13. Unfixed (Part I)

Look deep into nature, and then you will understand everything better. 

—Albert Einstein 

Fixed is a term we use to describe embalmed tissue. The quality of the structures are unchanging once they have been infused with the chemical preservatives that render them fixed. They are stiff but pliable. 

Unfixed refers to the absence of formalin. An unfixed body has not been embalmed or shaved. The tissue is flexible, full of color, and steadily reveals progressing signs of decay while we work. 

Both have advantages and disadvantages to the dissector interested in learning more about the human body. 

Three years following the dissection of Fable, I was seduced into the unfixed experience. After taking a year off to recover my finances, when I returned there were constant video feeds of the unfixed lab on the monitors as a fellow dissector weeded through edits of educational clips. The color and elasticity of the tissue was incredible in contrast to what we were currently working with in the embalmed donors. I spoke with those who had done it and agreed that, although I found it slightly terrifying, I had to experience an unfixed dissection. 

In our morning circle on day one, I’m telling the small group of a dozen or so Somanauts about how, on gray days at work, I watch outside in anticipation of the rain. Specifically, building anxiety over whether I’ll make it home before the rain or get caught in it on my forty-minute bike commute. The thing is, I love the rain. So all the anticipation is wasted the moment I’m on my bike, water pelting against my rain gear and a smile of relief on my face to finally just be in the moment. 

The anticipation of the unfixed lab is as familiar to me as my silly fixation on the rain. I am nervous about the unfamiliar state of the tissues. The divide between life and death in an unfixed lab is much subtler than in that of an embalmed one. The bodies here could easily be mistaken for the living, and suddenly I feel a little repulsed by the dark fascination that has me eager to cut one of them open. Again. 

The donors are kept in very cold fridges for up to six weeks, until we meet them. The smell is different and just as unique. Someone once described the unfixed odor as that of a butcher shop. For my first experience, I wholeheartedly disagree. Years of exposure through dissection can taint recall. We are so engrossed in the marvelous revelations of the body that details such as smell fade quickly, so I cannot discount this description entirely but I have yet to acclimatize to the new assault on my senses. Despite being meticulously wrapped and returned to the giant walk-in fridge while we lunch or break for the night, the donors are getting a little more fragrant each time we uncover them to begin again. As with a fixed donor, the more we cut, the greater the ooze of scent. It’s not less noxious, but it doesn’t sting the airway as the chemicals do. It’s a smell I have never encountered outside the lab. It’s not as pungent as that of a dead rodent rotting inside your walls—there is more control to the decay. The nose, mouth, and ears are quick to be coated with stinky bacteria, and the experienced dissectors who take less offense at the breakdown of a body will take the time and care to clean the offending orifice regularly. 

The unfixed body looks much more like a person, and there are moments when my mind tricks me into thinking one is alive. We are gathered around talking on the first morning of the unfixed lab when an arm of our donor “Betty” is ever so slightly moved, and her forearm naturally rotates as it settles itself to hang slightly off the table. The motion exposes the first cut into her skin, and the long incision glows with the bright red of her blood. I am not accustomed to the sight of blood pooling around our scalpel cuts. I am tricked into thinking she is alive. Her flesh color reveals pink shades influenced by the blood remaining in her circulatory system, a detail that is absent from a fixed donor. 

Betty is stunning in this natural state. A thin woman with perfect hair and a fresh mani-pedi. The old zipper scar running from the base of her ribs to her pelvis frightens me. Three years later I am still affected by Fable. Working with her eviscerated me emotionally, and I am not prepared for a repeat. I choose to work with “Cooper,” a sweet-looking eighty-eight-year-old void of obvious surgical scars. 

When the bodies are not chemically preserved, they are much more malleable and bendy. After the natural subsidence of rigor mortis—a physiological process of death lasting up to sixty hours—the bodies return to their loose state where we cannot stand them up as we do in the fixed lab. To meet them eye to eye, we pivot their bodies, allowing their legs to dangle over the edge of the table, and sit them up. 

