Severed Vacation

facial nerve illustration I do not enjoy vacation. Studying medicine makes me feel so useful that I go into withdrawal outside of it. Reading Atlas Shrugged with all my spare time doesn’t help matters any. I try everything I can. I cut my vacation short by starting a week late, electing to stay in Grenada to dissect cadavers for research. I cut another week by going to Milwaukee for the Annual Congress of Clinical Anatomists. I lose a week to a Michigan trip with my family, and I leave that early to spend a week at the University of Alabama at Birmingham (UAB). Why? To dissect for research, of course.

Working at UAB is my first time in the South and it’s everything with fresh eyes. Southerners chew gum lazily. Without wind, you’re under a heavy hot blanket. When walking for coffee in scrubs, everyone says, “Good morning, Doctor.” It’s pleasant.

I am at the UAB with other members of my group to finish dissecting projects in the hours between the classes of their first year students. We have complete access to 35 bodies and we all feel like kids in the dead people store. Each of us has come a long way from those first heady days of Anatomy Lab. After all, we have chosen to be here without threat of a grade.

We’re cutting into people? I don’t want to; I’ll just watch. I’m glad they put bags over their heads. Should we name her? That’s disrespectful! No it’s not. I’m naming her ‘mittens’. Should we say a prayer first? Oh, god. Give me the goddamn scalpel, Amen. How’s that?

For all the posturing, it was a special thing to watch my hand cut into someone for the first time. It was my hand that did it, by the way. I had nothing to do with it. After so many bodies, it losses its specialness. When it’s time to work, you approach, address the body, and then dive in for cleaning and measurement. A few minutes later you zip up your work and it’s time for the next axilla.

Most of us have been the ones quick through the door when it came to cutting, the ones that called for the scalpels. But here at UAB, it is a little different. Their cadavers are fresher, fixed with less formalin, smelling less, more robust. It feels like walking into a house so clean that you kick of your shoes even though that’s never been your custom.

Most of the students that flew down can give a few days or a week. We would stay longer but our classes are starting in a couple days, a few thousand miles away in the Caribbean.  A few students say, “screw it”  and decide to miss a few days of the first week, this being such a great opportunity for work.  It’s only because I decided to stay that I get this morning call,

“Marios, what am I dissecting this morning?”
“Severed head.”
Choking, “What was that?”
“Ask Vince to show you the severed head. Skeletonize the Facial nerve and clean away all fat and fascia.” Hearing my held breath, “Tophy, you okay?”
“Fine Marios. Just fine.”
“Congratulations. It’ll be fun. You’ll do fine.”

I find Vince. He takes me into the cooler where they keep the fresh cadavers. These people died a few days ago or a few weeks ago and have donated their bodies to the university. At UAB, there is abundance. I wheel a small bin into the prosection room and remove the lid. Thomas is staring straight at me.

I reach down to pick him up and can’t at first. Not expecting the extra weight, I give my arms a moment to recruit more fibers before he moves.  I hold him in the air while another student helps me clamp the vise grips into either side of his head. Of his head. I adjust the lights, pull up a stool, and grab my scalpel.

I can’t do it.

I push his cheek and it moves. I try to draw the backhand of the blade against his scalp to mark my incision and I scratch some of his skin. Before, I thought that cutting a fixed cadaver was the great big leap, and I was wrong. I stare at Thomas some more.

If you’re going to be a surgeon, you have to do this. How many people get to work on a fresh cadaver? What opportunity are you wasting?! Do it, topher. DO IT!

I let the blade sink in and I begin to draw the curve of his hairline down to the front of his ear, then drop to the bend of his jaw and forward to the point of his chin. I pull the line upwards and around the mouth, into the sweep of his cheek where tears would have slid and then around his socket and up, until I meet again at the widow’s peak. He’s bleeding, not in force, but in an ooze that marks each position of a superficial vessel. It’s creeping me out.

***********

His face flap is in the bucket. It took an hour to do, pulling up a corner and separating it from all the anchors of fascia. The beauty of dissecting is that you’re only as fast as your mind. I was trying to save every vessel and nerve fiber early on, terrified of doing harm, until I remembered that the Facial nerve has no cutaneous branches. At that point it became snip, snip. Finding the target nerves leaving the parotid gland was magic. Pulling against the fat to see all of the brilliant colors of muscle, nerve, artery and vein is something that my fixed cadavers could never do for me. I’m no longer bothered by how real this all is; I’m too busy being hypnotized. The nerves branch and split, branch and split until they are thinner than hairs and I can’t believe that I haven’t destroyed them yet. They’re so strong and wet and alive.

Gross, messy, scary, morbid.

Say what you want about dissecting the face of a man that died days ago. Just don’t leave these out:

Amazing, glistening, beautiful, perfect.

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2 Responses to Severed Vacation

  1. Viking054 says:

    That was very well said… I don’t know that I could ever toss a man’s face flap into a bucket, but reading this almost makes it possible.

  2. I once observed an ME remove the pituitary gland from an elderly woman’s cadaver (I was the tech who brought her down to the morgue-she had died 4 hours prior to the first cut.) I was fine until he peeled her scalp (and face) back. There is something about the face that is difficult to get past mentally.

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