10. Fable (part III)

Once we pass through the deep fascia, we put our scalpels down and use our hands to separate the bond between muscles. In a living body, the interfaces are comprised of a thin, transparent, slippery fascia that allows for movement and glide between structures. In embalmed donors, the sliding quality is mostly gone, but we can separate the surfaces with our hands because of this filmy separation. 

After an incredible day “fluffing” muscles and running my hands along the surfaces between, exploring contours and shapes—not only those of the donor, but my own as well—a classmate shares some bodywork with me. Using hands, navigating the confluence of my living tissues, manually clearing away tension and adhesion. Marty and I have shared the same end of the room for only six days, but I feel an unusual comfort with our quick connection. Perhaps because the rawness of the dissection has also removed our protective coverings and we are already beyond the superficial layers that we employ in our “real” lives outside of the lab. We go for dinner afterwards and talk for hours. I observe how easily the conversation flows and marvel at the comfort I feel in my own skin in front of another human being. There is a metaphor in this somewhere. A day spent playing with the tissues that separate two structures and examining how those tissues of separation are integral to the health of the relationship they share. 

It takes us thirteen days to arrive at muscle. Thirteen days of skin and fascia. Thirteen days reframing what anatomy consists of. Thirteen days of all the stuff that doesn’t make it into the books. It’s overwhelming, and words do not easily shape the texture of the experience. Muscle is the most popular layer in the lab; it’s what we are most familiar with. The room is full of bodyworkers who want to see the pelvic floor, the relationship between the hip flexor and the diaphragm, or the impressive strength of the Achilles tendon. Emotionally, I’m still unable to leave the previous layers behind. This is so typical of me. I continue to process long after an event passes. Fable has adipose deposits that are getting in the way of everything. This is not an easy dissection, and it takes a lot of time to make things look pretty, what the artist in me wants to see. Her beauty is overshadowed by my own ideals of perfection that interfere with the experience. I’m trying to control everything. 

My tablemates are making the most of it and embracing the challenge. Kimberly is hoping to carve out the pelvic floor, a much shapelier task than you would expect when three-dimensional. Before she gets there, she does a meticulous dissection of the psoas muscle (hip flexor) that she puts on paper—she’s a talented illustrator. I’m cursing my way around the thigh, where vasculature and adipose are tacked to the muscle in the same stubborn way her fat was adhered to the skin. Frustration rises again. Kimberly, sensing my state as my blade approaches her clean dissection, says, “Just don’t cut the psoas.” 

That evening Marty and I are leaving early so we can take in a popular tourist attraction, a tour of Alcatraz across the bay. Except we don’t actually leave early. Tickets are nearly impossible to come by for a sunset tour, but we manage to score a couple, and I’m already stressed that we’re not out the door sooner—if we miss the departure time, we forfeit our spot. I know that if we don’t catch a cab, we are not going to make it, and I’m going to lose my shit because it’s another thing I cannot control. Now that I have made Marty sufficiently nervous about my pending loss of shit, we arrive in time, board the ferry, and unpack the dinner he so thoughtfully arranged earlier in the day. He high-fives me, but I’m stuck in my anger over anticipating how the night could have turned out. I completely ruin our evening. The next day, inadvertently and carelessly, I cut the psoas. 

Having finally moved past the challenge of Fable’s superficial fascia and exposing her deep fascia, I discover yet another layer of my own armor. I become fascinated with the fibers embedded in this tissue—their thickness, strength, and direction. What is the role they play in holding me up? This shiny, fibrous stocking wraps around the muscle layer. In some areas it’s so thick that cutting through it feels like significant destruction; then there are places where it’s so thin, it barely exists. We note how the fascia dives into the muscle fiber, lending its strength and provoking the question where does a muscle’s integrity originate? Muscle fiber in the donor is the most fragile structure when compared to adipose and deep fascia. I can tear it accidentally with an effortless drag of my finger across its grain. It feels to be composed of the most delicate material we have encountered yet. The deep fascia’s location in the body between the cushion of the superficial fascia and the power of the muscle make me think it must be a protective layer. 

Journal Entry: 

How does one communicate with the deep fascia layer? The layer sandwiched between power and ease. It suggests to me it’s the protective layer—the one that is impenetrable from the inside, and out. It can hold me in, or hold you out—and what is the difference anyway? It needs to have integrity enough to hold my shape, but how much is too much? How much is not enough? 

