The Wills of Twenty Strangers

Anna Mirer

It is eleven o’clock at night, and I am stomping around with half a skull in
my hand. “Where are all the goddamn pipe cleaners?” I ask the room. The
situation is not really urgent enough to require profanity, but I am tired and
miserable, and I am resorting to overstatement in the hope of making my tired
and miserable colleagues laugh. My study partner and I are getting confused
about the difference between two holes in the skull, called the inferior orbital
fissure and the infraorbital foramen. They have similar names, but different
functions. The characters, if you will, of the foramen and the fissure are quite
distinct, and to demonstrate that, I need to push a pipe cleaner through each
of them to represent the paths of different nerves.

There are five days left in the spring semester, and the anatomy lab is
getting squalid. Printed lab guides and anatomy atlases with broken spines are
strewn everywhere. The pipe cleaners have all disappeared; there is a shortage
of forceps and probes; the dispensers are out of soap. The good model of the
inner ear is missing, and is rumored to have been hidden by a crazed medical
student. Skulls with the tops sawn off have been jumbled with the tops of
different skulls. There is a Snickers wrapper on the floor, which means that
someone first ate a candy bar in here, then littered. We have been stepping
around the wrapper for two days. The maintenance staff does not like to
come in this room, so the floors have not been cleaned since January, when
these twenty cadavers in tanks were wheeled in. In that time much liquid has
been spilled. The tanks are filled with a preservative solution that sloshes out,
but there is also blood, fat, mucus, feces, and the nondescript juice that fills
the crevices of an embalmed corpse.

Our last exam will cover structures of the head and neck. At this late
stage in our studies, most of the body below that has already been cut away.
Now the heads have been bisected to reveal the structures behind the nose.
It turns out, strangely, that people still look like themselves, even with layers
of their faces removed. We learned in neurobiology that there is a section of
the cerebral cortex devoted entirely to recognizing faces. People with damage
to that part of the brain may lose the ability to recognize others by sight, or
to know their own image in a mirror. This is called prosopagnosia, or face blindness. Here in the anatomy lab, faces are all that remain to remind us of
human individuality.

Tonight I am studying with Rachel. Level-headed, serious, and gentle, she
wants to be a surgeon, and she likes the tactile aspects of dissection. Rachel
once let fall that her lab partners don’t like to use their hands as much as she
does. This being as close as Rachel comes to complaining, I surmise that she
has been stepping up to the “gross” jobs, of which there are many. We are
searching for a muscle on the front side of the larynx, so we flip a bisected
head backwards, and lay two halves of a face flat on the table. For a fraction
of a second we take in the surreal vision, and Rachel cannot stifle a murmur.
I glance at her, but I do not ask her if she is okay. With a bit of a pang, I press
on, and in doing so, I signal to my friend that she is supposed to be tougher
than that.

Rachel’s murmur, any murmur, is such a minor thing on the spectrum
of medical student coping mechanisms. Among our colleagues, anatomy lab
has evoked responses which range from mild guilt to deliberate callousness.
Only one student actually abstained from dissecting; some of us suspected he
had a religious objection that he didn’t care to make public to the naïve and
frequently judgmental population that makes up a first-year class in medical
school. Many, many cultures hold the integrity of human remains sacred.
Medical culture initiates its healers through ritual disintegration.

The first day I came into the lab I was overwhelmed with sadness. I took
one look at my cadaver’s face and felt a rush of love. It wasn’t like me; I’m
not prone to strong emotions about the deaths of strangers. How illogical
to feel bereft when I hadn’t lost anyone or anything; on the contrary I had
acquired something, or someone. And I knew nothing about the character
of the woman I didn’t lose. Before she donated her body, she could have
been a miser, a philistine, a bigot, an abuser. Yet I felt the way I feel upon
learning of the death of a friend. When I came home from the lab, I sat at
my bathtub washing the smell of preservative off my arms and weeping. My
husband came in to comfort me. “It was harder than I expected,” I told him,
unnecessarily. “She was tiny.”

