Bedside Manner

The Prerequisite

2009-06-10T23:54:00.000-07:00

These students are trained to handle the lives of others. How many of them will be trained to handle the deaths?

For many students who have participated in this study, the path leading them here has been created well before high school. Though their level of comfort with cadavers is altered by the factors of personal lab experience, their initial reactions and perceptions have a range partially determined by the level of experience with cadavers or dissections prior to starting Gross Anatomy.
There were many students that have had their family play an important role in their direction toward the medical field. Whether it was wanting to treat the elderly because of their own experience with grandparents or having medical professionals in the family already, many students were already preparing for their journey through med school.

I noticed similarities with the students who participated in this study that I cannot necessarily generalize to the majority of other incoming medical students. It was evident during interviews that while many answered the question “What was your previous experience with death?” with a shrug of the shoulder and recounted the passing of an elderly loved one, it was later in the interview that their previous experience with death had been a great deal more than a funeral.
Some students share common themes. Three of them have had their fathers involved with the Church or Funeral Homes and have been to funerals on more occasions than personally losing loved one. While these three students have had experience with cadavers as bystanders, their exposure to topics of death and dying varied and affected them differently for future circumstances.

Preparation

One student in particular, Stephanie, had the most interaction with cadavers and the earliest and prolonged confrontation with death and dying out of the three aforementioned as well as any other student interviewed. Though other students may have had experience leading up to immersion or have dissected through high school, Stephanie was the only one in which cadavers were a part of her childhood. Her family owned two funeral homes, one of which they lived above for some time and her father went to the same mortuary school as Don Kincaid. Not only did living above a family owned funeral home offer some invaluable experience, she also occasionally helped and had seen the embalming procedures. Knowing and experiencing the life of a cadaver before beginning work as a student offered Stephanie a unique perspective prior to registration and enabled her to find a level of comfort that some other students couldn't.

For Sara, she described her experience with death as being minimal, then later recounted an incident in which a man died in front of her after having a heart attack while swimming. Sara also spent time working in Hospice prior to enrolling at Ohio University and was one of the students interviewed that emphasized the importance of valuing the humanity during dissection. Though she didn't discuss issues of death and dying with her family during adolescent socialization, Sara's previous experience with difficult issues gave her an enlightened sense of respect for the cadavers.

While not every student has had experiences such as Stephanie or Sara, many of those who emphasized the importance of retaining humanity during dissection have had some previous experience addressing the topic of death prior to becoming immersed in Gross Anatomy.

Retention

Some students and instructors crossed a line from viewing the cadaver as an human being to a human body within the first few moments. This line was their first cut. For some, the disconnection occurs shortly after the scalpel touches skin.

Students such as Sara, Stephanie and Amanda have all demonstrated the efforts they have made to retain the cadaver's humanity during their first and most trying times within the lab. The further the students go on with dissection, the easier it is to lose sight of the cadaver as their first patient which should be treated with respect and acknowledged as having been a human being. Instructors and students have discussed the differences between Ohio University and other campuses they have either visited or attended.

At OU, there is a card at the end of each table. This card contains cause of death, age, occupation and first name. For many students, this card helps to bring them back to who is lying on their table and provides a tether to humanity.

Addressing an individual by their name carries significance and displays a level of respect. This holds true to the cadavers at OU. The instructors and students have both discussed the prevalence of referring to their cadaver by their names (as displayed on their respective cards). Some students have stated that calling a cadaver by a nickname shows a lack of respect and using a pronoun is far more appropriate than using names that would be offensive if the person were still alive.

First Impressions

The introduction is essential to a students development. Sara remembers the orientation conducted by Don Kincaid as one of her turning points within the lab. Before unveiling the cadaver he asked a simple yet startling question- Are you ready? It was then that Sara became unsure of herself and felt she should have had more time to get to know her cadaver. Sara and other students have voiced the importance of the introduction and feel it is important for Kincaid or their first instructors to give students a few moments to become acquainted.

Many of the suggestions students had concerning their development involved getting to other students during immersion- their first time within the lab. Even with their experience, Sara and Stephanie still felt it would have helped them and others feel better about dissection were they given a forum to openly discuss the issues of death and dying.

A great deal of emphasis was made during the Memorial Service that these donors are the students first patients. It seems appropriate that students be made aware of this relationship during their introduction in order for them to mentally prepare for flood of emotions they may experience.

For some students, their relationship with their cadavers has already carried into their perspectives toward the patients they work with. For all of these students, the first impressions and experiences will prove to be a crucial factor in developing an appropriate frame of mind when handling their own patients.

Bedside Manner

The ability to achieve a balance between a social mind (emotions, humanity, empathy) and a scientific mind (instruments, biology, technicality) develops during the students first experiences within the lab. Appropriate bedside manner means acquiring a perspective of detached concern – to have a balance between the scientific and social minds. Students who view the cadaver from one perspective or the other already displays an inability to fully develop an appropriate perspective. For those who narrow their scope to the social may have a hard time dealing with the deaths of their patients or confidently addressing the families. For those who stay in the scientific, their bedside manner lacks emotion and they may begin to view their patients as conditions instead of individuals, making it difficult to relate to anyone other than fellow physicians. Either could prove detrimental to the relationship they have with their patients and may increase the pressure that physicians place on themselves in addition to societal conceptions of infallibility. Students going through Gross Anatomy are being taught more than the form and function of the human body; they are being trained by their peers, instructors and first patients to develop an appropriate and beneficial level of Bedside Manner.

Through the looking glass

2009-06-10T20:56:00.000-07:00

Med school is an entirely different world. It is filled with it's own realities, perceptions and truths. The norms and mores seem to flex as time progresses.

Even though each student begins immersion with varying levels of knowledge and experience, it has been through my observations and questions that I have noticed their further development due to the shared growth and experiences within the setting of the lab amongst other students. Even though a student has an idea of what goes on, everything can be completely altered through further socialization. In fact, some students may have been so impacted by their previous experiences that their cadaver interactions have little to no effect on how they relate outside of lab.

Jessica is a student whose father was a Preacher and she had attended several funerals. Her interaction with the cadavers was minimal and she wanted it to remain that way. Jessica initially altered her career path because she wanted to avoid gross anatomy. She realized she could not escape the lab if she really wanted to pursue her career goal of becoming a doctor. After the first ten minutes of immersion, Jessica found herself at the head of the table doing the majority of dissections. In theory, Jessica felt she could not handle dissection on a cadaver- In practice, dissection was something that fell into it's place. Jessica found herself gaining the ability to separate what happens in the lab and her other interactions. Watching violent, gory movies disturbs her and she doesn't watch shows like CSI. Having the media sensationalize death and dying affected Jessica before immersion as well as after. The key difference was that the activities performed in the gross anatomy lab are for learning, not entertainment. Associating the cadavers as a learning instrument helped Jessica incorporate the scientific perspective into her social mind.

The Instructors

I believe the instructors play an important role during this learning experience. They have the ability to set the tone for their lab work and guide them through their anatomical journey. The actions of the instructor carry out as being the measure for appropriate behavior because of the instructor's thorough experience and knowledge on the subject matter. It is crucial for students to acknowledge the differences between themselves and their instructors. For the students, this course involves anatomy, clinical comparisons, and assists in their development toward an appropriate balance of their social and scientific mind through the acceptance and understanding of death and dying. For the instructors, this course is anatomy. They have the ability to incorporate lessons of humanity into their dissections by teaching respect and creating an atmosphere where the students have the ability to view the cadaver as more than a body on a table- once again, emphasizing the individual as well as the instrument.

