We are delighted to share with you the first place entry for the 2022 MIPS x The Auricle Creative Writing and Visual Art Competition. The winner was Natalie Evans, with a piece titled “Stardust” in the Creative Writing Division. We hope you enjoy this fascinating read as much as we did. If you would like to see all winners in the competition, see The Auricle’s July-September Edition.
Meditations on Medical Dissection
It is 8am on a Thursday morning and in front of me lies a bag on a metal table. I am nineteen years old and never even been to a funeral. The room has very good ventilation – but an unsettling odour still lingers and there are small puddles on the floor. I am standing there with three other medical students – my anatomy group. About ten more groups in the room stand before their own dark blue bags. We are told to feel the bag, to orientate ourselves with the stiffness beneath. We do so, patting at the bag gingerly with our gloved hands. Then it comes time to unzip.
§
Long ago, another’s hands hover tentatively over a similar body – except this body is that of an executed criminal, his soul left back at the gallows where his breath disappeared into silence. The person crouching over the already decaying corpse is considered a criminal for this act of bodily desecration. This is in Ancient Greece in the second century BC, where medical dissection is recognised to have begun.(1) Those who wished to access bodies for dissection were forced to obtain them via illegal means such as grave robbing and body snatching.(2) A change in attitude towards dissection began in the third century BC, when royal patronage allowed dissection in Alexandria, Greece, in order to establish it as a ‘glittering centre of literary and scientific learning’.(1) Prior to this, official exploration of the human body was superficial both literally and metaphorically.
However, this small sliver of discovery was brief, and what followed was a retreat into the old ideas and beliefs surrounding dissection. Religious taboos and societal notions restricted scientific progress until there was a ‘revival’ in Medieval Italy at the outset of the fourteenth century.(1) At this time, religious authorities gave permission for human dissection conducted within university premises, and this occurred once or twice a year using executed prisoners.(3) In the fifteenth century, many physicians obtained bodies for dissection by unethically convincing families that their loved one required a post-mortem, which in most cases was untrue.(4)
It is not only medicine that has profited from the innards of man being explored. The artistic sphere was also responsible for pilfering the dead to further the ‘portrayal of [the] human figure’.(1) Leonardo Da Vinci, Michelangelo, and Baccio Bandinelli were all practiced in stripping back the flesh of man’s clockwork and uncovering what makes us tick. With such a dire demand yet limited supply of cadavers, even those still living felt under threat of being murdered for their bodies. Although individuals living in poverty were the main targets, there is a rumour that a Spanish aristocrat was set upon and dissected whilst his heart was still beating.(1)
Thus, human dissection has evolved from being a criminal act bestowed upon criminals, to a consequence of poverty, to a process of informed consent and respect.
§
Prior to entering medicine, death had been imagined as a stillness, an ending with closed lids, distant weeping, church bells, a tableau of black. In the movies, death transpired as a mise-en-scène of violence with gunshot or stab wounds, necks bent at bizarre angles, and scarlet pools spreading over wet asphalt. There had never been a time when the idea of death conjured up forceps, surgical scissors, sinks, gloves and slippery floors. But there we were, tentatively hovered around a cadaver, hands within white or blue gloves, and a tray of surgical instruments gripped nervously. Now we’re unzipping the bag and so is everybody else. I start seeing glimpses of the bodies and I wonder if anyone will faint and if so, that person better not be me.
Our donor was a man. His face was covered. Nausea needled my stomach because this was not how cadavers were supposed to look. Didn’t cadavers look like the preserved sections in glass we had studied in specimen class? Why did these bodies appear as if they had simply fallen asleep? However, after the initial shock, we became wholly invested in writing our dissection plan on the whiteboard and beginning the hunt for the elusive brachial plexus. After one hour we were all at the sinks, turning the taps to let loose streams of water which cascaded down the long metal basins. The sinks reminded me of the troughs that fed farm animals, and the crush of students washing their hands made me feel like I was part of a medical student herd.
