IT COULD have been any memorial service. It was held in a small stone chapel. Sun streamed through the stained glass windows, candles flickered on the altar. An organ sounded, eulogies were read, a choir sang. Loved ones dabbed at noses and eyes.
What made this service different was that the people being remembered were medical school cadavers, and the ones giving thanks were the students who dissected them.
Since the 1980s, McGill University in Montreal has been holding a commemorative service in June each year for people who left their bodies to the university’s anatomy lab. The service typically attracts over a hundred of the medical, dental and physical therapy students who studied the bodies, as well as their professors and relatives of the deceased.
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The McGill service goes a long way towards dispelling the negative image that donation often has. The thought of being pawed by first-year med students keeps many would-be Samaritans from donating their remains to the worthy cause. Even many who are happy to spare an organ after their death still can’t bear the idea of a student fumbling with their innards. But the service reveals that people’s perceptions are often far wide of the mark.
“Dear Donor,” began Erik Brown, a med student who hopes to go into paediatrics or public health. “I’d like to apologise for being startled the first time we met. I’d never seen death so closely.”
They all admit that first day was daunting. “It was pretty scary,” Mandeep Dhillon tells me. “I’d never done anatomy before. You walk in and see rows of bodies covered by green sheets. Everyone was quiet. Some people walked in and walked right back out.”
At the start of the year, the students are assigned four to a table, and on each one lies their cadaver for the year. They are told that these aren’t just unclaimed bodies, but the remains of people who had decided to leave themselves to medicine. After some preliminary instruction on the safe use of surgical tools, students are asked to draw back the shroud and make an incision across the chest.
“I was worried about having to look at the face,” confides Wael Chadi Hanna. As it happens, the faces and genitals are covered. Hanna didn’t see his donor’s face until the very last day of class. “Some students did it early on and regretted it,” he says. Many students, including Brown and Dhillon, never looked.
Cutting into a human body wasn’t easy. “I didn’t make the very first cut,” Brown admits. “I stayed back a bit.” The skin in particular upset Julie Boudreault, a dentistry student. “Cutting the skin was too hard for me. Skin might have been caressed, washed, touched,” she says.
Apart from the sex, and a guess at the age, the students knew nothing about the individuals whose bodies they were now exploring. But they say they wondered. Who was this person? Did they leave family behind? Had they achieved their goals in life?
There were clues. An abdominal scar, a tattoo on an arm. Inside, evidence of bypass surgery, a missing kidney. But the cadaver Brown worked on, an overweight man in his seventies, had no unusual markings or indications, and they couldn’t tell how he died. “I think I would have liked to have known a bit more,” he says to me. “What was this person’s story?”
“Over the course of this year I’ve thought about who you might have been,” said Brown in his eulogy. “I’ve imagined the lifetime’s worth of memories that you held. How many sad and joyous, beautiful and ugly moments have you lived? How many people have you reached out to and touched, the way you affected me?… For the first time in my education, I saw beyond the long words and confusing diagrams. I saw a real person, who had lived a real life.”
Some of the donors did give away details of their past to the students. “Every so often we came across what may have been the reason they passed away,” Dhillon tells me. Her donor was a woman who probably died of colonic cancer. Parts of her stomach and intestines were missing. Also, when her team cut open the heart to examine the chambers, they noticed she had an artificial heart valve.
Olivia Bottenheim recalls sensing a “distinct division of spirit and flesh”, as though the body became just a fossil. “There is no soul left in this body, only trademark signs of having existed there, having ‘used’ the physical body,” she says. “These telltale signatures are everywhere. She took good care of her skin and nails, and she kept herself trim and in shape.”
Of course, no one pretends that all med students are as thoughtful or considerate as the ones at the service. Some students, I’m told, had the bad habit of leaning on the bodies during lectures. Others made inappropriate jokes. Yet there was none of the outright irreverence that you hear so many rumours about. Indeed, one student pointed out that what happens in the anatomy lab was nothing compared with how some surgeons are reputed to treat their unconscious patients in the operating theatre.
The memorial service was originally conceived as a way of commemorating and thanking the donors. But it also helps their families appreciate what a significant thing they’ve done.
When a person leaves their body to the medical school, there is no body to mourn at a wake, nothing to bury in the family plot. Instead, the corpse is taken away for cold storage straight after death, and later delivered to the morgue for preparation. Many family members are deeply upset by their loved one’s choice.
What they wanted
“I was so touched that people came up to me after the ceremony,” says Ingrid Park, who is considering going into surgery. A woman tapped her on the shoulder and confessed she’d been so angry that her husband had given his body to science. Now she felt at peace with it, she said. It was their funeral ceremony, says Park
“When I first encountered the lifeless human form in front of me, I was a little shaken,” Park told the service. “I had never met this man, but I knew one thing: he had a human spirit. I often contemplate what that spirit was… He will be one of those people who have had a tremendous impact in my life.”
Many of the students say they would have liked to have known more about their donors, even if they’d just been given a short summary of the person’s life at the end of the year. And a lot of them hoped their donor’s family had attended the service, and say they wish they could have thanked them personally.
However, coming face to face with a donor’s loved ones can be overwhelming, as Dhillon discovered after this year’s service. It’s not clear how they learned which body she had worked on, but after the ceremony, several people approached her and introduced themselves as her donor’s son, daughter and cousins. “I saw them coming towards me,” says Dhillon, recalling the apprehension. They showed her a picture of an older woman and confirmed that she’d died of colon cancer. It was an emotional moment.
In retrospect, Dhillon’s not convinced they were her donor’s family, since they didn’t seem to know about the artificial heart valve. For a while this made her feel uncomfortable, but now she’s not sure it matters. “They really just wanted to know that the decision she’d made was a good one,” she says. Just as the students felt the need to understand their donors as real people with souls, so the friends and families need assurances that medical students are too.
“There’s a cycle that people talk about,” Dhillon said at the service. “That life in a sense never ends and that the passing of one thing marks the beginning of another… But beyond that last breath, you continued to impart knowledge and to inspire: things to which there is no end.”
All yours, virtually
Some of the guests milling about after the service, sipping punch and nibbling at brownies, will one day be under a green sheet in the anatomy lab. Many potential donors attend the McGill service before they sign the forms, in order to get a glimpse of the kinds of kids who will be rummaging around their thoracic cavities and inspecting their livers.
Coordinating the whole event is Sandra Miller, the anatomy professor who instructed the students all year. She is fast-talking and frenetic, and a warm and gracious host. One student confides: “Dr Miller looks at it as a way to recruit people to body donation.”
In fact there is no shortage of cadavers for medical schools. Universities need fewer bodies than ever now that they are turning to “virtual anatomy” classes with videos and interactive computer programs. McGill is the only medical school in Quebec that still teaches hands-on anatomy, says Miller.
And if the course does fall by the wayside, it won’t be for lack of cadavers. Instead, it’s the dearth of anatomy professors that poses the threat. McGill has only turned out one PhD in anatomy in the past five years, according to Miller. They’re all being lured away to “fancy new molecular technology”, she laments.
Miller is a strong advocate of the hands-on approach. “Patients aren’t virtual, they’re real,” she says. She doesn’t want med students to confront their first human body in the hospital, and insists the trend towards virtual teaching is not going to work.