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Learning The Difference Between The Person And The Body

Gross anatomy lab first year of medical school stands out in my memory of those four years. I don’t remember a lot of details about other classes or rotations, but I remember everything about Gross Lab. We all showed up for medical school fresh-faced, eager, scared, and proud. We knew we didn’t know much but wanted to pretend we did. We had survived undergrad and the harrowing application process and were actually going to be training to be doctors! The Premed years were filled with stress and uncertainty: is this the right path? What does it even mean to be a physician? Do I have what it takes? Can I handle the workload and schedule? Will I even get in? Now here we were and some of those questions were still unanswered.

Forming Real Bonds

There were four of us at each tank. We informally partnered with the four next to us and the eight of us formed a real bond: friends, future roommates, long-term connections. I am sure it was at least in part due to holding on to each other those first weeks in an environment which was radically different than anything we had ever known.

The Smell Stays With You

The lab started that first day, like every day, with bringing the cadavers up out of the preservative. There were these levers on the tanks. When you engaged them, the cover would open and this pale, waxy body would rise up on a metal table, liquid streaming down the sides and back into the tank. Very eerie. I will never forget the smell of preservative. And it stuck with you. After lab, some of us went across the street for lunch at the women’s dorm (UW Madison Liz Waters). People would get up and move away from us!

Well Coached On Respect

We were well coached on respecting the cadavers. These had been real people who had generously gifted their bodies for the advancement of medical science. They had relatives, loved ones, friends. In those days we weren’t told much about who they were in life. But we certainly wondered. We wanted some kind of permission or validation that what we were doing was valuable for something more than our own personal education. Would what we were doing really help our patients in the future? I would say yes.

Everyone IS Different!

It turns out, everyone is different. Surprise! A beautifully illustrated textbook with multicolored diagrams and labels looked nothing like the bodies we were starting to examine. Why is this nerve here and not there? I thought the heart was only supposed to be this big? What happened to the gallbladder? We once spent a whole morning carefully dissecting out the thymus gland only to have the professor come over, look at our final result, and throw it in the garbage stating it was just “silly fat.”

The Value Of Teamwork

We also learned the value of teamwork. What one student saw was different than another. Some had read more, some had better visual skills, some were better with the knife, some were better at getting us to consensus.  We learned to interact, trust, and come to agreement with much better results than any of us could have done alone.

The Real Difference: Person vs. Body

Most important is that we started to differentiate the person from the body. Right away we wondered “Is this still a person?” “Who was this person?” “Why is their body like this?” “What was their story?” In medical practice, there are times the body is in terrible shape, and there is not much we can do for it, but the person is whole and that relationship is rich. Sometimes the body is healthy but the mind has gone and the actual person is hard to find.  It is critical as physicians that we prioritize the person we have a relationship with and not just the body we are treating. It began that first day in Gross Anatomy Lab.

Thomas Mahn, M.D.
Chief, Section of Cardiology
Ascension Healthcare
Wheaton Franciscan Inc.

 

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<Photo of Ben Santer, Climate Scientist>
Dr. Ben Santer
Lawrence Livermore National Laboratory Member
U.S. National Academy of Sciences

Recapturing First Impressions

I am a climate scientist, not a medical doctor. You might therefore ask why I am writing a blog post about “The First Patient”. Other commentators on this unique documentary have taken gross anatomy classes. They are much more qualified to assess how well “The First Patient” captures their own personal experience of this centuries-old rite of passage. They were in similar dissection rooms, under similar bright lights, with similar smells and sounds. They witnessed and participated in the same gradual peeling away of layers of the body, the same discovery of functional beauty under the skin, and the same revealing of a whole new world of tissues, blood vessels, bones, organs, tendons, ligaments, and neurons. Those who have been through this rite of passage – like my friend Dr. Hernando Garzon – have affirmed that “The First Patient” recaptures the same strange mixture of awe, apprehension, and queasiness that they once experienced.

Finding The Human Connection

I watched this documentary through the lens of a science communicator. In my job, I try to distill the complexities of the atmosphere and ocean into plain English. I am always interested in learning from others – in seeing how the best science communicators tackle difficult subjects, capture and sustain the attention of lay audiences, educate those audiences, and find ways of establishing human connection.

Teaching About Shared Humanity

“The First Patient” achieves all of these things. Dissection of the human body would seem to be a “difficult subject” for documentary treatment. But from beginning to end, I was captured and captivated. The human body is a vehicle for educating the thoughtful and articulate medical students in the film. The film is a vehicle for teaching us about our own shared humanity. We are able to see the different trajectories that brought the students to the dissection room in Rochester. We are introduced to the cancer survivor, the soldier, the guy who pumped gas at the gas station, the student with poor grades, the employee from the fast food restaurant. The Hindu, and the Sikh, and the Moslem, and the Christian. The runner and the rower and the photographer and the dog-walker. Each of these students develops an individual voice. Each responds to the dissection of their own “First Patient” in a different way. By the end of the film, we care about all of the students in the gross anatomy class. We accompanied them, for a brief period of time, on an incredible personal journey of discovery.

Learning The Beauty Beneath The Surface

What did they learn? They learned about the beauty beneath the surface. That the body is “especially beautiful on the inside”; that there is art in anatomy; that the seamless functioning of heart and brain and circulatory system and nerves and muscles is like an orchestra, with many different sections contributing to the overall symphony. They learned that even your enemies have the same anatomy; that the act of dissection reveals commonalities of architecture and function. In exploring human anatomy, they discovered that more unites us than divides us – a particularly important lesson in today’s world.

A Miraculous, Transformational Experience

They learned to how to work together as a team, with individuals from different cultures and religious backgrounds. Big fish from small ponds were placed in an environment with other brilliant young minds, and then confronted with the humbling reality that there are many “really bright people” in the world. They held a heart and a brain in their hands – a miraculous, transformational experience. Their perspectives on the human body were forever transformed. Looking at a wife, a husband, a stranger on the bus, they would now see and understand the interplay of muscles behind the smile, the miraculous things that sustained life every second without any conscious human intervention. As one student put it: “I know what’s underneath you!”

Reconciling Science And Personal Faith

They learned how to make a mapping between two-dimensional imagery – the world of ultrasound, MRI scans, and X-rays – and the three-dimensional structures they were dissecting. They experienced the difficulties of reconciling science and personal faith. They were forced to confront their own mortality, and to recognize that the body on the table represented their own ultimate fate. As one student put it, “That will be you, some day”.

Finding Life In Confronting Death

And finally, in confronting death, face-to-face, they enhanced their own desire to work towards the preservation of life.

Preciousness Of Life

It is unlikely that I will ever experience what these young women and men did in their first gross anatomy class. But “The First Patient” has given me a small window into their world. It is a valuable reminder of the preciousness of life.

Dr. Ben Santer
Lawrence Livermore National Laboratory
Member, U.S. National Academy of Sciences

 

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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

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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

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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.

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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

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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.