IMPUNITY

My assignment this week was to dissect out the great saphenous vein.

Saphenous.  What a beautiful word, I mused. What does it mean, I wondered? It sounds exotic. Cobalt-colored. Erotic. Poetic. I would google it when I got home. In the meantime, I would get down to work with the tools the instructor had told my to use: scalpel, scissors, forceps, hemostat.

I started at the top of the medial thigh, the soft fleshy part of the inner leg that in any other situation I would have associated with sex. I pushed this thought out of my mind as I grabbed a corner of skin from the upper thigh with the cold teeth of the hemostat and locked the handle to hold it tight.  I pulled it gently away to expose the vein below.  Oval grains of fat surrounded and supported the vein so it looked like it was suspended in a bed of orzo.  Using the forceps, I plucked off one fat cell at a time.

In anatomy class, we learned that when people got fat, it wasn’t that they actually grew more fat cells than skinny people; instead, it was just that their fat cells were fatter. Fat cells are unusual cells because they cannot divide like most other cells do. They just puffed up like angry cats. The cartoon from the anatomy book was unforgettable: with their nuclei pressed over to the edge, fat cells looked just like bulging eyeballs. We learned that fat cells are actually good for us, because the fat stores energy and keeps the body warm. Fat cushions and protects internal organs, the eyes, the blood vessels. It is the packing peanuts of the body. Fat is amazing.

And it is also disgusting.  I made a mental note to self that from now on, I would stop eating so much of it. With my hands touching and my eyes seeing and my nose smelling the fat of the cadaver, I could not help but have x-ray vision into my own interior state, and that was not a pretty thought.

Fifteen years ago, my father had had quadruple bypass surgery, and his saphenous vein had been harvested.  I remembered this specific detail, even though I was foggy on where exactly in the body the saphenous vein was, because of verb the doctor had used, “harvested,” as though replacement body parts grew plentifully in fields like sheaves of wheat. I hadn’t thought about my dad’s open-heart surgery in a very long time, but now it came flooding back. How he had almost not made it through the night, how it had hurt him to sneeze for weeks after the operation, how even after the rest of him had been split open like a spatchcocked turkey, his sense of humor had remained intact. When a nurse asked him one morning if it would be all right if she checked his incision and changed the dressing on the wound, he replied, “That would be wonderful. I would like Roquefort this time, please.”

I now understood exactly where in the body the great saphenous vein was and why it was the perfect candidate replacement for a failing coronary artery.  It was the longest vein in the body, running all the way from the top of the foot to just below the groin, where I was starting to cut. With utmost respect for how this vein had saved my father’s life, I balanced the scalpel lightly on my index finger and moved towards the target. I was being as meticulous as I could be, but nevertheless I nicked a tiny hole in the vein. I felt terrible about the mistake. Life and death depend on the precision of the excision in any surgery. But a glance at the cadaver’s face jerked me back to the present. He was just as dead as he had been moments before I nicked the vein can could have saved a living being. “Use me,” he seemed to say. This is just an exercise in learning. Make mistakes on me so you don’t make them on others.”

The dead man was such a compassionate teacher. ‘Go ahead,” he continued. “It doesn’t hurt me, but it sure hurts your ego. Keep doing what you’re doing. The truth will reveal itself.”

My teacher Ruth saw what had happened.  “It’s OK,” I said. “The vein is still intact. We can superglue it if necessary, but I think you are doing just fine.” With relief and  renewed focus, I leaned even closer to the leg to see it better. I switched from using a hemostat (which is like a cross between a needle-nosed pliers and a pair of scissors) to using a forceps (which is like a tweezers), thinking I might have better control.  But again, I scratched the vein. This time it was more like a paper cut. I imagined blood spurting out of the perforations I had made in my clumsiness, spraying the operating table in a shower of fresh blood. The smell of the formeldahyde was getting to me.

I felt dizzy.  I had to pee.  I felt like I might pass out.  I backed away from the table.