Twice a week we shrugged on lab coats, donned gloves, fit blades into scalpels, and collected the scissors and forceps on the tray. We were practiced at writing on the whiteboard the list of tasks for the day’s dissection, unzipping the body bag, receiving a handover from the previous group about what they had accomplished, and beginning.
We also became adept at the unspoken things, like learning to hold your breath whilst opening the body bag, eating lunch even if you are not hungry beforehand, and remembering to wear shoes that you do not mind touching the fluid on the floor. At some time, at some moment – standing amongst both the living and the dead had changed from ordeal to routine.
One member of my anatomy group named our donor Sir Gregory. This christening into the afterlife was adopted by many other groups and for us, the name stuck from then on. We were very lucky to have Sir Gregory as he possessed clear anatomy and lacked any confusing anatomical variations. One day, an echo of his life unexpectedly emerged when we stumbled upon a tattoo on his arm of a name. We could only guess at what this name might have meant to Sir Gregory, a secret locked within his earthly vault.
Survival is the human body’s most gifted architect. Every hollow, chamber, space, layer of muscle, skin or outline of bone has been expertly crafted to imbue the greatest working efficiency and survival edge. Gazing down at this accomplishment of biological machinery, I could only imagine the sight if blood coursed within the vessels and the body performed its triumph of animation. However, with this complex feat of engineering comes a very weighty caveat – with such intricacy comes great capacity for error. This sentiment is true for many themes of life – but is equally and most pertinently true in the physiological nature of life itself. In this way, the benefits of dissection became very clear to me very quickly. The secrets of the human body were right before our eyes – presented in a form which a textbook could never hope to reproduce. Most startling was the discovery that the human body does not possess colour coding and that as each person differs mentally and physically, anatomically the variation can be endless.
Over time, my anatomy group began to develop the ability to differentiate between arteries, nerves and veins based on appearance and feel. To hold an organ, feel the elastic bounce of an artery, fashion a window in the atrium of the heart then view the valves within – these experiences are the capstone of dissection. It was in dissection where I realised that “heartstrings’’ are a real structure. Anatomically, your chordae tendinae, colloquially known as heart strings, are connective tissue cords that connect small papillary muscles to the valves in the heart. These small strings anchor your valves whilst the heart pumps blood. Thus, if something “pulls at your heartstrings,’’ I imagine some force pulling back on these strings like reins on a horse, causing the heart to buck under the strain of such emotion.
There is also an importance to dissection that is separate to the anatomy. To physically cut another human being does not come naturally – so as a student you learn how to cut with compassion. A new level of empathy develops to ensure you are both respectful to the donor and to minimise damaging a structure that might be required later. Simultaneously, the student must be confident when attempting the dissection, as if they are too anxious about each tiny incision, nothing gets done and precious time is wasted. Although it seems unkind to alter a person by such physical means, the purpose of the whole exercise is to learn as much as possible and ensure the donor’s contribution enhances your understanding. Some of the most important concepts our group learned were from making mistakes – mistakes like confusing the paths of major arteries – which are better to be made on someone who no longer requires their arteries than in clinical practice.
Our tutor described a case where a woman had an operation and was severely ill during her recovery. Once this was investigated it was discovered that both her ureters had been cut during the procedure, thus her body had been unable to excrete urine. It is hard enough identifying objects in a still body, let alone one that is aflush with life, however errors like these must be mitigated at all costs through rigorous training and educational experiences such as dissection.
§
One day we moved to the new anatomy building. Compared to our old building it was gargantuan, with a green speckled façade that resembled a fungus. Inside was a lot of empty space punctuated by black stairs that slashed down the middle like unimpressed eyebrows.
Seeing the donors in this new space I found I was glad they inhabited brighter and sleeker quarters. It was as if they too had been given a gift – and the snowy whiteness of it all imparted a heaven-like quality. There were also screens placed around the room, on which our tutors could illustrate a structure from a specific donor to the whole class. In a sense – with the bright lights and screens – the donors were metaphorical film stars in a limbo universe.
