9. Fable (part II)

“We are going to expose these forms. Fair warning: they are going to expose us. We are going to see each other. Let yourself see and be seen.” 

These are Gil’s opening words as over fifty students gather in the lab on day one, anticipating our first view of the donors. I always have these words with me as we step up to meet the work that lies ahead. It is a self-dissection, and I know that I, for one, meet myself with sometimes painful and equally joyous honesty in the lab. 

I have never seen so many tables in use in the dissection lab before, and as we circle the room on the first morning, Gil warns us that what we are about to see has not been seen quite like this before. On day one, twelve donors await discovery. Soon it would be twelve presentations of fat in the shape of those former people, then twelve shiny bodies preparing to expose their muscle and bone, and a dozen visceral sacs full of pathology. Brains and nervous systems slowly emerging in a room full of chatter. 

It would be my most emotional dissection experience to date. 

“Mable-Faye” was sixty-three when she died, and I find myself attracted to her immediately. As we round the room, getting to know each donor on the surface, my eyes are repeatedly pulled in the direction of Mable-Faye’s mastectomy scar. I am fiercely curious about her. Not just the mastectomy, but something undefined. Gil prompts us to select the body we want to work with and once several of us are standing around her, he directs everyone to move on and choose again. He is preparing us early for the inevitable frustration and attachment to expectation that lies ahead. I feel only a little shame around defying his charge, but still I don’t budge. Three other women complete the switch to claim a spot at the table beside me, and we will struggle side by side with Mable-Faye as the weeks progress. 

While we strive to come up with a suitable name for this mysterious woman, appreciating that we will never know the complexities of her personality, it is decided right away that she has a story to tell, which earns her the nickname “Fable,” a combination of the hyphenated Mable-Faye we began with. 

Typically there is at least one layer that a student struggles with on an emotional level with a cadaver. Often it’s the learning curve of a first-time dissector grappling with how to separate the unfamiliar quality of embalmed tissue in each layer from what is beneath without demolishing either one. We encounter feelings of inadequacy as, inevitably, some bit we thought was important gets cut away too soon. The struggle can be the intensity of the colors and smells that sometimes emerge too quickly for acclimation. Pathology can be exhilarating to discover or intense, especially if you, or someone you know, has had a similar diagnosis. One or more of these struggles will come and go during a week of dissection, peppered with amazing discoveries, inspirations, and awe throughout. For every challenge, there is a reward, and we blindly prepare for three weeks of these ups and downs. 

With Fable, pretty much everyone in the room could attest to the struggles we faced on several levels. She was a true gift to my learning and growth, and, as with all the great lessons of life, the further I get from my time with her, the deeper the learning becomes. 

Journal Entry: 

Skin [is] Deep 

In the lab, we spend a lot of time with the layers that make up the skin. More than just a wrapping, the skin is the first touch of a massage therapist, and because of its receptivity, my hands pick up the impressions of the underlying structures that begin to relay information about what is going on at a deeper level. 

The underside of the superficial layer of the dermis looks just like the skin of a cantaloupe. The texture allows for stretch, and here you can see faint marks where elasticity has been lost due to injury or overstretch. Stretch marks show up almost like scars on the surface of the skin, and the undersides of the marks are void of the cantaloupe patterns found where elasticity is still present. 

Fable has remarkably dense skin that measures up to eight millimetres in some areas. This measurement is three times greater than that of the eleven other donors in the room. 

Where Fable’s skin opposes our plans for swift removal, there are others who manage to create an impressive leather coat in the shape of a human by removing it all in one piece. It’s not until I have the opportunity to hold the massive weight of this outer hide that I consider the brilliance of even our skin, something I have always taken for granted: how the paper-thin covering of my fingers allows me the flexibility to make precise delineations with a scalpel, and how the stubborn thickness of that same skin on the bottom of my heels cushions the full weight of my body in motion. Imagine if the two were reversed: heels would constantly be ripping open and we would have absolutely no dexterity in our hands. 

In the morning circle, we wonder aloud what made Fable’s skin so tough, and a few days into the conversation the room is alive with energy. We are cutting into the remains of an emotional being, and the emotion is reflected in us. Each person rubs up against the work in a way that is personal to them. 

