Tuesday, October 19, 2010

Grossness in the Lab

There have been many, many books, articles, essays, and poems written about the cadaver.  There have been a similarly large number of writings about why death fascinates us.  I will try my best to avoid the obvious and cliched in this post.

Today marked the third day of dissection.  Every day, for the greater part of a month, we enter the gross anatomy lab at 8 am and spend the next two and a half hours palpating bodies, cutting through skin and subcutaneous fat, slicing fascia, probing superficial and deep muscle layers, and searching for nerves and blood vessels.  We started with the back, a relatively impersonal region with well-defined, thick muscles.  We then stayed with the donor prone, moving to the posterior upper and lower limbs during subsequent labs.

As expected, unexpected things have surprised me about anatomy lab.

Before our first day, our anatomy professor spoke briefly about the special (and privileged) experience we were about to undergo.  It sounded almost sacrosanct: "You will remember where you were standing.  You will remember where your lab partners were standing.  You will remember the first cut."

Though I write with less than week between that first cut and me, what I can say is that that cut was not our first interaction with the cadavers--and it was also not the most memorable one.  After we unzipped our body bag, we saw that our cadaver wasn't lying on its stomach, prepared for our incisions on its back.  We would have to flip it.  For several minutes, my labmates and I struggled to lift the heavy man--literally dead weight, and filled with gallons of embalming fluid--and carefully turn him onto his stomach.  I grabbed a left arm, a left leg, to steady the body, and I felt slightly sick.  Physically manipulating a dead body, feelings its contours, struggling with a rigid unmoving object, turned out to be much more crass and jarring than making restrained surgical incisions through his skin.

What I found throughout lab was that the worst, most disturbing moments were the most familiar ones--the ones when the body resembled a living human's.  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 unbendable 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 feeling.

It was the new, the unrecognizable, that unsettled me least.  Never having seen anything beyond animal muscle, seeing human muscle and its surrounding fascia fascinated me.  Pulling on a certain muscle to move the cadaver's thumb felt like a surreal version of a marionette--but still too unnatural to elicit a strong reaction.  Cutting away human fat, an inherently unpleasant task due to its color and texture, only vaguely differed from cutting away animal fat during dinner.  Rolling up the skin and subcutaneous fat like a carpet after we had removed it was still too far removed from reality to make me shudder.

Before I entered the laboratory, I was fairly certain that the experience would feel laden with emotion and that I would not be comfortable if my labmates treated the situation with anything other than intense seriousness  Again, surprisingly, this attitude changed fairly quickly.  I realized that "respect" didn't stem from how we felt or what we said--it came from our deeper attitude towards the task at hand.

What would I want if I donated my own body to science?  What would upset me?  What would satisfy me?  I can't presume to know the donors' motives, but I can say that my own would be to teach someone something unique.  I wouldn't particularly care whether students put on a--perhaps artificial--air of solemnity during dissection.  I would rather they treat my body as a specimen, something they could learn a whole lot from.  The worst form of disrespect, in my view then, would be wastage--students rushing through procedures, not being prepared to identify structures, and worst of all, not caring about what was in front of them.

To help further classify my feelings, I divided them into several categories: 1) unpleasantness from something that would disturb me if seen on a living person, 2) unpleasantness from something that reminded me of death but wasn't directly related to the body's appearance, and 3) unpleasantness stemming from the appearance of the body itself.  I believe only category 3 is particularly sad and something I would like to lessen.

These classifications have helped me hone my idea of "respect" for the cadavers.  Our instructors talked quite a bit beforehand about this concept.  We were told not to give them names (they already have names; we just don't know them).  We were told nothing of their age or cause of death.  (There are many arguments about whether this dehumanizes the cadavers or protects their status and anonymity.)

