I’d rather be dissected

There are not enough whole-body donations to science. Why don’t people want their death to help the living?

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Medical students make use of a cadaver left to science at the Humboldt University, Berlin. Photo by DPA/PA

Medical students make use of a cadaver left to science at the Humboldt University, Berlin. Photo by DPA/PA

Brooke Borel is a science writer. Her work has appeared in Slate, Discover, and BBC Future, and she is a contributing editor for Popular Science. She lives in New York.

I was in seventh grade in 1993 when Marie C Wilson and Gloria Steinem launched the Ms Foundation’s Take Our Daughters to Work Day, intending to show us young women that a big, wide world existed beyond our gender and our bodies. For me, it did just that, although it also seeded a lifetime obsession with bodies in a different sense. For while many of my classmates were sitting with a parent in a tidy office, I spent that inaugural daughter-at-work day in an autopsy room watching my father, a pathologist and former county coroner, dissect a dead man.

That man was a grizzled old farmer and he was delivered to the basement for autopsy at my dad’s hospital dressed in a long-sleeved shirt and denim overalls, a detail I remember clearly but that seems odd when I think about it now. I called my dad a few weeks ago to ask why the farmer wore overalls to his autopsy, and why there was an autopsy at all, which also seems unusual today. Dad doesn’t remember the case, one of so many over the years, but said there was likely no witness to the farmer’s death, in which case his doctor might have requested an autopsy to exclude an accident, suicide, or homicide. As for the clothes? That happens sometimes. People do, after all, often die while dressed. In our phone call I learned, too, that Dad doesn’t even remember taking me into the autopsy room. ‘I did that?’ he asked, laughing, incredulous. ‘An autopsy? Really?’

For me, the memory is clear. I remember that the farmer was the first dead body I’d seen. I remember standing at the edge of a cold room in oversized scrubs rolled up at the ankles and watching my dad, similarly dressed, struggle with the legs of the man’s overalls. I remember thinking that dead bodies don’t bend. I can see the farmer’s generous potbelly smiling at the ceiling after my dad finally stripped the clothes from him and laid him out, fully naked, on a metal gurney. I remember watching my dad as he wheeled the gurney to the centre of the room and transferred the man to an autopsy table, positioned under a bright light and over a drain. I can hear my dad dictating each step to a tape recorder in a business-like tone and, although I can’t make out the words, I remember that they seemed to be in a foreign language. I remember the long, Y-shaped incision the scalpel made on the man’s torso. I especially remember watching my dad cleave through the outer edges of the man’s ribs with an electric Stryker saw and then lift off his chest like the lid of a box. I also remember thinking: is that really my dad?

At the end of the autopsy, Dad rooted around the farmer’s still heart. Then he presented me with two grisly lumps in his gloved hands while earnestly explaining the difference between them. One was a tiny pre-mortem blood clot and the other a larger, post-mortem blood clot. In the former, the blood cells are mixed and the mass is uniform because the blockage formed when the blood still circulated. In the latter, the blood cells separate into distinct layers of yellow and red. If Dad found more of these pre-mortem clots and if the microscope confirmed what they were, we’d know that the farmer had died of a heart attack.

I don’t remember feeling scared or uncomfortable, but rather in awe at the scene in front of me. At the work my dad did. At the things that can happen to your body once you’re gone. And for the first time, it hit me that, after I die, part of me will remain.

Some of my strongest childhood memories involve gathering around the dinner table with my family and listening to stories of death. Of course this sounds morbid, but we were just doing what many families do over a shared meal, which is to talk about the kind of day each of us had. And for my dad, the day usually involved the dying or the dead.

The stories weren’t always about autopsies. Sometimes, Dad told us about receiving a hunk from a mysterious growth that a surgeon had cut from a patient, who still lay open on an operating table down the hall. Dad would quick-freeze the piece of tissue and slice it into thin cross-sections with something like a deli slicer. Then, he would put the translucent shavings on a slide, stain them purple and pink, and look at them under a microscope for the deadly harbinger of cancer. When I was young, the name for this process — frozen section — made me think of grocery stores.

Sometimes, the frozen section helped save the life of the person on the operating table: the doctors caught the cancer early, before it had spread, and removed the growth there and then. In others, the procedures came too late. These, Dad told with a heavy voice.

Other tales were about identifying a particularly rare disorder. Here, Dad described digging through medical literature and textbooks and then comparing one image of purple-pink-stained cellular architecture to another to look for distinctive patterns.

