When talk in the lecture hall finally settled on the bodies waiting upstairs, the rustling of paper bags filled with fast-food dinners ceased, and the students who had periodically dozed off be-came quickly upright, their eyes fixed ahead. The blowers in the ceiling roared in the silence.
The bodies will be shaved clean, they heard, and each will have undergone a craniotomy, the process in which the skull is severed to remove the brain, then reattached with string. There would be slashes near the armpits and in the legs, where embalming fluid was pumped in and blood pumped out. Whatever life-sustaining gadgets had been implanted would remain; students would find objects such as catheters and pacemakers, but that was good because, the lecturer said, “it’s like finding treasure.”
Everyone laughed, but only until they heard that when they first saw the bodies, the hands and feet would be bound with rope, the eyes might be open and there could still be polish on the fingernails.
The facial reactions of the 104 first-year medical students at the University of Chicago varied with these details: Some turned stoic, some inquisitive, and some looked as if a doctorate in history might have been wiser. In a week these students would be making their first cuts into the cadavers in the gross anatomy laboratory in the Biological Sciences Learning Center at the school’s Hyde Park campus.
The speaker was Kyle Nash. For each of the last six years, she has given this compulsory two-hour lecture to the U. of C.’s first-year medical students. The lecture is one of the least technical formalities of the four-year program – Nash knows little, if any, more than the lay person about medicine, and she loathes the cadaver lab, particularly the chemicals’ strangulating stench.
But under the almost mythical title of “clinical thanatologist” — more a description, she admits, than a qualified profession — Nash has taken a place at the school as an expert in the field of death and dying, integrating into her work components of the psychological, educational and pastoral. (Nash, who is 45, will receive a doctorate in ministry from U. of C. in June.)
Her presence at the University of Chicago makes the school one of a handful — also including the University of Massachusetts at Worcester, the State University of New York at Stony Brook, Stanford University and Harvard University — that have placed a recent emphasis on “humanism in medicine,” the idea that doctors should deliver care rooted in compassion and sensitivity.
“If you’re going to be in a service profession, you must be treated throughout your education in a humane and thoughtful way,” Nash says. “Instead of being belittled and told that to be a good doctor you can’t show your emotions, if you’re loved and cared about, you’ll be a better doctor.” Besides, she says, the medical attitude could stand a tune-up, and medical school is the best place to make the adjustment: “Physicians are often aloof and arrogant. That’s the experience I’ve had.”
Each summer, Nash brings her emphasis on the humane to students before they even reach campus, sending to all incoming members of the class a packet of quotes and poetry about dying and death, plus a cover letter that promises the school will be “acknowledging and respecting the entire range of feelings possible for students in relation to the unique initial experience of human cadaver dissection.”
Once they reach campus, students are eased into the gross anatomy lab, sent in after several weeks rather than within the first few classes, as is traditional. And in the lab, Nash encourages students to appraise their feelings honestly about cutting apart dead bodies, instead of simply steeling their nerves.
She hopes her efforts not only will make medical school more comfortable for students but will improve patient care when those students are doctors. She figures that if she can help prevent callous attitudes toward the cadaver, in part by eliminating the notorious “cadaver antics” — hurling body parts across the lab or lassoing people with intestines — interaction with patients ultimately will improve, as will health in general.
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Because her field is still developing, it’s not so surprising that Nash almost literally wandered into her job. Not long after entering U. of C.’s theological and divinity schools as a master’s student in 1991, she approached medical school faculty with questions about how students coped emotionally with cadaver dissection.
She discovered that, sharing similar concerns, the director of the human morphology course, Eric Lombard, had begun delaying students’ entry into the lab by two weeks and had gathered them into groups after the first cut to discuss the impact of dissection. But Nash also heard Lombard was planning to resign his post. Further questions led her through the chain of command all the way to Philip Ulinski, chairman of the Department of Organismal Biology and Anatomy. To him she proposed expanding Lombard’s work into a comprehensive program spanning the length of the two-quarter course.
Ulinski said he needed “about 120 seconds” to know Nash’s proposal could benefit the department, in part because of an uncomfortable cadaver experience he’d had as a doctoral student that “bothered me at some level for weeks after the fact.”
“You don’t want to rush out and say, `I just had this experience with a dead body,’ ” he says. “But the point Kyle was making is that that is the expected reaction. It was a very compelling presentation.”
Nash was prepared to do the work for free, but Ulinski insisted she receive some sort of salary; they settled on the $500 for the fall and winter quarters. “For the time I put in,” Nash says, “it probably came to less than a penny an hour.”
Struggling with her own insecurities, Nash questioned her motives and actions more than once. “I thought I was crazy,” she says. “A ministry student in a research environment? It was so lonely. I didn’t know anything about what I was doing. Most days after work I’d go cry in my car.”
