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Introducing Medical Students to Their First Patients

James Reed, director of Geisel School of Medicine’s anatomy lab, was in his first year of mortuary school when he saw a flyer for the Walt Disney College Program. It appealed to his sense of adventure and spoke to his conflicted feelings about entering his family’s profession.

Looking for a fresh start, he applied.

Reed grew up in a family of funeral directors beginning with his grandfather, who embodied the tradition of cabinet-maker as undertaker—Reed Furniture and Reed Funeral Home lived side-by-side in the same building in their rural Pennsylvania town.

“At that time, you could see prices for caskets, embalming, and funeral services on one page of the price list, and, on the next, prices for dining room tables, chairs, and cabinets,” Reed recalls. “My uncle has the original price list in his funeral home.”

In our culture, we don’t talk about death very often. But in my family, it wasn’t difficult to realize there is an end to all of this.”

- James Reed

Everyone in the family was involved in some aspect of funerals. Exposed to the intricacies of death at a young age, Reed says working in the family business shaped his thoughts about death and dying as a natural part of life. “In our culture, we don’t talk about death very often,” he says. “But in my family, it wasn’t difficult to realize there is an end to all of this.” He thinks it is something that needs to be discussed more often.

That being said, Reed rebelled against the family profession as a teenager although he never felt pushed into the business in the way his father had been pushed by his father. And though he went to mortuary school right out of high school, he contemplated doing something different.

Accepted into the Disney program, Reed happily left the funeral industry behind to begin his internship at Walt Disney World in Florida—his first foray into working outside the family business.

“It was very different for me,” he says. “For the first time I was around people who were not like me—my six roommates were different both in lifestyles and backgrounds, and for some English was not their first language. Being in this diverse environment was the most beneficial part of working for Disney.”

While Reed never feared trying something new, being pushed well outside his small town comfort zone at both work and home forced him to either embrace his fellow interns’ differences, or leave. He chose to stay.

Unafraid of talking to groups, a skill honed at both the furniture store and funeral home, Reed transitioned from being an intern to an employee leading attractions and conducting 10-minute tours at the Jungle Cruise. He was having fun, had met the woman he would marry, and was seriously considering a career in the hospitality industry. But several years later working in an amusement park was no longer fun, becoming nothing more than a job. Reed wanted a career.

It wasn’t until I could be present for the entire process, from the point just following the time of death to a time well past the actual funeral, that I could see the benefit of the profession.”

- James Reed

He returned to his hometown and began working in his father’s funeral home as an unlicensed assistant. “It was more fulfilling than anything I’d done—I began seeing it as a career rather than a job to just pay the bills,” he says. “I think being away from the funeral industry for three years gave me a new-found appreciation for it.

“Being able to help a family acknowledge and work through their grief was an aspect of the business that I didn’t really have much exposure to when I was younger; I was mostly helping my father behind the scenes after school and on weekends,” he adds.  “It wasn’t until I could be present for the entire process, from the point just following the time of death to a time well past the actual funeral, that I could see the benefit of the profession.”

Reed decided to return to mortuary school even though he knew he could no longer live in his hometown after he graduated—both his uncle and father operated separate funeral homes there, and it would be a long time before he could take over his father’s.

“Had I made any other choice back in Orlando, I would be such a different person than I am today,” he says. “I can’t imagine I would have chosen to leave my small town again to move to Vermont.”

Ever adventurous, he landed a job with a funeral home in Vermont for a few years prior to becoming director of Geisel’s anatomy lab.

As a funeral director, Reed thinks it is important to provide a space for people to experience their grief in a way that is right for them, as opposed to giving them what social norms dictate. “My father is very good at that and I think it’s the most beneficial thing you can do—respond to the bereaved rather than push them in a direction you think they should go,” he says. “I’ve never had to compromise my beliefs. I have always told families that if they are comfortable with a decision, it’s the right decision, and knowing that you are helping people who had difficulty processing a death to feeling better about it after the funeral—I’m proud of that.”

Drawing on his experience working with the bereaved, Reed strikes the right tone when introducing Geisel students to their first patients.

“I don’t know how other lab directors go about it, but I always take the stance we are here to perform these tasks in a respectful manner by acknowledging these donor cadavers were human beings with family members,” he says.

Though anatomy can be learned using casts, Reed believes they give students a false sense that all human bodies are going to look alike. “But if you spent time with 10 anatomical donors, you can see than none of us are the same,” he says. “We teach the students there is a pathology that led directly to the cause of death. But when they see an anomaly, they need to understand the anomaly did not contribute to the cause—I think the cadaver lab is the most effective way to convey this message.

“And when you talk about the humanist side of everything going on in the lab, it is not the least bit effective to look at cast models and treat that as a first patient experience.”

On the first day of anatomy lab when medical students meet their first patients, the hands, feet, and heads are wrapped to prevent moisture loss, “but also because they are also the most humanizing features,” Reed explains. “When looking at a hand, there’s no denying that it’s human—feet to a lesser extent—but when you look at the cadaver’s face you are able to intuit whatever your mind is able to imagine about them. We do have students who have issues in the lab, especially when we get those parts of the body that humanize cadavers.”

Humanizing patients beyond a collection of symptoms is something Dartmouth does really well throughout a student’s medical school experience.”

- James Reed

Reed says a big part of his job is talking about death and dying to help medical students having difficulties with cadavers move through the dissection process—balancing what they are learning in the lab with never letting them forget what they are doing. “I don’t remove tattoos or nail polish because sometimes it’s the nail polish that helps students get through it,” he offers.

“Humanizing patients beyond a collection of symptoms is something Dartmouth does really well throughout a student’s medical school experience,” he says. “They gain more than anatomical knowledge from this class, and anything that gives medical students knowledge beyond the subject matter is a keystone experience that will inform them as physicians.”