Nirusha Lachman, Ph.D. leads anatomy class at the Mayo Clinic School of Medicine

It was the summer of 1991 at the then “University of Durban Westville” in Durban, South Africa. The Department of Anatomy was not a highly publicized unit….nor was the anatomy program of the Medical Science Degree that each year selected just a handful of students to train as clinical anatomists.   I did not quite know then at 19 what it would mean to become a clinical anatomist nor was I prepared for the incredible responsibility that would be left in my hands. But the human body, its synchronicity, its vulnerability and intrinsic ability to heal and the beauty I saw in its perfection and imperfection intrigued me…….

Tall Tales from the Cadaver Lab

My class consisted of four students, each of us as much in the dark as the other.  We entered the building which was typically away from the rest of the university campus with its characteristic smell…no one was there to greet us and our orientation consisted of a handful of upperclassmen sharing horror stories and tall tales from the cadaver lab.  We learnt fast to depend upon the well-known chalkboard in the foyer that listed the week’s readings from Lord Zukerman’s anatomy text (a South African native born in British Cape Colony and later defined by his contributions to the subject of Anatomy in Oxford and then the Royal College) for instruction. The material was detailed, it was intense and it was downright daunting.  But such was the way of academic pursuit back in South Africa in 1992. Our expectations often exceed our ability, we worked hard, learnt to deal with the stress of uncertainty and found more paths than one to educate ourselves and each other.

Formalin-Fixed Human Brain

My first encounter with cadaveric material occurred in the cold, stainless steel decked laboratory of the anatomy department.  The four of us sat around the table staring at a white plastic bucket that contained a formalin-fixed human brain. Not sure who will be the one to extract the specimen, my teammates started considering the democratic process of pulling names from a hat … this was my moment and I took it – I decided it would be me! That moment did not bring me a feeling of pride nor the feeling of courage, in fact, at that moment, I was driven only by my sense of responsibility … a responsibility that came with the opportunity to explore what very few would ever get a chance to explore – an indebtedness that would drive my commitment to become so skilled that I would be able to produce dissections that befitted the beauty of the human body in its most splendid form.

Human Body – Defined by Its Uniqueness

It would take me many more years of failures, of trials and errors, of uncertainty and defeat … and many more years before I could see my successes. Such is the complexity of the human body that every dissection experience is defined by its uniqueness, its challenge, and its infinite beauty.

Who Laid Their Hands in Ours

My connection with anatomy has been built on my association with the many students, teachers, physicians, patients, artists and communities that I have the privilege of sharing my knowledge with. As my mentors have left behind a legacy, I too strive to do my best for those I serve, committed to those before us who have laid their hands in ours.

Nirusha Lachman, Ph.D.
Professor of Anatomy
Department of Anatomy and Department of Plastic Surgery
Mayo Clinic College of Medicine and Science

Excitement of Medical School

As soon as the excitement of being accepted to medical school wore off, the dread of entering the anatomy laboratory began in earnest.

“How could I be a doctor if I could not learn anatomy on a cadaver?”

Self-doubts were confirmed the first day of dissections. I almost quit: how could I be a doctor if I could not learn anatomy on a cadaver?

My Cadaver’s Human Journey

But I returned the next day and the next completing a full year of anatomy and dissections. What started as dread slowly turned into fascination and awe as the mysteries of my cadaver’s human journey revealed themselves to me. I remember wondering about who this elderly woman had been; what stories she could tell of her life and that I wish I had known her.

A Physician’s Reflection

Now 30 years later as I reflect on my time as a physician, I realize that my experience in the anatomy lab prepared my mind but also my heart for the journey ahead in medicine. My profound sense of gratitude to this unknown yet fully known patient has perpetuated throughout my career…I am honored and humbled to have been so intimately entrusted to “care” for her just as I am with all of my patients who put their faith and their confidence in me every day.

Alexandra Wolanskyj M.D.
Senior Associate Dean of Student Affairs
Mayo Clinic College of Medicine and Science
Consultant, Division of Hematology, Department of Internal Medicine, Mayo Clinic

The Most Challenging Course in Medical School

Anatomy class is often considered one of the most challenging courses in medical school. Acquiring a strong understanding of the human body sets the groundwork for the rest of a medical student’s education – that rite of passage toward becoming a knowledgeable physician. However, we would fall short if we did not share the cognitive and emotional metamorphosis that also takes place as students progress through this course. I believe that awakening is what this documentary so vividly captures.

Their First Patient

There is something almost mystical about the transformation of first-year medical students as they sojourn through their course in Human Anatomy and Dissection. They enter medical school wide-eyed and perhaps somewhat naïve, with a passion and commitment to care for living and breathing “patients.” For many, as they step into the anatomy lab, it is their first real experience with human death. The humanity they envision serving suddenly becomes real and personal in the form of a cadaver – it truly is their first patient.

The Art of Medicine

Dr. Fredric Meyer performing brain surgery.

