Session Three: Vision--Confronting the Margin

Thomas Cole, Ph.D.
Historian, Institute for Medical Humanities, University of Texas Medical Branch, Galveston

What I'd like to do is talk to you under the rubric, more of less, of "Can one learn compassion in the anatomy lab?" IÕve been a teacher of the medical humanities for about eighteen years now. And when we teach first-year medical students, I'm always very uncomfortable with the lack of humanistic education that goes along with gross anatomy. For years, I said, "Well, we need to have a memorial service. We need to talk to them about how they're feeling; we need to help them imagine these people." And my colleagues just looked at me like I was nuts, especially the anatomists. But I basically decided that the most effective way to try to explore this was through the medium of film. And I have long been convinced that there's a deep relationship between the donor and the dissector. The basic idea of my film is to explore this relationship between the donors and the dissectors, with a notion that there's a lot that we can learn as mortals, as students, as teachers, and as donors. And I'm pleased to have the opportunity to show you about fifteen minutes of this work in progress that should be finished sometime next year.

I also wanted to pick up on some things we were talking about yesterday, about the relationship between the living and the dead, because in my graduate course we've been reading some Adam Smith recently, in particular, his Theory of Moral Sentiments. Smith is a much-overlooked figure, I think, in enlightenment thought. For us, he can help us bring together the connections between imagination and art and moral philosophy. He's basically a moral philosopher who said, "Look, you really have to pay attention to feelings and imagination and empathy." Let me read to you from the section in chapter one where he talks about sympathy and the qualities of sympathy, and, in particular, sympathy with the dead. I think there will be a lot of resonance between this passage and the discussion yesterday.

To sympathize even with the dead in overlooking what is of real importance in their situation, that awful futurity which awaits them, we are chiefly affected by those circumstances which strike our senses, but can have no influence on their happiness. It is miserable, we think, to be deprived of the light of the sun, to be shut out from life and conversation, to be laid in the cold grave, a prey to corruption and the reptiles of the earth, to be no more thought of in this world but to be obliterated in a little time from the affections and almost from the memory of their dearest friends and relations. Surely, we imagine we can never feel too much from those who have suffered so dreadful a calamity. The tribute of our fellow feeling seems doubly due to them now when they are in danger of being forgot by everybody. And by the vain honors which we pay to their memory, we endeavor for our own misery artificially to keep alive our melancholy remembrance of their misfortune. That our sympathy can afford them no consolation seems to be an addition to their calamity, and to think that all we can do is unavailing, and that what alleviates all other distress that we grant the love and the lamentation of their friends can yield no comfort to them. It serves only to exacerbate our sense of misery. The happiness of the dead, however, most assuredly is affected by none of these circumstances, nor is it the thought of those things which can ever disturb the profound security of their repose.

The idea of that dreary and endless melancholy, which the fancy naturally ascribes to their condition, arises altogether from our joining to the change which has been produced upon them, our own consciousness of that change--from our putting ourselves in their situation and from our lodging, if I may be allowed to say so, our own living souls in their animated bodies, and thence conceiving what would be our motions in this case. It is this very illusion of the imagination, the foresight of our own disillusion, that is so terrible to us, and that the idea of those circumstances which undoubtedly can give us no pain when we are dead makes us miserable when we are alive. From thence arises one of the most important principles in human nature, the dread of death, the great poison to the happiness, but the great restraint upon the injustice of mankind, which while it afflicts and mortifies the individual, guards and protects the society.

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This is an interesting rumination on some of the issues that we talked about yesterday, particularly the realization that there's a cold face of the person who is dead, whose future we can't really affect in any way; and we have a relationship with them which is imaginative and no less real for that. It makes us frightened, and it makes us better people for that--it gives us restraint; it gives us a sense of caution.

So what I'd like to do now is read you a kind of prologue and then show you a clip of the film, and then we can talk about it during the discussion period. This prologue is what I read to students in the anatomy lab to set the mood for the discussion I want to have with them. It's very hard to talk about these issues. And, of course, these are students who have to get through the next practicum; they have to learn every artery and every nerve that their anatomy instructors insist on. And they will probably be resistant to questions like, "What's your relationship to this person? Who were they? How do you feel about this? Did you imagine your own death? What do you think this person was going through at the end of his or her life?"