§
Suddenly it was the last day with the donors who had helped us in our medical journey for two semesters (semester two of first year and semester one of second year). When I began dissection in first year, it was with a male donor who had been claimed by another group this year. This semester I had a new anatomy group and a female donor who had helped us to understand female anatomy. Our tutor told us to focus our dissection on the pelvic area – but we were also free to explore any other area so far dissected, as it would be our last chance to do so.
A timer ticked down to zero. At zero everyone returned to their donor and our anatomy lecturer conducted a minute’s silence. As silence descended we all shared a moment with the donors – silently thanking them for their generosity and the privilege they had honoured us with. I found myself imagining my donor’s life – projecting a film in my mind of someone running in the sunshine – a kindly voice – a smile.
The minute was up. Our anatomy lecturer walked down the rows announcing cause of death.
Table One – Male – 72 – Cause of Death – Multiple Organ Failure
As she read through the list I kept in mind Sir Gregory from last semester and wondered again which table he was this year. The lecturer arrived at our table. Cause of death:
Metastatic Lung Cancer
Cancer was the prominent grim reaper in the room. It is the great erratum of biology, our own cells turning rogue and militant against the life that bore them, a phenomenon that to this day we have not escaped from. We were very much surprised to learn that one of the donors was over one hundred years old, which generated a small crowd around his table. After discovering the cause of death, we were given a small window of time to view each other’s donors again, now with discerning eyes.
It was time to bid our donor goodbye. We made sure to replace her organs to their rightful place as best we could. I lowered her thoracic cage and moved the two halves of her pelvis back as close as possible to her abdomen. Then we zipped up the body bag.
§
With a new semester comes a new season, new tutorials, and new bodies. It is semester two of year two and a new workbook is provided in our first anatomy class. This time my anatomy group congregates around a different table. The man stretched before us will lend us his head and neck, and the Year Ones will simultaneously dissect the upper limb region. I realised that the other cadavers we had dissected last semester had probably been cremated by now, and this realisation made me feel as if the donors had died for a second time.
There is a 1941 film called A Woman’s Face, which stars Joan Crawford in the titular role. It revolves around Anna Holm, a facially disfigured woman who spends her life punishing the world that injured her. By chance, her path crosses with that of a doctor who specialises in restoring normal appearance to victims of facial trauma. The doctor offers to help her, pro gratis, and once she agrees the film falls away neatly into two halves – before and after the operation that changes Anna’s life. There is one line in the film that is quite magnificent. When the day comes for the bandages to come off Anna’s face – no one knows whether the operation has been successful – or whether her features will have been destroyed forever. The doctor says to Anna, ‘If this operation’s a success I’ve created a monster -’ There’s a beat as he flicks on the lamp, ‘- a beautiful face and no heart’.
The disconnect between face and soul is a concept often explored in literature, film and philosophy. We have no control over the face we are born with, and our minds and behaviours come from a deeper place – yet the face has such power to elude and seduce. However, all that beauty or distinctiveness is the equivalent of the thin crust upon a planet’s surface.
In A Woman’s Face, it unfolds that although Anna nearly crumbles into the monster she has always called herself – she ultimately chooses the path of one with a heart. Thus in the end, both face and soul are united. All of this provokes me to wonder at how our faces affect us – and how I will feel when removing someone else’s face. It is curious to note that the only part of the donor that is separately covered inside of the body bag is the face. For some reason, the face is deemed most private, and most revealing.
§
As I walk to the table of gloves I survey the room and the small but critical change in the presentation of the cadavers. The faces of the donors are visible. Standing around the table, I see that the skin of the lower right half of our donor’s face has been cut and can be retracted if need be. I had sometimes wondered, before my medical studies, what the face of somebody who had died looked like. Would their eyelids slowly shut and fall like a curtain over the eyes as life’s performance ends? The eyes are ‘the window of [the] soul,’ as described by Shakespeare who himself drew inspiration from the biblical phrase, ‘the eye is the lamp of the body.’ Would the departed individual appear calm, tranquil, or simply frozen, trapped in an expression as the winds of life changed? Now I can say that with death, the face assumes no ubiquitous, ‘deathlike’ expression. The face simply remains in a single pose that differs between donors, with eyelids that may be open or closed, and mouths that may also be open or closed.