Betty’s skin does not droop or sag with the introduction of gravity, unlike that of Cooper, who has a barrel chest and a solid gut that hangs to the left with the listing of his spine. He’s toothless and has a calm presence about him. 

All the digits apart from his great toe on the right foot have been amputated, which might explain why his body has the severe left lean. While we work on dissecting the muscles around his shoulders—I on the left and Sallie on the right—the contrast in tissue is notable. I find the muscles clearly defined, easy to differentiate, and the dissection comes easily. Sallie, on the other hand, is wrangling with tougher tissue that will not come away without a fight. We hypothesize about how much his missing toes have to do with the contrast in texture from one side of his body to the other. 

When we enter the viscera, his organs are neatly arranged, revealing the greatness of the lungs beneath the cage of his notably large chest. He has only one small adhesion on the right side of his colon, but deeper than that, every single vertebra, from his lumbar all the way up his thoracic spine, is herniated on the right side. A result of his leftward list and the cause for sticky muscles on the right, perhaps. 

I note that the bulges between each vertebra are just as dense as those in a fixed cadaver. I wonder whether embalming fluid can reach these bulges, or if what I am seeing in Cooper is the same as what presents in the fixed lab. It’s important, because as we articulate his spine, the bulges do not change shape. I take this as an indication that these are “healed” herniations that no longer put massive pressure on the nerve roots causing pain—how I imagine my old herniation to look. 

As I clear away all the meat along the backside of Cooper’s spine, Sallie points out that I have exposed the delicate threads of his sympathetic nervous system. I have to stand back to take it in. What a fantastic revelation. There is so much fibrous tissue around this part of the spine with all the muscle attachments and their tendinous embroideries that, to my untrained eyes, the nerves blend into the scene before me. Setting down my scalpel, with my jaw gaping behind my mask, I step back to see, plain as day, Cooper’s sympathetic trunk. Tiny organized strips of floss exit the spine at perfectly spaced intervals exposed where muscle has been pulled back, and diving into those same muscles further away where my dissection has paused. These impossibly delicate strings are the communication channels of the body responsible for the mechanics of fight or flight. 

After clipping through his ribs to fully expose Cooper’s heart and fantastically large lungs, we work as a team to inflate them. As I squeeze the lung, my nervous system immediately recognizes the texture, and I search my brain for its comparison. A sponge is most obvious, but there is a better example somewhere in the archives of my sensory recall that I cannot yet articulate. 

We insert a turkey baster in his trachea just above the thyroid. Someone holds the mouth and nose shut to block the escape of air: we are about to simulate the movement of breath through Cooper’s massive lungs. We replace the bulb of the turkey baster with a nitrile glove and pierce it to make a small hole that one of us will blow into, to give Cooper’s lungs breath. In a fixed cadaver, inflating the lungs is a much greater feat for the living lungs that are loaning their air to the task. It takes several breaths to unlock their rubbery thickness. Cooper’s lungs are soft and springy. Having removed the ribs, we see that his massive bronchi could expand to fill space beyond the confines of his body. I don’t think I have ever taken a deeper breath than the one inspired by the sight of these great wings inflating before my eyes. In fact, even when I think about it now, my breath is automatically richer in quality and expanse. 

And the sight of his breath dusts off the childhood memory of a spongy nerf football that has been soaking in a puddle on the lawn overnight. Each squeeze expels not just water, but air too, from the expansive absorbency of its soft, dense rubber. Between my palms, I feel the faint push of each tiny air pocket bubbling outward against my skin. It’s a subtle pressure, but unique and unmistakable. As we stand around the table following a stream of conversation unrelated to the body or dissection, it feels natural that at least one of us has been mystically drawn away from the murmur of talk while caressing the captivating texture of a lung. 