It was interesting to see the instructors as they were during lab and how much they influenced the direction. The first observation I did was for the smaller PCC group. In a different room off of the PCC lab was a group of Physical Therapy students doing a dissection on a single cadaver. There were four of them with one graduate student guiding them through their dissection of various parts. The differences between the PCC group and Physical Therapy students were evident. The Therapy students had a computer with music playing and one student was wearing his i-pod. The graduate student instructor wasn't wearing a lab coat and none of the students were in scrubs. The authority represented by the blue coat that instructors typically wear was absent and many associations were, too. The mood felt incredibly relaxed with these students and the music, i-pod and lack of uniformity seemed to blur a sense of direction. The professionalism created by the blue coats during PCC and CPC labs represents a level of dignity and respect. This striking comparison between the Physical Therapy students and the PCC (of CPC) students indicates the instructors ability and responsibility to create an appropriate level of professionalism and respect.
As the instructors slowly paced up and down the rows of cadavers, stopping for assistance or inquiry, the students displayed a multitude of roles that would shift depending on occasion (or body part).

Division of Labor

The first thing I noticed was the division of labor among students in their respective groups. It was evident that these roles had not been assigned but had been picked up throughout the year. Some instructors have indicated that what the students do in the beginning of the year is typically what they find themselves doing for the rest of anatomy.

Their roles can speak volumes about their past, present and future. For some, it could allude to what their career path may be. Catalina suggested the difference between students going into family practice and those who want to be surgeons. Catalina, desiring a path toward surgery, described her role as a dissector. This is an instance in which a role will change depending on the situation. For Catalina, she found herself standing back when there was a dissection for the face or limbs. Seeing herself as a surgeon, she found no immediate urgency to dissect an area on which she would not be working on later in her career. Other students described this scenario, and not all are aspiring to be surgeons. Sara also explained that it is easier to dissect when it is a situation that would happen to a live patient.
It just so happened that I observed two instances in which the activities done in the lab are unique to gross anatomy.

My first observation (for PCC) was head bisection, cutting the cadaver's head in half, and another observation was male and female genitalia (for CPC). Both situations were unique and some students proclaimed as being surreal. For the PCC students, their lab is in a smaller room with only six tables. The room was filled with nervous energy as the students proceeded to saw the much dissected head in half. One by one, as the students reached the section in the dissector that directed them to grab the handsaw, other students and instructors would take note of that particular group. Feelings were exchanged across groups and room felt cohesive as a single unit as opposed to numerous separated groups. As for the CPC lab, each group mostly kept to themselves and the tension was displayed prominently by the males of the group during dissections of the male genitalia.

These instances also gave me the ability to see more of a student than just their immediate actions. Their coping mechanisms varied though a common theme was the ability to do what they do as long as it is in an academic setting. In other words, it's just another class. While there are some students who will find themselves becoming dissectors for the majority of their time in the lab, other students will float freely from table to table and not offer much dissecting experience other than observation. From the instructors or other students perspective these floating students can be seen as having various angles of motivation for their activities. Whether the student is apathetic, restless, 'lazy', unprepared, nervous, or anxious, the reasons behind the floaters can be applied to students from other majors, degrees or classes. Not only were there dissectors, but some students could be categorized as 'gunners'. Amanda explained a gunner as someone who is typically dissecting and strives to always be the best.

In addition to dissectors and floaters, some students initiated their time in lab as readers. They read from the dissecting guide and illustrate the task for the dissector. This could hint at a range of emotions or personality traits, though one comparison struck me as most common. Throughout all the observations and some responses within the interviews, women readers are more common than men. Though this isn't the case all the time, from the instances I've noticed, women are guiding the dissections. After sitting next to the tool cart during the head bisection, I noticed the prevalence of men who would approach the cart for an instrument. Even though many women did partake in dissections, I noticed a reluctance among some that they would step back (and some look away) during an action involving force (breaking, sawing, ripping). In this instance it was using the handsaw the cut the head in half. All but one group had a male using the saw, the other group consisted solely of females.

While some women are reluctant to use the tools to break or saw, it was the men that had a difficult time during the dissection of the male genitalia in the CPC lab.

Gallows Humor

This is where I most often saw humor used as a means of disconnecting or coping. Dr. Witmer and other instructors refer to this as Gallows Humor. It is also important to differentiate appropriate Gallows Humor from disrespectful jokes. Throughout many of the observations, males displayed a higher frequency of telling jokes or sarcasm than the women. Both men and women used their sense of humor, though the men were typically louder or more frequent with their jokes. During the dissection of the penis, many males were very vocal and at times animated about their anxiety or level of comfort with the task at hand. This was an instance where women were more frequent dissectors than men...

During these times within the gross anatomy lab, students are experiencing a wide range of emotions and reactions. It is necessary for students to go through gross anatomy acknowledging these new feelings and learning an appropriate way to address and handle them. Early medical socialization is key in order to discover and identify what situations or roles are best for that individual. It is also important for the students and instructors to have a communicative relationship with one another where questions concerning anatomy as well as other concerns or questions can be discussed in a safe environment. In most cases, there is no way of identifying the line until it has been crossed. The families of the donors want a level of respect from these students though the ability to feel secure and sane from the tasks they must accomplish within the lab rests on the mechanisms they use to either cope or disconnect.

I feel honored to have had the ability to peer into the world in which these students reside. The circumstances I observed were partially altered by my presence, though I was still able to witness the form and function of the anatomy lab and the socialization that occurred during my time there.

Profundus

2009-06-04T22:32:00.000-07:00

Yesterday I put myself in the position of those I have been studying.
I have been introduced to cadavers before this project started and through observations I have seen what students do in these labs. While I've seen the embalming procedure and watched numerous dissections, it wasn't until yesterday that I could empathize with the array of emotions that are felt during the first cut.

For some, it is the senses that accompany this first instance of scalpel to skin that make the experience so memorable. For others, the feelings are fleeting and the cadaver becomes a specimen mere moments after the layers are revealed. During those first moments, when the cadaver is still a new and profound experience, is when students are facing feelings they are unsure of and perhaps contradictory to one another. The responses from those who can recall the senses of that moment vary but have one common and relentless reminder even outside of the lab- the scent.

It is one of the first things that struck me during my initial introduction to the lab before this project started, and it has followed me ever since. Just as the smell of citrus and sage will always bring me back to visiting family in Mexico, the smell emanating from behind the protected doors and body bags can follow me in my clothes or will be similar to another smell and it will always bring me right back.

The smell hangs in the air and permeates into the nearby rooms and hallways, making it a nuisance for some and inescapable for others. Almost every student I interviewed made some mention of the scent and some described how if effected them outside of lab. For Amanda, drinking Diet Coke was never quite the same. This was a common response among students and instructors. After lab, the smell seeps into clothes and skin. Bringing food or (in Amanda's case) drink to the mouth can be difficult when the smell that reminds them of cadavers and dissections is the first thing to hit them before the food or drink touches their lips. Some go to various lengths to avoid taking the smell with them outside of anatomy. Stephanie recalls some classmates wearing multiple layers (2-3) of gloves in order to reduce the permeation. Another student, Debra, insists that she still cannot wear the fragrance "Sweet Pea" from Bath and Body Works because of Ohio State University's embalming fluid which smelled vaguely like honeysuckle. The students, and anyone who has spent time in the lab, have the ability to instantly recognize the scent and associate it with dissection, cadavers, and death. These reactions could be caused by the simple annoyance of a foul smelling odor or by a deeper emotional connection to the smell and their attempts at compartmentalizing. What happens in Gross, stays in Gross.