While they are learning the biological science of the human structure, they are also learning the art of medicine – the intriguing interplay of every element of the human body and the uniqueness of each patient they will encounter. They learn meticulous precision and concentration. They learn that every scar tells a story and that the muscles, tendons and bone structures they are memorizing and identifying might once have played a concerto, run a marathon or held a child. Many of them also learn and see first-hand the ravages of disease.

Teamwork

The other unknown that is so genuinely portrayed in this documentary is that the students enter the lab as individuals, but the learning is structured in such a way that they finish understanding what it means to be an integral part of a team. The students learn every teammate should be treated as a valued contributor and there is a shared responsibility for the patient. That learning of teamwork, sharing collective knowledge, relying on and valuing your colleague is at the very heart of how we practice medicine at Mayo Clinic. They are learning and experiencing our primary value – the needs of the patient always come first. And that will forever change them.

I am so extremely proud of our students in this documentary. As they graduate and spread out to all corners of our country, they will pursue their residencies and take with them the valuable lessons portrayed so well in this film.

Fredric B. Meyer M.D., F.A.A.N.S.
Juanita Kious Waugh Executive Dean for Education
Mayo Clinic College of Medicine and Science
Dean, Mayo Clinic School of Medicine
Alfred Uihlein Family Professor of Neurologic Surgery

Healthcare Reporter

I’ve been a health care reporter for many years. During this time, I’ve stood by many surgeons as they’ve cracked open heart patients’ chests for life-saving operations, I’ve watched doctors remove organs from people who’ve died in horrible accidents, I’ve met the grateful recipients of those organs and documented their experience, and I’ve held the hands of people in their last days of life. Even after all of that, I was terrified to step into the anatomy lab on the first day of shooting. Before opening the lab door, I thought about what one surgeon told me as I was about to witness an organ transplant for the first time, “just lean against a wall, so if you faint you won’t make a scene.” So, I opened the door to the anatomy lab, and prepared to bolt in, but before I could reach the safety of a wall, the formaldehyde smell smacked me in the face and made my head spin a bit. But I didn’t pass out from the smell or from the bodies wrapped up like mummies. In fact, I was intrigued, excited and super curious. Plus, I was incredibly proud. Proud to have survived my fear and proud to be involved in this amazing documentary.

The First Day of Shooting

For me, the experience was transformative. For me, the project is not about anatomy or dead bodies. It’s about what it means to be human and alive. Sure, the process of dissection can be somewhat gruesome when taken out of context. But when you think about why it’s being done, you can’t help but be amazed and awed. Preserved flesh and bone become the threads of life-giving knowledge. The body donors know that, and so do all of the students. Looking back to that first day of shooting, I remember that before they made the first cut, a hush fell over the entire lab. Each group dealt with it in different ways, but afterwards I earned that every single student said some sort of thank you or prayer before using the scalpel. They knew that after they made that first cut, nothing would be the same. All of the students treated their cadavers with incredible reverence, kindness and compassion. The bodies truly were their first patients.

Scientists and Physicians

Standing in the lab amidst all of those bodies – some dead, most totally alive and super alert – you can’t help but think about what happens to the soul when you die. Throughout my years as a health reporter, I’ve talked to many doctors and scientists whom you’d think would disregard the idea of a soul. But they don’t. Most of the scientists and physicians I have talked to embrace the concept, even though there’s no hard data they can collect in a test tube or petri dish to prove it. But they believe it. As I watched the students dig into their dissection of the day, I was comforted believing that the souls of the donors were no longer there, and that the donors wanted their remains to be used to teach future physicians. The students came from various social, ethnic and religious backgrounds, but every one that I talked to about the soul concept believed that the soul leaves and the body stays behind. And because of this, the students were able to not only learn about the parts of the body or how the ankle bone’s connected to the leg bone, but they also learned about what it means to be part of the circle of life.

Compassionate Effective Doctors

Speaking of students, I was totally wowed by the quality of each student in that class. All of them are super smart, interesting and compassionate. I learned a lot from them and was humbled by their abilities. They are very brave, and I can’t wait to see what they all end up doing with their medical degrees. For some, I imagine the dissection experience will compel them to be surgeons, while others may choose cardiology because of their fascination with holding a human heart in their hands. Whatever they choose, I know they will become skilled, able, compassionate and effective doctors who will strive to improve the condition of people in our world.

The experience of watching the journey of the young medical students featured in The First Patient reminded me not just of the “science” I learned in anatomy class, but also of the deeper human questions and lessons that doctors begin to explore from the earliest days of our medical education.

Medical Education, A Rite of Passage, and Becoming a Doctor

Medical education has changed in many ways in the last several decades, but studying human anatomy remains one of the defining “rites of passage” to becoming a physician. Now thirty years into my career as a doctor and global health specialist, I still remember gross anatomy class and the five classmates assigned to my “dissection group.” It’s as if it happened last semester. For nearly all physicians, gross anatomy class is the first time we see a dead body, the first time we hold a human heart or brain, and the first time we become intimately aware of the inner workings of the human body.

