When cadavers speak

Learning in the shadows of heroes, dead and alive, at Wright State’s Cadaver Anatomy Procedure Lab

By Josher Lumpkin

Photo: In one of many simulations set up for practice, an emergency professional puts her skills to the test

There I was, 9 in the morning, holding a cold, grey human heart in my gloved hand. Staring face to face at such an organ was, I must admit, of particular interest to me, as a nursing student, an aide on a cardiac unit at a local hospital and as a sufferer of a heart condition myself.

Clenching the grisly, fascinating organ, I was able to peer inside and take a look at many of the tiny structures that can ultimately fail, causing the death of most Americans. Such a complicated machine. The significance of each of its components, most smaller in size than a U.S. dime, seemed a bit exorbitant and inflated.

I glanced around at the others at the table, each with his or her own heart in their hand. Gowned, gloved and masked, my cohorts and I were to examine some laminated sheets our instructor had handed out, showing electrocardiogram rhythms. The idea was to determine the pathology.

“This one shows first-degree AV block!” shouted a girl who looked to be about 23 years old.

“Mine has no visible P waves, indicating narrow-complex tachycardia!” a young man to my left enthusiastically declared.

I knew then that I was out of my element.

My editor had graciously volunteered me to attend Wright State University’s 9th annual Cadaver Anatomy Procedure Lab, an invaluable event that brings together EMTs, paramedics and others from the field of emergency medicine to train in several different workshops. While most of the workshop stations featured simulated emergency situations with expensive interactive mannequins, there were also a few stations where attendees were able to examine and train on actual dead people.

The morning had begun with coffee and doughnuts, along with an introductory speech welcoming us to the lab, given by assistant professor of emergency medicine Dr. Jason Raine Pickett, MD. The good doctor was not without humor, and his address was peppered with nuggets of wisdom like “As we change the diaper, the diaper also changes us.” His obvious intellect, coupled with crass accessibility made me wish he were my professor.

During the welcome address that morning, I looked around at the roughly 200 men and women gathered in White Hall at the Boonshoft School of Medicine. They had come from all over the region, some from as far as West Virginia, to attend. Most of them were in their uniforms, emblazoned with “EMT,” “Paramedic” or “Fire/EMS” in large, reflective letters, and the insignia of their various jurisdictions. Yours truly, clad in a colorful Aeropostale sweater and thrift store khakis, couldn’t help but feel like a tremendous imposter.

After cardiac, we moved on to the next station, cricothyrotomy. A “crich,” as they are lovingly abbreviated by those in the know, is an emergency airway cut into the windpipe of that unfortunate patient who is unable to breathe due to any kind of obstruction. The group was seated along the outer edge of several long tables assembled into a square shape. We were each given a long, bloody pig trachea to practice the procedure on. The tracheae were rested on Styrofoam holders that resembled, ironically, hot dog buns. The instructors handed out sheets of thick, flesh-colored, synthetic “skin” to drape over the entire gruesome relic. After showing a short video and giving a brief explanation of the intervention, the instructor told us to have a go at it.

Poking around on the skin, I was able to feel the cricothyroid membrane, the structure in which the incision is to be made. I said a little prayer and jabbed my penknife into it, narrowly avoiding slicing my own gloved finger, then twisted the blade in a circular motion to carve a hole. Satisfied with my handiwork, I now considered myself quite the fine surgeon! However, I was quickly deflated when I realized I had no idea how to assemble the remaining apparatus, which included some endotracheal tubing, a syringe I couldn’t figure out what to do with, and some other odds and ends. The guy next to me came to my aid, as did the instructor. The two appeared puzzled. How was it that I could not complete such a basic procedure? There was no way I could continue the charade. The jig was up.

“I’m just a reporter! I’m not an EMT; I’m with Dayton City Paper!” I blurted out, hands high in surrender.

After that, I felt much more comfortable with my group. Now that they knew I was not one of their ranks, I could step aside and allow the professionals to take part in the simulations, without having to participate myself. My affiliation with a news outlet also explained the camera around my neck, which had been gaining me some odd looks. Though photography of anything that had once been part of a living human being is strictly prohibited, I was encouraged to take as many pictures as I wanted of the group activities involving dummies and other equipment.

The next station was dedicated to new technology designed to make emergency personnel’s jobs easier. This included laryngoscopes with special intubation cameras that allow the user to see the inside of the airway without having to look in the patient’s mouth. These kinds of devices can be very helpful, because, as I learned, when someone passes out and needs to be manually ventilated, they don’t usually think to fall in such a way that makes it convenient for first responders.

Think about someone overdosing on drugs. They might be shooting up while sitting on the toilet, then fall to the side and have their head wedged between the commode and the wall. An EMT is trained to intubate someone by positioning himself at the top of the patient’s head and looking down the victim’s throat upside-down. If someone passed out with his or her head in a corner, it would be impossible to perform the procedure this way.

This station had dummies placed in precarious, difficult-to-access locations around the room, including the toilet scenario I just explained. Participants were encouraged to grab the high-tech gear and try their hands at it. There was Johnny O.D. in the corner by the toilet; there was a pretend car with a driver and a pediatric dummy in the passenger seat; there was a guy passed out under a table, where it would be hard to gain clearance overhead to do what needs to be done. There were even various baby doll-sized infant dummies on a table for people to practice intubating with smaller equipment.

