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Begin Cutting

Education By Knife

ISSUE:  Fall 2015

© Carollynn Tice /

“[T]here exists an allegiance between the dead and the unborn of which we the living are merely the ligature.”

—Robert Pogue Harrison, The Dominion of the Dead

Monsters. The label was affixed to a display case that housed a collection of glass jars. Sealed with a rusted screw-top lid or damp wooden cork, they contained malformed fetuses preserved in fluid. The term, seemingly a cruel joke, was part of an outmoded medical lexicon and described a fetus with gross congenital anomalies. Shelves of these specimens lined the passageway at the south entrance of the University of Virginia School of Medicine’s anatomy laboratory, displayed safely behind glass that spanned the height of the walls. Like many students before me, I passed by this grisly shrine during the first week of medical school and saw my own uneasy reflection in the glare of light against glass.

Taped to the double doors that led into the laboratory was a list of cadaver assignments by table number and cause of death: respiratory arrest, myocardial infarction, aortic aneurysm, pulmonary embolism, cerebrovascular accident. My cadaver lay at table number ten. Cause of death? Multi-infarct dementia. Death, that is to say, by madness.

Past the doors, the white cinder-block walls of the lab were lined with posters and diagrams portraying the intricate network of nerves, muscles, and blood vessels in the human body. In one corner, the chalk-white bones of a human skeleton hung from a metal frame. In another corner was a large biohazard bin that could hold several hundred pounds of dissected cadaver waste—about five bodies’ worth. Everywhere in the bleached walls of the laboratory—the sterile linoleum flooring, the burnished metal of dissection tables, the zippered white bags used to veil the dead, the gleaming instruments used to cut them open—I saw the landscape of a story into which I was being written.

My lab partners and I put on our full-body aprons and white latex gloves, then approached the table that held our cadaver, cocooned still in its polyurethane casing. I leaned and gripped the table’s lip to steady my trembling hands. Touching the table seemed to suggest that I was willing to unzip the body bag. I looked around and saw that other groups had already unwrapped their cadavers and begun the necessary shaving and cleaning of the body. Everyone at table ten was anxious to begin, so I fumbled for the zipper at the rostral end of the bag, where the head lies, and pulled.

The bag opened, revealing a woman’s body: anonymous, feeble, and atrophied, in its eighth or ninth decade. Staring at the table, I felt an uncomfortable awareness of my own body’s temporality, and to distract myself I thought of the sixteenth-century French poets who practiced the art of blason, intimately cataloguing the parts of a woman’s body in verse. I tried to put myself in their position, intent on keeping a mental inventory of the cadaver’s pieces.

First her name: Stella, Italian for “star.” My lab partner offered the appellation, elevating the frail body skyward. Her hair was next, wispy and uneven, absent in patches, her scalp translucent with blue-green vessels snaking just beneath skin. Several moles and polyps peppered her pallid brow. Her skin was desiccated; her face bore a stony countenance, like that of a mountain gradually eroding. Her cheekbones jutted out at angles. Her lips were deeply fissured, enough to reveal the yellow teeth behind them. She smelled of formaldehyde. Her eyelids, not entirely shut, revealed the green of her irises, afloat in a white scleral sea.

It didn’t take long to realize that this distraction wasn’t going to work.

Twelve years have passed since that first day in the anatomy lab, and the image of that anonymous woman beneath the polyurethane veil still grips me. It lingered with me long after her body had been dissected and discarded. To unburden myself, I tried to get to know her better. Was she a willing donor? A stranger with no final resting ground? Was she a practical woman? An idealist? Did she die alone?

To begin piecing my answers together, I borrowed a page from negative theology—the logic used by religious scholars to describe God in terms of what she is not. It was my own via negativa.

The first step was to contact the Virginia State Anatomical Program (VSAP), an office established in 1919 as the state’s sole agency authorized to receive donations of human bodies for scientific study. The State Anatomical Gift Act governs the logistics of anatomical donation to VSAP in the commonwealth. One of its mandates is a declaration of intent, an “Instrument of Anatomical Gift.” The single-sided form requires less information than a job application: name, phone number, address, Social Security number, race, place of birth, parents’ names, status of military service, and highest level of education. No references needed.