My favourites, however, were the coroner stories, which were ghastly in a way that absorbed me as a child but that carry a different weight now in my adult mind (although, with today’s ubiquitous forensics television shows, I suppose solving unusual deaths fascinates us all). There was the one about the woman who shot her husband through the common carotid artery with a .357 Magnum, and the cautionary tale of the toddler who was crushed by the wheel of a school bus. That one still haunts me.

What I learned is this. To study the human body, nothing but a real one comes close

Then there is the story I’d beg for whenever I had friends at the house for dinner or a sleepover, which now makes me wonder why they ever came back. It begins with Dad stepping out of his car in the wide rural farmland of north-east Kansas to the staccato retorts of gunshots. Startled, he turned to the sheriff waiting to take him to a death scene, who drawled: ‘Don’t worry. They’re just gettin’ the last of the dogs.’

My dad was there to examine the limited remains of an elderly couple who had died and to piece together what had happened to them. Based on the eviction notice in the mailbox and the half-packed car, he deduced that the couple had been moving out of their dirt-floored shack. The woman’s medical history suggested she couldn’t walk; her remains in the bed indicated she’d died there. Perhaps she had been waiting for her husband to help her to the car after he’d finished loading it. Instead, he’d had a heart attack in the thick summer heat. The hypothesis made sense, anyway, from the man’s own medical records and the suitcases that sat in the dusty drive between the shack and the open car. Unable to walk or to yell for the nearest neighbour miles down the road, the woman slowly wasted away.

All that was left of the man was a piece of his occipital bone, from the lower part of his skull. What happened to the rest of him? Through interviews, county deputies learned that the couple had befriended a pack of feral dogs. The dogs were accustomed to being fed scraps from the shack. When the couple died, the hungry dogs turned on them.

It’s a horrible, sad story, yes. However, to my child’s mind at sleepovers, it was like a ghost story. But better.

Twenty years after my Take Our Daughters to Work Day experience, although I am still young and in good health, I’ve been reliving that autopsy scene as I contemplate what will happen to my body when I die. We humans have a unique faculty for existential navel-gazing; to understand the difference between is and was, between life and death. We can trace the path of a life to its logical conclusion: no matter the precautions, the detours, or the scenic routes, some day it will end. And once I get past the paralysing, trapped-animal fear that accompanies such thoughts, I start to wonder what will happen next. What path might my body take once whatever makes me ‘Me’ is gone?

I don’t mean this in a spiritual way. Many people come to accept death through the promise that they will live on in an afterlife or through reincarnation, but these aren’t my beliefs. Nor do I share the view of the gerontologist who wants to cure ageing altogether, or the futurist who is waiting patiently for the singularity; to me, both seem like just another way to avoid accepting death, under the veil of science rather than religion. What I’m talking about is what will happen to my shell, my physical remains, when I die. I’d like to have control over where my body will go and what it might do, even in death. I find comfort in knowing I have a say.

The thought of being immediately sealed in an expensive box or cremated does not appeal. I understand that such longstanding cultural traditions console the people who remain behind, but to me it seems that my body would be wasted in either case. Before it reaches its final resting place, I want my body to be useful.

To do this, I need to think of a way for my death to make life better for the living. One option is to donate usable organs to someone who needs them: corneas for the blind, skin grafts for the badly burned, or a variety of other organs, from the heart to the kidneys to the lungs, for the diseased. I’ve already been an organ donor for as long as I can remember; it’s printed on my driver’s licence under a red cartoon heart. But lately, when I’ve thought about dying, I’ve wondered if, for me, this is the most meaningful donation. Coincidentally, my driver’s licence is due for renewal at the end of this year.

I recently wrote a short article on the different ways in which whole-body donations are used in research and in medical education. As I interviewed the scientists and doctors involved in this work, I realised that my questions about the anonymous cadavers they use were not just for the purpose of writing my article. The subtext was that I was asking how my body would be used, should I decide to leave it as an anatomical gift.

I'm told by those who have experienced it that the relationship between medical students and their first cadaver is a special one

What I learned is this. To study the human body, nothing but a real one comes close. There are usable proxies — computer models and crash-test dummies, for example. But neither replaces the real thing and, in fact, both are built and tuned with data collected from cadavers. Without input from real bodies, with their real anatomical complexity, neither substitute would exist.

There are never enough whole-body donations. In any given year, researchers make do with what they’ve been given, but they could always use more. There are obstacles: a person or their surviving family must give consent, different legal frameworks exist from one country or region to the next, and some bodies aren’t suitable for all areas of research. Not every donation programme is what it seems, either, and the best way to ensure that my body goes to research is to donate through a state anatomical board or a medical school.

