Ciarán Walsh of curator.ie writes about the Museum for RTÉ Culture > https://www.rte.ie/culture/2018/1112/1010315-the-skeletons-in-trinitys-closet/
First & foremost to say, it was such a thrill & privilege to be able to conduct – thanks to Siobhan in the department – our session in the beautiful atmosphere of the old Anatomy Building lecture theatre (as photographed so perfectly here by Fionn McCann). Everyone was most impressed … even a tad sorrowful!
Opened up with our group recitation of Yeats’ ‘Paudeen’. They’ll know it off by heart by the end of the module!
Then had quick recap from one of the group on last week’s proceedings.
Then I set the mood for this week by reading Tríona Ní Dhomhnaill’s ‘The Mermaid in the Hospital’ as translated by Paul Muldoon. (“It was the sister who gave her the wink / and let her know what was what.”)
Then, somewhat unusually, I gave a sort of lecture on anatomy as a human pursuit and its significance in medical training – based on an essay I wrote for the ‘Irish Medical Times’ years ago when the Anatomy department was moving from its charming, nineteenth century home to the shiny new Biosciences building >
The idea is that perhaps to ensure the students adopt the appropriate attitude towards the privilege that it is learning from cadaveric dissection, some civilising influence of the aesthetic on display in the old building (architecture, art, history) needs to be / is being replaced by comparable influences in the new facilities – the orientation programme, the relatives room.
Keeping it somewhat personal, I told them about an old friend, Max Aguilera-Hellweg, who sat in this very room as a first year MATURE medical student in 1998/99, but who transferred back to the USA for the rest of his degree because of a dispute with the School arising from conflicting views of his book ‘The Sacred Heart’, which he had just published the year before. I read and analysed extracts from Max’s book, highlighting how his interest in medicine arose (a photographic assignment that led to an obsession) and his resulting intense, artistic fascination with representing the most full-on images of the workings of the body as revealed by surgery.
… Far from getting sick, I felt what I can best describe as awe. Photographing my first surgery was so foreign to any of my previous experiences that I couldn’t place it. I couldn’t compare it to anything. It is one thing to know there is a spinal cord in the hollow of your back; to see one for real is altogether different…
The cardinal glow of oxygenated blood reminded me that there was a man in there. A thick, milky-white strand covering the nerve tissue that stretches from brain stem to tailbone, splitting off into minute and multitudinous nerves, producing the sensations of heat, cold, pleasure, pain; the dura of the spinal cord lay revealed. I saw the painting above my grandmother’s bed. The one I saw as a child waking up from my nap. The one of Jesus. His heart bleeding, wrapped in thorns, engulfed in flames.
I realised I was in the presence of the most intimate, most vulnerable, most inviolate thing I had ever seen. The spinal cord had never seen light, wasn’t meant to see light, and at this moment was bathed in light. My first impulse, I must confess was to spit. To defile it in some way. Bring it down to my level. I didn’t, of course, but I felt I was in the presence of something so precious, so amazing, so powerful, so pure, I couldn’t bear the intensity.
“What is that?” I asked. “What’s it made of?”
“It’s like a sausage,” the surgeon said, “with toothpaste inside.”
We discussed the heightened language and thinking here; the artistic impulse; the impact such descriptions have on a reader, particularly whether or not they can be said to have benefits for medical student readers; we debated why Max’s impulse was to spit (including wondering was it actual!); we discussed the surgeon’s disabusing and mundane reply, in terms of professional distance and general normalisation.
Where before [as photographer] I searched the eyes of a man [for his soul!], the wrinkles of his clothes, the wear and tear of his shoes, I look now in the recesses of his flesh, the colour and texture of his liver, the markings and capacity of his lungs.
We discussed our impressions of Max from the extracts we’d read and how suitable his motivations were for someone becoming a doctor. We got into a detailed discussion about empathy.
Then we read and analysed extracts from Sinéad Gleeson’s essay ‘Blue Hills and Chalk Bones’.
We discussed how the suddenness of the migration from the Kingdom of the Well to the Kingdom of the Sick is handled (“It happened quickly, an inverse magician’s trick: now you don’t see it, now you do. From basketball and sprinting to bone sore with a limp. Hospital stays became frequent, and I missed the first three months of school four years in a row.”); the unbelievable trauma to the body and soul some treatments involve; how quickly a patient, even a young patient, become conversant if not fluent in the language spoken in the Kingdom of the Sick.
