15. The Sagittal Cut (Part I)

There is nothing like returning to a place that remains unchanged to find the ways in which you yourself have altered.

—Nelson Mandela

Having spent most of my life single, one of the things I dislike the most is travel. I love being in new places to explore the culture and daily routine, but it’s lonely. For some reason, airports are the worst. Navigating customs and transportation to arrive at my final destination is anxiety-inducing in a way that overtakes the joy of being someplace new. As I’ve previously traveled to San Francisco on several occasions for dissection, the loneliness exists only long enough to get me to the hostel residence, where the staff welcome me as an old friend.

The year of the Sagittal Cut, I am met at the airport by John from the three-week. The previous winter, John joined my yoga retreat to Costa Rica, where he offered massage to the guests and engaged in long conversations with me over all things body.

What a delight to walk straight out of customs and into his familiar presence. He drives us into the forest, where we put our hands on a giant, 1,200-year-old redwood scarred by fire. We share personal stories, ideas, and concepts, launching into deep topics, despite not having seen one another in over a year.

The dense silence of the forest reaches into my gut to illuminate the same calm found inside of me. Numerous morning circles and dinners after removing skin, adipose, deep fascia, and examining disease place our conversations at a level we do not easily share with others. Esoteric discussions that exist solely with those who have journeyed through a body together the way we have. The relationship between Somanauts is incredibly special, and probably half the reason many of us arrive year after year in the same labs. We have journeyed to profound physical and emotional places in one another’s presence and shared visceral responses to the revelations of the body. We return the car rental in San José, and John prepares to board his short flight home, just as Caroline’s car pulls up to the curb. Honestly, I am a bit overwhelmed by their reception. Neither of them is attending this lab, but they made the space in their schedules to take advantage of my proximity—close enough to arrive, but far enough to make it an effort.

I have chased love all my life. Unwittingly choosing partners and friends who like my mother, made me work for their attention and affection. A familiar dynamic. I was so accustomed to chasing connection it took me years to realize that many of my relationships were conditional or one-sided. I had habitually taken all the responsibility for maintaining social links, but to have these two turn the table and arrive for me when I did nothing at all to earn it, feels foreign, and so uncomfortable.

Caroline and I waste no time checking into a hotel and park ourselves in the lobby bistro for a drink. Our conversation continues through dinner and into the late hours of the night, expanding on the seeds that have had a year to germinate since the last time we shared a meal.

The dissection now before me has been circling in my head for two years, and the stability of the deep human connection brought by John and Caroline nicely lays the foundation for the week of the Sagittal Cut.

Now that I have somewhat bridged the worlds of matter and sentiment, arriving occasionally in a place where they can coexist within my own being, I am curious to go deeper. The more I look, the more I want to see. This is true in my yoga practice, through massage, in the darkroom…in a cadaver.

It’s like there is this elusive answer to an even more elusive question that I am seeking truth about, and although I am not confident the answer can ever be found, I am driven by the adventure of inquiry. Nothing revealed along the way is lost or wasted. I suppose, in a sense, I just keep revealing more and more of myself. With that comes an uncovering of those around me, because we are not all that different from one another. Our injuries may vary, but our pain is the same.

I figure if you have read this far, you too are ready to look more deeply into what dissection has to offer. The Sagittal Cut is intense, and it demands you observe in more ways than one. After having spent hundreds of hours in the lab, mostly concentrated into a four-year period, I enter the lab for the first time with a project.

Here is where language becomes essential to the telling of the story. This particular dissection is epic for me, and challenging to share with non-clinical observers, because it is intimate in nature and, when told out of context, grotesque. Having said that, though, my caution in telling the story is not because there is increased risk of emotional discomfort. The Sagittal Cut, for me, is not emotional at all. It’s all physical and cerebral, which is, of course, the irony of cutting a brain in two.

A sagittal plane is an anatomical plane that divides the body into right and left parts—the first way in which language packages this dissection as an objective task. All sentiment is removed from the act. Not because there is no place for it—quite the contrary. Just that my current journey is grounded in a way I have not previously experienced. I’m feeling stable and confident in all areas of my life as I step into this experience. I’ve extracted myself from managing the yoga studio and have officially retired from teaching, which has freed me up to be fully present with my massage clients and emotional growth. I’ve reclaimed my personal practice and professional freedom. It just feels like the next best step is to look objectively at one of the most intricate areas of dissection: the head.

In a six-day dissection, the head is the part of the body that receives the least amount of attention. For many, it’s the presence of a person represented by the face, but more than that, it’s the complication and technical difficulty of working on the skull. The layers are tightly related and the crevices are confusing to navigate. Dissecting the head takes more time than most dissectors are willing to sacrifice when there is so much else to observe.

