6. Art (part II)

Each morning we reconvene to download dreams and all that we took in from the previous day. The morning circle becomes the richest arena for conversation, ideas, and confessions. We make fast friends, and the sharing is deep. Following the days of skin and superficial fascia, a fellow student shares with the circle how his dissection experiences have changed his sexual type, in terms of physical attraction. Where once, what he considered a well-sculpted woman with a lean frame and muscular build appealed to him, the appreciation of superficial fascia through dissection has turned him toward full-bodied women. He says he values the energetic shift that has come from exploring a body type he had not previously considered attractive and finds it not only liberating but erotic. A thin man himself, he no longer derives pleasure from the stiff intermingling of his bones against those of another. The extra padding of the adipose offers more roles to appreciate. I’m not alone when I say that the dissection lab has forever changed what society has told me about fat. 

“Art,” named for his physique as much as the era of his birth (if we call him Arthur), is a strapping specimen of a man. At ninety-eight, he stands over six feet with defined tan lines around his waist and upper thighs. If he died the same year we acquired him for our exploration, it would make his birth sometime during the World War I years. The pale skin over his pelvis shows us the shape of his sun shorts, and in contrast to many of the other donors, who show evidence of having died in a hospital with IV bruises at their wrists, we know Art was out enjoying life possibly right up until the day he died. We have a lot of discussion over Art and what he would have seen and experienced in his long, active life.  

Courtesy of the embalming process, which moves the blood into the erectile tissues where it coagulates, the men arrive in the lab with erections, and Art’s is spectacular. With room to spare, his circumcision is not too tight, giving the skin of his penis enough slack to healthily stand at attention. The dissection of the genitals, male and female, is ripe with animated conversation. We capitalize on Gil’s expertise with a knife, and are treated to a unique view of sexual anatomy, beginning with the topic of circumcision. 

A practice whose origin is not fully known, circumcision, some of history alleges, is a rite of passage marking a boy’s entrance into adulthood, a social status marker and a means of reducing sexual pleasure, and perhaps even a tool of humiliation by symbolic castration or discouraging masturbation. These are only a few of the many perceived reasons for the act that became the norm in North America, “as a medical practice,” claiming to be an important hygienic method in the twentieth century. Setting aside beliefs, we embark upon the discussion as both anatomists and sexual beings. Everyone in the room has a reference point, and the conversation evolves with each penis we dissect. 

A man is born with skin that covers the glans or head of the penis, and just as a woman’s hymen is broken through the act of sexual intercourse, the skin over the glans must also be broken for it to emerge. It is a self-cleaning organ that urine (a sterile fluid) passes through uninhibited in infancy; pulling it back on a baby for cleaning is unnecessary. Boys yank and pull on their penis the second they discover it, a natural treatment for the seemingly delicate tissue there. By the time erection occurs, the skin has been well-prepared for retraction and the exposure of the glans. From a sexual standpoint, a circumcised penis is at the mercy of where the blade made its cut. Removing too much skin means there is not enough space for a full erection, and it ends up bending in its aroused state. Most circumcisions can accommodate an erection’s influx of blood but may also be too tight, as demonstrated by the lack of available movement within the skin. On no part of the body should one’s hide be tacked down so firmly that there is no allowance for normal glide of the skin over the underlying tissues. An intact man has enough skin for his penis to glide inside its own sleeve, and without this glide, during penetration a circumcised penis exposes the recipient to extra friction that would normally be absorbed by its own skin. In Art’s early-twentieth-century circumcision, we see just how much glide potential there is beneath the skin and conclude, with great hope, that he enjoyed a lifetime of deeply satisfying sex. 

The same care is taken with the women who arrive in the lab with perky breasts, thanks to the embalmer who took the time to give them a lift by injecting a little more fluid there. On day one, before we have made any cuts and while we are still in the process of observation, we see the main incisions of the technician and several small pinpricks where extra preservative has been injected. Each embalmer has their own signature in the way they artfully prepare a body. It’s evidence that the embalmer is painstakingly preserving the body for us, but we view it also as a sweet dignity given to the donors who are gifted with postmortem cosmetic enhancements. 

There is a notable increase in interest surrounding the female genitalia, whose bulk is found internally. The surprisingly large body of the clitoris takes a bit of skill to properly expose by knife. Almost everyone in the room is astounded at how much of it is buried deep inside a woman’s vulva and how its legs branch off to wrap around the opening of the vagina, completely unseen beneath the skin. The head of the glans being the only visible part, the clitoris extends deep into the body and, because of its erectile function, is described as being the female penis. Looking upon it in the lab in its entirety, engorged with embalming fluid and fully exposed, there is no argument. 