Maybe, like the form, Stella could be seen as an “instrument”—her right of personhood legally revoked and her body made a vehicle for what the declaration of intent calls “scientific study, teaching, research,” and, more vaguely, “other purposes.” She was a tool, then, meant to unearth knowledge. A tool that the state reserves the right to discard if deemed unacceptable, like a dull knife or crooked plane.

To this end, VSAP states that only intact bodies are eligible for scientific research. Because Stella was not physically damaged or disfigured, she was considered suitable for dissection. Medical students, after all, must learn the whole of normal anatomy; a body with a shattered skeleton or missing pancreas would be like a book with torn or missing pages. Fortunately for Stella, she was not mutilated in an accident and had no violent trauma—such as dagger wounds, mechanical dismemberment, damage from high-velocity projectiles, bombs, etc.—that would have excluded her. Schools prefer symmetry.

Other things that Stella was not: Stella was not autopsied or embalmed. Stella was not in the beginning stages of decomposition. Stella was not suspected of having contagious and communicable diseases such as AIDS, hepatitis, or active tuberculosis. Stella did not have an antibiotic-resistant infection. She was neither exorbitantly obese nor emaciated. It was because of everything she was not, because of her ways of not-being, that Stella was suited ultimately to become our teacher.

Pointing a gloved finger at the area between Stella’s legs, a classmate asked, “Who’s gonna shave the hooch?” His crass humor was strangely alleviating. Distancing ourselves from the mass of flesh on the table (some might say dehumanizing it) made what came next easier. The body had to be shaved for visibility and ease of dissection, then washed to remove any extraneous debris. My lab partners and I turned to the only woman in the group, but she declined and pressed the plastic razor into my hand. Caught between its blades were the hairs of neighboring cadavers, already shaved.

I began at Stella’s head, where the hair clung flimsily by the root and fell away at scarcely a touch of the blade. The blade’s cutting edge, already dulled considerably, created nicks along the surface of her scalp. The deeper cuts offered glimpses of underlying bone.

I shaved the patch of hair between her breasts, rinsing the blade before moving carefully toward the mons pubis, labia majora, and perineum—translated literally, from the Latin, as the “mountain of the groin,” the “great lips,” and, from the Greek, as the “excreting part.” When I finished, my lab mates scrubbed the body with wet sponges: first the ventral surface, then (with the whole group turning Stella onto her stomach) the dorsal surface. Specially designed tracks ran along either side of the dissection table, draining the watery gray waste into a plastic bucket that hung at Stella’s feet.

Stella was only one of approximately forty cadavers in the lab. With an average estimated weight of 180 pounds per cadaver, a total of 7,200 pounds of flesh flowed through the anatomy lab each year. In light of such staggering numbers, no single body seems so radical an integer.

And yet it was almost impossible to see these cadavers (contained though they were within the walls of the lab) as mere assignments, rather than sudden existential provocations. Comfort can be taken, I suppose, in knowing that medical students no longer have to find the bodies they dissect. In centuries past, they were forced not only to study the cadaver as a scientific object but also, in the act of removing it from the place where its death was quietly concealed, confront it as a lurid phenomenon.

Consider, for example, the study of human anatomy in eighteenth- and nineteenth-century Britain. Before passage of the Anatomy Act of 1832, which expanded the legal supply of cadavers to include all bodies unclaimed after death (not just the bodies of those who died in prison), medical students desperate for a body to study would take it upon themselves to exhume the dead. Such practices are the focus of a disputed 1896 article by Thomas Wakley, in the British medical journal the Lancet, that is detailed enough to be read as a do-it-yourself instruction book for raiding graves. In Wakley’s account, a grave robber, or “resurrectionist,” would “remove a square of turf, about eighteen or twenty inches in diameter” fifteen or twenty feet away from the grave. He would then “commence to mine … [a] rough slanting tunnel some five yards long … to be constructed so as to impinge exactly on the coffin head.” The grave robber would then extract the entire coffin. If he was lucky, “the end of the coffin was wrenched off with hooks while still in the shelter of the tunnel, and the scalp or feet of the corpse secured through the open end, and the body pulled out, leaving the coffin almost intact and unmoved.”

