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Dead in Traffic: Reflections on Gross Anatomy

“I don’t have a body, I am a body.”  –Christopher Hitchens, Mortality

Cadaver. The word itself seems devoid of life. And, so too does the white plastic bag lying unceremoniously before me. It’s the first day of anatomy, and I unzip the tarp and stare down at a wet, grey lump of clay. There it is. There is what, exactly? What was I expecting? Some warm human soul, freshly sprung from the loins of life? No. That’s not this. The essence of life is gone — absolutely, irrevocably, unquestionably, gone. What’s left is more like a husk of corn, or the molt of an insect. The head has been shorn to the thinnest veneer of grey stubble and crudely sewn back up, Frankenstein-like, with the brain removed. The dead-fish eyes are cracked half-open, like a glass doll’s, with eyelashes curling daintily outwards and irises ghostly pale and alien beneath. The abdomen is bloated and moistened from two years of stewing in embalming fluid. Its skin is a sallow grey-yellow hue, with liver spots and freckles and moles faded to ashy dots, and small drops of fat beaded in the folds. The whole thing feels like leather left out in the sun — coarse, rubbery, thick, taut. When we lift it up to turn it over, there is an unsettling heaviness to it — “dead weight,” I think grimly. And the nakedness? It doesn’t register. In the postmortem lab, death makes sexless the human form. The breasts have long been flattened and become indistinguishable, and the genitals are squashed into an amorphous mass. Nothing about the cadaver’s identity screams “man” or “woman.”  It’s just there — a body, a corpse, a mummified relic for inspection.

In truth, I am not overwhelmed. My initial impression of the cadavers is one of mannequin lumplessness. Only over the course of the first week do they begin to assume a vague identity. I slowly uncover the telltale signs of human life in their cold remains — unearthing, like an archaeologist, the story within the ruin. The room begins to come to life. My eyes roam across the lab, and I spy on female cadavers lustrous red nail paint, as fresh and explosive as roses in bloom. The length of their nails — with their carefully manicured edges — unnerves me. Their strawberry sheen evokes images of old grandmothers making themselves up for one final visit from loved ones. “They want to look lovely before they go,” I think, and something catches in my throat.  Then, there are tattoos — a sailor with a ship on his arm, a woman with a rose on her hip and a man with a giant avocado on his thigh. Weird, bizarre images, all stamped with the spirit of human singularity. I find small, unspoken stories in birthmarks, scars, bruises, gold teeth and piercings. Depressions are found in the skin from watches and wedding bands. I see glimpses into lives I’ll never know.

As the dissection continues, I unravel stories of adversity and the miracles of medicine. I discover pacemakers buried in chests — the testament to failing hearts and second chances. I find holes in the abdomen for feeding tubes and staples down the sternum, where grave operations undoubtedly left family hands clasped in prayer. There are stents in clogged arteries, huge coils of springy wire found in the atrium of the heart, mastectomies, hernias, knee replacements, missing fingers, missing toes, screws in bones, corneal transplants, and cancer. God almighty, cancer: ugly, bubbling mountains of flesh spreading where there’s no room to spread. Everywhere, I find surgeries and triumphs and tragedies chronicling the journey from here to there — from the walking, living, breathing, laughing lives of the deeply flawed, deeply mundane, deeply human to the silent, stillborn army in this lab.

Who are they, these dead in traffic? We know little about them: a single sheet of paper, no name, but an occupation (“pipe fitter”), an age (“82”) and a cause of death (“multiple myeloma”).  However, it’s enough of a story for some of us to form a bond of our own, a doctor-patient relationship of the oddest sort. To an outsider, this might sound peculiar — a relationship with a dead stranger. But this is no stranger. After weeks and hours of working with one body, meticulously cleaning its muscles and organs, that cadaver becomes a quiet companion, a familiar face. Our friendship is born of the knowledge that these donors willingly offered their bodies for the purpose of being examined, exposed, cut, chopped, skinned and prodded.  They must have understood how little dignity would be afforded to them. They must have known that our scalpels would be blind to pride and vanity, and that, when we finally finished, their body would be disfigured beyond any recognition of their former self. All that would remain, would be ashes, carefully collected, cremated and commissioned to their loved ones.

