The Anatomist - Bill Hayes [61]
I immediately hit an obstacle: the ear.
The lab manual contains no instructions on how to remove an ear, so I operate on instinct only. I pull the pinna away from the scalp and slice in a slow circle. I dig at a sharp angle as if cutting a weed at its root. This proves startlingly effective. The ear comes off in one piece, and now I face a dilemma I had not anticipated: What does one do with an ear?
Becky suggests I just throw it away, but that seems a little rash.
“You could send it to someone,” Jenny offers wryly, making an allusion to Vincent van Gogh, who put his ear in an envelope and gave it to a prostitute for safekeeping. (Wasn’t her name Rachel?) For now, I fold the ear inside a towel and set it aside.
Where the ear had been is now a hole in the head the size and shape of a kidney bean. This is the entrance to the ear canal, which runs just posterior to the TMJ. No wonder my clicking jaw sounds so loud, I say to myself. For many years, I have had what’s officially called TMJ disorder—TMJ, for short—a catchall phrase for various problems at this juncture of two bones. Mine, exacerbated by teeth grinding while I sleep, mainly manifests as a pop or click whenever I yawn or chew or open my mouth too far. In my head, the sound is huge. I am always surprised people don’t hear it.
Having TMJ has made me hyperaware of my jaw, which, for the first time in my life, I am finding to be an advantage. The clicking is like a TMJ sonar pinging in my cheek, guiding my hand as I dissect. I cut back the parotid duct and gland, then gently slice through the powerful muscles of mastication. Next, alternately feeling with my fingers and using both the blade and the butt of my scalpel, I peel off the layers of fascia covering the joint itself. This is like peeling the skin from several stubborn cloves of garlic—tedious work, but I am utterly absorbed. I am a ping hunting a pop to its source.
After almost two hours, I have exposed a near flawless specimen of the temporomandibular joint, including one of its most delicate features: the tiny cartilaginous disk that acts as a kind of shock absorber between the temporal (upper) and mandible (lower) bones. When this disk is damaged or, as in my case, abraded, TMJ disorder results.
Stepping back from the lab table to appraise my work, I have no qualms about praising it aloud: “That is beautiful.” My lab partners heartily agree, as does Kim, who moves about the room telling other groups to come see my dissection. I am doing a final cleanup of the surrounding tissue when I see over my shoulder a wash of inquisitive faces. They have been quietly looking on, as if I were a sculptor brushing the dust from my latest work and they did not want to disturb me.
“Nice job,” Casey remarks, breaking the silence. “How’d you do that?”
With that, I become the go-to guy for the TMJ. Three groups invite me to their tables, where I tug at ears and talk through the procedure.
By the time lab is over, I feel as though I have truly graduated from this course in anatomy. Even so, I am not content. Too many gaps in my knowledge—mental foramens of the metaphorical kind, to coin a phrase—remain to be filled. I have never studied the brain, for instance, and I am still trying to work my way through the nervous system. Kim suggests that I take one last anatomy course—this one, for medical students. She promises to e-mail me the details as well as an invite to a postfinals celebration party she would be throwing at her home in a couple of weeks.
NEARLY EVERY STUDENT comes, a testament to the fact that I was not alone in the affection I had formed for Kim. The sole absentee, Rachel, had opted to take the course as an incomplete rather than risk getting a failing grade. She will have to retake PT anatomy next summer. Becky and Jenny got As, though, as