The Education Program in Anatomy at McMaster University is where the human body’s mysteries are peeled back and the dead teach the living. The Spectator’s Jon Wells spent several sessions in the lab observing dissection and study of cadavers, and interviewed teachers, students, and families of those who gave the ultimate gift, to tell the story of a place at once beautiful and jarring, where humanity’s greatest question – what are we? – is explored.
By Jon Wells, The Hamilton Spectator
A man in black stands before the congregation, framed by stained glass, but he is not a minister and this is not a church.
The families are unrelated by blood but have much in common. All had members who donated their bodies.
[pullquote align=”left” cite=”” link=”” color=”” class=”” size=””] Part two: Body and Soul: Teaching from the dead
Part three: Body and Soul: The machine [/pullquote]
Bruce Wainman, director of McMaster University’s Education Program in Anatomy, looks into the crowd. He knew each of their loved ones, in a sense in the most intimate way imaginable.
Wainman is a man of science, not faith, not in a religious sense. And this is not a funeral. But those here, throats tight with emotion, feeling unsure, even fearful, perhaps look to him for something approaching a divine sense of closure.
Tell us what it meant. Was it worth it?
“It’s difficult, really, to explain how happy I am to see you,” he begins.
Several weeks earlier, on a cold and dark evening, Bruce Wainman looked into young and invincible faces in the anatomy lab.
The lab is where the dead teach the living, mysteries of the human body are peeled back, where humanity’s greatest question – what are we? – is explored.
“For many of you this can be a very tough time,” he tells students. “It’s not the easiest thing to do.”
Thirty-two students have been working in four groups, each group with a body, called cadavers.
They have been dissecting a different anatomical area each week. Tonight’s session is cutting open the skull. That means he must prepare them to see, for the first time, the face of the cadaver they have been working on.
“This is the face they showed people their whole life. … But let’s realize that when the person donated their body, they wanted you to learn from it.”
He knows that a different teacher at a different school would opt for shock value, and theatrically fling back the sheet to harden medical students.
“It’s natural for you to feel a bit upset,” he says. “I’d be concerned if you didn’t feel anything. Your weakness for people is your strength, that’s why you are here.”
Even Wainman is not immune, even though he has prepared hundreds of cadavers for dissection and study, including two men he knew well.
Not long ago, a female cadaver was brought into the lab. It was her polished fingernails. Such care taken right to the end. It stopped him. He couldn’t shake it.
He finishes introductory remarks and students stand among the cadavers.
Sheets are drawn.
A male, in his 80s. His face. His cheek. Grey stubble.
A forgotten childhood memory: The prickly brush of your dad’s cheek on your lips, long ago when you used to kiss him.
The eyes are open but the colour gone, lips parted slightly, as though he is asleep.
A student who works in the lab, Nick Simard, looks at a cadaver’s face and wonders.
How did the man talk? What stories did he tell, what were his quirks?
An undergraduate student, Amit Sikder, struggles. He believes in an afterlife, a soul.
And the cadaver? What is there now? He’s not sure.
The high-pitched whirring of a rotating bone saw cuts the quiet.
A place too seldom view’d, yet still in view;
Near as ourselves, yet farthest from our care …
A foreign home, a strange, though native coast;
Most obvious to all, yet unknown to most.
Phineas Fletcher, 17th century poet
We’ve always had a curious relationship with the body. How much do we know and how much do we want to know?
In death the mystery deepens, touching on notions of spirituality. What was this vessel in which we travelled?
It is placed on display at funerals, but open caskets seem increasingly less popular, our willingness to view the finite nature of life weaker than past generations. And yet fictional dead bodies on TV, once taboo, are common.
We bury the dead in ornate boxes or incinerate them. Ashes are sprinkled on golf courses, in lakes and oceans, and even Fort Erie Race Track – at the finish line – or perhaps several locales, an echo of the medieval custom of dispersal burial, where portions of a corpse were spread far and wide so prayers would be as well.
