Everyone's on time for this class, Human Anatomy. Although taught by school of dentistry faculty, the class is held in a medical school lab: a 100-yard trek across the street. In the changing room outside the lab, the chatter ranges from what people had for lunch to the wisdom of trying to mask the pervasive smell of formaldehyde with something more pleasing. Eucalyptus, perhaps? Or maybe a dab of Vicks VapoRub?
Prior to today, many, if not all, have never seen a human cadaver. To prepare, they watched a series of videos ranging from scalpel safety and disposal to fundamental dissection skills such as removing skin and cutting bone. They also absorbed clinical tips on suturing and stapling. During all of it, safety precautions such as wearing protective eyewear and taking proper care of the dissection tools were stressed.
But nothing prepares you for the actuality of seeing your first cadaver. The elegance and symmetry of the body's muscles. The up-close look at its nerves and veins and tendons. The mustard-yellow color of fat.
"We are very fortunate to be able to study human anatomy at this level," said LaShonda, who before today had only completed rat and frog dissections. "They say that no two people are alike, and you really find that is true in anatomy lab."
For this first assignment, school of dentistry Professor Guang Bai, M.D.'s class is tasked with differentiating between the superficial and deep fascia of the neck and upper back. To do this, they will need to cut three flaps of skin on both sides of the neck and back in order to view these muscles: latissimus dorsi, trapezius, deltoid and sternocleidomastoid. All of the cadavers in this particular lab have been cut horizontally at approximately the level of vertebra L1. The abdomen, pelvis and lower limbs are used for other anatomical and teaching procedures.
The students — about 130 total — are assigned to tables in groups of five or six. Each table houses its own cadaver wrapped in red protective plastic casing until the students are given the signal to begin the dissection. Once it's time, they'll remove the casing and turn the body over to reach the back.
In a way, these scientific donations will serve as their very first patients — something the students keep in mind even as they contemplate the generosity shown by those who have donated their bodies to further knowledge and the enormity of the assignment.
Before the class began, Ben wondered how he would handle it. He needn't have worried.
"[I had] so many questions," he said. "From what would it smell like to what I should wear and what to do with my scrubs, gown and shoes afterwards. Would I even make it through the lab without fainting? All those random thoughts and more raced through my head in anticipation. Really, what it all comes down to is that people gave their body to science, so thousands of students could learn and hopefully play a part in bettering health care for everyone. When I think of it like that, as a learning experience, none of those small details matter."
A few students grow woozy, most likely from the fumes. They take refuge outside in the hall or lounge areas before returning to complete the assignment.
"What I found to be really helpful for me personally was just to focus on the lab procedures step by step," said Dan, whose previous dissections were a pig and a frog. "If I am just focused on the task at hand, I don't need to step back and process the whole idea that I am cutting into a body."
It takes about 25 minutes to cut through the hypodermis to reveal muscle. Methodically working on the upper back, the students take turns cutting through the layers of skin. Skin, it turns out, is tougher than they thought, with the added challenge of not cutting too deep.
"It's like leather," one student observes at table 26, Dan's table.
"Did I cut deep enough?" wonders another.
"This would be muscle fiber here," Dr. Bai advises. "It's easier if you are in the correct plane of dissection."
A member of the dental school's neural and pain sciences department, Dr. Bai, along with three additional dental faculty members, stops by each dissection table several times during the assignment.
"This is good," he says during a visit to table 11, Ben's table. "You can see the dorsi muscle."
During dissections, the students aren't graded. Instead, they use the experience to learn how to identify the muscles they will be expected to know during their practicals (clinical exams) at the end of the semester. The cadavers that most easily display examples of specific muscles will be noted as the best ones to study.
Instructor Diana LaPasha, Ph.D., suggests sharing an online file with the class on which tables to study prior to the exam.
At table 22, LaShonda's table, things are going slowly. Her group has one of the larger cadavers and has to devote precious time cutting through layers of fat, while they try to get to the assigned muscles.
Once the assignment is complete, the final step is cleaning up, which includes preserving the cadaver for the next time and the next. This means closing up the skin flaps to keep the body moist and wrapping up tightly.
"Never leave your cadaver open to air," Dr. Bai said. "Close it back up."
"We didn't lose anyone," remarks Thema Hepburn at table 11.
"Good job, team," Ben said.
"The experience of seeing a human cadaver definitely lived up to the anticipation," Ben said. "Today, I was lucky enough to take a giant leap into becoming a competent medical clinician who specializes in oral health."
"You really can't anticipate how you'll react to seeing a cadaver for the first time," LaShonda said. "I found myself feeling a little sad at certain points of the dissection because while this is our first patient, they're also someone's loved one, and you can't help but be a little curious about their story."Note:
Editor's note: In November, the ADA launched Becoming a Dentist, a new series that follows three dental students at the University of Maryland School of Dentistry — Dan Yang, LaShonda Shepherd and Ben Horn — during their journey of becoming dentists. The first story in that series, which introduced the students, ran in the November 6 ADA News.