Having been in the lab multiple times prior to my first dissection, the smell wasn't the first thing I noticed about this particular event. Aside from my eyes watering now and then from the chemicals, I recognized the sense of clarity and focus that came over me as I continued on my set task. With Witmer's guidance, I was able to proceed despite my concerns of making the wrong cut or ruining something. It was then that I was able to comprehend the difference between an individual who obtains a difference in perception and one who triggers an immediate disconnection.

Some students and instructors were able to view the cadaver as a specimen after the first few moments or even after the very first cut. Though upon closer inspection during observations and other various responses concerning their perceptions, it may be that it is easier to sever the tie between the cadaver and humanity than it is to retain the connection while shifting your perception.

Certain individuals have a difficult time seeing the human body and human being as one in the same when they are being dissected and need to completely separate the two in order to continue. Personally I found it easier to achieve that balance because of what this research has called upon me to do. Amanda also found it easier to retain this connection because of her personal research as a sociology student as well prior to becoming an OUCOM student. Stephanie was able to better adjust because of a college course she took on death, dying and suicide. Of the individuals I've interviewed, those with the least experience with death and dying on a psychological or philosophical level were most likely to immediately desensitize themselves and view the body through half of their scope- as a biological tool with the sole purpose of anatomical discovery.

There is the other half of the scope that is crucial for retaining humanity and showing another level of respect. This perspective can be reinforced by reintroducing the element of humanity. Witmer has explained the emphasis he puts on the cadavers as human beings during the students first exposure to anatomy during immersion, just as Montross has explained in her book (Body of Work). These human beings had families, were loved, and are missed. In order to fully grasp this concept, it seems crucial for the students to attend the memorial service at the end of the year. I attended the memorial service today and found it to be incredibly touching and an enlightening experience. Although attending the service is a suggestion to the students, for those who no longer see the bodies they're working on as human beings, I would deem it a requirement. Stephanie and Addie both discussed the importance of attending the service. Stephanie pointed out that the service tied everything together and for Addie it brought her back in touch with reality.

In the beginning, students go through a great deal and are faced with emotions that are difficult to comprehend. I know that even though I felt prepared for my experience, nothing could have prepared me for what it was really like to feel the inside of a human limb and gain invaluable knowledge from the entire experience. It is an enormous struggle to acknowledge the wave of emotions felt during that first cut. The students have a choice and through their inner battles and guiding environment they have the ability to stay the course toward a balanced state of mind and fully formed medical double-consciousness in order to fully provide and attend to their future patients.

Anatomy hinges the medical field and without donors we wouldn't be where we are or go where we are going. During the first few moments, even before attaching the blade and well before the first cut, students should have the ability to fully recognize and appreciate the tremendous gift that lay before them. Though the service is held at the end of the year, it is important for students to honor the selfless act of body donation throughout the course of their academic and professional career.

~Thank you~

Corpse to Cadaver

2009-06-03T00:34:00.000-07:00

A highlighted sign leads the way into the embalming room. Many are aware of what tasks are performed past this door yet very few students have been witness to or even fully understand the procedure.
For the Director of the Willed Body Program, Don Kincaid, death is not only a part of life, but in his job description.

Kincaid holds a different position than that of the students or many others. Not only does he interact with the individuals prior to donation, he initiates their transformation from corpse to cadaver.One of the first experiences I had within the anatomy lab was observing the beginning of an embalming procedure. It was a privilege to have that opportunity and to be able to interview Kincaid on the process. Careers such as Kincaid's demonstrate the ability to adapt to almost any environment. Having a position, or a role, assists in adaptation and provides the framework for acceptable emotions and appropriate reactions.

As an embalmer, Kincaid has gotten used to many of the physical and mental sensations that accompany the various tasks at hand. There is a certain level of comfort achieved when the task becomes a responsibility. For Kincaid, this responsibility involves carrying out someone's wish to donate their body. This perspective is also shared by students who feel it is an honor to dissect their cadaver because they are fulfilling the individual's postmortem purpose.

There is something comforting about having that level of allowance. Students who retain the connection between the individual and the cadaver have an easier time doing so if they feel they are given permission to do so.

Students interviewed have demonstrated the responsibility they feel not only to their task as a student in a class, but to their cadaver. Amanda, a med student, sees her task as a responsibility to the cadaver. Because the individuals donated their bodies for a purpose, it is important to honor the dissection in order to honor the individual. Another student, Sara, a first year medical student, discusses the importance of doing the assignments and preparing for lab. It's less about letting down the group members or the class, but being unprepared or disinterested it letting down the individual's wishes as a donor.

Giving a heightened sense of responsibility and purpose to the tasks within the lab assists in adaptation and offers a level of comfort for students and faculty who may be struggling with the concept of mortality. To acknowledge dissection as a privilege may be guiding students toward an appropriate balance between anatomy and humanity that could benefit their mental capacity later in their medical career.

Behind door #1?

2009-06-02T09:53:00.000-07:00

I have posted some pictures of the gross anatomy lab already, but yesterday I captured more detail from the lab that creates the atmosphere in which the students spend much of their time.

There is the PCC lab downstairs (with the red doors) and six tables, then there is the main gross anatomy lab upstairs which is what I have to show you.

Welcome to the Gross Anatomy Lab.

Off of this room holds another smaller room containing a few other cadavers, a cleaning room, anatomical preparation room and a cooler to keep prepared cadavers prior to dissections.

The suspended televisions project the QOD (Question of the day) as well as other useful information for students to reference.

Various objects that add to the feel of the gross anatomy lab are the various anatomical figures (skeletons, plastinations, models...), the cross sections, band saw, etc...

Behind door # 2?

The Bone Box collection. This is where boxes of various skeleton collections are kept for students to take home and study. Something about the all black boxes with silver latches that give them an eerie sophistication...

Cross-sections such as these are in the lab a few times.

...along with a few more skeletons.
It wouldn't be a lab without them.

It's also hard to ignore the two ominous
metal doors with giant locks on them...

Door # 3 needs a bit more privacy.
The cadavers awaiting dissection are not sheathed in white cloth and therefore are kept away from the prying eyes of the internet.

Thank you for taking my brief tour. There is more to be revealed soon. Take a few moments to stretch your legs and we will be approaching the next stop shortly...

Room 139 A-
Anatomical Preparation
with special guest-
Director of the Willed Body Program
Don Kincaid.

Deathsthetically Pleasing

2009-05-28T13:24:00.001-07:00

There are a variety of ways in which death and anatomy play in integral role in art and design.

Anatomy represents a relationship between art and science. Dissection is intriguing to those who wish to expand this field for the benefit of medicine while also being the inspiration and basis for various forms of artistic expression. This relationship between anatomy and art has its origins in the beginning of anatomical discoveries.

Leonardo da Vinci pioneered early illustrations with his renowned piece, The Vetruvian Man (1487). Da Vinci held an interest in proportions and desired accuracy of the human form in his work. This attitude carried through many of the artist’s work of the Renaissance and still holds true in modern times. Anatomical art relies on the individual’s ability to merge the scientist and artist in them to create a work of accuracy as well as beauty.
It is important to note scientific facts as a social construction belonging to the respective eras. While the field of anatomy was continuing to grow despite the restrictions of church and state, the knowledge held true at the time can be seen through such artistic renderings of the human form as portrayed by Andreas Vesalius.

(Pieces from Vesalius’ 1543 work De Humani Corporis Fabrica)

The work of Vesalius and other early anatomists through the use of cadaver dissections set the stage for medical and thereby accurate artistic developments.

