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The Body in the Dissection Lab: Thing or Taboo?

2006; Elsevier BV; Volume: 119; Issue: 9 Linguagem: Inglês

10.1016/j.amjmed.2006.02.046

1555-7162

Helle Mathiasen,

Empathy and Medical Education

Most American medical schools require their students to dissect a cadaver as part of first-year training. Such study of human anatomy goes back a long time; it offers hands-on experience and the chance to see the outside and inside of a real human body in all its intricacy. However, medical professionalism today requires cultural sensitivity and responsiveness to each patient’s culture.1ACGME Outcome Project. http://www.acgme.org/outcome/comp/compFull.asp. Accessed March 27, 2006.Google Scholar Indeed, Ravdin et al2Ravdin J.I. Peterson P.K. Wing E. Ibrahim T. Sande M.A. Globalization: a new dimension for academic internal medicine.Am J Med. 2006; 119: 803-809Abstract Full Text Full Text PDF Scopus (6) Google Scholar in this issue of The American Journal of Medicine suggest that US medical schools should encourage students and residents to study and work among populations that differ substantially from the US in order to increase cultural sensitivity. Such cultural competence applies to numerous areas of medical practice, including how to handle dead bodies. European-American cultures may view the body in dissection lab as a mere thing; however, from the perspective of some ancient Native American cultures, contact with dead human bodies means contact with evil. Lori Alviso Alvord, MD, writes about growing up Navajo in Crownpoint, New Mexico, during the early 1960s, when fear of the dead was inculcated in her by tribal elders: “They told me not to sleep with my head pointing north—that dead people lay that way”3Alvord L.A. Pelt E.C.V. The Scalpel and the Silver Bear: The First Navajo Woman Surgeon Combines Western Medicine and Traditional Healing. Bantam, New York, NY2000Google Scholar (p. 17). The daughter of an Anglo mother and Navajo father, Dr. Alvord exhibits acute cultural sensitivity early in life. Medical school at Stanford brings her face to face with Navajo taboos about the dead. In first-year anatomy lab, Alvord describes her trouble with dissection, “On the table was a long black bag with a zipper running down the middle. In the air around us, assaulting our sinuses, was the sharp chemical smell of formaldehyde. Inside the bag was a dead person—a cadaver”. Her “ultimate challenge” in medical school: conquering ingrained Navajo ideas about the dead: “… Navajos do not touch the dead. Ever.” Dead bodies contain evil spirits, left behind when the good spirits leave at death. She continues: “Sometimes Navajo people nowadays bring their dying relatives to the hospital simply to prevent them from dying in their home.” Hospitals are full of evil spirits because people die there. You can go mad, become infertile, or die if you touch the dead: “Even speaking the word “death” holds bad karma for a Navajo.” But this medical student thinks she has no choice: if she wants to become a doctor, she has to dissect. Looking at the corpse, she reflects: “… What will happen to me if I do this?” Alvord reasons that mastering this skill enables her to help others: “Okay, I thought. This is what I want, the knowledge I will acquire here is like that of a medicine man. I will bring home a tremendous gift”3Alvord L.A. Pelt E.C.V. The Scalpel and the Silver Bear: The First Navajo Woman Surgeon Combines Western Medicine and Traditional Healing. Bantam, New York, NY2000Google Scholar (pp. 40-43). And she performs the dissection. She now realizes that textbooks and virtual dissection might have spared her the trauma of breaking a Navajo taboo. But she did what was required. Teaching her tribe’s beliefs as a faculty member at Dartmouth, she tells the story of one of her listeners asking after class: “Dr. Alvord, I liked so much what you said about Navajo beliefs, but I am wondering—do these concepts have relevance for other cultures, for non-Indian peoples?”2Ravdin J.I. Peterson P.K. Wing E. Ibrahim T. Sande M.A. Globalization: a new dimension for academic internal medicine.Am J Med. 2006; 119: 803-809Abstract Full Text Full Text PDF Scopus (6) Google Scholar (p. 195). They absolutely do, asserts the author. Joy Harjo, a Muscogee poet and musician, offers a Native American patient’s perspective on Western medicine and its materialist view of the body. Indeed, she illustrates the paradox inherent in our medical schools’ teaching healing by way of cutting up corpses. In her autobiographical essay, “Warrior Road”, Harjo details her suffering at age 17 giving birth to her son in an Indian hospital in Tahlequah, Oklahoma. She describes her physician: “The doctor was a military man who had signed on this watch not for the love of healing or awe at the miracle of birth, but to fulfill a contract for medical school payments. I was another statistic to him; he touched me as if he were moving equipment from one place to another.” He “deadens” her with a needle in the spine, she gives birth, and immediately her baby is removed. His training on dead bodies has taught this physician the body is a thing; he ignores his patient’s feelings: “In that place I felt ashamed I was an Indian woman. But I was also proud of what my body had accomplished despite the rape by the bureaucracy’s machinery, and I got us out of there as soon as possible.” Years later, her granddaughter’s birth occurs under favorable circumstances because of Harjo’s good medical insurance. Harjo writes: “Despite this, I once again battled with a system in which physicians are taught the art of healing by dissecting cadavers” [my italics]. The way she sees it, handling the dead in anatomy lab furnishes inadequate preparation for healing the living in hospital. Harjo’s repugnance comes across clearly: “My daughter’s induced labor was unnatural and difficult, monitored by machines, not by touch.” Four days after her granddaughter’s birth, Harjo takes her to the saguaro forest before dawn and names her in an ancient tribal ritual: “Her name looks like clouds of mist settling around a sacred mountain as it begins to speak. A female ancestor approaches on a horse. We are all together.”4Harjo J. Warrior Road.in: Harjo J. Birds G. Reinventing the Enemy’s Language: Contemporary Native Women’s Writings of North America. W.W. Norton, New York, NY1997: 55-64Google Scholar What this patient perceives as the dehumanizing effect of Western medicine can be healed by a return to animated nature. Ancient Greek, Chinese, Islamic, and Indian cultures distrust human dissection. Christian tradition believes in the sanctity of the human body, and Jewish law limits autopsy. Considering that “The body is pregnant with symbolic meaning, deep, intensely charged and often highly contradictory,”5Porter R. Blood and Guts A Short History of Medicine. W.W. Norton, New York, NY2002: 53-54Google Scholar medical education and practice should include applied study of the moral, social, and symbolic meanings of the dead and living human body.