the class, which fed into the nursing school component of the college or to the state medical university, were allowed to view them but not to touch. However, I and a friend who had passed this class the previous semester received permission to dissect one’s finger, in order to see the physical origins of the fingernail.

The woman, our professor deduced, had died of malnutrition, and thus was very thin, which is crucial to the paws of a beginning anatomy student even if she’s just working on a fingertip: fat, he said, was a difficult issue when isolating and dying the innards of a body for its preparation as an educational tool. We were the first to work on her.

Of course, we didn’t know her name. The professor said she was probably a homeless person. Had she deeded her body to science? Had she somehow wound up dying in the local medical university’s hospital, which deemed her useful to a feeder school? She was white, but grayish, as dead bodies are, and maybe in her late fifties. My friend and I hunched over her digit for a day or two, very carefully peeling back the layers of her left middle finger. She was naked in front of us. I don’t recall our report about the fingernail, or the dead woman’s face, but I remember the sight of the fibers at the base of her first knuckle, and how they just disappeared into the space of the body we couldn’t access.

My dissection partner died unexpectedly a year later, and in the shock of it, I didn't realize that she'd have wanted her body donated to science as a cadaver, and probably to exactly that class.
posted by goofyfoot at 8:30 PM on October 20, 2013

A fantastic read. Thanks for this.
posted by bayani at 10:03 PM on October 20, 2013

maryr, does this work? Mobile version.
posted by zarq at 6:38 AM on October 21, 2013

Hm, nope. At least, I was hoping for something I could feed into Instapaper and read at my leisure. I suppose it makes sense for a print publication to want to make that difficult for me, but argh.
posted by maryr at 8:57 AM on October 21, 2013

(I can probably just copy/paste and email it to my Kindle. I'll have to try that.)
posted by maryr at 8:58 AM on October 21, 2013

Sorry. I was about to offer to do that (copy / paste into a text file) for you. :)
If you would like me to, please let me know.
posted by zarq at 10:59 AM on October 21, 2013

Wow, Nana Fotsch is a beautiful woman (who is also making a beautiful gift.)
posted by DarlingBri at 1:06 PM on October 21, 2013

etaoin: "The business about the leg really stunned me. "

Consider - it was someone's job to go in after everyone had left and perform this bit of work, and have everything ready for the next session.
posted by jquinby at 2:12 PM on October 21, 2013

Consider - it was someone's job to go in after everyone had left and perform this bit of work, and have everything ready for the next session.

That part really surprised me, too. I hope all those legs went to some research labs for the study of knees or ankles or whatever. I was also surprised by the part where (if I recall) the students arrive and the skull had already been sawed open, they just had to finish the job by prying off the calvarium.

Our students do everything. The only parts of a dissection that I perform are demonstrating a technique, or helping out if they are spinning their wheels trying to find a structure and it's eating up lab time. Otherwise, I instruct and guide them while they perform the dissection.

Of course the article's school has 35 cadavers and 200 students, which I consider big. And one could make an argument that knowing how to open a skull is a skill that few of them would ever need to possess, and that anatomy lab is strictly for learning structures.

I disagree; I think the process is profoundly important.

Medical school gross anatomy lab serves many functions, but two of the most important are, in a way, at odds with each other. 1) The students are developing a clinical detachment, the ability to emotionally separate themselves from a situation in order to be in control of their mental faculties and make good decisions. 2) The students are developing a humanism that will allow them to connect to and sympathize, if not empathize, with their patients.

Acquiring (1) isn't actually that hard. What really matters is that you don't lose (2). Good doctors are able to balance these qualities in a situation-specific manner.

I think these articles touch on that balance, how the students, to varying degrees, "get used to" dealing with a dead body (e.g.: seeing the face) and the many ways in which they relate to the life the person must have lead. Many articles don't get into that. They often just focus on the mechanics of interacting with a dead body.
posted by cyclopticgaze at 3:06 PM on October 21, 2013 [1 favorite]

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