Reading about medical school dissections, you’ll see that a common avoidance of the “person” is a theme. Perhaps this is due to the gross anatomy class being mandatory and packed with an obscene amount of Latin terminology that must be committed to memory over a short period of time. In contrast, my colleagues and I study our donor as a means to go deeper into the body and enhance what we have already learned. There will be no test, and the only pressure is what we have put upon ourselves.

I will admit, though, when I saw my first dissection, the face was a delicate matter to confront. Its presence suggested that at one time the eyes were taking in images, the same way ours are now. The lack of depth in the dull gray pupil and iris that recently lit up with life and emotion is unsettling. With Venus-Mary, I wanted to remove her eyelids, but my classmates would not condone it. There existed in me a morbid desire to look death in the eye in a way that everyone else seemed to recoil from. I was not afraid to see death in the donors. I was afraid of how it existed inside of me, and looking at those who had crossed that threshold hadn’t yet answered anything.

I accompany eager massage students to my local medical school lab, where all the faces of the donors are covered. Not just covered, but wrapped tight with fabric and plastic, sending a message that they should not be disturbed. I’ve caught myself once or twice unwrapping a face, completely oblivious to an unspoken etiquette that forbids me to do so. I wonder about this. With all my fears around intimacy, I have a certain boldness when it comes to looking deep at someone else. Perhaps especially when that someone else cannot return the depth of my gaze.

Arriving in the lab of the Sagittal Cut has taken me years. Maybe lifetimes. It makes sense to me that I was not prepared for the emotional journey yoga would inspire. Yet somehow I am even more surprised to find that dissection has brought me deeper into that same journey. Yoga should have been physical and dissection cerebral, yet both practices have exposed deeper meaning to everything in my life. Here I am, ready to take on the most intimate dissection thus far, and I am all about the task. I am going to cut a head in half, and there is no sentiment about it. I have to look at everything, and for once, there is nothing clouding my vision. This dissection is as objective as I have ever been.

The tools we use to explore a donor encourage a slow, deliberate pace that keeps us present with every cut. If we wish to penetrate bone, it is done with a regular garden-variety handsaw, which requires agility and a well thought out plan. It’s not surgery—my donor won’t die if I mess it up—but the way it goes down will follow me out of the lab and into my dreams, so I had better be ready.

The first time I explored a head in this way was with Mobe, alongside my three-week colleagues. I elected to open the skullcap in the regular way we’ve all seen on forensic TV shows, by sawing around the perimeter to remove the brain as a whole. Just as I took the saw in hand, it was suggested that since another table had done the same cut, would I consider a sagittal cut? “Sure!” I thought. “A different view would be cool.” What I did not yet realize was that the question was not simply a request, but a mild warning of the invasive images that the cut might later inspire.

Sawing through bone is similar to cutting through wood. Wood of the size and shape and texture of a skull needs to be supported on both sides to hold it steady in order to generate a smooth cut, making it a team effort. When you’re cutting a smooth log that is thick with wet moss, the blade can slide laterally, making the first scoring of the surface a challenge. With Mobe, we hadn’t done much dissection of the slippery fascia encasing the skull before beginning, so gaining control of the saw took some work. I had ample help supporting the head, and the cut was near perfect. Somehow I had blindly managed to saw straight down the center of the cranium, separating the right and left hemispheres of the brain. I had only ever seen this in books, and the energy in the room matched mine as we all gathered around to inspect the deepest parts of the human brain.

I was familiar with the structures inside the brain only by name. I was so overwhelmed with the newness of this view, I missed pretty much everything.

After returning home and to my massage practice, the incredible images of that experience would revisit me. At the end of a massage treatment, holding my client’s head in my hands, I cringed for a moment with the image of what I had done to Mobe’s head in the lab. I often find while I am working, the exposed structures of dissection appear under my hands as I attempt to identify what I am feeling. I not only welcome the visual references, I seek them out, but the sagittal cut was different, and I struggle to articulate why exactly. Immediately I want to say that cutting through a skull is obviously intense, but that is not it. Opening the skull is amazing, and pulling out a whole brain, even more so.

