The Donors Taught me Everything I Know (Part III of VI)
Part I: Upper Extremity | Part II: Thorax
Part III: Abdomen and Pelvis
I got a 94 on the thorax practical.
Ninety-four.
I refreshed the grade page three times because I was convinced I'd read it wrong.
I stared at the number for so long that eventually my laptop dimmed and I had to move the mouse to bring it back.
Before I texted my friends or even called my mom, I went to the anatomy lab.
Mary was the first person I told.
“Ninety-four,” I said into the room as soon as I passed the threshold into the lab.
Nothing.
I dropped my backpack beside Table 12.
“Did you hear me, I said I got a ninety-four!”
I heard you.
“You don't sound impressed.”
You got an eighty-eight last time.
“Exactly.”
I pulled on my gloves.
“That's a six-point improvement.”
Very good.
“‘Very good?’”
I stared at the vague impression of her face beneath the muslin.
“That's all I get?”
Something brushed the edge of my thoughts.
Amusement.
Then:
I'm proud of you, Juniper.
That shut me up.
I looked down, pretending to be very interested in adjusting the cuff of my glove.
“Yeah, well,” I cleared my throat, “I studied really hard.”
I know.
I pulled back the shroud.
We had finished the thorax by then. The anterior chest wall had been reflected, the lungs removed and stored separately, the mediastinum dissected until structures that had once seemed impossibly crowded suddenly made sense.
I could look inside Mary's chest now and understand it.
That still felt miraculous.
Things that had once existed only as lists and labels on PowerPoint slides now had depth. The pink-grey meat that I would be poking around with during the lab had meaning and purpose.
More importantly, I could remember them even after the exam was done.
“You know,” I said, “I think I'm actually getting good at this.”
Mary didn't answer immediately.
You are.
I smiled.
It shouldn't have meant as much as it did.
But I think that was the first time I'd heard someone say it and actually believed them.
------
It took about two lectures for the abdomen to ruin my confidence.
There was too much of it.
The thorax had been orderly once I understood the relationships.
The abdomen felt like somebody had packed an entire grocery bag full of organs, vessels, nerves, ducts, fascia, and embryology and then asked me to explain why any of it was where it was.
The peritoneum alone offended me personally, more than the brachial plexus ever did.
“Greater omentum.”
Yes.
“Lesser omentum.”
Yes.
“Gastrocolic ligament.”
Yes.
I looked up from my notes.
“Do you actually know these or are you just agreeing with me?”
Mary responded immediately.
The second one.
“Mary...” I felt like I was scolding her.
What?
“You're supposed to be helping!”
I never promised to know everything.
“But you knew thorax AND upper extremity.”
Some of it.
“You're telling me you don't know the branches of the celiac trunk?”
I know there are three.
“Name them.”
Silence.
“Mary-”
You already know them.
“That's not the point.”
Then what is the point?
“The point is—” I stopped and closed my eyes. “Left gastric, splenic, common hepatic.”
See?
“Whatever.”
I returned to my notes and bit the inside of my cheek. We didn’t talk much that evening.
For the first time, I had found something Mary couldn’t give me. I mean, I knew she wasn't omniscient but it bothered me more than it should have.
I went home earlier than usual that night.
------
A few nights later, I found that I had barely made any progress through the content.
Mary's dissection wasn't bad exactly, it was just unhelpful.
Too much fascia. Too much fat. Too many pale strands that all started looking like nerves after midnight.
I had been staring at the same structure for nearly ten minutes before shaking my head.
“I hate this.”
Go home.
“I have a practical in nine days.”
You have nine days.
“Exactly.”
I lowered the probe.
During the lab that afternoon, I'd noticed Table 17 had a cleaner dissection. I looked over at the table. The impressions of a body lay beneath another white shroud.
I reasoned that it would be good to check other bodies. Everyone has some level of anatomical variation, I just hadn’t looked before because Mary was special. But with this exam fast approaching and with the amount of content I still had to get through, I had to make some choices.
I looked back down at the table in front of me.