In my journal, I described myself as feeling “raw” after looking at the underside of Fable’s flesh for two days. As if I myself had just been skinned, my tough hide removed, leaving me vulnerable to the elements. I long for my friends at home to reach out to me, because I am involved in something that isolates me from the world beyond the lab. We are all aware of the ways in which we cannot fully share outside our group, the depth of what we are doing, and how it is revealing us all, living and dead. To call home and describe opening the stomach to find our donor’s last meal would be indecent. The morning circle becomes a sacred space where profound exposure is a regular theme, with connection penetrating deeper than the skin. Beyond the superficial layer—regardless of how thick it is. 

In my work, when I put my hands on another person’s skin, I wonder now what am I feeling and what am I feeling with. Somehow it appears it’s just the space between us. That the skin is not the feeling, nor the felt layer. The description of feeling “raw” does not describe the quality of the skin, but rather that of our underneath, which feels exposed. 

The adipose layer is the most fun both in the lab and in my massage practice. It houses a lot of cool stuff that contributes to the immune, sensory, endocrine, circulatory, and nervous systems, to name a few. On the morning after all the skin has been placed for good in the receptacle that guards our donor’s thoroughly examined tissue, we uncover a dozen fleecy superficial fascia bodies. We’re all in awe as we consider that it’s unlikely anyone has ever seen what we are looking at: twelve cadaver forms wrapped in their fatty blankets. We are reminded that anatomy labs acquire mostly lean bodies, and they don’t normally dissect skin from fat to have a look at the two separately. They are placed in the bucket together as one layer, overlooked. Gil is known for welcoming the bigger bodies in his labs, providing for us an acceptance and appreciation that changes our view in the living world. 

When I pinch the skin, I am also pinching adipose. Once dissection revealed the adipose, I began to wonder why my touch sense could not isolate the texture of this unique thick layer. In the lab, it’s full of bumps and grooves that are not obvious to my touch under the living skin. When I see cellulite, I am seeing the texture of the adipose layer (but I still may not be able to feel it). It’s a solid structure with impressive strength. (We stretch and pull it in the lab to test this theory.) Recently I have noticed that when I do feel the bubble-wrap texture beneath the skin, it directs me to tension in the muscle layer below, but I discover through Fable that there is also contractile tissue within the adipose, which I assume is what I am actually feeling. The contractile tissue in the fat assists in wound healing at the level of the skin, and Fable has so much of it that we are never quite sure if we are dissecting beyond her thick, compact fatty wrapping or if it’s just another layer within the layer. I struggle to maintain the delineation between structures above and below the blade as I work with her density. 

The “Linebacker” or “Lazarus,” referred to by both names, is the seventy-eight-year-old who according to his paperwork, died of prostate cancer, was “morbidly obese,” and suffered from renal dysfunction. 

Fable’s table is diagonal to Lazarus, and during this course we are in pretty close quarters with four or five other tables at our end of the room. We can pop in and out of conversations in any of these locations without leaving our work. Very soon into the dissection, we begin hearing a faint alarm or ringtone coming from somewhere close by. We don’t think much of it and hardly mention it for the first while. As it gradually gets louder, it’s muffled, making me think it’s someone’s phone buried deep inside a bag of fresh scrubs, and by the time a few of us notice, it becomes a conversation stimulant. Every hour we are alerted again by the alarm to discuss where it might be coming from. We joke that one of our donors is upset about our topic of conversation, unrelated to anatomy or dissection, and the alarm is meant to shut that conversation down, and it does. This goes on for days. Soon we are using the alarm for stretch intervals. 

It continues to get louder still, until it’s finally discovered deep in the superficial fascia of Lazarus’s abdomen. 

An intrathecal pump is used to manage chronic pain by inserting small amounts of pain medication directly into the fluid surrounding the spine. It stops pain signals from being perceived by the brain. A catheter is surgically inserted into the space around the spinal cord and connected to a device containing the medication just below the skin of the abdomen. When the device is empty, an alarm alerts the person carrying the pump that they are due for a refill, which can be done by syringe through the skin. 

Since there would be no refilling of the pump, we are stuck with the hourly alert for the duration of our three weeks in the lab. Every hour, the pump’s alarm interrupts the buzz of conversation, and the room is filled with the clanging of instruments as they are placed on tables, accompanied by the groans of stretch. We are so focused on what we are doing that we forget to look around, drink water, and move our bodies. I can’t help but wonder: if Lazarus had had hourly reminders in life to step back, would he have delayed the need for such an extreme treatment for his chronic pain? 

