Travels (2 page)

Cadaver
 

It is not easy to cut through a human head with a hacksaw.

The blade kept snagging the skin, and slipping off the smooth bone of the forehead. If I made a mistake, I slid to one side or the other, and I would not saw precisely down the center of the nose, the mouth, the chin, the throat. It required tremendous concentration. I had to pay close attention, and at the same time I could not really acknowledge what I was doing, because it was so horrible.

Four students had shared this cadaver for months, but it fell to me to cut open the old woman’s head. I made the others leave the room while I worked on it. They couldn’t watch without making jokes, which interfered with my concentration.

The bones of the nose were particularly delicate. I had to proceed carefully, to cut without shattering these tissue-thin bones. Several times I stopped, cleaned the bits of bone from the teeth of the blade with my fingertips, and then continued. As I sawed back and forth, concentrating on doing a good job, I was reminded that I had never imagined my life would turn out this way.

I had never particularly intended to become a doctor. I had grown up in a suburb of New York City, where my father was a journalist. No one
in my family was a doctor, and my own early experiences with medicine were not encouraging: I fainted whenever I was given injections, or had blood drawn.

I had gone to college planning to become a writer, but early on a scientific tendency appeared. In the English department at Harvard, my writing style was severely criticized and I was receiving grades of C or C+ on my papers. At eighteen, I was vain about my writing and felt it was Harvard, and not I, that was in error, so I decided to make an experiment. The next assignment was a paper on
Gulliver’s Travels
, and I remembered an essay by George Orwell that might fit. With some hesitation, I retyped Orwell’s essay and submitted it as my own. I hesitated because if I were caught for plagiarism I would be expelled; but I was pretty sure that my instructor was not only wrong about writing styles, but poorly read as well. In any case, George Orwell got a B− at Harvard, which convinced me that the English department was too difficult for me.

I decided to study anthropology instead. But I doubted my desire to continue as a graduate student in anthropology, so I began taking premed courses, just in case.

In general, I found Harvard an exciting place, where people were genuinely focused on study and learning, and with no special emphasis on grades. But to take a premed course was to step into a different world—nasty and competitive. The most critical course was organic chemistry, Chem 20, and it was widely known as a “screw your buddy” course. In lectures, if you didn’t hear what the instructor had said and asked the person next to you, he’d give you the wrong information; thus you were better off leaning over to look at his notes, but in that case he was likely to cover his notes so you couldn’t see. In the labs, if you asked the person at the next bench a question, he’d tell you the wrong answer in the hope that you would make a mistake or, even better, start a fire. We were marked down for starting fires. In my year, I had the dubious distinction of starting more lab fires than anyone else, including a spectacular ether fire that set the ceiling aflame and left large scorch marks, a stigmata of ineptitude hanging over my head for the rest of the year. I was uncomfortable with the hostile and paranoid attitude this course demanded for success. I thought that a humane profession like medicine ought to encourage other values in its candidates. But nobody was asking my opinion. I got through it as best I could. I imagined medicine to be a caring profession, and a scientific one as well. It was so fast-moving that its practitioners could not afford to be dogmatic; they would be flexible and open-minded. It was certainly interesting work, and there was no
doubt that you were doing something worthwhile with your life, helping sick people.

So I applied to medical schools, took the Medical College Aptitude Tests, had my interviews, and was accepted. Then I got a fellowship for study in Europe, which postponed my start for a year.

But the following year I went to Boston, rented an apartment in Roxbury near the Harvard Medical School, bought my furniture, and registered for my classes. And it was at the registration that I first was confronted by the prospect of dissecting a human cadaver.

As first-year students, we had scrutinized the schedule and had seen that we would be given cadavers on the first day. We could talk of nothing else. We questioned the second-year students, old hands who regarded us with amused tolerance. They gave us advice. Try and get a man, not a woman. Try and get a black person, not a white. A thin person, not a fat one. And try to get one that hadn’t been dead too many years.

Dutifully, we made notes and waited for the fateful Monday morning. We imagined the scene, remembered how Broderick Crawford had played it in
Not as a Stranger
, growling at the terrified students, “There’s nothing funny about death,” before he whipped the cover off the corpse.

In the amphitheater that morning, Don Fawcett, professor of anatomy, gave the first lecture. There was no corpse in the room. Dr. Fawcett was tall and composed, not at all like Broderick Crawford, and he spent most of the time on academic details. How the dissections were scheduled. When the exams would fall. How the dissections of gross anatomy would be related to the lectures in microscopic fine anatomy. And the importance of gross anatomy: “You can no more become a good doctor without a thorough understanding of gross anatomy than you can become a good mechanic without opening the hood of a car.”

But we could hardly listen to him. We were waiting for the body. Where was the body?

Finally a graduate student wheeled in a gurney. On it was a blue denim cloth, and an underlying shape. We stared at the shape. Nobody heard a word Dr. Fawcett said. He moved from the podium to the body. Nobody listened. We waited for the moment when he would pull aside the cloth.

He pulled aside the cloth. There was a great sigh, a great exhalation of breath. Beneath the cloth was a heavy plastic sheet. We still could see nothing of the body.

