16. The Sagittal Cut (Part II)

There are spaces in the body that are generally never seen or touched, unless by X-ray or scans. Essentially, by opening up the head, I am taking a giant step into something unfamiliar, unusual, and personally uncharted, but there is a comfort in knowing that the journey I am on is an intellectual one.

Inside the head, I’m looking deeper at what exists physically, and what arises emotionally through the inquiry. While looking into the other parts of the body, the same premise holds true; there is, however, at least some familiarity formed in my intellect surrounding the muscular spaces where my hands tread regularly. The learning curve in cutting through a skull and exploring crevices not otherwise available for palpation keeps me keenly present through each day. I am exhausted by the extreme focus my eyes take while guiding the precision of my fingers as they carve out new shapes, and the spinning of my brain that is working to capture the stills as the dissection flies by. At one point, Jim calls to me from the opposite end of the room. He’s got something spectacular to share, but I’m too full and exhausted to take it in. I indulge the request but honestly can’t remember what he so eagerly had to reveal.

As I take in all that is before me, sentiment is easily set aside and my left brain pushes the crease between my eyes deep toward the bone of my own skull. Allowing this dissection to be an academic exploration gives me an unexpected freedom. I find myself questioning the function of the strange tissue texture that makes up a brain. How is it that this tiny dense sack deep in the cranium is responsible for managing much of the hormone flow through the entire body? In the kidneys, I can see where blood flows and, despite some of the structures being microscopic, there is a visible path of function. The brain looks like pâté: spongy with two distinct colorings…but how does it do everything? Looking at it, I am reminded of my childhood neighbor, now in her eighties, who constantly marvels out loud about the mystery of the Internet: “But how is all this information traveling invisibly through the air?” Observing the dull grey of the brain with all its supposed intelligence and function is far less engaging than looking at the suggestion of strength in the fibers that make up the rotator-cuff muscles of the shoulder, yet I am enveloped in the unfamiliar, dedicating all my time to the view.

I saw off a section of the forehead to expose the frontal sinuses above the eyebrows and examine them repeatedly. I look at the channels that connect them to the deeper caves inside the cheeks, following the path of drainage and feeling the thin walls where pressure builds when there is an infection present in a living body. I gain so much understanding that when I sneeze, I feel a new awareness of my own physiology and the path of air forced through my skull. But then, in the time it takes to make those connections in my own brain, they are gone again. I have to look at the books to remind myself of all I have learned. Maybe because I am a kinesthetic learner, I need to trace and retrace those spaces in order to commit them to memory. With the volume of mapping and variance from body to body, the effort it takes to recall everything revealed in the lab hurts my brain.

Reading about the sinuses, I learn that they enhance the voice, which explains why I sound so different when I have a cold and my sinuses are inflamed and full of mucus. What is more interesting to me is that, upon emerging from a night of deep sleep, or a focused yoga practice, a meditative massage, or an hour in a sensory deprivation float tank, my voice is deep and rich in a way I don’t normally experience. This quality of voice isn’t always present after these types of sessions either; I observe for myself that there needs to be an element of absolute letting go. I continue to be surprised by the ways in which my nervous system is always paying attention and responding. Through observation of something as regular as my voice, I learn that going through the motions of self-care is not enough to initiate change in the deeper layers of my being. My nervous system is the greatest lie detector. I have to pay close attention to know for sure whether my effort to let go has been effective beyond my intellect. I am disappointed when I look at the sinuses, and they reveal nothing of this mind-body connection that has the power to enrich my voice.

Of course, it’s not just sinuses alone. The muscle tone of the diaphragm, throat, and vocal cords contribute to the quality of my pitch, and my mind delights in tracing the pathways throughout this detailed framework to observe how they might relate and affect one another.

We receive more information than usual on the donors in this lab. Midway through the week, we learn that Sir was eighty-nine when he died, but I am so wrapped up in my exploration of the head that I fail to record his cause of death. If memory serves, Sir died of sepsis, but his open-heart surgery took place more than a decade before. The scarring on his chest tells us that story, along with the removal of the long vein in his thigh that we find affixed to the exterior of his heart. For the first time ever, we are told the profession of each donor in the room. We are humbled to learn that Sir was a schoolteacher. The irony of the name we chose for him does not escape us as he continues to teach in death.

