Teasing Secrets from the Dead: My Investigations at America

That's why our instructors insisted that we cut into the body with the “I” shape they had chosen. They wanted us to be able to open the body, remove the organs, and then fold everything back exactly the way it was. If we just cut things out and discarded them as we went along, we'd never see the whole picture. Instead, we had to learn both the parts and the whole, both the individual structures and the way they fit together, so that we could someday make illustrations that would enable doctors and surgeons to have their own limited view of the body while visualizing the whole.

The medical students were going through a similar process. It was the only chance they'd get to see a body in layers, or to cut out an organ, trace its blood supply, and then put the dissected pieces back together like some three-dimensional jigsaw puzzle. During actual surgery, their goal would be to disturb as little of the body as possible, imagining-with the help of our illustrations-what they could not actually see.

After we had finished exploring the muscles, nerves, and blood vessels in our cadavers' backs, our instructors finally let us turn them face up. (My group immediately put a paper towel over our woman's face, covering her staring eyes and grinning mouth.) As we cut into the abdomen, I again expected to see what I'd seen in my dad's textbooks: the abdominal organs revealed as separate structures, each with its own unique size and shape. Instead, what I saw was that every organ was molded and folded tightly onto its neighbors, like one of those amazing Irish stone fences, in which a collection of separate stones somehow fit so closely together that mortar isn't necessary.

Sorting through loops of intestines, I realized that they are not just one long tube, like a garden hose, folded over to fit neatly into someone's belly. Instead, they are connected to the body's main blood vessels by huge, flat membranes, which, if torn or twisted, can rob the gut of blood and lead to someone's death. Then I was struck by how huge her liver was-about the size and weight of a wet, tightly folded bath towel. I knew that if I slipped my fingers around the liver's narrow edge, I'd find the gall bladder, tucked up underneath one of the liver's lobes. Since gall bladder removal is a pretty common surgical procedure, we students eventually made it a game to see whether we could tell by feel which cadavers had had that type of surgery.

The nervous system was particularly difficult for me to learn. Among other things, nerve pathways cross and crisscross at specific places in the brain and spinal cord. When the pathways are disrupted-from disease, stabbing, gunshot wounds-the whole system can be short-circuited. It took a leap of faith for me to understand that a gunshot wound that completely pulverized one section of the brain might leave the victim alive but severely disabled, while another gunshot wound that cut cleanly through the brain stem meant instant death as the diaphragm and heart quit forever.

Although at the time I was merely learning the architecture of the human interior in order to draw it accurately, one day this training would be vital for my work in forensics. Years later, while testifying in a murder trial, I became recognized as a court-qualified expert in gross anatomy as well as forensic anthropology-a rare distinction for a forensic anthropologist, and one I could not have achieved without my early studies at the Medical College. The case in question hinged on a minuscule cut in the victim's neck bone no bigger than an eyelash. I was able to prove that the tiny trace mark indicated a fatal knife wound when I demonstrated that in order to reach the bone in question, the killer's knife had to work its way through the victim's windpipe, esophagus, and a critical group of arteries, nerves, and veins.

Those nerves and blood vessels sure caused me enough trouble as a student! When I'd first looked at Dad's textbooks, I'd seen that each body part was rendered in a different color-red for arteries, yellow for nerves, and blue for veins. In real life, though, the colors seemed blurred and dulled, and all I could see were bunches of vessels, tangled together like three incredibly long varieties of overcooked pasta.

Gradually, I got used to the lack of color, and I learned to work by touch as well as by sight. When I could see the organs for myself and follow their contours with my hands, I could memorize their anatomy through my fingertips as the shape and location of even the tiniest lymph node flowed effortlessly from my hands into my brain.

In the anatomy lab, I had the luxury of being able to take bodies apart, piece by piece, to see exactly what made things work. Making my cadaver's fingers wiggle and her knees bend by pulling on a tendon imitated a muscle contraction. It might make this dead woman look like a macabre life-size marionette, but it taught me more than any textbook ever could.

