Featured Prose | April 24, 2019

Nostalgia and science converge in Gulchin A. Ergun’s “Afternoon with a Corpse,” her memoir about learning anatomy on a cadaver in an anatomy lab.  The essay begins with a question: Can anyone really learn anatomy without confronting the human body? In the closing paragraphs, the essayist, an M.D., reflects on the “grace” of donors who gift their bodies to science so that students can “discover the exquisite nature of human engineering.” The essay appeared in TMR 41:3.

 

Afternoon with a Corpse

by Gulchin A. Ergun

 

I skimmed the first two paragraphs of the fine print, then skipped the rest to sign at the bottom. The contract got me a membership in the gym and a black duffel bag I didn’t need but a few sessions with a trainer that I did. After the measuring and weighing, we toured the place, ending upstairs in front of a machine sprouting pulleys and cables. He squatted to pull a pin, briefly waving it before my knees, then settled on a weight that I self-consciously noted wasn’t far from the bottom.

“We’ll start here,” he said, toggling the peg into the brick. “This baby’s good for the shoulders and back,” he added, patting the trunk of the Universal, “but I think free weights are better for everything else.” He modeled the various muscle groups that resistance training would improve and gestured toward a poster of a body-builder with colossal trapezius and latissimus dorsi muscles. I looked at his ideal man, then back at my arms, and informed him that while my feminine biceps and triceps were perhaps underutilized, I had taken anatomy in medical school and still had a notion of what muscles looked like, even what they did. He almost giggled but looked at me with what might have been newfound respect and told me that he was starting medical school at the end of the summer. I took in his easy, confident grin, the bold yellow “Live Strong” wristband, and asked him if he was nervous.

“Well, I’m kind of scared of anatomy,” he admitted. “I heard it’s really hard. But I’m going to take an online course before school starts. That way I’ll be ahead.”

Typical premed thinking, I thought but said, “I’m not sure an online course is really necessary. It’ll get you started, but it’s not the same thing. Believe me, you’ll learn it anyway. Spend your money on a trip and enjoy your summer. You won’t get much more of them.”

He still smiled but didn’t say much more, leading me to believe he’d already made up his mind and thought I needed to mind my own business, so I did. I pushed, pulled, and grunted under his direction, finished my workout, and drove home. But rather than focusing on how I was going to rearrange my schedule to exercise three times a week, I found myself revisiting what we’d said, asking why I felt like this guy was making such a mistake and why I had to be the one to tell him. So what if he spent July and August learning anatomy with DVDs and 3D reconstructions of the mediastinum or retroperitoneum? I was surprised that I had such negative feelings about it. Had I become such a dinosaur in twenty-five years that I couldn’t imagine clicking and scrolling through diagrams of kidneys or lungs to understand how the body worked? Thinking of it took me to my own first days in medical school in Cleveland, Ohio.

***

“Everything you need to buy is in the bookstore. Lab coats, gloves, masks, and dissection kits. The workbook follows the chapters in Clemente, but any of the standard texts or atlases will do. They sell used kits, but most students buy new ones or piecemeal the equipment,” the instructor said rather automatically. “You’ll be working in groups of four, so pick your lab partners now or you’ll be assigned to a group.” Most groups formed based on the proximity of their desks, and so did we.

The class began in the lecture hall with a brief introduction by the anatomy professor.

“I know many of you have never seen a cadaver before,” she said, “so you may be anxious. I recognize that, but you’ll adjust. These people donated their bodies so you could learn from them. That’s why you’re here. Whether they died of old age or some illness, underneath we’re pretty much the same. That’s anatomy. Teaching assistants and professors will be in the lab if you have questions,” she continued, pacing the front of the lecture hall.

“The labs follow the systems covered in class, so you’ll have your cadaver for the year. They’re fixed with formaldehyde, so don’t touch anything without gloves, and wear your masks and goggles. In case you didn’t know or don’t remember, formaldehyde can be absorbed through the skin and mucus membranes. It’s toxic, maybe even carcinogenic, so don’t forget.” And she finally paused to face us, absent-mindedly rocking from heel to toe as she emphasized her last point.