Our curiosity sparks movements. What else could be the most intriguing aspect of our lives if not our very own bodies? In a quest to understand humanity, we explore our bodies and their function. Something seemingly rational has been continuously shrouded in mystery and surrounded by death. Students now have the ability to dissect human bodies and move closer to understanding these mysteries as they confront difficult issues of death and dying.
One of the questions I have been asking students is what they can recall about their first experience with a cadaver. What stood out to them the most and how has that changed?

In an interview with Amanda, a medical student at Ohio University, the complexity and mystery of the human body was something that compelled her fascination with anatomy. One of the first things she could recall was the anatomical beauty of the cadaver. While not all students interviewed expressed their love of anatomy, others such as Catalina, a second year med student, made it immediately apparent that she fell in love with anatomy from the beginning. To some, anatomy becomes an interest, not a requirement. The students who had a deeper appreciation and fascination for anatomy also sought to retain the connection between the cadaver and the individual. This may not be the case for all students going through their anatomy courses, but it is still important to note the relationship between artistic and scientific value even through the gross anatomy lab experience.

The anatomy lab experience has been portrayed through a number of artistic renderings, including those belonging to Vesalius. "The Anatomy Lesson of Dr.Tulp" by Dutch baroque artist Rembrandt, painted this famous portrait in 1632. Though the painting is of a real cadaver and public dissection, some clues hint at inaccuracy… As Dr. Claman of the University of Colorado points out - “The man being dissected is rather healthy-looking for a dead guy, isn’t he? That’s because he was a convict, recently executed in the prime of his life. But the scene, is it real? Would you really begin a four-day-long human dissection back in the days when there was no preserving of the body by opening up the arm? I don’t think so. You would have started with the intestines and gotten them out of the room.”

Also in the painting, some suggest the large book open in the bottom right hand corner is Vesalius’s De Humani text…

Another early representation of an anatomy lesson is by Pieter van Miereveld in "The Anatomy Lesson of Dr. Willem van der Meer" painted in 1617.

Other depictions of work in the early gross anatomy labs can be seen in the recent book Dissection: Photographs of a Rite of Passage in American Medicine 1880–1930, by John Harley Warner and James M. Edmonson.

“Without looking,” writes Warner and Edmonson, “we cannot see an uncomfortable past and begin to understand the legacies that American doctors and patients live with today.”
That uncomfortable past saw the gradual passing of state laws, from 1831 to 1947, to govern the awkward business of cadaver supply—ever inadequate—bringing an end to reliance on professional “resurrectionists,” grave robbing, and dissection as an extended punishment for murder and as a consequence of poverty. -

This review of Dissection and much more can be found on my new favorite resource:

http://morbidanatomy.blogspot.com/

Illustrations are crucial for scientific understanding.
Scientific understanding is crucial for illustrations.

The need for accurate imagery is heightened with the progression of anatomical understanding. This understanding has been achieved by students in the classrooms and laboratories for decades thanks to the anatomical pioneers that struggled to pave the way.
Our ability to understand the complexities of the human body and represent our knowledge through the accuracy of artistic mediums has been granted by the privilege of human dissection and those with the capacity to endure the struggle with humanity after taking a scalpel to skin for the first time...

Student Research Expo '09

2009-05-20T09:24:00.000-07:00

Ta-Da!
Isn't she a beaut?

Here is the finished product.
Setting up this poster really helped to establish some solid ground for my research and repeating it over and over at the fair really helped me out, too.

Now I'm (fairly) certain I know what I'm doing.

(Please take note of the Acknowledgments on the bottom right hand corner!)

If you click on the poster you can see an enlarged version.

I was part of the Sociology/Anthropology group that they hid from the rest of the presenters.
I guess they didn't want us taking notes...

Witmer was very nice and took a few pictures of me and my set-up. We wheeled a steel gurney from the anatomy lab across the parking lot and had a (new) sheet to lay on the table. I also had a dissecting kit, a fake heart, my lab coat with gloves, and all of the books I'm reading. It was great to have the lab coat because it made my area smell like lab... Perfect atmosphere.

Here are a few pictures from that.

The research expo was an incredible experience in which I could look at other students research and begin to feel more comfortable with my own. It also taught me that I have a long way to go but I look forward to the journey ahead.

And I got an awesome free t-shirt.

Beyond the red.

2009-05-06T16:02:00.000-07:00

It's been about a decade since I've last posted.
This project is picking up fast with the IRB approval. I am setting up interviews, doing observations and preparing for the research expo this next Thursday.
I haven't even put my poster together.
On top of all that, I'm in the midst of putting a graduate application together.
It's been a busy week.

I did, however, manage to do the hawk dissection I had previously mentioned.

I didn't want to post any more pictures. Too graphic.
The mask wasn't there until all the feathers started flying into my lungs...

This enabled me to get a feel for dissection in it's various forms.

It was also the first thing I've ever dissected.

I will be moving up. Way up. I plan to enter the anatomy program come fall and until then, as part of my research I will be observing others make their (first) cuts.I also made a few trips to the anatomy lab to take pictures for my poster and blog. As it turns out, the downstairs lab is where I'm doing my observations. It was good to get a feel for the room before hand. It looks very different with other (live) people in it besides myself and Witmer.

The room has an entirely different feel depending on whether or not the lights are on. In Body of Work, Montross couldn't stay in the lab after dark when she was alone. What external influences have changed our attitude for situations such as these? How much has the media on cadavers and morgues really changed our perspective? How much do we think it has and how has it really?

I told you. I fell in love with those red doors. Something about that splash of red in this room that seems so appealing. I had a fun time exploring the models on the table...
It's images such as these that create this world of anatomy and human dissection and paints it into a morbid world of mystery and fascination. Next time I will write more on our media influenced perceptions as well as some of my observations within the anatomy class.

If I don't write much in the next few days I'm probably working on 1) my poster 2) interviews and observations 3) my graduate application. Wish me luck on all three.

Postmortem Possibilities

2009-04-29T15:03:00.000-07:00

I gathered a lot from reading and analyzing Body of Work. One important transition to note is the ability our society has to will their bodies to the final destination of their choosing. There are many options for our bodies after death but our decisions can be swayed by family or religion and most always – tradition.

Pg. 198 Body of Work

...a community transformation must occur for anatomical exploration to be embraced and encouraged. The prospect of a dissected body created – and continues to create – a great deal of confusion around ideas of mourning and resurrection. Though in America an increase in the prevalence of cremation testifies to the decreasing emphasis on the body in funerary proceedings, this shift is definitely not universal.

As Montross points out, we are confused about how to mourn the loss of a loved one if the body is not traditionally buried or 'put to rest'. When deciding where our bodies should go, there are multiple factors to take into account. The thoughts and feelings of our families and loved ones should be acknowledged before making a complete decision. Our deaths impact the living in various ways and our bodies destinations should be carefully considered.

In order to fully understand our options we must first eradicate our preconceived notions. The cadavers used are viewed by many as being unnamed, unidentified, unclaimed and, at a time were thought to be unloved. This is far from the truth. “They were people, are people, were loved, are loved, were bodies, are bodies, have died. And what else?” That what else is the legacy and act of selflessness these individuals have left in their wake. Using bodies for science and education has undergone the transformation from punishment to privilege.

Soon I will learn more about the Willed Bodies Program and the body donation process. We are no longer dealing with the black market for bodies or mass grave-robberies. This is an area of great respect and education which allows individuals to make the decisions for themselves and to become an instructor after death. Montross makes this comparison as well. The cadavers in the lab are the teachers and are loved, appreciated and respected.

Pg. 289

“...I cannot begin to know what led Eve to give me such a gift, whether it was practicality or altruism or cynicism or love of science or some other, equally unknowable, aspect of her personality...her selfless gesture of donation will be my lasting example of how much it is possible to give to a total stranger in the hopes of healing...”

