In the old days of medical education, little thought was given to the emotional and spiritual weight of dissecting a human body. First-year medical student Ronan Payinda explains how that’s changed – and not just for those holding the scalpel.
Before I first cut into a dead body, it was as if there had been a curtain blocking me from a clear view of mortality. It was a veil that spared me from thinking about what the people I had known in life would look like in death.
For a couple of years before entering medical school, I volunteered as a caregiver at a hospice in Northland. Caring for the terminally ill always holds us in proximity to death. When you’re around people who know their life is coming to a close, death does not seem so distant and unimaginable as it does for most of us in our day-to-day lives.
The first patient I met at hospice was a man in his 50s who shattered my perceptions of life with a terminal illness. Every day I saw him, he was smiling and cracking jokes. He loved telling me stories of his journeys across the ocean and around the Pacific.
Sometimes, though, the jokes would leave the room, and he would look stern. It was in these moments that he clearly wanted to impart something important.“You’re young, don’t hold back, you’ve just got to go and experience everything that you can,” he told me.
In his journeys he had scored a crowd of amazing friends who came to visit him regularly. They all came from different walks of life, but their friend falling sick had reunited them. He seemed to be the common thread binding the group, and now he was weaving their lives together again. They would go for walks throughout the hospice gardens, change the flowers in his room every morning, and meet clandestinely in the carpark to sneak him McDonald’s.
One day I came into hospice and he was gone. His room was vacant, and his items had been cleared from the tables.
I stood dumbly in the room as an olive branch was used to flick holy water around the bed, the chairs. Karakia were delivered. The windows had been opened. A warm afternoon breeze circulated, rippling the curtains. Outside I could see the lush green of the Northland bush and the blue flash of the summer sky.
He was there, and then he was gone.
I followed row after row of medical students into the University of Auckland’s Human Anatomy Lab, approaching the room where lay the tūpāpaku – cadavers, as they are known in medical science.
In the old days of medical education, little thought was given to the emotional and spiritual weight of dissecting a human body.
In the 19th century, Harvard University faculty and students were sent to dig up fresh graves, stealing the bodies for use in the medical school. Generations later, medical schools have come a long way from the use of “resurrection men” to source cadavers, but, for students, the abruptness of the transition can still be jarring. One day, cutting dead bodies is illegal; the next, you’re handed a scalpel and told to get on with a dissection.
A group of Māori and Pasifika medical students first advocated for a formal process to lift the tapu from tūpāpaku and give the situation the respect it required. It was a demand to acknowledge those who dedicated their bodies to advancing medical learning, and to the whānau who let the body of a loved one be transferred to the dissection table.
The advocacy of this small group of students led to the introduction of a new process for the entire medical student cohort to participate in before our first dissection. Whakanoa is the removal of tapu, the act of freeing a tūpāpaku or environment from spiritual restrictions. And so, in March this year, all the new medical students of 2023 gathered in the lecture theatre of the medical school, filling every seat. People chatted nervously to their neighbours. The air vibrated with expectant energy. There was a sense of excitement (we had made it to medical school!), but also the growing realisation that we really knew very little about what it actually meant to learn medicine, or what to expect from the cadavers – what the faculty called our “first patients”.
It dawned on me slowly, and then all at once: nothing I’d ever done before came close to what I was about to experience.
We listened as members of the medical faculty described the significance of the whakanoa. We learnt about the psychological perspective, the importance of mātauranga Māori, and the emotionally charged process of bequeathing a human body. I started to appreciate the sacrifice the whānau of the donors were making. Almost immediately after death, they had allowed the body of their loved one to be passed to the university, knowing it wouldn’t return to them for months.
Among the speakers was Professor Papaarangi Reid who delivered a lecture on the significance of lifting the tapu from the tūpāpaku. She stressed that the process was non-denominational, welcoming those from all faiths and backgrounds. The effect of the whakanoa, she explained, was best described as providing a “cloak of protection”, shielding us as we embarked on a new phase of our life.
With this final note, we were directed to stand. Hundreds of students rose from their seats. University kaumātua and senior staff shepherded us down the halls of the medical school. We made our way slowly to the Human Anatomy Lab as karakia echoed through the corridors, shuffling through the bowels of a building we had never seen before.
As we filed into the chilling cold of the anatomy lab, I was still thinking back to my time at hospice. Death had always been present in that line of work, but I never had to look at it directly. When I had arrived at the hospice the afternoon when my first patient passed on, his body had already been taken away, the tables cleared, the windows opened.
There was that thin veil again, blocking me from seeing what this man – this living, breathing, wonderfully funny man – would look like when he had passed on.
When the time came to make the first cuts of the dissection, I picked up the scalpel and the toothed forceps hesitantly. This was not a synthetic model or a theoretical concept. This was the body of a woman with whānau and friends and a full life behind her, who had committed her body to help the next generation of doctors learn. The immensity of my privilege, and responsibility, weighed strongly on me.
I was surprised at how easily the scalpel glided through the top layer skin. I followed the instructions closely, slowly gaining confidence. I held the instruments more steadily. Nerves and muscle and tissue were revealed under the stark lights of the lab. But even as the hours went by, the thought kept returning: this could have been the tūpāpaku of somebody I knew.
The whakanoa was intended to lift the tapu from the bodies to be dissected, to respect their death and acknowledge their whānau. But at the same time I felt a lifting of the veil that had excused me from confronting the death of the first patient I had met at hospice.
I stood in the cold sterility of the anatomy lab in the University of Auckland, but my mind had returned to summer in Te Tai Tokerau, to the view of the Northland bush through the hospice windows, to the man who had sat in bed in that room and told me stories of his journeys across the sea.