The First Cut

Today we began the dissections.

Before I go into detail, I'm going to describe the earlier part of my morning. Maybe someday when I look back on all of this, I can deduce that some of what I'm feeling can be attributed to extenuating factors outside of the prosectorium.

I probably chose a bad day to do the requisite 12 hour fast for the blood tests my physician ordered for me, because not only did missing my morning coffee set me off on a bad note, I also had to forgo my usual breakfast of dried fruit and walnuts. Caffiene, fiber, proteins and omega 3 fatty acids baby, it's the breakfast of champions.

I was already feeling frazzled from returning late from Monday night's Kinesiology class, only to have to rush to school early Tuesday morning only to find the parking lot full. We parked over by Home Depot and practically ran to my Psychology class, which I ended up being about 5 minutes late for.

The topic in Psychology was stress. This was no mere coincidence, as I planned my semester around my Anatomy class. I would take Bio230 with Dan Trubovitz, and Bio232 with Kevin Petti, who I felt would be an extra boost, given Dan's lax teaching methods. I also decided this semester to retake Psych101, which I felt would help convince me that I wasn't sociopathic or mentally unstable for taking Bio232.

The past 3 days leading up to today, I'd been dreaming about the cadavers. It's always the cadaver of Mike, which is the one I'm most familiar with. I don't know what his face looks like, but in my dreams I see it. It's gray and emaciated, with the superficial fascia removed and only the musculature showing. The only dermal layers left on his face are the layers surrounding the orbit of the eye, and the lips. It's a ghastly sight in my dreams, but the ghoulishness is offset by his friendly demeanor. In my dreams, Mike is animated, warm, and alive... as warm and alive as a cadaver could be. Needless to say, I haven't been sleeping too well the past few nights.

After Psych class, I head over to the anatomy lab and wait for Kevin to open the doors. I lean over the railing and look out at the clear, blue sky. It's amazing how clear today was, for the past several days were filled with dark clouds, heavy with rain. It's cold and windy, and I wish I'd brought a jacket. I would lie if I said I wasn't nervous.

After Kevin let us into the prosectorium, we look at the harvested specimens once more. He says that it's up to us to be leaders and determine how we want to go about opening up our cadavers, to see if there's anything we can find that would be worth harvesting and saving. We wet down the specimens with embalming fluid and put them away.

We push Mike's cadaver aside for the meantime. We are to work on the middle cadaver (the male cancer patient with the chemo portal) and the newer cadaver (female cancer patient, obese). We split up into two groups of 5, pick a cadaver, and get to work. Kevin read us the death certificate of the female cadaver, and even though I saw her the day she arrived at Miramar, I didn't know all the details as I do today. She died in June of 2008 at the age of 60. We received her on November 4, 2008, so she's relatively fresh. She died of malignant lymphoma. We all wondered if we would see signs of cancer in her lymph nodes. We won't know until we open her up.

Kevin shows us how to score the skin before making our initial deep cuts. He shows us how to scrape the adipose from the dermis, leaving behind the honeycomb shaped structures of the dermal papillae. My group mates are Susan, Andrea (different from my Bio160 lab partner), Cynthia, and I think the last one is Natalie. Her name escapes me. Cynthia has taken the Bio232 class before and has worked on the face of our cadaver, prepping her for the head and neck seminar Kevin hosted over the winter break.

I like to say I was mentally prepared for the unveiling of her face. But it was already cut up and I wasn't expecting to see her right away, but it is what it is. You sink or swim. I was thinking we'd see her face towards the end of the semester, but I digress.

She looked like she was in pain, as if the cancer that ravaged her body decided that she would have no peace even at the very end. Her face was frozen in a painful grimace, her eyes shut, and a brownish liquid coming out of one corner, as if they were tears stained with the ugliness of death. Her lips were cut and split, and her facial skin was cut in sections so that it could be reflected from the body to show the underlying structures. I instinctively take my gloved hand and wipe away the tear-like secretion, then realize that she no longer feels any pain. She feels no sadness, she feels nothing. She has moved on.

We start to work on her torso, taking the time to reflect the epidermis and dermis, removing the adipose tissue from the underlying fascia. We chit chat with each other to ease the tension, to get to know each other, and to make this gruesome task more bearable. There is so much adipose along her sternal body alone that it takes us the better part of two hours to clear a section three inches across and seven inches down. We scrape away fat with scalpel blades and a metal scraper. It is a tiring and tedious task, and at one point Susan asked if we could use a spoon to remove the fat. Andrea and Tammy are working on her lower right leg, reflecting the skin along the anterior tibia, distal to the patella.

I ask Kevin what we should do with her breasts. She has substantial breasts, more than what usually makes it into the Miramar College prosectorium. The last female cadaver we had was a tiny, petite little thing, and she was relatively flat. Kevin comes to my group and we discuss what we can do with her breasts. I suggest skinning one of them to show what the breast looks like underneath the epidermis and dermis, and he agrees. He amends my suggestion by saying we cut around the areola and leave it intact. With the other one we agree to make a midsaggital cut through the areola and nipple, so that the breast tissue looks like what you'd see in a textbook illustration. We talk about her feminine parts as if they were objects, and not as if they were anything human at one point. I wonder if this means that I'm getting better at objectifying the tasks put forth, and learning how to separate my personal beliefs from my clinical side in a manner much deeper than I've ever had to before; or does it mean that I'm learning to be callous and uncaring?

Towards the end of our time, we have removed about 3/4 of a cup's worth of adipose tissue. I make a comment that it looks like ghee. Kevin asked, "Well, what is butter made of?" We all answer in unison, "Fat."

Somebody asked what we were having for lunch. I say anything without butter.

We clean up after our time is over, and we all head out of the prosectorium. I say bye to my classmates, and we walk out with Kevin. The first thing I do outside is look at the mountains in the distance, and inhale a large breath of cold, winter air.

I don't know what to think. I'm feeling lightheaded and overwhelmed. Jerry takes me straight to Kaiser Permanente so I can get my labs drawn, and from there he takes me to lunch. By the time I took a bite out of something it was 3:15PM. My last meal was the night before, at 10PM, seventeen hours prior. I instantly feel better, but I can't get my mind off of my cadaver.

She died young. She looked as if she were still in pain, and I couldn't help but feel that her grimace in death was also in anticipation of she guessed might be done to her body post mortem. She knew that she was donating her body to science, and I know that I should sleep in peace knowing that I'm not defiling her in any manner, and that she is being treated with reverence and respect. She was one of us, she is us, she is who we could be, and yet she is so much more than the sum of her body parts and structures. She is benevolent, she is generous, and she has given every student who steps into that room a gift that so very few are willing to give.

Great teacher, I give you the name of Ruth.