The life of Montross and others are effected by the decisions of many to donate their bodies. The life, death and bodies of these individuals are remembered and respected by all those they have touched. It is important to acknowledge our right to choose our bodies destinations. It is also important to note the necessity of cadavers and the lessons students learn as well as the new perspectives they may gain on life and death. The important theme connecting Body of Work as well as the next book, First Cut, is the importance of body donation and the interactions between student and cadaver.

It is also important to note the differences between those who see the body as a biological instrument and those who view the body as a human being. What are the consequences of narrowing your perspective to the scientific without acknowledging the capacity of the social? I guess that is what I'm still trying to figure out...

Finish Line...?

2009-04-22T13:51:00.001-07:00

It's a trick question.

I have one more chapter left and as I look at all the multicolored appendages my book has grown since I started reading, my shoulders slump and I realize I've only started. This book is just too good. There are so many important themes to expound that I don't know where to start.

I'll be tackling the incorporation of these themes as I progress with the observations and interview I'm allowed to do now (Woo Hoo IRB!).

One theme I've noticed from this book is the appreciation of the human body. Montross does an excellent job illustrating the beauty and elegance of the human form and mentions the various displays using anatomy as art.

A faculty member steps in during lecture and addresses the professor with the use of sign language. Montross and her colleagues have been in the lab all week dissecting and studying the musculature of the hand and as signs are flying by, "the room remains silent, and we all watch [his] hands: flexion, extension, adduction, abduction, anastomoses, blood vessels, sap vessels, inosculate, intercommunicate."

I understand this from various angles. The more you learn about the human body the more you are able to see during various other activities. Learning about the intricacy of the hands enables me to appreciate the form and movement more than I thought I could. This example is one I identify with because it was almost exactly how I felt last night in my Sign Language class. (I say almost because while reading the section of Body of Work on hands, I try to follow along using my own Clinical Anatomy book and see how much information I can attempt to comprehend...) As I watch my professor use her body to communicate and get ideas across to us that were previously unknown, I am in struck by the capabilities and the grace of the human body- especially in the hands. I can grasp what Montross feels to a certain extent because I am always amazed at how our bodies function and to have the ability to get a closer look and to examine and learn the process furthers this appreciation of body and beauty.

First- go ahead and pick up some ASL (American Sign Language) for yourself using this:
http://commtechlab.msu.edu/Sites/aslweb/brows er.htm

See what awesome word you can guess this is...

(you can totally see my palmaris longus...)

_______________________________________________________________

Montross and I aren't the only ones to view Anatomy as Art:

http://www.nlm.nih.gov/exhibition/dreamanatomy/da_g_II-A-1.html

http://fantasyartdesign.com/free-wallpapers/digital-art.php?i_i=343&u_i=93&s=3&np=69&srt=3&count=1

http://www.jyamazaki3d.com/jyamazaki3d_2dart.html

I probably should have put this post under Deathsthetically Pleasing, but I have other things planned for that.

I better get to work on those tabs...

Bedtime Stories

2009-04-20T11:26:00.000-07:00

I fell asleep while burying myself in the Clinical Anatomy book.
I dreamt about cubital fossa and the radial nerve...
Still, I understand just as much as before I started reading.

Part of this project involves empathy. It doesn't hurt that I am incredibly fascinated by anatomy. I said fascinated not educated... though I hope by the end of this quarter I gain a better understanding of anatomical procedures through the use of cadavers.

I am trying to empathize with the medical students I am reading so much about.I'm working with a much smaller and much more separated experience.

Next week I will dissect a hawk.

Unlike many of you, I have never dissected anything in high school biology class. My high school couldn't afford that luxury. I'm looking forward to it. I've already spent a few hours vacuum sealing various frozen carcasses in the lab and that was a very interesting experience...

(Note: Research in the Witmer Lab does not involve experimentation on live animals. Specimens of modern animals used in research are salvage specimens, obtained legally from commercial or governmental sources.)

I started to feel different after that. My experiences within the lab (handling various frozen animals) made me view animals outside of the lab in a different light. I went to the Cleveland Botanical Garden that weekend and whenever I saw a bird I pictured it frozen and in a sealed bag. I mentioned this to someone working in the lab and he said I'd caught it. Like 'it' is some sort of infectious disease...

I see this as an infection of knowledge. The more we know the more likely we are to apply it to external circumstances. Seeing a dead bird on the sidewalk can trigger many emotions but what specific thoughts or even actions might arise out of that situation based off of your experiences?
How would a biologist see it? An ornithologist? How many would think it would be a good specimen to bring back to the lab? (I did.)

This disease spreads in more ways than birds on a sidewalk.
Parents fear their children will catch this disease. Some think that the more they know about death, the more scared they will be about the world around them. We saw this in a previous post about When Dinosaurs Die. I don't see this particular instance as being a disease...this is more of an inoculation.

Another example of this 'knowledge disease' I can think of, concerns the topic of diseases themselves. A large part of this project was influenced by the work of Pamela Nagami, a physician specializing in infectious disease, who wrote The Woman with a Worm in her Head. The more I read the more I noticed that her work influenced how she acted and treated her family. She separated work and family but she still continued to add each new case and each death to her internal encyclopedia in order to better assist and possibly save a future life.

My favorite chapter is Chapter 9: Septic Shock. Last quarter I took a course call People, Plagues and Pestilence and I have to say it changed my life. I'm now a hypochondriac.
I wrote a reaction paper to this chapter and it might help to understand what I'm referring to by scientific and social minds when I use those terms.

Throughout this chapter, Nagami mentions the conversations and interactions with her family. This is what really added depth to this chapter and was presented in such a way to give the reader a first person perspective instead of just the medical approach to what is happening with such infections and complications. She was able to pull our scientific and social minds into this chapter by providing the emotional and thought provoking topics and discussions to support the analytical and medicinal approaches to sepsis and the medical profession.
Personally, this is what pulled the chapter together. The interactions between her and her husband really gave Nagami a personal structure in addition to the medical professional we've seen throughout the book. It took me out of this sense of 'omniscient being', to the reality that she is a person who learns, loves and feels. She feels an impact from the things she witnesses and is affected by the process. When she comes home, she is a mother, a wife, a woman, a person. She has a completed sense of self and it comes together when she acknowledges her role as "the protector of life". When she saved her daughter from choking and later held onto to her and felt her heartbeat, it really displayed the massive amount of care and protection Nagami offers through her personal and professional life. It is an enormous responsibility to consider yourself a “life defender”; yet through the interactions with those around her, it is easier to accept the responsibility knowing the meaning of life is life itself. The meaning of life does not just apply to Nagami as a doctor, nor does it solely apply to Nagami. We are all “fighting to stay alive” (Nagami 211) within our personal and profession lives, and through our social and scientific minds.

This follows the stream of medical double-consciousness. When Nagami viewed a patient she saw many things. She saw the person, the human being with a family, a history and a future- then she saw the disease, the infection- she saw what was killing them as a separate entity that she was fighting and trying to understand.

But seriously. I was afraid of everything by the end of this book (and class). Meningitis, Necrotizing Fascitis, Cocci, Malaria, Cysticerosis, and my personal favorite- Sepsis. The more I knew, the more vulnerable I felt. I was actually starting to feel human, instead of someone who could 'never' catch anything like that.
Many people avoid what they fear. This avoidance turns into ignorance. STI's, HIV, the common cold. People tell themselves it will never happen to them because they don't want to feel vulnerable. Some people probably think they will never die. This happens because they never acknowledge death as being a possibility. Death isn't just for the old and ill. Nagami met with death frequently and from the beginning of the book she tries to portray herself as one human being saving another. What separates Nagami from others is her experience and knowledge. Being a medical professional (or student) does not eliminate feelings like fear, concern and confusion. What she has experienced through medical school, patients and every infection, enables her to view the world from multiple perspectives, instead of narrowing her scope by avoiding her fears.