Journal Entry: 

Throwback to recess! In grade school, three times a day (more if you arrived early or stayed late), we had a mandatory, unstructured outdoor break. Why did we stop doing this as adults? In my teens and early twenties, I was a dedicated smoker, and after I quit for good, I realized that smoking, for me, was all about the fresh air (right?), the pause, and the breath. It was an “acceptable” reason to step outside and reset, and I miss it! No, not the cigarettes (really)—the break. What if we brought back recess? I bet we’d all be happier and a bit more productive. 

A classmate describes her perception of the energy shift in the room as we make our way through the superficial fascia as fast, playful, light, and soft. Words I would have echoed in previous labs, having enjoyed this stage of dissection so much. Funny, I feel the exact opposite now as I wrestle with Fable’s adipose. 

Conversation in the circle revolves one morning around layers and how they differ for each of us. It’s literal and figurative. If the skin is our top layer, it can act as a barrier between the emotional self and the world. The softness of fat beneath the skin might be the place we allow others to hug and sink into. The muscle symbolizes strength and action—perhaps a space that is void of emotion. We wonder about whether the trim, muscular bodies in the room move through life primarily as doers, while the soft, plump bodies navigate life as feelers. Questions arise around which layer we reside in or move from. What layer do we ignore or fear, and how do we meet people where they reside? As we feel through these internal spaces physically and emotionally, both as dissectors and human beings, it all becomes simultaneously so simple and yet painfully complex. 

I’m caught up in the romanticism of the body and our esoteric conversations of emotion and symbolism. It’s beautiful to think that the act of caring might have an anatomical location in the body that can be accessed through thoughtful communication with the layer where it resides. Like those hugs where two bodies not only embrace but do it so intently there is a feeling of our emotional layers having actual contact with one another beyond the skin. Being allowed to sink fully into someone’s flesh and share the sensation of true affection—wow. I have been embraced before by someone who wanted to offer the gesture but only in theory. Have you experienced this? A hug that feels like you have encountered a real-life, pencil-drawn stick person who should have just offered a wave from the page they jumped off of. The feeling is more like having gotten tangled in the branches of a bare lilac bush than actually being cared for. The unbending awkwardness that proves our bodies have language, and a communication style that goes beyond speech. Through the analysis of a hug, I know that the conversation of layers is not just theory. But the new level of intimacy that opens through this line of thought overwhelms my comfort with closeness. 

It’s taking forever to get through Fable’s adipose, and I am trying desperately to suppress the intense frustration bubbling inside me. I can’t handle the constant chatter at the table. Regardless of how many times I change my scalpel blade, I still cannot define one layer from the next with any certainty, and I see myself turning into the person we like to call the “butcher,” who fucks up every cut by removing something we have not yet examined. Her fat cells are so dense we are expecting it to be a simple removal, which only exacerbates my frustration. I want to reveal the finite details of her flesh but the strength of the matrix holding the adipose in place makes me feel like I am recklessly forcing the blade of a utility knife through a thick cardboard panel. Precision is lost, and I’m hacking my way through, when I want to be delicate with her. The other forms, in contrast, are shedding this layer with the ease of peeling a banana. 

The Lazarus alarm goes off, and I put down my tools and walk away. Several deep breaths and a short tour of the room leads me back to Fable with a calm determination to stay present with her intensity. I assume it’s her intensity, but I am having an internal dialogue to determine how much of it is mine. After a few more failed attempts with her flesh, sensation rises again, and I actually feel rage. Where is this coming from? 

This time I trade my lab coat for a sweater, put in my earbuds, and walk a few blocks away to the fresh air of the dog park. It is common practice during this lab to seek out the unconditional love of the dogs in the park. It doesn’t matter what state you are in—a dog just knows what layer to reach you through. But still, we joke about the times when even the dogs stay away. This is one of those days. 

Journal entry: 

How am I? I think I’m well… It’s hard to tell. There is a lot of adrenaline in the room as we uncover the nuances of one another and simultaneously process it all. It’s so foreign yet so normal all at once. 