Inspecting Sir’s eyes, I am reminded of a long-forgotten detail of Fable, who had donated her eyes. In their space, we found hard plastic caps and learned that this is the only organ a donor can donate before relinquishing their entire body to science. I wonder, had she not been so diseased, would we have been given the gift of her full body over the donation of her living organs to save the lives of others?

In an attempt to recreate the spectacular dissection I saw Laurenne do at the table beside me during the three-week, as I remove the extra fluffy adipose around Sir’s eyeballs, I’m deep in cerebral territory. Literally and figuratively. The sockets of the eyes are deep, and the quality of the adipose is more like lemon mousse than the dense sponge of fat that wraps around the kidneys, but it’s just as plentiful. There is no fascial matrix holding this adipose together inside the skull and I am in disbelief at how much of it I am pulling out with each dip into this yawning orifice of the head. All that is left once the adipose has been cleared away are the six muscles responsible for moving the eyeball, and the thick nerve that translates images directly to the brain. It’s fascinating to note that when you move your eyeballs, the tiny muscles connecting your cervical spine to the base of the skull also respond, but I cannot locate any obvious physical connection that might facilitate this.

I am surprised also to see the amount of exposed space between the top two cervical vertebrae. There is enough space here that I can actually reach between the bones and put my finger right on the spinal cord. I just spent many hours over the space of five days removing layer upon layer of meat to access this gap, but still I am shocked that this vulnerable part of the nervous system isn’t protected by more bone.

The actual sagittal cut is a physical workout. The thrill of the task has me less and less grounded as the cut draws nearer. I’m distracted by the delicate muscles at the base of the skull that are impossibly deep in our donor’s flesh. This is true with every donor I have encountered, but in a living body they are not so difficult to access. The soft, squishy nature of living tissue does not mimic the thick-packed layers of an embalmed specimen. Although we can emulate the glide of surrounding structure by tugging on a fixed body’s nerve, it’s a much stronger tug than would be necessary through living—or even unembalmed—tissue. Occasionally, I have attempted to massage a donor to see if I could change the quality of glide between structures; it helps but not much. As I expose the suboccipital muscle bundles encased in their shiny, delicate layer of deep fascia, the sight overwhelms me. The short ribbons of muscle are laid out so meticulously and organized in such a way that they once provided stability for the weight of Sir’s skull, while responding ever so subtly to the movement of his eyes. Looking at the perfection of nature in the delicate strings of muscle fiber, I catch myself singing out loud, and my closest neighbor at the table, my naturopath friend, joins in. We stomp our feet a few times with intent, reconnect with the present moment, and then I take the saw into my hands.

Up until this point, any use of a surgical mask or goggles has been purely to create a barrier against the odor and nasal/eye sting of formaldehyde. These measures are required now to cut bone, protecting us from bone dust, fragments, and marrow that may get in our nose, mouth, or eyes. The risk is low because we are not using power tools, but there are times, especially when removing a skullcap, when a crowbar is used to leverage open the skull—the saw might damage the delicate tissues that separate the brain from its bony casing. It’s exactly like breaking open a coconut, and sometimes chips of bone take flight from the force of the act.

Sir’s body is now lying faceup, head resting on a wooden block. Two brave witnesses have wedged his head between two more blocks and are pushing strongly from the ears toward one another. With the skull held steady, I begin to score the surface of the bone. Any semblance of a face has long been distorted. Having already removed the skin and a large portion of bone to expose the frontal sinuses above the eyes, I have cut the flesh of the nose down to the cartilage and have already dissected the eyes from their sockets. The only remaining flesh belongs to a few strands of the stubborn attachments of masseter and temporalis around the contours of the jaw. No face remains, and the skull is almost as smooth as a porcelain coffee mug. Coaxing the teeth of the saw into the bone takes a bit of patience, but once the track is laid, the work progresses steadily. At the other end of the table, the dissection of the pelvis and lumbar spine continues, mostly uninterrupted.

The shape of the cranium is such that I am forced to angle the saw upward to cut through the roundness of the front and top of the head. The torque on my wrist is so unique, it takes me right back to the time, years earlier, when I made the same cut through Mobe’s skull. My body’s memory of that cut slows me down in preparation for the endurance I know will be required. Everyone involved is exerting more effort than we’d expected.

