Kanter, Steven L. MD
A beautiful woman graces the cover of the July 2009 issue of Academic Medicine. Her eyes are knowing, her expression is confident, and her smile is warm. There is one fact, however, that is important to know: she is not real.
Instead, she is the result of the artistic imagination of a sensitive and caring, then-first-year medical student, Michelle Paff, of Drexel University College of Medicine. This student, upon meeting her cadaver in the anatomy lab for the very first time, began to wonder what the woman must have been like in real life. What did she look like? How did she feel?
As Michelle began to assimilate evidence of her cadaver's humanity,1 an urge grew within her to express her feelings and appreciation for the woman who was teaching her so much about anatomy and medicine, and even about being human. She did so by making a drawing of what her cadaver might have looked like when she was alive.
Michelle told me by phone that she had to muster a lot of imagination to develop this work of art. In fact, she notes in the artist's statement that accompanies her drawing: “She didn't look like a real person when I saw her for the first time.”1 And, in this issue of the journal, in a reply to a letter to the editor about her drawing, Michelle states, “I added features of my own grandmother's face to reflect how I imagined the woman looked during life.” This was necessary, in part, because the preservation process used for cadavers destined for an anatomy lab does not aim to preserve facial expression.
Embalmers, who have practiced their craft at least since the time of the ancient Egyptians, use different methods to achieve different goals. Embalmers who fix bodies for anatomic dissection use techniques that favor long-term preservation over a recognizable appearance. This makes good sense. In a semester-long gross anatomy course, it is more important to be able to discern fascial planes late in the semester than it is to discern the facial identity of the cadaver.
On the other hand, funeral home directors use preservation processes that are designed to retain as much of the person's living facial expression as possible. This is critically important in open-casket funerals. If family members arrived at a viewing and peered into the coffin containing their loved one but discovered that the corpse's countenance bore little resemblance to any memories they had of their dearly departed, the mortician's business would be short-lived.
In the letter to the editor mentioned earlier, Dr. Champney raises the issue of cadaveric anonymity. His concerns reflect the practice of those who are responsible for the use of cadavers in medical schools in the United States and many other countries, who go to great lengths to conceal the identity of a cadaver from those who will dissect it. While this is a meaningful value in many parts of the world, it is important to recognize that this approach to the use of cadavers is an ethnocentric concern that is not shared by all cultures.
For example, faculty members at Tzu Chi University's medical school in Hualien, Taiwan, shared with me that students not only learn the identity of the cadaver that they will dissect, but the students visit with family members to view photographs and hear stories about the person's life. Students and family members mourn together, and family members continue to communicate throughout the anatomy course with the students who are dissecting the body of the family's loved one. The cadaver is aptly referred to as the students' “Silent Mentor.” At the end of the course, students sew up the body, clothe it, write a letter to their Silent Mentor, and participate with family members in funeral rites.
In some ways, Tzu Chi University's approach to cadavers more closely approximates how Western culture views a surgical patient (e.g., meeting with the family, communicating with them through the process) than how it views bodies willed for anatomic dissection.
Clearly, the image of the woman on the cover of the July 2009 issue of Academic Medicine evokes a number of important questions. What should be the nature of the relationship between medical student and cadaver? Why do some feel so strongly about concealing the identity of cadavers? Why do others feel equally passionately that students must know all about their cadavers, to the point of engaging with the cadavers' closest living relatives? What should medical students learn from their cadavers in addition to the names and eponyms of every identifiable structure? How is this best accomplished?
For me, the image also reinforces the notion that a student with a compassionate heart, a creative mind, and skilled hands has just the right combination of traits to make a good doctor.
And so, I thank Michelle for reminding us, through her artwork, of the wonderful gift that a person can bestow on humanity by donating his or her body to medical science. I thank Dr. Champney for reminding us that, depending on sociocultural norms, it may be important to be mindful of issues related to identifying a cadaver. I thank the faculty at Tzu Chi University's medical school for reminding us of the need to continually examine and reexamine even what we consider to be our most basic assumptions. And finally, I thank the woman, whoever she may be, for inspiring medical students through the gift of her body by being an elegant yet silent mentor.
Steven L. Kanter, MD