We went into some detail on the particular impact of physical difference on young people (“I got used to the limp … but gained a new self-consciousness… What I felt more than anything was overwhelming embarrassment. Ashamed of my bones and my scars and the clunking way I walked.”) and how if it’s difficult for a doctor to properly empathise with an adult patient, it can be even more difficult when the patient is a young person or a child. (Though some of them have thicker skin than others, was a point that was made.)
We discussed the clinical aspects of acne and blushing.
There are a couple of particularly harsh doctors portrayed in Gleeson’s essay, and we discussed how prevalent their behaviour might be in healthcare settings these days and whether or not efforts were being made to reduce the instances of such ignorant behaviour:
I explain this to the orthopaedic doctor, this man I’ve never met, and he does that thing I’m used to male doctors doing: he tells me I’m overreacting. A rotating blade is slicing into my flesh, but I need to calm down. When my mother starts to cry, he demands that she leave the room. Fifteen minutes later, I plead with him to stop and he finally gives up, annoyed.
On an early visit to the surgeon, to check my spine for scoliosis, I was asked to wear a swimsuit. Mortified, I cried all through the exam, and the doctor, growing impatient, threw a towel over my lower body.
‘THERE, is that better?’
It wasn’t. I was a self-conscious girl being humiliated for her sense of shame.
Perhaps understandably considering her analysis and perspective, Gleeson summarises perfectly the lop-sidedness of the relationship, particularly as it was back in the 80s:
The Doctor patient relationship had its own imbalances. I have never forgotten the sense of powerlessness in instruction: lie down, bend forward, walk for me. I have felt it counting backwards from ten under the stark lights of an operating theatre. Or when skin is sliced cleanly through. You are in someone else’s hands. Steady, competent hands – hopefully – but the patient is never in charge. The kingdom of the sick is not a democracy. And every orthopaedic doctor who examined me during those years was male.
We discussed the difference between Gleeson’s language / perspective and Aguilera-Hellweg’s.
A variety of analyses were put forward on this idea: “Our bodies are sacred, certainly, but they are often not ours alone… we create our own matryoshka bodies, and try to keep at least one that is just for us. But which one do we keep – the smallest or biggest?”
We noted the empathy behind her observation of another person in Lourdes hoping for a miracle: “He twitches occasionally but is otherwise motionless. There is drool on his face, and I want to say something to him but can’t.”
Also the pathos in: “This is the breakdown of bones, the slowing of a heart, the confinement of our own bodies: a being that once sprung into the world, vibrant and viscous and pulsing with life.”
Finally, we read and discussed Doireann Ní Ghríofa’s poem ‘To the Stranger Who Will Dissect My Brain’ (unpublished) and the students who spoke were extremely moved and impressed with the final description of the “exchange” that happens at the end of the poem between the remains and the (say) anatomy student: “Your brain will blaze bright,// alive and wild, and I,/ I will be the light.” Not only capturing the awe felt by medical students (& some photographers) but also the enlightenment – the final gift of the person who has donated their remains to medical education.
One student spoke about how the poem captured in a way that she could never achieve herself (and that no other language register could, perhaps) that feeling of awe that some students experience when they begin their anatomy dissections.
And to top it all off, the students were able to look around the old Anatomy Museum and get a sense of the history – betimes quite freakish and grotesque – of their studies.
Yet despite the obvious layers of artifice, there is something insistent and revealing in these scenes [Corinne May Botz’s photographs of medical actors,the hired professionals who act out illnesses in order to train medical students in caring for patients]. In her 2014 essay “The Empathy Exams,” the writer Leslie Jamison explored her own experience working as a medical actor, and the complex negotiation and performance involved in expressing one’s own pain and in learning to respond to the pain of others.
Full article in the New Yorker >>>
Medical Council chief executive Bill Prasifka said he was disappointed that the reported experiences of bullying by trainees was no better this year.
He was also unhappy that many trainee doctors seemed to be receiving little or no feedback and have poor experience of induction.
“I am fully aware that the issue of bullying cannot be dealt with overnight and a cultural shift needs to occur in this instance,” said Mr Prasifka. “However, an improved induction programme, or the simple delivery of feedback, is something that can, in fact, be achieved quickly.
“If trainees working in a clinical environment are feeling underprepared, it is a patient safety issue and that is why we have decided to do all we can do within our regulatory role.” (Irish Examiner >>>)
A passerby may wonder
Why wistful I may be,
Why envy haunts my vision
When I view the willow tree.
A passerby may marvel
And admire my molded form.
My every branch and twig and leaf
Has learned how to conform.
My sculptured shape is chiseled
By shears too sharp to see,
For pruning is the price I paid
For this topiary me.