Dr. Fawcett removed the plastic sheet. There was another, thin white
cloth beneath that. He removed this cloth. At last we saw a very pale form. Limbs, a torso. But the head, hands, and feet were wrapped in gauze like a mummy. It was not easy to recognize this as a human body. We slowly relaxed, became aware that Dr. Fawcett was still talking. He was telling us details of the method of preservation, the reason for protective wrapping of the hands and face. He told us of the need for decorum in the dissection room. And he told us that the preservative, phenol, was also an anesthetic and that it was common to experience numbness and tingling in our fingers during the dissection; this was not a dread paralysis we had caught from the cadavers.

He ended the lecture. We went to the dissection room, to choose our bodies.

We had previously divided ourselves into groups of four. I had given this group choice a lot of thought, and managed to link up with three students who all planned to be surgeons. I thought budding surgeons would be enthusiastic about the dissection, and would want to do everything themselves. With any luck, I could sit back and watch, which was my fondest hope. I didn’t even want to touch the body, if I could help it.

The dissection room was large and, in September, uncomfortably warm. There were thirty bodies on tables around the room, all covered with sheets. The instructors refused to let us peek under the sheets to choose the bodies. We had to pick one table and wait. My group chose the table nearest the door.

The instructors gave a lecture. We stood beside our bodies. The tense feelings rushed back. It was one thing to sit high up in an amphitheater while a body was shown. It was another to stand close to a body, to be able to reach out and touch it. Nobody touched it.

Finally the instructor said, “Well, let’s get to work.” There was a long silence. All the students opened their dissecting kits, got out their scalpels and scissors. Nobody touched the sheets. The instructor reminded us we could now remove the sheets. We touched the sheets gingerly, at the edge of the fabric. Holding our breath, we pulled the sheets back from the feet, exposing the lower half of the torso.

We had a white female, but she was thin, and very old. The hands and feet were wrapped. It wasn’t as bad as I had imagined, although the smell of phenol preservative was strong.

Our instructor told us we would begin the dissection with two people on each side of the body. We would begin on the leg. We could start cutting now.

Nobody moved.

Everybody looked at one another. The instructor said that we would have to work quickly and steadily if we hoped to keep on schedule and finish the dissection in three months.

Then, finally, we began to cut.

The skin was cold, gray-yellow, slightly damp. I made my first cut with a scalpel, slitting across the area where the thigh meets the body, and then straight down the leg to the knee. I didn’t cut deeply enough the first time. I barely nicked the skin.

“No, no,” said my instructor. “
Cut
.”

I cut again, and the flesh opened, and we began scraping away the skin from the underlying tissue. That was when we began to realize that dissection was hard work, both meticulous and strenuous. You did most of it with the blunt end of a pair of scissors. Or with your fingers.

As the skin spread apart, what we first saw was the fat—a broad expanse of yellowish tissue surrounding everything we wanted to see. In the heat, the fat was slippery and runny. When we stripped away this layer, we found the muscles, enclosed in a milky, cellophane-like covering. This was the fascia. It was strong and resilient; we had trouble cutting through it to the muscle beneath. The muscles looked like what you’d expect: reddish, striated, bulging in the middle and tapering at the ends. The arteries were easy: they’d been injected with red latex. But we had no idea what the nerves looked like until the instructor came over and found one for us—white, tough, cord-like.

The afternoon wore on, and took on aspects of a nightmare: everybody working, sweat dripping down our faces; the smell, pungent and indescribable; the unwillingness to wipe the sweat away because you’d only coat your face with phenol; the sudden horrified discovery that a bit of flesh has been flicked away and landed, sticking, to your face; the ghastly drabness of the room itself, bare, hot, institutional gray. It was a cheerless, exhausting experience.

Just the names we had to learn were difficult enough: superficial epigastric artery, superficial external pudendal artery, pectineal fascia, anterior superior iliac spine, ligamentum patellae. All in all, forty different structures that had to be memorized for the first day alone.

We worked until five, and then sutured the incision, squirted liquid over it to keep it moist, and left. We hadn’t managed to finish the dissection, as outlined in the lab manual.

At the end of the first day, we were already behind.

Nobody could eat much at dinner. The second-year students regarded
us with amusement, but we weren’t making many jokes in the early days. We were all struggling too hard to handle the feelings, to do it at all.

The autumn heat wave continued, and the dissection room became extremely hot. The fat deposits melted; smells were strong; everything was greasy to the touch. Sometimes the doorknob was so greasy that we had trouble turning it when we departed at the end of the day. Even when maggots got into one cadaver, causing the instructors to run around the room with flyswatters, nobody made jokes.

It was hard work. We were just trying to do it.

The weeks passed. The heat wave continued. We were under terrific pressure to keep pace with the dissection, not to fall behind. The first anatomy exams were getting closer. Two afternoons a week, we worked in the dissection rooms. And again on weekends, if we had to catch up. We began to make sour, grim jokes.

One joke made the rounds:

A professor of anatomy addresses a woman in the class: “Miss Jones, will you name the organ of the body that increases four times in diameter under stimulation?”

The woman becomes embarrassed, hems and haws.

“There’s no need to be embarrassed, Miss Jones. The organ is the pupil of the eye—and you, my dear, are an optimist.”

After the first anatomy exam, I got a letter in the mail:

Panic. A cold sweat. I was shaken. Then at lunch I discovered that lots of other people had received letters, too. In fact, almost half the class. I
went to see Dr. Erikson that afternoon. He didn’t say much; just some encouragement, some hints on memorization. Talk to yourself, he said. Say things out loud. Pair up and quiz each other.