One individual noticed this as well in his comment on Goodreads.com:

03/25/08
Jason rated it:

recommends it for: people who like medical books

...she apparently is really clumsy, which is just not what you expect in a competent doctor.

Fourth and finally, her emotional responses are cold and strange. A lot of people, and I mean a LOT of people, appear to have died under her care, but it doesn't trouble her as much as failing to solve the puzzle of their illness seems to. And the way she reacts to tragedy is just subtly weird.

By the end of the book, while all of those things I mentioned still held true, I started to like her more, and to realize that she's just a normal person under a lot of pressure in a complicated job. And I think that's what made me dislike her originally: I expect doctors to be smarter, more caring, more dextrous, and more sane than I am. But she isn't. She's a real person, who readily admits in the beginning of the book that being a doctor has emotionally damaged her, and that she just can't feel things the way normal people do anymore.

Frankly, I'm glad she's not my doctor. But I did enjoy her book.(less)

It's hard for people such as 'Jason' to see their doctors as anything but infallible. He viewed her experiences as "gross" and "weird". What he didn't understand or appreciate, he brushed off as incompetence or inappropriate. By gathering from other reviews, the one mistake Nagami made in her book was revealing her social mind. She lifted the veil of omniscient being and when other readers saw the emotional, confused and vulnerable side of a medical professional, they cast her aside as unprofessional and inexperienced. Knowing a doctor is as human as you are terrifies you, doesn't it?
What separates Nagami from 'Jason'? Experience. Knowledge. Perspective.
Could someone such as this 'Jason' succesfully complete the immersion process? Could he work on the dead to help save the living?
Does everyone have the ability to acquire a death etiquette and use that knowledge to form a medical double-consciousness? Does the disease of knowledge and experience leave you feeling the symptoms of fear and avoidance? Or does it stimulate the senses into awareness, action and a desire to acquire more information?

Knowledge is experience, and the more I learn the more I realize how little I really know...

Currently Reading...

2009-04-14T22:09:00.000-07:00

Body of Work
-Meditations on Mortality from the Human Anatomy Lab

by Christine Montross

Reading:
Preface
Chapter 1- Bone Box
Chapter 2-First Cut

Chapter 1: The Bone Box

"The most alarming moments of anatomy are not the bizarre, the unknown. They are the familiar."

This book details the experiences of Christine Montross as she forms an interesting relationship with her cadaver during the first year of med school.

In Chapter 1 we begin to know a little bit about Montross as she opens herself up to her classmates and opens up her first assignment...The Bone Box.
It is a box which contains...you guessed it, a human skeleton, and she takes it home to get comfortable with what lies ahead.

Her descriptions are powerful. As she delicately describes each bone with excellent visuals (...it is lunar, with deep pits and sharp protuberances... to describe the "vault of the brain"), she also weaves in an anatomy lesson by identifying and accurately describing each piece so a lay person would be able to follow and pick up the terminology.

Montross throws in little jolts of thoughts to portray the emotional process of dealing with human remains. After describing the lower jaw, the mandible, and identifying the full set of teeth, her thoughts are represented in italics immediately following certain passages such as this- Someone kissed this mouth; someone touched this chin in love...

She continues to go through a description with emotion and accuracy of each bone. As she gets to the arm and moves it as it's joints, she stops. It is too eerie for her to continue for a moment.

Disconnection. We all experience it in order to handle a particular situation. This topic is getting close to the heart of this project.
We separate ourselves from the reality of a particular situation in order to avoid sensory overload. Some might consider this as a
blasé attitude, but in situations within medicine or anatomy, a concept isn't necessarily ignored or cast aside, but compartmentalized. Whether it is conscious or subconscious, it is this division between reason (scienctific) and emotion (social), which is what I will refer to as the medical double-consciousness, that enables people such as Montross to continue and accomplish anatomical and medical success within these fields.

Chapter 2: First Cut

Montross further supports this concept of a double-consciousness in chapter 2 as the med students begin the immersion process.

"One of the strangest things about dissecting a human body is the difference between a human body and a human being."

I really enjoyed the dynamic between the students, the instructors and the use of their text as a road map. The relationship shared between student and instructor is awe inspiring. The instructors are presented as omniscient beings with swift and fluid movements as they pull apart layers of tissue and bone. The one particularly memorable passage was when Ted Goslow offers a bit of advice before walking them through the lab.

"Some reflex pathways we can control, like our eye-blink reflex, and some we can't, like our knee-jerk reflex. This explains that our brains sometimes overpower our wills. So if, once we go down to the lab, you see someone talking but you can't hear them, sit down, because it means you're going to faint."

I loved this. It showed me the human experience felt by these all-knowing instructors. In my head I was reading Goslow as giving his advice in a deliberate parental tone. In fact, that is how I read all of the instructors. Her fellow table members are all young and have distinct personalities which seem to initially hinder their abilities to proceed with dissection. Montross and fellow lab member Raj, are the two that do the physical work with very different means of doing so. Having prior experience working with live patients, Montross treats her cadaver carefully because she is having difficulty being able to separate the body from the being. At the end of the chapter, Tamara, their table instructor, demonstrates how to cut through the ribs to reach the heart. Montross records her feelings as an inescapable feeling of wrong. As the demonstration continues, Montross feels the urge to soothe the body as it were a patient. This will only hurt a minute. This will be over soon.

________________________________________

That was only the first few chapters...
I can see this turning into a beautful relationship.

Respecting a tradition

2009-04-13T19:39:00.000-07:00

Though I may not be able to define respect, I can gather the associated feelings based off of its origin in this particular circumstance- The traditional funeral.

Death is the ultimate unknown. Since its origins, the bodies of those passed were feared. The various traditions that grew out of these fears were meant to protect the living from the dead, to protect them from the unknown. Some villages run away from the dead, others leave the bodies to be consumed by vultures or wild beasts. Many efforts were made to rid the living from the affects of death. We’ve turned the abstract concept of death into an entity. Our traditions stem from superstitions and the preservation of the living.

Keeping the dead from affecting the living by either spiritual or sanitary purposes. We preserve the bodies for the ability to view the dead one last time. For many, preserving the body preserves the memory. That is why beliefs of afterlife have an importance on how respect is formed. Various beliefs, various understandings of respect.

Respect for the dead is a social construction.

To stray away from the collective construction of respect is deemed inappropriate and, well, disrespectful. What I can gather from the burial tradition is our desire to say our final goodbyes and mourn the death of an individual by celebrating or honoring their life. Everything else surrounding this premise has been created by fear, religion, economics and sanitation. The numerous amount of cross cultural memorial or funeral traditions represents the vast array of cultural construction that emerges from outside influences and social demands, as well as personal and religious preferences.

The different means of memorial should not be cast aside due to standardization within a particular culture. Instead, we should have the ability to acknowledge our perception as one among many. We are not only showing respect to the dead, but to the lives that individual touched along the way. This topic can be difficult to untangle because we confuse respect for tradition.

By what means is something disrespectful? How should preferences be addressed? Is there a right or wrong way to have a memorial service or acknowledge the dead? Where do we learn what respect means in this context? How much does our understanding and socializing of death affect how we respect the dead?

Who decides where our bodies should go?

Is it always a funeral? If not, then what are the expectations and norms behind our other options?

What are the other options?