There were — and continue to be — other skeptics. “They say it wasn’t this way when they went to medical school, so why should it be done now?” Ulinski says of some faculty members. Betty Katsaros, an anatomy instructor who leads the dissection lab and works closely with Nash, said some might maintain this view innocently enough. “I think there is a lack of awareness among anatomy teachers that some students are uneasy with dissection,” she says. “We went into anatomy because we didn’t have those problems.”
Nash was hired as a full-time associate member of the Ethics Department faculty in 1993. Her present jack-of-all-trades duties include, aside from her work with the medical students, teaching fellows in the Ethics Department, consulting with staff and patients at the university hospitals on matters of death and dying, and coordinating the annual memorial service for patients who have died in those hospitals. Her duties, she says, are “truly scattered all around and dependent on the week or time of year.”
But what brought her to the school was a desire to help develop aspiring doctors’ sense of compassion and humanity, and Nash and Katsaros say students seem to have largely accepted the themes of her program. Many name their cadavers — usually something generic but endearing, such as “Abuela,” the Spanish word for grandmother. Many come into the lab early — alone or with a friend — to make their initial meeting with their cadaver more intimate. And one recent Valentine’s Day, a male student left a single red rose for his cadaver, an 80-year-old woman. Nash says she was “so touched and moved” by the gesture, but admits that a few of his classmates found it creepy.
But better to leave flowers for the cadaver, she says, than to leave pieces of it in a classmate’s locker as a joke. “Don’t judge your emotions,” she told the students at the lecture. “If you have a pounding heart or you’re crying, acknowledge that. There’s no emotional agenda.”
Norma Wagoner, an anatomy instructor who sat in the rear of the auditorium, then spoke up to invoke her own memories of a first cut. “The first cut is the most difficult,” she said, adding that a fainting student is not unprecedented. “It’s something you’ll always remember.”
Among those listening that day was 29-year-old student Mark Burno, whose mother had died seven years earlier. Burno never saw the body before burial and feared that “not being able to say goodbye might bring up some issues. Being able to say goodbye to the physical self sometimes helps.” He was nervous. “I don’t think I’ll faint, but I could.”
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One week later, the day of the first cut, the white-walled gross anatomy lab was cool and bright, with a constant swirl of air to prevent the stench from settling too deeply. Each of the lab’s 26 metal tables supported a lump wrapped in a blue bag, definable usually by the shape of feet at one end. Next to each table was a yellow trash can marked “Cadaver material only” — a place to store leftover parts that eventually will be cremated with the rest of the body at the end of the course. One of the chalkboards read, “Cadavers Are Dead People” — an aid to help remember the branches of the thoraco-acromial artery (clavicular, acromial, deltoid and pectoral), which they would be examining that day.
Katsaros, the lab manager who led the dissection, never flinched in the presence of the cadavers, even as she absently patted one of the bags from head to toe, to figure out which end was which. She dissected her first cadaver about 22 years ago, not as a student but when she was hired as an anatomy instructor at Tel Aviv University. “I can’t say I remember my first reaction,” she says. “Maybe curiosity. I think I was almost immediately able to separate the fact that it was a living human from this being an educational tool.”
Conversely, the students were palpably nervous, though no one seemed an immediate risk to pass out or need to leave. Even the most stoic seemed at least a bit preoccupied, like 21-year-old Sapna Ravi. “I’m a little nervous,” she said, then added perhaps as an understatement, “I’ve never done anything like this.”
At Burno’s table of four students, 22-year-old Ingrid Roseborough had been elected to make the first cut, a slash in the chest of a female cadaver. As the scalpel entered, Burno let out a small “woo-hoo!” of relief. Elsewhere in the lab, murmurs of “wow” and “incredible” arose.
“Does that look straight?” Roseborough asked.
“Looks good,” said another member of the group.
“We’ve got a future surgeon here,” added another.
After Roseborough finished with her scalpel, she laid it on the cadaver’s belly with the instructions, “Hold that for a second.” Burno reached over, but Roseborough stopped him: “No, I’m talking to her,” she said, nodding at the cadaver. The group feigned small laughs and continued.
That interaction might seem as if it could raise Nash’s eyebrow, but it did not. “Humor is a tension reliever,” she says. “There’s a line, but it’s a thin line and that doesn’t necessarily cross it. I might keep an eye on them to see if it becomes a pattern though.”
Nash spent most of the lab time hovering and engaging students in light talk about their undertaking. Afterward, a few students told Nash they were relieved at the relative ease with which they handled the task. Burno said with some relief that thoughts of his mother never flared.
“It was anticlimatic; I thought it would hit me more,” said Ravi. “It almost bothers me that it didn’t affect me more. Am I that cold that I could make this cut and not be bothered by it? I think it’ll be more life-changing when we start cutting the face. That’ll be more hard core.”
Could her expected reaction — the one that never came — have been the result of emotional manipulation by Nash?
“She’s not forcing us to feel a certain way,” she said. “She just keeps reminding us of the concept of death, to not forget that these were human beings at one time, and that they did us a favor giving us their bodies so we could become doctors.”
