Cancer in the gross anatomy lab

“I just want to learn the abdomen and the pelvis”, I thought to myself, while staring at our donor’s metastasized body. Nothing looked normal, tumor was everywhere, and for the 4th lab my group looked at each other, looked at the lab steps, and concluded it was going to be “just another day where we just … found what we could find and did … whatever was possible”.

Cutting into the abdomen we were told to “find the sigmoid colon”.  An easy task. A textbook positioned organ. But we could not find it.

The ovarian tumor in my donor had made this “easy organ search” virtually impossible as this “stuck” down abdomen (a consequence of both the cancer and the embalming of the donor itself) had the descending colon running right right into tumor, and the sigmoid colon basically missing.

How was I suppose to learn about anatomy, especially normal anatomy, if I could not even find parts of the abdomen, and the parts that I could find were in the wrong quadrant or looked/ felt completely abnormal? I began to become frustrated, even angry, that I could not learn anatomy. I did not think about my donor and her struggle, or my donor and her pain, all I could think about was how her cancer was affecting MY learning or altering MY course of study. It seemed so selfish. Had I become completely immune to the fact that I was cutting into a human being? Was I becoming just another stereotypical physician who lacked empathy and who had learned to objectify the human body?

With these worries in mind, we entered the next stage of dissection: The Pelvis. I immediately thought to myself, “She died of ovarian cancer. If I can’t learn in the abdomen because of ovarian cancer … there is about a zero percent chance I can learn in the pelvis”.  I was frustrated before I had even started. Maybe I had changed.

We were supposed perform a hysterectomy, but our group had trouble even finding the uterus. At first, we attempted to remove the tumor, which we later found out had engulfed the left ovary and was about the size of a Nerf football. After removing it, our group then split up into “let’s see what is inside a tumor” and “let’s find the rest of the female pelvic anatomy”.  I, for one, was completely grossed out by just removing the tumor (ie. it will be a long time before I eat tuna fish again), and so I opted for the latter group, all the while focusing my eyes away from the tumor dissection and the discovery of the “chocolate cyst” within it. It is one thing for anatomy to end my love of tuna fish … but I could not bear to let it prevent me from eating chocolate.

After an in depth search, we found the right ovary, also large and engulfed by about a baseball sized tumor, and eventually we also found the uterus, filled with fibroid tumors, a little further down from its’ normal position. We only think we found the bladder. This uncertainty further fueled my anger about my dissection experience and my “bad to learn from body.”  As I went from table to table to look at “normal” bodies, I was jealous of everyone else. Why did they get to have a normal lab experience where they found what they were supposed to, where they were supposed to, in the right color and in the right location? Maybe I had become completely selfish. Maybe I no longer appreciated the donation.

I looked down and realized that the gauze covering her arms had come off. I again saw the nail polish on her fingernails that had so affected me initially. My feelings of anger and resentment were quickly replaced by a feeling of remorse.

I was not desensitized.

Jessica Gold is a medical student.

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  • http://hokiemd.blogspot.com Christopher Bayne

    I never grow tired of these stories. Thank you for telling yours.

  • http://www.bryantsstatisticalconsulting.com Donald Tex Bryant

    Thanks for your sharing. It is very touching and sensitive. I appreciate that Dr. Pho publishes such a broad spectrum of stories related to medical care.

  • http://www.mdwrites.com md

    Thank you for sharing this story. It is so easy to get desensitized to human suffering when you have practiced medicine for many years. Every cat scan I read of a cancer patient is not simply ovarian ca with mets to the liver, omentum etc. There is a story of suffering behind the images. Perhaps a happy person with a family who was stricken by this devastating illness and whose life is now full of suffering and despair. Stories like this keep the human element of medicine alive. Thank you.

  • Laura Mozurkewich, CMT

    The daughter of a physician, my mother chose to donate her remains to Kirksville College of Osteopathic Medicine when she died of metastasized breast cancer. It had not occurred to us that her lack of certain anatomical features and extras of others (duplicated renal systems seem to run in the family) would cause consternation to her intended students. If nothing else, I hope she served as a reminder that each patient is not a carbon copy of a human being. I hope the other student groups share their findings so you could get a peek at “normal.”

  • Jessi Gold

    Dear Laura,
    Your mother’s donation was a great gift, one that I am sure was deeply appreciated by the students at Kirksville College and one that is not easy to do. My classmates learned much from our “abnormal” body, and I did the same from theirs. I am sure your mother taught others well, as was likely her intention. I can say nothing to express my appreciation but thank you

  • Molly Ciliberti, RN

    Thank you to all who donate their or their loved one’s body to science so that others might learn. One thing I learned in gross anatomy was that there is no “normal”, only variations on a theme. Learning that early helped me to understand that no patient comes in with a completely clean plate and only one thing as their problem. We are all shades of grey.

  • L. Thomas

    This is a fantastic illustration of how the curious person can learn something from every situation they find themselves in. What a generous donation as a last act.

  • http://offwhitecoat.wordpress.com The Scrivener

    This is an elegant reminder of why cadaver anatomy labs are so important to medical education. Schools are increasingly switching to online virtual labs, in part because of a paucity of donors. (Several of the bodies in my year, including my group’s, were “donated” because they were unclaimed.) But staring at a computer screen at a homogenized “body,” you lose the intense emotional experience that is really the *point* of gross anatomy.

    Everything else you can learn from Netter’s, but the wonder of learning from another person’s body — even an “imperfect” one — is irreplaceable.

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