Mind over matter

It wasn't the promise of saving lives that kept me attending an EMT class, but my will to witness the mystery of life in a bifurcated head.


JC Hallman
November 1, 2006 5:00PM (UTC)

I'm a reader and a writer, so I guess I'm used to the idea that deep down inside of things there is generally a kernel or a nugget of something, a theme or whatever. Meaning. You can talk about it, you can sense it; it's there. But that's not the beginning of all this. The beginning is when that stopped being enough for me and I wound up in Mike's class. People who traffic in ideas are famously underpaid, so money rears its head here, but I don't think it's uncommon, either, for writers to long for the kind of work where one's hands get dirty, where the sense of offering something up to humanity isn't so remote. I was broke; I was bereft. So I thought maybe I'd become a paramedic. Help people, get paid. Two birds, one stone.

Mike had been a paramedic once and now he taught the classes you took to become a paramedic at the hospital complex that dominated employment in Iowa City. Emergency medical technician certification comes in a variety of levels or degrees, and it's all vastly more complicated than it really should be. Emergency medicine traces its history back to morticians riding to accident scenes in hearses. That's why old-style ambulances all look like hearses painted white. They are.

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I enrolled in the basic class. It was dispiriting almost from the beginning. The class actually spent its first few days figuring out how to avoid helping people, navigating the tricky legal contours of implied and expressed consent. And even when we talked medicine, it was glory that won out, the cheap thrill of deciding when to run red lights and turn on the siren. Maybe that was the beginning of my disillusionment with EMT training. I didn't feel like I was helping people. You got your hands dirty, but as a whole the thing lacked a kernel or a nugget that you could point to and say, here it is, this is why I do this, here is its life. The only reason I didn't drop out was the bifurcated head.

Among the extracurricular goodies Mike had arranged for us in the EMT-basic course was a field trip to the hospital's cadaver lab. Pictures in books did not do justice to anatomy, he told us, and sometimes he would digress into monologues about the bifurcated head, a dissection specimen illustrative of something. Mike liked talking about the head. He thought it was fantastic. The head for him had stopped being a head at all -- it had veered away from what the rest of us thought of as heads.

I was interested, neurologically and philosophically. If once upon a time, I thought -- say, with the Greeks -- man had staked his faith on the idea that his core self, his identity, his soul, had matter and was made up of something like smoke (Homer), caught in his chest, somewhere just left of center, or fire (Leucippus, Democritus), warming the pleural space between the triple-lobed right lung and the slick forever-bulging pericardium, and if that whole theory had then been razed by Aristotle, then what had happened was that philosophy had been set on course for the harebrained notion that the human brain, hugely intricate and flabbergasting in its engineering, so fantastic and persistent that it still represents a frontier, that surely this thing, or maybe a gland wrapped inside of it, amounted to something that could be labeled sacred or spiritual, or at least crucial. But it didn't. The bifurcated head disproved all that. I began to think of the bifurcated head as the one real meaning of my time in EMT training.

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The hospital employed 14,000 in a town of about 40,000 people. It was the largest teaching hospital in the world. It was its own city, really. It was a hospital with three piano lounges.

The day of our field trip arrived. To get to the cadaver lab we had to descend through an old section of the hospital, what had once been its operating arena, where obsolete gurneys stood forgotten in the hallways and the walls wore toggles for gases that kept people going through the hopeful gamble of anesthesia. Mike guided us down twisting corridors that conformed to the hospital's herky-jerky history of expansion. "Is anyone leaving a trail of bread crumbs?" he said once. Then, after a few steps, "Can you imagine how many people died in this hallway? Thousands."

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We examined the corridor with reverence. The local ghosts stayed quiet. We filed down a flight of stairs, then another, and now the hospital began to look suspiciously morguish. In the air hung a faint chill and the phantomy expectation of formaldehyde. We were all nervous and the class started to joke about the cadavers. We plotted to stick some organ or other in our coats and produce it later, in the cafeteria, probably. We imagined what it might be like to actually be one of the cadavers and to be miraculously alive somehow with people fiddling around inside of you. The Bifurcated Head had us on edge, and the human reaction was to slip back toward adolescence, where the only proper response to a thing's being kinda gross was to exalt in it, to exceed its grossness if at all possible.

