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Image: Ezra Whittaker
Image: Ezra Whittaker

SocietyJanuary 12, 2024

The first patient

Image: Ezra Whittaker
Image: Ezra Whittaker

Summer reissue: We are all indebted to the people who donate their bodies for medical teaching and research. For those who work with them, their humanity is never lost. 

First published on August 9, 2023. Click here to read more of our Death Week content.

The museum

A soft glow filters into the small room. 

On a shelf, a human foot with one black toe is stewing in a jar. A ruptured spleen and a diseased bowel linger nearby, submerged in jars of yellow liquid. Brains sit preserved indefinitely.

Next to the jars are brief descriptions – diagnoses, ages, intriguing tidbits – each telling a story about the grey specimens.

I’m inside the pathology room, which is tucked inside the Anatomy Museum at Otago Medical School. 

It’s dim and eerie. I can’t find the light switch, so I move around in sepia tone.

As far as I can tell, I’m the only person in the museum. Just me and thousands of silent specimens. 

The prosector

Latin; pro ‘before’ and sectio ‘cutting’: before-cutting.

Djuna Elkan is working on a pelvis.

It’s intricate and time-consuming work, trying to preserve as many vessels and nerves as possible, peeling off the skin, working through layers of tissue and fat.

“There’s a tonne of fat in the butt,” she says.

Elkan is a rare breed, a prosector. She spends her working day in the anatomy department at the University of Otago, dissecting cadavers and preparing body parts for researchers and students to learn from.

“If you had a conference for all the prosectors in New Zealand,” says her colleague Elise Wolfgram, “it would just be Djuna and a cup of coffee and a sandwich. The roll call would be very short.”

While others at the university can embalm and dissect, Elkan’s work is uniquely detailed. If she touches something a nerve, for example in the wrong way, it will snap and break. The pelvis will take her about three months. Elkan is an artist, engineer, and scientist.

The donors

Twenty-five years ago, Chris Gamble was lying on a busy Dunedin road. He was a pile of blood and broken bones. He’d been run over by a truck. The handlebar of his bicycle had pierced his skin, forcing itself inches deep inside his right thigh. He was losing blood fast.

Gamble twists the skull ring on his middle finger as he retells the story.

“All these strangers came to my aide, and I owe them everything,” he says. “I made it to the hospital with 10 minutes to go on the golden hour.”

Today, Gamble thinks a lot about death, about why he survived. He reaches into his pocket, pulls out his wallet, flits through a collection of cards and places one on the table.

Upon death, it reads, call the anatomy department.

Gamble wants to give back to the medical community and plans to donate his body to the University of Otago’s body donation programme.

So does Brian Treanor.

“I’ve always thought, once you’re dead, you’re dead,” says Treanor, 77. Like Gamble, Treanor almost was dead a few years back. He suffered a heart attack and had several stents put in.

“If something useful can be done with your body then that makes more sense than just shoving it into an incinerator or burying it in the ground,” Treanor says.

As a pensioner, Treanor’s also put off by the cost of funerals. He bobs away on his rocking chair, next to shelves lined with Terry Pratchett novels, books about cars and planes, photography, and caving. A man of science, not religion.

In her mid-thirties, Stephanie Brown is likely one of the university’s youngest listed donors. “I know it sounds blasé,” she says, “but I don’t have any spiritual or religious beliefs around [death], so I may as well be useful to someone.”

“Reduce, reuse, recycle.”

The details

“At a dinner party, when someone says, ‘what do you do for work?’ you have to make decisions about how much to disclose,” says Ellie Stevens, the quality control technician for the anatomy department. “Do you actually want to know, or are you being polite?”

Stevens manages a database which lists every piece of human material in the department.“We are obligated under the Human Tissue Act to know where everything is at any one time, where it’s come from, when it was cremated, where it was cremated,” she says.

When a donor dies they have to be embalmed within 24 hours. The university has arrangements with specific funeral homes in the South Island which follow their embalming process. 

Standard cosmetic embalming is about making the dead resemble who they were when they were alive. Anatomical embalming is different. The embalming fluid – a mix of ethanol, phenoxytol, glycerol, formalin, and water – is put through the arterial system, usually through the femoral artery in the thigh, and into the skull to preserve the brain. The mix makes the cadavers softer and easier to dissect than using a predominantly formaldehyde-based fluid. It’s also less toxic for those handling the body, and doesn’t discolour the tissue.

