Anatomist, the

Book by Hayes Bill

One

On the first day of class, i am mistaken for a teaching

assistant six times, which, on the one hand, simply tells me I’m old— a good twenty years older than the average student—but, on the other hand, seems to imply that I look as if I belong. Choosing the glass half full, I smile through each mistaken identity.

The class size is 120 (150 if you count the cadavers). We had been warned that some students are overwhelmed by the first sight of the dead bodies. And sure enough, some students clearly are. But I am more freaked out by the woman in the gas mask. What does she know that the rest of us don’t?

“Class? Hello?” comes a disembodied voice, tinnily amplified. This is Sexton Sutherland, one of the three professors, although I cannot see him for the crowd. “Before we get started, some housekeeping rules . . .”

The first thing he mentions is the color-coded wastebaskets: red is for tissue (the human type) and white is for regular garbage, and, please, please don’t mix them up. Likewise with the sinks: use only the stainless steel for this and the porcelain for that, though I cannot catch the specifics for all the rustling. The mention of first- aid protocol finally brings the room to complete silence. And when Dr. Sutherland directs everyone’s attention to the emergency biohazard showers in each corner of the lab, I find a sea of eyes sweeping over me, as I happen to be standing right next to one of them. Towel, anyone?

“Finally, just some basic etiquette for the weeks to come: No eating your lunch in here.” This elicits a collective ewwwww. “No music. Please don’t take any pictures. And try to keep your voices down. Laughter’s okay,” Dr. Sutherland adds. “We love laughter in the lab— it’s a great way to release emotions. But not at the expense of the wonderful people who’ve donated their bodies to our program.” He lets that sink in for a moment. “Okay, let’s get going.”

A class orientation had been held the day before in a lecture hall downstairs. Afterward, we were invited to check out the lab and, as Dr. Sutherland had said in a masterful sweep of understatement, “to get comfortable with ‘the surroundings,’ ” by which he meant the reclining dead. About half the class had made the trip up to the thirteenth floor, myself included. I was anxious to put glimpsing the cadavers for the first time behind me. And I am glad I did.

If that was the orientation, however, this is more like disorientation. I am not sure what to do or where to go exactly, so I grab the crisp new scrubs from my gym bag, pull them over my head, and join the large group being led by Dana Rohde, interim director of the anatomy course for the University of California–San Francisco School of Pharmacy, whom I had met earlier. Using one cadaver as a demo model, she gives a brief overview of the afternoon’s assignment; pauses to explain how to put a fresh blade onto a scalpel; does a quick scan to see that we are all wearing the mandatory rubber gloves; and adds finally, “I’ll be back to see how you’re doing in half an hour.” Dr. Rohde then stands there for a moment, wearing the look of a swimming instructor who finds her class still standing on the deck of the pool: Why aren’t you wet yet?

Six of us arrange ourselves around cadaver number 4, but rather than looking at the naked female body lying before us, we all stare at one another.

“I haven’t dissected anything since high school biology,” one of the three women admits, breaking the ice. “And that was a frog.”

This seems like the right moment to make an admission of my own: “I should tell you, I am not a student here. Dr. Rohde gave me permission to come to your lectures and labs. I’m just going to be an observer.”

All but one of them look as though they would pay to change places with me. Gergen, the exception, a tall, husky, hairy guy who says he has never dissected anything in his life, cheerfully volunteers to begin the dissection. Now, technically, it will be Gergen’s first cut, but not this body’s. Like all the cadavers used in this ten-week class in gross anatomy, it was worked on during a previous course. Instead of fresh bodies like those routinely autopsied on CSI—blue- lipped and gray but still lifelike—these are closer to something from a Discovery Channel special. The cadavers are shrunken like unwrapped Egyptian mummies. The skin, where still intact, is tan and leathery, and the exposed inner flesh is as dark and dried as beef jerky. The heads, hands, and feet are wrapped in strips of gauze, which gives the impression that they had been badly burned. As Dr. Sutherland explained during the orientation, the gauze serves two functions: it helps preserve the delicate parts for a longer period, and it also protects us, in a sense.

“It’s usually most impactful to see the hands or the face,” he had said, treading carefully with his words, “because that’s really what represents a person’s identity.” When dissecting other parts, one quickly learns to dissociate, but this is much harder when you see the eyes or the mouth. Emotions can come up unexpectedly, he then added. “Sometimes, you’ll be dissecting away—maybe you’re halfway through the course—and then you’ll remove a piece of gauze and there’s a tattoo and you just stop cold. Or maybe you see nail polish.” Any individualizing mark is a stark reminder that this is not just a body but somebody. As Dr. Sutherland had explained, this is one reason why the first dissection is in a relatively neutral location, the thorax, otherwise known as the chest.

Though I am the sole spectator here today, I take comfort in knowing I am well represented in history. Human dissection has been a riveting spectacle for centuries, and the curious, whether by invitation or paid ticket, have long pressed into crowded rooms, craning necks and breathing through perfumed handkerchiefs, to witness that first ghastly slice, then the next, and the next. In Europe, the need to create a space conducive to teaching, learning, and observing resulted in the Western world’s first “anatomical theater,” built in Italy in 1594 at the University of Padua. A steeply raked amphitheater that accommodated three hundred, it became the model for other facilities that sprang up at competing schools, including the College of Physicians in London. Always at the center was the dissecting table, with the first circle of spectators barely a blood spurt removed. At UCSF, I and my fellow novice anatomists stand not in a theater but in a no-frills lab. In order to get the best view of what is being dissected at our table, I have to perch on the rungs of a metal stool.

Our cadaver, who in life probably stood no more than five foot two, does not bear the classic “Y” incision of an autopsy (shoulders to sternum, then straight down the abdomen to the pubis). Instead, a kind of double doorway was incised in her chest: the skin cut across the collarbones as well as beneath the ribs—roughly marking the top and bottom of the thorax—and then sliced down the middle. Before making a new incision, we need to “unpack” the previous work. As Laura reads instructions from the lab guide, Gergen folds back the two large panels of skin, then grasps the edges of the underlying breastplate, a solid shield of ribs and muscles that had been precut with a surgical saw. Gergen lifts, and a fresh wave of fumes escapes from the cadaver, making all of us flinch.

Peering down, I can see why the thorax was once known as the “pantry” of the body. It is a deep, squarish cavity packed full of various objects, one of which Gergen must now remove: a lung. He slips his left hand into the cavity and feels for “the root of the lung,” a short, fat tube that is not at the bottom of the lung, as one might imagine a root should be, but toward the top, connecting it to the windpipe. “Now what?” Gergen asks.

Laura, who is as small and slim as Gergen is large, scrambles to find the next instruction. “Let’s see here—‘Cut through the root of the lung superiorly and continue inferiorly through the pulmonary ligament.’ ”

“Translation?”

“Top to bottom—slice it off—I think.”

Although Gergen does the actual cutting, the rest of us, in spirit at least, help him hold the scalpel steady: Laura, Amy, Miriam, and Massoud are the fingers folded in around him, and I, opposite them, am the thumb. Gergen then steps back, indicating to Laura that she may do the honors. Biting her lower lip, she reaches into the thoracic cavity and, after a little tugging, frees the right lung. The size of a wadded-up T-shirt, it looks like a wet mound of gray taffeta. All six of us wear identical triumphant smiles, as if we have delivered a baby.