The Anatomist: A True Story of Gray's Anatomy (9 page)

Six

T
WELVE DAYS LATER, I AM BACK IN THE ANATOMY LAB. IT IS DAY
one, number two—the first lab of a new course—and virtually everything is different: the time (9:00
A.M.
), the teachers (no more Dana, Dhillon, or Sexton), and the class size (just twenty-six). Even the students themselves look noticeably different—more athletic, more tactile and engaged with the physical, which is fitting as these are physical therapy students. But the most striking change of all is with the cadavers. They are fresh. In fact, they are as fresh as medical school cadavers can be—only six months dead—which makes them ideal for the coursework ahead. The focus of the class is neuromuscular anatomy, how the body moves and how sensation—pain, in particular—is transmitted and felt. With the permission of course director Dr. Kim Topp, I will be attending the thrice-weekly hourlong lectures as well as the three-hour labs. Dana had put in a good word for me.

This is not only the first lab of the session but also the students’ very first day in the UCSF master’s program in physical therapy, so they have barely had a chance to meet one another. Nevertheless, I, in my green scrubs, would never be mistaken for one of them. Dr. Topp requires her “PT” students to wear white lab coats, which make them look more like junior pharmacists than the pharmacy students ever did. Every so often, another dress code will be enforced, I have been told: sports bras and shorts, to be worn on days when the class will be supplementing the study of the dead with the anatomy of the living—themselves.

“So, do we just start?” murmurs Kristen, one of the four students at the table I have joined.

For several minutes now, the entire class has been silently standing at their assigned tables, waiting for instructions from Dr. Topp, who is slowly walking the perimeter. None come.

Another minute passes before I see the message sinking in: the class is expected to have read the syllabus in advance and to get right to work. “Yes, I think so,” I whisper back to Kristen. “Here, let me show you how to put a blade on a scalpel.”

The others at the table are Kelly, Cheyenne, and one of the few males in the class, Sam. The sixth member of our group is a sixty-two-year-old female who, according to the “Cause of Death” list on the side wall, had died of a stroke. The only incisions on her body are the small cuts at the neck and inner thigh where the mortician had injected the embalming fluid into major blood vessels, thereby using the circulatory system for one last go-round. After a half year spent in darkness as the preservatives preserved, this morning marks the body’s return to light.

The skin feels moist and supple and, though cold, surprisingly lifelike, thanks to a wetting solution whose key ingredient is, believe it or not, Downy fabric softener. Surrounding the cadaver are puddles of clear liquid, as if it had been sweating profusely in its vinyl body bag. By smell alone, I recognize this as excess embalming fluid, though the fumes do not bother me as much as they once did. There is no scent of decomposition.

The head is wrapped in gauze and covered in clear plastic, as are the limbs, which are tied together at the ankles and wrists. Kristen snips the twine in both spots, then she and I each pull an arm to the side. “Okay, that’s better,” Kristen says to herself, and she’s right, it is. Tied up, the cadaver had looked like a kidnap victim for whom the ransom arrived too late.

Kelly returns to the table with a rectangle of thick gauze, which, in a respectful gesture, she places over the cadaver’s genitals. Sam begins to read aloud from the lab guide. The main assignment for the week is to study the muscles of the upper body, but, first things first, we have to strip the torso of its skin and underlying fat. Step one: remove the skin from the chest.

Taking the lead, Kristen, positioned on the right side of the body, makes a crosswise incision from the top of the sternum to the small bump of bone where the shoulder blade meets the collarbone, the acromion process. (Every one of our body’s “bumps,” as the art student had referred to them—or
processes,
as they are technically called—has a name.) Without a word, she hands the scalpel over to Sam, who makes an identical cut on the left side. Sam passes it to Kelly. She slices straight down the middle of the chest to the naval, and Cheyenne continues with a cut to the outer right side of the abdomen. Next is my turn, which, for me personally, is a major milestone. This will be my first incision.

Wanting to get a better feel for how Gray and Carter had jointly performed the dissections for
Gray’s Anatomy,
I had asked Dr. Topp earlier if I might participate, not just observe, during lab. “Well,
that’s
a first,” she had responded with a warm laugh, noting that she typically gets the opposite request, students asking to be
excused
from dissecting. She said I was welcome to take part but reminded me that the PT students would be graded on their dissecting skills. I promised not to ruin anyone’s GPA.

The blade’s tip sinks easily into the skin and meets no resistance as I pull it across the cadaver’s abdomen; it feels as if I am slicing a soft piece of leather. I’d feared that I might cut too deep and damage underlying muscle, but in my cautiousness, I only give the cadaver the equivalent of an eight-inch paper cut. I retrace my line, then set down the scalpel. Though it is only ten after nine, Kristen, Kelly, Cheyenne, Sam, and I have already become a team.

With the double doors incised, we now have to pry them open, then off. Working in rotating pairs on each side of the body, one person grasps a tiny corner of skin with forceps and lifts while a partner slices the underlying fascia—connective tissue—with a scalpel. To do it cleanly is slow, painstaking work. When on scalpel duty, I find that using a gentle sweeping motion, as if wielding a miniature scythe, works best. Another helpful tip comes courtesy of the lab guide: after you have peeled back several inches, make a
buttonhole
in the skin—yes, that’s the word used—and hook your finger through it; this allows a better grip than with forceps. One thing I will not soon forget is the sound of skin being pulled off, a tearing sound, like old Con-Tact paper being torn from a shelf. With the removal of the skin, what remains on the torso is a lumpy coating of bright yellow fat. It does not just scoop off; it has to be either cut or plucked away with tweezers. Along with the fat, we carefully remove all of the cadaver’s breast tissue.

