By Jennifer Eder
Joshua Jabaut’s first patient as a medical student was a 97-year-old woman. He never learned her name, as she was one of the 18 cadavers that first-year George Washington University medical students would dissect as part of their gross anatomy course.
Mr. Jabaut vividly remembers the first time he cut the cadaver’s skin with a scalpel. The feeling of dissecting and holding the heart of someone who lived 97 years. The alarm when a classmate accidentally nicked the ear with a scalpel.
“It’s very difficult learning how to invade someone else’s body, and that’s a big part of medicine,” said Mr. Jabaut, a 29-year-old first-year medical student at the George Washington School of Medicine and Health Sciences. “When someone comes in and they’re sick, there’s a certain level of privacy invasion in order for the doctor to figure out what’s wrong. I felt that way throughout the entire cadaver experience.”
“We learn so much from the cadavers, and I know we’ll learn so much from our future patients as medical students.”
Working with a cadaver is a rite of passage for medical students at GW and across the country. The experience offers invaluable hands-on experience for the future doctors. At the same time, it can be challenging, emotional and sometimes difficult.
“The experience can raise many issues for students,” said Christina Puchalski, director of the George Washington Institute for Spirituality and Health. “It may be the first time they encounter death. It may raise issues about the end of life. But it also raises questions about their donor’s life and what triggered them to give this donation. And all the students feel a tremendous amount of gratitude for allowing them to learn what they need to know to be good doctors.”
This feeling of gratitude for the body donors and their families has inspired GW medical students to hold a memorial ceremony for the donors. Every spring, several first-year students plan a service in which all of the donors’ first names are read aloud, family members speak about their loved ones and students express their appreciation. Mr. Jabaut is helping to plan this year’s ceremony.
“I really liked the idea of being able to show the families how much we as students deeply appreciate what the donors and their families have done,” Mr Jabaut said. “And I’d like to learn a little bit more about who these people were. They’ve become a really important part of our lives as students, and we know so much about them physically – their body inside and out – but we don’t really know about who they were as a person.”
A Vital Learning Tool
GW does not pay for body donations. Instead, its Body Donor Program, which is run out of SMHS’s Department of Anatomy and Regenerative Biology, accepts the remains of persons who wish to make an anatomical gift for the advancement of learning and scientific research. GW receives about 150 requests each year from people who want to donate their bodies, and 1000 people are currently signed up as donors. The program accepts bodies 18 years and older within a 50-mile radius of GW.
Because the embalming process must start immediately and the body must be kept in a very specific environment, families cannot have a traditional funeral service. Bodies are usually used for educational purposes for only a year and then will be cremated. The ashes are returned to the family upon request or are buried at Mount Olivet Cemetery in Northeast Washington.
Some of the donors were physicians themselves. Others were longtime patients of GW and felt a sense of gratitude to the institution. And others just wanted to contribute to medical education.
“Some people just feel they’ve worked hard all their lives, and they still want to be useful even after their death,” said Janette Krum, associate professor of anatomy and regenerative biology and of neurological surgery.
Students first meet the cadavers during medical school orientation. Faculty members try to prepare the students for the initial encounter by explaining how the body donor program works, how the bodies are prepared and how to treat their cadaver with the utmost respect. To protect donors’ privacy, their heads are shaved, and the students never learn their donor’s name.
“During orientation, everyone is kind of standing back emotionally, psychologically and physically because most people haven’t worked with a body at all, let alone a dead body,” said Mr. Jabaut. “There’s a little bit of apprehension and a little bit of a fear of the unknown but certainly a curiosity too.”
The students take gross anatomy during their first semester of medical school. Twelve students are assigned to one cadaver and work in two groups of six during the dissection. The two groups attend lab on different days and then teach the other group what they learned. While the students spend about three hours a week in the lab with faculty supervision, the lab is open 24 hours a day and students are encouraged to spend extra time studying.
The dissection is done in three stages. First, the upper and lower extremities. Second, the chest and abdomen. And finally, the head, neck and pelvis.
“The gross anatomy lab is the only venue in which students can fully explore and understand the relationships among the bones, joints, muscles, blood vessels, nerves and organs of the body,” said Frank Slaby, professor of anatomy and regenerative biology.
During lab, students wear scrubs, gloves and closed-toe shoes. The dissections begin by removing the skin and going through layers of muscle to reach the nerves, arteries, veins and bones. For most of the dissection, students use a probe and a scalpel, but they have to use a bone saw to cut open the chest cavity and remove the rib cage. Faculty members lead the lab, taking the students through the week’s dissection step by step. And the cadaver’s face remains covered until students begin dissecting the face.
“There’s a mental and emotional aspect of working on someone’s face. It’s a pretty extensive dissection. We remove the brain and look at the different facial nerves and the eyes,” said Elizabeth Yetter, a 31-year-old second-year medical student. “It’s one thing when you’re dissecting the back of someone’s leg. It’s easier to look at the donor as a tool then, but it’s a different ball park when you’re working on someone’s face. It’s the moment that it becomes more personal.”
For most students, making the first cut is a powerful moment.
“Even though they’re deceased, they’re gone and you cognitively know that, you still have that sense and feel like you might be causing them harm,” said Mr. Jabaut.
But with time, the students get used to the formaldehyde smell and become more comfortable dissecting their cadaver. While the students use textbooks and online programs to supplement their learning, nothing replaces the hands-on opportunity of dissecting a cadaver.
“You’re learning about the human body in a way you cannot learn from computers, textbooks or even actual skeletons,” said Mr. Jabaut. “You learn it in a three-dimensional way where you’re learning the anatomical relationship of all the organs. And what it feels like to take a scalpel and cut through flesh and separate tissues. There’s no comparison.”
Remembrance and Gratitude
For the past 13 years, GW has been inviting the families of its body donors to a special memorial service.
“The School of Medicine and Health Sciences holds the body donor memorial service to honor the men and women who donated their bodies to science in order to benefit the health and well-being of future generations,” said SMHS Dean Jeffrey S. Akman. “The service provides the students with the opportunity to personally thank the families for the incredible gift.”
The memorial service also gives the donors’ families an opportunity to see firsthand how their loved one’s body has made a significant contribution to the education of a future health care provider.
“The families really want to participate in the ceremony,” said Robert Hawley, professor and chair of the Department of Anatomy and Regenerative Biology. “It provides closure for them.”
For the students, the ceremony also provides a sort of closure. Second-year medical student Jamie Adler said the ceremony helped her to see the body donors as people, many of whom lived long and full lives.
“I wanted to make sure I acknowledged the gift that these people made,” said Ms. Adler. “It was a way for me to connect the cadaver with the person’s life, to see them as people. The ceremony is a really wonderful thing that our school does, and planning the service is one of the best things I’ve done in my life.”
Last April, more than 250 people gathered in the Marvin Center’s Grand Ballroom on a Sunday afternoon to celebrate the lives of the body donors. A few family members spoke about their loved ones. Dr. Slaby read the first name and last initial of each of the body donors, and then family members released live butterflies outside in honor of their loved ones.
“In choosing to donate their bodies, they have chosen to strengthen the future of health care by supporting our medical education,” Ms. Yetter said in an address to the family members. “Words cannot express how grateful I am to my donor for her contribution. She was my first patient and my first teacher, and today we are celebrating her life and the lives of all of your loved ones.”
Ms. Yetter, who helped plan the memorial ceremony, said her education would not have been complete without her experience with a cadaver.
“I’ve decided to be a body donor. I hope to not turn over my assets anytime soon,” Ms. Yetter said. “But when the time comes I can’t think of a better thing to do.”