Saturday, January 4, 2020

Surgical notes #4—2010: Anatomy students meet their first patient

De humani corporis fabrica (Of the Structure of the Human Body) by Andreas Vesalius
   (Metropolitan Museum of Art)
     You don't always come into a story at the beginning. When I first visited gross pathology lab at Loyola University's Stritch School of Medicine, it was December, 2009—the end of term. I was pleased with the column, posted here last yearbut wanted to see students at the beginning of the semester, when they first met their cadavers. So I returned the following October and produced today's and tomorrow's columns. 
     I give myself credit for going back, because seeing the flayed apart heads—think onion blooms—mentioned in that first column, lingered with me, and not in a good way. I remember, one night shortly after doing the research, in bed, staring up into the darkness thinking, "It's bad enough to have trouble sleeping, but do I also have to be awake and see the FACES OF THE DEAD?!?"
     Not to complain. These columns were my idea. Part of being a professional is, you gird your loins and do the task in front of you. Which has been helpful, post-surgery, such as every morning when I have to inject myself in the stomach with a hypodermic of anti-coagulant, to ward off blood clots and strokes. Do I like it? No. But I do it, before breakfast, to make sure I get it out of the way. 
    Anyway, I hope you enjoy these columns from a decade ago, and appreciate your patience while I convalesce. 

      It isn't as if Emily Zepeda, Hannah Johnson and Lisa Moore have never seen a dead body before. They have.
     "When I interviewed here, they took me around," says Moore, 23, as the others nod.
      Still, the women are nervous. "First-day jitters all over again," Moore says.
     "You do hear stories," says Johnson, 22, "about people who have to step out of the room to avoid fainting."
     "The room" is gross anatomy lab at Loyola University's Stritch School of Medicine. Every October, each first-year medical student goes from being someone who wants to become a doctor, who may have volunteered at a hospital or gone overseas on a medical mission, to someone who can take a scalpel and peel back the skin on a corpse.
     "This is unlike anything we've ever done before," said Johnson. "Some of us have taken some form of anatomy class in undergrad. But this is completely different."
     "This is anatomy," said Zepeda. "This is what every medical student has been doing since the beginning."
    But first, a steeply sloped lecture hall, lights dimmed, a setting straight out of a Dutch engraving, where students sit in 11 tiers. On the screen: "Human Gross Anatomy, Structures of the Human Body."
     "Good morning and welcome," says Dr. Frederick Wezeman, professor of orthopedic surgery and the classic grey-haired, white-coated image of what a doctor should look like. "We have a very full day for you."
     He crosses his arms, gazing at the room.
     "So what are we going to do?" says Dr. Wezeman. "We're going to be doing a lot of identification, of locations and relationships. You have to know your anatomy. What you learn might seem tedious and detailed to the point of 'Why do I have to know that?' Yes, you do have to know that."
     Almost every student has a laptop, some are already studying charts of skeletal and nerve systems. One is on Facebook.
     "We're going to teach you to speak a new language here," Dr. Wezeman says. "You're going to be talking anatomy. Obviously, dissection is very, very important. Lectures are important, you are paying $42,000 in tuition and you want to be able to learn in different modalities."
     He leads the students through the practical considerations of cutting up a body: wear gloves, no cameras, no souvenirs.
     "You can't take anything out to scare someone at Halloween," he says.
     Students must keep their cadavers moist.
     "If it dries out, you'll have to tag dried-out structures," he says.
     The cadavers are not idealized human bodies, but unique, real individuals.
     "Not all cadavers are normal," he says. "We will encounter a lot of surgical intervention, you will encounter pathologies, you'll encounter situations that you're going to scratch your head about. But they're wonderful learning tools. . . . All the things that normally occur in populations. They're going to be downstairs.
     "Some of them are obese. That's going to create an additional challenge. Be aware. Turning a cadaver over is a team effort. We don't want cadavers falling on the ground."
     Dr. Wezeman reviews the muscle system in the back where the students will first cut.
     There is a brief ceremony—three students come to the front of the lecture hall and speak eloquently to the former owners of the bodies waiting for them downstairs, describing the hands that caressed new babies, the lips that smiled and kissed.
     "These are not merely bodies, they have become our teachers," one student says.
     Then the students head downstairs, to change into scrubs, and enter a very bright white room where 22 body-sized white plastic bags are waiting on tables. There is another ceremony—the students bow their heads, fold their purple-gloved hands in front of themselves, praying.
     If Loyola seems to go overboard thanking the cadavers and stressing respect, remember there is a long, ghoulish history to gross anatomy that includes both grave-robbing and comic photographs of cadavers taken by medical students in the first half of the 20th century. That mind-set is long gone, and Loyola intends to keep it that way.
     The prayers done, the room shifts into commotion as students collect forceps and hemostats from large white buckets that once held Schwartz's premium pickles and take their positions around their cadavers.
     Emily Zepeda happens to be by the zipper, open to reveal a curled foot of indescribable color—a deathly greenish white with yellow toenails, arched at an unnatural angle. She reaches for the zipper and pulls.

      Postscript: Dr. Emily Zepeda is a pediatric ophthalmologist in Oklahoma City. Dr. Lisa Moore is in family practice in Glenview. I couldn't find any information on Hannah Johnson. 
    Part one of two parts.  To read Part 2, click here.

              —Originally published in the Sun-Times Oct. 20, 2010


  1. Thank you.
    I remember this well. It is not a place I would normally go, but, with your written description as my guide, I have a strong curiosity and need for the return trip.

  2. The excellent book Stiff: The Curious Lives of Human Cadavers, by Mary Roach, goes into detail about some of the “ghoulish history” you mention, as well as following some medical students’ experiences with their cadaver teachers, and it’s a surprisingly enjoyable read.


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