Meandering through scented shops,
Lounging by a pool,
Watching goofy sitcoms,
And trying to look cool,
Crosswords and sudokus,
Magazines and jokes,
These were clipped and hauled away
By the garden training folks.
I don’t begrudge the clipping.
It was my choice, to be sure.
But when the wind blows through the willow,
I feel its freedom’s lure.
From ‘The Inner World of Medical Students: Listening to Their Voices in Poetry’ By Johanna Shapiro
The first national survey of trainee doctors has found most are happy with their training, but in one-in-three has suffered bullying.
The ’Your Training Counts’ report was commissioned by the Medical Council and involved 1,636 trainee doctors who responded to approximately 100 questions. The number who responded constitute approximately half of the trainee doctors in Ireland.
There was a dramatic difference in incidences of bullying between the UK and Ireland. Some 33.7 per cent of Irish trainee doctors reported bullying or harassment in their post in comparison with 13.4 per cent in the UK. (Irish Times >>>)
First-year medical student creative writing assignments on anatomy:
I assumed when undertaking the anatomy dissection course that the strangest part would not be the dissection but the fact that we would be working on actual human specimens. I thought there was a strange sense of morbidity attached to educating someone who’s job it would eventually be to enhance and often prolong human life with bodies medicine may have failed. However upon beginning the course I have realised that this is not the case. The most unusual aspect in my point of view is the casual manner with which we all approach Anatomy, the relaxed and easygoing conversion that flows through the dissection theatre is natural yet one would think it out of place.
The donor bodies are often referred to as our silent teachers however they are never greeted with silence, be it the hum of chatter or the clank of our metal tools noise swells the dissection theatre to fill what would only be an eerie silence making the overall experience for students comfortable and and a place where learning comes easier.
Flicking through netters, there are thousands of images but none stand out. The memory however of holding a human heart is hard to forget. Its size, bigger than a human fist, the rough lumpy fat globules that cover the outer layers which contrast with the smooth almost silky lining of the inner vessels, and the dull red colour of its vessels is something that will stick in a student’s mind forever. It is undoubtedly an invaluable experience which enhances our ability as students to fully understand what it is we are learning.
Leonardo Da Vinci once said; “Our Life is made by the death of others”. In order for my life as a medical student to begin, someone on this earth had to die. I wondered, as I queued up behind another white coat, where my “person” was when I was born, when I made my First Communion, when I found out Santa wasn’t real? I pictured what their life was like as a mother, a father, a golf enthusiast who dreamed of attending the Ryder Cup someday. Flickers of an imagined life ran through my head as we filed into the dissection room. For some reason I wasn’t afraid or nervous. Seeing the white sheet only brought back memories. I had already been in this situation before. My uncle was under the same infamous white sheet when I had to identify him with my dad in the morgue after his car crash. Having experienced that, I was prepared for anything. Nothing phased me to be perfectly honest, the smell, the eerie silence, death. Certainly I wasn’t prepared for the dissecting itself, but the initial exposure was just a silent reminder of what I had witnessed before.
What affected me more than the dead body itself was the idea that this was someone’s wife or mother, best friend or neighbour. The thought of the family and the huge void left behind was something that struck a chord deep within me. I felt a sudden surge of emotion stir inside me – for I had been the one left behind before, and I could somehow empathise with this woman’s family, wherever they were.
We were immediately flung into the deep end and the only way we could tread water was by picking up the scalpel and cutting. At the start I felt protective of this woman, I was afraid for her but I didn’t know why. I knew it had to be done and that she wanted us to do it, but I still felt like I was intruding on something – on her life, her personality, who she was. However, as the weeks went on, she began to resemble less of a person and I suddenly began to understand what the American novelist Chuck Palahniuk meant when he said “We all die. The goal isn’t to live forever; the goal is to create something that will.” By donating her body and allowing us to dissect it and learn from it I believe my “person” has left something behind that will live on forever – it’ll live on through me and my medical career.
“Hey Tommy, can you tell me a scary story?
– Yeah, let me tell you about this place. It’s all white: the walls, the tables, the machines. Everything is white. And then there are these windows through which a genie-blue light emanates: no park or busy street down below to look at. It’s almost as though you were trapped underwater. No one knows why they’re like that – keep people in or keep others out? There are also a lot of books, strewn around, all yellow, grey and ripped. The ground is speckled blue and you know the only reason they chose it was because of how easy it would be to clean up if an accident ever occurred. And then, there are the ghosts.
– No, no. They’re not the ones who scare people. They’re the ones who are actually afraid.
– What? Why?
