Audiobook Now Available: Making the Cut

For those who prefer to listen rather than read, my latest book on how to heal modern medicine is now available on Audible and other audiobook platforms.

You can now order Making the Cut on audiobook. I’ve included an excerpt of the book here to whet your appetite. This is from Chapter 2, “A Patient Corpse,” which describes some formative experiences dissecting cadavers in gross anatomy lab.

---

My first patient was already dead. My only job involved painstakingly dissecting her lifeless corpse in the anatomy lab, reducing every inch of her body to tatters until there was nothing left to cut. I took her apart; I pulled her to pieces; but I never learned her name. And she never knew mine.

As far as I knew, she was an anonymous person with no social or psychological life, no family, no community, no context. Merely a lifeless body lying on a steel table. Unfortunately, medical students observe death before we observe life. I only later learned in the surgical operating room that a living body looks very little like a dead one. There is a strange historical myth, perpetuated still today, that early men of science in the late eighteenth- and early-nineteenth centuries pioneered dissection of cadavers by stealing bodies from graves to get around religious or legal prohibitions of the practice. It’s a myth because, while some scientific pioneers did rob graves for this purpose, it was entirely unnecessary. The practice of human dissection was neither legally prohibited nor frowned upon by the Church and civil authorities at the time.

Dissection had been forbidden earlier in Ancient Greece and Rome, and likewise prohibited in Islamic societies. It was the Medieval Scholastics who first permitted the practice under the theological justification that the soul, not the body, was unique to humans. Resistance to pathological anatomy in the early days of modern science came neither from the Church nor the law nor society.^[i] Ironically, resistance to dissection in those days came from medicine itself.^[ii] Dissecting clinics existed in hospitals in Vienna, Pavia, and Paris from the 1750s, but these were held in suspicion by the birth of new medical clinics.

Strange to say, there was no need for anatomists to rob graves, and yet they did. Why? The grave-robbing doctors of the early-nineteenth century wanted to see themselves as seeking a prohibited knowledge and exposing the inadequacy of the old ways of thinking for the new society,^[iii] as bioethicist Jeffrey Bishop explains in his book The Anticipatory Corpse: “The dead body became the fetish of medicine; the desired object was knowledge, and the dead body came to stand for that knowledge.”^[iv] Pioneers of modern anatomy cultivated a self-conception that science and medicine needed to venture into unseen realms to acquire secret—even “forbidden”—knowledge by penetrating deep within the previously inviolable space of the body.

Never mind that the early anatomists had no difficulty in the middle of the eighteenth century in carrying out autopsies, as Michele Foucault explained in his classic study The Birth of the Clinic. “There was no shortage of corpses in the eighteenth century, no need to rob graves or to perform anatomical black masses; one was already in the full light of dissection.”^[v]Nevertheless, the early anatomists felt the need to convince themselves and others that they were doing something forbidden to usher in this new science of the human body. Apparently, secret knowledge equated to special knowledge, available only to the few scientists daring enough to violate ancient taboos.

The practice of dissecting a dead body remains today a rite of passage for fresh medical students. The first thing I noticed when I walked into the lab was the smell of formaldehyde, which permeated everything (and everyone) that entered the room. No amount of washing could adequately rid our clothes of that smell. Even after two showers, my wife could smell it on my hair. The second thing I noticed was, of course, the body bags on the tables.

With due deference to ancient societies that looked askance at human dissection, I would question the moral sensibility of anyone who did not at least pause to wonder whether dissecting a dead body might be an irreverent act, perhaps one that should not be allowed. Respect for our mortal remains has been a permanent feature of human history from the beginning. The specific means of disposing of dead bodies differ across various cultures, but all share an innate sense that some ritual act of regard is necessary here. The human body can be desecrated in death, just as it can in life.

The penultimate lines of Homer’s Iliad describe how the indomitable Achilles drags the brave Hector’s dead body through the streets of Troy. Line after line of wanton death and destruction in the Trojan War, described in gruesome detail by the ancient bard, ends with this ultimate act of disrespect for the human body. The reader senses that amidst all the carnage of this poem, this is somehow the most brutal moment. Even more than the fear of death itself, Homer’s war heroes feared having their dead body left on the battlefield as food for the dogs. In the poignant final scene, Hector’s royal father, Priam, grasps the hand of the man who killed his son and desperately begs Achilles to return Hector’s body for a proper burial.

Consider this: Achilles did far less physical damage to Hector’s body than I did to another woman’s body in gross anatomy lab. We dissected her with painstaking detail: each structure was subjected to the knife. By the end, very little of her remains actually remained intact. Every bit of tissue had been opened, disconnected, removed, spliced. If this was not desecration, what is?

