Dead Science

The Baron did not want a funeral, so before he died, he gave his body away.\n*****\nAfter the living exit the room and close the door secured with a keypad lock, the eight operating tables start to resemble eight coffins. Metal lids are placed on top of each table and remain closed during the living's absence from the room. The lids mask the sights of what lies below, but a hint of the smell always survives. The stink oozes through the cracks and sours the air just enough to remind the living of their place every time they open the door from the other side. \nWhen the living return, the lids are removed and the contents that leak the smell come to life. The eight coffins transform back into eight operating tables, supporting the bodies that are about to go under the knife. The bodies wait motionlessly with hearts that don't thump, lungs that don't gasp and stomachs that don't growl.\nBy definition, these eight bodies are cadavers -- corpses used for dissection. But to the living who work and study inside the gross anatomy lab in Jordan Hall, these bodies are donors, people who graciously gave themselves to science for advancements in teaching and research. These donors are the first patients of the future physicians in their first year of medical school at IU.\n*****\nSoon after death, decay arrives. A mortician replaced The Baron's blood with embalming fluid, and then he was immersed inside a preservation tank for three months before he was transported to Bloomington from the School of Medicine at IU-Purdue University Indianapolis.\n*****\nThis class must stand out from the other courses on the schedules of first-year medical students: GROSS HUMAN ANATOMY (A550-551). For the 30 students enrolled, this class is part of their initiation into the medical world. It marks the transition from plastic models and diagrams in thick textbooks to three-dimensional views of real human anatomy. This is the class where some students will struggle not to gag from that first whiff of decay. This is the class where students will slice incisions into flesh, tear tissue and break bones for an understanding of the splendor of spoiling organs, nerves and pathologies.\nBut before they reach for the scalpel, these future physicians must first get to know their patients.\nOn the first day of class, Tony Neff, a professor of gross anatomy, lectures the students and emphasizes the respect he and the other instructors demand the students have during the labs. He makes sure the students understand not with what, but with whom, they will be working. They are not working with cadavers, stiffs or corpses. They are working with donors.\n"They were once humans," Neff says, "and should be treated with the same respect and dignity of a living patient."\nAfter the lecture, the students move to the lab room where the donors wait in body bags. The students are divided into groups of either three or four and are then assigned to the donor they will dissect for the next nine months. The groups gather around an operating table and open the bag. Because the zipper travels from head to toe, the face is the first thing they see.\nAs they wash and shave the donors to prepare them for dissection, there is no escaping the face that first day. The students look at the ears and the mouth and the closed eyes and cannot help to see a real person who, in one week, they will have to cut open.\n"That first look is a little unnerving," says IUPUI medical student Adam Morgan. "The face and the smell all come at you at once."\nEven the strong-stomached teachers can empathize with the students' initial fears.\n"There's something about the face," says Valerie O'Loughlin, also a professor of gross anatomy. "Even in death, the face is so full of expression."\nStudents can forget about the face for a while after that first class. Since the head and neck dissections will not begin until the spring semester, the heads are wrapped and covered with black plastic bags for preservation. But before the students put the faces totally out of mind, one last assignment is requested of each group: The donors must be given respectful names.\nGenerally, not too much time is devoted to the name selection. Some groups brainstorm several names before voting on a favorite; others pick the first name that comes to mind. This year's patients go by Karl, Emmeline, Lucy, Daisy, Ruby, Tad, Betty and The Baron.\n*****\nThe Baron will undergo four major dissections: abdomen and thorax, pelvis, head and neck, and limbs. Anything removed from his body will be kept and saved in a bucket underneath his operating table. At the end of the school year, his body and his bucket will be transported back to Indianapolis for cremation.\n*****\nAt table number six, The Baron's doctors -- Jason Clark, Adam Danielson, Adam Morgan and Matt Crosby -- have found what they call a "mystery lump." \nWhenever pathologies or discoveries like mystery lumps are found, the students gather around for a peek at what makes that donor unique from the others. In The Baron's case, though, a mystery lump isn't his only unique feature. Most in the class believe he smells the worst.