To begin our dissection, we refer to the other side of the face, and to the depths of previous cuts – and then the belly of the scalpel contacts the skin and someone makes an incision. The incision ends up being a straight line parallel to the nose, one long cut made up of many hesitant cuts interspersed by referring to the other side and discussion like –
‘But what’s that thing there?’
‘Should we cut it?’
‘Scissors are on the tray if you need?’
‘Could it be a nerve?’
‘Am I on the right layer?’
‘Maybe a bit deeper.’
‘You did a great job.’
We all stare at the fifteen-centimetre incision that took half the class to make. Looking around, the faces on other tables were in various states of removal. In life, some people are blessed with faces of great beauty and symmetry, others possess facial features that are striking in other ways. There are faces that tell stories of intelligence, disappointment, happiness, and regret. However, in the end, at the finale of existence, everyone possesses the same ultrastructure beneath. That dimple that emerged as you smiled, the soft blush that dappled your collagenous cheeks, the wrinkling that creases the thin papery skin – they all diminish once you wade into the pond of death. They hover as in a dream, just above the rippling surface of such a pond.
§
Our final day of anatomy arrived abruptly and without warning. Everyone was taking their lab coats out of plastic bags and donning them quickly – casting everything else aside. It felt strange to wear the starchy white coat outside of the laboratory, which in normal circumstances was against the rules.
Outside in the sunlight was a photographer as well as all the anatomy tutors and lecturers.
My anatomy group linked arms as we burrowed our way through the crowd to stand on one of the tiered stairs together. As the light flashed from the camera, capturing all our cohort and the tutors together, another image entered my mind. I saw the photographs of medical students which were printed on the wall of the anatomy imaging room, the photographs my eyes had often wandered over to whilst they were meant to be observing radiological imaging. I remembered when I found the first woman in the photographs – and then a few more appeared, and more and more. I had also found myself looking at the names below the photographs and wondering where those students were now. As I stood on those steps, I wondered where our photograph would end up. I wondered if one day somebody else would stare at the grainy image of our faces and imagine who we had been.
§
Throughout my astonishing journey in dissection, I had direct experience with three donors. The first, Sir Gregory, who assisted with upper limb, lower limb and the thorax. The second, a female donor – Miss Marple, who assisted us with the thorax, abdomen and pelvis. Our final donor was another male, Obi-Wan, who bequeathed us his head and neck. When we left each day to go home, they remained. When we went to the movies or the library or to parties – they lay patiently for us to return. I used to be afraid of death, I think I probably still am – but I realise now it is the caveat that comes with life. I have seen mortality with my own eyes, and I have seen that it is the ultimate equaliser, at least in the present day. Reflecting on dissection class, eternity, and the donors who were our first patients, I have often found this quote from the 1997 film Gattaca rippling up from my mind:
‘They say every atom in our bodies was once part of a star. Maybe [they’re] not leaving. Maybe [they’re] going home’.
References:
1. Ghosh SK. Human cadaveric dissection: a historical account from ancient Greece to the modern era. Anat Cell Biol. 2015;48(3):153-69.
2. Garment A, Lederer S, Rogers N, Boult L. Let the dead teach the living: the rise of body bequeathal in 20th-century America. Acad Med. 2007;82(10):1000-5.
3. Hildebrandt S. Capital punishment and anatomy: history and ethics of an ongoing association. Clin Anat. 2008;21(1):5-14.
4. Park K. The criminal and the saintly body: autopsy and dissection in Renaissance Italy. Renaiss Q. 1994;47(1):1-33.
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