And yet, there is a difference between Achilles’s act and that of a medical student performing a dissection. Gross anatomy lab is often defended on the instrumental grounds that it produces a great good: essential knowledge for future physicians. It thus contributes to the lives of future patients who will rely on our knowledge. This is true, but such utilitarian reasoning is not enough. The two acts differ in their total meaning, in the attitude and approach to the dead body. Achilles intended to destroy; the medical student intends to discover.

The students I discussed this with were, without exception, profoundly grateful to the person who donated his or her body for this purpose. We approached the dead bodies—at least initially—with wonder and awe. Georgetown has a tradition of offering a Catholic Mass every year for the repose of the souls of deceased donors and for their families, who invariably express appreciation for this gesture.

The human body is an astonishing work of art—arguably the most beautiful thing in the natural world. The wisdom of the body, which I began to really understand only by dissecting it, consisted of a million secrets, none of which was divulged readily. Any gain in anatomic knowledge required probing, coaxing, and teasing it out with scalpel and scissors. I learned less in a week of studying anatomy books than in an hour of cadaver dissection. Pictures and diagrams are no replacement for the real thing, turned over between your fingers.

Gross anatomy lab totally absorbed my mind. At home, after a long day of many hours in gross lab, I would try to think about something other than medical school for a while, only to find myself staring at my forearm at the dinner table, flexing one finger at a time, watching tendon and muscle move underneath the skin. “Are you studying your arm again?” my wife would interrupt.

Snapping out of my trance, I would sheepishly reply, “Sorry . . . can’t help it.”

“You’re obsessed.”

“Yep.”

* * *

“There are no locker rooms. Where are we supposed to change for gross lab?”

“Most students opt to change next to the lockers in the hall. Or if you’re not comfortable with this, you can use the bathrooms.” The case for changing in the hall included the claim that it was a “bonding experience” among classmates. Failing to understand how this would further my professional solidarity with my female classmates, I made my way to the small men’s room, where a dozen other guys had crammed themselves. After donning the clothes that would be sacrificed to formaldehyde, I made my way back through the hall past the bonding bras and briefs on either side.

The first day, the atmosphere was somber. A feeling of quiet trepidation pervaded the room as we thought of what we were about to do. We uncovered the chest first. It appeared as the off-human color of life drained away: neither gray nor brown, but somewhere in between, a washed out yellow-beige. Putting scalpel to skin, we began to cut. The knife drew no blood, for no blood could flow from a corpse. Our pace gradually quickened as we went to work dissecting. In the days that followed, the atmosphere relaxed: the volume rose, laughter returned.

A few months later, the days of gross anatomy were winding down. Each group of four students was ready to be through with our cadaver, to finish the last section of the course: head and neck anatomy. One day near the end of the course, we uncovered the face, until then hidden under a plastic bag. The somber atmosphere of day one suddenly returned. It took us off guard. Had we gradually disregarded what we knew at the beginning? Had we forgotten what we had been doing for the past three months? “Man grows used to everything, the scoundrel,” said Fyodor Dostoevsky’s Raskolnikov in Crime and Punishment.^[vi] How quickly we had accustomed ourselves to dissecting the dead.

Before we cut again, we looked at the face, that mysterious place from which the human personality radiates most fully. We looked at the mouth that had smiled and the eyes that had cried, now dry and drained and stiff. This face—the seat of the senses and the window into the soul—arrested us for a few moments. The eyes gave us pause. Then, as instructed, after a few moments we picked up our scalpels and applied them to the face.

It is strange, the things you find when you carve open dead bodies. One man’s liver was rock hard, cirrhotic, probably from years of alcohol abuse. We discovered tumors, remnants of old surgeries, food still in the stomach, stool still in the colon, a spleen six times the normal size. One of the brains, not having been adequately preserved with sufficient formaldehyde, had begun to liquefy. After removing the top of the skull like a hat, we watched, disgusted, as the brain slid partially out, oozing in a semi-liquid sludge toward the floor. Eating lunch was sometimes difficult after anatomy lab.

The day we dissected the genitals—not an easy endeavor, mind you—we discovered that one cadaver had a prosthesis inside his penis. Until then, I was naïvely unaware that such devices existed. They are among the remedies for men with erectile dysfunction (in common parlance, impotence), and they come in various and sundry models: some inflate and deflate, while others remain permanently erect. (The latter type folds down when not in use, in case you were wondering.) One of our professors, a urologist, was delighted with this find. Students gathered around him as he held up the device, turned it over in the light, all the while explaining to us the year, make, and model. One could see a gleam in his eye as he admired the materials and craftsmanship. Urologists, I thought, must be a unique breed.