I have been journaling seriously since my mid-twenties, and it’s possible that through writing, I nudged myself toward yoga asana, knowing I needed a physical outlet of some kind. It’s become therapy for me over the years, and I find that when I write, I can tap into feelings and concepts that are hidden inside. Sometimes it’s as if there is a much wiser person holding the pen, illuminating the lessons I need to learn. For a long time, I wouldn’t record dates or even feelings; I didn’t want a journal that would identify or embarrass me if I lost it. This fear of getting caught expressing emotion came from high school, when my mother found some of my writing and burst into my room, waking me in the middle of the night to confront me for the language contained in the words she read. Teenage angst spilled across the page, relieving my heart of the burdensome feelings, and all she could register was disappointment of who she thought me to be because I wrote fuck a few times. It took years to regain the confidence to write privately and reignite the creativity pouring into the pages of my diary. 

During this longer lab, I am two years into a severe recurrence of my lower back pain, and my yoga practice is almost out of reach because the sensation is so sharp in all directions. In the place of asana, I commit to a daily journal practice to process the intensity of the hours spent dissecting. There are several methods for opening the emotional structure of my cells. The writing helps my body to purge and process, and I see the many ways in which my emotional metabolism is managed through my body, but also through writing and deep conversation with peers. 

As we navigate changing physical and emotional spaces of dissection, the energy of the room is in constant flux. Sometimes I am shut down and removed. Sometimes I share, too quickly, parts of my history I would not normally share. I catch myself wondering why I am revealing or shutting down so much. As we try to reconstruct the biography of our donor, we are learning one another’s stories. During the days of superficial fascia, we relate how some of us hold the shape of our history, but we can only know this through the living narratives we share. We are not given anything of the donor to draw from other than their body… We want to believe they are telling the story of their own lives in some way. 

The delineations of skin, adipose, and deep fascia in Fable are not easy to find. They are well-defined yet interwoven in such a way that we have no choice but to be completely present with her, or give up and walk away. My experience with this tissue prior to her had been so different. Although I initially found it shocking to look at, Venus-Mary’s adipose was cut away effortlessly. Art’s must have been similar because I scarcely remember it. With Fable, for the first time, I am confronted with the question of who she was when she walked this earth. How much of her personality was responsible for creating the stubborn tissues we are now wrestling with? It truly feels like a fight, and I vacillate between frustration, anger, and quiet determination, walking out of the lab more than once as we make our way through, hoping to eventually uncover her deep fascia. 

As I navigate the shifting of my state from anger to frustration to empathy, I wonder about myself as much as I do about Fable. I feel out of control when these old familiar feelings arise and I try to manage my rage by employing empathy for the subject that has brought it to the surface; in this case a cadaver housing the fictional character of Fable, one of my own manufacturing. It doesn’t work, but it’s a technique I habitually turn to. By empathizing with the challenges I consider Fable to have had in her life, I can distract myself from the hatred of my own anger and frustration that is rising up in the moment. Here it is again, empathy as survival. Turning my attention to anything other than my own discomfort. I lie in the grass reeking of Fable, digging deep in hopes of transcending the murk she pulls out of me so I can get back to removing her fucking adipose.  

Three weeks with one form means more than a passing day with each substratum, and it’s becoming clear there is more to this fatty muscular overlay—commonly discarded as something other than anatomy—than I had previously acknowledged. The layer of feeling, conductivity, lymph, emotion, and the place where the adrenal response begins. As a massage therapist, this is the layer that either lets me in or doesn’t. The layer that wants to snuggle and be touched. It knows others and wants to be known. 

I am vaguely aware that I have been staring at the color of her fat for four days, and it’s possible I am reacting to the supposed emotion of this yellow nervous system stimulus, but I can’t help but question if what I am feeling is emanating from Fable’s flesh, and whether the people around her struggled similarly with her in life. Energy can be almost tactile at times—the dogs in the park can attest to this. 

When I approach the subject in the circle, a deeper conversation begins as others express thoughts in the same vein. I realize there is a benefit to the intertwining tissue I am wrestling with because I am forced to be completely present with both myself and Fable, as I create the definitions I seek with my blade. It occurs to me, as my eyes scan all the different body shapes, sizes, and densities in our living circle, that we are all shaped from our experiences and our flesh holds pieces of our history and that of our families. Who was the woman who created the rich tapestry of Mable-Faye? The borders between her and me are beginning to overlap, and I wonder about the barriers that the people in my life rub up against in their efforts to access more of me. 

Although I cannot articulate it, because I am still unaware of the process, she is dissecting me. Although I’m the one holding the knife, Fable’s non-judgmental yet strong presence is allowing me space for safe inquiry. I am the one focusing the light, but Fable is reflecting it back, and it’s me who is being illuminated.