The doors to the cadaver lab were unmarked. We snapped on latex gloves and cellophane aprons before we pushed through. Inside was roughly what you, too, have probably come to expect: 30 or 40 bodies covered over with white sheets, spaced apart from one another like tables in a pool hall. A brown extension cord hung overhead for each, meant for lights or recording devices or cutting appliances, and a weathered "Gray's Anatomy" stood near each body on a small podium. A few skeletons hung about like Halloween decorations someone had forgotten to take down, and bright red disposal bins marked with biohazard symbols stood everywhere. A row of shelves against a wall held saws and mallets, an array of tools plain enough for a Mennonite and of as broad a variety to take down a barn.

The cadaver lab employed a full-time mortician, Mike said, in introduction. The facility had a state-of-the-art crematorium. The cadavers themselves were embalmed twice -- once when they died, and again here. I knew from a little research that deeded body programs sometimes got themselves into hot water, as in winter 2004, when the director of the willed body program at UCLA was discovered to have profited $700,000 from the sale of "knees, hands, torsos and other parts" to individuals for private research. A middleman had been arrested as well, making the whole incident something like a drug bust. Before UCLA, similar enterprises had turned up in Texas in 2002, and U.C. Irvine in 1999, and a Tulane official had once been caught selling bodies to the Army for explosives research. Just last week a half-dozen funeral directors, caught up in a scam run by a disgraced dentist, pleaded guilty to yanking body parts out of corpses without families' permission. Historically the furor over these incidents is short-lived, and the result has usually been that violating universities get their bodies from another university from then on. There's no discussion of who the customers were, and a thriving shadow industry of parts isn't hard to imagine.

Mike led us to a table of brains. He didn't say anything about it right away, but the bifurcated head was already there, a foggy lump behind the translucent plastic of a large bucket labeled "Bifurcated Head." There is no sophisticated terminology for head. The skull is really the cranium, the observable part of the ear is really called the pinna, and the little bumps behind one's ears are the mastoid processes, but for the whole system of the head, the brain socket and the complicated plumbing for exchanging heat and nutrients and fluids and electricity with the trunk and the extremities, all this was just the head and there was no other way to think of it.

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But Mike wasn't going to show it to us yet. He yanked back a sleeve and pried the lid off a bin of brains. The room's formaldehyde climate was a forever-changing concentration, pockets of gases mixing and diffusing and coming together again like pressure systems, and whenever anyone broke the seal on a cask that had been closed for a while its particular vintage of embalming fluid and the inevitable rot of soft tissue lofted up invisibly, like a jinni set free and allowed to roam the room. We caught the scent of the brains just as Mike reached in and gently scooped one out. "Imagine it," he said, excited though he'd done this many times, "I'm holding a human brain."

He set the brain down on the table. I wasn't that impressed. It looked a little chunky and squishy, like a cleverly shaped pbti, but there really wasn't a great deal to it beyond what one expected based on the drawings and diagrams in our textbook. He showed us the brain's wrappings, the dura mater that was tough enough to protect the brain from puncture, the microbe-thin arachnoid (named for its webby appearance), and the pia mater, whose function was still a mystery and that was too thin for us to actually see. The triple layering of the maters and the arachnoid, with cerebro-spinal fluid flowing between them, was a system of wrappings that extended over the brain and spinal cord both, all the way down to L2. Mike touched the brain once, pushing it around in a little tray just to show us that you couldn't stick your finger into it. Embalming -- double embalming -- had changed it. The language of brain anatomy was rife with synonyms for containers -- cavities, aqueducts, ventricles, districts, fissures -- but this brain was clay through and through.

