Six students hunch over a yellow cadaver in the basement of Wayne State University’s Basic Medical Science building.
“Is this the artery?”
“It might be a vein.”
It’s the second day of lab in Human Gross Anatomy (the study of anatomical structures visible to the naked eye) for Mark Ireland’s, Ph.D., first-year medical students. Today, they’re learning to identify the network of nerves between the neck and shoulder called the brachial plexus.
It’s the beginning of a four-month course that will lead them through a full dissection of the human body in four, four-week sessions: first, the upper limbs and back; second, head/neck; third, thorax/abdomen; and fourth, pelvis/perineum/and lower limbs.
By December, the students should know how to identify and explain the function of multiple muscular, skeletal, circulatory, and nervous structures.
For now, however, they are hesitant.
â€¨“Is that the brachial plexus?” a student asks Ireland.â€¨
The teacher bends down and traces something gray with his scalpel. Ireland gives a slight nod.
“Keep exploring that,” he says, prodding the cadaver. “I’ve got some ideas what it is, but I want you to figure out what it is, too.” Ireland moves on. There are a lot of tables for the course director to attend to. There are 306 med students enrolled this year, and with six students to a cadaver, that means 51 cadavers in lab.
They’re all here today, spread out across four connecting rooms. Their faces are hidden beneath white plastic, their legs are wrapped and held in place with masking tape, and their exposed arms are splayed out on either side of the body, open for dissection.
Under different circumstances, this might be a grisly scene, but the room is charged with an intense focus. All eyes face down, into the bodies.
â€¨“We’re not playing games anymore,” Ireland says. “This is really serious stuff. You’re going to have somebody’s life in your hands, and you’re not going to have time to think about it, you’re just going to react.”
The students have likely heard this line before, but that doesn’t make it any less true. No matter what their discipline, these next four months dissecting a human body will prove crucial to their general understanding of medicine.
It’s an opportunity not to be taken lightly — one they’ll revisit throughout their studies as physicians and surgeons in training.
Of course, none of it would be possible without the lifeless cadavers lying on the tables with open arms — their gift to the university’s Body Bequest Program.
BODY BEQUEST PROGRAM DIRECTOR BARB ROSSO-NORGAN EMBALMS AND PREPARES DOZENS OF CADAVERS FOR WAYNE STATE AND OTHER LOCAL MEDICAL SCHOOLS.
The Most Personal of Gifts
In 1968, the National Conference of Commissioners on Uniform State Laws passed the Uniform Anatomical Gift Act, allowing a person to make an anatomical gift at the time of death of all or part of the body for medical education, scientific research, or organ transplantation.
In effect, the act standardized and streamlined the body donation process, much to the satisfaction of the country’s medical schools; historically, many had struggled to collect suitable cadavers for research and dissection. Prior to the act, Wayne State, like other schools, had already been collecting bodies for scientific purposes, but the university wasn’t able to rely on donations.
“They were getting bodies — mostly unclaimed — from area hospitals,” says Barb Rosso-Norgan, director of Wayne State’s Body Bequest Program. “But they didn’t need a lot of bodies because they didn’t have a lot of medical students.”
That may have been the case in the school’s early years, but in the past 50 years, enrollment in Wayne State’s School of Medicine has grown — now approximately 300 students each year.
In order to accommodate medical students, the Body Bequest Program now receives 250 to 300 bodies annually, the majority of which (95 percent) are used for teaching purposes in courses like Gross Anatomy. The other 5 percent are used for ongoing research at the university in disciplines like bioengineering, while others are reserved for doctors and surgeons researching new techniques and developing new procedures.
Not all of the cadavers that belong to the Body Bequest Program stay on Wayne State’s campus. Rosso-Norgan sends cadavers to several schools including University of Detroit Mercy’s dental school, Oakland University’s biology department, and Central Michigan University, where cadavers are also used to teach incoming medical students. Area hospitals also receive cadavers from Rosso-Norgan for their residency programs.
Medical schools at the University of Michigan, Michigan State University, and Western Michigan University have body donation programs of their own, but in southeast Michigan, Wayne State — the largest single-campus medical school in the country — has emerged as a primary resource to obtain cadavers, which keeps Rosso-Norgan’s hands full. On any given day, she’s arranging the arrival or departure of any number of cadavers.