By my next visit to the lab, though, my dominant emotion was fear of
screwing up. Grades (even of the pass-fail variety) have the unfortunate
effect of promoting self-absorption, and performance anxiety can consume
the impulse to reflect. I tended to project my insecurities onto the cadavers, imagining that with each missed test question I was letting them down. I
would try to justify my presence by naming structures and reciting their
functions, pouring my energy into diagrams and mnemonics and repetition.
Alas, I am not very good at anatomy exams, so I was left hoping it was
enough that having passed anatomy would allow me to do the things I am
good at and the things I came here to do.

Obsessing over tests is a convenient, if unconscious, method of
dissociating from the act of cutting into people’s bodies. But there are others.
Most of my colleagues seemed to follow the grand tradition of objectification,
striving to perceive the tissues in their hands as inhuman. Others relied on
the equally time-honored strategy of gallows humor. One of my lab partners,
a former nurse’s aide, prided herself on her strong stomach and did the lion’s
share of our dissecting. By her own admission, she hasn’t got much of a
filter, and she seemed at times to be daring us to object to her frankness.
When we removed the brain she observed, “Mmm, the cerebellum looks
just like hamburger.” At the time I considered protesting, but decided she
didn’t deserve moralizing from me, so instead I responded, “More like turkey
burger.” I immediately apologized to the group, but felt like my comment
lingered for the rest of the day.

My other two lab partners were quite open about their discomfort.
One usually tried to get out of the lab as quickly as possible. She sometimes
seemed to retreat mentally, distracting herself by trimming fat off our
cadaver’s organs. The other one occasionally got faint and needed to step
out. Both would become agitated if the shroud covering our cadaver’s face
began to slip off. They never saw her face until the day it had to be skinned.
“She looks like such a nice lady,” the one prone to faintness observed sadly,
as I was preparing to cut into the forehead. “She may have been,” I replied.
“We know she did a very nice thing.”

The woman whose cadaver we were dissecting had, in fact, done
something great for us: she had willed her body to the school through the
Anatomical Gift program. It’s a comfort to me to know that all of the people
whose bodies we were using in this way knew what would happen to their
remains. We have no John Does in the anatomy department, and like many
schools we honor the donors every year with a student-run memorial service
to which the donors’ families are invited.

I was involved in planning the memorial in the beginning, but stepped
down over creative differences. My notions of how to honor the dead
involved too-candid descriptions of the bodies, and too-open discussion of our ambivalence. Where I come from, people take offense at the slightest
hint of sugarcoating, especially at memorial services, where grief is the point.
But, as I am daily reminded, I’m not from around here. Even if it wasn’t my
cup of tea, the service was still quite moving in the end.

Curiously, it seems that every year all of the donors have been white.
That is remarkable even in a Midwestern state like this one, teeming with
Caucasians. I have no idea why it is so, but it makes me wonder. What kinds
of privilege might be invisibly woven into the decision to donate one’s body
to science?

The skull I poked with pipe cleaners did not come from our cadaver,
or from any other donor. It came from the remains of a person who died
in India many decades ago, and who was probably extremely poor. Some
people or some company made a living by hauling away the bodies of the
destitute and burying them with a particular species of beetle that ate away
flesh. Months later they dug up perfectly clean skeletons and sold them to
Western medical schools. The schools are no longer allowed to buy skulls
this way, so our professors remind us that the ones we have are irreplaceable.
Treating them with care includes not resting them on top of cadavers, so that
they will not be covered in juices. Despite the warnings, slime accrues, spiny
prominences break off, teeth fall out. None of the skulls is completely intact;
only an expert could look at one and imagine a face. Any connection to the
memories that used to lie inside these bones was broken long ago.

Though Rachel and I can still find the vision of disoriented flesh uncanny,
the moment passes and is quickly forgotten. We have a long list of structures
to identify, and as the evening wears on I must fight the temptation to panic.
We cannot find a useful example of the stylopharyngeus muscle on any
of the cadavers dissected by students, so we move into the room with the
prosections (a near-cute nickname for professional dissections, which are the
work of trained anatomists).

