What started in the mid-seventies as brown-bag lunchtime optional seminars for students, faculty, and staff of the (then) University of Massachusetts Medical Center evolved into a magnificent project. The medical students’ courageous willingness to acknowledge their feelings about death and dissection has made this book possible. It is our hope that this slim volume—this collection of words and images created by the medical students at University of Massachusetts during the last thirty years (and augmented by Meryl Levin’s documentary photographs of students from Weill Medical College of Cornell University and their journal entries written in 1998 and published in Anatomy of Anatomy)—will provide you with what good doctors provide for their patients: catharsis, personal insights, and support. From the Foreword One of the enduring images of my first year in medical school is the narrow, unshaven face of Ernest, the cadaver I shared with three classmates whose names I can’t remember. We named him “Ernest,” so we could impress our parents by telling them how we were working in dead earnest. In reality, like most cadavers in those days, he was an anonymous indigent man who died in the county home and whose remains were used for our education without his consent. My group was considered lucky because cancer had burned away every bit of Ernest’s fat, thus making him an excellent “specimen” for dissection. Even then I knew that Ernest was more than a specimen, but it took a long time to understand that he was actually my first mentor in the joys and sorrows and successes and failures of medicine. Surprisingly, it was Ernest rather than my basic science professors—the living ones, that is—who provoked the most important questions about what it means to be a doctor and forced me to confront them. As I recall, though, this was a solitary process because my classmates and I never discussed, or perhaps even admitted to ourselves, our feelings of ambivalence, fear, pain, gratitude, and exultation, or the changes in us as persons during the first year of medical school. We tried to hide all this because at the time that’s what doctors were supposed to do. Today things are different. As students at UMass, you are especially privileged to have a module like One Breath Apart integrated into your anatomy experience. This module provides you the opportunity to explore and share your personal responses to dissection, and with this publication it gives you access to an additional resource: a splendid introduction to the written and visual tradition established by UMass students over the last two decades, along with evocative photographs and journal entries from the medical students at Cornell, documented by Meryl Levin in Anatomy of Anatomy. As I read through this book, I was struck by the Nancy Long’s title poem. She writes, “I pretended you were here/To teach me the details.” How reminiscent of my own experience those words are! “Then I saw your face/And I knew…” That’s the turning point. As physicians we can either embark on the journey of learning to see others’ faces and to hold their hands, or we can attempt to distance ourselves and focus only on “details.” This is a decision that every medical student must make, and our cadavers present the first difficult challenge. In a 2006 class poem, UMass students wrote, “We felt the brain/And imagined its power to create. We held the heart/And imagined its ability to embrace.” These words represent an affirmation of empathy and compassion over detachment. One of the most compelling images of One Breath Apart shows the anatomy cadaver as a bridge spanning the chasm that lies between ignorance, darkness, and death on one side and knowledge, health, and life on the other. Dozens of tiny figures march across the span. Like me, they won’t forget the backbone of that bridge. As another UMass student writes, “I know that I will be irrevocably altered.” Jack Coulehan, M.D., Professor of Medicine, Stony Brook University, NY Intended Audience: This book speaks to the humanity of physicians; equally suitable for the novice medical school student to the seasoned clinician. Healthcare professionals and educators of anatomy, art and reflective practice in medicine, death and dying, religion and spirituality will all find nuggets of great value in this unique and beautifully designed volume. Praise: "Here is the brilliance of this book: we readers can see, can feel, can be assured of these proto-doctors’ great and now not wordless awe inspired by our human frame. We know, now, that these future doctors kneel in prayer in front of the body, our bodies, to whose health they commit their lives. Let no one fear, when faced with an indifferent or cold doctor, that there never beat a warm human heart in that chest. The heart beat, and it beat in resonance with or even for the now still heart of his or her anatomy cadaver. If only we can keep alive that warmth and awe, our medicine will be transformed. This is what this book will do." —Rita Charon, M.D., Ph.D., Professor of Clinical Medicine and Director, Program in Narrative Medicine, College of Physicians and Surgeons of Columbia University "One is never the same after Gross Anatomy class. Sandra Bertman’s One Breath Apart is a collective diary of the medical profession’s time-honored right-of-passage and a tribute to one of the sacred privileges accorded physicians-in-training. This delightful book is at turns poignant, profound, earnest, and awkward, just like the first year medical students, who are its subjects and contributing authors." —Ira Byock, M.D., Professor, Dartmouth Medical School, Author Dying Well and The Four Things That Matter Most "Perhaps by serendipity, I obtained a copy of the book at my medical school, the Medical College of Wisconsin. Just a tremendous book. I wish I had it during my medical school years, 1967-1971." —H. Steven Moffic, M.D., Department of Psychiatry, Medical College of Wisconsin "That anatomy lab! The memory remains forever in every doctor. This book helps remove the scariness and increases the true humanity of the experience." —Eric J. Cassell, M.D., Author of The Nature of Suffering and the Goals of Medicine "Alternately moving