Just something to think about...

I'll keep elaborating on these as I learn and experience more about death myself.
It doesn't really help that the IRB process isn't all the way through. My focus is on completing this step in order to learn more from the medical community and those dealing with death as a profession.

Oh and I forgot to mention.
I've been summoned to serve on a jury.
Tomorrow morning at 8am.
I wish I was kidding.

Extension

2009-04-09T21:31:00.000-07:00

In my attempt to tackle such a hefty topic, I gave myself a very small time frame to do it. As it turns out, there is a lot of material to cover with many resources available. I'm not planning on the next post being ridiculously large, but I would like to try to make a few connections. I would like to have this done by Sunday night in order to keep Monday's post on schedule.

What I can do is leave you with a few fun websites I found in my search.

http://www.geocities.com/yamataro670/americanfunerals.htm

This was a fun one. I'm not entirely sure how accurate or up-to-date these answers are but it's fun to test one's knowledge every now and then.

http://www.nmfh.org/exhibits/fantasy/index.html

I didn't even know things like this existed...

Another thing to hold you over is a paper I wrote for an environmental sociology course taken this past fall. While this is a completely different angle on the traditional funeral, it still raises questions and acknowledges the societal reluctance to address death. I edited this paper (originally five pages) because the focus was mainly environmental. I wanted to include this to show 1) The various ways death affects life, 2) How traditional burial respects the dead and 3) How much I think about death...

...The means of disposal see a dramatic shift in accordance to belief and culture. Theology has the power to sway the masses into what method of disposal is appropriate and their attitudes toward the afterlife. An opinion on such religious matters will greatly influence how their bodies are treated after death and where they will remain. While Western thought has a tendency to avoid topics of death, dying and disposal, ideas such as these are embraced elsewhere and typically have less of a demand for land or resources. In Buddhist Tibet, the body, which is considered worthless once the soul left its vessel, is left outdoors to be scavenged by birds and predators. Numerous other cultures leave the body to return to nature, such as in Mongolia, the Haidi of the Pacific Northwest and the Masaai tribe of Africa. Dale Harrison, author for Brave New Traveler speaks of burial practices as “windows to a culture that speak volumes about how it lives.” In the United States specifically, our rapid depletion of resources and vast overconsumption is mirrored through what we consider a socially acceptable and respectful tradition of conventional burial.

...Until the late 1800’s, families cleaned their deceased and crafted a pine box which was buried in a community cemetery, with neither embalming nor a burial vault being a part of the process. What we know of traditional burial now consists of noxious chemicals, millions of board feet of hardwood and tons of copper and bronze for caskets, along with thousands of tons of steel and reinforced concrete for vaults. Originally formulated in the 19th century to prevent grave robbery, the U.S. funeral industry uses vaults to prevent seepage, sinking and marker movement. These vaults require additional energy and resource consumption, as it takes 1.6 tons of concrete to be produced.

...Wiigh-Masak created promession to turn the deceased into a form of compost rather than a sterile ash. The process and it’s in depth description is in detail on Wiigh-Masak’s site, Promessa. It begins by dipping the body into liquid nitrogen, freezing them to minus 18 degrees Celsius, then using gentle vibrations to turn the body into a dry powder .The powder is removed of any metal and can be disinfected if required, then placed in a coffin made of cornstarch where it is then place in top soil and will compost in 6-12 months. By the request of the deceased or a loved one, the compost can be used to plant anything, thereby creating an environmentally friendly memorial. Wiigh-Masak hopes promession will grow in popularity the more traditional burials are acknowledged for their environmental damage and with more people searching for alternatives for disposal.

...In 1998, Campbell founded the Ramsey Creek preserve as a conservation burial ground for the Green Burial Council. Those wishing to have a green burial can choose from a few sites that have been established since Ramsey Creek. For many of these green burial sites, the body of the deceased is covered in a shroud and laid in a biodegradable coffin where it is then buried without vaults or plastic flowers and is covered with natural rock as a tombstone. The sites for green burial are more like parks and are protected instead of manicured and treated with chemicals like traditional cemeteries. The cost of these burials is also less and the profits from places like Ramsey Creek go toward funding land conservation through Upstate Forever, a non-profit conservation group in South Carolina.

...Our reluctance into other means of body disposal has a lot to do with our avoidance of death. There are many factors which contribute to our inaction. Societal pressures which tell us how and where to be buried. Family can play into the role of tradition. It is important to note, however, that respecting our loved ones is different than respecting tradition. The majority may not be aware how tradition emerges but are willing to succumb to its ways. Religion also demands societal attention and death brings about images of cross-ridden fields and hovering angel monument, instead of the nature from which we came. We live through nature yet we are supposed to die in chemicals and halt ecological progress in the acres in which we’re laid to “rest”. Traditional burial will always be a choice amongst us and will remain a niche, yet our future in body disposal doesn’t have to look so grim with the multitude of options that surround us.

Some information presented here was provided by:
Promessa Organic
Centre for Natural Burial
Brave New Traveler: Dale Harrison
Arsenic and Old Graves: Jason Goodman

For the list of references for the entire paper (not just the clips above), I will be making a reference site shortly.

Respecting a tradition- Up by Monday.

"Isn't being alive awesome?"

2009-04-08T09:15:00.000-07:00

The title of this post is the last line in this book.
When I first read this book all the way through I was surprised to say the least. The last line stood out to me at first as sidestepping death entirely. The more I thought about it, the more I understood the message of this book.

To respect death we cherish life.

The first two pages of this book display a large illustration in which dinosaur families and various little creatures are running around a park and playing. It starts by saying "What does Alive mean?"...
Go ahead and ask yourself that question and see what you come up with.

To some, this simple question can trigger a deeper cognitive process. Amongst others, when reading the question aloud and waiting for an audience response, I waited around for awhile. It seemed as though they were intently searching for meaning, philosophical answers and were trying to answer the question 'Why are we alive' , instead of addressing the simplicity the authors intended.

For this, the authors focused on what we do while we are alive. Things such as seeing, hearing, thinking, feeling, were all indicators of being "alive and a part of the world."

This leads into the harder question. "Why does someone die?"
These pages are great in getting a reaction out of people.
The explanation used emphasizes the various ways in which a life may be taken.

Striking examples such as:
-deaths of premature infants
-soldiers at war
-suicide
-accidents
-terminal illness
and "for reasons that are hard to understand, such as poverty, prejudice, and drug abuse."

There are also explanations of natural death, stating that "most of us live long, healthy lives."

Such as they did with asking "What does alive mean?", the next question is "What does dead mean?". Animals are also used as examples throughout this book, possibly because many children first deal with death through that of a lost pet, or an animal they may find outside.

Again, this question focuses on the mechanism behind the term.

Alive- breathing, seeing, tasting, etc.
Dead- heart stops, brain doesn't send or receive messages, the entire body stops working.

As you can see from the above video example, this child acknowledges Lucky as being dead (not swimming around, not coming back) as being permanent. She also portrays her feelings about death (going to fish heaven) and what she will do to keep Lucky with her (having a picture around).

In my opinion, the next section is by far the most difficult to explain. It focuses on the feelings about death and takes up a large portion of the book.
This section triggered emotional responses from most who viewed these examples. One is of a little dino-child denying the death of her grandmother by yelling "It's not true. Grandma isn't dead!". Another is of a dino-child praying "Please, God, let Daddy be alive again. I want him back."