Today, when we palpated the gluteal muscles, feces emerged from the cadaver's anus.  This happens sometimes, and it's not particularly common or uncommon.  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.  It is really any more respectful, then, to hide a feeling of disgust when the subject happens to be dead?  (This falls into category 1 of aforementioned unpleasantness.)

Similarly, I was fairly horrified the first time I held the cadaver's cold hand for an extended period of time.  Probing my feeling, I found that it wasn't the hand itself that repulsed me; it was that it very explicitly symbolized death.  It was inhuman.  This, also, I don't feel is particularly disrespectful--to have a visceral reaction against death.  (Category 2 of unpleasantness.)

What about making small jokes, at no one's expense (including, and especially, the cadaver's)?  I surprised myself by laughing during lab.  When we dissected down to the trapezius muscles, I mentioned that it was cool to see the muscles that felt so good when they were massaged.  My labmate gently squeezed them and said, "Yeah, it's like he's getting a really deep massage."  It felt okay.

So what wouldn't I want if I donated my body to science?  It's not an easy question to answer.  Clearly, we want our sacrifice to be taken seriously--though not to the extent that emotion renders us less effective learners.  I realized that I would be bothered if people were disgusted by my remains.  Not of my feces, not of my cold hand, but of the natural processes that my body undergoes as a result of being dead--that is, category 3.

It would sadden me, for instance, if someone saw my long toenails, or squished backside, or flaking skin, and as a result, saw me as less than human.  I don't mind if people see my feces as disgusting, or as death itself as disgusting.  I suppose I do mind if people see what I've contributed as repulsive.  It's a dehumanizing feeling--to repulse someone--and it would put me on a separate plane from my dissectors.  We are no longer the same species; I am alien.  They cannot see themselves in me.  Understandable, of course, but sad nonetheless.

Tomorrow we dissect at 8 am.  It may be serious, but hopefully not too serious.  It may be enjoyable, but hopefully not distracting from all we need to accomplish.  It may even be disgusting--but hopefully for "better" reasons.


  1. Shara, Not to be overly morbid but what happens to the cadavers after dissection? Are the various portions parts removed for prosections? Great job on the blog.

    1. Each cadaver has its own separate disposal unit in which all the dissected body tissue is placed. At the end of the academic year (or however long a cadaver is used for) each cadaver gets a funeral - either a cremation or a burial. Relatives, friends and the medical school staff and students are invited to attend the funeral.
      Each cadaver is treated with the utmost respect and dignity. After all, they have donated their body to us. It is our duty to them to ensure that the last rite of passage is done in proper fashion.

  2. Shara, I have just completed a six week superficial and deep dissection program. Never in my life have I been thoroughly fascinated, humbled, repulsed and sad all at once. I think I grew attached to my cadaver. They were not alive anymore of course but I felt like I had shared a part of their body's history on Earth. I felt immense respect for them and for the huge sacrifice the cadaver's grieving family made. It saddens me to think that there are people out there who don't appreciate this act of donating a body with the seriousness it deserves. That is, not to say that I think we are not allowed to have 'fun' while doing it. It may sound morbid but how many times can you really see how an actual human body works? When will I ever get the chance to see the muscles, feel them and see the different veins and understand how our body is from the inside? probably never again (I'm studying biomedical science and in our university it isn't a requirement to actually dissect to pass the course).
    Your blog made me feel 'thank god' I'm not the only one. You don't make jokes of the cadaver, of course, but you can make jokes at the situation - surely. Other wise you get too emotional and are not able to do the task at hand, which is essentially to learn through dissection. I felt honoured to have done this programme, but I have to say I often find my self thinking about my cadaver as if she were alive. I often find myself, when I have some spare time, thinking about what her life must have been like. And finally I often wonder if there is an afterlife and she can see her body - can she see the true reverence I hold her in?
    I guess death is something that will always remain a bit of a mystery and it is such a sensitive area to discuss but to advance clinically we must.
    Thanks for writing this blog, can you only imagine what I must have been searching to come across this in the search engine!

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