“You’re adults, so I hope this is obvious. Don’t eat in the lab, don’t take pictures, and don’t bring in your curious friends or family. Everyone wants to know what you’re doing in here, but they don’t have to see it. Also, nothing leaves the lab. I know it’s October, but I don’t want to hear about someone smuggling a skeleton to a Halloween party. When we’re in the lab, there’re rules. In general, we keep the head and genitalia covered. This is out of respect. We only expose the parts that we’re dissecting. Last but not least, unless you have a reason to keep your cadaver out, put it away when you’re done working. Housekeeping will appreciate it.”

With that, we filed into the labs. The rooms with our desks, personalized by microscopes, wooden boxes of pathology slides, three-ring binders, and clusters of highlighters, pens, and number-two pencils, had been transformed into private dissection arenas, a surreal cemetery of metal gurneys bearing outlines of human forms covered in white sheets. We were struck by a pungent, thick, artificial smell that stung the eyes and bit the nostrils. With involuntary palms to noses, we understood that the cloying odor was formaldehyde, the preservative and antiseptic that erased the living odors like sweat and bad breath. As we surveyed the landscape, we couldn’t help but notice the variety of mounds on the tables. They came in all shapes and sizes: some big and wide, some so tiny they barely occupied the gurney. We gathered around a bundle closest to where we were standing and buttoned up our lab coats, pulled the white, plastic aprons over our heads, and broke open a box of latex gloves.

“Okay, time to play ball,” Matt said, cracking his knuckles and giving his arms a good stretch before snapping on his gloves. “Who’s going to unwrap him?”

“You’re not warming up for a pitch, Matt. Why is it always a sports thing with you guys?” Laura kidded while Bill coolly circled the gurney and proved he was going to be the man most economical with his communication. “Let’s get started,” he said.

I remember taking a corner of the sheet and lifting it to look underneath. Masculine. The forearms were broadly muscled with substantial hands and squat fingers that were splayed, almost too thick to rest next to each other. The knuckles were knobby and callused, with sparse tufts of curly hair on the biggest fingers. I touched the hand lightly, thinking he might even be frozen, since he was shockingly cold, even through the gloves. A peek to the south confirmed his sex, and I pulled the sheet back over his body.

We took our dissection kits with gleaming scissors, forceps, hemostats, and scalpels and put them on a wheeled cart as we shuffled around the gurney. It made the most sense for someone to read the instructions out loud from the workbook while the other three took turns doing the actual dissection. Laura started with the directions.

“It says make a midline vertical incision from the xiphoid to the pubis.” Lifting her eyes from the page to us, she pointed to the diagram and held it up for us to see.

“Make an incision in the middle from the bottom of the chest all the way down to the pubic hair. Then we’re supposed to ‘remove the skin and superficial fatty layers over the lower thoracic and anterior abdominal wall.’ After that we identify ‘the aponeurosis of the external oblique,’” she chuckled. “I don’t know what an aponeurosis is,” she said, “and I’m not even sure how you say it,” she added, “but I guess we’ll figure it out when we get there.”

So we began. We took turns bending over our subject, focusing only on the practicalities—how deep to make the cuts, whether to use scissors or hemostats to remove tissue getting in the way. The room got pretty quiet. We took to working seriously, sparing the usual chitchat. No one talked about who was on Saturday Night Live or how different this was than the frog pinned to a paraffin tray in college biology. Our objective involved huddling over a dead guy, skinning and digging into the guts of someone who didn’t flinch when you poked sharp objects into his flesh.

It wasn’t so easy. With surgical masks Saran-wrapped over our faces, it was like breathing through a Baggie, and while the masks may have been designed to keep bacteria out, they were better at keeping things in, recirculating hot breath and muffling what we said until every phrase condensed on our goggles. I-can’t-see and what’d-you-say dominated the conversation until we loosened the ties. While that made it easier to talk, it created a different problem—masks sliding down our faces. Not wanting to risk touching our faces with dirty gloves, we waited to take the gloves off and adjust the knots until the masks dangled from our chins. We were like kids with sagging pants, trying to walk without falling over until gravity declared victory and they had to stop to pull them up or fall over.

Using the dissection tools wasn’t much better. We were knife and fork users bungling a try with chopsticks. With such tough tissue, too much force and the instruments (including debris) would go flying. When we did expose a landmark, it didn’t look like the drawings we had studied the night before. Somehow I thought it would have been more like surgery—or my mind’s-eye of one, since the closest I’d been to the inside of an operating room was a treatment room having my wisdom teeth removed.

