DISSECTION - AN INITIATION INTO THE BROTHERHOOD

Joseph Ong, July 1999

    The dissection laboratory is tucked away in some isolated corner of the Medical Faculty from the realm of public consciousness and scrutiny. It is a protected territory of the medical profession, out of bounds to the non-medical world, save for a sign of 'trespassers will be prosecuted'. The dissection of a human cadaver is the first rite of initiation into the medical profession for virtually every medical student. An article entitled "First Cut" in the New England Journal of Medicine sets the scene: A sign above the doors said: "Medical Students Only". To pass through the doors was a small rite of passage, a grisly privilege, rows of cadavers lay bathed in cold bleaching light, a submissive, as yet unflayed, welcome to the new initiates. Whatever its obvious practical educational value, human anatomy lab carries enormous symbolic value as a sort of hazing ritual. The interior of the NUS dissecting hall fits this apt description completely. There were 25 cadavers in total; with 8 students and 1 tutor assigned to each cadaver. I still harbored vivid memories of my first dissection session. We took an oath before the actual dissection by placing our hands together, palms down, onto the cadaver and recite a passage, promising to treat the cadaver with respect and to use it solely for our learning and education. We are allocated 2 hours for the dissection and I was amazed at the speed at which we removed the skin and the accompanying fatty and muscular layers. The cadaver appeared less than human than it was originally before the dissection. 

    This is the first time I've seen the actual 'ingredients' I'm made of - the muscles, fats, nerves and blood vessels. The Buddha described the human body as a 'bag of bones, flesh and sinews." How true are his words! Physical beauty is only skin-deep. Will we still use the words 'pretty', 'handsome', 'sexy' and 'gorgeous' to describe this human body if we are able to see through the superficial skin layer and see grotesqueness of the structures below it? I can't understand why all of us are so smitten by sensual beauty and lust. According to the New York Times: Americans spent $8 billion a year on cosmetics - $2 billion more than the estimated annual total needed to provide basic education for everyone in the world. We are living in a world of deception, one that is purposefully and skillfully created by our senses for our indulgence and pleasure. The Lord Buddha exhorted his followers to forsake sensual pleasures in the quest for the truth. "The body is like a lump of foam. Feelings are like bubbles. Perceptions are like a mirage. Mental formations like a plantain-trunk. And consciousness like a magic trick." Like my Indian cadaver, this human body we fussed so much about in our lives will be nothing more but an empty shell when it's devoid of life. 

    Where do these cadavers come from. Did they actually agree to contribute their bodies for the 'learning and benefit' of medical students after their deaths. I doubt so. It smacks of hypocrisy to extol the ideals and nobility of donating one's body to the progress of medical science and education while the very people in the medical fraternity who have been using these cadavers for whatever purposes appeared less than willing to contribute their bodies to their purported cause after their deaths. In exploring medical student attitudes, sociologists hit upon a particularly telling question. The question, "Would you yourself consider donating your body to a medical school to be used as a cadaver?" was asked of 99 medical students during their gross anatomy course. Only 11 said yes. In another study only 3% of medical students were willing to give up their bodies for dissection. "Even more striking than the numbers were the tone and phrasing of the answers, "the researchers report. "In response to this question, students abandoned their customary calm. Their answers became abrupt, tension-laden, and filled with emotion." 

    Dissection has been mistakenly portrayed and interpreted by many as an investiture for students joining the files of the medical profession. Do I feel proud to be one of the 'privileged few'  being allowed access to an experience unique only to those in the medical fraternity? With each slice of blade I wield on human flesh, I could feel a small fragment of my humanity being sliced away. "As I know them," Henry Spiro writes, "college students start out with much empathy and genuine love - a real desire to help other people. In medical school, however, they learn to mask their feelings, or even worse, to deny them...Dissection of a cadaver in medical school teaches primacy of the eye over the ear, for cadavers don't complain, and no one has to listen..." Quoting from an article called "The Inhumanity of Medicine," "Few people would disagree that two years spent in the company of a corpse is not the most imaginative introduction to a profession that, more than any other, needs to develop the skills of talking to distressed people." Becoming Doctors, a book on the professionalization of medical students, describes a typical student comment: "We start by dissecting a dead person, then spend long months in cold medical sciences....When you don't work with patients until the third year in medical school, it's too late - something has already died within you." The obvious conclusion? Depersonalizing our cadaver was good practice for depersonalizing our patients later.

References:

1.    Hafferty, FW. Into the Valley: Death & the Socialization of Medical Students, Yale University Press, 1991:122.

2.    Gropper, C. "First Cut." New England Journal of Medicine 338(1008)"845-846

3.    Spiro, "What is Empathy..." Annals of Internal Medicine 116(1992):843-846

4.    Weatherall, DJ. "The Inhumanity of Medicine." British Medical Journal 309(1994): 1671-1672