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A fascinating exploration of the medical student's most decisive course -- gross anatomy -- and of the intellectual, emotional and spiritual transformation that turns young men and women into doctors Medical Gross and Developmental Anatomy is a course every medical student dreads. As one future physician told the author, Steve Giegerich, passing the notoriously difficult course is "paying your dues for medicine. It's the bridge you have to cross if you want to become a doctor." More students leave medical school during this course than any other. Now Body of Knowledge puts readers in the classroom as potential doctors come face-to-face with their first human cadaver and dissects the factors that determine whether they succeed or fail. In January 1999, 181 students at the University of Medicine and Dentistry, Newark, began a course in gross anatomy. Among them were Sherry Ikalowych, a former nurse and mother of four; Jennifer Hannum, an ultracompetitive jock; Udele Tagoe, a determined Duke graduate of Ghanian descent; and Ivan Gonzalez, a Nicaraguan refugee and unlikely medical student. For these four lab partners, Tom Lewis, the cadaver lying on the stainless steel table, remains anonymous during dissection; but for the reader, Lewis springs to life. As the students grapple with love, hate, power and awe, Giegerich explores Lewis's life and his generous decision to donate his body to science. Ultimately, as the students gain reverence for medicine, they too develop gratitude for Lewis's thoughtful gift.
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Steve Giegerich is a journalist and teacher. A Pulitzer Prize finalist in 1998, he resides in Locust, New Jersey.Excerpt. © Reprinted by permission. All rights reserved.:
At mid-morning on Tuesday, April 1, 1997, a late-model station wagon, ordinary but for the smoked glass obscuring its rear windows, turned from South Orange Avenue into the main entrance of the New Jersey Medical School parking lot. From the driveway, the car made a hard left, descending immediately down a ramp leading to a submerged loading dock.
Because the height of the dock accommodated trucks, not cars, the driver parked off to the side. Unlatching the tailgate, he slid his delivery from the vehicle. Workers in another venue might have been unsettled by what emerged from the cargo hold, but in this environment no one paid the slightest attention. Here, dead bodies were a matter of course. Every day, someone was either coming -- into the embalming room operated under the supervision of the NJMS anatomy department -- or going -- the dock also served as the dispatch point for undertakers retrieving the deceased from the medical school's sister institution, Newark's University Hospital.
Once the collapsible gurney was removed from the station wagon, the driver clicked the stretcher into position and wheeled it up a foot ramp and through a set of automatic metal doors warning away all but authorized personnel. Inside the building, he approached a second authorized personnel only sign, where he pressed the buzzer outside a brown, windowless metal door.
Twenty seconds later, the door swung open. "Got one for you," said the driver, handing a folder to a stocky man in his early sixties with the erect posture of a military veteran. The driver, an employee of Funeral Service of New Jersey, a company dedicated to the transportation of human remains, ignored a surge of air redolent with chemicals. Pulling the gurney behind him, he entered a room cast in drab institutional yellow, its purpose distinguished by two stainless-steel cribs with drainage basins, each flanked by a pair of fifty-five-gallon chemical drums. In the corner, next to a third table, stood a fixed eighteen-inch single-blade jigsaw.
Roger Faison accepted the folder and tossed it onto a countertop. Excusing himself, Faison returned to the room a moment later with a medical school stretcher onto which he and the driver transferred the body. Plucking a receipt from the folder, Faison signed it and slipped it to the driver, who was on his way out the door within five minutes of arrival.
Faison thumbed absently through the folder and considered his schedule. It was a slow week; the students were gone, as were most of the faculty. Along with the medical researchers and support staff, Faison usually remained behind during spring break. He didn't mind staying put. In fact, he rather liked having the place more or less to himself, if for no other reason than it decreased the number of emergencies, real and imagined, requiring his immediate attention.
Through the years, Faison had used the respite to catch up on paperwork and other assorted tasks that tended to be pushed aside while, in the laboratory one floor above, the first-year students were enmeshed in the medical school initiation known as Gross and Developmental Anatomy. From January through April -- desiring to acclimate the students to the rigors of medical education early, NJMS, unlike the majority of medical schools, scheduled the mandatory gross anatomy curriculum during the second semester -- chaos was the order of the day, every day. The pandemonium would resume the following Monday; until then, Faison set the pace. He put off the embalming until Wednesday.
Faison wheeled the gurney into a walk-in refrigerator. One hundred eighty-five corpses, most wrapped in clear plastic bags, lay inside. All but ten rested on open-shelved compartments arranged in a grid twenty-five rows across and seven rows deep. The most recent arrivals were on gurneys, a temporary arrangement until space on the grid became available.
