Book Review

First Cut: A season in the human anatomy lab

N Engl J Med 1998; 338:846March 19, 1998

Article

First Cut: A season in the human anatomy lab
By Albert Howard Carter III. 308 pp. New York, Picador, 1997. $24. ISBN: 0-312-16840-3

Dissection of the human cadaver is the first rite of initiation into the medical profession for virtually every medical student. Whatever its obvious practical educational value, human anatomy lab carries enormous symbolic value as a sort of hazing ritual. Touching and exploring a dead body violates deep taboos of our society, which shuns death. For this reason, the medical student's lay friends and relatives typically are intensely curious: What was it like? Did you faint? Were you squeamish? Most medical students have difficulty responding properly; the emotional impact of anatomy lab tends to get dissipated in the whirlwind of stress and excitement that is the first year of medical school. To capture fully the sublime quality of this experience requires the voice of a poet.

First Cut: A Season in the Human Anatomy Lab is a compilation of the observations and insights of Albert Howard Carter III, an eloquent professor of English who accompanied first-year medical students during their anatomy course. Carter had personal reasons for taking on this project. His father had donated his body to a medical school, and the author wanted to satisfy his curiosity about his father's fate, perhaps to reach a kind of closure that he felt he was denied because of the lack of a burial. Moreover, he wished to allay his concern about whether his father's remains had been treated with proper dignity. Carter also viewed this project as a chance to take a few steps on a road not taken. He had considered becoming a physician but instead became an English professor; although he was happy with his career, his love affair with things medical persisted. He sought out medical topics within literature and even completed an emergency-medical-technician training course simply out of his love for medical terminology and ways.

Carter, a superb writer, paints us a marvelous picture of the human anatomy lab. He captures the “many moods on this trip, from disgust and repugnance to elation and wonder, from jokes and high spirits to fatigue and depression.” He focuses on the little things — the sights, smells, and sounds — that startle the students and compel them to remember the humanity of their subjects. He found that students passed through three stages in their relationship with their cadaver. First was “disgust and aversion.” This was soon replaced by an effort to reduce it to a “biology exhibit.” Finally, there emerged slowly a “rehumanization,” as the cadaver asserted its individuality through its unique features. The philosophical challenge was to try to come to terms with death. Though a chaplain was present throughout the course, and a service of reflection and gratitude was planned and held, it fell to each student to create his own private understanding of mortality. “Our society's attitudes toward death are another kind of ice within the minds of the students, an ice that melts as the students learn.”

The author has created an elegant record of the first milestone of a medical career. This book would be a very useful complement to the standard textbooks of anatomy; it might serve as an atlas for the emotional and spiritual aspects of dissection, standing alongside the classic dissecting atlases. It would also be ideal general reading for a recertification course; the senior physician is allowed to step back briefly to experience the energy and optimism of the first-year medical student. It is refreshing to peer into the medical world through the eyes of an outsider filled with admiration for what the physician is and can be.

Carter's visit to the anatomy lab enabled him to conquer his personal demons. He was satisfied that his father's donation of his body was worthwhile and that the cadavers were treated with respect; he did achieve a measure of the healing and closure for which he longed. The experience persuaded him to make a serious commitment: “When the time for my death comes, I can think of no higher purpose for my muscles and bones, blood vessels and nerves, skin and, yes, even fat, than to send them to a human anatomy lab.”

Charles Gropper, M.D.
Mount Sinai School of Medicine, New York, NY 10029