Among animist religions the idea that the body is home to some other entity, a soul, is fairly common. Sometimes the soul is pictured as resembling the body itself, other times it's as small as a grain of sand. The soul is often associated with functions or organs -- the heart, breath, the placenta, the liver, the kidneys -- but it's a mistake to oversimplify the soul theory at this point. Early conceptions of the soul were vague metaphors, sophisticated in their own right, and it was later philosophy that tended to fix the soul. The soul was a divinity trapped in the profanity of the body, and Gnostic writers built on Plato by calling the body a "filthy garb" or a "fleshly envelope." Aristotle helped with the hardening of the soul when he said, reacting to Plato, among others, "For the soul is not a body but something of a body, and, because of this, it exists in a body." Descartes wasn't so sure when he argued that the pineal gland in the brain was a possible source of transmission and reception for communication between the mind and the soul. Emerson disagreed in "The Over-Soul" when he claimed that "the soul in man is not an organ, but animates and exercises all the organs."

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Souls aside, consciousness is still a puzzle whose most convenient solution is to think of it as somehow embedded in the brain. Set out on the table, Mike's brains sort of forced this kind of thinking. And what I thought was that if people could ever be peeled back to some kind of identifiable essence, something you could say was us, then it would probably have to be the overwrapped present of the brain-spinal cord conglomerate that the rest of the body was meant, basically, to provide transportation for, this disturbingly insect-looking creepy-crawler of a thing that was more our heart than our hearts. And Mike had one of these as well, a brain removed with the spinal cord still attached, which he produced from the nether of another bucket, cupping the brain like the head of an infant and providing support to the drippy spinal cord like a pet snake. Mike marveled at his catch.

Mike introduced us to a doctor who worked the cadaver lab -- one of those modern forensic heroes you see on television. We gathered around a chalkboard so she could deliver an impromptu lecture on the heart, and she seemed pleased to be dealing with live people for a change. She told us about the heart's automaticity -- apart from the brain, the heart was the only part of the body that could generate its own electricity, the sinoatrial node shooting its charge out to the Purkinje fibers in careful patterns that allowed it to recycle six liters of blood, the body's entire volume, in about a minute. This made a pretty good argument for the heart's also representing something of humanity, but the class wasn't really listening. The cadaver lab had more of a graveyard's sense of decoration and serenity than a wake's solemnity and sadness. It distracted us.

When the lecture was over, the doctor led us to the first full body we would examine as a group. She pulled back the sheet, but inside was a plastic wrapping, top to bottom, and inside that were more wrappings, a shroud of moist towels to keep the body humidified. Beneath all that lay the cadaver. The man's age, "67," had been magic-markered onto his shoulder, though it was tempting to read it as a mysterious tattoo. We didn't see the man's head because there wasn't one. It was already late in the semester and the medical students had been going at the bodies for months now. The doc pulled back the man's skin -- or rather, she lifted it back, everything from the neck to the groin had been stiffened somehow like plaster of Paris so that it was like tilting back a trap door. Ditto the muscles.

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It was about then that the whole idea of a central feature of people, be it a gland where the soul lived or a spindly pulsing bug playing parasite to the host of the body, broke down completely for me. There was no cream-filled center. People were simply collections of wrappings; everything in the body was a container for something else, from microscopic films to the formal containers of the hollow organs like the stomach or the heart. Everything that was solid in the body held something else, another kind of wrapper usually, so that the best metaphor for people, for us, was not whatever sophistry the ancients had performed to trick a home for the soul -- instead, the best metaphor for the human body turned out to be those awful little Russian folk dolls who kept getting smaller and smaller as you screwed them open. They were actually called Matryoshka Dolls, nesting dolls, and in they went, deeper and deeper, always in expectation of something central and new -- a home, a nest, a revelation, a meaning -- but always what you uncovered was another fractal frustration, a repetition, a smaller piece of the puzzle just as maddening.

A puzzle was exactly what they had in store for us when we next turned to a long table laid out with two specimen trunks. Not trunks in the luggage sense, but trunks in the tree sense. Trunks are bodies missing their heads and all four limbs. The first was a sidis inversis, all the organs reversed left to right, a one-in-a-million mutation. One guy in our class was the first to notice the heart aimed down the wrong way, and the whole point of having the sidis inversis on display seemed to be for that little game of who-noticed-first. The other trunk was male. We could tell because its genitals were still attached. Its top end was its tongue. All the internal components of the upper airway had been left intact and now the peak of its head -- its head -- was that sloppy gray-pink disembodied tongue, spread out as if to indicate a kind of 1970s Rolling Stones defiance of public mouth etiquette, an I-don't-care lick-swipe at the world. This was the man's head now. At the other end of things were his penis and anus, the former shrink-wrapped and slicked down against his skin, his pubic hair still visible and useful as a reference point. The rest of him was gone or exposed in a cavity as wide as he'd once been. Even here, the body was all wrappers. The pericardium, the sack that held the heart, and the peritoneum, the bag for all the abdominal organs. We stared in at the man's rotted groceries.