The book emphasizes how hard it can be to understand death when it is someone who is special to you.
The grieving process is briefly outlined through the various feelings one can have after a death. Feeling sad, lonely and scared about your own life are a few of the emotions that can be experienced. "Things you weren't afraid of before may scare you now". On the first page there is another dino-child saying "All this dying stuff makes me feel sad, worried, and afraid.". It is difficult to avoid these feelings in many people. A lot of the reviews on Amazon are from parents who apparently feel the same and do not recommend this book for children.

23 of 27 people found the following review helpful:

Preview first - way too graphic for our family, October 9, 2006

By HappyMom

I had intended to use this book to help my 7-year-old but when I previewed it, I found it to be a case of "too much too soon." It appeared the author tried to address every conceivable way a child might encounter death but, for my child, it would have introduced MANY more fears than it alleviated. Many of the illustrations were especially disturbing. Having a child wail "can we keep our house?" as the obituaries float around the picture was too much. Introducing death by substance abuse and suicide was too much. Discussing the donation of eyes to an eye bank or having the word "autopsy" in the glossary was too much. For young children facing death and the grief process for the first time, I would use extreme caution if considering this book. My child would have had nightmares for ages.

In a later comment, HappyMom states that she was not saying she did not like the book, but that death should be an on-going discussion with a child.
I completely agree but I also think this book is a start to bring about these questions to further discuss them.

These in depth discussions should start somewhere. Our society now has hushed tones about death discussion. Obviously the author's intention was not to frighten children, but to heighten awareness in both children and adults. This is possibly the case in emphasizing the enjoyment and gratitude of our lives when dealing with the topic of death.

This book illustrates various ways to honor the life of someone who has passed.
Various customs are addressed (funerals, lighting a candle, burning incense...) as well as various activities to do (plant a tree, visit the grave, photograph, etc.).
Althought one 'activity' struck me as odd.
"Make a new friend that reminds you of her".
... as long as you don't tell that new friend 'Hey, can we be friends? You remind me of someone I lost.....'
Perhaps I found it uncomfortable to acknowledge this as something people do because it strays away from keeping their memory alive, to putting this new friend into a difficult position.

Either way, this book did an excellent job in addressing even the most difficult of topics...

"What comes after death?"
The authors explanation:
Some things about death and dying are very hard to understand, even for grown-ups. No one can know for sure what comes after death, but almost everyone has an opinion about it.

Heaven, resurrection, reincarnation, donation and 'living in our hearts and memories', are some of the topics which are mentioned.

I love the direction this book maintained, because the title of this book isn't "Which religion are you", it is a book to assist children in understand death.

So far I applaud the books efforts to explain death as an integral part of life. While the initial feeling of fear is triggered after explaining to a child that death happens to all of us, this book reaches out further to emphasize the importance of life- or being alive. While HappyMom did not agree with showing this book at an early age, she did make an excellent point about the topic of death. Death should be an ongoing discussion. This is advice for us as well.

We want to avoid socializing children with death because we are afraid of the feelings they will experience. It is a parents decision to introduce death to their children, not to avoid it. We have grown into traditions already established and are uncomfortable discussing death now because it started out that way. Death discussion at any age shouldn't necessarily be easy, but it should be exercized with a level of understanding and respect. Respect, however, is an entirely different topic, and as an abstract concept, is impossible to narrowly define.

Many of us are taught to 'respect' the deceased, but what is our understand of respect in this circumstance? As it relates to death, 'respect' and memorial traditions are cultural. So what is the majority culture? What is 'disrespectful'? Does America have a standard tradition? If so, how did this come to be? These questions are difficult to answer, and some would say even more so to ask.

Stay tuned for the next post, where I'll sure as hell try to answer them...

This week in Death

2009-04-06T10:13:00.000-07:00

I received this book over the weekend.

When Dinosaurs Die: A Guide to Understanding Death
-Laurie Kransy Brown and Marc Brown

I've skimmed through it but haven't taken any notes yet. From what I've seen this book is incredible.
(If it looks familiar it's because Marc Brown does the illustrations for this as well as for the kids show/book Arthur.)

I'm looking forward to sharing this one with you. My reactions (as well as some from others) were priceless....

However! This post is just an introduction to the week. So.

Hello. This week in Death I will be covering a few topics.

- How we socialize children with death (with reference from above book)
- The American Funeral. How this became the tradition (along with some personal experiences)

First, I would like to do a summary/reaction post to When Dinosaurs Die, and of course encourage you to read this book. Tying in with the reaction post, I would also like to discuss death socialization as a young age (or at any age).
Second, I would like to examine the American Funeral. Past and Present along with my own personal experiences.

I'm going to try to fit in as many substantial posts about death as possible before moving into the core books/topics for the quarter.

Stay tuned for more on death, dying and children literature.

The Plan

2009-04-03T10:23:00.000-07:00

On March 24th I completed the arduous task of writing up, putting together and dropping off an IRB (Institutional Review Board) proposal to work with human subjects as part of this project.
The expedited review process takes 3-4 weeks. If there are items in the proposal they do not like or would like further clarification on, the process could take longer. Once the proposal has been reviewed and accepted, then I will be able to incorporate observations (Willed Bodies Program Presentations, Labs/Classrooms) and interviews (various positions among the College of Osteopathic Medicine and Willed Bodies Program) into the running theme of this project. I will also be able to present my findings (and project as a whole) as research, as opposed to a temporary student exploratory project.

Until then...

Here's the plan.
Continue with my topic and themes by using various references and incorporating various activities. Because this is a course which is essentially based off of my preferences, I am setting the pace and creating my own schedule.

Since the topics of death, dying and the medical field have so many dimensions, I am putting an overall direction to the quarter but creating weekly agendas as I progress.

The direction will be as I have already mentioned:

Beginning with Death & Dying:
-Socialization among various groups of people about death
-The American Funeral
-Various postmortem body options
-In general: The American culture of death
(I would like to narrow it down to the American culture because I really only have a few weeks...)
-Discussing the difference between Death v. Dying
-Etc. Etc.

Moving into the Medical Field:
-The immersion process
-The transitions of surgical residents
-Division between Scientific and Social mind (and the formation)
-Etc. Etc.

Although I have already pointed out general topics, it will be up to me to decide the topics for the week.
Mondays will be when I post what my agenda will be for the week.
I have given myself a weekly two post minimum. I understand the addictive qualities of blogging so I will probably end up with more than two posts, though at least two of them will be substantial.

As for the readings...

I played the role of instructor! I ordered my books for the quarter through Amazon last week.

They are:

When Dinosaurs Die: A Guide to Understand Death

To explore the socialization of death

The above six books will assist in both the socialization of death and dying as well as the formation and representation of the medical double-consciousness (division between social and scientific minds). Each book is a compilation of personal experiences within the medical field and provides an array of perspectives from the gross anatomy lab to the operating room.

In order to better my own understanding of the immersion process, I have been equipped with study material...

That's it for reading material.
I will also be using online sources, and will search for the Omega Journal through the library (or Witmer). I will need to develop a reference site in the near future to store all of my resources.

Summary:
-Monday agenda posts followed by:
-Two post weekly minimum
-Using books, online sources and media references until further notice from IRB

Next week we get down to business.
You'll find out what that business is this coming Monday.
Stay tuned.

Introduction

2009-03-22T11:12:00.001-07:00

This is an exploratory student project in which I will investigate how medical students engage with death as part of their medical socialization and the development of a medical consciousness.

In medical education, students study cadavers prior to engaging with the living. However, students often are ill equipped to handle death due to a broader American culture in which the concept of death is feared and avoided.

Throughout the quarter, I will be studying the cultural preconceptions of medical students about working with cadavers and their experiences as they deal with them. I will also identify how physicians and other medical authorities reflect on their own consciousness , their own socialization, and their attempts to speak back to American cultural understandings of death.