Stella’s hypothetical tunnel, to accommodate the girth of her abdomen and hips, would have to have been at least three feet in diameter. Plus an additional foot to leave space for any maneuvering that might be required. And at least five yards of rope to drag her out.

Standing above her shaven body, I was surprised to be facing this moment with Stella at all. Just minutes before, I was packing my bag to leave the auditorium across the hall when the professor’s instructions—“Begin cutting”—stopped me cold. I had thought dissection wouldn’t start for another week. I wasn’t ready. Before this, “dissection” had been mostly metaphorical, a lit-crit term. Now the implications of the word were almost paralyzing. I knew I could dissect a poem, but a body was another story.

I wasn’t the only one with concerns. I could sense the minor panic of some classmates, but it was muted by the zeal of a larger contingent rushing to get at it. Their enthusiasm was welcomed, expected even. “Anatomy is power,” a professor said briskly as we entered the lab. It was clear: The timid were at a disadvantage. We had better get ready, and quickly. 

I had assumed this irrevocable moment would unfold differently, that there would be someone to help us understand what was at stake, what we might stand to gain or lose with that first cut. I had spent the year before medical school immersed in the work of physician and writer Robert Coles. In class I had recalled his insistence on the moral education of medical students. “All the time we … send moral signals to our students,” Coles said, “we let them know (by how we teach what we teach) the kind of people we expect them to be.” I once envisioned medical school being filled with professors and students like Coles, a Platonic academy where thinking and doing came together in a moral synthesis. But as I sat there in the auditorium, thinking about Coles and his belief in the power of our vocabularies to shape our moral imaginations, I wondered: What are we today? Butchers?

There was hardly any time to indulge these questions in the anatomy lab. Before I knew it, the razor in my hand was swapped for a scalpel. But the prospect of actually cutting into Stella threatened to force me into reckoning with my own vulnerability. As a countermeasure, I tried to make meaning out of matter.

My words came out shaky. “This cadaver,” I said, “is a blueprint … for the future.” I paused to look at my classmates, unsure if they wanted to hear any of this. I had already been slow shaving Stella’s hair; this was only dragging things out more. “It’s a map of … more than just these organs,” I stammered, “a guide to the bodies of the patients … the living ones we’ll see one day.” For years I had immersed myself in medical literature, reading physician-writers—Richard Selzer, Lewis Thomas, Abraham Verghese, William Carlos Williams—with an awe that affirmed my desire to live a life in medicine. But I struggled to reconcile their dazzling language with the reality on the table. And as my stilted monologue unfolded, one of several instructors pacing the lab quietly materialized from around a corner to deliver a perplexed, impatient look in my direction.

Still, it felt good to say something and offer at least some clumsy resistance to the subtle pressure to be silent, to name only the things that the lab manual instructed us to name, to see only what the lab manual told us to see. I suppose that what I had wanted to say was that if done right, the relationship we were cultivating with this body would shape our relationships with future patients. If we could stand in reverence before this mass of decomposing flesh, how could we not care deeply for the living, breathing bodies that would one day come under our care?

Washed clean and lying on her stomach, with her nose pressed against the table’s steel surface, Stella was now in the proper “prone” position described in the lab manual. The dissection was organized by tissue layers. Our first task was to peel back the skin and subcutaneous tissue from the underlying muscle. With the help of a partner, I made a vertical incision along the length of the spine, slicing through skin and tissue until, going slightly too far, I arrived at the vertebral column itself, announced by the soft knock of the scalpel’s steel against bone.

