Body and Soul: The machine

Neurovascular surgical residents gather in McMaster’s anatomy lab to practice treating pituitary tumours in the brain. A camera is inserted through the cadaver’s nasal cavity, and images shown on a monitor. Photo by Cathie Coward/Hamilton Spectator

Neurovascular surgical residents gather in McMaster’s anatomy lab to practice treating pituitary tumours in the brain. A camera is inserted through the cadaver’s nasal cavity, and images shown on a monitor. Photo by Cathie Coward/Hamilton Spectator

Dissection in the anatomy lab at McMaster is an intense learning experience. The soul is not part of the curriculum, but spiritual notions infuse the annual Service of Gratitude for those who donated their bodies to science

Jon Wells, The Hamilton Spectator

Clack-clack-clack-clack.

A student taps a hammer against a skull key, a type of chisel, to open the cranium.

Holding a brain for the first time is a remarkable moment, says Nick Simard, a biomedical engineering student.

[pullquote align=”left” cite=”” link=”” color=”” class=”” size=””]Part one: Body and Soul: What we come to

Part two: Body and Soul: Teaching from the dead[/pullquote]

He likens it to the “overview effect” astronauts had seeing the Earth – a cognitive shift in awareness.

“You hold someone’s life; their memories, emotions, everything that is the makeup of a unique human being.”

Under brilliant lab lights: green scrubs, blue surgical gloves, bright faces and wide eyes peering over masks.

On the tables: body cavities of heavily-fixed cadavers open, the skin appearing like sheets dipped in coffee.

Bruce Wainman, the director of McMaster’s anatomy program, often notes the juxtaposition: young students and old cadavers, the beginning and end.

(And driving home the observation, one of the students in tonight’s class is in the midwifery program, training to bring babies into the world.)

To the uninitiated the scene in the dissection suite is jarring, but not for long.

There is no blood; blood is life. And there is little odour. Formaldehyde, used for fixing cadavers, is carcinogenic, so levels are kept low in the lab. It smelled stronger in your high school biology dissection class.

Students are animated dissecting cadavers but speak with reverence of the donors.

“It’s about respect,” says Robyn Murray, who is studying physiotherapy. “I have to give myself completely to the cadaver, because these people chose to donate and they wouldn’t want me to shy away from it.”

Nick Simard calls it a journey of discovery, “how all these veins, arteries, nerves, and muscles are interwoven in this beautiful network, all of them working together synergistically.”

Dissection reveals natural aging but also pathologies from unhealthy living: a massive liver, perhaps genetic but more likely the liver grew as it continually repaired connective tissue damaged by such things as consuming excessive cholesterol and alcohol.

Injected pink latex allows blood vessels in the brain to pop with colour on the monitor, as though this male cadaver is a living patient. Photo Cathie Coward/Hamilton Spectator

Injected pink latex allows blood vessels in the brain to pop with colour on the monitor, as though this male cadaver is a living patient. Photo Cathie Coward/Hamilton Spectator

Black spots dot the lungs on one cadaver: likely workplace exposure to asbestos, causing chronic obstructive pulmonary disease. To the touch, the lung has no density, it feels spongelike. The same would be true for a heavy smoker’s lung.

Students never report findings to families. They don’t know the identities of the cadavers, nor are they trained pathologists.

“Oh! Here it is!”

A student finds the pituitary gland, a pea-sized piece of tissue attached to the base of the brain, that controls functioning of other endocrine glands that produce hormones to regulate metabolism, sexual function, reproduction, and growth.

Later, more excitement, finding the arbor vitae – “the tree of life,” white matter found in the cerebrum of the brain.

“Teachers work a lifetime to get this kind of engagement from students,” Wainman says.

Touching and holding organs from a cadaver is a powerful experience that cannot be duplicated using multimedia or plastic models.

But there is a school of thought that suggests other modes of learning could be, if not the same as using cadaverous material, at least as functionally useful to train doctors.

A 2014 study in the U.S. concluded that cadaver-based instruction is more effective than computer-simulated teaching, and all of the largest medical schools still dissect.

But some use cadavers less, and one in the U.K. has opted to stop dissection altogether in favour of models and digital imaging, arguing that cadaver dissection can be stressful for students and uncomfortable for those with cultural barriers.

Resources are one issue: A steady supply of body donations is required, and it costs McMaster about $2,000 per cadaver to prepare and store them in the lab, in addition to cremation costs when the donor is finished “teaching,” also covered by the program.

Wainman believes McMaster strikes a good balance between using technology and cadavers to teach, which includes prepared prosected specimens, which means their demand for cadavers is not as high as medical schools such as Western’s or University of Toronto’s.

He is not on a body donation drive, but wants people to know about the work they do and, for those who feel they might want to donate, that it’s a good thing both for them and the anatomy program.

“I think it’s the last great thing you can probably do.”