A tablemate walks past and averts my attention long enough to utter a profanity in praise of this badass act, and I blush. I am embarrassed that it might be obvious, externally, how undeniably giddy I feel inside.

The requisite inhumanity it takes to saw a head in half is bumping up against my moral compass, and the two are engaged in an intense tango in my brain. I feel a paradoxical connection between the foulness of the physical act and the highest honor of looking into this former schoolteacher’s brain.

There is a distinct change in texture as the saw transitions from bone to brain. My eagerness is not overriding the miracle of physiology. The effort it takes to penetrate bone eases as the teeth of my saw graze the softness of the brain’s gray matter.

The cut takes longer than expected because we have to account for the angles and the limitation of the space between the saw’s blade and frame, which arcs overtop with only six inches of clearance, less than the depth of a human head. It is decided at one point that we have to decapitate. Everyone at the table is involved in the task now, because we need to turn the body from back to front to complete the cut. We collectively decide to leave the entire cervical spine intact with the head and remove them together. A few others in the room, who are eager to participate now that I have paved the way for the most morbid of acts, take up the saw to give my wrist a break. At day’s end, and less than fifteen minutes after the cut commenced, we have two halves of a head. From the top of the crown, all the way down to the seventh cervical vertebrae. The precision of the cut is almost exactly center, which seems like a miracle to me, and I wonder if Sir taught science or biology.

Walking out of the lab that day is a blur. My nervous system is all at once exhausted and stimulated. On my way back to the hotel, I take a detour to pick up some quick eats to devour in my room. I’m not familiar with the sparse selection of wines in this grocery, so I go with the one that calls me, walking out with a bottle of red, a skull on its label. I am full to overflowing, and forfeit all of the day’s reflection to sit in front of the TV, nearly emptying the bottle. Glass raised in honor of our donors.

Refreshed by a night of sleep and a morning of downloading the details of the dissection onto the pages of my journal, I am ready to pack it in at the end of this day. Day six is usually a mournful one, as dissectors are forced to wrap up and let go of projects that barely got underway, as the depth of inquiry exceeded expectation. This is the first time I have approached day six with a feeling of closure. I turned Sir’s head inside out, and although I have no hope of retaining all that I saw and cut into, my body carries the transcript of the week.

I spend the final day carving out the tiny spaces between each vertebra of Sir’s neck. A couple of women at the other end of the table are echoing the dissection by halving his pelvis and lumbar spine to do the same. We take note of a slight scoliosis in his structure that surprisingly shows up in the position of his brain.

Some of the time it took to cut through the head was given to meticulously ensuring that it was halved in such a way that the brain would not be disturbed in either hemisphere. As we study the two halves, it appears the cut was slightly off center, leaving a sliver of the left hemisphere sitting upon the right. On further inspection, it is determined that the cut is indeed center, but the brain is not! The deviation of Sir’s spine was reflected all the way up to his brain, which sat ever so slightly on a lateral tilt. I think now of the probability that my own brain is sitting at a lateral tilt atop my own crooked spine.

In the early days of my yoga practice and anatomy studies, I had become more observant of the body and its variations. Trying on a pair of high boots that stopped just below my knee, I noticed that one of my shins was bowed. I thought it was a weird body deviation until, years later, while desperately trying to fix my lower back pain, I had an X-ray. The images confirmed the scoliosis I had suspected for years because I could not correct the way my body veered to the left in a deep back bend. The X-ray showed my right hip to be significantly lower than the left, indicating a short right leg. My brilliant body adapted by bending my left lower leg bones to shorten that limb in an attempt to balance with the opposite side. Looking into Sir’s crooked brain, I wonder about my own with a smile (which is also crooked).

Removing the tissue between the tightly packed spaces of the cervical spine is made easier by only having to navigate one half. Similar to the jaw, muscles attach to the bones of the neck with a relentless commitment, and each vertebra has several connections, meaning a lot of stubborn tissue is present to challenge the exposure of the joints. I want to see the articulations of the small spaces in the spine of the neck, but there is so much meat to weed through. For years I have attempted dissection of these spaces, always unsuccessfully. My eyes are burning with fatigue, and although I feel complete with all I have already exposed, there is an underlying urgency to not waste all the work that has brought this final detail so close.