Rosso-Norgan’s line of work may seem grim to some, but as a licensed funeral director and director of the Body Bequest Program for the past 25 years, she’s never seen it that way. Much of the reason she got into the job in the first place wasn’t to work with the dead, but the living.
“You see people right after the worst possible thing happened in their life, and you’re the one who’s going to help them start moving forward from there and you arrange the whole thing for them,” Rosso-Norgan says. “I’ve always kept that in the back of my head. I help them — or I hope I help them — move forward in their life.”
At Wayne State, Rosso-Norgan also helps move the medical community forward by securing donations. She knows firsthand how valuable cadavers are for medical students in training, though she’s also seen how difficult it can be for families to donate a loved one to science.
Nonetheless, if a family is wary about donating, Rosso-Norgan doesn’t hesitate to offer a new perspective.
—Nikita Khetarpal, Gross Anatomy student
“I tell families this,” she says. “You wouldn’t want to go to a doctor who learned anatomy on a computer. You want them to be hands on, to see all the different nuances that we all have. Three hundred students are looking at just 50 bodies. How many patients are those 300 students going to have in their lifetime?”
There’s no telling, but if you’re ever going to be one of those students’ patients, you’re probably hoping your body isn’t the first they’ve worked with.
ANATOMY ATLASES AND DISSECTION MANUALS GUIDE STUDENTS THROUGH THEIR WORK.
Pink Nail Polish
Back in Gross Anatomy lab, Nikita Khetarpal is working to uncover the brachial plexus on her cadaver. Like most people, she’d never dissected a human body — until yesterday.
“I was scared,” Khetarpal says. “I was really terrified. But when I got in — it sounds so cheesy — but I got the idea that I’m doing this for a reason. This body is here for a reason. The family donated this for a reason. This person is here for a reason, and it’s so that I can save lives in the future. That kind of kicked in, and my fear kind of melted away.”
For the most part, Khetarpal’s reaction seems to be the norm. Day one in lab is unsettling. Most students have never touched a body without a pulse, and cadaver skin, though distinctly human with its wrinkles and body hair, looks artificial and leathery.
But the “ick” factor dissipates quickly, either out of necessity or out of sheer fascination.
“It’s a very strange and surreal thing,” Khetarpal says. “But you just kind of forget it because it becomes all about finding the structures inside.”
Here on day two, some students are already becoming deeply engrossed in the work. A week ago during a tour of Gross Anatomy Lab for orientation, Irene Kitromelides says she had to remind herself to breathe to keep from passing out — something that no student has done yet this year. Now, her rubber gloves are wet with embalming fluid.
“As you get into the body cavity, you’re just doing your job, following the instructions,” Kitromelides says. “It’s not personal anymore as long as you don’t think about it.”
Still, the human aspect is always there, and to fresh eyes, there are plenty of reminders: freckles, arm hair, fingernails. Rosso-Norgan recalls one student, whose memory of unwrapping his cadaver on the first day of lab stuck with him.
“Her pink nail polish just stuck out in [his] mind the entire time,” Rosso-Norgan says. “She was someone. She was someone’s mom. She was someone’s grandma probably. She was human with that nail polish.”
Working with cadavers requires a unique combination of detachment and respect. To maintain the latter, the students abide by Rosso-Norgan’s code of conduct. No cadaver goes on a dirty table, and the golden rule applies: Treat every cadaver as if they were your own loved one.
Of course, loved ones come with more information than age, gender, ID number, and cause of death — the only four pieces of information that students receive about their cadavers. It’s just enough detail to remind students of their subject’s humanity, but it also gets the imagination going.
“Most of the students will make up a story about their cadaver,” Rosso-Norgan says. “They give a whole history about the person. ‘Oh yeah, this man was a grandpa, and he had seven kids and he did this kind of work for a living.’ It helps them to cope with what they’re doing because it is pretty intense.”
At the end of the school year, families are invited to attend a memorial service at Oakland Hills Cemetery in Novi, where Wayne State maintains burial property for its donated bodies. Students are also invited to share their experiences working with their cadavers, allowing them to reflect on the course.