– Because their bodies are covered by stiff, wrinkled and crackly plastic sheets. The few moments when it does get lifted, they’re staring straight up at white, sterile monster-machines that look like Doc Ock, with prying arms bent at awkward angles around their core. Their only companions are smirking skeletons who have long since grown accustomed to the chilling air that wraps around their bones and the dull humming in the background. They know they shouldn’t be afraid, they know they’re here for a good reason, but when they turn their heads and see the grey veterinarian tables next to them, they can’t help but retreat as deeply as possible into their skin.
George lies in the name of science
in a room with strangers
whom he never met or never will know
He feels neither pain nor pleasure, just very low
They come in the name of science
They see him and they nod
But every ticking second turns glitter from gloom
And they forget George was his name.
Once, he gave trust in the name of science
And in white coats they played God
They assured and yet they failed
Yet now George was at their aid
The place was brighter, cleaner than I initially expected it to be; a synergy of a morgue, surgical theatre, classroom and a cinema all rolled into one room. Sitting there staring, reflecting, the white sheet remains motionless, like fallen snow it weaves only the bear contours of what lies beneath and of what once stood of a beautiful landscape. In that time I wondered about my first anatomy experience and what it means to grow, learn, achieve, and finally become a cadaver. Having just come from an all night TV marathon of ‘The Walking Dead’, the first time I entered that room I was very anxious but acutely prepared to see a body devoid of its humanity and excited about the panorama of discovery that will be viewed in this room over the coming year. I wondered why he donated his body? What were his motives? Was the end painful for him?
As the sheet was removed, I stood transfixed; absorbing every detail -my first patient’s skin was white, smooth and very cold, a marvelous marble statue to a lost hero. He was thin with signs of bruising along his arm – the result of countless hospital injections. At that point I wondered what his life was like, did he marry, did he have children? Our first task was to dissect the muscles of his chest and shoulders. This was it, I still couldn’t believe we were going to cut open a human being. Who is this guy? What did he like to laugh about? What did he cry about? As the scalpel surgically makes a trailing pathway through the skin down his chest, I am careful not to cut too deep in fear of damaging the vista beneath. His skin is slowly peeled away and I look and see what it means to be a cadaver, a person that was once a man. Muscles, heart, lungs liver, kidneys, stomach – they were all present. Dreams, goals, hopes, aspirations, love – they had passed on. What lies here now are merely the tools used to sustain life’s elements, a parting gift sculpted by the chisels of time and donated to education.
Before the words lecture, tutorial or even welcome had been spoken, we were rushed to the anatomy lab. My first thoughts of the room were that it was too quiet, too impeccable, too new. It’s funny looking back, because at the time, I also thought that my new classmates, in the dissection room with me that day, were too quiet, too impeccable.
Apprehension was the primary feeling amongst us. We were all eager to make a good first impression in front of our new classmates, our future friends. Fear wasn’t allowed. We were in med school now- looking at these donor bodies was soon going to be an everyday occurrence. Everyone tried to look brave. Nobody wanted to be ‘that girl’ or ‘that guy’- the one who fainted when he or she entered the anatomy lab for the first time.
It was my first time seeing a dead body, except that of my grandmother’s. That was different though. She was dressed in her Sunday best, her hair done and her makeup on. She wasn’t frightening. In this vast, unfamiliar, and chemical smelling room lay 12 dead bodies, unclothed, with only their towels and plastic coverings protecting us from the fear of failure. What if I couldn’t handle seeing what lay underneath? What if I found doing the dissections too gruesome? What if I failed at the only thing I had ever wanted to do?
Only four months later and I look at the anatomy lab through new eyes. It is no longer daunting. It is where new friends were made. It is where we laugh and chat. It is where we study what we ached to learn, what we came here to learn. The 12 donor bodies are no longer just dead bodies. They have identities and they have meaning. They are men and women that gave their bodies, so that we could go on to become exceptional doctors. It is no longer too quiet, too impeccable or too new. To my distaste however, it’s still as bad smelling as ever.
The graveyard is like no other, neither gloomy nor spooky. The smell. The environment. The sight. Everything is different. The grave is bright. Everything is white. From the floor and the wall, to labcoats and gloves, even the cover sheets for the cadavers. Everything is white. Maybe, so the students could stay bright, but not to feel fright. It is a grave, where the medic students have to learn, from the outermost skin of the body to the innermost complex organs, from the largest femur to the tiny little sesamoid bone. It is a grave that the medic students should fall in love with. Even the grave is full with creepy skeletons staring at them but yet they still come often. Even the striking smell of formaldehyde destroys their nose but it will eventually become addictive instead. And the corpse, will always wait faithfully on their grave for the students to come, giving every bit that they could so the students could one day be a doctor. So yeah, this is the graveyard, totally like no other.
