USC Med Students Find Humanity In Unlikely Places
Unlike the other 32 dead people in the basement-level room, this cadaver isn’t infused with a mixture of preservative chemicals and formaldehyde and lying beneath a simple white sheet. Instead, this donated corpse has been sliced from head to toe into one-inch-thick cross-sections, then frozen and embedded in clear slabs of Lucite.
While medical embalming fluids turn human bodies a uniform greyish brown, Lucite slabs permanently preserve a colorful slice of recently extinguished life. The orderly arrangement of yellowish brown bones, ligaments, tendons, muscles, nerves, veins, arteries and other intricate structures of the flesh offers a strange glimpse into what a surgeon might see in the operating room—and what first-year medical students encounter on a daily basis in their Gross Human Anatomy course. From the moment they step into USC’s lab, they begin learning the lessons that will transform them from ordinary laypeople into doctors capable of working with the vulnerable, sick and dying.
“You put your white coat on, and even if you’re not ready, the rest of the world is going to treat you differently,” says medical student Lauren Nosanov. “Somewhere in the four years of medical school, you have to become that person, whether it be someone who knows what the inside of the human body looks like—not that many people do—or someone who has handled many dead people and is okay with it. Anatomy’s a big part of that transition.”
The course is a rigorous psychological journey, but most medical students take it in stride. A few feet away from the sliced-up body in Lucite, Professor Mike Snow is unwrapping a shroud that encases a traditionally embalmed cadaver, which lies face-up on a metal cart. Next to the cadaver are tools of the trade—scalpels, picks, probes, forceps, hemostats and scissors. On the cart’s bottom shelf, two biohazard buckets store the detached bits and pieces of the cadaver until they are reunited with the body prior to being cremated and returned to the family. On the same shelf, a clear plastic box contains a bony collection of human clavicles, vertebrae, ribs, hips and scapulae.
With bright white hair, lively blue eyes and wire-rimmed glasses, Snow is tall and classically professorial. Behind him, full human skeletons hang on rolling racks scattered throughout the room, light boxes illuminate a collection of X-rays and MRIs of internal organs and drawings of circulatory pathways for blood and nerve systems cover the many chalkboards on the walls.
Two female medical students in sneakers and blue scrubs peer into the heavily dissected body as Snow reviews a recent lesson about the abdomen. Beside him on a bookstand, an open copy of the “Atlas of Human Anatomy” depicts pretty, pastel-colored illustrations of the same organs in the cadaver on the cart.
My eyes momentarily drift from the young, studious faces of the medical students to the ragged remains of the grayish-brown human specimen. I try to make sense of the discolored, disassembled figure, but I can’t. It’s a mess. A pang of shame hits me for having such a disrespectful thought. This mess was probably somebody’s grandfather.
The medical students appear completely at ease with this intimate, up-to-their-elbows encounter with death. But getting to this point required some mental adjustment.
“You go from undergraduate to the first week of medical school, and you’re already thrown into a lab, and there’s a whole body,” says student David Ibrahim, who serves as a teaching assistant for anatomy. “A lot of my friends thought this was intimidating at first.”
Nosanov remembers being “really, really nervous” because her undergraduate degree was in theatre, not science. “Some pre-meds take anatomy as undergraduates,” she says. “The closest I came was a pig dissection.”
Snow, who vice-chairs USC’s cell and neurobiology department and has taught anatomy for 40 years, addresses the issue head-on in an introductory lecture in which he covers course basics. First-year anatomy unravels the insides of the entire human body with the exception of the reproductive system, which the students study for a month during their second year. First-year topics span everything from circulatory system to the musculoskeletal system to the respiratory system. A topic such as the digestive system alone requires six hour-long lectures accompanied by six three-hour lab sessions, where students dig through preserved human flesh to see the veins, arteries and nerves that supply organs such as the stomach, gall bladder, liver and intestines. That’s all while learning about the related microscopic anatomy, pathology and medications.
Snow also emphasizes that the students must show the highest respect when working with deceased human bodies, which are not meaningless lumps of inanimate flesh. In life, the same people laid out on the metal carts donated their bodies specifically to USC for the purposes of medical dissection. “That helps somehow, just knowing those people wanted us to learn,” says Nosanov.
In his introductory lecture, Snow invites students who are unsure how they’ll react to the cadavers to go to the lab with him before the first class meeting. During these visits, he uncovers a cadaver and allows students to gauge their comfort levels and process their feelings in private rather than in front of 185 classmates. Every year, roughly a dozen future doctors take him up on his offer to have a one-on-one encounter with the cadavers before the first class.
“When they actually see the body uncovered but still with the skin intact, it doesn’t look very humanoid,” Snow says. “The color and texture of the skin is altered by the chemicals in the embalming process. And for both males and females, the hair is shaved off the heads so that when we get to dissecting that region, it’s much easier than working with long strands of hair that are in the way.”