Rosso-Norgan remembers a speech given by one student, who affectionately named his cadaver “Moe.”
“He talked about how ‘Moe’ has formed him into the person he is now at the end of school here, that he’s got a whole new appreciation for life because of this great teacher he had.”
The memorial service helps both students and families to cope, Rosso-Norgan says, and it’s a way of thanking families for their invaluable gift.
ONE OF THE STUDENTS’ FIRST TASKS IN GROSS ANATOMY IS TO PLACE THEIR CADAVER IN A BODY BAG. FROM THERE, IT’S ON TO DISSECTION.
A Difference After Death
Jessica Allen’s father, David — a former Marine — died of lung cancer in June at the age of 65. He had always planned on making some type of organ donation when his time came, but as his illness worsened, he chose to participate in a body donation program.
“I had taken Dad to all of his appointments, and driving back and forth from the hospital, the conversation had come up quite a bit,” Allen says. “It was more toward the later [months] that he wanted to find out more information about the body donation and requested the necessary paperwork to participate in that.”
Jessica and her family supported David’s decision and honored his wishes, even when they discovered that his body wouldn’t be accepted into the University of Michigan’s body donation program — his first school of choice.
Donating a loved one’s body can be challenging. There are the emotional ties, but there are logistical matters, too. At Wayne State, as well as other medical schools, bodies must meet a list of criteria. No recent major surgeries, no decomposition, no amputations. If a body is going to be used for research purposes, the list is more restrictive. The remains of a loved one also may not be returned for anywhere between two weeks and two years.
“I try not to think about that because he’s doing what it is that he wanted to do and the medical staff will learn what they want to learn,” Allen says. “I know that it’s what he wanted. Even though he’s not able to be here with us, then at least he was able to give back to the medical field, and hopefully to someone else in need.”
A sense of altruism — an ability to give back to the medical community that in many cases prolonged a donor’s life — is a major reason why people donate. For others, the donation simply comes down to money. Funerals can cost several thousand dollars, and direct cremations can reach up to $2,500. But when a body is willed or donated to Wayne State and the death occurs in southeast Michigan, the university picks up the tab.
“We will go to the place of death and bring the body to the university on our dime,” Rosso-Norgan says. “So the family has absolutely no expenses. The only thing the family has to do is pick up their certified death certificates at the city or county clerk where the death happened.”
It can be a relief for families during a time of struggle, and their donations don’t go unappreciated. For Allen, receiving a card from Rosso-Norgan and the Body Bequest Program was a reminder that, although her father was gone, he was still making a difference.
It’s always noisy on open lab days in Gross Anatomy. The students ask questions and chat about the lecture. They make friends. There is laughter. For a room full of 50-plus dead bodies, there is very little death.
Toward the middle of each room, in between the dissection tables, there are a series of biohazard bins lined with plastic bags. Half of them are for waste like paper towels and surgical gloves, and the other half are for … parts. Trimmings. Fat. Tissue.
At first glance, it’s freakish, but it’s a matter of perspective. These are the things that have served their purpose, and now, their work is done. Parts out of order. At rest. That was then, this is now, and now, they’re in the way of discovery.
Gross Anatomy is not concerned with the past — it builds on hundreds of years of medical history, and uses it to move forward. And although some students may need time to acclimate while working with a cadaver, there’s no time for hand holding.
“We try to be personal about it, but we can’t be,” Ireland says.
That may seem cold, but anatomical dissection isn’t about providing the warm fuzzies. It’s designed to provide training, facts, and the opportunity for a healthier, safer future.
“We have seatbelts in cars because of research with cadavers,” Rosso-Norgan says. “Collapsible steering columns, and airbags, and all sorts of stuff with vehicle safety.”
We didn’t get to airbags and seatbelts without spilling a little blood. We didn’t learn how the spine communicates with the hand without opening up an arm. Thankfully, there are eager students and generous donors who will spend hours beneath a bank of fluorescent lights, linger in the smell of embalming fluid, and try to determine which nerves in the brachial plexus innervate with the C7 vertebra.
The rest of us will go home, hope they figure it out, and take a long shower.