Dissection

Dissection in anatomy class usually begins with the back, or someplace, anyplace away from the face or the hands or the other parts of the body which are confronting reminders of the “humanness” of the lifeless body in front of us. By the time med students begin investigating the details of the face, the brain, the hands, and the heart, it becomes unavoidable to ask deeper questions about what makes us human. We see a lifeless body in front of us every day in the anatomy lab, and no medical student can help but wonder what their cadaver’s life was like, who were their friends or family, what were their hardships and successes, and what made THEM human. Most first-year medical students are young enough to have many more years in front of them than behind them, and while many are aware of death, anatomy class often serves as a forceful reminder of how precious life is, and how finite our human experience can be.

Cadavers, Medical Students, and Learning Empathy

Most medical students, dentists, and physical therapists spend enough time with the cadavers in anatomy class to develop some connection to the life and spirit that their bodies once represented. Empathy for that human body in front of you comes naturally. So does an appreciation for the sacrifice made by the donor and their family with the gift of their body to science. It seems universal that medical students feel reverence for the life that once was as it continues to teach us the values and depth of scientific and medical knowledge associated with the profession. The “memorial service” at the end of anatomy class can provide genuine closure for the students and the donor families along with the recognition and acknowledgment of the contributions made to medical education by those that are no longer with us.

After Gross Anatomy

After gross anatomy class, medical students learn to do a medical interview, to take a medical history, and to do a physical exam. Their “living” patients continue to teach each student as they become doctors, medical residents, practicing physicians, and occasionally medical educators. The road is indeed long, and most of us change as people as we become medical professionals. Beyond the science of medicine, we also learn lessons about what it means to be human, and about how physical and mental health affect life and death. Yet much of the critical work we do in medical school and as doctors began with our first patient.

For more information about the film check out director Chip Duncan’s blog HERE.

Hernando Garzon, M.D.
Emergency Physician, Kaiser Permanente
Medical Director, Sacremento County EMS Agency

 

During my college years at UW-Madison, I walked to class each day past a medical school building where a very strange thing was happening – human bodies were being dissected. What, I wondered, was that all about?

Breaking Ground on a Med School Documentary

Nearly forty years later, I have an answer, and it’s much more complex than I could have imagined. I’ve enjoyed a long career as a documentary filmmaker, but no film I’ve ever directed is as soulful or emotionally powerful as The First Patient. After years of development and research, the Mayo Clinic School of Medicine allowed the Duncan Entertainment Group the opportunity to follow first year medical students through the “Gross Anatomy” class. During seven weeks of filming this medical documentary at the Rochester, Minnesota campus, we followed a diverse and brilliant group of young people on a scientific, emotional and soulful journey of discovery. We knew we’d be breaking new ground as filmmakers, but the outcome is far more entertaining, educational, and thought provoking than we could have imagined at the start of class. That’s due, I believe, to the insights of the students that comprise the final narrative of the film. Their brilliance and diversity of thought is what makes The First Patient a “fantastic voyage” (yes, that’s a throwback to the feature film from 1966).

Documenting a Rite of Passage

Most doctors, dentists, and physical therapists will tell you that their first patient was a cadaver. Many will tell you that the first time they ever saw a dead body was the day they opened the door to the anatomy lab. Most consider their class in gross anatomy a rite of passage – it’s the one class that makes or breaks students on their quest to succeed in patient care. Part of the complexity of the dissection experience is based on the language of science and the rote memorization process involved in determining the location and function of individual organs, muscles, and nerves. But much of that can be learned from a book or 3D printed model. What makes the class worth taking and the film worth watching is that it’s experiential. The film chronicles the journey of the students, as they make a discovery, the audience makes a discovery. It’s a journey that can only be learned from a hands-on lab experience that challenges students to confront mortality, to overcome fear, to consider the moral and ethical questions associated with patient care, and to learn the true meaning of “teamwork.”

In the Lab

The lab portion of the medical school class we documented took place on the 9th floor of a non-descript office building. Of the fifty-two students in the class, twenty-two agreed to participate in our interview process, and sixteen made the final cut of the film. Of the approximately 250 bodies donated annually to Mayo Clinic for medical and educational use, 13 bodies were used in the gross anatomy class. Three professors and six teaching assistants participated on a daily basis with numerous medical specialists adding their insights for a day or two throughout the seven weeks.

The First Patient

The First Patient is pure documentation in a classic journalistic style. It’s not historical, there’s no retrospective. Instead, it’s like newsgathering – it’s real life happening on camera with as little impact from the filmmakers as possible. Our crew showed up when the students showed up. We never moved a body, we never interrupted a student, TA or professor, and we never had a “do over” moment. What happened on screen is what happened in class – and the humor, compassion, pain and joy of discovery articulate the students’ journey. As the class began, we knew we’d witness a progression from fear to confidence. We imagined that we’d see the students learn what it means to become a doctor. What we didn’t expect is what happens in act three of the film as students answer the most important question of all: What are we? Their journey becomes our journey; their answers become our answers. It’s for that reason that we invite audiences to embrace their courage and overcome any judgments or objections they may have to watching the film. It’s my belief that you will not be disappointed.

For more information about The First Patient please Contact Us.