The atmosphere in the lab is very different from the pharmacy class, which often had a jovial buzz. There is no chattering here, no laughter. If anyone is squeamish, they are doing a good job of keeping it to themselves. But I do hear lots of sniffles, and at my table, everyone is teary-eyed, as if listening to Sarah McLachlan on an endless loop. This is the classic reaction to formaldehyde fumes. The farther we get into the cadaver, the harsher the smell.

Once the front of the torso is skinned and defatted, the musculature is exposed from the collar to the waist. We now must do the same to the back. The body is a good 170 pounds and the very definition of deadweight. Plus, it’s wet. So turning it over takes all five of us. We place a wood block at the forehead so the nose under the gauze will not be crushed.

Though we have gotten our skinning technique down, the rear torso proves difficult because there is less subdermal fat and the skin is more tightly enmeshed with the muscles of the back. The skin comes off in pieces, not panels. Ninety minutes later, though, our cadaver shows an impressive-looking vest of musculature, and all we have left to do is clean up our table. But this raises a somewhat uncomfortable question. As Kelly bluntly puts it, gesturing to the pieces piled on paper towels, “What do we do with all this skin?”

The short answer is, we throw it away, and I cannot help recalling how troubling this had been for one of the pharmacy students, a young man named Edo. After the second lab, as he and I left the building together, Edo had something of a meltdown. “We’re just tossing out parts of a human being,” he said. “Into a wastebasket!” He seemed in shock at what he had been party to. “It just feels wrong. That’s going to be
us
someday.” I understood what he meant. And yet, as I told him, I think there’s another way to look at it. Aren’t we treating the body with respect by using it for its intended purpose—to learn—and shouldn’t properly disposing of the remains be part of the ritual?

I point out to Kelly the large red medical waste receptacles placed throughout the lab. “We put it all in those,” I tell her and the others, “—skin, fat, anything from the body.” The material is saved and later cremated along with the cadaver. At the end of the academic year, the school holds a memorial service in tribute to those who gave their bodies to the program.

Kelly nods thoughtfully. “I’ll take care of it,” she says. The rest of us divvy up the remaining housekeeping duties, and, soon after noon, day one comes to a close.

The physical therapy class is small enough that, by the second lab the next morning, I’ve had a chance to meet all of the students. I am surprised by the range of specialties my fellow dissectors are considering once they have earned their PT degrees. Some, including Sam, plan to go into sports medicine, helping athletes get back in the game after career-threatening injuries, while another few, Cheyenne among them, are interested in working with individuals who require a much longer and more gradual course of rehabilitative therapy, such as victims of stroke or spinal cord injury. Kelly and a few other students plan to specialize in postsurgical PT, helping patients recover from mastectomies, for example, in which the loss of tissue and muscle requires relearning basic movements. One woman told me she hopes to work with pediatric patients, another with the elderly.

Whatever their chosen field, working with muscles is in all of their futures—and the body has some 650 to study. Today, we have to identify just 15, the major muscles of the back and shoulder, which, in the abstract, sounds quick and simple, but in reality, not so much. What makes it challenging is that musculature in an actual body rarely looks like musculature in an anatomical illustration, where each muscle is helpfully differentiated with shading and texturing. In the body, individual muscles often lie or fold so closely together that it is hard to tell where one stops and another begins. To identify them, we will need to find what look like seams between the muscles—“fascial planes,” these are called—and tease them apart with our fingers.

Our group is luckier than most, for our cadaver has an unmissable trapezius, the diamond-shaped muscle extending from the very top of the neck to the middle of the back and from shoulder to shoulder. It is so large and well developed, in fact, that the five of us wonder aloud what this woman could have done for a living.

“Probably a nurse,” offers Kristen, “you know, having to lift patients—”

“No, I’ll bet she was a truck driver,” muses Cheyenne in her
Fargo
accent.

“Yeah, a truck driver,” Kelly agrees, “and that might explain the stroke: too much fast food.” This gets nods all around, though I am still wondering why no one has suggested
physical therapist.

Using the trapezius as our compass (its attachment at the occipital bone being north), we are able to get oriented. Directly to the east and west, we find the deltoid muscles, which look like epaulets draping each shoulder. Deep to the deltoids are the four rotator cuff muscles and, just medial to them, the major and minor
rhomboideus
muscles, so named for their tilted rectangle, or rhomboid, shape. I have known of these muscles for years but only in the parlance of the gym—
delts
and
traps
and so forth. When seen as flesh, they command a higher level of respect, it seems to me. It just would not sound right to use
lats,
for instance, to refer to the huge sweep of muscle rising from the small of the back to the axillae, the armpits. (This is the muscle—a
single
muscle, in fact—that gives bodybuilders that distinctive triangular silhouette.) No, here in the anatomy lab, it deserves to be called by its full formal name, the latissimus dorsi.