The wonder of those first few months stays with me to this day. I walked around in a perpetual state of awe, amazed at the infinite variety of us humans and our bodies, even as I marveled at how alike we all are. I found myself looking at the crowds of people in the local shopping mall, people of different ages, races, and sizes, thrilled at my new knowledge that each anatomical structure shared a common shape, location, and function. Touch the inside of a wrist-anybody's wrist-and you'll feel the pulse of the radial artery in the same tiny spot… every time… in every body. This “human design element” is what makes modern forensic science possible-the fact that we know so much about any individual body before we've ever seen it.

Gross anatomy class was also where I learned that you must never-never-discuss “the bodies” in front of outsiders. You never knew who might be acquainted with the person whose body you were discussing, or who might accidentally overhear the conversation. What if your casual joking was heard by someone whose father had donated his body to science? How might the listener feel hearing you and your fellow med students blowing off steam by making derisive remarks about one of your cadavers? I'm grateful for the lesson now, since the same rule applies to forensic investigations: You talk about them only with fellow investigators. I think that's one reason why cops and forensic specialists maintain such a closed society. Only among our own can a case be discussed openly and freely, without fear of inadvertently wounding a grieving friend or family member.

This was also when I first encountered the peculiar balancing act that is the hallmark of my profession: Dead bodies are treated as objects to be probed for clues-and yet they must also be viewed as the living human beings they once had been, humans whom we try to honor by learning who they were and how they died. When I first started working in forensic anthropology, I'd approach each case like a puzzle, and I spoke only of “the body” or “the bones.” When I finally learned to refer instead to “the dead person” or “the human remains,” I was better able to hold on to my sense of each victim's humanity. Out in the field, it's easy to get wrapped up in the act of searching for bones, teeth, and evidence associated with the victim-jewelry, clothing, maybe a bullet-and it's all too common to find yourself shouting gleefully when someone finds one of these “treasures.” Among cops and other forensic specialists, it probably doesn't matter too much, but the effect can be devastating when civilians are looking on. I've learned to make a habit of acting as if the victim's mother were always looking over my shoulder and treating every piece of tissue, every scrap of evidence, as if I had a personal connection to the victim.

This approach really paid off when I was working with the remains of the people who died in the World Trade Center. Then, my every move really was under scrutiny by dozens of people, often including the victims' friends, families, and fellow firefighters or police officers. I was thankful, then, that I'd learned to treat every human remain with the respect it deserved, and I was moved by how much my colleagues in the morgue appreciated my gentleness and care.

As I continued with my medical illustration class, I was most fascinated observing surgical procedures. The medical illustration program at the Medical College of Georgia is considered one of the best in the nation, and one thing that makes it so special are classes in surgical observation, where students get to sketch actual operations while standing at the surgeon's elbow.

Writing these words today, I'm struck by how different my first surgical experience was from those of students today, who have access to television and movies that depict surgery in relatively realistic ways. The closest I'd ever gotten to an operating room before I observed my first surgery was TV's Ben Casey and Marcus Welby, M.D. In true 1970s television style, I imagined surgery as taking place in cathedral silence, amidst an atmosphere of high seriousness, with reverent doctors and obedient nurses clad in spotless white coats and immaculately clean rubber gloves. I simply had no idea of how bloody surgery can be and how raucous the process is, with music played by many doctors, and banter and cross-talk among the staff.

When I walked into my first operation, I was surprised to see the entire patient covered with the sterile sheets known as surgical drapes. Only the relatively small area that comprised the surgical field-the part of the body on which surgeons were operating-was exposed. With the patient's face, arms, and legs all blocked from view, I found it remarkably easy to forget that this procedure involved an actual human being, especially since the only people monitoring the patient's responses were the anesthesiologist and his or her nurses. During my first few surgeries, I was periodically startled out of my concentration on the procedure whenever the surgeon asked the anesthesiologist, “How's our patient doing?”

The most surprising aspect of my first surgery was the smell of burning flesh. This particular surgeon cut into his patient with a scalpel, then immediately burned the bleeding edges of the wound with a tiny cauterizing tool. Over the years, I've tried to describe the smell of burning flesh and the closest I can come is freshly burned toast thrown into a skillet already simmering with rotten fish, pork fat, and an old leather shoe. However, even that description may not do justice to the aroma. All I can say is that anyone who has ever experienced it recognizes it instantly. It's not like the smell of a fresh steak slapped on a grill: The odor of roasting human flesh is nauseating, pure and simple. And the sound of that cautery knife was horrible. I had to stop myself from jumping each time the surgeon touched it to the patient's flesh. Every time the knife hit the end of a bleeding blood vessel, I heard a little ssst, like the sound when you put a match into water. Ssst… and a fresh burst of the smell… a tiny tendril of smoke, rising into the air.