The room abuzz with potential and the ticking of the clock, Fran and I slip out for an early lunch.

With a surge in calories to get me through the remainder of the day, I sit down with Sir’s hemi-head and cervical spine to meditate on removing the remaining flesh from the bone. The tediousness of the work now feels like a gift I can sink into. I’m too full to undertake anything more complex, and the patience required to complete this task allows my brain to turn off. The hemostat can only grip a few tiny fibrils at once in the small spaces surrounding the complex bones of the spine. The work is painstakingly slow, and I’m not sure I will uncover what I’m hoping to see before our final day closes. Past attempts to reveal the bony surfaces deep in the neck have yet to uncover anything that feels complete or satisfying, which loans me a calm surrender to what will be. It takes all afternoon, but I finally locate the tiny facet joints that facilitate movement of the intricate vertebrae of the spine. I’m intrigued to find them at such a severe angle and delight in the way Sir’s body again leads me to a more complete comprehension of a space I thought I knew.

I return home on a high, and it’s one dissection I just don’t know how to share. Clients and friends often express curiosity about my experiences in the lab, and I have always found it a challenge to articulate what I’ve been through. The physical task and learning in the laboratory are more than just cutting into flesh. I want to share how the experience opens me up to the deeper layers of a human being, and it takes me ages to locate the words that might provide a sliver of the experience as I have felt it.

The sagittal cut was so physical, and I know it will take longer than usual to link all the facets of matter to sentiment this time.

Shortly after Sir’s return to the earth, I journey to my father’s hometown. I have driven there twice before in my adult life—once to see my grandmother while I was in college, and again for her funeral a few years later. Aside from those brief visits, I have not spent any time in this town since I was little.

I use GPS to guide me, but I don’t need it. It’s a seven-hour-plus drive, and I make every turn as if I had just been there yesterday. Approaching the tiny beach town, I see the ice cream shop that was a ritual stop when I was young. Passing the cemetery where my father is buried, I wonder why my mother never once took us there. In town, crossing over the drawbridge, I recall, as a kid, sitting in the car with my dad’s mom chattering away as we watched the road mechanically lift at its hinge, high up into the sky, allowing a boat with a terrifically tall mast to pass from the Great Lake into the harbor. All these images are brushing against soft places that had been calcified inside me, like Mobe’s transplanted kidney. Functioning but not fully integrated.

I spend five days here. The entire town is walkable, and I walk every inch of it. I am reminded of the meals we had when my dad cooked for us kids. His family had a canteen on this very beach, and we would be treated to his homemade fries, potato chips, and pigs in a blanket to the backdrop of those stories in our kitchen at home. Standing on the beach, I can feel that little has been altered here by the years. As I walk from my grandmother’s old house on the hill, my feet carry me straight to the stairs that descend the dunes to the smaller, less populated beach. Here I wander to a quiet outjutting on the rocks where I can sit still and reflect. As I settle on the edge above the water and take in the panorama of the giant lake, I am startled by the figure of a man chiseled into the rock face at my side. It’s a jarring sight; his hands grip the rock with a desperation that is depicted also in his face, and I wonder how many other stories this place holds and how many bodies house those same stories, like mine.

While I am in my dad’s hometown, I meet with our old family friends, hoping to gain a little more insight into my own family. By agreeing to meet with me, they have angered my mother to the point that she ends the friendship. She is showing me how fear of vulnerability is masked by anger. Is this something I learned or inherited? She and I are intrinsically connected through these traits, and I wonder how far back they can be traced. How much of her unresolved pain lives inside me? I dissect bodies as a way to distance myself from emotion, but I am brought closer with each cut.

Journal entry:

I wish we could all go back at least two generations beyond the wounds of our friends and lovers. As one removed from the inherited scars, we can tell the tale of how the suffering that passed from parent to child impacted the babies of the generations that followed. If you had warning that your inability to heal now would show up in the relationships of your children and grandchildren, would it give you strength enough to consider the effort?

For the wounds that are too deep and the ones that know not of their strength, know that the suffering belongs not to one, but to a lineage. The smallest step toward healing now may pave the road to miraculous recovery later.