Embalming bodies for a medical school was not what Roger Faison had in mind when, in 1957, he applied his GI bill toward a degree in mortuary science. He had emerged from the navy a firm believer in the American dream, believing "all that crap that I read about economics in magazines about how if you work hard, the world is yours." In Faison's case, this meant becoming the owner and operator of the best funeral home in the Brooklyn neighborhood where he grew up, Bedford-Stuyvesant.
Fresh out of mortuary school, he landed an apprenticeship and began to expand himself academically. Understanding that mortuary wasn't the only science he'd need in order to make a name for himself in the funeral industry, Faison enrolled at Fordham University. Four years later, he departed with a degree in economics.
A submariner at the height of the cold war, Faison's navy stint only heightened his sense of adventure. In the navy, there had been exhilaration in spending weeks tracking Soviet submarines below ocean surfaces. In business, the thrill came in the pursuit of financial success.
Traditionally, in small towns across America and especially in the South, the black community revolved around the churches and the mortuary. The local undertaker was a professional, a man of dignity and grace, a man who, before civil rights laws prevailed to change the scope of race relations, served as the nominal link between his community and the prevailing white power structure. Brooklyn, which, in the early 1960s, still prided itself on being the biggest small town in America, was no different. With a gentle demeanor that masked a droll sense of humor, Faison settled into the niche. His business took off. Bed-Stuy brought him its dead; he, in turn, provided compassion and understanding, services he brought with him also to Manhattan's Upper West Side after borrowing the money to open a second parlor there.
Back in Brooklyn, a borough with a population larger than all but a handful of the country's biggest cities, Faison conceived a plan he hoped would appeal to the huge untapped market residing in Bed-Stuy's tenements and housing projects. Knowing a funeral could be arranged for far below the going rate, $1,000, Faison launched a marketing campaign, papering the projects with leaflets guaranteeing a complete funeral, sans burial expenses, for $500. Citing a law prohibiting such a blatant form of advertising, state regulators told him to knock it off. The competition took an even dimmer view, twice phoning bomb threats to Faison's mortuary within an hour of a scheduled funeral. Faison took the hint and reverted to the standard fee assessed by the city's other mortuaries.
Economics, the very subject he'd gone out of his way to master, proved to be his downfall. When, in the early 1980s, conglomerates began buying up New York mortuaries en masse, Faison refused to sell and gamely tried to compete. With the advantage of volume economics, the bigger companies eventually undercut the competition; in other words, the same economic theory that two decades before had brought Faison bomb threats was now turned against him. In 1986 he gave up, sold the funeral homes, paid off the banks and moved to New Jersey and a job immune to the trials imposed by the free-market system.
Embalming at NJMS brought with it a different set of predicaments. In the private sector, embalming emphasized presentation -- the undertaker's objective, on behalf of the deceased, was to create a lifelike appearance engineered to last for the intervening period between death and burial. At the medical school, aesthetics went out the door; preservation became paramount. Faison no longer cared what the bodies looked like; his only concern was to ward off decomposition. The bodies in a Gross and Developmental Anatomy laboratory had to last fourteen weeks lest Faison incur the wrath of faculty and students alike.
Each year, at their own request, the donated bodies of nearly a hundred men and women were transported to the basement of the ten-story NJMS medical science building, located in the heart of Newark's Central Ward. Of that number, slightly more than half ended up in the anatomy lab: forty-five to be dissected by medical students, another twenty-five dissected by students attending the adjoining institution, the New Jersey School of Dentistry, ten to fifteen more to train surgical residents and a handful beyond that deployed to assist qualified surgeons in the development of new surgical procedures and techniques.
Bodies that didn't go to the laboratory normally wound up in the university's medical research wings. While some donors requested their remains be channeled to researchers with a specific area of expertise, most placed no restrictions. The decision about placement was usually Faison's. His was a simple formula: Bodies dispatched to the gross anatomy laboratory had to merit an "AA rating." Meaning a lean body, not prone to decay.
Preventing decomposition became all the more difficult when, two years after Faison came to NJMS, the federal Occupational Safety and Health Administration (OSHA) showed up for a routine inspection of the first-floor gross anatomy laboratory, four windowless rooms with dropped ceilings. Citing poor air quality and substandard ventilation, the agency declared the formaldehyde used to preserve the dead to be hazardous to the living and ordered the school to shut down the lab. The action, halfway through the semester, triggered a spate of appeals from the school administration to a bureaucratic entity that dictated that the lab doors remain locked until Faison came up with an alternative to formaldehyde as an embalming solution.
