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A cadaver gets under her skin

A first-year medical student can't help but wonder while working on an anonymous donor — who was this man?

April 25, 2011|By Shara Yurkiewicz, Special to the Los Angeles Times
  • Shara Yurkiewicz learned more than just anatomy from a donor body.
Shara Yurkiewicz learned more than just anatomy from a donor body. (Phillip Kim )

We enter the gross anatomy lab at 8 a.m. and spend the next two-and-a-half hours palpating bodies, cutting through skin and subcutaneous fat, probing muscle layers and searching for nerves and blood vessels.

Before our first day, our anatomy professor spoke briefly about the special — and privileged — experience that lay ahead. "You will remember where you were standing," she said. "You will remember the first cut."

That cut was not our first interaction with the cadavers. Nor was it the most memorable.

We were supposed to start with the back — a relatively impersonal region with thick, well-defined muscles. But after we unzipped our body bag, we saw that our cadaver wasn't lying on its stomach. We would have to flip it.

For several minutes, my lab mates and I struggled to lift the heavy man — literally dead weight, and filled with gallons of embalming fluid — and turn him onto his stomach. I grabbed his left arm and leg to steady the body, and I felt slightly sick. Physically manipulating a dead body turned out to be much more jarring than making restrained surgical incisions through his skin.

It took me a few sessions before I could hold the scalpel and forceps correctly. Grudgingly, I learned to wield the dissecting scissors more like a surgeon (fourth finger in the hole) and less like a kindergartener.

What I discovered throughout lab was that the worst, most disturbing moments were the most familiar ones. To position the arm for cutting, I had to twist it carefully. The elbow joint still worked and the flexion resembled a living person's, not the stiff limb I had imagined. Brushing against the man's fingernails — grime still underneath them — was unpleasant in its familiarity. Seeing toughened skin and hair on the man's arms and legs gave me the same unnerving feeling.

It was the new and unrecognizable that unsettled me least. Human muscle and its surrounding fascia fascinated me. Pulling on a certain muscle in the forearm to move the cadaver's thumb felt like operating a surreal version of a marionette. Rolling up the skin and subcutaneous fat like a carpet after we had cut it away was too far removed from reality to make me shudder.

In these six weeks, I have learned that our bodies can differ substantially, with apparently no impact. There are certain things we'll never know about ourselves unless a careful anatomist dissects us. Some arteries, veins and nerves follow paths that differ substantially from what's shown in textbooks. Sometimes, they simply do not exist. In some people, the right kidney is higher; in others, the left is. A thigh can have a large benign mass, made entirely of fat. Cysts are very common, sprinkled throughout the body.

I learned that the body is almost entirely shades of brown, yellow, gray and red. The gallbladder and its contents are the only exception: a stunning bright olive green. In living people, it is robin's egg blue.

Our instructors talked quite a bit beforehand about how to maintain "respect" for the cadavers. We were told not to give them names — they already have names, we just don't know them. We were told nothing of their ages or causes of death. (There are many arguments about whether this dehumanizes the cadavers or protects their status and anonymity.)

When we palpated the gluteal muscles, feces emerged from the cadaver's anus. Should I feel embarrassed that I was thoroughly disgusted? I certainly would feel about the same way about a living person, and I'm not ashamed to admit it. Is it really any more respectful, then, to hide a feeling of disgust when the subject happens to be dead?

I was horrified the first time I held the cadaver's cold hand for an extended period of time. It was inhuman. This visceral reaction against death doesn't strike me as particularly disrespectful either.

I had been fairly certain that the experience would feel laden with emotion and that I wouldn't be comfortable if my lab mates treated the situation with anything other than intense seriousness. But I quickly realized that "respect" didn't stem from how we felt or what we said. It came from our deeper attitude toward the task at hand.

Intimate anonymity

One night, alone in the anatomy lab, I was reviewing our cadaver's abdominal and pelvic organs. I knew that the next time I saw him, I would be dissecting his face and neck. There would be little time for reflection. I lifted the sheet that had covered his face for the last month.

Our guy was entirely dissected, in some places far less than perfectly. During lab, I no longer mused about the now bloated, skinless hand while I was wrist-deep in intestines and embalming fluid. I no longer thought about "the person" or "the patient" while I cursed the smell — a mixture of embalming fluid and bodily contents, particularly when we dissected near the rectum.

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