The iliotibial band that runs from the lateral hip down the thigh to the outer knee is made up of a thick, deep fascia. It looks just like packing tape, the kind with threads running through it for more strength. The threads of the IT band run in several directions, forming an organized matrix of deep fascia. There are therapies that talk about stretching this structure with the hope of freeing up tension in the knee or thigh. In the lab, we’ve pulled at it from end to end in an attempt to see how much stretch it has. We’ve been unsuccessful. No one is surprised to see that we can’t affect its length one bit. 

The integrity of the deep fascia is incredible, and we note that it exists in almost every layer. As we narrow in on finer detail, curiosity around the superficial fascia inspires Caroline, who is dissecting at the table beside Fable, to painstakingly remove the fat pods from its structural web, revealing a doily of deep fascia that held the fat layer together. She goes one step further and floats it in water to demonstrate how the walls of each pod wrap around the space where the fat was previously held. We discuss whether its strength comes from the adipose itself or the deep fascia it is embedded in. Deeper questioning has someone strapping weight to a slab of superficial fascia to see how much it will hold before it tears. I have seen this done with both embalmed and unembalmed tissue, with fairly consistent results. It is astonishing to see how strong the fabric under the skin actually is, and our perceptions constantly shift through the experiments we engage in. I know now that the challenges I was having with Fable’s adipose was actually the incredible strength of the fascia hidden in her fat. 

The mood of the room begins to thicken as we prepare to enter the viscera. We are releasing more than just chemical preservative into the space as we descend into the caves containing life and death. It’s the organs of life that show us where death may have originated, and the questions continue to expand. Twelve sets of petrified lungs, twelve still hearts, twelve deep red spleens, and numerous kidneys—all looking quite the same and yet entirely different next to one another. Twelve greater omentums floating freely or stretched to the max, adhered to some far corner of the cave where it didn’t appear to have a natural reach. One uterus out of a possible six, still in situ, where the other five had been removed sometime during life. A dozen livers, some with their green gallbladder sac present and littered with small, gravel-like stones. Others with emerald stains in the wall of the small intestine, where the release of bile from the liver flowed uninhibited by the absent gallbladder. There are missing appendixes, and in the case of Fable, so much abdominal turmoil we are unable to decipher what is what. 

Fibers of intercostal muscle overlap in opposing diagonals between ribs. They assist in breath by allowing our rib cage to expand while air is drawn into the lungs by the changing pressure initiated by the pull of the diaphragm. We cut away some of the intercostal meat, opening windows in the rib cage to view the lungs. Using garden clippers to snip through the ribs, the breast plate is removed, exposing the thoracic cavity. When we hold the breast plate up to the light, we can see the striations of the muscle, circulatory, and fascial matrix that give the front of the chest its integrity. In the summertime, when the maple trees are thick with leaves, the sun highlights the veins of each leaf when the angle is just right. I noticed as a child the same translucent nature of my skin when I placed my palm against the inside of an illuminated lampshade, allowing the light to shine through. My imagination filled in the blanks, but I see with the rib cage that I was not wrong in my imagined view of blood and bone through the not so opaque quality of my skin. Human or tree, we are nature. 

Of the twelve, a quarter of these sternal plates are fastened together with what looks to be coat-hanger wire following an open-heart surgery. Strong metal wire is literally pushed through the thin bone of the sternum, their ends spiraled together like a twist tie and folded against the outer surface of the bone. It’s hard to imagine not feeling these rough ends scraping up against the underside of the skin when the person moved or breathed, and we note how the sharpness has been softened by the tissue the body laid down to protect itself. The sight of this indelicate repair speaks to the massive internal pressure that could break open a chest were it not for the living matrix of bone, fascia, and skin holding it all in place. 

As we take in all the details of this new exposure, I’m pretty sure I am not alone in directing my attention to my own guts. What are they doing in there? 

During my first dissection with Venus-Mary, the picturesque bladder, kidneys, and ureters lay proudly on the table while Gil delivered a monologue of function. One of the women present felt so keenly aware of her kidneys that she had to sit down on the stability of the floor to steady the waves of light-headedness that overwhelmed her. When empathy penetrates, it can be a truly visceral experience. During the days of viscera, the lab door swings in both directions at regular intervals while Somanauts come in and out via their own visceral processes. 