By this point in the dissection, we have dropped all pretences, and conversation flows uninhibited around sex, orgasm, and the function of anatomy in both. In an extended three-week dissection, someone scrawls on the chalkboard, “To the truly open eye all things look like a clitoris.” In fact, most of the posts to our online forum from that longer lab are pictures of things in nature resembling (mostly) female genitalia. Think tall narrow entrances to hidden rock caves, openings glistening with condensation. The ribbon-like folds of flesh along the edge of an oyster lying delicately against its iridescent shell, or deep cavernous gaps naturally chiseled in the trunks of trees, reeling you in by revealing more and more of a textured interior as you move closer. 

Following the dissection of the genitals, we are ready to enter the deeper compartments of Art’s viscera. One of my tablemates is obsessed with cutting everything in half, which initially makes me uncomfortable, but the revelations quickly change my mind. Take Art’s giant gallstone. We see gallstones of all shapes and sizes, but like everything else with Art, his is exquisite. About the size of a large macadamia nut, it is a glistening black gemstone with a deep green hue. The smooth, hard surface gives it the look of a stone polished through years spent in the salty surf of the ocean. When cut in two, it reveals a clear crystal with a sunburst pattern beginning in the center, its rays spreading to the thin dark walls of its border. We joke about how things may have gone down if he’d had it surgically removed and turned into a piece of jewelry. 

“Wow, what a beautiful gemstone!” 

“Why, thank you. I made it myself. In my gallbladder!” 

In contrast to Art, the table next to us is working with a fifty-four-year-old male they have named “Jerry,” who has a football-sized tumor in his abdomen. I used to wonder how someone could carry around a great big tumor and be completely unaware. This is common with ovarian cysts; women find out through routine exams that they have a grapefruit-sized growth in their pelvis and had absolutely no clue.  

The abdomen is a well-organized space where slippery organ surfaces accommodate the pulsing action of digestion, and unlike the tissue directly under the skin, around muscle and bone, organ surfaces are smooth and lack an excess of fascial wrapping. Blood and lymph vessels in the abdomen carry fluid directly from one place to another and do not wind their way through extra layers of adipose or fascia. Visceral fat is very well organized inside the gut. It varies in mass from person to person but is consistently located in the same places: as part of the greater and lesser omentums, the padding around the kidneys (behind the abdominal sac), the epiploic appendages that hang like chandelier crystals from the large intestine, and the mesentery that houses circulatory vessels and anchors the small intestine to the posterior abdominal wall. In health the abdominal contents are clean, organized, and flexible. The body digests by churning, squeezing, and compressing the contents of the intestines, and there is plenty of acreage in the abdominal cavity to accommodate for this movement. Healthy organs have a great range of motion inside the body and will move and shift to make space for a foreign body. The size of an individual will determine how large something can grow inside before it starts pushing against the abdominal wall to be seen from the outside. For example, most women carrying a first child will not have an obvious baby bump until the fetus is twenty weeks and the uterus is roughly the size of a papaya, invading the abdominal space as it continues to grow. 

Body donation is anonymous, and we receive very little information with each donor: cause of death, and their age when they died. The dissection progression reveals other details of health and disease along the way, and records are not normally shared in these labs until closer to the end of the week, once we have had an opportunity to draw our own conclusions. 

Jerry’s diagnosis was retroperitoneal carcinoma, a tumor located deep to the abdominal organs in the back section of the midriff. The dissection slows down as we examine the tumor, taking note of the blood vessels within that were feeding its growth. It’s mass is pushing up against the diaphragm, distorting the position of the liver and right lung, and wrapping around the inferior vena cava (the main vessel carrying blood back to the heart and lungs). The tumor has pushed one of his kidneys way down close to his pelvis, about six inches lower than the other. Jerry’s big gut gives the impression of having been shaped by adipose rather than the tumor itself. 

We remember back to day one, standing the bodies up and observing their shape. For first-time lab participants, there are more assumptions surrounding fat. We assume that as we peel away the layers, the bodies will get slimmer. In reality, removal of the adipose layer does not always change the shape of a body. We continue to find pockets of fat nestled in other areas, providing extra volume in and around muscles or the padding surrounding important glands. There is a certain amount of consistency from body to body, but an even greater amount of variance. We see with Jerry that there was initially no obvious clue as to whether his shape was fat or tumor. We would not have guessed from the outside what he had hiding within.  

