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A Season in the Human Anatomy Lab
By Albert Howard Carter III
Picador Copyright © 1997 Albert Howard Carter III
All rights reserved.
A HEART IN HAND
THE ANATOMY BOOKS make it sound so simple. To remove the heart, you cut through the pericardia (the two tissue layers around the heart), you make sure the eight major blood vessels are completely severed, and then you lift the heart out of the chest. For the first-year med students in the anatomy lab, however, everything becomes complicated: the fine cutting in a crowded area, the hope of a good grade, the fear of "screwing up the dissection," and the thought that this heart was beating, strongly and warmly, in a living human being some weeks or even days ago. The med students cut slowly, some taking up to two hours to remove the heart from their cadaver.
I'm in one of the lab's four rooms to watch these students dissect. In this room there are six tables bearing six embalmed bodies of people who have died in the past year. At each table there are, usually, two students of the Human Anatomy course. At Table 4, however, there is only one student, Karl Jacobs. A quick worker, he is the first to have a heart entirely removed from the body. I watch him cut the last blood vessel and pull the heart up and out. For a moment he stares at it in the palm of his hand, then suddenly raises it over his head in an exaggerated gesture of triumph. Lights flash off his glasses; his lab-coated arm is a dramatic white column. He roars out "Hahaaaaa!"— the very image of a deranged scientist in a Hollywood thriller. Karl makes a huge grimace, as if he were a monster ready to bite right into this grayish but recognizable human heart.
Everyone else in the lab stares at this, the first heart in hand and the first truly theatrical gesture of the course. Up to today, students have been sober, timorous, in awe of this place and its strange proceedings. The five other dissecting teams envy Karl's progress and, perhaps, his unabashed outlook.
"Just like the Aztec priests!" a woman calls out appreciatively from across the room.
"Those Aztec guys must have been good — you know, strong," another student says. "To bust through the ribs and sternum, all these tissues." He gestures at the wreckage he is simultaneously creating and ordering in his own cadaver.
"Yeah — and fast," another adds. "The victims were alive, remember. The idea was to get the heart out while it was still beating."
I shiver briefly, recalling the Diego Rivera mosaics in Mexico City that re-created such primal rites. Although I'm across the aisle at another table, my eyes keep looking at this heart, Karl, and the new cavity in the chest of the spindly dead man lying face up. Now Karl examines the heart, turning it over in his hands. He trims up around it, pats it with paper towels, and starts to identify the coronary arteries. Soon he sets it down and turns to the chest cavity. But he has seen me staring.
"Come take a look," he invites.
I walk across the aisle to look at this complex thing, meaty, but punched with holes. I lean forward in my starched lab coat, my hands clasped behind me. About the size and shape of a fist, the heart lies on a paper towel. The color of cardiac muscle is somewhere between red and brown, but there are also bands of yellow fat and eight scattered holes, through which I glimpse the four chambers that pump our blood. Under the diagonal bands of fat lie portions of the coronary arteries; I can see them circling down from the top of the heart, vaguely like the "crown" that the word coronary suggests. So, I think, these are the faithful fellows you don't want to clog with fat.
"Go ahead, pick it up: it even fits real well," Karl says. I place my gloved hand over the heart and grasp it gingerly. When it doesn't collapse, I gently tighten my fingers around it. This odd thing pumps in my chest right now, I think. I turn my hand over, and the heart settles into my palm perfectly — just as Karl said.
"Hey, you're right," I say, and he smiles, a beginner in anatomy, but already a teacher to me.
I find the weight of the heart paradoxical: as a chunk of interlocking muscle, it has some heft. As a shell of meat with four empty chambers and eight holes, it feels light.
Karl is busy in the chest cavity. I look around the room. Ten other students work intently on dissecting hearts from their cadavers. I forget the smells, the tedium, the strange sights of the anatomy lab. I am glad to be in this strange place where the veils of the human body are pushed aside so we can see the secrets within; I am glad to look over the shoulders of these young people, full of energy, faith, and commitment. This is an odd place for an English professor on leave from his college, far away from home. How did I get here? Why?
THE OPENING OF the course seemed like a series of thresholds to adventure. Late August in Atlanta is steamy hot; the sun dazzles, even on the green-forested hills of Emory University. I have come here for several reasons. Ever since I was a kid, I have wanted to know what was inside the body and how it worked. As a teenager, I thought I would become a doctor; part of me has always wanted to go to med school, even as an observer. As a college teacher, I have felt that texts mean the most when they link up with reality, and what's more real than the human bodies we live in? I have enjoyed authors who give some sense of the embodiment of human life — Richard Selzer, Sharon Olds, Robert Murphy, Reynolds Price, Oliver Sacks, Paul Monette, Lucy Grealy — and I wonder whether my abilities as a writer can deal with the strange sights I am about to observe. I am risking an academic year on this project, one of my rare leaves from teaching, without knowing what the results will be. In a time when granting agencies virtually want your conclusions in your proposal before any investigation, this is a strange undertaking indeed.