In my beginner’s hands, the tapping of the scalpel against the spine sounded like beats of Morse code. The rhythm reminded me of the dean’s address to students at the beginning of the term. An infectious-disease specialist, he used a linguistic analogy for medical education, likening our training to the acquisition of a new language. In this way, medical students could be seen as novices sounding their way through volumes of scientific knowledge in search of the vocabulary and grammar of medicine. We would be learning a new alphabet so as to string together words to a story we did not yet know. But not only this. Because language also writes its reader, we would be broken down and reconstituted: rewritten so that we might read the world with new eyes.

But the task at hand was to cut. Carving paths through Stella’s flesh, we aimed for symmetry. Radiating perpendicularly from the initial incision along the spine, we made six horizontal cuts. Two bisected Stella’s back along the transverse plane. The other four extended outward to points equidistant from her spine. Next, we pulled back thick layers of skin and flesh with tweezers and scissors—teasing them apart from the fascial junction, beneath which glistened rows of muscle fibers. We guided our knives with instructions read aloud from the manual. We peppered one another with questions to reinforce the names of dissected muscles, their nerve supplies, their skeletal origins and insertions. I slowly learned the characteristic feel of each tissue as it was translated through the blade: the leathery resistance of skin, the oily give of fat, the tenacious spring of muscle, the harsh grate of bone. When we finished, broad sections of Stella’s back were flayed outward like a set of wings.

Weeks later, we were finishing dissection of the head and neck, the final chapter of our mortal lessons. This last phase required bisection of Stella’s skull along the sagittal plane—straight between the eyes—using a vertical band saw that stood as tall as a man. We released the brakes on our anatomy table and wheeled it toward the saw, which sat, like a sturdy red obelisk, in the hall of jarred fetuses, its blade dull and gray and slightly rusted along the edge.

Not much was left of Stella now. Her abdomen had been eviscerated—emptied of bowels, kidneys, stomach, spleen, gallbladder, pancreas, and liver. Her chest wall had been cracked open to get at her heart and lungs. The muscles of her arms and legs were flayed open, just as her back once was. The top of her skull, which we had removed with a hammer and chisel when the bone saw simply couldn’t cut it, wobbled like a bowl on the lab bench beside her. Her brain rested in a two-gallon plastic bucket on the floor. We could now study her eyes from the inside of her hollow skull. Parts of her that had begun to grow mold—her foot, a few of her ribs—were lopped off to save what we could.

We transferred what was left of Stella onto the cutting block. Her arms and legs dangled off the sides. With a flip of the switch, one of the professors brought the saw to life, filling the room with a whine. The table shook. The professor gave us the cue, and we slid Stella headfirst toward the blade. Saw met skull. The whine became a high wail and the room filled with the smell of burning bone; a fine ash was thrown up by the cutting—human sawdust.

It was supposed to be easier after the skull. We moved the body farther along the table, letting the saw slice through the forehead, between the eyes, along the nose. It slowly split Stella in two. I focused my gaze just beyond her head, on the white cinder-block wall, tinged slightly yellow and red in places from years of this sacrifice. The final cut through the jaw seemed interminable. The gray blade cut and cut. The professor’s hands thrust the jaw closed, breaking a couple of Stella’s front teeth.

Then there was a grating metallic screech, the sudden sound of metal biting metal. Sparks erupted from Stella’s face. The air filled with the scent of singed flesh as embers spilled from her mouth. “She’s on fire!” one of my partners hollered wryly. It certainly seemed that way as the sparks flew. We stepped back from the table—not far, but far enough—leaving the professor alone with Stella as he thrust the saw through her mouth.

“Dentures,” he said calmly. The saw did its work. The gray blade cut. Stella spit fire. Finally, like a heavy deadbolt locking, the saw just stopped. I flinched, then beheld the saw stuck motionless, lodged in Stella’s jaw. Now it was the jammed machine that shook, trying to break free from Stella’s bite.

