Jun
09

A Week in the Lab – Thoughts on a 6-Day, Hands-on, Human Dissection Workshop.

posted on June 9th 2015 in For Practitioners & General Interest with 0 Comments

In April, I and 27 other individuals gathered in San Francisco to participate in a 6-day, hands-on, human dissection workshop. It was facilitated and led by Gil Hedley PhD and assisted by Sallie Thurman LMT.

 

This was my first time in such a workshop and I was a bit surprised by the number of folks that were returning for a second, third or fourth time! I believe that there were 5 or 6 people that had attended one or more workshops previously. The rest of us were first-timers with varying degrees of trepidation.

 

It was readily apparent from the start that Gil is a practiced teacher and facilitator. As we were only beginning our 6-day adventure, he had just spent the past two weeks ushering two other groups of people through the same process. Needless to say, the first part of the initial day felt comfortable, purposeful and unhurried and the cadence of the entire week was smooth and practiced.

 

My main feeling at the beginning of day one was of excitement and impatience to get started. As we finished up introductions and made our preparations to “meet our teachers” I realized that much to my dismay I was feeling a bit queasy. This sense of digestive distress increased when the first cadaver was uncovered. What proceeded, was a remarkable ritual of “getting to know the cadavers”. We spent some time simply observing (both visually and by touch) the bodies one by one. It was a gentle process of becoming familiar with the forms and the beginning of the shift in perception needed for the week ahead.

 

I went from feeling queasy and thinking of our cadavers as dead people to recognizing that they are (for lack of a better term) artifacts, left to us by real people who are now gone. This sense grew over the course of the week and was solidified upon my return to my bodywork practice. What I touch and interact with on a daily basis are intelligent, alive, complex systems and what we dissected during this workshop were excellent approximations of people, but were in fact not people any longer.

 

Once we had had an opportunity to get to know the forms and had taken a look and feel from all angles we sorted ourselves into teams; seven people per cadaver and then, in keeping with tradition, we named our cadavers. (Almost all accounts of modern cadaver labs that I have come across seem to share a custom of naming the cadavers.) My team dubbed our cadaver “the Captain” due to his navy tattoos. We had at the other tables “May”, “Hans Leo” and “Alphonse” aka “Big Al”.

 

I experienced the overarching theme of this week to be “connection and disconnection”. The first day brought about opportunities to connect to the general goals of the workshop as well as to our aspirations for the days ahead. We began to learn about each other and form new connections and a new community with one another. We gathered each morning and spent some time reflecting on the previous day and the day ahead. Time was devoted to reflection of our relationship to our experiences and for contemplating our relationships to the larger world. Our undertaking during the course of the week was to explore the interconnectedness of the human system by intentionally cleaving those connections after observing them.

 

Anatomy

 

We began with the skin layer. It is (somewhat surprisingly to me) VERY connected to the layer immediately deep to it, the adipose layer (called the superficial fascial layer in this course). Only through focused and dedicated work with a scalpel can the skin and superficial fascia be separated. I found the task to require much more effort than I thought it might and we went through scalpel blades at a rapid clip. The skin is also surprisingly variable in its thickness from region to region and cadaver to cadaver.

 

This was the day that embodied the truth of a comment made early on, that “it is a bit terrifying how quickly and easily we all became comfortable with the business at hand.” How rapidly separating skin from a human form becomes “normal”.

 

Day two was exploration and removal of the superficial fascial layer/ adipose layer. This day (as well as most of the rest of the week) I found myself so completely immersed in the project in front of me that I had only a dim awareness of what was transpiring at the other tables. The removal of this layer was fascinating when I was focused on the pectoral region and excruciatingly frustrating when I was working in the lumbar region. In some areas, the adipose/ superficial fascia came easily away from the fascia profundus covering the musculature using nothing more than a gloved hand, such as in the thigh. In some places like the pectoral and deltoid regions, the distinction between the superficial and deep fascial layers appeared to be almost non-existent. To my eyes the layers were essentially indistinguishable from one another. Liberal use of a scalpel was needed to differentiate the two layers and extreme care required not take muscle fibers with the superficial facial layer. In the lumbar region, the depth of the superficial fascia led to a huge amount of confusion and second-guessing on my part about the location of the musculature that I was expecting and looking for. In short, I became totally lost.