Cold spills out like an open hotel door
Every fake skeleton’s missing a limb
Near open boxes full of people’s bones
The closest to strangers they’ve ever been
Every skeleton is missing something
By crusty old copies of Netter’s map
This is the closest to strangers we’ll be
The dentist smell just seems inadequate
Thick yellowed books like unanswered letters
Spotlights on elbows that never inflame
The dentist smell with no sense of judgement
And no shade of white plastic is the same
Spotlights on hinge joints make do for the sky
By open boxes spilling people’s bones
Where no shade of white plastic is the same
And cold falls out of the old hotel door
The Dissection Room
The white walls, the bright lights, the stainless steel surfaces, one may confuse this room for a hospital ward; however no patient is going to be discharged from here. Then bang; it hits you, the poignant aroma of decaying flesh combined with a concoction of chemicals; stomach turning, nauseating, almost overpowering, however, to the experienced anatomist it is somewhat familiar.
In each bay, beneath the white plastic tarps, they lie, stiff, cold, lifeless, preserved in time, positioned as they lay during embalming. They lie as though asleep; however will never awaken; for they are now in an eternal slumber.
Accompanying each cadaver is a brief description outlining their name, their age, and their cause of death, but one can only wonder; how they might have lived?, where had they be from?, what had they been like?. However we choose to disregard such details, as thinking of them may make the task at hand somewhat more difficult.
Although we can try overlooking the facts, we cannot however ignore the valuable contribution that these individuals are making to our training, we should feel privileged that they have given us an opportunity to attain a greater insight into the inner workings of the human body, knowledge that will hopefully stay to us for our entirety of our medical careers. For it is said that “knowledge is power” and to truly be an expert in something; one must first fully understand it and how it works. Just like an experienced horologist needs to comprehend the inner workings of a clock, we need to fully understand of the inner workings of the human body and appreciate how it ticks.
However I can’t but wonder; if these individuals had been fully aware of the fate that lay in store for the bodies. Had they envisioned, that on a weekly basis, five to ten overly enthusiastic students using an array of weaponry to cut fascia, sever muscles and break bone. Like a bunch of excited children on Christmas morning, ripping through the wrapping on their presents to discover what wonders lay inside, all in the name of exploration, all in the name of medicine.
But one may ask “is this really medicine?”, “is the purpose of medicine not to treat, to heal, to help?” Is the practice of dissection not a bit abstract from the grand scheme of modern medicine?, was their sacrifice truly worth it? only time will tell.
Probably the greatest testament to their gift will be how we apply this knowledge to help others.
What’s disconcerting in a dissection theatre isn’t necessarily the jury of twelve cadavers or the startlingly clean smell and feel of the place. Rather, it’s a mishmash of the two.
The moment you enter, the smell of formaldehyde is almost overwhelming but it fades so quickly you almost forget you ever noticed it at all. Until, in a lonely of intense concentration, it comes rushing back on the tail of the new smell, of sweat and evaporating fat.
When working at a table, it’s so easy to see yourself as a butcher, fixated on and meticulously carving up the slab of flesh in front of you.
“Did Pamela have any children?” I wondered of my last donor. “What kind of life did she have?” “What does death feel like?” The banal and the profound aspects of life mesh and grind with the visceral reality of what was once alive before you and the sense of shame for momentarily forgetting these questions takes over – for me, at least.
That’s not to imply I’m above all the laughter surrounding the table. The humour in the theatre is shockingly bleak: “Death hilarious”, to quote Cormac McCarthy. Apparently it’s a coping mechanism, for dealing with the arguably traumatic scenes we see but whatever it is, the strangled laughs at a poorly cracked pun about the donor giving us a leg up or such hint at an emotional charge to the proceedings that we, as somewhat arrogant youths would try to deny.
“I’ve often gone into [the operating] theatre and they will be grilling you – ‘what are the complications here ? What is the blood supply to that? What school did you go to?’ ”
The school question follows as naturally as breathing. The school was in Finglas, she tells them. “And you can see their eyes widen. I’m never quite sure what it is – is it surprise or admiration ?”
In first year, Lambert was almost overwhelmed, partly by the “outrageously tough” course but also by a sense that she didn’t belong. “I withdrew into myself. I almost felt that I shouldn’t be here. For example, people were milling around with all those notes and I said, where are they getting them from?” (Times) >
My feature on the Anatomy Building in Trinity as published in the Irish Medical Times >>>
Anatomy teaching in Trinity is being re-housed, and Paul O’Connor wonders if anything is being lost in translation.