You can know someone’s not alive, but you still half expect to see blood being pumped to other organs. But without any blood to carry hemoglobin and oxygen, there were no shades of red, not even a hint of rose or purple you might see in a bruise. What was under the skin was a tangle of adipose tissue that looked like a heap of yellow chicken fat. Under that corpulence were inert, mud-colored muscles that reminded me of a sincerely overbaked turkey carcass. We flung the unnecessary fat and dried skin into garbage cans on wheels, making sure the pieces stuck to the biohazard plastic rather than hitting the floor. It reminded me of picking over remains in a roaster pan at Thanksgiving. No wonder they called it “gross” anatomy. It was revolting.

Poor guy, I thought, but there really wasn’t any time to feel bad for him or adjust to the feelings that come with seeing the first dead body of your life. I was glad that I didn’t know anything about him, even relieved that I couldn’t tell what color he was. The anonymity made it easier to work. I could avoid speculating about his life. I didn’t ask who he was, whether he had a wife and kids. I could skip wondering whether he’d taught his children to drive in the parking lot behind the church or scraped the snow off his wife’s car in the winter; all those things would only have made filling the garbage can by the gurney more difficult. It was easier not to think of him as a person at all.

It was only in the quiet of the drive home that I’d drift to wondering how he’d ended up on the stainless steel table crowded by student hyenas. Did his family really know where he was? Had they signed him over, or had he volunteered himself, despite the fine print? I hope you got paid, I thought, I hope you got paid a lot. But was there any price that made it okay to be so nakedly displayed, then discarded? No wonder painters and scientists scavenged morgues or paid grave robbers. Who would willingly donate their body if they knew what they were getting into? Of course, if no one donated bodies, you’d have to snatch them. Hippocrates and Rembrandt did it; at least you would be in good company.

I didn’t lose sleep worrying about how I would die, but questions about the soul and what really happened after death lingered like the smell of formaldehyde clinging to my clothing, books, and hair, despite extra-soapy showers and deliberate drenchings with Calvin Klein’s Eternity.

Can they smell this? I would wonder, sniffing my arms like a hound searching for a trace of a victim, convinced that people noticed the odor if they stood too close to me at Russo’s, the grocery store up the street. Maybe they guessed that I’d spent an afternoon with a corpse . . . the lady in the velour track suit who eyed me as I leaned over the celery, or the mother who scooped up her toddler and stepped back as we lined up at the cash register. Sometimes I’d turn my head, imagining someone whispering about me as I sipped the French roast while studying at Arabica in Cleveland Heights. Maybe they recognized the stench that separated medical students from the normal people enjoying their muffins and the Plain Dealer or Times on Sunday morning.

We’d gotten through the first few weeks when someone said, “We’re getting the hang of this. We’re almost in the peritoneum,” as the obliques and the transversus and rectus abdominus came into view. Lifting the muscles out of the way, Matt grinned and said, “Omentum,” like he’d planted a flag on the top of Mount McKinley, then reached in to loosen the bib of fat and connective tissue covering most of the intestines and the solid organs.

“What is this?” Bill was the first to ask. “It’s supposed to be gallbladder and liver, but it doesn’t look right.”

We um-hmm’d in agreement but snipped and trimmed a little while longer. Finally Laura rolled her eyes impatiently. “It’s almost four o’clock. We’re not getting anywhere. Even Reichmann’s group is gone, and the only way they could be slower is if they were the ones on the table. We need some help.” She waved over the anatomy professor.

“We’re having trouble. We can’t identify anything in our guy’s abdomen.”

Dr. Boyd shouldered her way between us and peered over her glasses into our field of dissection.

“Well, that’s because there isn’t anything to identify. This belly is full of cancer,” she said matter-of-factly and used a little baton to point at what used to be the gallbladder.

“It probably started there. The whole biliary tree is obstructed. See how dilated it is? You can’t identify his viscera because they’ve been replaced by tumor,” she said, then looked up at our shocked and embarrassed faces. “Didn’t you notice that earlier? Didn’t you wonder why he was jaundiced? And why he had omental masses? Everything in here is covered with bile. That’s why it’s green. Probably ruptured his gallbladder.”