Stevens, Elkan (the prosector) and Elise Wolfgram (the anatomy technician) all know how to embalm and dissect.

Death is scary, Stevens says. People don’t want to think about death, or the people who work with it. “That means that all our jobs get put in the background.” 

“We’re young and normal,” says Elkan. “I’m a figure skating coach, so when people ask me about my job, they’re like ‘Wait, what? You deal with death and then you go and teach my child how to ice skate?’”

Pop-culture and the funeral industry have perpetuated a myth of an older man who works in the death industry, says Wolfgram. “He’s wearing a suit, he’s probably got a moustache. Undertakers wear the same suit for 40 years. It’s a suit from the 70s.”

“Things are changing,” says Stevens.

Elkan: “They’re… dying out?”

The history

From ancient Egyptian embalming techniques to early Greek physicians, humans have tried to make sense of what’s under our skin. For centuries human dissection was limited for religious reasons, but during the Renaissance period, the dissection trend was buzzing. Anatomical theatres were built and the public were invited to peer down at the anatomist with his blades and the cadaver – usually a criminal – at the centre of the stage. In the 1650s, the word “autopsy” was coined, from the Greek phrase, “To see with one’s own eyes”.

As the Renaissance gave way to the Enlightenment period, the study of medicine continued to grow, and with it, the need for more cadavers. But dissection was viewed as desecration, and bodies were still hard to come by.

In 1752, the British government introduced the so-called Murder Act. Anyone found guilty of murder would be executed and their bodies could be dissected by medical schools. But the Murder Act did little to meet the insatiable demand for cadavers. British medical schools were desperate for bodies and were even losing students to other European schools with more cadavers.

Schools were quietly willing to pay for bodies, and the business of body snatching and grave robbing mushroomed. So-called resurrection men would snatch bodies from freshly-dug graves, usually under the cover of darkness. Body snatching became so frequent, grieving loved ones would keep a watch over a burial to stop it being violated. The British public became outraged when William Burke was caught and found guilty of murdering 16 people and selling the bodies to medical schools. He would go on to be executed in front of a cheering audience of thousands. His body was dissected.

Three years later, in 1832 Britain introduced the Anatomy Act which influenced similar acts overseas, including New Zealand. It was intended to reduce grave robbing by legalising the trade of corpses. Medical schools were able to use the bodies of those who died in prisons, workhouses, and hospitals if they lay unclaimed after 48 hours.

However, in reality, families often didn’t get told their loved ones had died, nor given enough time to claim their bodies before they were traded in to medical schools.

The teacher

“I still remember my first dissection. I still remember what they looked like, I can see their face,” says Dr Latika Samalia, the self-described mother of the anatomy teaching department.

Samalia prepares medical students for whole-body dissection by giving lectures on the donor programme, human tissue laws, the history of using cadavers, and ethics.

Before students touch the cadavers they attend a whakawātea, a nondenominational Māori ceremony to “clear the way” for both staff and students to start working with the bodies. Students walk single file into the dissecting room where forty bodies are laid out on tables inside body bags.

“There’s different smells in there. It’s quite daunting to be in that space with so many bodies,” says Samalia.

Despite three decades working in anatomy, Samalia still has her bad days or sad days.

“Mine is seeing a body with nail polish. It reminds me of my mother when she was dying, and we used to sit and put nail polish on her.”

The students

The bustle and chatter of students chimes down the department’s hallways. A student has forgotten his lab coat and asks to borrow one from the office. A notice for bottomless brunch is pinned to the wall.

Like most medical students, Amelia Mance had never seen a dead body before. “I remember being very nervous, because I didn’t want to do anything wrong,” she says. “I didn’t want to waste the opportunity, nor did I want to do anything to disrespect the person.”

The bodies are naked, although a cloth is usually placed over genitals and the face during dissections.

“I remember seeing fingernails on them, and that just got me,” says Charika Muthumala, a student. “I was like ‘it’s human, it’s so human’.”

Most students handle dissection well, but about a quarter need more support. Staff can spot the students who are struggling by the colour draining from their face. They sit them down for a chat, passing them a biscuit or a glass of water.

Staff say they’d rather students show some emotion than none. After all, it is important doctors have some empathy. 

Over the school year, students develop confidence, their nerves dissipate, and they begin to see the cadaver for what it is: their very first patient. An extraordinary gift to their education.

At the end of year it’s time to put the body back together.