The premise of this film is that the dead have a great deal to teach us. But we must open our hearts wider to receive their wisdom. People who donate their bodies to science have much to teach us beyond yielding up the intricate structures of their bodies. They can teach us about life, about what it means to be human, but only if we are willing to ask questions which are emotionally and spiritually as intimate as the physical delving, cutting, looking, pulling, sawing, and slicing that takes place in the anatomy lab. Learning in the anatomy lab is usually limited to knowledge obtained by careful dissection, observation and memorization. Perhaps learning compassion can also begin in the anatomy lab, where a cadaver is the first human body encountered in medical education. Is the cadaver a human being? What is the proper attitude to take towards someone who has died? Respect, said Freud, for a person who has accomplished a difficult task. How do we show respect to a dead person's body? Can a cadaver be respected? Can it be harmed? Can one show compassion for a cadaver? No, compassion is a disposition towards people or creatures who suffer. Cadavers don't suffer. Do their spirits, their souls, their ghosts? My head says no. My heart says yes, of course. How can one learn compassion in the anatomy lab? First, by daring to feel the awful truth, that each one of us will some day be equally dead. Second, by realizing that this cadaver was once as full of life, joy, and pain as we are today. Third, by realizing that while medicine has developed powerful tools of prevention, diagnosis and cure, there is no cure for mortality, that inescapable condition of being human. And, fourth, by appreciating the gift received from the person who willed their body to science so that we can learn. Compassion, then, may flow from wrestling with these existential questions, learning to connect anatomical knowledge with personal powerlessness. Is this too much to expect of students beginning their medical education? Yes, but it is not too much to expect them to begin this journey to give themselves knowledge.

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[Professor Cole then went on to show clips from the film in progress. The following comments are made by medical students in the film.]

This is the first time I felt that this was actually a different person and that someday I would die. I've never been around the dead, all my family is all alive. This is the first time I've actually experienced death.

I saw the cancer that had taken over her stomach and her colon. And I thought, "What was she going through the very last couple of hours? Was she sitting, was she lying down, was she feeling any pain?" That's what I started thinking about, about how she was when she was alive.

The more I think that this was a living person, it kind of scares me. So I kind of try to shut it out as much as possible. The less I think that this was a living person, I think the more comfortable I become, and the more I can just come in and focus on what I can do.

Our cadaver died of colon cancer. And I saw a bit of what she possibly could have been going through because my grandmother died of pancreatic cancer about four months ago. And the only thing that allowed me to come grips with it is that in the Christian religion, the body is deemed as a vessel, and we're only borrowing it. We had to slice through the spine. I had to do it because I had told myself that this was just a vessel. We do this, you know, so we can continue to learn. Now, there were thoughts that, "Man, what if you were doing this to a living human? You would be causing extreme pain."

I felt that [the cadaver was] saying, "Okay, you can do it." It helps me to come to terms and be able to be okay with it and say, "They wanted me to do this."

Well, I'd say the body was beautiful, but I usually associate beauty with romance, and there's absolutely nothing romantic about it at all, either in its purpose or in its color, anything. But it was beautiful in the sense that there was just an absolutely amazing order to everything. And that kind of order is like a gothic cathedral. It's as if somebody tells you, "Look, you go into the first room on the right and youÕre going to find this nice little wooden treasure box."

When you see, for example, The History of Surgery, you see these idealized drawings of cutting up cadavers. But when you actually get in here, there's no art to it. The most amazing image I have of having the experience is of one of the members of our group standing over the body--it's already fairly well protected--with a saw. It was the most dehumanizing aspect of it. This really was a person. And the image really drove it home to me, how much this was really just a body now, just parts.

I would say thank you to the person for giving us her body to study. But I would also feel horrible knowing what goes on to the bodies once they're in here. It would be hard to face her knowing what we did.

What else can you do? Do to the best of your knowledge; work in what you have to do; learn something from your body.

I wish there was a better way of knowing it besides the total dismantling of a body. When you throw away a large body part into the buckets, or the trash can, essentially, that's very disturbing.

It's sadÉ to me it is. To me it's sad every time we dump ashes. So many people. I just wondered if you heard them talking, what would they be saying or what would they be thinking?

This remark came from an instructor:

The students took the cover off the cadaver. The first thing they noticed is how young he was. And one of the students said, "I wonder what he was like?" I told him, "He was a nice guy, and you better learn a lot of anatomy from him."

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