I have recently been on a quest for meaning and have found it in the most unlikely place: among the dead.
Sometime in my mid-40s, I began to feel more afraid than ever about my chosen career path, which I loved. I had been keeping a journal for over thirty years, and had been making documentary films for close to twenty years. Other people’s stories inspired me. They touched my heart. They surprised me. I had followed a Parkinson’s patient for half a decade as he got electrodes implanted in his brain to stop the dyskinesia, then got an infection and had to have the deep brain stimulation apparatus removed, and then had the electrodes re-implanted and finally got his life back. I had travelled to India with a paralyzed woman who was getting stem cells, convinced they would make her walk again. They seemed to help. She could feel sensation and pressure in her legs she had not felt for twenty-four years. I had filmed open heart surgery and chemotherapy treatments, had filmed in maximum security prisons and museums, rainforests and community gardens, health care clinics and hospices. Whenever I was on a project, I was completely consumed physically, intellectually and emotionally. I went to sleep at night feeling fulfilled, knowing I had made the world a better place by telling other people’s stories with heart. My presence had helped people to speak their truth. I knew that in some small way, this work had made a difference.
And yet when each project ended, I was filled with a hollowness that would not go away. A sense of dread that something was missing. That I had missed the boat. That I wasn’t good enough. That I wasn’t making enough money. I ‘d convince myself that I wasn’t living up to my potential and that there was something out there that would combine my interest in people, storytelling, and healing.
The thought “I should have gone to medical school” looped in my head like an earworm. This thought was like the black dog in the Coppertone ad that had gotten hold of the little blonde girl’s bathing suit bottoms and wouldn’t let go. It kept nagging at me, exposing me.
“I think you turn over that rock and see if you like it” my husband suggested one night. He had been watching me go through this cycle of fullness and emptiness for six years. “You have never taken a science class in your life,” he continued. “You have no idea if you will enjoy it, or if it’s just a fantasy with a big paycheck. You don’t even know if you are any good at it.” I listened, head down, ears open. My beloved husband is always the voice of reason. He’s a risk taker, but he takes calculated risks. He’s not reckless. He’s thorough. “You have been taking about wanting to go to medical school ever since I can remember,” he said, “so it seems to me you either have to start down that path and see where it leads or stop talking about it.”
The next day I registered for my first class: Biology.
One class led to another, and before I knew it, I was working in the Anatomy Lab at the University of Colorado, Boulder. The following blog posts are my attempt to come to terms with the emptiness that I have discovered lies at the core of what makes us all human.
WEEK 1: SKIN
In the Anatomy Lab, I buttoned up my white coat – I was glad to see they had been freshly laundered – and pulled on two pairs of baby blue nitrile gloves – two pairs for extra protection. I grabbed a scalpel handle and a #22 blade, a toothed forceps and a hemostat, and a tray. “Why don’t you start on the leg,” suggested Ruth, my instructor. I was her dissection assistant for the semester. “We’re taking the skin off today.”
I pulled back the thin, damp white towels covering our man’s lifeless body. He lay on his back, eyes closed, jaw relaxed, but there was no lavender for him to inhale. His right foot splayed out like Charlie Chaplin. His skin was firm and smooth. Not freckled, like mine, nor tissue paper thin, like some of the other cadavers. This man’s skin was pink and plump, and he had such strong, well-defined legs, I had to keep checking to be sure he was really dead. His muscles seemed to be practically pulsating under my hand on his thigh, but I knew that could not be. This man did not seem like he had wasted away. No, he seemed like he had died more suddenly, like life had just snuck away in the night, like a cat burglar. He had a huge barrel chest, and big meaty steaks for feet. There was some kind of a port on the left side of his chest and another leading to his bladder. I wondered why. Since the cadavers didn’t come in to the university with medical histories, or even the person’s age, all we had were clues like these to the lives they led.
I stared at his leg for a long time. I was unable to move, and so was he. The leg represents foundation, our connection to the earth, our independence. Like a seed putting out shoots as it rises from the earth, we start to crawl, then walk, skip, jump, hop, play hopscotch, tag, and soon we are racing against the clock of life, deadlines, commitments, and aging towards death. Our legs carry us the whole way on that journey. I wondered where this man’s legs had taken him. I looked at his face, the stubble on his chin, the crookedness of his teeth just visible through barely parted lips. Where have you come from? I asked him silently. What did you love in life? He was mute. He just stared into his eyelids.
