On a Friday afternoon near the start of the first term, seventy students go up to the dissection room. Next door, there’s a cloakroom with metal pegs and benches. We dump our bags and take off our coats and remind each other to take out our chewing-gum. Everyone has a soft blue package, which unfolds into an apron. They’re thin and tacky like pedal-bin liners. The sleeves end in a hook that goes in the as-yet-nameless place between forefinger and thumb, anchoring the sleeve in place – so there’s no gap, the anatomy professor explains, between the glove and the gown. No gap, ‘because there’s quite a lot of fat, and you don’t want human fat on your skin, not really.’ The gloves are dainty and powdery and very tight, ladies’ gloves in hospital blue. A pair of plastic glasses (‘you don’t want splashes in your eyes’) completes the outfit. We go into the dissection room.
The DR is, like the rest of Brighton and Sussex Medical School, brand new. It’s brightly lit, with large picture windows at one end showing the South Downs, the trees turning various shades of red and gold. The side windows are opaque glass, to shield the next-door room from view. The doors are alarmed, to prevent anyone coming or going without permission. In front of us are nine shiny metal trolleys; there is a plastic-wrapped body, a cadaver, on each of them.
Up at the front is the lecturer’s cadaver, with the anatomy professor, Diana Watt, standing behind it. She is managing the tricky feat of looking smart in scrubs. Smartness is evidently something of a tradition. My copy of Gray’s Anatomy, the famous doorstopper, has a smudgy black and white photograph of Henry Gray posed next to a dissecting table in a dark suit and a cravat, a pair of naked human feet sticking out stiffly in front of him.
Behind the professor is a soft screen on which the main unveiling will be broadcast. My group of eight students has a smaller video monitor above us, showing the same event but in viscerally brighter colour. We’re on table 14; our cadaver is a man aged 83 who died of a heart attack. A shallow metal tray next to his head contains scissors and scalpels and other metal tools of the sort you see at the dentist’s; there’s a small swing bin next to his wrapped feet, numbered 14, into which scraps of flesh must go. The major organs are put back into his body at the end of each session, to keep them moist. In a year’s time, when our relationship with him has ended, all the pieces of his body will be gathered up and cremated, and there’ll be a memorial service at Southwark Cathedral to which, the demonstrator suggests, we might like to go.
Jars of yellowy lungs and hearts and all the other horrors of the biology lab are ranged along the windowsill, where they twinkle in the afternoon sun. The DR is moistly hot, and smells of formaldehyde and bodies, something like a nail parlour and something like a butcher’s shop. Professor Watt gives us a brief lecture about behaviour, and respect, and taking care to match body parts to buckets. During this talk she rests both her hands on her cadaver, patting it occasionally for emphasis.
‘Now,’ says Professor Watt, who is very reassuring. ‘First of all, we’re just going to unwrap’ – there’s a rustle of plastic, and something grey appears on the bleached-out screen. At table 14 we look at each other and then we each take an edge of covering and start rolling it back. There’s a great crackling, like Christmas morning, as all the other tables start doing the same thing. I have a sudden flash of unreality. I wish I were somewhere else. We have decided, for some reason, to call our cadaver ‘Frank’. So we take the plastic off Frank, with lots of gentle encouragement back and forth as though we were unpacking an awkward piece of furniture. There you go. You take that corner. Oh, hold on. All right, it’s coming. That’s it. The facecloth – a moistened piece of muslin wrapped around the cadaver’s head like a scarf in a Magritte painting – must stay on today; must stay on, in fact, until everyone in your group is absolutely ready, the professor says. So we unwrap only from the neck down. There are dampened sheets of white muslin, like dishcloths, under the plastic, to keep the cadaver moist; we pick these off down to the waist. My arms seem to get longer and longer as I hold the rest of myself away from what’s underneath – it’s like washing up in an overfull sink, afraid of getting splashed. But when we finish and stand back, it’s impossible to understand what we’re seeing. The skin is sheeny and age-spotted and slightly yellow. Like marble – cool, with a soft glaze. There’s a row of bumps – the ribs – but the torso seems to be at an odd angle: it looks bent. No one dares say for a moment what they’re thinking. Where are his nipples? For a mad instant I wonder if this is something that happens in death, or old age even. Perhaps it’s like Ruskin’s shock with the pubic hair, but in reverse – the shocking absence of nipples. Everyone is too nervous to think sensibly. It takes a long second to realise that our body is lying face down.
‘Not a problem,’ the demonstrator says. ‘The surgical guys were doing some stuff round the back, I think. We’ll turn him.’ A couple of students take a wrapped arm each. I take hold of a leg, but it’s heavy, and the heaviness makes him too real: it’s one thing to be unwrapping a cadaver, quite another to be heaving him about the table like this. The body rolls over in a series of quick glimpses, a hand, hardly wrinkled, leading the way; a square of bald, liver-spotted scalp; peeking from the bottom of the wrap a large foot with a hairy big toe. I’m suddenly convinced I can’t do dissection, and the student opposite me looks as though he can’t, either. We stare at each other unhappily. My face is burning. Someone down at the sunny end of the room has already fainted – he went over before the unwrapping even began.