It’s quiet now, the Anatomy Building in Trinity College, more like it seems in Fionn McCann’s photographs than it was on the day I last visited it in April when a mass of highly animated students, mostly in white coats, occupied every available space while revising for their anatomy exams. Handling a bone, a model or an organ, some students worked alone at various tables, looking from text book to specimen and back again. Others worked in pairs or larger groups, gathering around the cadavers they had dissected during the year, to test each other on the course of blood vessels or the description of features. I thought of Kevin Myers’s sarcastic image of a medical student’s brain: “a cerebral shoebox containing a vast anatomical index, in which you can find the name of every nerve-ending and every follicle, and also, in an un-swept and unvisited corner, a small, withering organ called common humanity.” Meanwhile teaching and technical staff members went about their work, helping when required, offering friendly encouragement and ensuring the other functions of the building continued to be performed.
All these human activities and structural functions are now being relocated to the brand new Biomedical Sciences Institute on Pearse Street, recently opened by An Taoiseach Enda Kenny who declared it, enthusiastically, “another significant chapter in the history of Ireland’s oldest university”. That movement from old to new is universal and often for the best, especially when it comes to scientific research. But in the case of medical education, especially a subject like anatomy, new may not always be entirely good. It’s worth reflecting, I think, on what is possibly being lost in the transition from charming, nineteenth-century, purpose-built Anatomy Building to high-tech institute housing an anatomy department.
Since its construction in the early 19th century, the Anatomy Building has been recognised for its quality. According to Provost Mahaffy in his history of the college, its Anatomical Museum and Dissecting Room were considered to have “none of the dinginess so generally characteristic of rooms of this kind”. In his time as Professor of Anatomy from 1947 to 1984, Cecil Erskine brought to life a personal vision of the building that fused art and function to give it the charm it has to this day. Joint Technical Officers of the Anatomy Department, Siobhan Ward and Philomena McAteer, say that when Gunther von Hagens visited he described it as the best dissecting room he had ever seen. The Trinity Buildings Office is itself fully aware of the historical importance of the spaces and even though their fate awaits an official College review it seems likely they will be preserved in some form.
The building’s interior and contents, as seen in Fionn McCann’s photographs, reflect a time when objects embodied our knowledge, when it was possible to point at much of what was known. Now that our knowledge has penetrated to cellular and molecular levels – giving us physiology, biochemistry, genetics etc. – abstract representations are necessary to explain what we know, visualisation technology plays catch-up, museums are displaced by microchips, and some ask is anatomy even worth studying. But novices benefit from a familiar and tangible starting point that gives a necessary context for what is to follow, so it makes sense that our medical students should begin their health science studies with anatomy. How it is taught, is what is debateable: should we allow first-year medical students, some as young as 17, to dissect the remains of a fellow human being? Perhaps the models, photographs, diagrams and computer generated imagery used in some medical schools would be sufficient and more suitable?
Though there have always been difficulties, from moral to financial, associated with cadaveric teaching, as Siobhan Ward and Thomas Farrell write in a study entitled, ‘Are students of Anatomy adequately prepared to encounter donor remains?’: “Medical schools which have retained the study of practical anatomy with cadaveric specimens are now perceived to have a resource of great value.” Much of the complex stuff that makes doctors’ work different from mechanics’ may take place at a molecular level, but some of it emanates as colouring, texture, swellings, tears, smiles, words and so forth. Doctors need to be trained to notice and interpret the signs, and rightly, as Trinity Professor of Anatomy in the early 20th century, Andrew Dixon, wrote: “A great deal of importance is attached to the surface anatomy of the living body and efforts are made to get students to ‘see’ the deeper parts through the skin in the living subject.” But this can only be fully achieved by way of an intimate knowledge of what lies beneath. Furthermore, the variations between bodies and the differences from textbooks discovered in dissection prepare students better for the particularities of symptoms.
So, the donor remains will be moving with the Department, and thanks to good management and benevolent donors the entire donor programme will remain as is, meaning our medics can continue to have this great opportunity: “a true privilege,” as one student put it; “very honored to be given the gift of knowledge by the donors”, another. The success of the programme is down to the sensitive design of each element, from the donation procedure, to the removal to Trinity, from the briefing on respect that the students now receive, to the dignity ensured for each donor in the use of first names, partitioning and in the remembrance service.