The contrast between Art and Jerry continues from skin all the way to bone. When we peer into Art’s intestinal cavity, we find the organs of a much younger man. Sure, his heart is enlarged from ninety-eight years of hard work assisted by the pacemaker located beneath the skin of his left upper chest. His arteries are crunchy with plaque, but his intestines are those of a healthy man. His small intestine is plump and thick with muscle, the girth and consistency of a small breakfast sausage. Jerry’s intestines are more like the balloons that are twisted into animal shapes at a fair: wider with paper-thin walls. We imagine that Art ate food that needed chewing and a strong bowel to break down, which was how his intestines came to look so robust. We must also consider what people ate in the early to mid-1900s, when Art would have been a young man. Jerry’s organs suggest he may have consumed foods that would pass through the system easily, denying the intestines their physical workout. 

What the body presents are clues to the life lived. We fill in the blanks with many possibilities, knowing that any one of them could be true or not, and this raises questions around accuracy. The donor stories feel important when we uncover such contrast, because our clients and colleagues at home are eager to learn about dissection through us, which furthers the subject of consent. What are we allowed to say outside the lab when telling the stories of what we are uncovering, especially when we haven’t got enough facts to draw from? Is there such a thing as cadaver-dissector confidentiality? I am aware that when I share my lab experiences, I am telling a story of myself, inspired by what has been roused by the donor. Through the process of looking into the body, dissectors develop a relationship with donors that brings their spirit to life. By donating their body, they have consented to the work we do in the lab, but how far does that consent reach? The stories we tell of them are subjective to our own beliefs, thoughts, and life experience. The best we can do is share our learning in a way that respects the donors and their loved ones, who together make it possible for us to contemplate our discoveries. 

Such ethical questions infiltrate the experience regularly. 

A midwife has an emotional struggle as she performs an internal exam on a female donor. In the absence of obvious abdominal scarring that would indicate a C-section, we are curious to know if the donor has given birth to a child, or if there is a uterus inside her at all. We are too eager to wait until her pelvis is open and choose to observe through palpation the shape of her cervix, which will tell us her status as a mother. Prior to giving birth, the opening of the cervix is the shape of a fleshy O. In many women, following a vaginal delivery, the sphincter flattens to become a soft smile. In the absence of living muscle to push the opening of the uterus lower, the exam is more forceful than anticipated. The examiner, whose profession is centered on consent, feels an acute sense of it being a nonconsensual exploration. The lines of morality are blurred, keeping us fully present with every act in the room. We are aware of discomfort as it arises and openly discuss the implications of our behavior in the lab. We must now seek the consent of the group, knowing the donor has already symbolically signed her waiver. The violation belongs to us, not the donor. The discomfort demands that we move through the act of dissection with reverence to the living. We are exploring the internal landscape of our own emotion through the mislabeled indecency of exposing the innermost parts of our donor. 

Art’s arteriosclerosis is the only real thing to suggest his age. His joints are void of arthritis, with the exception of some tiny rough spots on the bony surfaces of his right knee. Arteriosclerosis is a narrowing of the arteries caused by a buildup of plaque. Composed of fat, cholesterol, calcium, and other substances carried in the blood, plaque deposits accumulate on damaged sections of an artery’s interior. Damage inside the arteries can occur when blood pressure is high and the force of blood moving quickly through the passages causes small fissures or bruises where blood cells bump up against artery walls. The body’s immune response repairs the damage through a natural process, but after prolonged periods of injury, will lay down plaque as a permanent fix. The permanent repair frees up the immune system, but it also inhibits the artery’s ability to expand and contract—an important function to control blood pressure. Arteriosclerosis increases the risk of stroke and heart attack due to the danger of plaques dislodging and traveling to smaller vessels where they can get stuck and clog the channel. It is a natural immune process that demonstrates a skewed example of health in the body. The result is an artery that does not function normally, but the mechanism comes from a healthy response: repeated damage to the artery walls necessitates a stronger repair to permanently fix the problem. 

Having the opportunity to break the plaque with my own hands, to feel the strength of the calcium and the sharpness of the edges, gets me thinking about how important it is to maintain a flexible interior. There are several practices in Thai massage where knowing plaque is present in the arteries would be something to pay careful attention to. The accumulation of study, coupled with experience in the lab, has opened my eyes in a more critical way to see the whole while I work and continue to learn. 

My own injuries and body pains regularly color the dissection process as I become conscious of my curiosity around how the physical embodies the emotional. Exposing the sciatic nerve, my body returns to high school and the debilitating pain I experienced in my mid-teens.  

I started working at a grocery store just before my sixteenth birthday and spent long hours standing at a cash register and lifting heavy boxes of groceries before the weakness in my body became apparent. 