The government regulators, however, failed to take into account the perseverance of the students. Undeterred, they began showing up at the lab in the wee hours of the morning. Employing the hammers and chisels issued them for the purposes of dissection, they unhinged the doors and went about their task nocturnally. The school looked the other way. When the faculty, support personnel and OSHA monitors arrived the next morning, the doors were again hinged and locked.
As the students pursued their course of study by night, Faison spent his days grilling chemists, funeral home directors and medical school embalmers across the country for answers. Faison's mission -- to find a low-toxicity chemical with long-term preservation qualities -- tested the creativity of the best minds in chemistry and the mortuary sciences. Finally, two weeks after they first locked the doors, Faison proposed to OSHA that formaldehyde be substituted with a concentration of phenol, alcohol and glycerin. The compound smelled as bad as formaldehyde, and there were no guarantees that it would preserve a human body over fourteen weeks, but with the administration and anatomy faculty breathing down his neck, Faison had no other choice. To the relief of all, the agency accepted.
Because the cadavers in the lab were already embalmed with formaldehyde, a compromise was reached to allow the resumption of the semester: Permitting the lab to reopen, OSHA stipulated that its representatives be present for the weeks remaining in the academic term to monitor toxicity levels. For the rest of the semester, the students and faculty worked with overhead measurement booms, similar to those used by television news crews. The students resented the intrusion, and though the booms over the tables were an irritating distraction, they felt they gained a measure of retribution in the obvious discomfort that the OSHA team had with the lab's primary activity.
Despising the substitute compound, Faison never again embalmed with formaldehyde. That OSHA subsequently forced other medical schools to switch to phenol did nothing to allay his consternation. Especially when a counterpart at an Ivy League institution gloated, "You guys just don't have enough clout." Faison knew it to be true: Among the prestigious medical schools lining the Northeast Corridor from Boston to Washington, NJMS was pretty much relegated to the status of poor cousin.
Ten years after the OSHA crackdown, Faison still struggled to find an adequate level of phenol-glycerin to keep the cadavers viable. Using weight as a criterion, most of the time he guessed correctly. The X factor was metabolism. There was no way to know which bodies would most effectively metabolize the compound and which would begin to decompose the moment they were removed from the refrigeration unit.
Before OSHA, Faison took pride in his embalming. In the years after, the caliber of his work became a source of embarrassment: "When we used formaldehyde these bodies were standing tall and right. Now, halfway through the semester, I'm ashamed. Just ashamed."
Governmental interference notwithstanding, the medical school provided Faison with a secure environment. Unencumbered by obligations to lending institutions, Faison no longer had to worry about the competition. With money no longer a factor, an unexpected dividend emerged: the students. Fascinated by their swagger, confidence and how, despite some unbelievable setbacks, they always bounced back, Faison loved interacting with them. Their youthful optimism was contagious, and best of all, every year a new batch arrived -- filled with just as much brio as the class before.
The downside of academia resided in office politics. Faison, with a front-row seat for the internecine squabbles both inside and outside the anatomy department, had never seen anything like it. The anatomists blamed the cell and tissue biology faculty for inadequately preparing the students for anatomy; the senior surgical fellows pointed the finger at the anatomists for not fulfilling their obligations to the students. On and on it went. Within the anatomy department every decision, be it by administrator or faculty, triggered endless second-guessing. "Sometimes it amazes me that anyone ever learns anything here," said one anatomy instructor, who added, "Against all odds, though, it happens."
Faison may have witnessed firsthand the endemic political infighting, but he also had a place to escape: a refuge seven floors below the academic battlefield on the G level, home of the NJMS Department of Anatomy.
The first thing Roger Faison did upon arriving at his sanctum early on the morning of April 2, 1997, was to remove from the refrigerator the body that had arrived the previous day. Maintained at a constant temperature of 34 degrees, the refrigerator preserved the integrity of capillaries that would otherwise collapse should the thermal reading inside the unit drop below freezing.
With the assistance of Dr. David Abkin, a former Russian surgeon who in addition to operating the anatomy lab supply room also served as Faison's assistant, the mortician shifted the body from the gurney onto one of the stainless-steel basins. While the refrigerator was kept warm enough to prevent the deterioration of veins and arteries, its algidity nonetheless dictated a ten-hour thawing before the onset of embalming.
At four o'clock that afternoon, Faison slipped a Miles Davis CD into his boom box and returned to the body. Peeling back the sheet covering the head, the mortician made a three-inch incision in the right side of the neck. From the top of the chemical barrel, he retrieved ...
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