Holding a living head in my hands, I am aware of the person in a way I am not while working on a shoulder, for example. The uniqueness of the face, hair, and expression are right at the surface on a living body. The flicker of the eyes and how the skin creases between them reveal a lot about the level of comfort a client embodies in the moment. When I feel the full weight of a head and am granted the freedom to move it about as I navigate the intricate spaces and muscles of the cervical spine, I am aware of the trust in this therapeutic relationship. I can feel the blood pulsing beneath my fingers when I hold a living skull. The sudden movement of the muscles that assist in swallowing alert me to the arousal of thought. The slow rolling of the eyes as the iris pushes up against the underside of the eyelid indicates deep relaxation. In these moments, I am fully present with the nature of my touch and how it translates.

While making the sagittal cut on Mobe, I was present, but not in the same way I was with Fable’s organs. With Fable, I felt emotion for what I thought she had been through. Emotion for what was being stirred within me. As I cut through Mobe’s skull, I pushed aside the internal judgment surrounding this bold act. I wasn’t thinking about the disease in his kidneys or the intellect that fueled his career. I wasn’t thinking about the fact that I was sawing a head in half.

That thought didn’t come until I went back to work the following week.

A client’s head cupped in my hands, and an image of the perfect cut down the center of the nose flashes inside of me. I turn my head to the side and close my eyes tight, wanting to refuse the invasiveness of the memory.

“Oh my god,” I think. “I sawed a man’s head in half!”

I know this is not what took place, but I am allowing language to reframe the experience in a crude manner because my skewed recall is shocking in the moment. Almost as quickly as I had tried to escape, I launch into the image and lay it over the face before me. This is when the regret comes, because missing from my overlay is everything but the line of the saw. I got to see and feel for real the images of the brain I had studied in textbooks. Textbooks are wonderful but limited when I want to better understand the finer details of everything that comprises a skull; the flat images of reference books offer only a hint of what’s beneath. I journey back to my grasp on the brain stem to feel the wiggling of the toe some five and a half feet away, and I am transported back into the lab, looking deeper at the things I couldn’t fullydigest at the moment I was standing right there. Overwhelmed again, I am forced deeper by the sagittal cut, and the mystery of the brain overtakes me with a wave of sheer awe. At the same time, the memory of amazement conjures up feelings of disappointment. Why didn’t I look at the sinuses, the eyes, the muscles of the jaw? How could I have let that head go without turning it inside out?

Two years pass before I am able to revisit the same dissection in order to fill in the blanks. Two years attempting to penetrate the bones of the face with my gaze. Repeated glances at X-rays, photos, and artistic renderings of the sinuses. My attempts to mentally reconstruct the cavernous puzzle of the head serves only to deepen my determination to repeat the sagittal cut.

Meeting in the lobby on day one, several alumni reunite, including Marty, who I have not seen since the three-week, four years earlier. Marty and Sallie are assisting the course, and I am staying with Fran, also a three-week alumnus. Jim is there as always, and there are others I have not met but who are already part of our tribe because of the connections we share. The lab is an immediate buzz of familiarity, and the circle introductions are heavier than usual, as many of the participants are grieving recent deaths of loved ones. A few students share that the experience is a bucket-list item, paid for by GoFundMe campaigns. The lab has been a sacred space for me. I feel a bit protective of how this might change the intimate nature of these courses and do my best to embrace that fear; I want to be better at sharing the experience than I actually am.

As we prepare to meet the donors, I announce my intention for the week. It’s met with more enthusiasm than I’d expected—because it has taken me so long to get here, I’m surprised that the others are eager to observe right out of the gate.

While there are many similarities among donors and dissections, after a few I realize that choosing one donor over another could make or break my dissection plan. Up until now, I did not have a lot of experience working with a head, just enough to know that it was tough. Dissecting the face can be like peeling a thin-skinned orange that has a firm connection to the fruit beneath. It comes away reluctantly in several tiny pieces and leaves me terribly frustrated. Dissection of the neck, with all the intricate bony protrusions of the spine, is not unlike trying to peel the thin wrapping around the knobs and small crevices of ginger root. With Mobe, I did not fully dissect the face before moving forward with the saw. That detail had not been planned, and this time I want to see and feel everything.

There are five donors to choose from, and as we cruise the room, I am on a mission. I go straight to the head of each. The delicate nature of my chosen project is unlikely to be met with resistance. Apart from the dental hygienist, no one else is keen to monopolize the skull. The only real detail I am looking for in each form is ease in accessing the neck. With age, and depending on habitual or work-related posture, many of the bodies tend to have an overexaggerated hump at the upper back that causes the head to hang quite far back in order to rest on the surface of a dissection table. This means the cervical spine becomes compressed from behind, making it a project in itself just to remove the skin. (Think of the folds of skin on a wrinkly Shar Pei puppy.)

