Reflections from the Anatomy Lab

Working and Learning Among the Dead, and How it Changed Me

Alex Loinard-Gonzalez

At the start of medical school, I feared the anatomy lab more than almost anything else-barring perhaps the death of a patient under my care. I feared the room itself, picturing rusty bone saws and our donors' sightless eyes staring unblinkingly past me. I feared the dissecting process-I had cut myself with a (clean) scalpel before — since then, I'd developed a thin scar on the palm of my right hand, and a healthy fear of the unimaginably sharp blade. What if I cut myself with one that had touched and cut through a body? One coated in preserved bodily fluids? I feared, also, my own mind and body, and what they might do when faced with a corpse: I was sure I'd faint. 

One of my classmates told me that they frequently dreamed about the donor they worked on. In their dreams, he would sit up and talk to them. They also mentioned needing to remind themselves that their donor was not alive and could not be hurt by their work. Before the first session, I often wondered if that would happen to me. 

On my first morning in the lab, I was sitting on a stool, listening to our professor talk about the day's workflow. The room was brightly lit, chilly, smelling strongly of formalin. I felt both sweaty and cold in my old scrubs and oversized lab coat, my breath under my facemask fogging my protective glasses. Like something out of a movie, four metal tables held the bodies of our donors, covered sensibly with white blankets. I could see the contours of their bodies, the sloping up and down of their heads, their feet. When our professor went to uncover the first donor, I felt my stomach drop at the glimpse of the curve between shoulder and jaw. 

I did not faint. 

We got no information on the people that the bodies in the lab had once been: no name, no age, no reason why they died and ended up in this room with us. In my head, I | named the person I worked on (with?) on that first day. I did not mean to, but the name came and stuck. 

Unlike my classmate, my donor never came to me in dreams, and I never worried about hurting her. There was no way to mistake her for someone alive. She was so obviously dead, still, cold. Her skin did not feel like skin. Her limbs did not bend, or they did, but not the way yours or mine do, epiphyses rotating past each other in their synovial capsule. They bent... well, like a preserved limb would. I suppose not everything is like something else. That said, I always did try to behave as if she could hear me, as I would hope a fellow medical student would treat my own loved one if they were on that table. After every session, I carefully replaced the shroud, as gently as I could, imagining that I was tucking her in. I gave her a silent thank you for her generosity, a silent apology for the unavoidable violence of our learning. I sometimes pushed down guilt at the crudeness of my unlearned techniques, the loss that her family must feel. I tried to remind myself that this is what she had wanted: in life, she went to multiple meetings that prepared her for this, and likely received fairly detailed predictions of what would happen. I told myself that I was fulfilling one of her last wishes. 

Anatomy lab, for me, was tinted by a fresh loss. My anatomy lessons started shortly after the death of a dear friend and former lover of mine. Young, tall and beautiful, seemingly healthy, Nat had passed away suddenly and without explanation days after graduating from cosmetology school. Days after texting me for the last time: a gif of a dancing cat. Immediately behind her death came a shockwave of stunned grief. Desperate to feel close to her, hoping irrationally for the whole thing to be revealed as some terrible misunderstanding, I had called her sister, Kelly, many times in the months that followed. In one such conversation, she relayed that according to the hospital pathologist, Nat's autopsy had been completely inconclusive: no drugs, no blood clots, no tumors. Nobody, not the pathologist who cut her open, not I with all the medical training I had yet to acquire, would ever know what cruel turn of luck had stolen her away from us. Despite my own experience in the lab, I had winced at Kelly's graphic comments about the process, aghast at the thought of my friend's body being split apart for examination: "They put her brain back in her head. I asked them about it. It bothered me to think of burying her without it." 

Sometimes, I imagined what I would do if Nat's eyes stared up at me when I removed my donor's shroud. It made no sense, of course: Nat was hours away, in the ground by then, and I would never see her face again. But I couldn't shake the thought. Sometimes, as I was tucking my own donor away for the evening, I held back tears. I thought about her family and friends, and how terribly they must miss her. After all, what wouldn't I give, after having had to miss Nat's funeral, to have sat with her one last time? To have held vigil over her before she was lowered to the ground? And here I was, getting that privilege with this stranger who had likely been somebody's favorite person in the world. 