With the heart fully exposed between Cooper’s pulmonary lobes, one of my tablemates claims the project of its crimson dissection. All five liters of blood remain as liquid in the system of an unfixed donor, and the colors of the organs and tissues are spectacular compared to those of an embalmed body. This also means the integrity of the internal structure beyond the skin is delicate and short-lived. When we open his skullcap, we have mere minutes to observe the brain before it oozes its way out of its casing to fall in a thick puddle on the table. Had we looked at his brain on day one, we may have been granted more time before it lost its shape, but the brain of the deceased, if not preserved, does not hold its form for long once released from its membranes. By day five, the tissues have been too exposed to the elements, and cellular bonds are few. 

By the time the heart is removed from its more fibrous pericardium case and cut into, the great muscle quickly expands and flattens itself over the tray it had been laid upon. A glorious deep red infuses the strands of muscle as they dissolve, exposing the heart valves and their delicate papillary tendons. Also known as the heart strings, these tendons keep the valves from inverting against the powerful flow of blood between the chambers of the heart. I’ve often been told that the quality of my heartbeat is loud and strong in comparison to that of others—a family trait, I think. Sitting with my mom’s sister, I could practically see her heart valves slamming shut—the closure would reverberate through her body with a steady rhythm. I recognize my own heart in the subtle pulsing sway of her bobbing head in silent moments. 

Dissecting the muscles of the thigh, we have to pause and tie off the great saphenous vein to prevent hemorrhage. It’s a strange concept in the unfixed lab that these bodies can still bleed. A colleague from previous dissections writes to me about how messy and disgusting she finds the unfixed experience, compared to the cleaner, embalmed and coagulated blood presentation of a fixed body. It brings a different awareness to the work when you have to consider the impact of each cut before it is made. No one wants to be held responsible for suddenly releasing litres of blood into our field of work. Thankfully, the dissection stations in the unfixed lab are equipped with individual water and drain sources, making the cleanup of unintentionally bloody cuts manageable. 

When one opens up a joint, whether embalmed or not, there is little difference in the quality of the gooey synovial fluid that lubricates its movement. We find inconsistent volumes of synovial fluid from body to body, depending on age or supposed activity level, and probably other factors I have not yet considered. It’s thrilling to see this thick fluid come pouring out of a knee or hip joint. It appears that the more fluid we find in the joint capsule, the smoother the surface of the bone it is bathing. When they are healthy, joint surfaces are as smooth and bright as beach glass. As I peer into the small joints of Cooper’s fingers, I discover tiny granules in place of the joint fluid, and excitedly shout, “Pannus!” 

Pannus—a painful inflammation that damages cartilage, bone, vasculature, and ligaments—is present in the joints of those who suffer from rheumatoid arthritis. In the case of Cooper, he has severe affects in his left knee. The friction caused by the loss of the lubricating synovial fluid carved deep grooves into the bone surfaces that made up the joint. It’s hard to know how much pain he felt in his body with his missing toes, herniated discs, and rheumatoid arthritis. He also has some arteriosclerosis, which tips us off as we guess his cause of death to be heart-related. Confirmed in his paperwork: he died of a heart attack. 

Betty’s adipose layer is the most delicate I’ve ever seen. The pods of her fat range in size from that of a perfectly cooked grain of basmati rice to the plump soft lumps of bulgur: a great contrast to the raisin and date-sized pods in most of the other bodies I’ve seen. She died at fifty-five of sepsis. I wondered how long it took to overcome her, and if her manicure was for us. We are honored to be present to see to her final request, and hope our pending exploration of her tissues gave her a sense of purpose as she drifted away from her body. 

