Sunday, January 5, 2020

Surgical Notes #5—2010: Loyola anatomy lab illustrates shortage of medical cadavers

Torso of a Male Cadaver, by Eugène Delacroix
(Metropolitan Museum of Art)
     Six days post-surgery, and I'm doing ... fine. Not too much pain, getting around the house on crutches, haven't gotten the okay to go outside yet. The physical therapist has been here twice, to stretch the new hip. I'm doing my exercises, sort of. I've mused on starting up writing on current topics—the Trump administration seems to have started a war with Iran, for instance, and is now threatening to attack Iranian "cultural," aka religious, sites. 
     But you don't need me to trill "Woe!" over that, or whip out a felt board and laboriously explain Why This is Bad. You get it.
    The bottom line is, I'm in an odd, rare, twilight, I-don't-feel-like-writing-anything-right-now-thank-you state. Must be the meds, which I've already begun to dial back, though I understand their connection with the thing not hurting too much. The bandage covering the incision—and this I did not expect—is nine and a half inches long. Check a ruler if you have trouble envisioning just how long that is. The bandage comes off Monday, and I can't say I'm eager to see what's underneath. But this is all about moving forward, gingerly. Anyway, I might try a stab at something new Monday. So one final day of the end of my visit to Stritch, which started yesterday. Thank you for your patience. If your comment did not get posted last evening, I may have accidentally deleted one that I meant to post, so please re-submit. It wasn't a conscious rejection. 


     The rope is a surprise.
     In the hour that Dr. Frederick Wezeman spent preparing first-year students at Loyola University's Stritch School of Medicine for what to expect in gross anatomy when they cut into their first patient—a medical cadaver—many issues were covered, from the importance of not wearing open-toed shoes (scalpels can fall) to the need to wear latex gloves (embalming fluid can irritate the skin) to the value of working as a team.
     He didn't mention the rough brown rope tied tightly around each corpse's chest.
     "Let's lift him up a bit," says a first year, feeling along the rope. "It's a sailor's knot."
     At each of the 20 stations, students introduce themselves to one another and cope with the ropes used to move the cadavers. The rope leaves a deep impression in skin already flattened from the bodies lying on their backs, as tissues lose pliability after death.
     "That's crazy," says Steve Zuniga. "I didn't know they get flat like that."
     Today's task for 150 students is to expose the trapezius—a large muscle in the back, named for its trapezoidal shape. The reason students start there, as opposed to any of the other 640 muscles in a human body, is that it is large and thus hard to miss or ruin.
     They position the bodies using sections of wood beam—worn, blackened blocks that seem at odds with the medical setting.


The 1885 Illinois Cadaver Act allows it

     David Neubauer consults a big red Gray's anatomy atlas, then returns to the body.
"This is the sacrum," he says, cutting along the spine from the nape of the neck to the small of the back, exposing a layer of yellow fat under the skin.
     How did the group pick him to go first?
     "I had the scalpel first," he says.
     I wanted to be here under the assumption that students dissecting for the first time would find it difficult. But while some admitted to nerves in Wednesday's column, there was no sign of emotion in the room. I never saw a student so much as wince.
     "We jumped in," said Anthony Rutkowski.
     Dr. Wezeman, the course director and professor who has been teaching at Loyola for 30 years, says students today are far less squeamish than students in the past.
     "They're ready for it," he says. "They're exposed to blood and guts much more than when I was growing up. When you watch TV you see a lot of medical things that are pretty graphic, so they're not as shocked when they come into a cadaver room."
     Though TV can't explain it all, as students leap to tasks not seen on prime time.
     Issra Rashed, 21, wordlessly takes a paper towel and removes some waste left behind when a cadaver was inadequately washed.
     "Didn't want us all looking at it," she says.
     The cadavers cost $1,500 and come from the Anatomical Gift Association of Illinois.
     Loyola students must crowd eight to a body, in two teams of four, as they work because cadaver donations have been falling.
     "Quite a bit," says Paul Dudek, executive vice president of the association. "Twenty-five years ago we had 700 to 800 donations. So far this year, we've had about 330."
     Dudek blames the growing popularity of cremation and pre-need funeral packages. Driver's licenses also once had a box allowing you to donate your body to science
     "That for some reason was dropped," says Dudek, adding that he could easily place twice as many cadavers as he receives—he gets requests from as far away as England and the Caribbean—but that the supply bottleneck might finally be dissolving.
     "The 1885 Illinois Cadaver Act allows medical schools to request individuals buried at public expense," he says. The association has recently worked out an agreement with the Cook County medical examiner's office and the County Board so that some of the county's 500 yearly unclaimed bodies of indigents can be sent to them. Prisons might be another source.
     "We're pretty excited about it," he says, using an adjective that might sound odd, until you realize the joy of learning involved.
     Watching the first-year students work is Oma Lawrence, 26, a fourth-year from Hawaii.
     "They'll all go home today and reflect," she says. "I remember my first cadaver—a lady. I can actually still picture her nerves. You can't help but be a little queasy."
     Or maybe not. A few days later, I speak with Emily Zepeda—a doctor's daughter from St. Charles who had enthused, "I can't believe I get to learn this!"
     "Today was amazing," she says, describing how midweek the students took turns using a bone saw to expose the spinal cord.
     "I was a little scared, at first," she says, of handling the Stryker saw. "But it truly was like getting to see a treasure."

     —Originally published in the Sun-Times, October 22, 2010 

2 comments:

  1. You're worried about the length of the incision? You will probably have to contort yourself to get a good look, and a 9 inch bandage means a 6-7 inch scar. I've got one that long on my face and after 3 years I barely notice it. Better to worry about actual complications.

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  2. Having not too much pain is always good. And being housebound in recovery has some upsides: toleration of one's annoying habits by'she who must be obeyed'; essential books one has never found time to dip into. And, as a devotee of the art, you will no doubt be looking forward to hearing Saturday's broadcast of "Wozzeck" from the Metropolitan Opera.

    Tom

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