And yet, I feel, this is what they wanted — to disappear entirely, like a candle burning brightly from both ends. And, in doing so, they have illuminated my world.

I try to cling to that sentiment as I face with the dirty, grisly reality of what I’m doing. What other choice do I have? The noble field of medicine is built upon the grotesque and the unsavory. We embark on this profession with the grisliest journey: the dismantling of the human body. In the crudest terms, this means picking apart every bit of sinew: skinning a face, sawing off a leg, transecting a labium, prodding and poking and opening a heart, a brain, a lung, a bowel. Yes, it is hard to think about. But, as the days and weeks roll by, these tasks become easier and quicker, bred with familiarity of the body and an engrossing fascination in the work itself. I become keenly aware that most people will never have the opportunity to do what I am doing, unveiling the mechanisms of life, intertwined beneath our skin like the inner workings of a clock — why should it not be enthralling?

Of course, when I talk to my friends about dissecting a human body, they recoil in horror. Their minds go to dark and ghastly places, spurred on, no doubt, by sadist television and silver-screen cannibals. Not only do they bear a physical abhorrence to the act, but an emotional repugnance at the desecration of flesh. And why not? The sanctity of the body and spirit has spanned the arc of history. For hundreds of years, the Church maintained that human dissection was a desecration of the human soul. Until the 1800s, punishment for violent criminals often included “medical dissection after death,” an added horror to those believing their immortal souls were at stake. Even today, the human body is seen as sacrosanct. For many of us, our sense of “self” is intricately bound to our physical essence. Perhaps we believe that we may, in one form or another, live on in the physical world long after death has claimed us. Perhaps we are searching for another form of immortality. “From my rotting body, flowers shall grow,” wrote the Norwegian painter Edvard Munch, “and I in them, and that is eternity.”

But there are other ways to live on in the world: namely, in the art of knowledge, or in the passing of ideas from one generation to the next. Mortui prosumus vitae, reads the inscription on many donors’ tombstones. Even in death do we serve life. I find it such a beautiful sentiment to serve as a teacher from beyond the veil of death. I liken the feeling to that old children’s book, The Giving Tree, in which the tree has offered everything to the boy it loves, but discovers one last gift from the shadow of the grave: an old stump for sitting and resting. There’s something wonderfully cyclic about the lessons of life and death to be found here: something that catches at the essence of religion, philosophy and art, some final message passed on to us by our elders, who formed us within themselves. From the dying, we learn how to live. And likewise, “While I thought I was learning how to live,” wrote Da Vinci, “I have been learning how to die.”

It’s hard to feel sorry for my cadaver, when I’m just a few quick dreams from his place. He is the future, the unyielding truth. When I look at that cold metal slab, I see myself there — empty, undreamt, and unborn. Shorn of pride. Free of self. Monastic, destitute, naked and fearless.  Surrendered against life. And that’s okay. That’s comforting, and peaceful and beautiful.  It’s the completion of the circle we were born into. My only question for the dead man lying before me is this: did he learn to let it go? And will I?

For me, that journey begins with a cadaver, a scalpel and a nervous heart.

Photo credit: Photograph by Osmar Valdebenito.

Matthew Trifan Matthew Trifan (6 Posts)

Contributing Writer Emeritus

University of Pennsylvania

Matt Trifan is a current resident of emergency medicine at Thomas Jefferson University Hospital in Philadelphia. He was a former medical student at the University of Pennsylvania. In his free time, he reads, writes, travels, and never misses a chance for brunch. He owes his life philosophy to Albert Camus and Adventure Time, equally.