As the surgery proceeded, I was especially struck by the smell of warm blood that pervaded the room. The smells of surgery are something the medical shows haven't conveyed at all. While burning human flesh smells nothing like its animal counterpart, human and animal blood smell eerily the same-and as someone who had done her share of hunting and butchering wild game, I hadn't expected the smell of blood to bother me. But it did, maybe because of the visuals that went with it. Every so often, the surgeon would hit an artery and blood would spew up like a tiny geyser. Even the smallest artery could cause an arc of blood to splat across his blue-green robe.

Although I loved watching these surgeries, I realized early on that I'd never make it as a pathologist. Frankly, I don't like to see or smell blood. I can't stand to see someone insert a needle into an eyeball to withdraw fluid, and the sounds and smells associated with aspirating stomach contents make me want to vomit up mine. Even today, I avoid the “squishy stuff” whenever possible and I'm profoundly grateful that I was able to go into first orthopedics and then forensic anthropology, where I could work with muscle and bone rather than internal organs.

Nevertheless, my class in pathology, where we, shoulder to shoulder with the medical students, would watch pathologists perform autopsies, gave me a valuable insight into my own capacities. My budding ability to visualize a body in three dimensions began to pay off: Before the pathologist made the first cut through the skin, I knew precisely what he or she would find underneath. Since I now knew what normal organs and tissue should look like, abnormalities caused by disease or injury seemed glaringly obvious.

It's one thing to stand at a surgeon's elbow and watch the most intricate procedures. It's a whole other thing to perform surgery yourself. The Medical College of Georgia believed that in order to illustrate surgery properly, medical illustrators had to pick up the knife and know how to use it. Of course, we illustrators were never going to operate on our own patients. But if we had never performed operations ourselves, how would we discover how much tension is needed to suture intestines, and how that differs from suturing skin? How would we learn exactly how to hold each instrument, or the correct direction and technique for applying force when retracting a rib cage? And if we didn't thoroughly understand these procedures, how could we translate such information to our drawings? These were things we could only learn by doing.

So in its wisdom, the Medical College had decided that we illustrators would enroll alongside the budding surgeons in their classes in dog surgery. Each of us students-future doctors and illustrators alike-were assigned a large dog who'd been abandoned or donated to our program, on whom we could learn the basics of surgical technique.

From the first, I had mixed feelings about this aspect of our training. On one hand, I love dogs-always do, always have. So I wasn't without sympathy for the critics of the Georgia program, who considered it cruel, disgusting, even unethical for us illustration students to cut up helpless animals in order to learn surgical techniques that we were never going to perform.

On the other hand, the dog surgery program turned out to be one of the most valuable experiences in my education. Here was where I really began to understand what surgeons experienced- because, albeit it on a very small scale, I was doing their work. Each dog in the program received a thorough medical “workup,” then underwent a series of operations over a period of several weeks. We removed their gall bladders and spleens, and resectioned their bowels. Working around the clock, we did everything we could to ease their post-op pain. All of us, illustrators and med students alike, were deeply committed to our dogs' care.

The most surprising thing to me about actually performing surgery for the first time was that the tissue I was operating on was warm. The only tissue I'd ever handled before had been in the dissection lab, and it was almost icy. Now suddenly my hands were warmed with the vital heat of a living creature, a warmth that crept up through my fingers and wrists and into my arms. It wasn't unpleasant, exactly, but it was a shock.

Being a dog lover, I had bonded with my dog patient as I performed the series of operations on him. He was a large German shepherd with melting brown eyes, and I never failed to spend a few minutes on each “medical” visit scratching him behind the ears and telling him how beautiful he was. Although I purposely never gave him a name, I did manage to block out the fact that our final exam required us to euthanize our dogs and perform autopsies on them.

For the medical students, this was a crucial rite of passage: Could they maintain the detachment they would need to cut open human bodies, to depersonalize their patients enough to be able to