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Requiem for a Cadaver

Med students honor their dead.

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By Bridget A. Clingan

Words were never spoken between them, smiles never exchanged--yet Susan Kramer felt as though she knew Anne, a woman in her late 60s who died of lung cancer and donated her body to science. Kramer had spent seven months cutting Anne apart in a gross anatomy course last year at Northwestern University Medical School. Near the end of the term, she was ready to move on to other things.

Then Kramer and four classmates uncovered something peculiar, and she began to think about who Anne had been. "I remember when we dissected the head," Kramer says. "Her skull was three inches thick in one area. We found a cauliflower-shaped bone growth compressing her brain." The abnormal growth was protruding into Anne's frontal lobe. Every day thereafter Kramer was haunted, knowing that she had discovered a condition even Anne hadn't known about. "It really took me aback, like we had no right being there. I remember feeling as though I had invaded this person." Though most of the students found it easy to detach themselves when working with the cadavers, Kramer was having trouble. "I had to hold the hand while I dissected it. She had red nail polish on....A hand is so familiar. You start to really think about this person and find yourself flipping back and forth from thinking about the person to doing your job."

Kramer's bond with Anne inspired her to plan some sort of formal farewell for the 36 cadavers in the class. She had a ceremony in mind, a memorial service honoring those who gave their bodies for the benefit of the doctors-to-be. "Med students go through school and it's a very selfish time in their lives," she explains. "We needed to recognize others who have given themselves to help us."

While uncommon, such services are not unknown. Kramer called a friend at the University of Vermont's medical school, where she knew of a student-initiated cadaver rite. For a while she even considered tracking down family members and making them part of the service, but she decided against it. There wasn't time, she says, and "it might have been difficult for family members to hear about the students' cadaver experience."

In the spring of 1996, Kramer organized Northwestern's first Closing Ceremony for Gross Anatomy. It was held in Thorne Auditorium on the university's downtown campus. As with most first-time events, the turnout was smaller than expected, even though Kramer had invited the entire class. "But it didn't bother any of us," she says. "People were still really touched by it, and we figured it was the first year and hopefully it would continue."

Kramer's anatomy lab instructor, Larry Cochard, says most people who sign up to donate their bodies do so later in life, usually after an intense conversation with family members. But the family can still donate the body even if the deceased never made the decision to do so. Anywhere from 650 to 700 bodies are received each year by the Anatomical Gift Association, which distributes them to eight medical schools in Illinois. In recent years, the organization has liberalized its policies and will accept bodies for donation that may be missing a few organs. Cochard, who also serves on AGA's board of directors, notes that "some bodies we've accepted have had their eyes donated." The nonprofit group will also accept bodies that have undergone surgery or an autopsy, but it won't take bodies with contagious diseases, such as hepatitis, AIDS, tuberculosis, or herpes.

When the body arrives at AGA, it's embalmed and stored until it's delivered to a medical school. Then it's wrapped in plastic sheets and placed in a tank hooked to the ceiling, enabling students to lower the body for dissection and to move it out of the way when they're done. After the course is over and the body has been fully dismembered and dissected, it's cremated. The donor's ashes are returned to the family if it wants them. Where each body ends up is a secret--just as students never learn the cadaver's last name, hometown, or occupation.

This spring Jennifer Damm was nearly finished with her cadaver when she heard about last year's service, and she volunteered to organize a new observance. "We can't know a whole lot about them, but we wanted to celebrate their lives, their generosity," she says. "By donating their bodies, they had a chance to make that gift into something special for someone else." Like Kramer, Damm felt she'd developed a relationship with her cadaver, a 93-year-old man named Edward who died only days before his body became hers. "When we first started, I'd catch myself rubbing up against his arm and apologizing for it, or I was knocking his hand, stubbing his toe, and I kept apologizing," she recalls. Unlike other students in the class, Damm refused to give the cadaver a nickname. "This guy had a name, a family, a job," she told her lab partners. "We don't want to assign him something that he already has."

Fifteen minutes before the ceremony, Damm is running up and down the stairs of the auditorium. Students begin to file in; more than 100 of the 180 students in her class arrive to pay their respects. Thirty-seven of them--one for each cadaver group--sit in the front row, each grasping a flower. A piano sits off on one side of the stage. A glass vase at the center is filled with water.

One by one, students climb onstage and express their gratitude by playing the piano, reading a poem, or simply placing a tulip in the glass vase. Slides are projected on a movie screen. They show anatomy sketches, Thomas Eakins's paintings of surgery, and candid photos taken in the lab.

When it's Josie Lehrer's turn, she reads a poem written for her cadaver, an 18-year-old named Robert who was shot in the head. His family insisted that his body become a gift. "This kid is too cool to be dead / Too much like us to be dead / Too infinite to be dead. / He has people sticking their fingers in the bullet holes in his head to see whatever they are trying to see." Lehrer pauses, fighting back tears. "Many of the older people wanted this, for one reason or another. / Realize that they wanted this, that somehow they knew or know they're here. / Respect them. / Remember them. / Thank them."

Damm follows up with a poem she wrote for Edward. "I noticed the freckles on your shoulders this afternoon. / Tonight I noticed the freckles on my own. / We're the same, you and I. / Only you've been there / And I haven't."

The auditorium is silent. The students in the front row stand up, still clutching their flowers. Each places the flower in the vase as the cadaver's name is read aloud. "Group 3, Lillian... Group 24, Berda...Group 31, Arnold." The lights dim. Some hold the hand of the person next to them.

A five-months pregnant Kramer couldn't stay away from this year's service. "I wanted to hear what they learned and hear them express their feelings," she says. Though they've both decided to become organ donors, neither Kramer nor Damm will commit to donating her entire body after death. "The PC answer would be to say yes," says Damm, who calls her experience with cadavers a "reality check." Then she pauses to reflect. "I'm just not sure." o

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