and thought provoking, this verbal and visual record of what medical students confront not only in the body, but also in themselves teach lessons in humanity as well as in anatomy. I recommend this book as a guide to this intimate journey, as relevant in broader death education settings as in a medical school curriculum." —Robert A. Neimeyer, Ph.D., Editor, Death Studies and Author, Lessons of Loss: A Guide to Coping "I strongly recommend that every student read One Breath Apart before they enter into the area of human dissection. While this area is one of the most challenging of the health professions, the knowledge gained separates the health professional from all others. This book introduces this very important but delicate topic in a profoundly visual way. The images in this book truly serve the saying well, that a picture is worth a thousand words." —Roy Lee Aldridge Jr., P.T., Ed.D, Associate Professor of Physical Therapy, Arkansas State University, Jonesboro Arkansas "The book was put together for medical students, to help them to confront the anxieties, fears, discomforts, ambivalences, ethical concerns, and other issues of taking gross anatomy and of being medical students. But for those of us who are not medical students, it is interesting to see the path medical education takes students on regarding emotions, emotional control and expression, empathy, relationship to the dead, relationship to other medical students and the medical profession, and the balance between detachment and emotional involvement with patients and cadavers. Beyond that, and the reason the book merits a review in Death Studies, it is a book that will interest, even fascinate, anyone who is interested in how people face death. As Bertman makes clear, this is a book about how the dead teach the living. There are quite a few lessons in this book for teachers to consider. I suppose one could also take this as an art book, because there is much in the book that, like any good art book, fascinates, illuminates, and stimulates. There are, for me, some drawings, narratives, and poetry in the book that stay with me, that I return to, that pique my curiosity or get me thinking about things I had not thought about before. Maybe it would even be a quirky but very interesting coffee table book. But for those of us who focus on thanatological issues, there is the perspective and depth the book offers about what we as professionals and scholars write about, think about, and face in our every day work, matters of life and death." Click here to read the review in its entirety. —Paul C. Rosenblatt, Morse-Alumni Distinguished Teaching Professor of Family Social Science at the University of Minnesota. Death Studies, Volume 34, Number 5. Author of: Shared Obliviousness in Family Systems, African American Grief (with Beverly R. Wallace), Parent Grief: Narratives of Loss and Relationship, and Bitter, Bitter Tears: Nineteenth Century Diarists and Twentieth Century Grief Theories. "This unusual book was compiled by Bertman (psychology, University of Massachusetts) from thoughts and sketches made by first year medical students upon facing their first cadaver. The intent is to prepare the students for the fact that they will be cutting into a person who used to be alive. In order to learn what they need to from the body, students cannot be frozen in horror or sympathy for the deceased. And yet, in order to become good doctors, they can't lose their humanity. It's a greasy tightrope. The comments and, even more, the drawings show the conflict the students face. This is an excellent starting point for students who need to discuss their feelings about dissection and also for those who may be considering donating their bodies but don't like the idea of being treated without respect." —Annotation ©2009 Book News Inc. (http://www.booknews.com) Portland, OR Featured in: The Boston Globe, Health Section, Monday, August 17, 2009, and the Literature, Arts and Medicine Blog, posted Sunday, April 12, 2009. ABOUT THE AUTHOR Sandra L. Bertman, Ph.D., FT is Distinguished Professor of Thanatology and Arts at the National Center for Death Education, Mount Ida College. Synthesizing visual and creative arts, literature, spiritual values, and cultural beliefs, Dr. Bertman’s expertise is cultivating the therapeutic imaginations of clinicians in clinical and academic settings through illustrated lecture-presentations and workshops. For most of her career, Bertman was Professor of Humanities in Medicine at the University of Massachusetts Medical School and Graduate School of Nursing, and founding Director of the Program of Medical Humanities and Arts in Healthcare. She was affiliated with the Graduate School of Social Work at Boston College as Research Professor in Palliative Care, and holds adjunct appointments at Dartmouth Medical School and Nova University. Her publication and media credits include the classic handbooks Facing Death Images, Insights and Interventions, Grief and the Healing Arts: Creativity as Therapy, the film Dying, the United Press International award winning radio show Sing a Song of Dying, and the DVD and book Art, Spirit and Soul (forthcoming). Currently for healthcare practitioners, she tailor-makes seminars on “Reflective Practice and Renewal,” “The New Ethics of the Human Spirit,” and is developing “Other Ways of Knowing: Using the Arts and Humanities to Teach End-of-Life Care,” which draws from the work she facilitated for the Botswana Nursing and Social Work Associations—intensive training in grief dynamics, principles of palliative care, multiple loss and compassion fatigue of caregivers affected and infected by HIV/AIDS—(see manual “Caring for the Caregivers”). Bertman was named “Outstanding Death Educator” by both the Association of Death Education and Counseling and the National Center for Death Education, honored by the University of Massachusetts for Distinguished Professional and Public Service, co-recipient of the first humanities award by the American Academy of Hospice and Palliative Medicine and inducted into honorary membership to Sigma Theta Tau, the International Graduate Nursing Honor Society.
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