With excitement I push open the door to the anatomy-physiology building. I walk slowly down the hall looking for the lecture room, seeing lab-coated instructors stride briskly past me; the students, typically in shorts and carrying knapsacks, also make their way to the first class meeting.
Settling into the back of the auditorium, I take a look at these students.
There are 113 of them, I've been told, and they are clearly a varied lot. I see men and women, white and black, Hispanic, Asian, and Anglo, a much more diverse class than it would have been ten years ago. They are mostly in their twenties, but some are a bit older. Among the men, I see a yarmulke, a turban, and two baseball caps. There is no headgear among the women, but a profusion of black, blond, and brown hair. We take our places in rows in the traditional steep rise of medical auditoriums, so that we look down on the lecturer. In the past, this arrangement allowed viewers to peer into the body of a cadaver as it was being dissected. Today, dissecting takes place in other rooms, while the high front wall here provides a huge area for projection of slides, one at a time or two side by side, at the eye level of the audience.
The first lecture describes the aims of the course and its organization. Dr. Arthur English, the course director, clips on a microphone and explains the details. A Ph.D. in anatomy, he is a moderately tall man, with a vivid white mustache. Having taught this course many times, he explains convincingly how it works. The course has three lectures per week describing the areas of the body to be dissected in the lab: the first lecture will discuss the back, and the assignments for the first two lab sessions will be to locate the parts just described.
English then introduces the university chaplain, Donald G. Shockley, saying that he will come to the labs and be "available for anyone to talk with." English says that we should be aware that the cadavers were living persons, all of whom died in the past year. They have willed their bodies to the university for research and education. While the six members of the teaching staff always wear lab coats, Chaplain Shockley never does: in his sport coat and tie, he's a reminder of the outside, nonmedical world, and the still larger world of spirit, transcendence, and ultimate values.
"Nine years ago," Shockley says in his soft Alabama accent, "some med students came to me and said, 'It just doesn't seem right to walk away from the table without some kind of closure.' I helped them create a Service of Reflection and Gratitude, as we called it, and every class since then has carried on this tradition. Near the middle of the course, I will ask for volunteers to develop this year's service."
I have heard about this ceremony; indeed, it is one of the reasons I have come to Emory. I want to see what impact it makes on the emotions and meanings evoked by the lab two floors above us.
* * *
The next day is the first formal lecture of the course, and our topic is "The Vertebral Column and the Spine." As I listen, I imagine that students must be thinking, How does the picture on the screen compare to the cadaver I am going to meet in the next hour? The lecturer is Dr. Steven L. Wolf, an intense man who strides about the stage, gesturing at the huge images above him. He uses a laser pointer — a bright red arrow — to focus our attention on particular features of the slides.
The lecture over, students head up to the lab. Some take the stairs, others the elevator. The eager ones surge ahead, the reluctant ones hang back. As I enter the third-floor hallway, I smell the sharp odor of formaldehyde. Students mill around in the hallway, clustering in prearranged groups of six and checking and rechecking the bulletin board where their assignments are posted. This information includes the table numbers, with groups of six students, whose names are followed by A, B, or C to indicate the pairs, or "teams," that will dissect together. Students recheck these assignments, in part to be sure where they're going, but also, it seems to me, to delay crossing the threshold through the wooden door with the opaque window. They plop their backpacks on large metal tablelike structures in the hall (probably unaware that these embalming tanks, called New Yorkers, have a cadaver floating inside). They put on their lab coats, most of which are fresh from the store, stiff and creased in rectilinear patterns. They take books and dissecting kits in hand, push open the door, and in a mild parody of a dinner party look for the numbered tables where they will work for the next sixteen weeks. I enter too, in the borrowed lab coat that gives me protective coloration. I intend to be invisible, a mute observer hidden by a magical one-way mirror. Dr. English has told me that he'll try to find some students I can follow through the course, but today will be a more general overview.
In the three main dissecting rooms, six stainless-steel tables are arranged and numbered as shown in Figure 3. The strange numbering system, I'll learn later, is for sequencing in lab exams. There is also a fourth room, with a single dissecting table, an addition caused by the large size of this year's class.