\nInside the lab on a dissection day, the room is loud and busy like an emergency room. Two instructors, two assistant instructors and almost all of the 30 students, each dressed in scrubs and tennis shoes, stride from table to table. A constant exchange of anatomic glossary terms fires back and forth in the room, while group-exclusive chatter is muffled through operating masks. \nThere's joking and laughing from time to time, as well, which, given the nature of the room, seems necessary. When dissecting the dead for at least four hours every week, humor can sometimes be the best medicine.\n"I hope it's not a lymph node," Clark says of The Baron's mystery lump. "A third kidney would be much cooler."\nAnd then there's the smell -- that unmistakable stench that erupts as soon as the lids come off. Walking into the room for the first time is like opening a broken refrigerator stocked full of expired dairy products. The smell sinks into skin and clings to clothes. It's a smell that can unexpectedly hit you three days later just as you're about to eat lunch. It's enough to take away your appetite.\nAlready two months into the course, the smell becomes less noticeable for the students each lab day, but not for a visitor in the room, who, from time to time, pulls a sliver of an orange peel from his pocket and holds it to his nose for a breath of fresh air.\nThe sights are everywhere. In the front of the room beside a biohazard garbage pail full of blue latex gloves filthy with human residue, a pile of saws wait for the moment when the students will hack through the donors' vertebrae. In the back of the room, a head floats inside a jar of green liquid that resembles pickle brine. And in the middle of the room are the eight donors.\nThey rest on operating tables with their chests and abdominal cavities completely exposed and with peelings of dry muscle and wrinkled skin hanging off to their sides. The heads, arms and legs of each are wrapped in black plastic, and the hearts, lungs and rib cages have all been removed, leaving a wide-open space where Jill Taylor, a professor of kinesiology and an assistant in the gross lab, sees beauty.\nTaylor can smile at a heavy pile of intestines that are thick like snakes, pinkish-brown like earthworms and covered in gelatin-like bits of yellow fat that squish and slip when handled. She can admire the rich green shade of bile on one of the donor's gall bladders. She can marvel at the exposed nervous system -- the part that gives you a rush of adrenaline.\n"Let's make this clear," she says, "we're here because gross anatomy is gorgeous. It's fun. It's beautiful." \nBut then there are the encouraging sights that can be easy to overlook between the gorgeous and the rotten. The encouraging sights are those of a class of future physicians who, at the moment, are simply students in the most basic and pure manner.\nSome of them will mend broken arms and legs, but for now the students watch with impressed eyes as their teachers effortlessly glide scalpels around lumps, bumps and nodes. The students are slow with their tools now, but in time, precision is what will make them experts.\nSome of them will become accomplished surgeons, but for now the students can take a few minutes to be young and chat with the assistant instructors about parties and second-year class schedules.\nSome of them will cure diseases, but for now the students flood their teachers with questions, asking over and over to repeat the names and locations of anatomic structures. For now the students have a deluge of information before them, but in time, it will all be clear.\nFor now these students only have impressionable thoughts about what type of doctors they want to become, just as freshmen only have ideas about their majors. For now, these students -- these future physicians -- only know that they want to help.\n*****\nPosted throughout the lab are signs that list the following information about each donor: table number, donor number, sex, age and cause of death. The Baron was 87 when he died, and dementia and hypertension were among his causes of death. Beside only some of the names are asterisks that indicate which families of the donors have requested to receive the ashes after cremation.\n*****\nDuring the final minutes of the lab session, the groups start to clean. Anything dissected from the donor is placed inside the bucket kept beside each table. Next is the less glamorous job of dabbing fat globs that liquefied inside the abdominal cavity. Wads of soaked and yellow-stained paper towels breed into piles in the trash cans. The up-close sight of fat-caked intestines has inspired Clark to exercise more.\n"It all just makes me want to go to the (School of Health, Physical Education and Recreation) and work out," he says.\nWith the inside clean, a wetting solution is poured into the body, and then Crosby looks at The Baron and says to his partners, "It's time to put him back together."\nThe rib cage is put back first, then layers follow: the muscle, then the skin, then a sheet of cloth and finally a plastic bag. After everything is in place, the lid is closed.\nOne by one, eight operating tables transform into eight coffins.\n*****\nCremation is the last step for some donors, but not for The Baron. His family has requested to receive his ashes.\n-- Contact staff writer Colin Kearns at cmkearns@indiana.edu.