“You'll survive without me for five minutes?”
I don't know, June. Things aren't looking particularly good.
“Wow.” I deadpanned as I walked away before she could say anything else.
Table 17's was cleaner than ours was. Mary’s plastic shroud had become wrinkled with the amount of times it had been moved around. This table looked almost untouched. I leaned down to read the card tied to the table leg.
The donor was male. Seventy-four. CVA.
I stood up again and my hands gripped the edge of the plastic shroud. I mumbled a quick, “Sorry” on instinct as I pulled back, the rustling of plastic filling the lab.
I carefully reflected layers of skin and muscle back, before coming to the abdominal wall. It was a beautiful dissection. There had been more fat and fascia on this body but that had since been removed and the tissue was cleaned.
Compared to Mary, this donor had larger structures to look at, partially due to height and partially due to body habitus. I began tracing along the larger structures.
Psoas major.
Iliacus.
Quadratus lumborum.
Easy. So I moved on to the lumbar plexus.
“Iliohypogastric.”
Another strand.
“Ilioinguinal.”
Lower.
“Genitofemoral.”
No.
My probe stopped as a frown crossed my face.
“What do you mean, no?”
No answer. I glanced over my shoulder and looked back to Table 12. What did she mean no?
“Mary?”
Still I got nothing from her.
Then:
Try again.
I turned back toward the donor in front of me.
Just like with Mary, there was no sound. No direction. But I knew that thought wasn't hers. I leaned closer and saw two pale structures sat nearly parallel against the surface of psoas. I moved my probe slightly before looking up at where the donor’s head would be.
“This one?”
Yes.
“Genitofemoral.”
Congratulations.
I stared down at him.
“So you're…”
I stopped.
Dead seemed redundant.
“…also doing this.”
Apparently.
I looked back at Mary then at him again. My mouth suddenly went dry.
“What's your name?”
A pause.
Call me Arthur.
I’m not sure if that was his actual name but I nodded slowly anyway. “Okay, Arthur.”
Okay, Juniper.
My hand tightened around the probe.
“How do you know my name?”
You aren't quiet.
From across the lab, amusement brushed against my thoughts. I could tell that one was Mary. I whipped around fully.
“You told him?”
You tell everyone.
Arthur added:
Constantly.
I looked around the lab.
Thirty tables. Thirty donors. They were always there but for the first time, they stopped looking like furniture.
“Can they all hear me?”
Nobody answered.
“Mary?” I urged.
Some of them.
“Some?”
I stepped into the center aisle, eyes skimming over the sea of steel and white plastic.
“How many?”
Nothing again. This was getting ridiculous so I turned to survey the rest of the room.
“Hello?” I asked a little louder. But again, I was met with silence. I suddenly felt very stupid standing in an empty anatomy lab asking thirty dead people to identify themselves.
“Okay,” I muttered. “Apparently I'm talking to the entire room now.”
Only the unfortunate ones.
I spun toward the back. That wasn't Mary. Or Arthur.
“Who said that?”
Nothing.
“Im serious.”
Table Six.
I practically ran over and found the number plate.
Male. Seventy-two. Chronic Obstructive Pulmonary Disease.
“You have a name?”
Yes.
I waited but he didn't elaborate.
“Are you going to tell me?”
No.
“Fine. You're Six.”
Creative.
“Thank you.”
Mary seemed to find this incredibly funny.
Then something occurred to me. I looked from Six to Arthur. Then toward the other tables.
“Can all of you talk?”
Nothing. I was learning that dead people enjoyed making me repeat myself.
“How many of you can do this?”
A thought surfaced from somewhere to my right.
Enough.
Another:
Unfortunately.
Then another.
She's going to be here every night now, isn't she?
Someone laughed.
Then someone else.
There was no sound, nothing for my ears to detect but it was still a cacophony.
My mind began to feel more and more crowded as impressions brushed against one another before they started pushing to the front of my mind. Amusement pushed away at curiosity, which pulled back at annoyance. Words that weren't mine appeared and vanished before I could decide whose they were, I couldn’t even pick out my own feelings in all of the mess. All I knew was just pressure and pain inside my skull.
