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.

Advertisements