This tragedy, of our donors' deaths, of the grief that must exist in the world because of it, was at once explicit and invisible. We were swimming in it and thus lost sight of it. In the throes of the focus required to commit anatomy to memory, the awe of learning about the human body, and my gratitude to the people whose last dying wish was to contribute so much to my learning, I eventually would push away thoughts of my donor's life and family. At least, during the lab itself. Leaving that room, however, walking away from its fluorescent lights and pungent smell to the world above, the ramifications of what I had been doing would hit me anew. I felt irreparably different from the people around me on the street. I was keeping a monumental secret: surely no one could imagine what I had been doing with my afternoon. Surely I shouldn't have been able to spend my days in such a way without going insane. And yet. 

Watching passerby's limbs move, the sweat shining on their foreheads, I imagined their hearts pumping. The wrist-thick arch of their aorta curving gracefully down toward their diaphragm. I felt that I had seen their future, and my own: every last one of us will die, will decay, no differently from the donors laying immobile in the guts of the anatomy department. The fallibility of Nat's body and its devastating consequences, the impermanence of my own, became tangible and oppressive over those weeks. I had touched it, named it, learned it. I had taken it apart, and ultimately I could (can) do nothing to fix it. I felt that I could sense every last one of our slow, oblivious march towards death, our inevitable return to dust. 

Every night as I fell asleep, I clung with newfound vigor to my husband's body, ran my hands along his back and arms and face, desperate to convince myself of his warmth, of the rise and fall of his chest. I marveled at my own thoughts, my fear and knowledge and grief, how it was all little more than sodium and potassium moving in and out of the long, thin cells inside my brain. More frequently than I'd prefer to admit, I thought sheepishly about Nat at the same time. I wished I had held her tighter. I should have committed better to memory the heat of her skin that was now cold, the smell of watermelon gum on her breath that was now extinguished forever. 

In the midst of my grief, discomfort, and gratitude, I still could not help but give in to the mental transformation that anatomy lab is designed to put medical students through: The process of dissection was a necessary, temporary setting-aside of my humanity, of my fear of causing damage, so that I could care for others. Through it, I began to understand the body with academic precision. With the flexing of a mind muscle that became stronger by the week, the body became two things that I could detach at will: a person, with a soul that I see, cherish, and value; and, a machine for me to understand, so that I may do all I can to preserve its function. 

I once held my donor's windpipe in my hands. So small, so much smaller than I thought it'd be, barely wider than a roll of quarters. A few inches connecting the inside of her body to the life-giving breath outside of it - breath that, without her lungs pulling it in, was now only air. I was told to open it, "like a book." My lab partner cut it lengthwise on one side with scissors. Despite my discomfort, I dug my thumbs through the cut and pushed up on the other side with my fingers. After a few tries and readjustments, it snapped open with a series of cracks, cricoid and thyroid cartilages giving way under the pressure from my phalanges, the muscles and tendons in my fingers and forearms. 

Pushing aside the disturbing thought that I may now have an action in common with some serial killer out there, I pointed the structures out to my professor, one by one, with the tip of my forceps. "False vocal cords, superiorly. True vocal cords, right underneath. Thyroid cartilage, cricoid cartilage, trachealis muscle. 

Like a book, indeed. 

Thinking about it now, the memory of the clammy room, the feeling of a body part breaking open, coexists with all the knowledge I have committed to memory about neck anatomy, about breathing. I can visualize, as if they are in front of me, my microscopy slides: how magnified a thousand-fold the hyaline cartilage of a trachea becomes a vast, violet, crescent-shaped lake, dotted with tiny white islands of chondroblasts. Farther down our respiratory system, the cartilage chips that distinguish a bronchus from a bronchiole: pink, smooth, acellular. Like a seashell, or a thin slice of quartz. 

We hold treasures, just as beautiful as jewels and infinitely more valuable, in every millimeter of our body. And here I am, privileged to see it all up close, because of the death of another person. Here I am, ready to convert that privilege to the practice of medicine, to keep others healthy for as long as possible.