Frank’s torso is broad and hairless; he has a handsome barrel-chest, scarcely sagging at all. He’s the colour of milky tea, with the faintest hint of puckering, a cup of tea gone cold. I think of his journey to Brighton, down the motorway in the back of a chilled van. He was sent by the London Committee of Licensed Teachers of Anatomy, who are in charge of the allocation of bodies in this area. Each school asks for particular things when they request their cadavers – trying to balance genders, heights and weights – and the deceased often leave themselves to a particular teaching facility; the Committee’s job is to match everyone up. Once the allocation is done, the anatomy lecturers choose where to have their cadavers embalmed. Professor Watt uses St George’s in Tooting: ‘The embalmer there is a genius.’ Brighton and Sussex’s cadavers arrived at the university before the students did; half the class would just have been finishing up their gap years when Frank got here. Embalming plus eventual cremation comes to around £1000 per specimen, £18,000 for the first year’s bodies alone. ‘Donald’, the department’s life-sized anatomical model, cost £7500 and will last for ever. But Donald is perfect rather than real.
Our laminated instruction card tells us we must fold back the cadaver’s chest wall: that is, ‘deflect the skin laterally’. The skin has already been cut for us, a neat bloodless line across the base of the neck and another straight down the chest to the top of the abdomen. The students opposite me put their gloved fingers into the cut and pick up their side of chest and fold it back. The dermal layer is as thick as a slender paperback, and, without blood, the same beige as old paper. It sits neatly folded over the cadaver’s arm as though he’d slung it there himself. We roll our side back, too – thankfully it stays put, rather than springing horribly shut – and get our first glimpse of the amazing. The neat, putty-coloured ribbing of the pectoral muscles forms two perfect wings over the ribcage. Everything’s covered in a glistening pith of translucent connective tissue. It’s just possible to make out the Angle of Louis, the ridge in the middle of the sword-shaped breastbone where its immature plates, the manubrium (handle) and sternal body (blade) fused. We take turns putting our fingers into the suprasternal notch, the dimple at the base of the neck.
We are being especially nice to each other in our group, and making up illogical rules. We will not leave our cadaver unfolded, we decide, as we’ve seen another group doing. It seems disrespectful. The student beside me has picked up a scalpel blade with tweezers and is fitting it onto a handle. He holds both parts rigidly away from him, like a gun that’s about to go off. I have a go: it’s stiff and fiddly and requires a knack that’s not clear even after the demonstrator has slipped the blade off and on to show how easy it is. We have to cut round the pectoralis major to expose the pectoralis minor underneath. The knife is unfamiliarly sharp; just touching it to the muscle makes the fibres part. I trace along carefully, marvelling at how organised everything is inside, edges clearly demarcated. The room grows quieter. It takes concentration, which means you forget to feel sick as the flesh heaps up on each side of the blade in pinkish flakes like tinned tuna.
A couple of weeks after our first cutting lessons, when people are more relaxed – this is before the day with the bone-saw, which makes some students feel strange all over again – we do living anatomy, to help us understand how the inside and the outside of the body are related. During the first two years of the course, we’ll do dissection weekly and living anatomy frequently: in the third year, on clinical rotation, we’ll still be coming back into the DR to look at specific organs. In this, our first living anatomy class, we try to find on each other the external signs of the structures we’ve seen under the cadaver’s skin. First we’re handed a box of spine: a set of vertebrae made from waxy cream plastic like a cheap chess set. An accompanying jiffy bag holds a handful of rubber spinal discs and a slip of blue paper saying this is a complete vertebral column with sacrum and coccyx. Before I started the course I had no idea of the apparently roaring trade in plastic models of human bits and pieces. In the university bookshop they’re selling anatomically correct key-rings featuring ears and hips, and there’s a pile of cardboard boxes labelled: ‘Budget Human Skull with Removable Teeth’. The demonstrator has brought in a few real vertebrae and ribs to show us, too. They’re lighter and finer than the plastic models, and the groove at the bottom of the rib in which the bundle of nerves and blood vessels sits is a sharp gutter. The plastic models quickly become warm. The real rib is cool, elegant, an ‘elastic arch of bone’, just as Gray’s describes it. It is, like everything we’ve seen inside Frank, obvious and unique at the same time.
The inimitable variousness of real cadavers is matched, it turns out, by the inimitable variousness of real people; or the inimitable variousness of male students, at least, as the women are excused having to take off our T-shirts and have pleura drawn on us with a make-up pencil. Counting ribs and other sharp edges, we draw the beginnings of what we know, which isn’t very much. But dissection helps the frightening complexity of bodies make sense more quickly. At the start of the second term we take Frank’s lungs out. They are shapely grey sponges speckled with soot (which may mean only that he lived in a city, not necessarily that he was – sharp breath – a smoker). They are also bigger than the hole we have to squeeze them through, and well-anchored. Even with our increased confidence it’s hard to see where to cut. At last, with a lot of unsophisticated tugging, they’re out. We sit them on his stomach like babies, though no one can leave them alone: they’re too impressive. And now we can see the heart as well, snug in its leathery sack, with the enormous aorta plugged into the top. Or that’s what you can see on the lecturer’s cadaver. In Frank everything is squashed and unclear and covered in a kind of black felt that comes out in pieces bearing the impression of the pericardium. It turns out to be blood. At his death, something, in the heart or in one of the heart’s great vessels, must have burst: the chest cavity is full of clots. ‘Oh God, I feel so sorry for him now,’ someone says. ‘No, it’s all right, that’s not a bad way to go,’ the demonstrator says. ‘It would’ve been fast, and it wouldn’t have hurt.’ ‘But wait a minute: that means he died of a broken heart!’ ‘Don’t be so silly,’ says Professor Watt.