 

Andrew Palombella, the head of prosection, is alone in the lab. He fills a syringe with a pink latex solution. He cuts an incision in the neck of a cadaver with a scalpel, inserts a syringe into the carotid artery, and slowly injects the solution, which will flow into the base of the brain.

Andrew Palombella works to inject latex into the veins and arteries of a cadaver making identification easier for students working in the anatomy lab at McMaster. Cathie Coward/Hamilton Spectator

Andrew Palombella injects latex into the cadaver’s carotid artery the day before a surgical skills session in the lab. Photo Cathie Coward/Hamilton Spectator

“It will make the vessels pop with colour, which make it look more the way it would appear in life, and easier to see.”

He injects seven cadavers in preparation for practice by neurovascular surgical residents. The cadavers are lightly fixed, keeping them pliable, more life-like, the skin and tissue colour resembling a living patient.

If the solution does not flow well, the vessels won’t show colour. The surgical skills session will reveal if it worked.

The next day, Palombella watches in the wings as an instructor feeds a probe through the nasal cavity to the brain of one of the cadavers.

Surgical residents watch images on a monitor captured by the probe inside the skull. The vessels appear bright red for the demonstration, as though blood is coursing through a living patient. Palombella nods to himself. Good.


The guest lecturer is Amin Kassam, a neurosurgeon from Milwaukee, who volunteers teaching procedures at medical schools. Today’s lesson is operating on pituitary tumours. The equipment has been loaned to McMaster from a U.S. company.

Kesava Reddy, a clinical professor in neurosurgery at McMaster who invited Kassam, says at least 30 per cent of this type of surgery is done by entering the nasal cavity, which is a less invasive procedure than a craniotomy. He performs about 50 pituitary tumour surgeries a year, all through the nose.

He says that learning this complex anatomy, and surgical skills, takes practice and is costly, which is why borrowed equipment, a volunteer guest teacher, and donated bodies, are critical.

After the demonstration, residents practice on their own cadavers. There are other types of specialized surgery where cadavers cannot assist.


 

Pediatric residents sit at a table with tiny pink rolls on trays. Pigs’ feet. Wearing surgical gloves they practice suturing: the tissue resembles the sensitive density of an infant’s.

The lab has no child cadavers to work on. A few parents in the past offered stillborn babies for research, but McMaster will not accept them. It would be too emotionally difficult for staff and students.

It is mid-August. Over the summer, cadavers and prosected specimens are prepared for the new school year.

First-year students tour the lab. Wainman chides a young woman who forgot the rule about no open-toe shoes, who wears surgical baggies over her digit-revealing footwear.

He walks through the dissection suite, where a cadaver lies on his stomach, back opened up, large metal screws inserted, as an instructor teaches orthopedic residents external fixation of the spine.

Wainman, who was a competitive marathoner for years, runs every morning. He always feels sore at first. Old age, he says with a smile. Sometimes he must walk down the stairs at home backwards, unable to straighten his ankle, a remnant of an old skiing injury. Once he gets the engine going, though, he is a man floating through the dawn; he likens it to an out-of-body experience.

When he dies, if there is no opportunity to donate organs he will donate his body, although not to McMaster. It would be too difficult on staff members who know him. A previous director of the program donated her body, and it went to U of T.

In a few weeks he returns to the big amphitheatre at the Michael G. DeGroote School of Medicine; teaching, performing.

Out in the community people die, and a rare few of them come here, the cycle of life in the lab continuing.

The end of that cycle, in a sense, comes each spring.


 

Relatives of body donors gather for the service of gratitude in McMaster's Alumni Hall.

Relatives of body donors gather for the service of gratitude in McMaster’s Alumni Hall.

It is May, towering old trees in full bud under an infinite blue sky. A breeze flows through windows of Alumni Memorial Hall, where tender notes from a flute and Spanish guitar ripple over hearts.

The flautist is Bev Wilson and the guitarist is a fair-haired 19-year-old named Markku Wainman.

His father, Bruce, uncharacteristically dressed in a suit, addresses the congregation at McMaster’s annual service of gratitude for families of donors to the anatomy lab.

“Many of you are sad, and today we have a chance to help you feel better, and that’s exciting for us. I have this votive debt that builds up all year, and this is the chance to let you know how important it is.”

It is a chance for families to say goodbye once more, but also to learn a bit about the mysterious journey their loved ones took.

Donating to McMaster’s Anatomy Program

To obtain information or a Donation of Body to School of Anatomy form, write:

McMaster University

Education Program in Anatomy
1280 Main St. West, HSC 1R1
Hamilton ON L8S 4K1

Phone: 905-525-9140 x 22273

Online: fhs.mcmaster.ca/
anatomy/bequeathals.html

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.

McMaster’s Education in Anatomy program receives about 30 to 50 body donations a year. Other universities that use cadavers more widely among medical students receive 200-300 a year.

“Part of what we do in the program is show students the fragility and frailty and beauty of life,” he tells them. “And it’s because of the donors, and you, that we can do that.”

