Dissecting Gross Anatomy

IN THE 1951 FILM PEOPLE WILL TALK, DR NOAH PRAETORIUS, A PHYSIcian played by Cary Grant, is followed everywhere by a large, silent man. The man is with him as he addresses an anatomy class, as he conducts the student orchestra, as he stands over a patient in the operating room. The man speaks only at rare moments, each crucial, coming to Noah’s aid as the voice of wisdom, of conscience, or of the past. When Noah is finally challenged by a university tribunal to defend his relationship with the odd man he calls “my friend,” the story comes out: the man is a convicted murderer, executed by hanging and sent 20 years earlier to Noah, a medical student who needed “a cadaver of my own. ” The “cadaver” awakened as soon as Noah stuck a gloved finger in his mouth, and has never since left his side. Early experiences in the anatomy laboratory underpin later practice in ways that are not easy to articulate. The knowledge gained there guides diagnosis, allows us to link phenomena that seem on the body’s surface to be unrelated, and gives us fluency in a discourse that lets us to describe what is happening to our patients. Visualizing the structures hidden beneath the skin allows us to identify conditions otherwise beyond our grasp. Although the overwhelming bulk of the knowledge we use to care for patients is learned outside the lab, and the centrality of the experience wanes even by the end of first year, what we learn in anatomy lab is somehow, quietly, always there. In this issue of MSJAMA, literature professor John Bender recounts his season as an outsider in the lab and describes how the process serves as a ritual entry into the medical profession. Beyond the technical knowledge it affords, anatomy lab links us to the past and begins our socialization to future practice. We dissect knowing that we are making the same cuts and seeking the same structures as physicians centuries earlier. But today, we pride ourselves on taking more from the experience, on engaging with the gift that is the donation. Samantha Stewart and Rita Charon describe anatomy study as an initial confrontation with life and death that will follow us throughout our careers, and discuss a way these early lessons might be retrieved. S. Ryan Gregory and Thomas Cole describe the history of dissection across centuries, while Aaron Tward and Hugh Patterson account for the shift from grave robbing to cadaver donation in the United States. Finally, to launch our new creative writing section murmur, Matthew Ehrlich evaluates his cadaver’s chief complaint. The first body in our care has neither the needs nor the agency of a patient, and yet for many of us, it is the body we will envision as we examine the intact surface of each patient who comes to us. Whether it is our initiation into “the professional tribe of physicians” (Bender), “the scientific method” (Gregory and Cole), or “the use of affective responses” (Stewart and Charon), anatomy lab is as much a part of how we see as what we know. “The trouble with you, Elwell,” Noah’s ally says to his accuser at the end, “is you’ve never had a cadaver of your own. ” ON THE COVER Mike Javernick, Georgetown University School of Medicine, Amnion, pastels and charcoal on paper, 91.4 106.6 cm. Editor Stuart P. Weisberg Columbia University College of Physicians and Surgeons