Dissection of cadavers – cadaver from the Latin “to fall” – is used to teach anatomy and surgical skills at all large medical schools, although questions have been raised about its necessity in the digital world.
Anatomy, defined as the study of the structure and functioning of the body, also means dissection: the word derives from the Greek, meaning “to cut.”
Physicians in ancient Greece were among the first to dissect. The practice was later outlawed, considered a violation of Christian belief in the primacy of the body. That changed when doctrine evolved toward the notion that the body was not needed to transport the soul to heaven.
The earliest influential writings on anatomy were by the physician Galen, but his research was based on dissecting apes.
The field blossomed during the Renaissance but physicians were not the only ones dissecting: artists performed cadaver dissections to inform their art, and in search of something more.
Da Vinci dissected brains looking for the soul. His theory ran contrary to the conventional belief that it dwelled in the heart. In 1533, the Catholic Church ordered an autopsy on conjoined twins to see if they shared a soul. Finding two hearts, two souls were declared.
The air in the cold room is chilled to between 3 and 5 degrees Celsius. Cadavers zipped in white vinyl bags lie on metal trays stacked on shelves.
Anatomy lab staffer Andrew Palombella lowers a cadaver using a hydraulic lift and slides it onto a gurney. He closes the steel door and wheels the cadaver into warm air, down the hall, as though transporting a patient.
When he was a student at Cathedral High School, Palombella never dissected so much as a frog but now spends most working days among the dead.
In 1832, British lawyer Jeremy Bentham was dissected as part of an anatomy lecture, as he had requested in his will. His body was later embalmed and preserved, and can still be viewed in a climate-controlled telephone booth in the U.K.
Renaissance artists dissected cadavers to inform their art work, often in secret. Two U.S. neuroanatomists wrote a paper asserting that Michelangelo’s most famous work, the painting on the ceiling of the Sistine Chapel, contains concealed intricate representations of the brain stem and spinal cord that he could only have known of from his dissections.
Da Vinci dissected stillborn infants or pregnant women who had died in childbirth, to try and pinpoint the moment of the implanting of the soul.
In the early 1900s, American physician Duncan MacDougall performed experiments to measure the change in weight of tuberculosis patients as they died to determine if the soul had vacated the body.
17th-century anatomist William Harvey’s lectures included showing an enlarged colon and spleen from two bodies he had dissected – his father’s and sister’s.
In the 18th century, criminals in the United Kingdom executed for capital crimes were also dissected because it was considered additional punishment. A shortage of murderers led to grave robbing by physicians and their students, as well as body snatchers paid for their services.
In the 1820s, a pair of Irishmen murdered 16 people to sell the bodies for dissection. When one killer ratted out the other, the convicted man, William Burke, was sentenced to death by hanging – and publicly dissected in front of thousands. Small pieces of Burke’s body were sold as souvenirs, and a purse made from the skin of his hand is still on display at the Police Museum in Edinburgh.
The cold room can store 60 cadavers. Each bag has a tag with an identifying number and cause of death. Most donors are in their 80s or older, and died from heart failure or cancer. A rare few have been younger, including a woman, several years ago, who was 24.</>
Palombella works full-time in the lab. Growing up in the Gage Park area he watched a lot of TLC and The Discovery Channel – “when they used to include actual science” – and episodes involving human and animal physiology.
While taking his masters in clinical anatomy at Western University, he made his first cut into a cadaver.
He walked very slowly into the lab that day with nine classmates in new lab coats, fearful but aiming for nonchalance. The cadaver face-down, Palombella gripped the scalpel and tried to ignore the churning in his brain. He pressed the knife into the skin on the back, surprised at its toughness, pushing harder than he expected.
“I see the same thing now in our lab with students,” he says. “They think it will go in like a knife through butter like on TV.”
