“Hello there,” I thought upon meeting my first patient in medical school. I did not get a response. Not that I was expecting one; my first patient was, as are most medical students’ first patients, a cadaver. She was draped with a bed sheet. Even when we began making the first cuts on her back, we kept her covered from the waist down.
All medical students remember meeting their first cadaver. Our faces automatically curl in disgust as soon as we enter the room, an automatic reaction to the stench of formaldehyde. There is that initial internal aversion to being near a dead body. I remember being reluctant to even touch our body. She reminded me of Bernini’s statue Ecstasy of Saint Teresa — pale as marble, head thrown back and mouth parted with her palms up, as if she, too, were in a trance. While the cadaver was, of course, a real person, it doesn’t initially feel quite right to call it a person — it can’t breathe, its skin isn’t the right color, and it reeks of preservative fluid. It may be nearer the mark to call it a resource with which we will learn, possibly for the first time, the anatomy of the human body. Our dissecting guides certainly seem to suggest this when they refer to the “specimen.” No room for empathy or emotion. But “it” is not really an “it” at all; he or she was once a person who was kindhearted and altruistic enough to sign away their previous body for the sake for the sake of our education.
When one such person wants to donate her body, how does she ensure it becomes a tool for study or research? It may surprise you that she doesn’t ask her doctor. Legally, doctors may not talk to patients about donating their bodies. Technically, they aren’t even supposed to ask patients if they would consider donating their organs unless they are specifically trained as an organ procurement representative. If someone wants to donate her body, it’s up to her to take the initiative and contact any donation center — there are many across the nation.
The easiest option is to use an organization that specializes in body donation. Sites such as Science Care, Medcure, and Biogift entice would-be donors to consider this “life affirming alternative to a traditional funeral or cremation,” wherein their bodies would be used to educate future physicians for medical research. These organizations act as brokers; they take care of everything, even transporting a donor’s body to your final cremation. The downside? The donor and donor’s family won’t know where her body will eventually end up, be it in a medical school for first-year students introductory gross anatomy class or with plastic surgeons for the practice of complex procedures (in “Stiff,” Mary Roach describes sitting in on a class where surgeons learned to perform facelifts on severed heads).
If the donor is passionate about a particular cause, she can also donate her body to a specific institution. She can contact her medical college of choice about donating her body (best to stay local, since the body will be unusable if she decomposes too much before the university can have her preserved). If she’s a bit of an exhibitionist, she could donate herself to Body Worlds. If she’s always dreamed of being a crash test dummy, Wayne State University is the place for her. If she has a rare condition or physical deformity, the Mutter Museum in Philadelphia might be the place for her; this museum is dedicated to helping scientists and physicians learn about the anatomical makeup of rare conditions.
What happens to a donor’s body once it has been accepted for donation? It is embalmed with formaldehyde to prevent decomposition and phenol to prevent mold. (As an aside, if you are a medical student and you find your stomach rumbling during gross anatomy, you are not secretly a cannibal. Formaldehyde is an appetite stimulant.) If by chance she ends up in the Body Worlds exhibit, her body will undergo plastination, a process that replaces the body’s fluids with plastic. During this process, the body is first pumped full of formalin and then dehydrated with an acetone bath. The body then undergoes forced impregnation, during which the body is immersed in a polymer solution and then placed in a vacuum chamber, where the acetone will be removed and the polymer will enter every cell of the body. The body is arranged in the desired position (Body Worlds exhibits show bodies frozen in the act of running, jumping, sitting, and so forth) and then hardened with gas, light or heat.
Then the body is used. Medical students make their hesitant but anxious first cuts, eventually gaining the confidence to dig around in crevices to find each specific elusive nerve or artery. They experience the awe of holding a human heart in their hands, marveling at how muscular it is. They stop being squeamish at the notion of body fat draining underneath the table the body lies on, and we won’t hesitate to pour some of it back onto the body. (Does that sound completely disgusting? It is, but it keeps the organs and muscles from drying out. It feels disrespectful when we neglect to do things like this — the donor has relinquished funeral rites and burial and has allowed us to have free reign over their remains in order that we might learn. The least we could do is keep her in good condition.)
Once all are done learning, or researching or observing, each U.S. medical school has a memorial service in honor of the donors and their tremendous gift that ultimately helps us become physicians. Students and professors will say a few words and prayers. We write thank-you notes to the families, or we invite donors’ families to the service. They rarely attend. We of course understand that reliving a loved one’s passing is undesirable, especially in a room full of strangers, but we really would like to thank families for their relatives’ gifts to us. We’d love to tell them how we were in awe at learning how the human body is made up outside of a textbook for the first time, the fun of discovering all the anomalies that can exist in a body with no ill effects to the person, the pride we felt when our body had the best preserved muscle or a particularly lovely set of nerves…if they were interested in listening, of course. The donor is cremated, and every institution takes care to ensure that the remains in one urn belong to only one donor. If organs or parts are separated from the rest of the body at any point, it is noted and the parts are labeled so they can all be reunited when it comes time for cremation.
It is interesting to observe how students treat the bodies. Our relationship with our cadavers seems complicated to an outside observer. Some things medical students do may at first seem disrespectful, but they are to get comfortable with the body and learn to care for it in this most intrusive of situations. For example, the cadavers’ real names are confidential, so we give them nicknames. We might name them Janet or Grandpa Jerry because it makes us feel less anxious about the fact that Janet is a dead woman, and it also rolls off the tongue more easily. And anyway, without a name, we can fool ourselves into thinking the body in front of us is an object. (Which it isn’t.) We greet our cadavers with a jovial “Hello!” when we open up the lab tables. We mock-exasperatedly ask why Janet has such a large Adam’s apple for a woman (one of those anomalies that sometimes occurs). We might spout, “Janet, blow your nose!” when we find crusty bits in our cadaver’s nostrils.
Despite all this, we are careful to respect you. Despite the plethora of urban legends about medical students’ hijinks, the majority of us would never dream of stealing one of your limbs or playing pranks in the anatomy lab. We keep the parts of the body that are not being observed covered with a sheet, affording the cadaver the same privacy we would a living patient. When we uncover evidence of disease or hardship — our cadaver, Janet, had multiple tumors, a hysterectomy, and a unilateral oophorectomy — we feel genuinely sorry that our donor had to go through so much pain. This is where some of us learn how we will treat our future patients — after all, a patient under general anesthesia is just as much at a surgeon’s mercy as a cadaver.
Aforementioned hijinks and disrespecting the bodies can land the people responsible in some major trouble. The donor’s confidentiality is just as important as a living person’s. When a teenager snapped a selfie with a cadaver in Alabama, the photo was immediately removed and the student disciplined. Many students, researchers, and health professionals have anecdotes about someone who made an off-color joke and was reprimanded. Some of these may or may not be tall tales, but urban legends get retold because they play on our worst fears. The donor has given us a gift and an opportunity to learn, and none of us wants to be or deal with an ungrateful recipient.
It is too easy to forget the body in front of us was once a person with ambitions, family members, regrets, and innermost thoughts. Those thoughts are lost now, but it is important for us as current, past, and future medical students never to forget this fact. Learn from your cadavers, yes, and don’t be afraid to explore and make mistakes with the gift they have given you, because that is precisely why they have given it to you. But never lose perspective. Your future patients will appreciate it as well.