The team of a half-dozen students that dissects each cadaver must balance this vision of a bald, impersonal specimen with the fact that the cadavers were recently living people just like them. Ibrahim explains, “You take on that cadaver like it’s part of your group or part of your family.” Nosanov’s team nicknamed theirs Lucy after the famous Australopithecus afarensis skeleton of an early human-related species that lived approximately three million years ago.
The students tend to be most acutely aware of their cadavers’ humanity at the very beginning of the year and when they first cut into the face and hands, which are sometimes still adorned with nail polish.
Nosanov expected the facial dissection to bother her, but ended up feeling inspired by the complexity of the human body instead. “There’s a step in one of the labs when you cut the head in half and split it, and I just remember thinking: That is the coolest thing I’ve ever seen in my life,” she said. “It strengthened my desire to want to do surgery because of the utter awe and fascination of all the little parts and how they can break, and we have the capacity to put them back together.”
Not all students relish dissection to this extent. But those who brave the anatomy lab get a glimpse inside the human body, and few if any remain unchanged by the experience.
A recent group of students opened up an 80-plus-year-old cadaver and found the major internal organs and vessels inverted or mirrored from their usual positions. “I knew it existed,” says teaching assistant Justin Hall. “But to look in there and see the heart [on the right] and the lungs opposite as well and the vessels pointing the other direction was just—it was awesome.”
The rare condition, called total situs inversus, often causes no medical problems whatsoever. By witnessing this normal but dramatic variation, the future physicians realized that anatomical differences between individuals do not always spell pathology.
Students also learn through their encounters with cadavers’ pathological variations. “You’ll see the hearts with multiple bypasses, and they don’t even look like human hearts almost,” says Professor Gene Albrecht, who has taught anatomy at USC for more than 30 years. “And at the same time, you’ll see cadavers where there’s no visible pathology, and they might have died of a stroke where one small artery shut down. So you see how fragile life is, and also how robust it is.”
The physical structures of the human body aren’t the only lesson on the table in the anatomy lab. For doctors, a day at the office can include anything from delivering a baby to losing a patient on the operating table. In specialties such as oncology, heart surgery and emergency medicine, doctors can witness death on a weekly, daily or hourly basis. But usually, they’ve all seen dead bodies before during training.
“In a way, it reinforces the cycle of life—that everything’s born, everything lives, eventually everything dies,” says Hall. “I think anatomists often wind up being more comfortable with the idea of death—both of people that are close to them and themselves. It’s something that I’m much, much more comfortable with.”
Hall has made peace with his own mortality to the point that he’s currently an organ donor and eventually plans to donate his body for medical dissection.
For other anatomists, dealing with death never gets any easier.
“We lost one of our colleagues, Bernie Slavin, a wonderful teacher,” says Professor Michelle Winfield, a physician, surgeon and dentist who has taught anatomy for 15 years. “Death is so final and so sad that it’s extremely hard. I don’t think anyone ever gets used to it.”
Winfield’s feelings extend to the cadavers in the lab, which she and her colleagues view as the students’ first and best patients. “To me, it’s always tough to see them not alive,” she says. “No matter how well people handle things and all the current jargon about closure and all of that, loss is loss.”
At the end of each year, the students acknowledge these complex feelings at an on-campus remembrance service for the cadavers. The future doctors share reflections and poetry about the dissection experience, perform music and light candles. For the past two years, some of the donors’ family members have attended and met the students who learned from their deceased relatives.
At least half of USC medical students return to the cadaver lab voluntarily in their fourth year, because they realize doctors and especially surgeons need to know human anatomy well. Others have expressed regret when they can’t fit these dissection-based electives into their jam-packed schedules.
“The lab was always my happy place,” says Nosanov. “I love knowing how the body works both in terms of the macroscopic level—how the organs fit together and all those things—as well as microscopically and chemically. You look at someone, and you look at their abdomen, and you’re like, ‘I can see your liver, and I know what vertebral level that is.’ It permanently changes the way you think.”
In the USC anatomy lab, Hall pulls out a Lucite slide, containing a slice of human knee. For a brief moment, I get lost in the wonders of the joint that supports nearly the entire weight of the human body and enables walking. The surprising strength of the thin femur, tibia and fibula bones, the delicate, milky-white cartilage of the meniscus, and the fibrous stability of the ligaments are show-stopping feats of natural engineering. I begin to understand.
“The lab more influences how I approach life as opposed to death,” says Nosanov. “Life is finite, and so you better damn do with it whatever it is you think is most worthwhile because you won’t be here forever. That informs my choice of wanting to do surgery even though it’s a really long, hard road. It’s what I love, and whether you end at 30 or 40 or 90, what’s the point in not doing your utmost?”
Reach Contributor Cristy Lytal here.