Fixed donors have surprisingly little mobility in their joints prior to dissection. They become more flexible as layers and the fluid contained in the tissues are removed. My hope is to find one with a minimally compressed neck canvas, even a small amount of flexibility. I am torn between two gentlemen, and make my selection based upon where the dental hygienist is not.

Introducing “Sir.”

A broad neck and space to maneuver easily. My tablemates readily surrender Sir, from the collar up, to me. For the most part, interests are elsewhere, but also everyone really wants to see the sagittal cut as a spectator. A fellow Canadian, a naturopathic physician, and someone who has woven in and out of my life for nearly twenty years, is a surprise colleague during the course. She attributes my incessant talk about the lab over a dozen years earlier to her decision to finally attend. We haven’t lived in the same city or had any contact for at least a decade but bond quickly again through casual conversation while we dissect side by side. To be honest, I am so involved in the details of the sagittal cut, I am embarrassed to say I cannot fully recount more than a few of the other participants at my table that week.

Day one always sees the removal of skin, and the face is unique in that this layer lies just atop the muscles of expression that are buried in the adipose. Every other part of the body has at least two more layers to penetrate before muscle is exposed. Despite my advantage of having less tissue to remove, the intricacy of it has me right on pace with the rest of the room. Apart from the jaw, the muscles of the face have no bony attachment and are too thin to palpate, but they are responsible for the unique lines and character of our wrinkles as we age. I love exploring the facial muscles. I learn the names as they emerge and I begin to look differently at the faces around me that are so animated, as together we uncover the fatty layer of superficial fascia.

Marty, who I am eager to reconnect with, is all over the room, visiting the sagittal cut project sporadically throughout the days, offering suggestions and sharing his enthusiasm for the project. We argue about whether or not the muscle I have just exposed is occipitalis or contractile tissue within the adipose (a common debate in the lab). Both of us prepared and expecting to be wrong. Learning in the lab is about uncovering not only what we know, or what we think we know, but also what we don’t. Any time I make a statement about something I am looking at—in the lab or not—I hear Jim say in his light, facetious but serious way, “Are you certain?”

It’s a statement that always brings me back to what I am looking at.

The head, again, is unique because it changes form entirely once its fatty layer is removed. Except for the few muscles on the jaw and neck, the bony skull is fully exposed. I am reminded of a social media post from the year before the sagittal cut:

Total anatomy geek moment on the bus.

A man with very little superficial fascia sat in front of me on the side-facing seats, giving me a profile view of his face. He was chewing on his gum with so much vigor, I could see the strands of his masseter muscle contracting and relaxing. The temporalis gently pulsed beneath his hair, while just distal to the zygomatic arch, the condyle and the shadow of the coronoid process slid back and forth as if on a track. I couldn’t tear my eyes away! What a rare opportunity to see all the muscles beneath the skin.

I wonder if this vigor makes for a super-strong jaw or super-intense headaches.

Whether this speaks to you or not, my Geekdom is your win!

(Most of the comments following the post are from fellow geeks and a few others who claim to have learned some new words or confirmed that aggressive gum-chewing results in headache.)

It’s no secret that the muscles of the jaw are some of the strongest in the body, so I am not sure why they appear so slight on a page. There is the small masseter that spans from the cheekbone, just in front of the ear, to the lower jaw and is responsible for chewing. Its partner-in-crime, the temporalis, fans the side of the skull and dips behind the cheekbone to a spot on the mandible that hides inside the flesh of the cheek. In a sense, these two muscles sandwich the jawbone and power your bite. I am more than surprised when I expose beyond the surface of the musculature here. The masseter is almost as thick as it is long (an inch and a half on this specimen) and is stitched tight with tendons that are embedded into the bone so strongly you’d think they were the same structure. Temporalis appears at first glance to be a mostly flat muscle attaching to the surface of the skull, fanning up from the ear, but it is way more than this in the flesh. With the time to detail the dissection, I discover that as the muscle journeys beside the eye socket, it thickens and descends deep into the hollow of the face, threading under the cheekbone into the mandible. It doesn’t just clip onto the bone, it wraps around its edges, gripping the inner aspect with enough force to match the masseter.

I have manually massaged these muscles, mostly blindly, for years. Client feedback confirms my ignorance was not of great consequence, but they are in for a treat following this dissection. Coincidentally, when I return from the Sagittal Cut, my practice contains an unusually high number of requests for jaw treatments, many on new clients. It always happens this way. As if the universe calls out to those in the vicinity of my practice, subliminally leading them to me following my in-depth anatomical study of their exact problem.

