First year medical students dissect a cadaver at a gross anatomy lab at Georgetown University Medical Center in Washington, Nov. 5, 2009.
Kyle Gospodarek expected to feel nervous about seeing a dead body up close on his first day of anatomy lab. He steeled himself for the smell — a pungent blend of latex, embalming fluid and something indescribable whose odor would cling to his clothes for days — but he never imagined he would have to get in touch with the cadaver’s family. “I’ll be honest: when I first heard about what we were doing, I was weirded out,” he says. “I didn’t know what to say to them.”
At Indiana University Northwest, an IU branch campus located in Gary, Ind., anatomy professor Ernest Talarico instructs his medical students to probe beyond the nerves and muscles of the bodies lying on their examination tables and think of the cadavers as their “first patients.” “We ask students to use the name of the patient out of respect and to acknowledge that this was a person,” he says. His students also typically exchange letters with family members to glean more information about their patients’ medical histories, hobbies and interests. They may even meet the family in person at the conclusion of the course during a memorial service held in the laboratory.
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The annals of medical school training are filled with sordid tales of students taking glam shots with corpses or assigning unflattering nicknames to cadavers. When Talarico was in medical school, he remembers his classmates calling one cadaver “Salty” because of the tattoo of the naked woman on his chest. “These people had lives and names,” he says, “and to use other names disrespects them.”
Talarico believes his approach not only helps students be more respectful of the individuals who have given their bodies to science but also prepares them to act as empathetic clinicians when they’re faced with the cold, hard medical decisions they’ll have to make in their careers. He has no formal data to prove his approach gets better results, but anecdotally, the students say they feel better prepared to address patients as individuals and consider their feelings. As one student, Adam Harker, explains: “I think it translates into better post-op care and compliance.”
While Talarico has won praise from many of the individuals involved in the program, he’s also raised concerns among critics who question the ethics of his teaching technique. When donated bodies are passed on to medical schools, the institutions are usually only given the basics — the donor’s name, gender, age and immediate cause of death. The name of the donor is typically not shared with students, and students do not usually interact with the donor’s next of kin.
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Larry Rizzolo, who heads up the anatomy course for first-year clinical students at the Yale School of Medicine, says he believes that donating one’s body to science is an anonymous gift that should be respected. “I am uncomfortable with the ethics of approaching the donor’s family without the donor’s consent,” he says. Interacting with family members of the recently deceased could also put students in situations they’re not trained to face, such as answering medical questions about the donor’s cause of death, he adds.
Another anatomy professor, Todd Olson, who teaches at the Albert Einstein School of Medicine at Yeshiva University, appreciates the spirit of Talarico’s approach and agrees that releasing the names of the cadavers can help humanize them, but he doesn’t think students should contact the next of kin. “To me it is an issue of risk,” he says. “First-year medical students dissecting a cadaver are not conducting an autopsy, and their discoveries are not equivalent to the findings and conclusions of a trained pathologist.”
Talarico initially only tells students the first names of the bodies they’ll be working with throughout the course — allowing the families to remain anonymous in case they don’t want to communicate with the students. He then acts as the gatekeeper and makes the first contact with the families, explaining the program in a letter and asking for more medical information about their loved ones. He also includes a bundle of letters from his students thanking the families for their gift and detailing their goals as doctors. If the families respond to Talarico, he then connects them with the students.
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Jane Corsette received such a letter from Talarico two years ago when her family donated her mother’s body to the state. After reflecting on his request to be a part of the course, she decided she wanted to help. She spoke with Talarico and the students on the phone and even shared pictures and videos of her mother’s life with the class. But she also had an ulterior motive: she hoped the experience would give her some answers to the lingering questions about the cause of her mother’s death. When she posed those questions to Harker, the student working on her mother’s body, he didn’t have any answers for her. That was frustrating, Corsette says, but “I knew it wasn’t their fault.” Though she didn’t get the information she was looking for, she was touched by the experience — especially the memorial service. “It was moving to hear what [the students] said, how they cared and how it would shape them as doctors.”
Harker also believes that meeting Corsette and her family was a key part of his anatomy experience. “Knowing [Sally] was someone’s Mom or Grandma resonated with me and made sure we took better care of her,” he said. And for both Harker and Corsette, the experience had another lasting impact: both are now considering willing their bodies to science, as well.