You are the beneficiaries of an unparalleled opportunity to learn gross anatomy through cadaveric dissection. This unique learning experience has been provided to you solely through the generosity of the people of the Commonwealth of Kentucky who have donated their body after death to the University of Kentucky Body Bequeathal Program. As a student in the health-related professional fields you should be acutely aware of the critical role the Body Bequeathal Program, and its participants, play in the preclinical education of every medical, dental, physical therapy and physician's assistant student. In addition to the 300 students that annually acquire their anatomical knowledge through dissection, clinical research and education of residents and interns from over 8 specialty fields at the University of Kentucky are also benefactors of this selfless act our donors have undertaken to ensure the education of future generations of health care professionals.

Anatomy, because of its relevance to all health-related fields, is one of the first courses you as a health professional undergraduate student undertakes. For many of you it is also the first exposure you have with death, some of you may relate it to a recent passing of a family member or friend. Because of this, we find that many students form a unique bond with the individual they have the priviledge of studying. You will spend from 13 to 16 weeks studying the specific details of human anatomy relevant to your field, through not only your own cadaver, but every one of the cadavers in the lab. The great majority of students personalize their cadaver to some degree - a practice we encourage as depersonalizing your cadaver leads to the practice of depersonalizing your patients later.

As you begin your semester in the gross anatomy laboratory, you may feel that humanity at its best - and at its worst - with regard to your cadaver, are curiously missing or left behind, as you begin your scientific journey. And rightly so. It would be too painful to know the detailed history of the hands that once held others, the eyes that watched the world and the heart that knew love as well as sorrow. The personal history of your cadaver is one you will not know, left only to your imagination to construct. The person's age, county of residence in Kentucky as well as the stated cause of death on their death certificate will be posted on your table. However, you should resolve to let these individuals, your first teachers and patients, be your last unknown patient's history, however uncomfortable and challenging that may be to you. They have given you the gift of emotional distance to prepare you for the challenge of accompanying your future patients in their times of life, as well as times of illness, and death.

In many ways, your cadaver is your first teacher and patient, one from which you will acquire a wealth of information that forms the basis for a lifetime of clinical work and dedication to helping others. An expression with deep meaning applies here - "those who live in the hearts of others never die". You will recollect the structures, the complexity of systems, and the intricate details of the human body that comprise the knowledge you gain from dissection long after you leave the dissection lab for the last time. This information remains with you throughout your career, used every day, perpetuating the usefullness and lives of those who have donated their bodies for medical education and research.

I doubt many of the donors in our laboratory today realized the great gift and opportunity they provided all fields of health care when they made the decision to donate their body after death to the University of Kentucky Body Bequeathal Program. We ask that later this semester, at the Departmental memorial service, as well as next fall at the graveside service, that you join us in celebrating their lives and recognize that one of their greatest contributions to the world in which they lived was their final one - donating their body to medical education and research. This selfless act has undoubtedly helped make the world a better place for them having lived here.

Ellen Rothman (Harvard Medicine) contributes a column "On Becoming a Doctor" in every other issue of Focus. The one on Dealing with Death is an especially relevant one. It is excerpted here:

We don't know who they are. We will never know why they chose to be here. To them we are Medicine. To us, they are The Human Body.

I was a lucky one. Anatomy lab presented me with my first real experience with death. On the first day of medical school, I faced a room full of dead people who had chosen to donate their bodies to medicine. I met my cadaver, and became acquainted with her body. Over the course of the block, I developed a more detailed understanding of her anatomy. I traced her splenic artery to the celiac trunk, her median nerve through the brachial plexus, and the entire length of her gastrointestinal tract.

Yet my introduction to death feels backwards. I was thrust into the physicality of death without experiencing the human struggle of the dying process. I knew my woman's body more intinmately than any other living person, but I knew nothing of her spirit or stamina.

The preparation for the lab had stripped away even the most basic clues to her personhood. The fixative obliterated her years and made her ageless; the dissection process chipped away at her body to make her formless. Her face was sealed away in its muslin shroud.

At the memorial service for our cadavers, one of my classmates voiced her struggle to make the transition from the physical body to the uniqueness of the individual. "Every time we would look at a new structure," she said, "I would think, this is the one that's going to be different. This is the one that's going to make him special. Yet every time it was the same. All our bodies look the same."

Almost all of us dreamt about our cadavers at some point during the anatomy course. Dean Ed Hundert forewarned us: it's common. I was prepared for nightly visions of scalpels dissecting, and gloved hands retracting. But my recurring dream was about holding my cadaver's hand. In the dream, all five of us were standing in our customary positions around the gurney, obviously at work on the body. I was holding her hand as one might to reassure a friend or relative undergoing a painful and frightening medical procedure. In my dream I was forging the human connection and bond that cannot exist in the lab.

Despite the frustation with the lack of personal connection with our cadavers and our attempts to create it, I don't think I would want to know any more than I did. It would be too painful to dissect structure after structure with the burden of personhood, and the relationships and responsibilities it entails.

But if my first experience with death was the physical, it wasn't long before I confronted the emotional, human aspect. I received my initiation into the struggle of the dying process fairly soon after my anatomy experience. Betty was 74, dying, and alone. Alienated from her family and isolated from her friends, she was finally ready to die of congestive heart failure after outliving a one-year prognosis by 11 years. She was struggling to assert her personhood even as she began the process of reliquishing her humanity. She was frustrated by doctors who no longer made time for her; she attributed their brusqueness to her rapidly deteriorating medical condition.

"I understand that it is difficult for them to get close to someone who is dying. But when they don't say anything to me, it means either they have nothing supportive to say as physicians, or they don't care as people." she said.

And there have been others. There was Denise, 16 years old and in the terminal phases of AIDS. She had watched her mother and her younger brother die of AIDS the previous year. Now she mostly watches television all day. We asked what her favorite show was. "I don't know". We asked her favourite actor. "I don't know". Her favorite thing to do. "I don't know." She had already begun the process of relinquishing her personhood. And there is the couple with AIDS. They have begun discussing auctioning all their antiques in preparation for their deaths. They have stopped setting longterm goals for themselves, although not for their cat. Inky has been put on a diet.

I think about them almost daily. I think about Betty the most. Her physicians didn't expect her to live past December. As I was planning my trip home for winter break, I thought about Betty and wondered if she were still alive. Was she able to reconcile with her family? Was she able to forge a more meaningful relationship with her friends?

I find myself drawn to these dying people. I am taken with their struggle to be human and to be a better human in the face of death.

At times, during this last year, it has felt like death is everywhere. In anatomy lab, we finally uncovered the facial shroud and hemisected the skull, and that was OK. I talked to a patient who had nearly died the previous evening and would certainly die within the next months, and that was OK. I came home, and my goldfish had died, and that wasn't OK. I sobbed for half an hour.

Through my anatomy experiences and my conversations with terminally ill patients, I am grappling with the human and physical aspects of death. And it's overwhelming.

Amy Marie Millikan of Rochester, NY published the following poem on dissection and the anatomy learning experience in the The New England Journal of Medicine in April of 2000:

The internet has numerous sites dedicated to student impressions of cadaveric dissection, their learning experience, and how they as individuals dealt with this first encounter with death. I have listed a number of them that have become widely used by many gross anatomy courses nation-wide. Should you do a personal internet search and find others you feel have helped you, I would appreciate your forwarding the URL to me for inclusion in this site for future students.

• On Coping With the Gross Anatomy Experience
• The Legacy of Table 37
• Two Lives
• Honoring Those Who Have Donated Their Bodies
• Comments Linked to Print Articles on Dissection

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