Later he spoke with his classmates about how unsettling the experience had been. The cadaver had been someone’s father, mother, sibling. It didn’t seem like a normal thing to do.
The professor was a gentle man with an English accent who used lighthearted humour to put them at ease. To help students remember the name of one facial muscle, he sang it like a British choir boy: “Levator labii superioris alaeque nasi.”
Palombella grew to embrace dissection, the learning, the nobility of the donor’s gift. He was hired as an anatomy lab demonstrator at a medical school on the Caribbean island of Dominica. He answered a McMaster anatomy lab job posting and interviewed on Skype.
“It was so hot all I wore was a shirt, tie, and shorts, but they couldn’t tell.”
He was hired as head of prosection at Mac. Prosection involves embalming a cadaver (“fixing” it) over several months, and planning a dissection where muscle and tissue areas are preserved for further learning.
Not all university anatomy programs offer prosection study to students. It’s one way to teach to a larger number of students without every student engaging in full dissection. In this way, while Mac’s lab uses about 40 new cadavers a year, about 200 of them are actively used in some way for teaching at any given time.
More than 2,000 students a week access the main anatomy lab – security is tight – which offers anatomical models as well as prosected specimens in containers and fixed in glass slides.
Palombella is well beyond the emotional challenges he faced as a student, but there are moments that give him pause, times when a cadaver has come from the hospital or retirement home with a get-well card or teddy bear in the body bag.
The lab has a buddy system where two lab staffers unveil new cadavers, in order to support each other. Sometimes feelings are discussed further after work over a pint at the campus pub.
And there are moments at home, he sees a birthday card addressed to him on the coffee table, and it hits him: Love, life, and roads travelled, all ending in the same place.
But he enjoys his job, working with students and a dynamic program director who has given him opportunities to expand his teaching role.
“Bruce has been like a mentor to me.”
“Hi, I’m Bruce Wainman.”
About 300 students filling an amphitheatre in the Michael G. DeGroote School of Medicine greet Wainman with applause and even a stray “Whoo!”
Applause? On a Tuesday anatomy class after lunch, when students might be expected to nod off or not show at all?
One woman in the back has indeed descended into dreamland, another into her smartphone, but the rest seem with him.
The slides begin with the kidneys, found on either side of the inferior vena cava – a large vein that carries de-oxygenated blood from the lower body back to the heart.
He tells them that ureters run down near the side of the vena cava, draining the kidneys.
“That ureter is going to take that urine you make in the kidneys all the way down into your bladder, which is all the way down here, just behind your pubic symphysis, so if you just had 500 mL of Coke before you got here, your bladder will be peeking up over top of your pubic symphysis any time now; feel free to probe yourself now.”
“And finally you have your urethra, and because this is female it’s quite short, and in males – well, who knows, they lie a lot.”
Wainman informs and entertains, speaking without notes, a juggler trying to keep neurons in young brains firing.
It’s not mere theatre.
“If I see the smoke coming out of their ears,” he says after class, “I like to tell a joke or a little story. What I’m trying to do is get them to dump a little short-term memory, leave them some space and start again so they can process it.”
Body Donation at McMaster’s Anatomy Program
To obtain information or a form for a Donation of Body to School of Anatomy, write:
Education Program in Anatomy
1280 Main St. West, HSC 1R1
Hamilton ON L8S 4K1
Phone: 905-525-9140 x 22273
All registered donors are not necessarily accepted, for reasons including the health and size of the body. If you register to donate, make sure your wishes are clear to your family or executor.
There is no cost to donate apart from transporting the body to McMaster ($400). Donors are cremated and interred in the McMaster University crypt at Bayview Cemetery, paid for by the program, or a family can choose to inter the ashes privately at their own expense.
A body donor can still donate tissue to Trillium Gift of Life Network – but only the eyes.