The professor’s collar, always crisply starched, sagged a little around his neck now. He shut off the power and gripped Stella’s split face with his hands. Back and forth, he torqued her skull until it was freed from the blade. At last, a plate of artificial teeth landed on the table with a knock, freeing the saw to finish its work.

It was lightning that jolted Victor Frankenstein’s creation out of oblivion: A patchwork of cadaveric fragments shook, like Stella trembling in her steel cradle—much like me.

There’s no mention of Frankenstein and his monster in the stained pages of my dissection manual, of course—nothing at all that could have prepared me for the spark waiting in that final cut. Perhaps because it wasn’t supposed to be so difficult. There should have been no cinders. No struggle. No final metallic screech breaking the spell of ritual. Or perhaps there were simply no words to explain what might happen—because anything could.

A man could enter the cold halls of a cadaver lab and find himself galvanized by the intricacy of the human form, which possesses, even in decay, the beauty of a crumbling temple. There he could become a reluctant disciple, stepping through the temple gates. Carving out a path to its innermost chambers, he could arrive at the altar and ask his burning question: “What have I to do with thee?” And in the sound of his own voice hear himself figured anew.

And so it was. Dismantling the stuff of matter, I had reassembled my mind. Through Stella’s unmaking I had made my way closer to becoming a doctor. Where the living raised the dead in Frankenstein’s world, the dead animated the living in mine.

In both cases, it’s a spark that brought the monster to life.

A few years ago, I asked my old professor if there were any records of Stella’s identity in life. “We do not know the names of the cadavers,” he replied. “We only know them by the number assigned to them by the State Anatomical Program.” When I asked if there was anything else he could tell me, he wrote back: “Female. 90yo. Homemaker. COD Multi-infarct Dementia. That’s all the information I have.”* When I asked VSAP for additional information, I was told that privacy rules protect the information of decedents for fifty years after the date of death. There is a kind of mercy in this rule; the dead, after all, need their rest.

In the end, my efforts at remembering this woman amount to a kind of eschatological diversion. After all, what is the act of dissection if not a task concerning, quite literally, final matters? If dissection is the study of last things, the paradox of a medical education is that it all begins in the anatomy lab.

When the blade stopped, we slid Stella once more onto our dissection table. I saw the rows of malformed fetuses again: monsters. My reflection stared back at me from the window pane. Beyond it was a specimen identified only as giant: a thickset form bobbing in preservative, its whale-white skin stretched across muscles and bones that hadn’t known when to stop growing. Everywhere, osseous formations protruded from under the skin, giving shape to a gnarled, knotted, treelike creature. Its head was huge, an uneven globe perched atop a bulky stalk. The skull looked engorged. The face coiled in upon itself.

Suspended in my memory, this creature has become a reminder of nature’s awful power—its cool indifference, its limitless possibilities. I think of those jarred specimens even now, silent witnesses to my education. Each one living up to the etymological meaning of the category: “monster” from the root “monstrum,” which gave rise to “demonstrare” and our modern “demonstrate.” Indeed, these creatures demonstrated the fragility of life itself: They were signposts at nature’s frontier, products of her visionary experimentation. Reminders of what can happen. Of what did.

Our cadavers’ remains were consecrated near the university cemetery. Their cremated ashes were scattered in early spring. Around us, the sharp branches of trees rustled in the breeze; tufts of newborn grass marked the green edges of graves. We’d never been like this with them before—outside, in the sunlight. The ashes caught the rays as we poured them from plain cardboard boxes. Even here, there were traces of the anatomy lab: in the anonymous numbers identifying the remains, in the rubber gloves worn by students dispersing ashes, in the care we took to keep from mingling with the dust. After a box full of ash was deposited in the cemetery, the remaining boxes were driven to the summit of the university’s astronomical observatory. And though I shall never quite know her, it is here, scattered on the mountaintop, that I like to think Stella found her final rest. And it is here, when I want to seek her out again, that I’ll come looking for the stardust under my boots.

* Distinguishing details have been changed to protect Stella’s true identity. I am grateful for her immeasurable contribution.


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