The Hulk, I thought. We’ve been dissecting the Hulk, and thus our cadaver was christened.

Yet the day our cadaver got a name was the day we had to let him go. He was no longer suitable for us to dissect. We would never be able to learn normal anatomy from him. The professor gave us the choice of dividing up and joining other groups for the rest of the year or starting again. We voted to start from scratch.

Everyone in the class was bright, that was obvious. We all had the intellectual power to master the material, but now our group was starting from behind. It was a handicap for sure, but it didn’t scare me that much. My fear was reserved for biochemistry. In college, appreciating the inclination of electrons in chemical equations hadn’t been intuitive, so I’d expected to slave over acetyl‑CoA and ATPs of cellular respiration in the Krebs cycle. But since I was good at languages, the advantage in learning the lingo of anatomy was mine, or so I thought.

But this wasn’t about learning basic verbs and conjugating them to develop a conversation. You didn’t formulate a question to get a reply. It was a noun fest. You had to study the list, and even if the words made no sense—platysma, psoas, sesamoid, geniculate—bone or muscle, you had to memorize where they started, where they ended, and what they did. There was no context. You were lucky if you recognized a root from another language that helped it make sense. Even words you knew reacquired meanings and orientation. North became superior, south was inferior, and things in the middle were medial, lateral, anterior, posterior, proximal, or distal to some other point of origin. In high school they said Latin was a dead language so I’d taken French. How was I to know that the dead language was precisely the one you needed if you were studying dead people?

We had to hustle, but it was a fickle process. Picking apart a few muscles could take ten minutes or an hour, but at least it was a team effort. It was the after-hours work, the by-yourself slog to understand a three-dimensional relationship through the sludge of a two-dimensional text, that took up most of the time. For instance, from Netter: The superficial (subcutaneous or external) inguinal ring is formed by a splitting apart of the fibers of the external abdominal oblique aponeurosis, with those fibers which pass superomedial to the ring going to intermingle with similar ones of the opposite side and attach to the antero-inferior surface of the symphysis pubis. . . . The lower border of the external oblique aponeurosis is folded under upon itself, with the edge of the fold (and variable added fibrous strands) forming the inguinal ligament.

You could spend an entire evening concentrating on three lousy paragraphs and remember nothing.

I remember, one desperate evening, clearing off the kitchen table and spreading everything on it: the workbook, class notes, syllabus, and both the Netter and Clemente anatomy atlases, determined to master the material. After spending the better part of an evening circling a few pages, I was officially worried that I wouldn’t make it through the first year. I made some Red Zinger tea, poked around the apartment, and ended up in my bedroom closet—not surprising, since I have a devastating need to clean which surfaces when I’m angry or aggravated. As I stood poised to thin the closet of old sweaters, I happened upon a pile of books a neighbor’s son had given me when he’d graduated medical school.

Flipping through the pages, I stumbled upon a black-and-white photograph of a man with an attention-getting bulge the size of a beach ball emanating from his groin. The bulge was so big it obscured his testicles and penis. It was hard to imagine that he could have walked, let alone pulled up his shorts or zipped up his pants without it getting in the way. The caption indicated that it was an inguinal hernia. Next to it was a cutaway of the inguinal canal, highlighting the relationship of the layers of the abdominal wall and the potential weaknesses in the inguinal ring where the spermatic cord and blood vessels exited the abdomen. It detailed how these hernias in men occurred because of the migration of the testes out of the abdomen into the scrotum during fetal development. Since the normal pathway was obliterated after testicular descent, a hernia could occur if it remained patent. Immediately I got it, how bowel could sock through an anatomical defect and how it could be fixed. It was so simple. This was the relevance I was looking for.

The more pages I turned, the more examples I found, although none were more graphic than the man with the hernia that could have been carried in a wheelbarrow. The medical history was captivating and the references to real medical problems fascinating. Everything—names of blood vessels, muscles, and bones—hinted at the past discoveries and personalities of early explorers. I learned how in 1628 Harvey correctly described the circulatory system as we know it but suffered great ridicule and humiliation since his ideas were so opposed to Galen, who thought the liver was the origin of venous blood.