Study of the body is usually completed within five years. Some will be lightly embalmed (“fixed”) so tissues are pliable and used as test subjects for surgical training. Others are heavily fixed to allow for dissection, and some undergo a planned dissection (“prosection”) where the prosected materials, such as various muscle or tissue groupings, are studied. The remains of each donor are kept separate and identifiable.
The anatomy program director says respect for body donors is paramount at McMaster. It is discussed in class at length, and no cameras are allowed in the lab, and students are forbidden to turn on any type of smartphone as well.
McMaster’s Education Program in Anatomy receives about 30 to 50 body donations a year. Other universities that use cadavers more widely among medical students receive 200-300 a year.
He has taught the material many times but never ceases to be jazzed by it, for example the relationship between the heart and the kidney. You take a pill for your heart, he says, but the medication is actually for the kidney: two organs in different parts of the body so closely linked that pathology in one is treated by drugs in another.
“It closes a nice big loop in my mind about how the world actually works.”
Wainman turns 54 on Halloween but looks younger; slim in beige pants and light blue patterned shirt, appearing square shouldered and fit because he is.
Growing up in Sudbury, his mother, Irene, was a homemaker, his father, Reg, a car salesperson. Endlessly curious, when he was young he asked for a set of encyclopedia – and read them. He felt like a fish out of water in high school where most students and teachers didn’t seem to care about learning.
Majoring in biochemistry at Laurentian University was a revelation: finally, most everyone seemed focused. His life was academics, and also competitive running, and he couldn’t understand when others were not as driven – a perspective that softened with age.
“I didn’t have role models, and I just thought you did everything full out. Why wouldn’t you make the most of life? I might sound puritanical about it now, but back then I was unbearable.”
On the road to his masters in medical science at McMaster, and PhD in biology at York, he ran on Canada’s national cross-country team. He won a marathon in Japan, among others. His style was sprinting early, setting a crazy pace, and trying to hold on.
After bursting to the lead and winning the Ottawa Marathon in 1986, the runner-up told the local newspaper: “Bruce is known for that, and it worked today.”
In 1998 he was hired at McMaster as a professor in obstetrics and gynecology, and in 2005 named director of the anatomy program. He put his stamp on it, modernized the lab, and became a sought-after speaker.
Learning and teaching anatomy filled Wainman’s tank, along with getting up every morning before dawn to run.
Another passion is fly fishing, with its esoteric pleasures and intricate technique. When he speaks at conferences he tries to work in some angling. In Mexico earlier this year, a guide took him out in the Sea of Cortez: sea lions vying to grab his line, whales breeching in the distance. It was, he says, epic. He ate his catch, tuna, in a café that night.
His philosophy teaching anatomy is that it must go beyond simply pointing to parts of the body without context. Otherwise he likens it to bird watching and claiming you are studying ornithology.
He has met medical residents who carry with them an unspoken terror that they don’t truly know anatomy.
Wainman teaches where the parts are located, how they function, the interdependence, cause and effect, embryonic roots of how they develop, all in the context of clinical implications.
“I’m not comfortable if I don’t understand how something works, top to bottom,” he says. “I was always like that.”
Few know the machine better than Wainman. But the human condition can also defy, or painfully challenge, understanding.
His brother, Grant, the youngest of Reg and Irene Wainman’s four kids, majored in psychology at Laurentian in the early 1990s.
In his thesis paper, Grant discussed inconsistencies in deductive reasoning (“The syllogistic reasoning task was considered by Aristotle to be the greatest accomplishment of human rationality …”).
In 1998, Grant Wainman completed his masters in psychology at York University, and was about to start his PhD, when he died from a self-inflicted gunshot wound.
Some wondered if his brother’s suicide influenced Bruce Wainman to embark upon studying and teaching anatomy with such intensity, as though on a quest to figure out what happened.
That theory doesn’t ring true with him. He says Grant had a long history of depression.
“It was a terrible, terrible event. … You can probably keep people from committing suicide if you lock them to a bed but at some point they live, and sometimes life becomes too difficult for them and they choose to leave it. And you can’t save everybody.”