I imagined thirty pairs of hands reaching out to caress every single groove and sulcus of my cortex and feel the bundles of nerves that trailed down my spinal cord. I briefly wondered if a brain could burst from too much input. I knew that it couldn’t but the pain began to make me feel otherwise.
“S-Stop!” I finally yelled.
Then everything disappeared. Immediate relief.
The lab became empty again and the intrusions evacuated from my consciousness.
I stood there beneath the fluorescent lights, staring at rows of covered bodies, panting. My head still throbbed but now I could think clearly.
Until that moment, I'd thought Mary was one impossible thing I had somehow incorporated into my life. Part of me still rationalized that her speaking to me could have just been some sleep deprived delusion, even if what she was saying were things I had no way of knowing.
But this was not something my mind could conjure.
I should have been more terrified.
But a bigger part of me was thinking about the practical.
I thought about what I could do over the next nine days.
I looked back at Arthur's table where the genitofemoral nerve sat perfectly exposed against psoas major. Not only was the dissection beautiful, but Arthur had recognized it immediately.
Mary had known upper extremity. She'd been amazing with thorax.
I had no idea what Six knew.
I had stood there for months among the sea of thirty tables and thirty donors. Now I knew I was also among thirty minds.
My pulse quickened.
Thirty donors. Thirty minds.
Once again, I saw an opportunity.
“Okay,” I said shakily. I swallowed that dry lump in my throat as the room waited. As if they could have done anything else. “Who knows the pelvis?”
Several answers arrived at once.
—---
The next night, I met Evelyn.
She was at Table 23. Female. Sixty-two. Metastatic Breast Cancer.
I had been trying to orient the uterus when the thought appeared.
You're going to tear something holding it like that.
I let go immediately.
“I am not.”
Then stop pulling.
“I wasn't pulling,” I defended but adjusted my grip anyway. “You could be less dramatic. Mary told me this stuff doesn't hurt….”
That question was answered the night after we removed the chest plate in lab.
I remember holding the bone saw with sweaty hands, trying to listen for any hint of discomfort as I pushed the electric blade into the sides of her ribs. I remember the clicking noise it made as we broke through each one. I remember the TA coming by to assist and then wrenching their hand beneath the sternum like a crowbar, peeling her ribcage off, inferior to superior, exposing her heart and lungs for the first time.
I walked into the lab that evening distraught before Mary assured me that she felt no pain when it came to dissection. Even then, it took a couple more weeks to stop thinking about it.
Your patients will feel. You could be more competent.
I stared at the donor before turning back to Table 12.
“Mary, I already don't like her.”
The response came from across the room.
You asked who knew the pelvis.
I hated how that was true.
Evelyn was precise in a way that bordered on hostile.
If I gave her a general term when she wanted the branch, she made me specify.
If I used a clinical shorthand, she corrected me.
If I pronounced something wrong—
“Pudendal.”
Silence.
I looked up.
“What?”
Again.
“Pudendal.”
The repeat was met with another pause.
I sighed.
“Close enough.”
Not if you're going to be a surgeon. Imagine what your colleagues will think.
That worked.
So I said it again.
Better.
That one word was all she said but I hated how satisfying that felt.
There were others as well. I couldn’t remember all their names but I really did try.
Table 4 told me his name once and I forgot it the next day and I felt terrible. He told me not to worry about it.
Table 8 barely spoke unless I was about to make a mistake.
Table 19 gave terrible mnemonics.
Remember, I GET SMASHED for causes of pancreatitis. Idiopathic, Gallstones, Ethanol-
He continued the list as I stared in disgust. Unfortunately it worked really well.
Six refused to tell me anything about himself but had an alarming amount to say about the perineum.
Within two weeks, the anatomy lab no longer felt quiet after hours and I found myself there almost every night.