The early formative experience of human cadaver dissection powerfully shapes—for good or ill—the ethos and imagination of physicians. It sets the tone for the entire practice of modern medicine. Beginning with gross anatomy lab, the dead body becomes medicine’s template for understanding the living organism. The medical student constructs his knowledge of the human body on the foundation of the static, frozen-in-time, lifeless, decontextualized corpse. This “dead” knowledge is later overlayed onto the dynamic bodies of the living. The corpse serves as the normative starting point against which the dynamic flux of life is understood.

But this gets things backwards. Consequently, the living body comes to be seen as a machine—as dead matter somehow kept in motion by mysterious forces we do not understand. Consider, for example, this dubious claim from a contemporary textbook of medical physiology: “The human being is actually an automaton, and the fact that we are sensing, feeling, and knowledgeable beings is part of this automatic sequence of life.”^[vii] This reductionist view of the living body as mere dead mechanism is not new: we finds the roots of this cramped attitude in the advent of modern medical science, including physiology, which is supposed to study the dynamic processes of life. The dead/mechanistic model ails medicine to this day.

Modern medical training has embraced a mechanistic philosophy that views the living body as no more than passive matter-in-motion—a machine that is not fundamentally different in life than in death. The physician is trained to view the human body primarily in terms of dead dissected parts that can subsequently be reconstructed, rather than as a self-directed, coordinated, dynamic, living whole greater than the sum of its parts.

Biological life is an intricately choreographed dance that cannot be captured in a photograph. Trying to get at its essence by dissecting it into ever smaller parts and examining each part in isolation, as we would do with a machine, “would be like trying to account of the unique quality, the power, and yes, the life of a piece of music by examining each note, or at most a phrase, in ever greater detail, outside the flow of the whole work, in the hope that by this ‘drilling down’, as we say, there at last we will find the secret.”^[viii] The machine model of the human body persists in our imagination not because it is true, but because “it encourages the sense that we can easily understand what life is and learn to control it”^[ix]—a tempting proposition for our Faustian age. But because the mechanistic view of the body as a dead machine built up of distinct parts is not true to life, the cadaveric starting point is not necessarily the only—much less the best—approach to medical education. But it is the one we have deliberately chosen, and we now reap the fruits.

---

^[i] “It was the Scholastics, not the Greeks, Romans, Muslims, or Chinese, who based their studies on human dissection. In fact, during classical times, the ‘dignity of the human body forbade dissection,’ which is why Greco-Roman works on anatomy are so faulty. Aristotle’s studies were limited entirely to animal dissections, as were those of Celsius and Galen. Human dissection was also prohibited in Islam. But, with the founding of Christian universities came a new outlook on dissection. The starting assumption was that what was unique to humans was a soul, not a body. Therefore, dissections of the human body had no theological implications. To this, two justifications were added. The first was forensic. Too many murderers escaped detection because the bodies of their victims were not subjected to a careful postmortem. The second was that adequate medical knowledge required direct observation of human anatomy. Consequently, in the thirteenth century, local officials (especially in Italian university towns) began to authorize postmortems in instances when the cause of death was uncertain. Then, late in the century, Mondino de’Luzzi (1270–1326) wrote a textbook on dissection, based on his study of two female cadavers. Subsequently, in about 1315, he performed a human dissection in front of an audience of students and faculty at the University of Bologna. From there, human dissection spread quite rapidly throughout the Italian universities—given added impetus by the calamity of the Black Death. Public dissections began in Spain in 1391, and the first one in Vienna was conducted in 1404. Nor were these rare occurrences—dissection became a customary part of anatomy classes. The ‘introduction [of human dissection] in the Latin west, made without serious objection from the Church, was a momentous occurrence.’” Stark, Rodney. Bearing False Witness. Templeton Press. Kindle Edition, pp. 142-143.

^[ii] Cf. Foucault, Michel, The Birth of the Clinic: An Archeology of Medical Perception, trans A. M. Sheridan Smith, New York, Vintage Books, 1973.

^[iii] Bishop, Jeffrey P., The Anticipatory Corpse: Medicine and the Care of the Dying, Notre Dame, IN, University of Notre Dame Press, 2011, p. 51.

^[iv] Ibid.

^[v] Ibid., 125.

^[vi] Dostoyevsky, Fyodor. 2006. Crime and Punishment. Translated by Sidney Monas. New York: Signet Classic.

^[vii] Arthur C. Guyton and John E Hall, Textbook of Medical Physiology, 11^th Edition (New York: W.B. Saunders, 2006), p. 3.

^[viii] Emphasis in original, McGilchrist, Iain. 2021. The Matter with Things: Our Brains, Our Delusions, and the Unmaking of the World. London: Perspectiva Press, p. 712.

^[ix] Ibid, p. 735.

---

---