My fears surrounding her abdominal scar are realized as her dissectors penetrate her visceral sac. Her intestines are tacked down and bound together by strong connective-tissue fibers. They should have a slippery quality you would expect to part if you plunged a hand deep into their space. The introduction of a benign foreign body would cause them to rearrange themselves like water around a rock, which we observe is not possible with Betty. It’s almost as if someone had entered her viscera with a darning needle and stitched together her intestines with yarn. How would this affect digestion, a process that relies on the movability of these exact parts to break down food, absorb, and eliminate? We hypothesize that she was significantly inhibited in this department, but why? 

Caroline is one of the most meticulous and patient dissectors I have ever worked with. I have watched her painstakingly remove individual fat lobules from the matrix of fascia to float it in water, demonstrating the intricate scaffolding that gives it structure. It was her I witnessed spend an entire day unwinding the heart during the three-week. Caroline brings a depth of curiosity that goes far beyond biology. She is an experienced and inquisitive Somanaut, and in her careful hands, Betty’s abdominal adhesions are slowly released so we can make sense of how she came to be with us. 

Caroline frees the abdominal space of all its adhesions and invites us along as she manually traces her way through Betty’s bowel. Tracing the small intestine uncovers some confusing details that prompt her to take up the knife again, discovering that Betty had what appears to be a gastric/duodenal bypass. Surgical staples are found at the pyloric sphincter of her stomach, where her duodenum would have connected the stomach to the liver and small intestine. This is where the majority of fat in food is digested; the absence of this organ means Betty was not digesting fat. The bypass is a cosmetic surgery aimed at eliminating fat absorption, promoting weight loss, or as a preventative to weight gain. We project our opinions of what compelled her to take such drastic measures and wish we had more information on who she was. There are no stretch marks on Betty’s skin to indicate that she had ever been larger than the woman we are now dissecting. The long scar on her abdomen remains a mystery. Perhaps it was related to the duodenal bypass. Perhaps not. I would later meet a client with a rare condition requiring surgery that sounds strikingly similar to what we observed in Betty, and I am rethinking our old hypothesis years later. 

The morning circle is holding space for conversations of embodiment—this is not new. The surgical alterations of the donor are found also in those who step forward to dissect. Although it’s not intentional, there is often a slight tone of judgment as we work out the reasons society struggles with shame surrounding the body—as if we in the lab are immune to this phenomenon. Inevitably, someone in our circle will reveal that they too have had a cosmetic procedure to assist in their acceptance of self. Then others come forward with stories of struggle yet to be reconciled. 

We are unearthing the intricacies of our own existence as we penetrate the literal layers that make up the skin to eventually dive into our metaphorical viscera. Some of the confessions that surface through dissection dialogue are deeply guarded secrets that have not been released previously—to anyone. Cutting into a body bonds us uniquely. The guts required to slice into human flesh surely must exceed the guts required to be even a little bit emotionally vulnerable, so we trust one another quickly. We have literally stared at the grossest parts of a body while casually discussing some of our deepest personal stories with the strangers we met just a few days earlier. We are keenly aware of the impermanence of this moment in time. Once our donors are back in their boxes, we will return to life beyond the lab, a life that rarely pauses to connect and reflect. We revel in the conversations as they move from the morning circle to the more intimate space around our donor. The unfixed laboratory is small, and for this week there are only two donors, providing a sense of security as we uncap confessions that bond us as humans. 

Surgeries and pathologies are opportunities in the lab where we all gather around one donor to discuss what we are looking at. There are a lot of questions and a lot of answers. It is not unusual to drop what you are doing to leaf through one of the many anatomy books in the room. Dissectors retreat to the hallway where cell phones emerge and Google attempts to answer some of the deeper mysteries brought forth by the body. Most of the time, we leave with more questions than answers because information on donors is sparse. They are being autopsied by us: untrained novice dissectors without diagnostic skills, tests, or labs at our disposal. What we find in a body is never confirmed or studied before their final cremation. The paperwork accompanying a donor often cites cause of death as respiratory or cardiac arrest, which even as rookies we can assume to be the case since they are no longer breathing. But the body has more to say about these simple conclusions.