The pain came on gradually over weeks or months, and at its worst, it traveled all the way down my leg, into my foot. It was so intense, my foot would go numb and I would have to leave school in the middle of the day because I found it unbearable to sit, stand, or walk. I visited many doctors and specialists and had X-rays and scans that all came up empty, leaving at least one of my health care providers to suggest I was making it up. The problem was that because the pain was in my leg, that is where the search was directed, but my spine was where the issue originated. I am cloudy on the eventual diagnosis because I was not included in the conversations—they were the property of my mother and the doctors. I can only assume the conclusion was a herniated disc because the recommended treatment was surgery on my spine, which, thankfully, was not pursued. 

For two years I suffered bouts of unbearable pain followed by dull aches and a constant threat of relapse. Physiotherapy made me feel worse. With surgery out of the question, bed rest was a suggestion I also rejected. This was in the late 1980s, when common treatments for sciatica were bed rest and discectomy. 

According to Henry Sigerist, a Swiss medical historian, early societies attributed the lancinating pain of sciatica with evil roots born of witch curses and elf arrows. Having experienced it firsthand, I can attest to the evil nature of sciatic pain. 

The sciatic nerve originates in the lower lumbar spine and sacrum as mere threads. By the time the nerve exits from deep beneath one of the gluteal muscles in the buttock, it is as thick and strong as my index finger. No shit that thing causes so much pain when irritated. It travels in the gap between muscles of the thigh and lower leg, getting narrower until it reaches the foot. The old pain, absent for nearly fifteen years at the time I got to see the nerve, is palpable as I trace its path down our donor’s leg. Having now a small understanding of the role of fascia in the body, I can see how crucial free movement of such an expansive nerve would be. My experiences with sciatica were one thing, but having also experienced foot drop—an abnormality of the gait—years later, I wonder about the importance of nerve mobility. My sciatic pain was the result of an intruder—a herniated/bulging disc—in the spinal canal that put pressure on the nerve. How likely is it that injury, scar tissue, or general stiffness due to a sedentary lifestyle can trap any nerve and stop it from moving in a normal way? 

With my hand inside a skull, I take hold of the spinal cord where it would have led into the brain, had we not already removed it. A classmate at the foot of our donor takes a hold of a toe to gently articulate the joints, and I can feel the pull all the way into the spinal cord, where I’m holding it at its root. I have to tighten my grip to stop it from escaping my grasp and slipping down into the spinal column. Try as I might, I cannot feel my brain move when I wiggle my big toe, but I know the connection is there. 

“Rose,” an eighty-four-year-old woman standing about four-foot-ten, is wrapped in a soft, squishy blanket of fat that begins off-gassing almost immediately, making it a challenge for her dissectors to work. This is common by the time the visceral sac is cut open and the chemical smells in the room become more pungent, but on occasion there are cadavers like Rose that release the bulk of their preservative through the superficial fascia. This means that by the time her viscera is exposed, everyone has acclimatized to the nasal sting and can give full attention to the surprise she is hiding. Rose likely had no idea in life that she was carrying around a rare anomaly called a horseshoe kidney. In fetal development, such kidneys grow together as one while they descend to their position behind the abdomen beneath the adrenal glands in the mid-back. The result of the fusion is a single U-shaped kidney that in most cases functions normally and is asymptomatic. 

Similar to Rose, “Mobe” (pronounced Moby), begins assaulting our noses with his pungent burn well before we reach his visceral cavity. Our defense is to wear masks generously scented with essential oils of peppermint, lavender, and the like. I’ve even gone so far as to wear my cycling glasses to protect my eyes from the burn of the gases floating in the air around our donor. Mobe has a giant umbilical hernia, about the size of a grapefruit, which has pushed aside the adipose, and we find ourselves accidentally in viscera as soon as his skin layer is penetrated. According to his paperwork, he had received a kidney transplant the year prior to his death, and his new kidney awaits our inspection beneath a calcified wrapping at the anterior lip of his pelvic bowl. His body had encapsulated the new kidney. The body walls off the new organ with a layer of connective tissue cells because in the absence of self-identifying genetic markers, it recognizes the organ as a foreign body that cannot be eliminated. This protective measure keeps the offending structure separate from other “self”-identified tissues. It happens with many foreign objects—bacteria, cosmetic and medical implants, and sometimes cancer. In this instance, the casing is calcified, but we most often find it to be more like a soft silicone sac. Here we spend extra time examining the new kidney and the body’s reaction to it. For a time, the dissection slows down as we take in the ways in which a body adapts itself toward renewal and continued life.