I took his thin lips, his hooked nose, his long ear lobes, his barrel chest, his plump tummy, his long legs and his skinny ankles – these features all reminded my of my father. My father was very much alive, but I knew he was a time bomb waiting to explode. It occurred to me that perhaps the reason I was working in the cadaver lab was to prepare myself for the inevitable. To make peace with death before he came for my dad. I didn’t know when he would come, but I knew he was lurking around the house all the time because I could feel him.
My father lived on Scotch and bacon. He didn’t exercise, he didn’t eat anything green, ever, unless it was a breath mint or a green M & M. He had COPD, heart disease, acid reflux, melanoma, and gout. He’d had a quadruple bypass years ago, and peripheral artery disease now that was so painful, he could barely walk. But despite his physical challenges, my dad always had a joke at the ready and never complained. He still travelled frequently, and always insisted on being the driver and manning the grill. My dad was proud of my interest in medicine. My daughter the doctor. It was what he had always wanted.
Ruth had already started to remove the skin from the man’s upper torso, but below the belt was a fresh field for me. I watched her, bent over with concentration as she carefully cut a straight line through the bloodless integument that covered the surface of this man’s body his whole life. Until now.
The skin is the biggest organ in the body, accounting for about 8% of a person’s total body weight and covering over twenty square feet of surface area. It both protects us from and connects us to the world around us. It stops and destroys bacteria, protects us from dehydration, regulates our body temperature, excretes liquids and salts from the body, and contains an exquisite array of sensory receptors that respond to temperature, pressure, pain, tickle and touch. It’s water-resistant, layered, and beautiful. The skin is a gateway to the body. The saying “beauty is only skin deep” resounded in my mind as I watched Ruth carefully peel away the top layers of tissue from this man’s cavernous chest.
She looked up from her work. “You doing okay?” she asked. I nodded. It was the first day of class. It was my first day of dissecting a real human. I wanted to take everything in while the body was still whole. I knew I had to get started, but I wasn’t ready just yet. The man lay on the table in the anatomical neutral position. He might have been sleeping. Or maybe he was. How would we know? Except that he was never going to wake up.
I thought about his skin and I felt my heart leap into my throat. Somebody had loved this man. Somebody had caressed him here, on the upper thigh along the hip, where I was about to cut. Somebody had slow danced with him, and made love with him. I imagined he had bounced children and grandchildren in this big lap. I thought about the skin as germ barrier, temperature regulator, pressure sensor, and immune system guardian. And yet, the skin, for all the myriad ways it is the body’s gatekeeper, cannot protect any of us ultimately from death. I didn’t think this man had died of old age because his skin didn’t look old. I felt he must have died of something else, some kind of Trojan Horse that snuck into the gates of his city, and waged a deadly war from the inside. Some surprise attack had happened inside the walls. I was going to find out what it was.
The first cut is the hardest. This man’s skin was firm and taut, unyielding as a steak. I cut into the thigh with my sharp scalpel. Sliced cleanly through the epidermis, the dermis, the hypodermis, to the fat below. I made a perfect square, like a middle brownie. The skin gently resisted me. With the forceps, I peeled away a corner. It made a soft sucking sound. I began to cut away the fat, which practically melted beneath my blade. I switched to the hemostat – a blunt-edged scissors-like clamp with a locking handle that afforded a better grip – so I could grab the skin more firmly. Now that I had a solid hold on it, I could peel it off as easily as a mailing label from a New Yorker. The underside of the skin looked exactly like the cartoon in our anatomy book – honeycombed, lattice-like. I could see where the hair follicles were when I turned it sideways. They shone like millions of tiny dots of light scattered from some distant universe.
