First Cut

“Your cadaver is your first patient, treat him or her as such,” our course director said.

We sat feverishly waiting for the Gross Anatomy lecture to be over; the allure of the lab was irresistible, and our excitement was palpable. No experience could define medical school so distinctly as this, our first examination of the human body. During the first two months of medical school, we had prowled the white halls outside the lab, barred from the silver amphitheatre. We didn’t have access, our IDs did not work, and we would not know what to do anyway, if we could get in. The hall was lined with plaques from past classes. Each one an ode to the individuals who had made the noble sacrifice of their bodies, to teach us students. We had been told that there was a memorial after each class had concluded the course. The family members of the people who had made this precious donation would be there and students would have the opportunity to thank them.

After the lecture finally ended, we trooped down to the hallway to review what would be our first dissections. We learned that on this day we would be examining the superficial extrinsic muscles of the shoulder, and probing further later in the week. On the prosections – completed dissections – we would be identifying structures of the spinal cord and the vertebral column. We would also be reviewing classic injuries and irregularities of the spinal cord and learning about the procedure of a lumbar puncture. Finally, we watched an anatomist dissector video, to prepare us for our first venture into the lab. A little over an hour later, we changed into scrubs and sneakers – which we were not permitted to wear out of the lab area from that point – then we finally walked into the white and silver hall that was the Gross Anatomy lab.

It was cold – not extremely so, but just uncomfortable enough for us to be aware of it, and the scent of formaldehyde was pungent. Since we had been split into smaller groups for our pre-lab review, other students were already in the lab ahead of my group. My group of 8 students was assigned Table 7A. We stood around the table, waiting for all the members of our group to arrive. Someone was flipping through the dissector booklet that listed all the structures we were to identify that week. Someone else was swiping through our table’s iPad to review the prosections. No one was looking at the white zipped up body bag before us.

“Sorry guys,” our last group member said as he joined us.

“Okay let’s get started,” someone said.

Two of my classmates unzipped the bag, one person taking the bottom end, the other the top. We had not made a decision on this, it was simply whoever chose to take the first step. Our male cadaver was wrapped in a sheet covered in preserving fluid, to keep him from getting too dry, and he was lying prone (with his back to us) already, so we would not have to turn him over.

“So it says to start here, and cut downwards,” someone began, indicating the dissector guide. And we began.

While we had sat in the second lecture, just before the video review, I had turned to my small group and said I wanted to make the first cut. I couldn’t explain why I had wanted this at first, but in retrospect there was a feeling of ownership of the encounter that spurred this declaration. It wasn’t, as one of our TAs suggested, an indication of my inclination toward surgery, but more a desire to dive headfirst into this new territory. It was something like running into the water at the beach, knowing it would feel cold, knowing the seaweed at the bottom may not be pleasant, knowing there could be shells that could scrape at your feet. But also knowing that it only got better once you took that first dunk under. And so I jumped right in. We ended up splitting the job, and choosing items we wanted to personally uncover, and for the most part, we stuck to the plan.

The lab went on for several hours. We attempted to combine precision with efficiency as we moved down the list of muscles, nerves and arteries of the shoulder and back. Our TA – a fourth year – was on hand to confirm our findings and to assist with the trickier cuts. This was the foundation, at our next lecture we would be introduced to the brachial plexus – the slightly less convoluted cousin to the lumbar plexus, which we really shouldn’t worry about now, because that would be in a few weeks. We soon stopped noticing the smell, and even, to an extent, that our clinical dissection of a person without flinching was not what other people might call normal. But we never did forget the person before us; the thought was there in every time we covered him when the wrapping slipped, or we referred to him as “our guy.”

In retrospect, although there is some desensitization of medical students in the “Gross” lab, there is an even stronger element of humanization with such a constant reminder of the frailty of the human body. Our encounter with our cadaver, our body, as we made those first hesitant cuts changed us. It was not simply learning the mechanical qualities of the human body, it was a confrontation with the fragility of that machine; the delicacy of those parts and their almost contradictory resilience. It was a reminder of the burden of knowledge we endeavored to bear to approach the complexities of the human body. It was a reminder of the trust that another human being would put in our ability to utilize that knowledge. It was a reminder that we were not simply students but truly physicians in training. And of course we were given every reminder to respect this man whose body we now examined, but I wonder how we could not have. Yes, he was our first patient, but I would add that he was also one of our first teachers. And we treated him as such.