For a while the doc fingered her way through the floppy organs as though searching for an edible piece of fruit among the ruin. The tongue lolled at us. It was in a permanent state of loll. We lolled right back at it. This made me wonder whether there was something basically ghoulish about medicine to begin with. Did all doctors have to reenact Da Vinci's fascination with corpses? Was it just a way of getting used to death? Was that what our trip to the cadaver lab was about? Was that what our culture was doing now with its forensic thrillers and surgery channels? And was that why I wanted to see the bifurcated head?

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Finally, it was time. Mike got a little giddy. He'd put on a white lab coat for the excursion, and he looked like a boyish mad scientist as he lugged the bifurcated head over from the brain table and ran his hands around the rim of the jar. He introduced the head, sculpting the tension of the moment by alluding to some horror movie where a head was similarly presented or held aloft, but we were all a little too rapt at the contents of the jar to follow his image. The head needed no introduction. "Well," Mike said, and lifted the lid. The head's scent came out first, a billowy prelude of gore, and Mike bobbed into the jar two-handed, as though he wanted to maintain c-spine immobilization, and then brought the head up out of its forever bath.

That the head had once belonged to a man is I guess the way to say it. His right eye was closed, his left half-lidded over a blue-gray iris awash in a blood-sodden sclera. I wasn't sure at first what the face expressed. But some reconstruction was necessary before you could take a crack at that because the head was cleaved, bifurcated after all, struck from the top down, front to back, as if from an ax blow, from the skull's crown to mid-neck, and there was a wedge of nothingness left there in the middle. It was a V of a head. Or a capital Y. The man still had hair. He still had teeth, he still had lips and jowls and a nose sliced just right of center. Moving in, as we all did, we could see all the wrappings and layers as clearly as rings in a tree trunk.

The three dermal layers, the muscle layer, itself wrapped in a protective sheen called the fascia, the bones, which are themselves made up of layers of compact tissue enclosing quantities of cancellous tissue, and inside that the brain wrappings (see above) and the outermost layer of the brain itself, the cerebral cortex, which was sometimes described as an extensively folded sheet -- a crumpled wrapper -- which was divided up into six layers of its own, each responsible for various kinds of processing. Maybe this was the most basic of all expressions of humanity, the brain's gangly collection of wrappers and conduits. What if the long search for humanity ended here, not in science or philosophy, but in a hasty dissection that let you see all the wrappers at once, like looking into the cross section of a nautilus, the winding chambers a looping trace through history and evolution? Wasn't that why Mike found it beautiful? Nobody had much to say about the head. We were all a little afraid of it. Not even our jokes could protect us, which may be the thing that makes a monster a monster.

The ancients hadn't known it, but it was possible to dig so deep into the human package that you simply passed up a defining layer, shot past the soul, and hit a layer that was definitely pre-human. There wasn't a kernel of anything at the center of humanity, and the head wasn't a nugget of anything else. Themes were strictly things for books, and all the head proved was that it didn't mean anything. Eventually, when you were past all that, you could put the head back together in your mind. And when I did I realized that if the head had not been the head, if he was still the guy he'd been before becoming the head, I might have known him. I could have recognized him. He was that complete. And now I could read his expression. The head, stitched back together in my mind, seemed to be thinking, and what he seemed to be thinking about was this whole deeded body program, and maybe it wasn't such a hot idea to be leaving your body to science after all.

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JC Hallman

JC Hallman is a writer-in-residence at Sweet Briar College and the author, most recently of The Devil is a Gentleman: Exploring America's Religious Fringe (Random House).

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