We open up the tank full of heads. Some still have all their hair, many
have broken noses, a few still have eyes over which the lids do not close.
Rachel shows me one specimen, identifiable by its color, that has been here
since the 1960s. The man it once belonged to must have been born in the
nineteenth century. “What do you think he would have thought,” I ask her,
“if he could have known that forty years after his death, medical students
would still be learning from his preserved head?” I like to think he would
have been proud, but I am inventing. He may have wanted nothing more from his donation than to save his family funeral expenses. Perhaps he was
so sure of the finality of death that the fate of his remains wouldn’t even have
interested him.

I find it easy to imagine stories for him, because I can see his nose and
mouth and eyelids. It is harder to construct a biography from the contents
of the next tank, the tank full of female pelvises. We used these specimens to
study structures like the labia majora and the clitoris. Occasionally when my
mind wandered I would think these are what someone used to make love, and perhaps to bring people into the world. In the beginning I covered our cadaver’s genitals with a shroud whenever possible. A friend pointed out that I was using the
same draping technique we had been taught to preserve a patient’s modesty
during a physical exam. Eventually, though, so much of the lower body had
been cut away that it no longer felt like a meaningful gesture. I no longer felt
I was looking at a naked body, only parts.

A student at a medical school in another state told me a story about a
cadaver. When she took anatomy, her group dissected the body of a man
who had died young. Young body donors are very unusual (among those
at our school the average age at death is eighty), and this person seemed to
have been in excellent health—athletic, strong, and apparently free of injury
or disease. On the ankle was a tattoo of his own name. Curious about the
man’s story, the student looked him up on the internet. She learned that he
had been a serial rapist and murderer, who was executed by lethal injection.
She would go on to dissect the rest of his body, including his penis, thinking
all the while of how it had been used as a weapon.

I had been hoping to learn our donor’s name at the memorial service, but
I didn’t recognize her among the photographs brought by the families.
Although we were not to learn about her life, one of my lab partners eventually
learned the contents of her death certificate from the school morticians. I
was expecting the cause of death to be complications of an aortic aneurysm,
since we could see the place in her chest where her largest artery ballooned
out, and crunch the plaques in the vessel wall between our fingers. We knew
from the fragility of her skeleton and the exaggerated curve of her backbone
how severe her osteoporosis had been. Once when we were flipping the body
over, I broke her scapula just by bracing against the turn. We also knew she
had been feeble at the end, because her muscles were too atrophied to have
been well used. Her stomach was empty, and so small that she could not have
eaten normally in some time. According to her documentation, she died in
her late seventies from dementia and advanced Parkinson’s disease.

Because of the woman’s progressive deterioration, on the day of the face
dissection we couldn’t make out the muscles used for chewing or forming
expressions. We called a professor over to help. “I don’t blame you for having
trouble,” he said, probing and cutting through the unrecognizable mush
below her cheekbone. “This is the body from hell.” I took his comment
personally. She was old and sick and paralyzed, I wanted to snap. She’s not from hell,
and she’s not in it either.

I prefer Rachel’s response, when I tell her about the face dissection. “I
don’t want to die with mushy muscles,” she says. Neither do I. I think I might
like to die of an epidural hematoma, caused by a falling geranium pot that
cracks my skull while I am out for a stroll on my 108th birthday. I wouldn’t
mind having my body donated afterwards, but I’d rather it be put to use
testing automobile crashes or something—not for dissection.

After that first day in the lab, my feelings of love remained, but I never felt
sad again. Eventually I found I didn’t need to dissociate, or to objectify my
cadaver, because I was sure that my cadaver was not a person. It was an aspect
of a person. I feel lucky to hold that conviction, because as long as I believe
that to be true, I know the work we did in that room was not an unfortunate
means to an end, but was itself the right thing to do. We began with a dead
body, and over many months we transfigured it into memory, skill, strength,
gratitude, and indistinct organic matter. No matter what we make of our lives
next, we have done a good and appropriate thing to honor twenty people by
respecting their wishes for their remains. They did not wish for a semblance
of rest, and they did not wish to seem whole. They wished for us.