By this point in the day, I was getting to know my partners pretty well, and it was awesome to see them in action, even if it was all pretend. As the simulations got more intense, you could see the team slip even more into their groove.

The next stations included a pediatric simulation, where an administrator from Dayton Children’s Hospital gave our team a scenario and let them go to work on keeping a child dummy “alive” on the trip to the hospital. Conversely, there was a geriatric simulation that followed, where our guys and girls had to save an 80-year-old man who had been involved in a car accident.

At the OB/GYN station, which was a lecture rather than a simulation, I learned that several of the members of my group had actually delivered babies. There was a girl who looked to be about 25 who said she’d assisted in two deliveries out in the field over the course of her short career.

A full picture of my group members was really starting to form now. Though they ranged in age from 23 to 58, they shared in common their willingness to risk their own safety to save lives. They do this every day they go to work.

They save people who have made bad decisions all their lives in regard to diet and exercise, or drug users, or even drunk drivers who have crashed their cars and hurt themselves and others. They don’t judge those who they save. They just help them.

My favorite of the simulations was the mass casualty exercise. The group was told there had been an explosion at a nursing home, and had to go in and triage the survivors to assess who could help themselves, who needed help and who couldn’t be saved.

It was a dramatic exercise.

The team rushed in to a large, darkened room, where there were about 10 or 12 actors, yelling realistically as if injured, and wearing bloody makeup depicting various levels of gore. There was a smoke machine belching out fog, further obscuring vision in the dark room. It was a bit like the set of a horror movie. I can only imagine what this would be like in real life, and how difficult it would be to have to decide in a split second whether or not it is possible to save a dying person’s life, and move on to the next poor soul, who hopefully can be helped.

For the final three stations of the day, we gowned and gloved up and went back into the cadaver lab. I am not sure I can express here the surreality of the remaining exercises. Any time you see a dead person in the flesh it is very bizarre, but to have them opened up in front of you, so that you can see the viscera that are normally hidden, is something else entirely. I was told that at least one person had passed out earlier in the day at the sight.

There before us was what looked to be about a 60-year-old man. Half of his chest had been cut away, the underside of his rib cage lying next to his left, open like a book. Inside, you could see his left lung. Below, separated from his chest by the thin muscle of the diaphragm, the cadaver’s abdominal cavity lay open for us all to examine. The young doctor in charge of this station peeled back the greater omentum, the apron-like membrane that rests over the organs that reside in one’s belly, to expose the gentleman’s small and large intestines. Elbow-deep in tissue, he wrangled the moist, pink intestines aside, to show us where the liver was. Some group members weren’t able to watch. I was okay as long as I kept my nose in my face mask.

On the right side of the cadaver’s chest, the side that had not been cut open, our group practiced pneumothorax decompression. This involves inserting a rather large needle just below the collarbone, between the second and third ribs. Others were practicing using an intraosseous drill into the cadaver’s shinbone. It was all very intense.

At the neurology station, we took turns holding a human brain. I was surprised at how small it was. You would think a brain would be about the size of someone’s head, but it’s actually small, considering. Another notable mention at this station included a long spinal cord, which was interesting to see.

Finally, my group and I arrived at the station that would conclude the day; the last cadaver the team would get to work on. This was a station focusing on the emergency treatment of fractures. As such, the body had multiple bones that had been broken post-mortem for the purpose of education. The instructor had our group locate the fractures. Turns out, the cadaver’s left tibia, right femur, pelvis, left radius and cranium had all been broken. My mind inevitably wandered toward picturing the person whose job it is to fracture a cadaver’s bones. This was a real person in front of me, one who only a couple of days before had been alive. Sick and in a hospital, but alive.

It was obvious, though, how valuable the exercise was to the group. They were practicing traction splints on the cadaver’s broken femur, and utilizing their training to care for the other fractures that they’d not yet encountered in the field.

That day, I was surrounded by people, living and dead, whose acts of selflessness cannot be overstated. Though the day was overwhelming to me for many reasons, I was touched at the the thought of those incredible people who donated their bodies to the Anatomical Gift Foundation, so they could help people help people. Their gift will touch lives far beyond those who actually encounter the cadavers, but also those that the brave emergency personnel now will be able to treat as a result of this training. From the people who attended C.A.P. Lab with me, to the doctors who volunteered their time to teach the workshops, to everyone in between, the Cadaver Anatomy Procedure Lab was such a positive environment, it was impossible to come out uninspired.

For more information about Wright State University’s Cadaver Anatomy Procedure Lab, please visit med.wright.edu/em/CAPLab.

 Reach DCP freelance writer Josher Lumpkin at josherlumpkin@DaytonCityPaper.com.

 

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Josher Lumpkin is a nursing student and aspiring historian who enjoys writing about music and geekdom of all kinds. He is especially fond of punk rock, tabletop gaming, sci-fi/fantasy and camping with his wife, Jenner, and their dogs, Katie and Sophie. Reach him at JosherLumpkin@DaytonCityPaper.com.

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