The Anatomy Lesson

Before my first day of medical school, I spent a lot of time thinking about the goal of anatomy lab. Was it to endure a historical rite of passage that would give me a shared experience with Hippocrates, Galen, Da Vinci and Ted Bundy? Was it to get to know my new classmates while we took turns chiseling a spine in two? Was it to marvel at the once in a lifetime experience of visualizing cranial nerves neatly slithering into each of their grooves in the skull before using a bone saw to bisect them? Was it to mark myself and my freshly ironed white coat as unique from the rest of society--so unique that I am (hopefully) the only recipient of the pick-up line: “So I hear you’re the girl who cut a penis in half.”

I learned that while all of these goals existed for our anatomy lab instructors, none of them could be accomplished before one massive hurdle was overcome. The professors had to convince a group of 140 people to go against every single moral rule ingrained in them since childhood and peel the skin off of another human being’s body. Our professors accomplished this feat year after year – not through brainwashing or making us pay for a year of tuition before we entered the lab – but through a system that was based on the stripping of identity. To get a group of idealistic, charitable, and empathetic young students to cut into a dead person, we were taught how to view our cadaver as merely a series of compartments. We learned how to de-identify. 

Up until a year ago, I had a very good grasp on what made me me: my parents (literally), my twin brother (scar above my left eye and competitiveness), my upbringing on the Upper West Side of Manhattan (deep love for Zabars’s lox and Riverside Park), my all-Girls school education (feminist), and my pet cats (not a dog person). I was forced to question all of these components of my identity when my parents revealed to me and my brother that our father was not our biological father. My father was Anonymous Sperm Donor #33XXX. Afterwards, I began to study my face with the same intensity with which I studied T cells under a microscope. In my bathroom mirror I would see my reflection with shock, fear, and awe: who is this? Whose nose? Whose freckles? Whose lazy eye lid? Whose intense desire to practice medicine without a single doctor in her family?  

For centuries, medical school educators have dehumanized the cadaver through a brilliant, methodical procedure: students dissect from the most impersonal portions of the body, to the parts that are the most individualized. Students begin with the back, move to the chest, and then reach the pelvis. Following these portions, students are considered qualified to handle the hands, feet, and finally, the face.

Human backs are remarkably indistinguishable. We have all had a moment when we’ve tapped the shoulder of a person only to find that the person we think we have alerted is not the one we intended to alert. When you are looking at the true back—from the top of the shoulders to above the gluteus maximus—this portion becomes indistinct from one person to another. It may reveal their general weight and skin tone, but those characteristics are the same ones that those faceless animated cartoons which are supposed to be representative of the world’s entire population on an uplifting public service announcement have; one faceless body can belong to a huge number and diversity of individuals. 

My stark first image of the anatomy lab was a sea of backs; each one appeared smooth, differently colored and sized. They faced the ceiling in an alarmingly organized and seemingly calm manner. Skinning became the hardest part -- anatomy cherry-popping. As I placed my scalpel into our cadaver’s back—the instrument I had been dreaming of using since I was 16—I felt like I was fulfilling a dream. The first pull of the skin felt morally disgusting and twisted. In my head I repeated, “You got this. You’re going to be a fucking surgeon keep your shit together!” Before I knew it, the first flap was pulled away, and I took a step back while my fellow anatomy group mates leaned in for their turns. As the hours passed it got easier and easier. I realized as I looked around to the tables around me that the bodies upon them that had once looked unique from the one in front of me now all revealed the same shiny yellow goblets of fat and dark, striated back muscles. A back is a back is a back.

Once we had graduated from the back, we were ready to get into the chest, or, as we first year medical students loved to refer to it as: The Thorax. This was our first opportunity to sound pretentious to the rest of our friends—Oh this week? Yes, we dissected The Thorax. You don’t know what this is? Oh, pardon me, I slip into Latin every once in a while now!)

I hate to break it to the other people with breasts, but like the back, the thorax reveals very little about an individual. I would like to think that every person that has had the privilege of witnessing my tits has never seen anything like them; however, when a pair of breasts were splayed out under fluorescent lighting in a room that reeked of formaldehyde, the only thought anyone had was: “Okay. This person has tits.” The thorax was not as tantalizing as I had expected. 

The most striking thing about our cadaver’s thorax was his chest hair. It was long and mostly grey, though a few black hairs stood out as though yelling to my anatomy group: seventy-four isn’t that old! Soon, however, we were once again in the land of monotony as we carefully dissected his pectoralis major and minor, marveling at the truly serrated appearance of the serratus anterior muscle along with the table next to ours. It was only after we reflected his rib cage that we got our first glimpse of something personal about the person in front of us: his left lung was nearly half the size of his right. 

A TA informed us that our cadaver likely had had a portion of this lung removed. Was it cancerous? If so, what caused the cancer? His genes?  His environment? He didn’t have “smoker‘s lungs,” but they had a black-colored webbing on their surface that indicated he had lived in a city. Was that what my lungs looked like? Did they look more like my mothers’ or the sperm donors’? Did it matter?

