Is the first cut the deepest? What it’s like to dissect your first dead body
Sue Black, Professor of Anatomy and Forensic Anthropology at the University of Dundee, tells us what it was like to begin her journey into unlocking the secrets of the dead, making her first incision into a cadaver.
Perhaps my Saturday job in a butcher’s shop prepared me in a very minor way for what lay ahead. The first experience of a dissecting room is, though, daunting for everyone. It is one of those moments nobody forgets because it assaults every single sense. There were only four of us in the class and I can still hear the echoes that reverberated round that vast, grand room which, with its high, opaque glass windows and intricate Victorian parquet floor, might have served in different circumstances as a conservatory. I can still smell the formalin, a chemical stench so thick you could taste it, and see the heavy glass and metal dissecting tables with their peeling green paint – forty or more of them set out in regimented rows and shrouded in white sheets. On two of the tables, hidden under their sheets, were the bodies that were waiting for us, one for each pair of students.
The first thing to master was how to put on a scalpel blade without slicing your finger off. Lining up the narrow slit on the blade with the ridge of the handle, then guiding it with forceps until it clicks in to place, takes some dexterity and practice. As does removing it again. I often think to myself that surely someone could come up with a better design.
If you cut into the cadaver and noticed it starting to bleed with bright red arterial blood, I was warned, just remember that cadavers don’t bleed. What you will have cut is your own finger. The scalpel blades are so sharp and the room so cold that you don’t feel them slicing into your skin. So, the first indication that you have injured yourself will be the sight of scarlet living blood pooling against the pale brown of the cadaver’s embalmed skin.
Once the blade is finally on your scalpel handle and your finger has stopped pumping blood, you lean over the table and immediately your eyes start to water from the formalin fumes. The manual has told you where to cut, but it doesn’t tell you how deeply, or what it will feel like. Nobody has given you explicit permission to ‘feel’ the cadaver’s anatomy so that you can figure out where to cut to and from, and none of it seems to make any sense. It is all a bit terrifying and faintly embarrassing. You pause for a moment to consider how you will make the incision down the centre of the torso, from the hollow of the sternal notch at the base of the neck to the lower border of the ribcage. Which of you will watch and which of you will make the cut? Your hand shakes. That first incision stays with every student, however blasé they pretend to be. If I close my eyes I can still remember what it was like, and how impeccably our cadaver tolerated our youthful ineptitude.
As your motionless teacher reclines in patient repose, waiting for you to begin, you inwardly apologise to him for what you are about to do, for fear you will make a mess of it. Scalpel in the right hand, forceps in the left… how deep do you cut? It is no coincidence that most students begin dissection with the thorax. The breastbone is so close to the skin that no matter how hard you try, there is little you can do wrong. You simply cannot go too deep. You lower the blade to the surface of the skin and draw it carefully down the chest wall, leaving a faint line in its wake.
It is surprising just how easily the skin parts. It is leathery to the touch, cold and wet, and as it separates from the tissue, beneath the blade you glimpse the contrasting pale yellow of the subcutaneous fat. Feeling a little more confident, you extend the incision from the sternum in the centre across both clavicles, out towards the tip of each shoulder and you have made your first ‘T’ postmortem cut. So much anxious anticipation and it is over in a moment. The world has not stopped. The relief is immense and only now do you realise that you have not breathed through the whole process. Though your heart is racing, and your adrenalin is pumping, you are surprised to find that you are no longer afraid but intrigued.
Now you need to expose the tissue underneath. You start to peel back the skin, picking carefully at the corner of the free flap in the midline above the breastbone, at the junction of the two limbs of the ‘T’. You grip the skin with forceps, applying just enough tension to allow the blade to separate it from the tissue. You never really need to cut. The yellow fat appears and as this comes into contact with your warmer hands it liquefies. Holding the scalpel and forceps suddenly becomes tricky and the flicker of confidence you had a few moments earlier evaporates as the forceps slip off the skin and fat and fluid splash up into your face. Nobody has warned you about this. Formalin smells nasty, but it tastes worse. You only ever make that mistake once.
Continuing to peel back the skin, you notice tiny red dots and realise that you have unavoidably cut across a small cutaneous blood vessel. Suddenly, the immense scale of the human form, and the vast amount of information it contains, hits home. The day before you might have been wondering how on Earth it was going to take you a whole year to dissect a human body and why you needed three whole dissector volumes to instruct you. Now it dawns on you that a year will be nowhere near long enough to do much more than scratch the surface of your subject. You feel like the true novice you are. You despair that you will ever remember all that you must learn, let along understand it fully.
You put a little strain on the forceps and the sharp blade slices into the connective tissue with disconcerting ease, even though it seems to you that your scalpel is barely touching it. As the underlying muscles are revealed, the white transverse bony walls of the chest stand out starkly against them like a bleached toast rack. Your eyes trace the shape of the hollows and ridges of the skeleton standing by your side as you feel beneath your fingertips the cadaver’s muscle and bones. You begin to identify and name the bones and their constituent parts – the scaffolding of the human body – and before you know it, you are speaking an ancient language understood by anatomists all over the world; a language that would have been familiar to Andreas Vesalius, the fourteenth-century founder of modern anatomical study and my undisputed girl crush.
As a living person, you remain separate from death, but the mesmerising beauty of human anatomy has created a bridge into the world of the dead, one that few will cross and none who do will ever forget. The sensation of traversing that bridge for the first time is an experience you can never repeat. It is special.
We may stand on the shoulders of scholarly giants, Hippocrates and Galen, and their descendants Da Vinci and Vesalius, but the real heroes are undisputedly those extraordinary men and women who choose to bequeath their mortal remains so that others may learn: the anatomy donors.