Student Erika Donald lights a candle and speaks at the podium.

“Our learning in the anatomy lab helps to deepen our understanding, appreciation, and our amazement at the intricacies and complexities of the human body,” she says. “Our donors have given the ultimate gift in selflessness and generosity.”

Nick Simard is next. Bioengineering students study systems, he says, and the human body is the most complex and poetic system they could explore.

“Your loved ones have opened our doors to a new world of inspiration. The only way we can come closer to figuring it out is studying it, learning from it, spending a lot of time with it.”

He offers a personal note, that his mother said after seeing how much he had fallen in love with the study of anatomy, that she wanted to register to donate, too.

Wainman feels it near the end of the service, after initial apprehension it’s like air filling the room, anxiety among the families gone.

In the past, after the service, some have apologized to him for having resisted the wishes of their relatives to donate.

“And I tell them, ‘You don’t have to apologize. How could you know? You did what you thought was right.’”

There is just one reference to God, a candle lit for “the mystery of God and the gift of life,” but the service is steeped in spirituality, invoking the “life force that creates, animates, and sustains every living thing.”

To the families, Wainman is perhaps like the man behind the curtain – the one they had never met who tended to their loved ones, in whom they had faith.

But faith of the religious kind is not what he’s about. He is driven by science; that which can be seen, studied, measured, his inspiration coming from what he calls the “real magic” of anatomy.

Here he is, weeks earlier, in the dissection suite. After an exhausting day, he finds a second wind at night teaching students over an opened cadaver, discussing the ganglia of the sympathetic chain they dissected: nerve fibres running along the spinal cord in long chains, responsible for the fight-or-flight response.

He explains its function this way: Imagine he introduced a tiger into the room, and you had to run away fast. The sympathetic chain is the engine directing the response: blood must be rerouted from the kidneys and gastrointestinal tract to the muscles; the heart rate, and pressure, must increase.

“And the sympathetic trunk sends those messages at the same time, broadcasting messages all over the body in seconds, that converts you from this lump that might be sitting around drinking a coffee, to an object in flight.”

And then, once safe, the sympathetic chain slows its firing, and the system allows the body to resume normal function, increase gastrointestinal activity and slow the heart rate. If the transition is too sharp, the person could suffer a hypotensive (low blood pressure) crisis and even die – which is what can happen to someone who suffers hypothermia in cold water and is instantly warmed up after rescuing, for example.

“One is the gas, the other the brakes,” he says. “They are constantly fighting it out, trying to stay balanced.”

“It makes sense now,” says a student.

“How can you forget it?” he says, beaming. “You have found it.”

He says there is nothing left to discover in an anatomical sense in the body, although studying how the brain works in concert with other parts may yield new answers.

The soul is not part of the curriculum. And yet students studying among the dead cannot help but feel transcendental questions hovering.

“Every component is here, but an essential part of them is not,” says Samantha Krueger, standing over a woman who died in her 90s.

“I believe there is a divinity to life, but I don’t put a name to that divinity,” says Robyn Murray. “I believe that our energy is released from our body (after death). So there’s kind of an existential anxiety that surrounds you in the lab that you fight in your head.”

Humanity has long searched for words to describe that energy: spirit, psyche, soul, mind.

Perhaps faith in a metaphysical force in the body is just anatomy at work: neurons in the brain creating a story, throwing illusory shadows on the wall as in the story of Plato’s cave.

But if that’s true, how could we possibly know?

Philosopher Ludwig Wittgenstein once wrote: “The human body is the best picture of the human soul.”

The cadaver fully dissected, its anatomy bared of all that is visible to the naked eye, both demythologizes and deifies the human form.

Spent tissue, fat, bone; it is as though all the wiring has been pulled from a simple machine.

Is that all there is?

Roll back the story: the cadaver on the table now an older person; back further, into middle age, youth, childhood; birth, and the spark of creation.

Love, hate, imagination, thought, hope. When the light is on, that machine – it is something to behold.


 

“You shall ask,

Why are the leaves so green.

And I will tell you,

Because they are rich with life.

You shall ask,

Why must summer end.

And I will tell you,

So that leaves can die.”

Reverend Allison Barrett reads from a poem, and near the end of the service of gratitude, says: “Love and kindness are never wasted. They always make a difference. They bless the one who receives them and they bless the giver.”

Finally, the names of 38 recent donors are read, from Kathy Agnew to Joseph Zundle.

Among the others: Billy, and the captain, and the unclaimed treasure: William Jamieson, J.J.L. Fernand Nobert, and Rosa Evelyn Parry.

In the audience, old and young, a spouse, sons and daughters and grandchildren; tight throats, smiles, tears.

Anatomy lab teachers and students and families of the deceased leave the hall.

There are three sleeps until Mother’s Day, summer at their fingertips.

They leave into warm air and the white light of spring, carrying glimmers of insight, the mystery deeper than ever.

 

jwells@thespec.com

905-526-3515 | @jonjwells