One night, I was walking into the lab when my phone vibrated. I looked down and saw a brief "Hey girly, you still coming?” flash on my screen. Beneath it were two missed calls from Mom. I told myself I would get back to them later as I stuffed my phone into the bottom of my bag.
Then I walked in.
“Hi, Mary.”
Hello, Juniper.
“Arthur.”
Unfortunately.
“Evelyn.”
You're late.
“Six.”
Go home.
“Love you too.”
Then I'd start studying.
------
Things started to become easier.
Part of that was because I was getting better.
I had spent months studying anatomy by then. I'd learned how to look at relationships instead of isolated structures. I'd finally begun building the spatial reasoning that seemed to come naturally to some of my classmates.
But part of it was them.
If I couldn't understand portal circulation, someone could.
If I couldn't distinguish the ureter from the gonadal vessels, someone could.
If one donor's anatomy was difficult to visualize, I had twenty-nine others.
There was always another body. Another variation. Another answer. Another option.
I also started asking better questions.
Not just:
“What is this?”
But:
“Where does this go?”
“What happens if you cut it?”
“What would a surgeon have to move to get here?”
“What's the easiest way to distinguish these two?”
“Which structure is most likely to vary?”
People began to notice the change as well.
During one lab, one of my groupmates was trying to identify a vessel along the lesser curvature of the stomach.
“Left gastric?” she asked.
“Right gastric.”
She traced it back and sure enough the answer was confirmed.
“Oh.”
Another groupmate looked over.
“How can you tell that fast?”
I shrugged. “Direction.”
Later, a TA stopped at our table and pointed toward a structure near the hepatoduodenal ligament. “June? Embryologic origin?”
"Lesser Omentum. Ventral mesentery."
Then another question
I answered that too.
Then they asked about the relationship of the ureter to the uterine artery.
“Water under the bridge,” I said, thinking about what table 19 said to me just two nights before.
The TA smiled and walked away satisfied.
“Jesus, June,” one of my groupmates said. “When did you get so good at this?”
I looked down at the table to hide my smile.
“I don’t know.”
------
That night when I got to the anatomy lab I went to table 12 like I always did.
“Did you see me in the lab today, Mary? I impressed the TA.” Of course, Mary had something to say to keep me humble.
Would you like a parade?
“Yes,” I quipped back immediately.
I don't have one.
That was expected. I shuffled through my papers thinking about the practical in just 48 hours.
“Okay, I need to go over pelvic autonomics.”
Mary was quiet. I was already walking toward Evelyn's table when she said:
How was your day?
I stopped and looked back. The shroud was still covering her body. I hadn’t pulled it back when I came in.
“What?”
Your day.
“Oh.”
I thought about it. Lecture. Library. Some conversation at lunch I hadn't really paid attention to because I'd been reviewing flashcards…
“Fine. Just lectures and then I spend some time in the library.”
I answered quickly and continued toward Table 23.
“Evelyn, autonomic innervation to pelvic viscera.”
Nothing.
I waited.
“Evelyn?”
You're not even going to say hello?
I blinked.
“Hi.”
Hello, June.
I cleared my throat.
“So, sympathetic innervation-”
You are becoming very unpleasant.
Arthur laughed from across the room but I didn’t understand what was funny. I didn’t have time for this.
“Can we please just study?”
Nobody answered. I looked around in exasperation.
“Anybody?”
Sacral splanchnic, Evelyn finally supplied.
I sighed with relief. “Thank you.”
And that was that.
------
The practical exam came two days later.
I walked from station to station with a confidence I had never felt before.
At one station, I actually had to stop myself from laughing because the structure they had pinned was so obvious.
When grades came back, I scored a 96. For approximately thirty seconds, I was thrilled. Then I saw the highest score.
I stared at it. The numbers taunting me on the screen.
Two points of separation. If I got four more I would’ve topped them.
I looked at my own score again.
A few months earlier, I would have cried from happiness.
Instead, the first thing I thought was:
What did I miss?
That night, I went straight to the anatomy lab.
“Okay,” I announced, dropping my backpack beside Table 12. “Which one of you knows cranial?”