I saw how there were seven vertebrae in the cervical spine. Though numbered, they referred to the first and second only by their names: atlas and axis. Broad and sturdy, atlas held up the head, just like the Titan who shouldered the heavens, while axis, with its toothy little protrusion, provided the pivot around which atlas could rotate. With the mouth, it made sense that the uvula dangled from the soft palate above the tongue. After all, uva meant grape. When I got to the bones of the middle ear, I learned how the tiny ossicles were named malleus, incus, and stapes for their distinctive shapes; hammer, anvil, and stirrup were thoughtful, precise metaphors for the engineering of hearing. Anatomy was understandable. There was a reason for everything. Every push to a muscle had a pull, and it was all explainable by the muscle’s origin and insertion. The more I learned, the more of it that stuck.

After that, I felt ready. I was ready to see what was important. I showed up for the lab with my mental camera poised to take photographs at the important sites. I enjoyed the satisfaction of understanding what we saw and prepping the others to the significance, but I still cringed, putting on that foul lab coat. It was fine with me to leave the actual cutting to someone else.

My surprise was how much others actually liked it. Matt would bounce in, and you could tell he was excited to come to lab. He didn’t hesitate. He enjoyed the tactile skills of using the scalpel or forceps correctly. He was like a mountaineer relying on picks or axes to secure him to the face of the rock. He climbed, feeling the rough of the organs, using internal tributaries to navigate his trail, always enthusiastic in the dissection. Laura, too, loved the hands-on work. She said dissection was like Halloween. She didn’t care about picking out the candy or choosing the perfect pumpkin. She didn’t even want to carve a face, my favorite. All she wanted to do was stick her hands in the middle and do the scooping. Her comment was always, “It’s the best part.”

Bill, I never understood. He stopped showing up for lab and class. He appeared like a ghost for the tests and practicals, although we knew he came in when we weren’t around. Sometimes we’d discover neatly dissected areas in the morning, maybe his contribution after his disappearance during the day. Perhaps he thought we held him back or that the group experience was overrated, but I always had the feeling he was like the guy most comfortable on a motorcycle, cruising open highways, stopping only when he felt like it, unrestricted by speed limits, deadlines, or other students.

We talked about the grind of school, debated whether the health sciences library or the hospital cafeteria was the best place to study, and then gossiped about other people in class, occasionally speculating about where we might live when we got out of school. Sometimes we said nothing at all. We got to know each other, recognizing how Matty hummed “Hotel California” when he was happy and Laura tapped her foot and twirled her hair around pencils when she was anxious. We developed a rhythm in the work, playing to our strengths, rotating who gave the instructions while rubbing elbows in a literal way. We forged friendships while passing forceps and scissors to each other, Laura and I wryly winking, “Do other people really know what we do in class?” as we slid our homework back into the fridge. We moved far beyond wondering where this new body came from. We didn’t wonder at all.

As we caught up and the novelty of do-it-yourself dissection wore off, we visited other groups to learn the variations of normal. We engaged in mock practicals—practice tests with stations of expertly dissected bodies that had strings tagging pertinent structures we’d have to identify correctly within a minute. We studied and studied. We made lists, flash cards, drawings, and we highlighted, underlined, and starred everything we thought was important, quizzing each other and ourselves.

“Quick! What are the cranial nerves?” we’d ask while manipulating the skeleton that hung by our desks. When we couldn’t remember, we’d resort to common mnemonics, chanting “Oh, Oh, Oh, To Touch And Feel Virgin Girls’ Vaginas Ah, Heaven” like it was a nursery rhyme when we couldn’t conjure up the ten nerves that fed the head, though Laura and I would groan and roll our eyes at how ridiculous and insulting the words were, even as they rolled off our tongues. We just didn’t have the time or wherewithal to make up new good ones that incorporated V for vestibulocochlear and vagus.

We prioritized and strategized, sifting through the data to concentrate on what mattered most. We put in grueling hours laboring to guarantee that we’d know what was going to be on the test. Then, in those hours when the rest of the world was sleeping, we’d be suddenly overwhelmed with fatigue and rationalize what we could skip in the interest of time, half convincing ourselves that we didn’t need to know cross-sectional anatomy because there was no help for a patient who came in sawed in half. We learned how to learn, and by the end of the year it wasn’t even creepy to come back to cadavers after hitting Presti’s Bakery in Little Italy for the hot glazed donuts that came out at 1 am.

