As a medical student it is rare to be able to dedicate a month and a half to one project. After Christmas I had this opportunity and, as a budding surgeon, I chose the dissection room.
Previously, my understanding of anatomy had come from textbooks, lectures and demonstrations. While the teaching was comprehensive, I found it hard to appreciate the layers of anatomy — the precise relationships between organs, muscles, nerves and so on. The chance to see it all first hand couldn’t be passed up.
Arriving on the first day, I was extremely excited. I’d seen body parts expertly dissected and isolated, forearms stripped of skin and fat, pelvises scooped empty, and heads cut cleanly in half. The works. I had been ‘desensitised’.
But this day was different. We walked over to the stainless steel table upon which was a white body bag. My supervisor opened the zip to expose a pinkish body. A skinny, peaceful-looking old chap lay there rigid, mouth open, staring at the ceiling.
My inquisitiveness subdued the shock. A few colleagues and I proceeded to collect our dissection gear, clipped the blades on to our scalpels and decided on a body part. I chose the arm — a nice mélange of nerves, muscles and bones that work in concert to produce a vast array of movements we take for granted every day.
As we got to work, peeling up layers of skin, separating them from the garish yellow subcutaneous fat beneath, we decided to nickname our body ‘Robert’, or ‘Berty’, as he gradually became known. Perhaps it was an unconscious way to make sure we kept his humanity at the forefront of our minds, as we stripped away his exterior. (Read more about how Robert ended up in our hands here.)
Dissection used to be the norm for medical students. In some medical schools (Cardiff and Cambridge) small groups of students gradually uncover ‘their’ body over a two-year period. This way of learning is regarded as the gold standard for anatomy, but very few places now offer it.
Dissection is extremely time consuming — it took me an entire month to strip the arm and preserve the nerves running from the neck to the tips of the fingers. Now, newer subjects such as genetics, neuroscience and virology compete for ever-slimming timetable slots. At Oxford, where I am, the decision was taken in the 1980s for dissection to be replaced with learning from pre-prepared specimens. In the interests of time-efficiency, a long-standing tradition was lost.
I wonder if this is wise. Retaining a knowledge of intricate anatomy is very difficult unless you do surgery or dissection (as I have been told more than once). For medics this knowledge is fundamental. As an orthopaedic surgeon blurted at me recently, as I bumbled my way through the layers of anatomy during an anterior hip replacement: ‘There’s really no point being a doctor if you don’t know exactly where the problem is … and for that, you need to know your anatomy.’
Medical faculties face a catch-22. You need to do surgery (or dissection) to retain your anatomy, and you need to know your anatomy to help a patient. However, we also need the time to learn about new theories behind Alzheimer’s and Parkinson’s diseases, to get our heads around epigenetics, and to analyse the tricks used by HIV to attack our immune system.
Our anatomy exams are rigorous, and I don’t doubt our knowledge will be sufficient. But to provide a gold standard of medicine it only makes sense to be taught according to the gold standard. I hope, therefore, that we can bring this fascinating, artistic and humbling aspect of anatomy teaching back into the mainstream, to allow us to fully appreciate the subject, and to reflect more deeply about what it is to be human along the way.
The journey to the dissection room
At some point, each donor freely offered their body to Oxford Medical School, in accordance with the Human Tissue Act, 2006. For some, donation is made early; they feel strongly (and rightly so) that their body is a valuable gift to students, and will have paperwork in place long before their demise. In other cases, body donation is brought up when writing wills, and not infrequently, partners decide to donate their bodies together.
Before signing on the dotted line, potential donors will speak on the phone to one of the dissection room staff. Some want to know the minutiae of what exactly happens to their body: Will my face be dissected? How will my body parts be stored? Others just want to ensure their heart will eventually go for cremation, to be buried alongside the ashes of their spouse.
From the point of view of the family it can be very hard not to have the body at the funeral, yet most will hold a memorial service of some kind to commemorate their loved one. At the end of their time in the medical school, the university will pay for a cremation and the family choose whether or not to attend. For some, this is an important ceremony of closure, while for others it is something that they prefer to have happen without their involvement.
At some medical schools (for instance in Cambridge and in Otago, New Zealand) the group that dissected that particular body will also be invited to attend. Of course, it is a time of great anxiety, coming face to face with the spouses, children and friends of the person that, only months ago, you took a knife to. However, many talk about it fondly. Joe O’Sullivan, who studied preclinical medicine at Cambridge, says the experience was ‘overwhelming’. ‘All year you had known they were a real person,’ he says, ‘but you didn’t really understand that until you read their name and about their life. There were lots of tears.’ Being regaled with happy memories and funny stories adds a different dimension to the otherwise purely academic, gory exercise, and also allows the students to share their sincere thanks.
More details about body donation can be found at Hta.gov.uk