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Warning: This post concerns my experiences in cadaver dissection. At this point in my medical training, I can casually chat about what went on in lab over dinner and not think anything of it. You, on the other hand, may have slightly conventional standards, and might find it a bit graphic. Please take that under advisement before continuing. 

Ready? Let's go.

Ready? Let’s go.

 

It’s a relief learning you are not the only person who finds skinning and separating out muscles on a cadaver oddly satisfying. It’s not really something you can bring up in polite company, but when a group of med students are sitting around the lunch table waiting nervously for their first practical exam, these sorts of things come up.

We’ve just finished our third week of lab and our cadavers are now largely sans skin. Removing it is a time-consuming process; skin and the fat underlying it are rather firmly fixed to the fascia and muscle below. The technique involves making two incisions to create a corner flap of skin, carefully going deeper layer by layer until you can see the red of the muscle or the silvery stripes of tendons. Then you grasp your flap (careful to not grasp any of the muscle tissue along with it) and pull back hard, like you could peel it right off. Then you scrape gently at the wisps of fascia between the fat and the skin with your scalpel, slowly detaching them and peeling away the skin. The idea is not to go so deep at to cut through the muscle and also to remove enough of the fat and fascia that you can see the muscles and structures below.

When it is going well it is not unlike managing to pull the entire peel of an orange in one piece. Or finally getting the long red piece in Tetris you’ve been waiting for the whole game.

When it isn’t going well, you can’t tell muscle from fascia from tendon from fat and you kind of want to start throwing your tools around the room.

Separating the muscles is similar, although you usually don’t even need a scalpel. You run your fingers or a probe through the fascia surrounding the muscle groups, pulling it apart like spiderwebs.

Nerves and arteries are more frustrating. They are usually bound up in a lot of fascia, but delicate enough that you want to avoid ripping through with your hands or slicing through with the scalpel. They also often look enough like bits of fascia (especially the smaller nerves) that you might not even notice them at first.

Going to lab has utterly revolutionized our schedule as medical students. Instead of spending four hours in a classroom listening to an array of lectures, we spend three or four hours on our feet, actively working through a lab. In some ways it’s a break for our brains; the concentration required to decide if you’re in a muscle or still on the plane above it is completely different than that required to memorize innervations or artery bifurcations. Most of the lab is physical work with breaks to try to identify structures. The time flies by and there is absolutely no risk of falling asleep.

We’re also divided into two groups per cadaver. One day my group might dissect the abdomen, the next day the other group will examine our work and dissect the front of the thigh. Which means a whole day off, at least once a week. After the non-stop slog of Monday through Friday 8 a.m. to 12 p.m. classes in the fall, this is like a dream come true.

That isn’t to say anatomy is a walk in the park. Some things in medical school are difficult simply by virtue of the fact that they require decades of experience to really master. Reading x-rays for example, or recognizing histology slides. I can memorize the nerve innervation for every muscle in the lower extremity, but learning to distinguish artery from nerve at a glance is an art. Sometimes even the professors aren’t quite sure what they’re looking at. This is the part of medicine that takes the most practice and is the hardest to explain how to do. It is also the part of medicine that feels the most like being a doctor.

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Okay, so this isn’t a blood draw needle, but you get the idea.

I’m thinking of creating a version of the Who Said It game called “Medical Students or Burgeoning Serial Killers?” Here are some approximate quotes I’ve collected over the past several months.

  1. “I’ll just keep all of the blood vials in this basket here until I can figure out how to dispose of them.”
  2. “Skinning a human cadaver is harder than I expected.”
  3. “We should get some pig’s feet to practice on. It’s more like human flesh.”
  4. “He gets all the supplies by telling the clinic staff we’re planning to practice blood draws.”

Okay, since I don’t actually know any serial killers in training (I hope),  the game is pretty one-sided for now.

For a bit more context (lest you think perhaps a quick call to the FBI might be in order), this week marked our foray into cadaver dissection, and also the third so-called phlebotomy party.