End-of-day cleanup is meticulous. We leave every table with a bright shine, wiping off overhead lamps, cleaning tools, and picking up small cadaver bits that get tracked around the room on our shoes. As each layer of the donor is removed, it gets stored in a bucket lined with a heavy plastic bag that belongs to them alone. We try to keep every particle of fat contained in the room. Some of it inadvertently gets washed down a special drain where we empty the small pails that catch the day’s dissection fluid beneath each donor’s table. A small closet to the left of the row of regular washing sinks contains a drain dedicated to the liquid waste. Several floors below, a drum collects these liquid remains—formalin and smaller particles of soft tissue—where it can later be safely disposed of. We leave the lab in a change of clothes to spare the professionals in the building our dirty dissection attire, but we carry the smell of the day with us. Only those who have done what we have recognize our offensive presence in the stairwell or elevator. We have become so accustomed to it that at least one night out of the week, we all head straight to the bar, where talk of the day inevitably infiltrates the conversation. Under a cloud of embalming scent, we speak without filter about all we have uncovered in the body.

One eve I’m waiting for Marty to wrap up so we can reunite over dinner with local friends of his who hosted us a few times four years earlier. Out of nowhere, the room erupts with shouts of surprise and panic. I turn to see that a full bag of soft tissue has burst in the process of swapping it out for a fresh liner. A flurry of Somanauts run over with gloved hands to help clean up the mess. It’s an absolutely horrifying scene of skin and tissue spread across the floor, but we are all in fits of laughter despite the incident’s seriousness. It’s not normal that we can dismember a body so casually, sweep up its remains and then show up as dinner guests across town, I realize this.

I have a moment at the bus stop when Marty is talking and I find myself fixated on the fact that I can see the smoothness of his skull beneath the skin of his face. Dissection is in everything I do, and looking at the lines in a face, I see the display of the mind-body connection I am so curious about. The contents of my mind are not so easily hidden by the expression on my face: my body betrays me. It’s a blessing and a curse. I have unreadable clients who confess to the use of Botox as a means to better hide their inner thoughts. I observe in my own expression that the deep furrow between my brows has softened over the years. Although the skin creases still turn red after a day of staring at a computer screen or when I have been a little too deep in thought, I like to think these lines show evidence of my deeper emotional work as they cease to cut so deep.

In my massage practice, sometimes I see several generations of one family and am humbled by the determination of each bloodline’s structural blueprint. Skin texture and coloring that is passed from generation to generation is as strong as the personality or mannerisms learned at home. As I seek out my own family’s lineage, sitting with my dad’s sister for the first time in decades, I see my grandmother’s face in hers. I remember my grandmother’s kindness in the gestures of my aunt, and it feels like home; perhaps these feelings have been captured and stored in my cells. Not only from my childhood memory, but directly from the markings of my ancestry upon the genes passed on to me by my father.

A new massage client comes to me on referral from her mother, and I don’t notice any remarkable resemblance as we chat briefly before the treatment. I’m not even thinking about familial similarity until she is on the table. The distinct curves of her spine and the shape of her frame are ones I have seen before. Not from her mom, but from an older body I worked on the previous year—this scaffold was the exact match to the body of her mother’s mother.

By the time we convene for our morning circle on day three, I realize I haven’t written a single word on the Sagittal Cut in my journal. Fran’s place is over an hour’s train commute from the lab, and while our travels are packed with tidbits from the day—Fran and I are dissecting different donors—I am only vaguely realizing at this point that my days so far have not permitted my usual download. I chose to stay with Fran so we could visit and deepen the experience through an ongoing dialogue into the evening, but also because I wanted to cut down on my costs. Typically, I would spend my evenings with a glass of wine either visiting with other classmates in the hostel or enjoying some much-needed introvert time. The mornings are a deeply entrenched routine of coffee, yoga, and writing. I generally prefer to travel solo to the lab before engaging in the energy of the room.

A comment in the circle reminds me of these rituals that have been absent. How could I have forgotten myself? I was easily carried away by the energy of my project, as well as the connection to Fran, with whom I have shared the lab several times by now, but the sanctity of my morning routine is enormous. I’d say it’s what defines my day—not just in the lab, but every day. I’m less grounded and more reactive when my day does not begin with space for attending to my inner world. As a consequence of leaving early for the lab, pre-coffee—because who wants to be stuck on a train with a full bladder and moving bowels—my body had not eliminated in days. I can’t help but note the tandem halting of my creativity and my gut.

Before the circle dissolves, I silently make the decision to pay for the remaining three nights and book a room in the hotel right next to the lab. My problem with elimination clears up immediately. The following morning, I write in my journal that the head project almost became all left-brained in the absence of my inner process.