I survey one room. Each of the six tables supports a horizontal corpse wrapped in white plastic. Despite the covering, outlines of bodies are clearly discernible: the feet stick up, and the head has the necessary roundness.
I drift along the side, by the sinks. Nearby is Chaplain Shockley in his sport coat. One student passes by us and blurts out, "I don't want to touch the thing!" He doesn't stop walking, though, doesn't even look at Shockley, but continues through the tables until he finds his number.
The thirty-six students are now assembled at their tables, making a crowded room. Ordinarily, only two per table will dissect at a time, passing on their knowledge to the other four; this way a single cadaver serves six students.
The tables have solid rails all around, so that the bodies can't roll off. One end is tilted downward so that any liquids can drain into a bucket suspended under a hole. Each table has two blocks of wood to prop up parts of the body for easier exploration, and four attachments for book racks so that texts can be kept near at hand. Near each table is a big lamp on a tall, wheeled stand. There are also some twenty wheeled stools throughout the room, with circular seats of red, blue, yellow, and ivory, the only bright colors in this stark concrete room with beige walls.
There is a particular strategy at work here: by leaving the cadavers on their backs, the anatomy instructors make sure that students will have to touch and handle the dead body; the teams must work together to turn the cadaver over for the first dissection, the back. The students, therefore, will have to confront this cadaver, work as a team, and, symbolically, take charge of this dead body.
"How did he die?" I hear murmured at a nearby table.
"It's on the wall, over there, for each one," a student murmurs. I sidle over to the piece of paper taped by the door and see typed information about the cadavers; for Table 3, for example, it looks like this:
Table Number Six Age Date of Death Cause of Death
The five-digit number (also on a plastic band on the cadaver's wrist) will allow the university to return ashes to the family upon request. The cause of death was in this case cerebrovascular accident — probably a stroke. As I look over all the sheets I see that heart attacks, vascular disease, and cancer are the most common causes of death for these cadavers, as they are for the American population as a whole.
The class is subdued today. If students talk at all, it's very quietly and at their own tables.
The students open their boxes of latex gloves and awkwardly put them on. (Even recently, med students didn't use gloves for dissections; in the era of AIDS, however, gloves have become standard.) They draw the large white plastic sheet from the body and fold it up. Some hesitate with the damp, white blanket below, but that, too, is pulled away, and a strange sight lies there, an embalmed corpse. It seems a paradox. On the one hand, it is clearly the remains of an elderly person, a known entity. On the other hand, it is an eerie, almost unearthly version of a living body, something that is so foreign that I instinctively feel something here is wrong, dangerous.
As the coverings come off, the smell of formaldehyde intensifies, filling the lab.
Students wrinkle their noses and shake their heads. Some wipe their eyes, which are running in reaction to the fumes. Others wear face masks (with activated charcoal) over their noses and mouths to lessen the fumes' effect. The syllabus warns them not to wear contact lenses in the lab because these might absorb gases and chemical irritants.
"I wish I hadn't eaten lunch," mutters one, but no one becomes sick, and no one faints this year. Fainting is rare, actually, and is often attributable to other causes, such as no food for twenty-four hours. I have heard that some students cry upon receiving their cadaver, but I don't see any tears today. Either they are hidden from me, or the emotional preparation (including the presence of the chaplain) has, somehow, been sufficient.
The cadavers themselves are a tannish gray, lacking the enlivening pink from the red cells in circulating blood. Lips and nipples are not crimson, purple, or even pink, but muddy shades of gray. The eyes are shut, the features slightly swollen, perhaps from embalming. Fingernails are grayish yellow. The nail beds underneath are gray. The hands are lightly curved, as in life. The pubic hair is generally sparse and typically without any white hairs. The hair on the head has been close-cropped on all cadavers, leaving a stubble usually gray or white. The prevalence of cadaveric white hair seems to say, Yes, I was old enough to die; my death makes some kind of sense.
If I look at these aged heads alone, I find that the short hair makes discerning male and female difficult. And, lying down, the cadavers give few clues to relative height. The breasts and genitalia are the obvious marks of male and female. Three long cuts are common, the work of the embalmer: one at the throat, two at the groin; these have been sewn shut in large, even stitches.
The cadavers range in age from 57 to 101. This is a comforting fact: what a horror it would be to turn back the coverings and find a young person, or one the same age as the students. There are stories that circulate about this unveiling; some seem to be folkloric renderings of our deepest fears: "Did you hear about the med student who pulled back the shroud and found her grandmother — who had just died?"
Excerpted from First Cut by Albert Howard Carter III. Copyright © 1997 Albert Howard Carter III. Excerpted by permission of Picador.
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