The phlebotomy parties came about around Thanksgiving after a primary care conference where students were able to practice skills like suturing and blood draws. I wasn’t there, but from what I heard, many of the blood draws were not terribly successful.

I don’t know about my fellow students, but practical skills in medicine make me nervous. I know that I can memorize pages of information and answer multiple choice questions with reasonable accuracy, but none of that guarantees I will be any good at basic medical skills like lumbar punctures or taking blood pressures. The latter I can practice whenever, at least. Mostly of my family and friends have been subjected to me brandishing my stethoscope and sphygmomanometer. But the stuff involving needles? At best you might get to practice them on a dummy, which is really not going to prepare you for a terrified patient, angry at being used as a training tool.

Blood draws, at least, are fairly straightforward. So with a few donations from a local clinic, one of my small-group classmates with some phlebotomy training gathered together everything we might need and had six of us over for dinner and bloodletting. After all, if you’re going to mess up poking someone with a needle, it might as well be someone who is planning to stick you right back.

The first stick is, in a word, terrifying. There was this moment before I slid the needle in that I was thinking to myself, “I can’t do this. How could I ever think that I could do this?” Then bam, a minute later I was triumphantly holding a full vial of blood, my heart pounding in my chest and a general feeling of “Holy crap, I can’t believe I just did that.” Then I turned around and offered my own arm up for some first-time needle sticking.

Our first session was such a success that the host has had two more since. They are well-attended and it is a relief to watch everyone go through the same spectrum of emotions each time: terror, followed by determination, and then elation at their eventual success. We can do this! It’s for real.

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Uh…now what do we do with it?

A friend of mine pointed out that as physicians we probably won’t be taking a lot of blood. That is more the purview of nurses and techs, even if we will eventually learn the skill. Still, it is a relief just to know that I can handle the basics. For the first time I was able get past the literal barrier of the skin, into the parts of a living person that we generally never see. I don’t expect this will make me less terrified or apologetic when I finally do have to practice on a stranger for the first time. But at least now I don’t have to wonder if I am even capable.

And, even if it’s only the barest of comforts, at least I can say, “I’m new to this, but I’ve done it successfully a few times before.”

I have been waiting to write about cadaver lab since I started this blog. It is such a defining piece of medical education and is surrounded by so much history and mythology that it is hard to imagine where the reality lies. Cutting open dead bodies is the stuff of horror films or indelicate humor. The idea that one body will become my template for understanding how humans work inside is creepy and exciting all at once. I am already intensely curious about the body I will be working on. Will it be a male or a female? How did she die? What kind of life did he  have? What made her decide to donate her body to us?

The school takes cadaver lab very seriously. We have several classes designed to address the implications behind dissection. At the end of the unit there is a memorial service for all the cadavers. We are warned to treat them like patients.

Our first assignment with the cadavers will be to wash and shave them. We have very specific step-by-step instructions on how to go about this. They are curiously impersonal and somewhat vague. For example, if your cadaver is lying face down you are to turn it over onto its back. And yet I have no practical idea of how one would efficiently go about this. There are certainly enough of us to manage the weight, but the logistics of arms and heads and the immediacy of lifting a dead body for the first time seem perilous.

If necessary, we are to trim and then shave the hair on the head, armpits and pubic region of our cadaver. I am interested as to how a group of nine people decides who is responsible for shaving the genitals of its cadaver. Certainly we are all going to have to get extremely familiar with uncomfortable areas of the body, but I will confess I am a little intimidated. I can’t even figure out if the fact that our cadaver is dead makes it better or worse.

I am excited to start anatomy in the same way I get excited at the top of a roller coaster. Part of me is thinking, “At last the thing I have been waiting for,” while the other part is thinking, “Um…maybe this wasn’t such a great idea.” I expect that, also like with roller coasters, I will be glad I did it in the end.