 

One of the most remarkable parts of this process was an idea offered by Gil to “remove the fat” from the superficial fascia and compare the “empty structure” to a piece that was still full. I did in fact take two pieces approx. 2”x 4”x 4” from the chest of the Capitan and do just that. I used my hands to “work” the tissue in order to remove the lipids. This was actually quite difficult. I would compare the experience to popping bubble wrap except the bubble wrap was 3-D vs. 2-D and made of something akin in texture to felted wool. In any case, it took a fair amount of time, persistence and force to manually extrude the lipids from the tissue and when all was said and done, what I held in my hands was a piece of mobile, strong, interwoven connective tissue fabric. It felt like a large folded or wadded piece of cheesecloth. I then took the “empty” piece and the “full” piece and placed them side-by-side in a bucket of water. When filled with water rather than lipids, it was beautifully obvious that the structure of our “fat” is guided and held by this connective tissue framework. The fabric “ghost” or shell of the emptied piece of the adipose layer existed in that bucket as an entity in it’s own right and it deserves gratitude for it’s unique form and for the functional role that it plays as part of the whole.

 

I have never been one to have overly negative feelings about my body or parts of my body, but I was intrigued that one of the effects of this experience was that I now have overtly positive feelings about my superficial fascia. I really love my adipose layer! It has it’s own shape and integrity. It is not passive. It is not an unwelcome passenger. My hypodermis provides structure, support, protection and energy reserves. And, just as my muscles and bones have their own personas, quirks and functions the superficial fascia is now better known to me as a significant part of my being, to be aware of and embraced.

 

One of my tablemates had devoted much of her time during the week to the head, neck and face and I was thrilled to have an opportunity to see the small, often delicate structures of this region unveiled. The platysma, some of the muscles of facial expression (orbicularis oculi and orbicularis ores as well as the zygomaticus major and minor and frontalis) were revealed and observed. Some of the hyoid musculature, specifically the sternohyoid and the omohyoid were identified in situ.

 

The removal of temporalis revealed the heft and depth of this muscle as evidenced by the void left between the zygomatic arch and the temporal bone. Having seen and observed skeletons and their skulls in the classroom for many years, something that had never fully registered for me was the depth of that space, which in life and in the un-dissected cadaver is filled with muscle tissue.

 

The pterygoyds were a bit harder to reach and required a saw to remove part of the zygomatic arch and mandible. Once observed intact in the human form, it seems odd that they have until this point been so difficult for me to envision in a living form.

 

For lack of any better ideas I wound up choosing the shoulder girdle and upper extremity as my region of focus for the duration of the workshop. Some of my team members (notably those who were returning to the lab) had a much clearer sense of what they wanted to accomplish over the course of the week. Due to the needs of others on my team to adjust the position of the Captain, I found myself on multiple occasions jumping around from area to area. If left to my own devices, I might have been more systematic in my approach to the region. As it was, I skipped from the pectoral region to the posterior brachial region to the lateral elbow (and to the dreaded lumbar region) depending on the Captain’s position.

 

During my exploration of this particular cadaver’s shoulder girdle, the fallacy of coracobrachialis and biceps brachii being two distinct individual muscles was readily apparent. Pectoralis major and deltoid did not, in fact, have a tidy division between them although there is a lovely groove where a division is often depicted that provides a place for the cephalic vein to nestle. On the posterior aspect the straightforward linearity of the teres major and minor and their relationship to the long head of triceps was not in evidence. The teres major and the proximal aspect of the medial head of the triceps were indistinguishable as far as I could tell which led me to a fair bit of confusion and speculation regarding my understanding of the biomechanics of this region.

 

One of the most delightful surprises of the week was the parotid salivary gland. It was beautiful and large, covering the mastoid, embedded in the spongy tissue and subcutaneous fat layer of the cheek and wrapping itself around the inferior aspect of the mandible. It resembled the brain in its structure and for some reason landed at the top of my “favorite anatomy” list for the week. Other notable contenders for the “top ten” were both the serratus posterior superior and the pronator quadratus. I was ridiculously pleased to locate and observe these two minor muscles that looked much like they do in the anatomy atlases! Given the ample opportunities to observe anatomy that bore only a passing resemblance to the pictures in my head, these small confirmations of my understanding of “reality” came as a bit of a relief!

 

The truly impressive connective tissue “origins” of the erector spinae group (versus the musculature) had the distinct appearance and textural density of strapping tape. Based on this observation I am led to think that this type of strong, dense tissue (also found in abundance in the fascia latae) is likely not particularly amenable to manual interventions and I am inclined to believe that most of the manual techniques that I use are mediated and translated by the superficial fascial layer which in turn creates changes in the deeper tissues.

 

There is quite frankly an abundance of information (Fascial Research) and opinions (It’s all pish-posh!) regarding the nature of the role of connective tissue both superficial and deep and I for one hope that our interest and curiosity will continue to spur research and new theories about how our connective tissues behave, how they serve us and how this information might translate to bodywork and movement therapies.