Indeed, the Department’s sensitivity in this regard extends beyond the donor to the donor’s family. In research into the impact of donation on bereaved families, Philomena McAteer was surprised to discover that with no graveside to visit for two or more years while they waited for the final burial, family members were meeting outside the Anatomy Building on anniversaries using the grounds of the college as a kind of cemetery: “She is in there, still helping others” in the words of one interviewee. This phenomenon helped the Department secure an additional room in the new building for use a relative’s room, where families will be able to go with the hearse after the removal, and visit at various times afterwards.
But there are other elements of the Anatomy Building which have yet to find a home: the skeletons of various individuals, including that Cornelius Magrath (showing acromegaly); preserved and labelled dissections carried out by Daniel J Cunningham; a pathological collection from the 18th century; and teaching material, including my own grandmother’s Edinburgh Stereoscopic Atlas donated by her son. Although there will be no museum in the new facility, the staff are hoping over time to develop ways of incorporating some of these collections into the new spaces: “we see ourselves as custodians of all the donor remains here … and we feel protective of the specimens too,” Philomena McAteer explains.
The new Institute certainly offers the Department many other improvements. They will finally have enough plug sockets, which is only a trivial matter when you have them, as well as state-of-the-art audiovisual and temperature-regulated lighting equipment beside each donor remains, taking Trinity’s facilities from charming, ‘old-world’ to state-of-the-art, high-tech in one step. This will facilitate advanced surgical training in the future as well as the usual undergraduate learning that will recommence in September. The technological improvements and improved facilities for donor remains are making the move positive for the staff, who have been going through a grieving process of sorts themselves.
Prominent in many of McCann’s photographs, though least practical in terms of the Department’s collections, is the art of Cecil Erskine. His copies of Vesalian illustrations can be seen as an antidote to the somewhat messier business of actual dissection; though they reveal, being classically inspired, they are more celebration than gritty realism. “In medicine anatomy is applied, in art it is transformed,” Erskine wrote.
Fionn McCann’s photographs of the Anatomy Building are quite “applied” in relation to the interiors because they don’t hide much. They are architecturally Anatomical, in that while beautifully composed and lit, and somewhat stylised in their emphasis on historical space over current functioning, they do dissect the spaces to show us the asymmetry as well as the symmetry, the irregularities as well as the patterns. They open up the building, revealing layers, from structure and fixtures, through fittings and layout, to placements and hangings. The photographs are, though, it seems to me, unavoidably transforming in relation to the study of anatomy because they don’t show, as per the Department’s custodial modus operandi, the actual bodies of donors or of students and staff. Without them, so much is left to the imagination that one pictures a version of dissection, amidst these grand sets, that is cleaner and simpler than the reality.
It’s a reality that historically has made us somewhat uncomfortable. Dixon tells us that in the 1920s, at the time when my own grandmother was studying there, the Anatomy Building had, for such reasons, a “special dissecting room provided for women students”. Daniel Shapiro, who teaches in a medical school in the USA, has written about how he felt when he discovered that his mother was donating her body to medical teaching:
I didn’t want her body to reside, naked, under a plastic tarp in a cold room dominated by the hum of heavy fans and the smell of formaldehyde. I didn’t want her to be called cadaver. I didn’t want her name replaced by a table number, nor her body touched intimately by anyone who didn’t know her. (Daniel Shapiro, ‘The Last Gift’, JAMA, November 14, 2007—Vol 298, No. 18 (Reprinted))
Putting myself in the pictures, going back in time to 1987 when I was in one of the groups of medical students allocated to a cadaver, I recall the initial discomfort caused by the sticky smell, the formaldehyde-soaked skin, the sunken features and rigid weight of the body we dissected. I don’t think many of us paid a great deal of attention to the interiors of the Anatomy Building, to the reminders of Vesalius, to the elegance of the displays. Some of us were too caught up in our white-coated selves or in medicine or both. But, in the absence of a thorough orientation programme such as is conducted nowadays, perhaps the surroundings took on such a role, and had some impact on us, caught us up in their dignity. Perhaps, unnoticed and despite ourselves, the building’s aged beauty was straightening us out somewhat, putting us in our place, making disrespectful behaviour less likely if not totally eradicating our teenage showiness, before we made the first cut.
The Anatomy Building itself, as clearly seen in McCann’s photographs, at the very least provided a kind of sacred backdrop to that most profane of acts which we were embarking on. The question is can the new setting match it? Perhaps using Fionn McCann’s photographs the way Erskine used the illustrations from Vesalius would be an appropriate way to help it along.
