‘What do we lose when we can’t go to the anatomy lab?’

Abstract

Correspondence: What do we lose when we can't go into the anatomy lab?

Dear Editor,

I am currently researching, first hand, the experience of dissection. I am concerned that the COVID‐19 closure of anatomy laboratories will impact on learning, but also upon something of the experience of it. I have raised this issue with my supervisor, Regius Professor Simon Parson, who offered this thought to contextualise my concerns.

Many have written on the importance of handling the human body in the anatomy laboratory, through either dissection or prosection, as essential surgical training: an opportunity to practice manual dexterity, an appreciation of mortality, a team‐building experience or a rite of passage. Equally, the emotional aspects of anxiety and apprehension as well as gratitude and responsibility to the donor have been discussed (Hyung‐Joo et al., 2018), but is there something else essential in the opportunity to handle cadaveric material? The benefits of direct experience over conceptual knowledge, in terms of the key significance of direct handling of cadaveric material, have been discussed (Gillingwater, 2008), but the present pandemic and closure of anatomy facilities worldwide provide an opportunity to stop and think: just what is the nature of the essential experience of the body which we lose when we move wholescale to online/virtual teaching?

Questioning in the light of this and my personal experience, I want to ask ‘What do we lose when we can't go into the anatomy lab? To begin with a quote by the American Philosopher John Dewey,

Every experience enacted and undergone modifies the one who acts and undergoes while this modification affects, whether we wish it or not, the quality of subsequent experiences. For it is a somewhat different person who enters into them. (Dewey, 1938)

A faint smell of formalin hangs in the air. Without the need for thought, my body senses my imminent arrival at anatomy. I prepare, button up my white laboratory coat and with safety goggles in pocket, am set to enter. My hand reaches for my identity card, presses it against the sensor and the door sounds open. I push the cold metal hand plate, leaving behind an indexical print of the palmar surface of my left hand. The door closes behind me. I am inside.

I am reminded by the cultural historian Jonathon Sawday of the impossibility of seeing inside our own bodies ‘that the interiors of our own bodies are endlessly deduced, but very rarely experienced directly, we are given to understanding via representation and trace’ (Sawday, 1995). I know this. I can look to myself as a living model for surface anatomy, partially as direct object, extended in reflection, but it is to the donated anatomies of others that I must turn to seek material understanding of the body's interior.

I walk down the corridor watched by professors from the past. I stop to address one in particular; his work is significant to me. I turn to him for guidance. In ‘The Art of learning Anatomy’ (Lockhart, 1927), Professor Lockhart declares dissection ‘the royal road’ to anatomy. I continue along the corridor to the dissection room, a dedicated facility off the Wet Lab.

It is dark inside. I press both rubber switches labelled ‘close’ and ‘far’, and the lights turn on. The space is filled by the background hum of the ventilation system, polished stainless‐steel surfaces, cabinets, stools and, most noticeably, differently formed volumes in white. My hands now gloved in a medium opaque blue, pick up a size 4 handle. It sits gently in the palm of my left hand. I unwrap a size 22 blade, grasp it with haemostats and slide it into the recess. It snaps firmly in.

In this space, the dead teach the living. I find the encounter affecting. Here, knowledge of the body is not mediated, it is gifted directly. John Shotter considers there to be 2 types of knowledge; ‘aboutness’ and ‘withness’ (Shotter, 2005). ‘Aboutness’, like theory, stands apart from us, and it describes with generality, understandings that have built overtime from the wisdom and experience of many. Knowledge understood as ‘withness’ comes from getting close to. In this space, direct knowledge of the body builds within me, bound by a deep sense of responsibility.

I carefully lift the specimen from its container and place it on a ground steel work surface. Pink droplets leak out; I wipe them away with the transparent green surface cleaner. I now know the weight of the specimen and appreciate its form. Each time, as I carefully unwrap the muslin cloths, I participate in a silent understanding. In becoming an ‘active’ learner, I take on responsibility for meeting the wishes of the donor, through this awareness, and I start to develop an ethical and sensitive practice, one with clear focus. I see the person first and then their individual anatomy.

I carefully observe and make sense of where I am to begin. I feel the bony landmarks hard beneath my glove. I orientate my eye, mark out a plan and then start. With little pressure, I direct the weight of the blade and separate the skin's surface with a faint line. The changing qualities of underlying tissues feedback through instrument then hand.

I begin to appreciate a sense of tightness or freedom, degrees of ‘wovenness’ and adherence. Signifying qualities communicated directly to my hand. This newly felt understanding of material difference extends questions of transitions, joinings and bodily ‘coming togethers’. The body has become texturally rich to me, and I consider this in terms of its functional significance.

I uncover a shiny pink point; it is quite firm to my press. Using my scissors, I push open a small space immediately below it. A small window appears in a web of white threads. I tentatively trace its journey, working together hand and eye to eventually glimpse sight of it as a tiny vessel. Its journey, movement through and between, navigates complex spatial relations, it plots a meandering line, branches and then divides its flow. It is impossible to separate its pinkness, from its firmness, from its pathway. Its qualities can be separately described but exist only in their completeness. I try to make sense of its full nature, before identifying it. A small artery.

In ‘Advice for a Young Investigator’, Cajal recants Perez de Ayala's recommendation ‘Look at things as if for the first time’. He expands to stress ‘That is, admire them afresh, disregarding what we remember from books, stilted descriptions, and conventional wisdom. We must free our minds of prejudice and fading images, and make a definite point to see and judge for ourselves, as if the object had been created expressly for the gratification and delight of our intellect alone’ (Ramon Y Cajal, 1999). This advice has helped me to understand the significance of my work. I am not just re‐seeing what has been seen before, I am embarking on a new experiment, examining the body anew, and with different eyes, I am learning to see for myself.

I rewet the specimen with pink preservative, replace its muslin wrappings and store it away. After returning the dissection room to darkness, I walk back along the corridor and exit the anatomy laboratory. Now outside, I sit at my desk, and in the absence of the specimen turn to my textbook. I look carefully at page 3, a schematic drawing of the skin. It is vivid now, coloured with direct experience. I picture it as if it were real. I read,

There is no magicians mantle to compare with the skin in its diverse roles of waterproof, overcoat, sun‐shade, suit of armour, refrigerator, sensitive to the touch of a feather, to temperature and pain, with standing the wear of three score years and ten, and executing its own running repairs. (Lockhart et al., 1959)

Perhaps what we will miss most during our current absence from the laboratory is a sense of wonder in the extraordinariness of our bodies. A deep sense of meaning, which gives a quality of knowledge, only found through direct experience. I would like to close my letter with an anatomist's quote from Rachel Prentice's ethnography of ‘Anatomy and Surgical Education’. ‘Anatomy education begins with touch, with identification of the human body, and with wonder’ (Prentice, 2013). I have found this to be true.