Many areas of research require cadavers. Scientists who study the biomechanics of injury, for example, want to understand how the human body gets hurt so that they can help to prevent it. They craft controlled tests to understand the impacts a cadaver can withstand. Then, after translating these measurements to a model or a dummy, they test and perfect the protective gear that keeps us safe.

My body, I learned, could help improve safety belts in a car or seats in a train. My brain might help designers make helmets that mitigate the traumatic brain injuries an American football player sustains in a rough tackle, or a soldier gets from the shockwave of a bomb blast. When the research is done, if my family wishes, they can have my cremated remains (in which case, I wouldn’t mind if my ashes are spread somewhere I once loved). If not, I might be honoured alongside other unclaimed donors by a plaque, a tree, or a solemn annual ceremony.

Forensic scientists, too, use cadavers in their work. A handful of universities take donated bodies and plant them in the ground or place them in a secluded wood. Then the scientists map out the time it takes for the blowflies, dermestid beetles, and other scavengers to render the bodies to bones. This, I suppose, is a different sort of reincarnation — to become part of the ecosystem of a field or forest floor. It might seem a grim end, but the data can help forensic researchers identify the time when a person died and what injuries they might have suffered, which in turn helps law enforcement officers to solve murders.

If I were to choose this route, my body might eventually be used to recreate a specific crime scene — hanged in the forest, or stuffed in a car trunk — which could help a coroner solve a case, or a cop bring a killer to justice, just as my dad once helped unravel deadly crimes. Maybe this would bring some solace to a grieving family. Afterward, my skeleton might rest in box in a forensics collection, occasionally living on in the form of research on the ageing of bones.

These are all worthy legacies, but there is one more option for whole-body donation, a longstanding tradition in medical training, that feels a better fit for me. Every first-year medical student takes a gross anatomy course in which they dissect a human cadaver. This is their first patient. It might be the first dead body they have ever seen or touched. When they enter the gross anatomy room, they might see two- or three-dozen different bodies, each a unique example of the dizzying array of human size and shape.

I’m told by those who have experienced it that the relationship between medical students and their first cadaver is a special one. The cadaver provides knowledge the student wouldn’t have otherwise; the student is awed and thankful for the gift. One physician I interviewed told me: ‘You learn the facts, but you come out of the process with appreciation, with a reverence for this majestic structure in front of you. And you appreciate a human being in a very different way.’

In this scenario, if I were to choose it, my body might teach a future doctor the physical landmarks for inserting a spinal tap, or for ruling out appendicitis. A surgeon might learn to dissect the delicate nerves in my hands. Or, perhaps, a pathologist might realise the difference between a pre-mortem and post-mortem blood clot.

It’s a heavy decision, to choose where you’ll go when you die, and a deeply personal one. Many people don’t want to bother, and some don’t even get a say. For me, I choose an active role, and I’m lucky to have that opportunity. I haven’t made a final decision yet, but a medical school body donation application form is saved on my computer desktop. Maybe, by December 31 of this year — the day my driver’s licence expires, as well as my birthday — I will fill out this application and drop it in the mail.

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Comments

  • Natural Death Centre

    A great piece. At the NDC we’d love to see the joining up
    of thinking and publicity of the organ donation groups and the body donation /
    tissue donation. This would make it so much simpler for the public to
    understand. To donate a body in the UK see the Human Tissue Authority web @HTA_UK http://www.hta.gov.uk/bodyorganandtissuedonation/howtodonateyourbody.cfm

  • Archies_Boy

    Wow! That is one pungent article! My immediate thoughts while reading it: • Had that been me at the autopsy at that age, I probably would have fainted and been marred for life. • Since then (and I'll be 77 in about three weeks), I have become a donor of my body parts. If I have something of value left over, why shouldn't it go to someone who can use it? • I have come to something of a settlement about death. I'm not terrified the way I used to be when I was younger. My thoughts have evolved a lot over the decades. • If the earth is billions of years old, even the redwoods and sequoias — living for millennia — live only for a fraction of an instant upon this earth compared to cosmic time spans, what to say about 80 or 90 years! Hmm — to be the child of a medical examiner — quite gives one pause for thought...

  • Angus Lyon

    A very thought provoking article on how to contribute beyond death

  • Joan

    My husband had cancer for seven years before he died and when he did, I dressed him in a never-worn tee-shirt from a school of science that had colorful silk-screened creatures of all species printed on it and he was taken away in a black body bag. He had donated his body but his doctor, also a medical ethicist, asked me particularly if there were any restrictions on the use of his remains. I said no but that I would like to know what had been learned by people who researched his parts. I got his cremated ashes but never got any news of what had been learned and that causes me to feel reluctant when it comes to deciding about my own body. I'm certain it's another set of tasks to report back but it would have pleased me (especially since I was told I would get something). It was too much for me to followup on my own.