One night, as I scan the web for answers to visceral questions, a notification pops up in our group forum. Someone has posted a video of a teddy-bear dissection, and I imagine a collective clicking on the link from many of us in bed with our laptops, scanning pathologies and falling down the rabbit hole of the electronic body. The video takes the viewer through an exploratory surgery to find out what is wrong with the patient, and the first thing revealed is that his “bonbon” layer is faulty. Under the skin of the stuffed bear are a dozen or so unopened candy wrappers intended to make his personality sweet. Upon further inspection, it is found that the wrappers do not contain candy but cigarette butts—the first indication of disease. It’s implied, as we go further, that Teddy’s disease is emotional. His “play pouch is lacking,” but there is evidence in deeper layers that he has a good imagination, so there is hope. I find the video creepy. Marty comments, “That’s effed up,” and maybe it’s that this dude with the teddy bear has just hit the nail on the head. We are so deep in the emotion of organs and dysfunction, we don’t know if it’s funny, twisted, or eerily accurate. 

The thoracic and abdominal cavities are (mostly) neatly organized environments void of free-floating fat and fluid, allowing a lot of space for the sliding and gliding of organs while they work to breathe and digest. Fable’s organs do not resemble any others in the room. Her lungs are bathing in a pink fluid filled with clumps of pale red gelatin-like lobules. Some of this liquid is formalin but most is due to whatever her organs were up to before she died. I don’t recall if the same murk was in her abdominal cavity or not, because I am too busy trying to assimilate all I’m looking at in the moment we penetrate her peritoneal sac (the compartment that holds the majority of the abdominal organs). I don’t recall seeing a greater omentum blanketing her diseased-looking viscera. At first glance, the organs all have the same look: they’re gray-brown and lack the usual splashes of red, green, and pink we expect to see around the liver and spleen. The surfaces are dull and knobbly, with little to no distinction from one quadrant to the next. It looks as though her stomach could be her intestine, or even her bladder. Everything looks like everything else. Up until now we have been very curious to see what she’d been keeping inside. As the forms around the room change shape with each layer removed, the silhouette of Fable’s belly does not soften, despite having already placed dozens of pounds of her tissue in the bucket. 

At a complete loss for what to do, the four of us walk away. 

I’m right back to the first week, fighting with the woman who evolved into the cadaver before us. What are my organs doing? What do they look like? Am I doing enough to care for myself in this life? 

I’m looking at her and examining me. I barely sleep that night with all the curiosity and confusion running through my brain. I should have changed tables back on day one, when I had the chance. 

It’s a lot heavier than any of us have anticipated. Gil says he has never seen viscera in such a state before, and everyone in the room is now avoiding Fable and our workstation. I feel so sad for Fable, because I am making up a story about her and all the facets of her personality that made her skin so thick and her organs so troubled. Which, of course, is more about me and my walls than anything having to do with her. 

After a break from the intensity, we fully investigate her abdomen, where we begin with locating the stomach, then follow the path of digestion, until everything is identified. Normally this can be done at a glance. With Fable, visual recognition is not sufficient, so instead we label each organ by location. We need the experienced hands of Gil to direct us in lovingly washing away the effusion—remnants of infection, clipping arteries, veins, lymph, and nerve to finally free her body of the manifestation of disease inside. Gil says he finds it satisfying to add some love to the formula by restoring a sense of clarity where disease has prevailed. “If not a relief to the donor,” he says, “it always seems a relief to the team working with the form so encumbered.” He’s right, and we feel lighter witnessing his care for Fable while he speaks as much to her as to us during this cleansing process. 

With her viscera on the worktable away from her skeleton, I gather the courage to dissect her organs. Although her official cause of death was “respiratory arrest,” Fable also had metastatic breast cancer and was diabetic. I want to see how far the cancer has spread, and assume the bumpy presentation of her viscera to be the infiltration of that disease. Her lungs have the same rough texture, but her heart is free of lesions. When I open her colon, there is no feces to clear away, which is unusual. I guess it had been a while since her last meal. The inside appears surprisingly healthy. It’s smooth, with an average-sized pathway, unobstructed by obvious mutated cell growth, and it looks to be a bit of a shinier gray and, by all accounts, “normal.” I slice partway through the liver to maintain its integrity and include a major vein in the cut. Having also left a tiny portion of the vein’s wall intact, when I cup the two liver halves in my hands, the hole created by the hollow vessel is in the perfect shape of a heart. Not an anatomical heart, but the kind I carved in trees as a kid. The sight calls me back to the present moment, and I just sit there with Mable-Faye’s sixty-three-year-old lumpy liver cupped in my hands, staring at this accidental heart. Her liver, with all its fatty deposits, is not the healthiest in the room, but it’s not the sickest either. I am beginning to soften toward her and the fear she has stirred up in me. I’m admittedly afraid that the story I’m projecting upon her is what could have been my own. Without any evidence at all, I had decided her disease was emotional. 

I spend the entire afternoon silently in my own insides while palpating those of Fable.