Or perhaps the newness itself, along with the work of the Department, will release us from our awkwardness around the idea of dissection and help us hear more clearly Daniel Shapiro’s mother whispering:
“Study me hard, and come back to me again and again. You learn everything there is to learn from my body—so that someday you can do something about these dreadful diseases.” (Daniel Shapiro, ‘The Last Gift’, JAMA, November 14, 2007—Vol 298, No. 18 (Reprinted))
Fionn McCann’s photographs are available to buy as prints from his website, http://fionnmccann.com. Two of the photographs are on display at the 181st RHA Annual Exhibition which runs in the RHA gallery until 30 July, 2011.
Paul O’Connor runs the website Ars Medica. See https://arsmedica.wordpress.com/ He would like to thank Paul Glacken, Siobhan Ward, Philomena McAteer and everyone else in the Anatomy Department for the time they gave him in preparing this article.
We looked, first, at what makes up this thing we call medicine. A spider sprawl on the black board based on the group’s contributions to the question What makes up this thing we call medicine? produced the following (give or take):
Accepting that we would not be able to cover all these apsects of medicine in course of a 6-week module, we then read some letters to the Irish Times about the late Maurice Nelligan (here >>>) as an indication of how one (exceptional) doctor’s life can reflect so much of that fuller picture of medicine-in-the-world; while also realising that most doctors will only ever be confronted with most of the issues in passing.
Focussing in a particular aspect of the education/training of doctors, we then read some extracts from a few highly rhetorical Irish Times columns – by a columnist (now with Indo) who shall remain nameless – about the impact of medical training on students: “Possibly the young hospital doctors deserve everything they get. After all, it’s the life that they chose for themselves. Nobody made them do it, and most of them must have had a pretty shrewd idea of what lay ahead from the very first day in medical school, the greatest oxymoron of them all. For medicine and school are antithetical terms.
School for the rest of us means broadening our horizons; but the study required to be a doctor is the precise opposite of that. In what it does your brain, medicine comes a narrow second to placing your head in a piledriver. The latter is, to be sure, a little quicker and somewhat more Hammer-horrorish in special effects, but the net result is the same. Encephalectomy.
Why does the medical profession do this to young graduates? Why are they forced to know the christian names of every single cell of the body? Why do they spend 23 hours a day forcefeeding their brains with vast quantities of useless information which they will never need again? If geese were treated there would be uproar: so why is it acceptable to turn the bright young brains of medical students into cerebral foie gras?” ….
“The very first taks of medical school is the conversion of the brain from a vital ratiocinative organ for analytical thought and speculation into a machine for storing facts – a cerebral shoebox containing a vast anatomical index … and also, in an unswept and unvisited corner, a small, withering organ called common humanity.
This is not the fault of the students. It is almost impossible for the spirit of ordinary sensitivity, of optimistic enquiry, of normal ignorant speculation working its way to enlightened conclusion, to survive the Gradgrindery of medical training. Medical students probably work five or ten times harder than arts students; and correspondingly, they discover five or ten times less about human nature. That discovery is made in casual college discourse, in unstructured debate, in wide and varied and undisciplined reading. It is the very purposelessness of the liberal arts which give [sic] them purpose.”
… and so on.
After the break, we moved on to looking at what literature is & where it might fit into a medical student’s & doctor’s life. I pointed out that I was not limiting the course to fiction but including poetry, scripts, memoir, essay and journalism; only looking for fresh & interesting perspectives being offered on any aspect of medicine.
Wanting to take an extreme perspective on what use literature might have in the life of a medic, I read an extract from Rita Charon’s Narrative Medicine:
This led to a discussion on how far one could go in treating a patient (and in taking a history, in particular) using one’s imagination. The thesis that “clinical imagination” should be used by doctors was seen as perhaps going too far, in that mistakes could be made; the antithesis that it’s all about facts misses out on the fact (!) that people tell stuff about themselves in stories that don’t always give up their facts neatly. The sythesis emphasised that a sensitivity to how narratives work, how stories are told, might help a doctor get to and unearth the important facts in patient’s situation to aid a sound diagnosis and treatment.
Finally, I quickly mentioned some other benefits of reading outside the course:
- It can enthuse you about a topic
- It can provide new perspectives
- It can lead to a deeper understanding
- It can put you in your place (in society) both in the usual meaning of that word (as in keep you real!) but also in a more positive sense (as in boost your confidence)
- It can show you that your situation or stuggle is not a first, that others have gone through similar
- It can make everything new & fresh again, giving you the eyes of child in a sense
- It can help you get a rapid second-hand insight into particular issues without you having to go through them
We discussed the next session’s text: William Carlos Williams’ stories.