At one med school, cadavers don’t leave personhood behind

Indiana University Northwest has budding doctors confront emotions, embrace empathy during anatomy course

August 2, 2011

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(WBEZ/Michael Puente)
Students in the cadaver lab at Indiana University Northwest in Gary, Indiana.
(Photo courtesy of Purcell family)
Dorothy 'Dot' Purcell of Munster, Indiana, donated her body to science.
(WBEZ/Michael Puente)
Jim Purcell at his home in Munster, Indiana.
(WBEZ/Michael Puente)
Med student Lucas Buchler (left) along with Jim and Michael Purcell.

Most people look to have a personal relationship with a doctor and want to appear as a whole person, not just a collection of ailments to be fixed. But ironically, most med schools require coursework that’s impersonal, especially in classes where students examine donated cadavers. A handful of med schools feel anatomy lessons should be personal; they require med students to learn more about the dead than what killed them.

For Doctor Ernest Talarico, a dead person is still a person. And every person has a name. He says that should remain true even when the person is being studied and dissected in an cold, antiseptic exam room.

TALARICO:  They were human beings. They are human beings. And, they deserve the same respect and human dignity in death as we would give them in life.

Talarico isn’t speaking in the abstract. He’s assistant director of the Medical Education program at Indiana University’s Northwest satellite campus in Gary. At his campus, med school cadaver donors, as they’re called in science, are not just John or Jane Doe’s, or numbers; students learn the cadaver donors’ names. They learn their backgrounds and how they died. They even meet the cadaver donors’ families.

TALARICO: That’s something that’s not done at any other campus within the IU School of Medicine system. It teaches things such as professionalism, respect, empathy that we really can’t teach in academia. We can’t teach that in the lab. Knowing the name of the cadaver doner does that for us.

This is a remembrance service at IUN’s med school facility. I’m in a section that looks kind of like an operating room. This service from earlier this year is typical -- it involves students and families coming together to “give thanks” to the donor. The med students recite poems and sing songs. Instructors and other med school officials pay a role, too.

INSTRUCTOR: We have gathered to pay our respects to memories of these who have given the gift of their bodies for our education. And to give thanks for this gift. The poet John Donne wrote: No man is an island.

BUCHLER: We always taught that your cadaver donor in anatomy lab in your first year of medical school is really your first patient.

That’s Lucas Buchler. He recently completed his first two years of medical school at IUN. He says learning about a cadaver’s life -- how they were and how they lived -- helps students understand better how the person may have died. And, it makes the specimen feel more real.

Sometimes ... too real.

BUCHLER: Working with any patient can be an emotional roller coaster and it’s something we need to be prepared for down the road. There may be patients in our career that we become incredibly emotionally attached to. We need to understand how that is so that doesn’t influence us being able to give the best care that we can.

IUN has incorporated a personal touch to its medical education program for 12 years, and so far it’s alone in the Indiana University Medical Education Program. They’re rare in Illinois, too. Medical experts I talked with were intrigued with this approach, but some had reservations.

One of them is Doctor Elizabeth Kieff, a psychiatrist and assistant dean of student affairs at the Pritzker School of Medicine at the University of Chicago. She says there’s a notion that doctors lose touch with patients. She says maybe that’s true, but maybe it goes too far to learn a cadaver donor’s names and family ties.

KEIFF: I think that in encouraging students to fantasizes about their cadavers, to really try to know a living person when what’s before them is a scientific specimen prevents us from engaging in the opportunity to really start to talk about this tension in what we can know and not know.

Kieff says the U of C doesn’t take the “get close” approach they do at IUN. She says just think about what’s going through a med students’ minds when they finally encounter a cadaver’s family.

KIEFF: I do think that students in that moment are potentially vulnerable. They are certainly not doctors, they haven’t had any clinical experience. They’ve been in a scientific laboratory learning anatomy and suddenly they are before a family that has all kinds of emotions about this scientific specimen that they do not have. They may have all kinds of questions about the experience that may or may not be appropriate to share.

Scientists and educators have strong thoughts about Indiana University Northwest’s approach to body donation, but so do cadaver donors families.

You can get a sense of what’s at stake for them by following the story of Dorothy “Dot” Purcell, a woman who lived most of her life in Munster, Indiana. At 86 years old, Dot Purcell died from a rare kind of cancer in 2008. Shortly before that, though, Dot had agreed to donate her body to Indiana University Medical Education Program.

The decision came too soon for Dot Purcell’s husband, Jim.

PURCELL: She always talked about leaving her body for medical research. I used to try to discourage it. It was not a subject that I particularly wanted to address and I didn’t want to think about the specifics of it.

Dot’s son, Michael Purcell, didn’t like the idea either. After all, he’d heard stories about med school from his brother-in-law, a doctor.

MIKE PURCELL: He used to joke around how they played with one donor’s brain and how it fell on the floor. At the time you don’t think about it. But now that it’s my mom who donated her body to science, it’s horribly disrespectful.

But Dot’s decision to donate her body was honored, and just hours after her death, the body was whisked away. Jim and Michael Purcell weren’t sure where Dot’s body would end up, but they never expected to hear about her again.

Maybe she would go Northwestern University, where Dot’s father was a graduate or maybe the University of Notre Dame, where Dot had attended nearby St. Mary’s College.

PURCELL: But we found out that it they don’t work it that way. The bodies are sent to a central distribution center and whatever hospital needs somebody, they ship them out.

Instead, Jim heard from Doctor Talarico at Indiana University Northwest in Gary.

PURCELL: It was a surprise to us that he had Dot’s body over here.

Dot Purcell’s body had its own ceremony, and that’s where Jim and Michael Purcell met the med students that studied her. Son Michael Purcell says he’s grateful that IUN takes this approach, because most families never learn where their loved ones end up. From his perspective, everything turned out fine.

MIKE PURCELL: All the students were great that we met and caring and respectful. But from a donor’s family, the more they know they better because not only for science but then they are vested.

Jim Purcell says he’s on the same page as his son. He says his family grew close to that med student you heard from earlier, Lucas Buchler, the young man who worked on Dot’s body.

Mr. Purcell says he hopes Buchler learned the right lessons from working on Dot, and that he and the other students achieve their future goals.

PURCELL: The in-depth knowledge that they have gained as a result of this program about people who die has to be of great benefit to their education and knowing that human beings are more than just a body.

Mr. Purcell says with his wife in the IUN program, she's close to home. And for him, that's OK -- Dot Purcell was never one for traveling far from home.