    Also interesting to hear (and hope) about med students and their first cadavers because my daughter (who was twelve when her dad was removed in that black bag) needed anatomy to graduate from Tulane with a degree in exercise physiology. She was traumatized by the repeatedly-used bodys that had been handled so many times and she needed to make a special trip after her whole class graduated, just to complete that one course. There are skills of disassociation and they might not be understood well enough to be taught. The writer had a good experience with her father -- my daughter not so good.

    It's helpful to have these issues on the surface. I'm a potter -- bones are good in glazes -- too bad there aren't more community kilns.

    • Brooke Borel

      I am sorry that you did not hear back about specifics on your husband's contributions. I would want to know, too, although I think there are likely varying policies on this depending on where you donate. I'm also sorry to hear that your daughter had a bad experience in the lab. It sounds like there weren't enough bodies, which is part of the problem. Since I wrote this essay, I learned from one researcher that some schools don't even have enough donations for students to see a body at all, which I think is a shame.

      • babby660

        Well, if they're going to bill the widow for the cost of the "autopsy," it's no wonder there are not many donations.

        I was notified after my husband died of cancer, that the only usable body part turned out to be the sclera, the white of the eyes. I was gratified that we were able to make that contribution.

        I'd like to know what ghoulish group tried to bill docbets for the "autopsy". That was disgusting & I'd like to make sure my body doesn't go to that agency.

        • docbets

          I don't mind telling you, but since I am small and they are large, I would not like to find myself in the middle of a libel suit or something.

          • babby660

            don't blame you at all, docbets. Since the Supreme Court declared that corporations are people, we, the people are left with no recourse but grumbling.

    • docbets

      See my comment above for what happened when I did get a report. I am sorry it turned out as it did for you.

  • alanborky

    One o' the reason why there're never enough whole body donations to science's simply because medical students're lowest in the food chain. There're far too many vested commercial int'rests growing in numbers and specialisations daily who get to harvest the primo material. Only stiffs with low monetization possibilities reach those their donors imagined they were bequeathing themselves to. This situation won't be improved by Google's announcement they intend to cure old age. Part of the problem's people're allowed to choose which parts of their bodies they wish to bequeath but ain't allowed to specify what use those parts'll be put too and the commercial harvesters and their cohorts aim to see it stays that way.

  • Anonymous

    FYI your description of the blood clots is reversed. Pre-mortem clots are "organized" into distinct layers.

    • Lines of Zahn

      I agree. The pre-mortem clots are the Lines of Zahn, organized layers of fibrin and platelets.

      • Brooke Borel

        Thanks for your notes. To clarify, the layers I describe in my essay are not Lines of Zahn, which are usually observed by microscope (and, indeed, would appear in pre-mortem clots). Instead, I am describing the "currant jelly" and "chicken fat" separation you see in post-mortem clots in a gross examination. See for example this description of post-mortem clots: http://compepid.tuskegee.edu/syllabi/pathobiology/pathology/genpath/chapter1.html

  • Bill Williams

    Our son, William, died of an accidental heroin overdose at age 24. Determined that his death not be in vain, one of the things we did was to give his body to a medical school. To a person, the doctors that we asked about doing so, commented on how important their anatomy class was in their development as physicians. The head of the program who "accepted" William (getting a deceased 24-year-old into medical school, even as a cadaver, isn't as easy as you might think) was emphatic that an anatomical donation could ultimately be even more important than an organ donation. We lost William a mere ten months ago. I confess to images of him both pickled and sliced - not the whole boy I kissed goodbye in the hospital. Nonetheless, your essay is sweet balm and encouragement to follow in my son's footsteps when the time comes.

    • Mabel

      *hug* What a thoughtful thing for you to do, especially in your hour of grief. I'm so sorry for your loss.

    • Brooke Borel

      Bill, thank you for your comment as well as your email. Again, I am so sorry to hear the wrenching story about William, which I have been thinking about all day. I am glad that you were able to find at least some comfort in your ability to do an anatomical donation.

    • wallstreetcrime

      Words cannot convey my sympathies and my admiration for you. I'm so sorry you have faced this issue.

      Last May, my 20-year old niece died suddenly and her mother (my sister) was able to get her only child's brain to Harvard for research on Retts Syndrome, a genetic disorder her daughter suffered from. Despite her extraordinary grief, my sister had the presence of mind to remember that her daughter had a variation of Retts that is rarely seen and one that required research. That important research will be helped because of the her donation to one of the world's preeminent institutions.