The musician’s hand grips the bone saw. She presses the spinning blade against the skull, cutting in a circular arc, bone dust spraying. Students take their turn with the instrument on their cadavers.
In a previous life, Erika Donald wielded a different instrument: a cello bow.
She performed in Europe and China and taught students in Afghanistan.
She did her masters in cello performance and PhD in music education at McGill, and studied music therapy, which brought her back to what had always been there: an interest in how the body works and helping people. Medical school was now or never.
The saw’s grinding sound is shrill, but its cutting power limited; the blade spins and vibrates, slices through bone, but wouldn’t break the skin on your arm.
Donald dissected her first cadaver last year. She was one of the 32 students out of more than 150 applicants whose names were picked from a lottery system to take Wainman’s 10-week Interprofessional Education (IPE) dissection course.
(Students are drawn from the medical, nursing, physician assistant, midwifery, occupational therapy and physiotherapy programs.)
She had seen the Body Worlds art exhibition – which features plasticized cadavers – but knew this would be different. She had made incisions while on a rotation in Hamilton General Hospital’s E.R., suturing wounds, but the tissue on her embalmed cadaver felt different, less pliable.
The man lying before her had a tattoo on the upper arm: a blue heart and the word “Mom.” She wondered about his life, if he had been a sailor. They dissected his gastrointestinal tract. His final meal had been mushroom soup.
This year she was invited to be one of the student assistants for the course. She arrives for the skull dissection session after working a placement shift in the Intensive Care Unit at the General, where she witnessed three patients “pronounced,” or declared brain dead, a neurological determination of death.
And now she is in the anatomy lab holding a human brain.
“Our cadaver’s brain has extremely clear neuroanatomy,” she says. “You can see all of the cranial nerves and the blood vessels that supply different areas of the brain.”
She remembers a patient she met on one of her rotations, who had a blocked blood vessel in his brain which had led to a stroke. She felt for him.
“It’s hard to believe that a mass of cells can be organized so intricately and be so malleable and resilient in many ways, capable of everything that it is, but then it’s also got weaknesses that can be catastrophic.”
Bruce Wainman stops at each group’s cadaver. He points to shrivelled, pale-pink coloured brain tissue. The person likely had dementia.
“This is a sort of normal geriatric degeneration,” he says. “Sometimes it’s referred to as senile wasting; it’s basically the neurological tissue getting smaller and smaller. The smaller brains stretch the blood and this traction on the vessels can lead to tears. There are two times in your life when those blood vessels are really delicate: when they are growing rapidly as a fetus and child, and when you get old.”
The students witness mortality in a way most people never will. It is the most fundamental lesson of all. This will be them, one day.
Wainman smiles to himself.
They don’t believe they will ever actually ever be like that. They think they believe it, but they don’t.
“This degeneration is in fact perfectly normal,” he continues. “To be honest, this is kind of what we come to. They didn’t die ‘of that.’ they died ‘with that’. You die of very few things, but you die with many things.”
Her first time, Erika Donald had been hesitant to look at her cadaver’s face, but grew to appreciate the privilege.
“It’s such a valuable learning opportunity. The donor has made an incredibly generous gift.”
If Wainman and his lab staff are the brains of the anatomy program, and the students the heart, then the donors – 90 per cent come from within 50 km of campus – are the soul.
But while students find clues to lives lived – lungs darkened with black spots, an enlarged liver, shrapnel from a long-ago war – they know the nameless donors only in death.
They never knew Bill, who nearly perished in a disaster far away. Or Fern, who stormed ashore at Normandy, or Rosa, an “unclaimed treasure,” she used to say, who had loves in her life but never found the one she was looking for.
Cicero, the Roman philosopher, wrote of old age as “the crown of life, our play’s last act.”
For donors in the anatomy lab who are teaching, it’s not quite.