But instead of leaving the room, I chose to stand there in the full swirl of sensation and disorientation.  I knew inside the hollow spaces inside my own body that the point of working in the anatomy lab was ultimately a journey into self-knowledge and self-awareness.  I paused to enjoy the ticklish pressure of my full bladder, and the sensual pleasure of engaging the muscles of my pelvic floor. I noticed the contrast between how intense my own bodily sensations were and the indifference of the dead man, his genitals covered with a stained yellow towel, pubic hair sticking out like weeds, a catheter in his bladder. My bladder reminded me that it was working normally, thank God, and it still wanted me to void it, so this time I listened to my body and skipped off to the ladies’ room, which was a breath of fresh air compared to the cadaver lab.

When I returned, I saw that an undergrad had waltzed in sporting a spaghetti-strap tank top and shorts so short they barely covered her bum. Sweat beaded on her upper lip. She knew she was hot and was flaunting it. How beautiful shone her near-naked vitality beside our man on the table, who was volunteering his body in a much more modest way in the name of science.

I couldn’t help but notice also that I was somewhere in the middle. I was young and hot once, but now aging had graced me with some grey hair, a few wrinkles and a slower metabolism. Working in the anatomy lab has made me aware that I am dying and living with every breath. I’m fully alive to sensation, beauty and experience, and at the same time, I know that my stomach cells are replacing themselves every three days, my skin cells every six to seven weeks, my knees are getting creaky, I’m losing bone density faster than I’m rebuilding it, my gums are receding, if I laugh really hard, I might lose a drop of pee.  It’s a race now between my body’s inherent ability to regenerate tissue, bone, and cell and it’s equally inherent wisdom to slow down. I can’t help but think: one day this dead body will be mine.

Unlike the cells in my body (except for fat and brain cells) that have collectively reproduced themselves millions of times, I have not reproduced myself once.  In Darwinian terms, I am unfit. When I die, my genes die with me. How did I miss out on this most basic biological opportunity?  There’s no better cosmic kick in the butt to make something of your life than working in an anatomy lab.

“How are you coming on that vein?” Ruth asked. When I pulled the skin away and cut the connective tissue with the scalpel, it made a whispering sound like tearing tissue paper. The fat around the vein was oily and slippery, so I kept losing my grip. I accidentally sliced the saphenous vein a third time.

“I’m destroying it,” I sighed.  “I just can’t seem to get it. I give up.”  I had travelled no more than an inch from the where I had started in the past three hours.

“Let me show you a different technique,” offered Ruth.  “Since this vein is carrying the blood from the top of the foot back towards the heart, you will have better luck if you work your way up the leg, in the direction the vein goes.”  She showed me how to start at the medial side of the foot, above the arch, and to use the reverse scissor technique with a blunt-edged scissor under the skin because this is such a superficial vein. This technique worked perfectly, and it made perfect sense.  I had been trying to force my way against the way the vein naturally flowed. Of course, I encountered resistance. I was going against the body’s grain, and it was talking to me, had I only been smart enough to hear it.

Working with the flow of the body now, I was able to dissect out the remaining three feet of great saphenous vein perfectly without damaging it at all.  In no time, I had completely excavated one of the body’s great subterranean rivers. I had been standing over this cadaver for hours, and it occurred to me that my own great saphenous veins had been steadily returning blood flow from my feet to my heart without ever making a peep.

My dad’s veins, however, talk to him all the time. They complain loudly. My dad has been good at outwitting death his whole life.  “My nickname is Impunity,” he told me when I was five.

“What’s that word mean?” I asked.

“It means that no harm can come to you,” he said, showing me the scar on his nose that resulted from someone accidentally casting a fishhook into his face. He had later survived capsizing in Lake Superior when he was 35, quit chain smoking when he was 45, and recovered from a quadruple bypass when he was 59.  But now his legs hurt him so bad he could barely walk a block without being sidelined by the pain.  As I worked on the cadaver’s legs, and admired his intact great saphenous vein, I couldn’t help but wonder what my dad’s great saphenous veins looked like. And then I remembered: they were wrapped around his heart.

When I got home from class, I googled the etymology of the word saphenous. Here is what I found:

“It may come from the Greek saphenes meaning obviously visible (which it is when varicose) or it may come from the Arabic al-safin meaning hidden (which it may be, lying deep in the subcutaneous tissue). No one knows for sure.”

Check back soon to learn what happens in Week 3, when we dive into the muscles.