Gross Anatomy at Harvard Medical School:

David E. Munoz remembers her hands. "Her nails were all done," he says of the woman with whom he has worked very closely during the past eight weeks.

Sherleen H. Huang worked with a man. She says she remembers seeing his tattoo. And he had freckles, she adds, smiling.

She got to know him well. "He was like a friend," she explains, though his chest hair still bothered her. "It was too human."

Of course, Huang's and Munoz's friends are human. They're also dead.

There's no way to get around the "Gross Anatomy" lab, part of "The Human Body" course taught at Harvard Medical School. Doctors need to know human anatomy. And to know human anatomy, aspiring physicians must study cadavers.

But whether medical students look forward to viewing the intricate digestive system or whether they dread the prospect of spending hours bent over a dead person, they don't have a lot of time to think about the idea: The lab comes up during the first eight weeks of a student's first year at medical school.

Before formal study begins, students have an opportunity to go into the lab early, look at their assigned cadaver, and get used to the idea of dissecting a human being.

Elbert S. Huang '92 was one of the students who took advantage of the preview. "I thought I needed to do that," he says.

Although Jennifer B. Ogilvie '91 was too busy to come in early, she says she does feel that "we were really well prepared." While all medical schools try to ready first-year students for the experience of working with cadavers, Ogilvie thinks Harvard is particularly sensitive to students' fears and concerns.

It's not as if one lecture answers all the questions, says Dr. Daniel A. Goodenough '66, one of two course directors for "The Human Body." Talking to students about the bodies is "a very complex and long process. It goes on throughout the eight weeks," he says.

Goodenough distributes materials he's written, including one article he wrote for Ann Landers' column. The article responded to a reader's question about "what it means when you donate your body to a medical school," he says.

"There are a lot of very important learning issues that come up with this," says Goodenough. Preparing students to work on cadavers is not simply about "the horrors of looking at the dead," he says. It also introduces them to a way of thinking about living patients' "boundaries" and the need for physicians to respect the sanctity of the body even as they are permitted to violate those boundaries.

Goodenough also gives each student a copy of a letter written by a woman who donated her body to medical school.

The letter, which expresses the woman's hopes that her body would contribute to their study of human anatomy, was "touching," students agree. "It was amazing to read beforehand," says Ogilvie. "She thought of her body as a gift to us," says Huang.

Long before students ever see a body, however, Jim E. Clerke, office manager of the Anatomical Gifts Program, files the donor's "instrument of anatomical gift." "All our donors are pre-registered," he explains.

There is never a surplus of bodies, according to Clerke and Goodenough. In fact, says Clerke, "we just made it in under the wire this year. People aren't dying as quickly as they used to."

About 200 people sign up for the program every year, yet the average age at the time of death for most donors is now above 80 years, he says. Donors who are in their late 50s or 60s "are still around. They're still out there," says Clerke.

The "Harvard" label, which can add prestige to the most ordinary sweatshirts and coffee mugs, may be an advantage even for the Anatomical Gifts Program. "I think that the name gets us more registrants than at other schools," says Clerke, "but we need everybody we can get."

The period of time between death and final disposition of the body is usually one or two years, says Clerke. After death, the bodies are embalmed and stored in "a rather extensive system of freezers and refrigerators," he says. The main freezers has a capacity of 160-"so we have room," says Clerke.

At the beginning of the course, bodies are moved from the basement-level morgue up to the fourth floor lab of the Medical Education Center. The transportation takes place early in the morning, says Clerke, since "it's a better time to work. Especially in public areas."

On the first day of gross anatomy lab, students don white jackets. They "double-glove" to protect their hands from formaldehyde and the coldness of the body's insides. Some students choose to "triple-glove."

Some students may have decided to keep a special "gross anatomy" outfit in their locker outside the lab, feeling that clothes are unfit to be worn after eight weeks of formaldehyde saturation.

When the students enter the lab, they see the cadavers set up on metal tables. The bodies are covered first with layers of plastic and material to keep them moist, and then with a blue denim-like cloth. A metal bucket at the end of the table collects the excess formaldehyde that drains from the body. "Sometimes [the bucket] seems like it's getting a little full," says Elbert Huang.

Another plastic bucket under the table is for the removed organs. All parts are kept and eventually buried with the body at the Medical School's burial ground in Tewksbury, or else returned to the donor's family.

Four students are assigned to a cadaver. Their tools include forceps and scalpels, but also grislier instruments which might look more appropriate at a hardware store: hacksaws, wooden mallets, and pliers for cutting ribs.

"There's electric saws, too," says Elbert Huang. "The smell of bone is pretty incredible." He pauses. "Yeah, it's pretty gruesome," he says. "It's pretty gruesome."

A dissection group spends the next eight weeks not only getting to know the cadaver's insides, but also developing a sense of what the person might have been like when alive. They find clues to personality and reminders of the body's humanity that are sometimes amusing, sometimes disturbing but always thought-provoking.

Tattoos, pacemakers, and even staples have all been located in or on cadavers, says Elbert Huang, and often prompt students to hypothesize about the person's life. "We made up this story about him," says Sherleen Huang. Her cadaver's tattoo, large size and physical fitness made her think he may have been in the military.

Elbert Huang says that the cadaver's smooth hands indicate that the man may have spent much of his life sitting behind a desk: "I had visions of him being an executive," he says.

Other features of the cadaver are more upsetting. "The worst day" for one student isn't necessarily as bad for another. But students agree that the process doesn't get easier as the course progresses, since different parts of the body are worked on at different times.

"I think that the worst experience is dealing with the fat that you have to cut through," grimaces Munoz. Trying to clear it away from various organs, he says, was like "sticking your fingers through mush." It even dripped on his shoes, Munoz says.

Many students agree that the face is difficult. "That's the part of a person you identify with," says Ajeya P. Joshi. Some of the cadavers' facial expressions added to his uneasiness, Joshi says: "Some looked like they were pretty distressed."

Students are required to split the skull in half, an act which adds to their queasiness, says Sherleen Huang. "That's where I really felt like we were messing up his body," she says.

The genitalia are also disturbing reminders of the cadavers' humanity, students say. In addition, it's a challenging region of the body to work with: "It was so messy." says Mario A. Meallet.

It was "a reality check" to work on her cadaver once the group began examining the abdomen, Ogilvie says. "There was just cancer everywhere," she says. To look at certain organs, her group had to remove tumors. "To see...what caused this man's death was a draining experience, and hard," she says. "It was really up close--what cancer looks like, what death looks like."

In order to study the back of the body, students have to pick up the body and "flip it," says Sherleen Huang. The contact made her uncomfortable, she says: "it was like you're hugging the body."

But most students say that dissecting cadavers is ultimately a rewarding experience. "I love learning this stuff," says Meallet, though he adds, "but the formaldehyde stinks."

"It helped for getting a sense of where things are in the body," Ogilvie says. The cadavers are also valuable at an emotional level, she says. "Irrational thoughts disappear: 'what am I doing here, why am I cutting up a body'," she says.

Working so closely with the bodies reminds students that everyone dies eventually, says Elbert Huang. "It makes you think about becoming older. It's all about mortality, death, dying, getting sick."

And one of Goodenough's essays explains that the living students have more in common with their cadavers than they might think: "We see ourselves in these donors...We see our histories, our roots, and our futures, what we must become. The donors were what we are; they are what we will be."

At the end of the eight-week lab, students can choose to attend the Medical School's service honoring the donors. Sherleen Huang says that she is considering going to the service.

"I feel like this man really did give us something," she says. By attending the service, she explains, she would be "giving him something back. Basically, saying 'thank you.'"