 

Although not a specific area of focus for me during the week, several other participants had dedicated many hours of attention to the psoas and it’s relationships to the diaphragm, quadrates lumborum, and contents of the abdominal cavity. My short and sporadic observations of the psoas in our cadaver as well as at least two others led to the following clarifications/ observations.

 

The psoas is (absolutely) retroperitoneal and observing the abdominal contents prior to evisceration helped to clarify and solidify my understanding of what we have to “go through” to get to the psoas and iliacus when working on those muscles. One of the observations that was made during the exploration and removal of the digestive tract of one of the male cadavers (Alphonse?) was that in some cases, adhesions once established, may develop their own nerve and vascular supply and over time become permanent “anatomy”. The basic idea that adhesions do exist and can become permanent was not new but the point being made here was that when working within the viscera (if doing visceral manipulation) or through the viscera (when working iliacus and psoas for example) it wise and prudent to remember that “stuff will get out of the way”…unless it can’t.

 

The final few days had me attempting to trace the major nerves of the brachial plexus into the upper extremity. I was quite pleased to locate and identify the radial nerve as it made it’s way through the tissue of the triceps brachii and the supinator. Unfortunately both the median and ulnar nerves had been severed at the level of the elbow so I lost their continuity into the forearm. The most remarkable thing about the nerve dissection was my observation of the extent of tethering and connection between the actual nerves and the nerve sheath. I had an idea going into it of what the relationship of nerve to sheath must look like. That “fuzzy” mental image was clarified, in that the nerves don’t glide freely within their sheathes but are moored to the surrounding tissue by tiny fibers that allow some transition but serve, fundamentally, to keep the nerve firmly in place.

 

There was so much more that I took away from this experience. There were aspects that touched me deeply that I am unable to articulate. It was overwhelming and confounding. It was enlightening and a call to personal evolution on a multitude of levels. It was pretty darned magical and as of this writing, I am committed to becoming one of the folks that makes a yearly or biennial pilgrimage to an anatomy lab.

 

Some Final Thoughts

 

There were many small enlightenments and large epiphanies over the course of this week. Many were taken from the gathering in the mornings and others were offered throughout the day by the cadavers, my classmates and the city itself. I had mentioned earlier that the theme of the week for me was “connection and disconnection”. This idea was also mirrored by the city surrounding us.

 

We were privileged to take part in a direct observance of the interconnectedness of the human form. We were reminded that we are connected to our larger communities and that vast webs of relationships comprised of families and friends, students and co-workers, support us. We contemplated how these sustaining networks allowed us to be in San Francisco for this incredible experience. How our family members, clients and students spent a week back home, holding a place for us until we returned. One gift that this workshop offered was deeper insight into the much larger and interconnected “body of humanity”. I spent quite a bit of time pondering my interconnectedness, both in my physical form and in my relationships to the rest of….well….everything.

 

I can attest, that gasping for air and feeling my heart pound after running up some epic San Francisco hills had a whole different connotation once I had held a heart in my hands and explored the shape of the lungs within the thoracic cavity. Once the relationship of heart to lungs to diaphragm to ribcage is unveiled and recognized, how it feels to embody these relationships was changed. What did this mean for my relationships to the world at large? What else can I glean from my observation of the fascial fabric, the “endless web” that can help to create a shift in my own system and how I fit into the larger whole?

 

My week was spent in a shiny new lab, surrounded by vibrant and curious individuals all seeking to expand their understanding of the human system. We were located in one of the most connected cities on the planet, filled with (one may assume) some of the most connected people on the planet (financially, technologically and politically). Down the street, within blocks of the lab were perhaps some of the most disconnected humans I have ever observed. San Francisco (like my hometown of Portland) has an acute homeless problem. Many of these folks are dealing with extreme mental and physical maladies and all might serve to hold up a mirror to the rest of us about the health and the integrity of the larger webs in which we all reside. Some of these people were rotting in their shoes. Some I observed defecating in homemade outhouses. I also saw that here, much like at home, there was a distressing “normalcy” to it all.

 

We are the “human body”. Me in an anatomy lab, the Silicon Valley wunderkind, the guy driving the cab, the old lady walking her dog, the man with a gangrenous foot sleeping on the street. The pristine lab, the swanky office buildings and hotels and the homemade outhouse are within blocks of one another. The people making use of all of these facilities are part of the same whole, belonging equally in the same net and not as separate as one might like to think.

 

I don’t know if my delight in seeing a salivary gland can help to heal the world or make me a better person within it, but I hope that the gifts of this week, the shifts in perspective and acknowledgement that everything really is connected, can be a step in that direction.

 

“You can’t dance if you’re angry.”

– Gil Hedley

“You will be confused, but you will be confused at a higher level.”

– Lauren Christman

As always, please be in touch if you have any questions or comments.

Best Regards,

~A

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