The Anatomist - Bill Hayes [70]
The sight brings to mind vultures swarming around a half-eaten corpse: the table is encircled by other students with this same assignment, all poking and probing the detached parts. Their bodies form a wall, and Kolja and I and a couple of dozen others are already shut out. No instructors are around, as they are all off helping with dissections.
“I think this is partly personality screening,” Kolja comments as we wait for a spot to open up. “You know, weeding out anyone who’s not an alpha male. A ‘survival of the fittest’ kind of thing—”
“Yeah? So how do you respond in situations like this?” I ask.
“Not well,” Kolja admits, and indeed, he suddenly looks paralyzed.
With that, my inner alpha male ascends. “Okay, people,” I say in a raised voice, “can we get in here, please? Please?” I tap someone on the shoulder—“Hey, can you scoot over a little?”—and she obliges. Kolja and I settle in. “Okay, let’s get started.”
Lying before us is not only a selection of preserved specimens—hearts, lungs, and rib cages—but also a fresh cadaver that Dana and Kim had dissected earlier. Its entire chest cavity has been reassembled so we can go through it part by part. It reminds me of a teaching tool popular during the seventeenth century, “Anatomical Venuses,” as they were called—life-sized human models made of wax, with removable parts—except that this Venus has a penis.
Going from the outside in, I first show Kolja the two visible layers of skin, the epidermis and dermis, as well as the major chest muscles, pectoralis major and minor, parts that I had learned so well under Kim’s guidance. Next, I remove the entire rib cage so we can examine the “intercostals,” the space between the ribs. The three thin layers of intercostal muscles—external, internal, and innermost—are clearly distinguishable, thanks to Dana and Kim’s expertise. What they have done is akin to exposing the different layers of a Triscuit, showing the various weaves of wheat. “See how the muscle fibers of each go in a different direction?” I point out.
“Cool,” Kolja responds each time I introduce a new anatomical part.
Moving on, I show Kolja the internal thoracic artery and vein—“They don’t run parallel to the ribs, it’s important to remember, but lateral to the sternum”—and prod him to finger three portions of the parietal pleura (costal, diaphragmatic, and mediastinal), to help him remember how each is different. In this dissected cadaver, with rib cage, lungs and heart set to the side, it is easy to find the phrenic nerve, lying like a loose guitar string from the neck down to the diaphragm. “You can’t breathe without this thing,” I tell Kolja, then share the one mnemonic I had learned from Dana: C-3, 4, and 5 keep the diaphragm alive. “That’ll be on a test, I can almost guarantee.”
As we continue, a young man across the table interrupts: “Hey, can I ask you a question?”
“Me? Sure,” I respond, “but I’m not a TA or a professor—”
“Well, are you knowledgeable?”
I don’t hesitate. “Yes.”
“What’s this?” He points to a prominent vessel in the cadaver’s neck.
“Well, first, tell me what you think it is,” I say.
“The superior vena cava?”
Everyone else at the table is listening in by this point.
“No,” I answer, “the superior vena cava heads directly into the heart. The one you’re pointing to—see how it goes under the clavicle?—that’s the subclavian vein.”
“Oh, of course, the subclavian! And it changes names, right? Into the, what is it, the ‘axillary’ vein?—”
“Right, very good, it changes from the axillary into the subclavian once it hits the armpit, right at the level of the first rib.” This guy is not just a good guesser, I