      • Bill Williams

        Bravo to your sister. It is so important to make a donation, especially under the stress of the loss of one so young. Your sister is a heroine.

  • Rahntwo

    Excellent article. Just a few days ago I told my wife of 22 years I wanted to be cremated instead of embalmed and buried in a sealed box. It just seems so unnatural to me. When we die, we should be returned to nature, not preserved in some box under the ground. I think she didn't like my decision but she agreed to it. After reading this article I think she my like my new decision even less. Ive been in the medical field most of my life. Teaching people how to draw blood, give shots, do arterial draws, and then inviting them to practice on me. This seems to be an excellent way to carry on the practice and continue to be a benefit after death.

    • edward hessler

      I hope you sign up. I signed up to do this and carry a donor card that notes I want my body to go to a nearby medical school. Seemed like a good idea at the time; still does and I I don't expect that to change. The only thing I'm sorry about is not being able to hear the conversation!

      If you've not read "The Anatomist: A True Story of Gray's Anatomy" by Bill Hayes, I think you'll like it. It is about the author of the famous text and the illustrator (much less well known)--both brilliant, talented and hard working--but it is also a bittersweet memoir and a perceptive description of Hayes's time in the dissection laboratory where he was a student in a variety of classes, including medical students. They are different cultures! And you get to know a little about the effort required to become a teacher of gross anatomy--hours and hours at the bench.

      For a preview see here: ( )

      Take care.

  • 10010101101011

    faaaaaaaaaaaaascinating
    reminds me of the egyptians - i'm sure they were one of the first to explore anatomy

  • Mabel

    I'm very interested in forensic science, so I've been thinking about donating myself to the Body Farm (the one where they put you in the woods, etc.). I want to make sure the arrangements are made before I die, because I don't have anyone who would take care of it, and my relatives really don't care or understand anything I want and why. They would probably waste money burying me.

  • simonny

    wellMadelyn. you think John`s story is impressive,
    on saturday I bought a t0p of the range Land R0ver Defender when I g0t my pay
    this past weeks. with-out any question its my fav0urite-j0b Ive had need
    pr0ve see here. s­i­t­ℯ­6­4­.­ℂ­ℴ­m

  • Daniel

    My bday is Dec 26th! Happy Capricorn

  • Valere

    I work at MedCure.org which is a body donation program for medical research and education. It has been interesting for me to learn how much body donors teach the living! From studying human anatomy, surgeons practicing new surgical techniques and a lot of research and development of improved medical treatments and devices. Our donors do not participate in any forensic studies or crash-test studies though, just what one would commonly refer to medical research and education.

  • docbets

    My mother, who felt terribly useless in her later years due to infirmity from Parkinson's, wanted to be useful by donating her brain. The day she died, the university medical school was delighted to receive her body for this purpose. They asked me on the phone if I would be interested in a copy of the report that would be generated, and I said yes.

    Imagine my surprise a month later to receive the report and a bill for "the autopsy." I hastened to call and explain that I had not asked for an autopsy, nor did I wish to pay for it. I was told that such research costs a lot of money, funding was tight, and every effort was made to guilt me into paying. In due time, I was asked instead to make a donation. I refused.

    No matter what I said, in that phone call or subsequent ones, and in written communication, I don't think anyone ever grasped that the donation had already been made, and it was the brain! Instead, I received condolences, and inappropriate assertions that of course I couldn't be expected to be entirely rational, given my mother's recent death. Actually, I was relieved by her death, and any grieving I had to do I had done long before. The entire appalling, insulting experience was one I am not willing to repeat.

    • babby660

      that's an appalling story --guess you have to write out a contract when you donate a body. thanks for the heads-up

  • CatheyBarrett

    on a side note...such an amazing article on internet jobs..interesting read... ℰ­x­i­t­3­5­.­c­o­ℳ

  • Brandon

    I am very thankful to you for this. I was searching this for a long time. It is very helpful and interesting material for me.Habitatfit!

  • Phrase Finder

    Thank you for this an oddly lovely story!
    When my grandmother donated her body to the local medical school, we learned that the school holds a memorial service every spring to honor the people who do so. The service was a meaningful event for my family -- a reminder of my tough 94-year-old grandma's generous nature.

    Details in this PDF: http://www.utoledo.edu/med/depts/neurosciences/pdf/UTADP_Application_Packet_Jan20.pdf

  • Carl Richmond

    I dodged a bullet when I was a heroin addict in the early 70s. In my will, it says to give any usable organs for transplants, and I suppose after reading this, that I will leave the rest of my body to science.

    Heroin is a terrible scourge. My heart goes out to you for your loss. nothing could be worse than losing a child. But your courage is admirable. From one who knows.

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