Short of seeing an autopsy in my third year, I thought I was done with dissection until I was in residency. I was taking care of a young woman with an aggressive leukemia who’d undergone an experimental bone marrow transplant. She was jaundiced with terrible diarrhea and multiple infections, and on multiple antibiotics. There were numerous consultants, none clear as to why she was deteriorating despite everybody’s best efforts. Rejection was suspected, although the skin and bowel biopsies were inconclusive. They wanted to do a liver biopsy, but low platelets and a coagulopathy precluded that. She eventually died, but everyone felt that a tissue diagnosis was critical to understand what had happened. Although her husband was against an autopsy, a liver biopsy was proposed in lieu of a post. While a medical intern wouldn’t have normally been the one to perform the biopsy, I was recruited for the job.

A sour, stale smell of chemicals mixed with sweat still hung over the room when I walked in with the biopsy kit. She was tremendously swollen with a turban hiding her baldness and violet bruises interrupting the intense yellow background of her skin. I lifted her gown and pressed my fingers along the right side of her abdomen, noting how her skin was unexpectedly warm and pliant, despite the massive edema. The liver was firm and enlarged, dipping dramatically into her pelvis. I made a tiny cut that oozed some pinkish fluid and sunk the needle in, dropping the sliver of tissue into the specimen jar.

There was an odd familiarity to the scene, though I’d never done this before. Maybe it was the smell or the jaundice, but I thought of the Hulk. But this time, she was no stranger, not some mound under a sheet. I knew who had brought in the fuzzy blanket folded on the chair; he stood outside the door. It felt gruesome, more like raiding a fresh grave, but justifiable. Getting this piece of tissue would explain why she’d died.

It’s ironic how fast innocence can fade. As a student I was shaken seeing my first dead person, appalled at being complicit in what felt like a desecration ritual. I couldn’t shake what I’d seen or done. I thought about it, dreamed about it, and when the cadaver was gone, the hint of formaldehyde brought it back. Yet a transformation had occurred: the emotional distancing necessary to complete the task had begun. Perhaps professionalism begins when you stop reacting with disgust at the unpleasant sights or smells of your work, and doctoring begins with simple things like acknowledging the gravity of your task and doing your best, even if it’s something you don’t want to do.

In those days, we didn’t talk much about the emotions and ethics of donation and dissection, but I think about them now. I think of the countless patients I’ve taken care of, yet I no longer see John Does as nameless, faceless bundles. Imagining those cadavers now, I see people who were my patients, maybe even family I’ve loved and lost. When you start this process, you learn on the anonymous dead. Later you consider that they were anonymous only to you. It makes their sacrifice so much more valuable and highlights how important it is that you make the educational effort of dissection worthy of their sacrifice. This way you pay homage to and honor those remarkable donors.

I kept a few books from that time, but I don’t go back to them. They aren’t what I remember now, any more than the lectures, because it wasn’t just information or medical language that we were learning. It sounds like an overstatement. It’s easy to romanticize experiences when time fades the honesty of memory. But while I would never volunteer to do that lab again, I recognize the privilege in our education. The grace of those donors let us discover the exquisite nature of human engineering, and we were allowed into the most sacred of places, the body, to do it. They served as our guides, our first physical exams, our first patients. They entrusted their bodies to us with the hope that we would apply those lessons to the living. I see it as tremendous faith, and humbling. More so in retrospect.

So when I think about learning anatomy in the virtual reality of an ideal man, I remember our very imperfect man. I think of that class and the effort we made to learn what it is to be human, through a footing in death. I am reminded of the groundwork laid in these lessons allowing a doctor to ask the question, “What went wrong?” if someone dies and she is the one in charge. It wasn’t just a body or a class. How do you teach that online?

***

Gulchin A. Ergun is a proud Turkish American and an Ohio native. Her essay “Sleeping with the Dead” won first prize at the 2013 Literature and Medicine conference. She is a member of the Inprint writers workshop at the Houston Methodist Hospital, where she practices gastroenterology. Her nonfiction has been published or is forthcoming in North Dakota Quarterly, Bayou Magazine, Concho River Review, Existere Journal, Green Hills Literary Lantern, Jet Fuel Review, Sou’wester, Superstition Review, and WomenArts Quarterly.