At the top of the stairs on the left is the doorway to the locker room, on the right the long and narrow hallway leading to the laboratory. Doctor Ivan Ostrog turned to the right and made his way as he did every day to the double doors under the archway at the end of the hall. Swiping his ID card in the reader, he entered the brigh maze of interconnected chambers, full of steel sarcophagi and students. Whitewashed walls with pastel mouldings, fluorescent lights, and the faint whirring of the de-ionizing air filtration system greeted him.
“The students are oblivious to it, but they are lucky this year,” he said to himself. Over the summer the dean finally appropriated the funds to renovate the anatomy laboratory. Over the years the old tanks had rusted, became leaky, the lids didn’t close properly, and worst of all the chains used ot raise the cadavers out of fixative broke. The new tables, on the other hand, looked to Ostrog like miniature battleships of shiny stainless steel (and cost a couple of thousand dollars each he had heard). Forming the upside-down hull of the ship are the two beveled lids of teh table, with a seam running between them like the line between a door and its frame. “Each a door leading to Hades,” he thought to himself. The cadaver lies flat on the table, teh surface of which is grooved adn equipped with a drain and stopcock. Ironically, there is a shortage of cadavers, meaning that six or even seven students are crowded to one specimen and that of the whole shiny fleet of fifty or so tables, only a minority are used.
As he arrived he was surprised to see a crowd of about a dozen students around one of the empty tables in his section.
It was soon clear what was attracting the crowd. On top of the table was a woman, very pretty with long and deeply red hair and skin the color of whole milk. She was semireclined, propping herself up with one arm, and she was naked, though she had tucked herself into one of the translucent white bags in which the cadavers were stored and zipped it up to cover her lower limbs and perineum. Ostrog suddenly had the most curious sensation. A panic welled within him; like a bubble of air trying to make its way to the surface of a pool of syrup, he felt trapped by the world, by the room, he was being asphyxiated as he moved but there was no hope of every getting anywhere. He felt his cheeks get warm, and was afraid that the students might notice when, just as suddenly, the sensation passed, and Ostrog was once again his cold, and one might even say lifeless, self. It took him a second before he recognized the woman as a medical student. Her name was Rachel.
“What’s going on?” he asked.
“I’m volunteering for dissection. I talked to Dr. Broch about it and he OK’d it,” she replied.
“I’m not sure I understand. You volunteered for dissection Why?”
“I’m getting a tuition waiver and $2,500.”
Ostrog could not believe that anyone would allow themselves to be dissected in front of their peers for a mere $2,500 and tuition; he himself could not even imagine anyone being willing to so expose oneself in front of one’s peers. But there she lay, neither embarrassed nor scared. He could only make sense of the situation by remindng himself of American women’s famous immodesty.
After recovering from his initial shock, Ivan Ostrog was actually very pleased to have in his experience this unprecendented opportunity to demonstrate some fresh anatomy to his students. Today they were beginning the thorax, and the manual called for a demonstration of pectoralis major and minor, the intercoastal muscles and vessels, and the insertion of the abdominal fascia into the costal margin. On female specimens the dissection included hemisectioning one breast while leaving the other intact but freeing it from the thoracic wall and retracting it to demonstrate the retromammary space.
He started by drawing the lines of the incision he was going to make on her chest with a felt-tipped pen. Starting at her left clavicle, he drew the dashed line towards her sternum. Ostrog spoke loudly enough so that the whole assembled crowd could hear: “Always mark in your mind the significant surface anatomy as you begin your dissections, since it is impossible to re-construct later…” From the jugular notch he drew the line downward along the sternum to the xiphoid process, and then laterally along the costal margin to the mid-axillary line. “You can feel a ridge an inch or two below the jugular notch – go ahead feel it on the specimen or you can even feel it on the ‘blade’ – and it is called the Angle of Louis. The Angle of Louis is the border between the second and third rib, and in cross-section is parallel to the fifth vertebrum.” An additional incision would cut across the ribs from the xiphoid process and through the nipple to about one third of the way down the medial aspect of the arm. The right side was the same, except the areola and nipple itself would be actually cut through on the left side only. “The nipple lies at approximately the fourth/fifth rib interspace,” he reminded the students as he drew the dashed line on Rachel’s right side.
After the lines were drawn, he put a fresh #11 blade on his scalpel. Resting his hand on the girl’s chest, he lightly, as though he were going to tickle her with a feather, lowered the tip of the scapel onto her breast. Her skin split apart on either side of the blade as though it were being relieved from tension, opening up a softly pink seam along where the felt-tip line had been. “Remember,” he told the fascinated students as he worked his way up to the collarbone, “the facial muscle platysma originates at the clavicle, as do many of the neck muscles, and so if you want to see them next semester make your incision at the lower margin of the clavicle and not above.”
Her head was turned not looking at him, her blue eyes not focused on anyone. So he continued with the scalpel, pressing neither too hard nor too deeply, pulling back on the skin with a hemostat and freeing the pink dimpled undersurface of the epidermis from the subcutaneous fat beneath. Soon the skin was entirely free over her left breast, forming two large flaps, one still connected at the arm and the other at teh side of her ribs.
Again, Ostrog was pleased to have this unique opportunity: the anatomy was superior even to that seen during surgery, where there is so much blood, and the field of view necessarily restricted, that one cannot see clearly.
He continued to pull at her breast, until it began to separate from the chest wall, the strands of fascia splitting like cobwebs. Advancing his hand further and further in this plane formed between her ribs and breast, he finally freed it from its tethers. Gently squeezing the red and white marbled fatty tissue, rolling it between his fingers, he could feel the densities within, strands of fibrous tissue. “Achilles,” he said, referring to an earnest but slow-witted medical student whom Dr. Ostrog favored because of his Greek descent and quaint classical name, “give me your hand.” He took the student’s hand and put it in her retromammary space. “These fibers are Cooper’s ligaments, also known as the suspensory ligaments of the breast. Upon them is hung the adipose and glandular tissue that forms the bulk of the breast.” Achilles repeated what he had done: squeezed the breast gntly, rolled the tissue between his fingers. He could feel the ligaments, he could understand how they functioned.
“‘I profess to both learn and teach anatomy, not from books but from dissections; not from the positions of philosophers but from the fabric of nature.’ So said the great English physician William Harvey. You have the fabric of nature in your hand, Achilles. You should never forget Cooper’s ligaments now.”