Medical Meanderings 10 June 2009
Cutting Up ©
“He lived for others, he died for us.”
Common epigraph written on dissection tables circa 1900.
I clearly remember the first day of anatomy class, the second day of medical school in the summer of 1995. A large group of us, mostly new college graduates, stood nervously outside the anatomy lab doors. Although no one had told us to be quiet, we whispered with strangers who would soon be our lab partners. After a brief introduction from our professor regarding the layout of the anatomy lab, the textbook we’d be using, the location of the bathroom and so on, the big doors were opened and we filed in.
My three partners and I found our “humidor”: the metal table with two heavy, hinged doors in which the cadaver was kept. The doors were unlatched and carefully swung downward under the table. On the table was a white body bag with, obviously, a body in it.
When instructed, one of us (not me) unzipped the body bag, loosing a strong whiff of phenol and formalin preservative. The thin plastic was rolled back, and the petite 73-year old woman, whom we would come to know intimately, was exposed. She was on her back, naked, with face, hands and feet wrapped in moistened gauze to preserve them until that part of dissection—and to preserve our emotions for now. Her hair was shaved off, a fact that surprised me until I reflected on its necessity here. Her skin had an unnaturally firm, plastic look from the embalming process, which had also created many wrinkles as it dissolved some of her scarce body fat.
We started with her upper extremity—the arm. Two of us dissected each arm, one reading instructions and the other cutting. The first cuts were unnerving—we expected her to flinch, or bleed, or cry out, but of course skin is simply a material thing when life has left it. In a few days, we became comfortable learning to separate skin from muscle, ligament from tendon, nerve from artery. The details were overwhelming, the names foreign and functions complex. It didn’t take long to become so absorbed that we often forgot the arm we were exploring had hugged and waved goodbye.
From the upper extremities, we moved on to the chest and the back (which required the unexpectedly difficult task of turning her face-down). The head and neck required dissection of the face, another emotionally troubling task. Finally, we explored the pelvis and the lower extremities. Our cadaver was slowly disassembled into her component tissues, which were meticulously kept together. Finally, when we had learned all we could and passed the final examination, her 73-year old remains were cremated together, and given to her family for burial at a yearly ceremony held at the medical school.
Why, in this age of computer simulation, must doctors-to-be dissect human bodies? Because the feel of a nerve compared to an artery cannot be well-simulated. Because human beings vary more than books or programs can comprehend. Finally, because to help the living, the presence of death must not be as unnerving as it was to all of us uninitiated novices on that first day.