“We have dissected the body through and through, it’s all sorts of pieces,” says Samalia. “And we say to the students, ‘put it back as best as you can, tidy it up’. And they do. It’s amazing to watch them.”

Students take their time, tending gently to the bodies, reassembling the cadavers before a farewell is held, followed by a minute’s silence where students are encouraged to reflect and “say thank you – somehow,” says Samalia.

The bodies are then cremated and either returned to the family if requested, or sprinkled on the rose garden at Andersons Bay Cemetery, overlooking the ocean. A final resting place for the silent mentors.

The thanksgiving

On a chilly Spring evening, a bagpipe plays outside the Glenroy Auditorium in Dunedin. People are milling in the foyer, welcomed in warmly by student ushers. They have come to celebrate and remember their loved one as part of an annual thanksgiving service held by the department to thank the donors and their families.

Candles are lit, flowers are placed, a waiata is sung. Student Patrick Topp tells the audience that learning anatomy from cadavers was a privilege: “My whole outlook on university went from studying for a test and a grade to now working to be a good doctor.”

Rev Dr Jordan Redding leads the service in a minute’s silence. A deep hush falls over the hall. A few seconds pass and then: Beep-beep-beep! A phone has accidentally gone off. The Reverend looks up and smiles. “Someone’s communicating with us from the other side,” he says, and the room laughs.

The decline

The use of cadavers in medical schools around the world is declining. And in some cases, has stopped entirely. Reasons vary, from new technology to a lack of available bodies, and the cost of looking after cadavers. Ethical debates bubble away: unclaimed bodies are still used by medical schools in some countries, and like the past, the unclaimed are often poor who haven’t consented. There are overseas reports of body parts being bought and sold across borders. 

Everyone I speak to – donors, staff, students – agree there’s nothing quite like a cadaver.  Textbook learning, staff say, is based on what’s typically considered ‘normal’. But in reality our bodies have anatomical variations, it’s not necessarily a pathology, that something is wrong, it’s just different. Cadavers show that variation.

“We had one person come and show us what virtual anatomy is,” says Samalia. “You wear these goggles and you click on something, like a brain and you start seeing a brain, but you take the goggles off and there’s nothing on the table. It’s really hard for me to master that. I want something in my hand, the touch of tissues, cutting skin on a cadaver.”

And, the anatomy technicians ask, do you really want your surgeon making their very first incision on a live person?

These people are already dead, says Wolfgram. “It can’t get any worse from here.”

The reflections

I ask everyone I speak to for their thoughts on death. People are surprisingly forthcoming.

Stephanie Brown, the young donor, sorted out the paperwork for body donation when she was arranging her will. “My personal belief is about contributing. We have a social responsibility to support each other and contribute to society. I’m a social worker and this is another way to do that. I’m not going to need my body anymore.”

Mike Lilian, another donor, says giving his body is “the last good thing I can do”. He pauses, chuckling, “And, it’s the only chance I’ve got to get into med school.”

While some of the donors are strong atheists, others remain religious up until the day they die. Cultural and personal beliefs vary. A common theme is an appreciation of science and medicine, and a desire to give back.

Anatomy technicians Elkan, Stevens and Wolfgram are not religious, but they still talk to the bodies they work with, they still care for them, and put them in “comfortable” positions rearranging limbs.

Wolfgram describes the steps from death to dissection: removing a person’s pyjamas, issuing the cadaver with a number, embalming them, and sectioning them down. When she accidentally bumps their heads, she finds herself apologising to them. “At no point along that journey does the humanity get lost for me.” 

The question

Our understanding of the human body is built upon thousands of years of research which has been stymied or advanced depending on the current zeitgeist of the time, religious beliefs, ethical debates, and access to bodies.

Anatomy, like medicine generally, has uncomfortable truths laced through its history: there are stories of power, greed, and questionable ethics.

But it is a remarkable history, too. Throughout the centuries, humans have strived to improve anatomical knowledge and ultimately medical care. We are indebted to the people whose bodies were dissected, contributing to the knowledge we have today.

I turn to Treanor sitting in front of me, the warm afternoon sunlight shining through the windows in his living room. I ask him why he wants to donate his body, what he thinks about death, funerals, and science. And then he takes me by surprise, looking at me from his rocking chair, surrounded by beautiful books. “Are you considering donating your body?” he asks. I’ve been thinking about his question ever since.

Keep going!