Abruptly, the hard-eyed wax woman is at my side, demanding to know who I am. I explain that the surgeon in charge of the symposium invited me to observe. This is not an entirely truthful rendering of the events. A entirely truthful rendering of the events would employ words such as “wheedle.,” “plead,” and “attempted bribe.”
“Does publications know you’re here? If you’re not cleared through the publications office, you’ll have to leave.” She strides into her office and dials the phone, staring at me while she talks, like security guards in bad action movies just before Steven Seagal clubs them on the head from behind.
One of the seminar organizers joins me. “Is Yvonne giving you a hard time?”
Yvonne! My nemesis is none other than the cadaver beheader. As it turns out, she is also the lab manager, the person responsible when things go wrong, such as writers fainting and/or getting sick to their stomach and then going home and writing books that refer to anatomy lab managers as beheaders. Yvonne is off the phone now. She has come over to outline her misgivings. The seminar organizer reassures her. My end of the conversation takes place entirely in my head and consists of a single repeated line. You cut off heads. You cut off heads. You cut off heads.
Meanwhile, I’ve missed the unveiling of the faces. The surgeons are already at work, leaning kiss-close over their specimens and glancing up at video monitors mounted above each work station. On the screen are the hands of an unseen narrator, demonstrating the procedures on a head of his own. The shot is an extreme close-up, making it impossible to tell, without already knowing, what kind of flesh it is. It could be Julia Child skinning poultry before a studio audience.
The seminar begins with a review of facial anatomy. “Elevate the skin in a subcutaneous plane from lateral to medial,” intones the narrator.
Obligingly, the surgeons sink scalpels into faces. The flesh gives no resistance and yields no blood.
“Isolate the brow as a skin island.” The narrator speaks slowly, in a flat tone. I’m sure the idea is to sound neither excited and delighted at the prospect of isolating skin islands, nor overly dismayed. The net effect is that he sounds chemically sedated, which seems to me like a good idea.
I walk up and down the rows. The heads look like rubber Halloween masks. They also look like human heads, but my brain has no precedent for human heads on tables or in roasting pans or anywhere other than on top of human bodies, and so I think it has chosen to interpret the sight in a more comforting manner. Here we are at the rubber mask factory. Look at the nice men and women working on the masks. I used to have a Halloween mask of an old toothless man whose lips fell in upon his gums. There are several of him here. There is a Hunchback of Notre Dame, bat-nosed and with lower teeth exposed, and a Ross Perot.
The surgeons don’t seem queasy or repulsed, though Theresa told me later that one of them had to leave the room. “They hate it,” she says. “It” meaning working with heads. I sense from them only a mild discomfort with their task. As I stop at their tables to watch, they turn to me with a vaguely irritated, embarrassed look. You’ve seen that look if you make a habit of entering bathrooms without knocking. The look says, Please go away.
Though the surgeons clearly do not relish dissecting dead people’s heads, they just as clearly value the opportunity to practice and explore on someone who isn’t going to wake up and look in the mirror anytime soon. “You have a structure you keep seeing [during surgeries], and you’re not sure what it is, and you’re afraid to cut it,” says one surgeon. “I came here with four questions.” If he leaves today with answers, it will have been worth the $500. The surgeon picks his head up and sets it back down, adjusting its position like a seamstress pausing to shift the cloth she is working on. He points out that the heads aren’t cut off out of ghoulishness. They are cut off so that someone else can make use of the other pieces: arms, legs, organs. In the world of donated cadavers, nothing is wasted. Before their face-lifts, today’s heads got nose jobs in the Monday rhinoplasty lab.
It’s the nose jobs that I trip over. Kindly, dying southerners willed their bodies for the betterment of science, only to end up as practice runs for nose jobs? Does it make it okay that the kindly southerners, being dead kindly southerners, have no way of knowing that this is going on? Or does the deceit compound the crime? I spoke about this later with Art Dalley, the director of the Medical Anatomy Program at Vanderbilt University in Nashville and an expert in the history of anatomical gift-giving. “I think there’s a surprising number of donors who really don’t care what happens to them,” Dalley told me. “To them it’s just a practical means of disposing of a body, a practical means that fortunately has a ring of altruism.”
Though it’s harder to justify the use of a cadaver for practicing nose jobs than it is for practicing coronary bypasses, it is justifiable nonetheless.
Cosmetic surgery exists, for better or for worse, and it’s important, for the sake of those who undergo it, that the surgeons who do it are able to do it well. Though perhaps there ought to be a box for people to check, or not check, on their body donor form: Okay to use me for cosmetic purposes.[2]
I sit down at Station 13, with a Canadian surgeon named Marilena Marignani. Marilena is dark-haired, with large eyes and strong cheekbones. Her head (the one on the table) is gaunt, with a similarly strong set to the bones. It’s an odd way for the two women’s lives to intersect; the head doesn’t need a face-lift, and Marilena doesn’t usually do them. Her practice is primarily reconstructive plastic surgery. She has done only two face-lifts before and wants to hone her skills before undertaking a procedure on a friend. She wears a mask over her nose and mouth, which is surprising, because a severed head is in no danger of infection. I ask whether this is more for her own protection, a sort of psychological barrier.
Marilena replies that she doesn’t have a problem with heads. “For me, hands are hard.” She looks up from what she’s doing. “Because you’re holding this disconnected hand, and it’s holding you back.” Cadavers occasionally effect a sort of accidental humanness that catches the medical professional off guard. I once spoke to an anatomy student who described a moment in the lab when she realized the cadaver’s arm was around her waist. It becomes difficult, under circumstances such as these, to retain one’s clinical remove.
I watch Marilena gingerly probing the woman’s exposed tissue. What she is doing, basically, is getting her bearings: learning—in a detailed, hands-on manner—what’s what and what’s where in the complicated layering of skin, fat, muscle, and fascia that makes up the human cheek. While early face-lifts merely pulled the skin up and stitched it, tightened, into place, the modern face-lift lifts four individual anatomical layers. This means all of these layers must be identified, surgically separated from their neighbors, individually repositioned, and sewn into place—all the while taking care not to sever vital facial nerves. With more and more cosmetic procedures being done endoscopically—by introducing tiny instruments through a series of minimally invasive incisions—knowing one’s way around the anatomy is even more critical. “With the older techniques, they peeled everything down and they could see it all in front of them,” says Ronn Wade, director of the Anatomical Services Division of the University of Maryland School of Medicine. “Now when you go in with a camera and you’re right on top of something, it’s harder to keep yourself oriented.”
2
I’m a believer in organ and tissue (bone, cartilage, skin) donation, but was startled to learn that donated skin that isn’t used for, say, grafting onto burn victims may be processed and used cosmetically to plump up wrinkles and aggrandize penises. While I have no preconceived notions of the hereafter, I stand firm in my conviction that it should not take the form of someone else’s underpants.