I removed the fat. It lay arranged in layers like scales or feathers, like something primordial. Just beneath the surface of nicety and beauty we all present lies our connection to who we really are: creatures who crawled out of the swamp four hundred million years ago. Beneath the surface, we are all connected, I thought, scraping away yellow oily bubbles of fat that looked like vitamin E gel caps. They were squishy and hard to grab, unlike the skin, which was firm as shoe leather. Beneath the surface, I thought, we are all still evolving.
Finally I got to the connective tissue. It had the consistency of cotton candy. I was amazed that beneath the façade of solidity and denseness we take for granted that we are, in fact, we are squishy, oily, watery and soft. The deeper I went into the skin, the less dense the tissue became. This was a shock to me. I expected to find something solid for the skin to rest on, but instead I found that it floated on a delicate web of tissue that was as fine as gossamer. This delicate fibrous network known as fascia, runs throughout the body from head to toe. Its fibers wrap around and support every muscle, bone, nerve, artery, vein and organ, much like an enormous spider web that suspends its catch in its threads. Fascia, in other words, is what gives our bodies their structure. It’s the Velcro that holds all our parts together.
I made a small hole in the thinnest part of the fascia running alongside the iliotibial band, the thick ligament running from the top of the outer thigh connecting the hip and the shin. The IT band was tougher and thicker than the surrounding fibers, so it was easy to identify by touch. It’s stiff yet pliable, strong yet flexible, like a webbing strap you’d use to tie down a canoe down on your roof rack. Even though I had never done this before, my hands seemed to know exactly what they were looking for. I felt for the edge of the band and found it easily. With the pointy tip of the scissors, I made a tiny hole the size of a sesame seed. Then, carefully coaxing the blades into this opening, I used what’s called the “reverse scissor technique,” working the blades open and closed, open and closed, separating strands of fascia thread by thread until I could eventually get my fingers into the space. As though opening a well-sealed envelope with a letter opener, I wiggled my hand beneath the IT band and freed it from the cobwebs of fascia that connected it to the quadriceps below. With my left hand in the body, underneath the IT band, and wielding a very sharp scissors in my right hand, I made a sushi-perfect cut that revealed the fan-shaped ribbon of ligament that had stabilized this man his whole life.
I cleaned up the frayed edges of fascia so they were even. My motion was precise and confident, as though cutting an entire length of wrapping paper from the spool, but my mind was anything but celebratory. I was slicing up a human body, which is weird and amazing and awe-inspiring enough, and it seemed the most natural thing in the world to peer into a body, which made the whole thing feel even more surreal. Most people have trouble expressing their feelings and emotions even a tiny bit, we pee with the bathroom door closed, we never talk about body fluids because it’s not dinner table conversation, and yet here I was, my face a foot away from the insides of a total stranger, my hands wrapped around his muscles, and I was mesmerized. There was something intimate and terrifying about being this close to another body, a dead body, and at the same time it was oddly reassuring to see what we all look like on the inside. Now I had a map of my own interior landscape that I could follow.
With my right hand sandwiched between this man’s iliotibial band and his quad, I felt his strong lifeless legs, and I felt the life in my own legs I was standing on. I had worked out this morning. I had done lots of lateral leg raises and squats and lunges. I knew exactly what my IT band did for me, and I felt how it ached after each set. I thought about how painful it would be to have someone cutting into my leg, the way I was carving up this cadaver. He never complained. He never moved. He just kept sleeping quietly there on the table while we took him apart, piece by piece.
When I was done for the day, I washed my gloved hands, cleaned my tools, then took off both pairs of gloves and washed my hands again. I hung my lab coat on a hanger and put it on the rack, just like Mr. Rogers, replacing his cardigan so it’d be ready for him the next time he came to the neighborhood. I noticed the plant growing by the side of the sink, the way its shiny leaves twisted towards the light. I noticed how brightly the sunlight reflected off the linoleum as I strode down the hallway. I noticed the dull thwack of Dansko clog soles on the floor with my every step, the crinkly sound the posters flapping on the wall as I passed. It was a sunny day outside. The sky was royal blue. I walked to my car, feeling the strength and solidity of my legs carrying me, appreciating my connection to the earth, the brisk wind on my skin, and the sheer wonder of being alive.
Check back soon to learn what happens in Week 2, when we go deeper into the leg.