We then graduate to the pelvis. (Genitals!) Now, I thought, I’m really going to get to know who this person is! I’m going to delve into their most private area and it will reveal all of their deepest kinks and experiences. It’s uncomfortable. We were all nervous. It was like our anatomy group was taking a field trip to a sex shop where we were all trying not to giggle and were avoiding staring at anything for too long. We were not in a dark back room behind a shiny wall of plastic beads, however. We were in our fluorescently lit anatomy lab where we were instructed to stare and study this man’s penis. After sitting through an hour of images of genital deformations and hurriedly memorizing all seven layers of the scrotal sack, we embarked on this region with an eye that could only be described as educated. 

My cadaver's genitals did not reveal anything about who he may have been as a person other than that he had a penis. One mark of individuality was, however, uncovered in this region. Just underneath the skin in his upper pelvis we hit what looked like a large plastic telephone cord. We soon learned this telephone cord was a surgical rewiring of his venous system that was implemented to connect his two femoral arteries. Questions began to fill my head. A fem-fem pipe was evidence that he had suffered from peripheral artery disease. Peripheral artery disease was most likely the result of diabetes. Suddenly we had another identifier: diabetic. Was diabetes something he was born with—something coded within his DNA—or was it something he acquired later on in life? Did peripheral artery disease affect his day to day life? No one could see the portal connecting his femoral veins to one another, but did he ever feel it? I thought about my mother’s body. I think about the endometriosis around her uterus and her strained arteries from high blood pressure and I wonder if these will be inscribed on my body too. I think about my biological father and wonder what unique differences lie under his skin. I wonder if they too are inscribed on me.

Before our next section—the extremities—we were primed by other students and TAs that this was the big step. On a persons’ hands and feet their personal history is inscribed. It is through these parts of our body that we touch and communicate with our environments. I stared at my own hands, trying to figure out what makes them mine. 

• size, skin tone, and poor circulation: genes

• years of nail biting and skin picking: environment (and genes?)

• compulsive love of nail polish: mom.

As I geared myself up to identify the significance of a small crease on my cadaver’s palm or a mole on the side of his ankle, a member of my anatomy group yelped as she carefully removed the plastic bag around his left foot. He had no toes. 

A new picture materialized in my head of the person lying in front of me. For the first time, I pictured him upright and standing. I imagined him walking. He would have had a unique walk—favoring his right side more so than his left. I imagined myself watching him walk by on the street. I wondered if I would have noticed whether or not he was limping. I wondered if he would have smiled at me. 

I was nervous to remove the black bag had been covering our cadaver’s face for the past six weeks. I thought that the action of removing the bag would identify him. I already felt an intimate connection to him. I had been under each layer of skin, between each sheet of muscle and inside every cavity in his body. During exams, I would close my eyes and picture his left recurrent laryngeal nerve wrapping underneath his aortic arch before innervating his larynx. He taught me that the tibias posterior tendon is anterior to the flexor digitorum longus nerve and that the femoral nerve, artery, and vein run together in a sheath that goes through the femoral triangle. A part of me was nervous to be disappointed. What if his face looked completely different than I had expected?

I can still feel every massive thump of my heart contracting as I zoomed in on a photo of my biological father for the first time. It was a small, pixelated thumbnail on a sketchy website that let you find someone based off of an email address and city of residence. Even though I couldn’t make out much, the second I saw the photo I knew it was him. His eyes turned down in the same way mine do. He also looked a lot like my dad who raised me, which was comforting and a little funny. I had spent the past month obsessing over what this face would look like and what answers about my own identity it would provide and a person who looked like my dad but a little more like me was staring back. In that moment, I instantly felt lighter, like 100 questions were answered and their weight had been lifted off of me. In the hours and days and months that followed this discovery, however, I was left with one question that continued to pull me down: how does this person affect my identity?    

As we carefully untied the bag from around his head and tilted his neck forward a 74-year-old man with half-opened eyes looked up at the ceiling. I thought I would be able to identify him, but I didn’t recognize him. I thought about all of the people who would: children, grandchildren, friends, students, coworkers. I wondered what thoughts they would have when they looked at his face. There was no way for me to know this. A fem-fem pipe and 5 amputated toes did not reveal what his partner thought when he or she saw him, or for that matter whether or not he had a partner at all. 

On my part, I felt gratitude. I would never know who his parents were or where he was from. The only thing I knew was that he was a generous person who donated his body so I could learn. 

I have now communicated a few times with my biological father. He knows who I am and what my brother and I do (although I didn’t give him the details of my day to day dissecting as a medical student). While I want to learn more about him and hear updates on his life, I have no desire for another father figure. I already have a dad who made me who I am today.  

What did I learn in anatomy lab? Identity is not your genetic code, your body, or your face. It is built by the relationships you construct around yourself. When I am no longer around, the only way I will exist is in the memories and stories of the people in my life, which only I can control. A cadaver taught me a great life lesson.