Warning: some of the photos in this article are extremely graphic, so if you're made queasy by images of cadavers and cadaveric material we would suggest you proceed with caution.
Look around you. How many people do you think have seen a dead body? In some spheres, death is a business. For pathologists, funeral directors, private ambulance drivers and gravediggers, death is an important part of day-to-day life. There is a part of death that is important to everyone's life, however, and one that allows life to be extended in those lucky enough to still possess it: scientific body donation.
To donate your body to medical science is, essentially, to give yourself a final bit of agency. Death is an automatic surrender of volition, but to donate means to know while dying that you've chosen that your cadaver should be used for the greater good of humanity. But how does one go about it? What kind of bodies can you donate? Could I donate my own? If I did, what would my mother say?
It all has to start somewhere, and in this specific case the afterlife of human flesh begins at King's College London. Inside this palatial, magnificently appointed, beautiful old building sit a couple of tiny office cubicles separated by a corridor. This is the London Anatomy Office, where all those in the London region who wish to donate their bodies log their requests.
In one office sits Emma Cole, whose official job title is co-ordinator. Emma liaises with the families and works with her colleague Jeniene to send out consent forms and organise transportation for the bodies to the medical universities. Once she was even party to a guided tour around the college dissection rooms.
"It was alright, 'cause I'm not bad with stuff like that, and I find it all quite fascinating," she told me. "When I went down there, there were three SAS medics in that day that were looking at new techniques to treat chest trauma. They let me watch them for a bit; that isn't something people get to see very often."
There are a few types of consent that a person can give before they sign their body away, Emma told me. There's indefinite consent, which, when granted, allows the school to keep the body for as long as they like. Another type of consent allows the school to keep it for up to three years, after which they must release it. A third type is where the timeframe is limited, but the school can keep parts of the body and take photographs for usage in textbooks. A body cannot be donated if the person had any infectious diseases, such as HIV, AIDs or viral hepatitis.
I asked Emma what makes people want to donate their bodies. She told me that one of the motivations could be the rudimentary funeral service provided for the donors by the school after their bodies are released, which takes away a lot of the financial burden put upon people by a death in the family. "It's a ten-minute service, there's a chaplain there, the families have the option to attend... they can't really personalise it, though. They have the option to collect the ashes afterwards, but yeah, the medical school cover the cost of funerals."
There is also, at the end of term, a service of Thanksgiving for the families of the donors which is held in Southwark Cathedral. The students who have worked on the cadavers can also meet the families of the donors to provide a sense of closure. Some schools even allow the students to attend the funerals of bodies they've worked on.
Above Emma's computer is a pin-board with cards and well wishes from the families of donors. She gleans more satisfaction from this job than she did working as a PA in big recruitment companies. "I enjoy it," she said. "It's still got a certain amount of pressure to it, but nothing compared to what I've been used to dealing with with corporate chief executives who think they're a bit special."
That's the thing about the dead, I guess; they don't have egos.
A short walk from East London's Mile End tube station sits the Queen Mary University, where the bodies are taken from the funeral homes. The small, unassuming Bancroft Building houses the Turnbull Centre for Basic Science Teaching, where students learn about the anatomy in a variety of ways. Much like any school, it's fitted with innocuous carpeting and light brown MDF furniture, a couple of drinks machines dotted around. Through certain doors, though, are the formerly occupied cadavers of around 20 people, and a variety of preserved spare parts.
The manager of the centre – who, along with the other technicians, including those who embalm the bodies, wishes to remain nameless – spoke to me about how they come in.
"We have a dedicated entrance to receive the recently deceased, so a private ambulance comes into a loading bay and then the recently deceased is taken out and brought directly into the mortuary," the centre manager told me. "We don't receive them through any public access points for our own standard operational procedures. It would be unseemly and it may have a negative impact of sorts on passersby. In addition, we also have to follow the HTA [Human Tissue Authority] guidelines, which are quite precise, about how you receive a cadaver and what procedures you have to have in place. So we receive the subject – recently deceased, I should say – through a dedicated entranceway."
The bodies are then taken to be embalmed by the centre's technicians. I watched a part of the embalming process, in which the body was being cleaned, and found it quite an odd thing to witness. I'd previously seen the bodies encased in their plastic coverings, stationary and waiting, but the embalming had this subject being quite rigorously cleaned in preparation for the chemical preservation. To the left were racks of bodies post-embalming, stacked in large cubby holes.
The centre, when I visited the first time, was still in the process of being readied for term's commencement. There was a coffin in the main room in which the dissections would be taking place. I was told that they won't have coffins anywhere near the students when term starts as it shoves too much of a human sense of death in their faces.
Interestingly, the job of the embalmer doesn't require as much extensive academic knowledge as you might think. "For a general technical post it can be academic qualifications – so maybe two A-levels – and you just get trained up as you go along," the manager explained. "Or it's at least five years experience in the technical field. For the embalming, that's different. You come in already from that background. You get commercial embalming, which is different to medical school embalming, and is very – I don't want to say 'straightforward' – but very niche to its setting, whereas with commercial embalming there are routes to get into. You would join a funeral directors and start off as an apprentice, and gradually be trained up. In terms of embalming in a medical school, you'd already have the knowledge and be trained up by a trained embalmer. It's a specialist skill to have."
In the room adjacent to where the cadavers are kept is another classroom where the desk study is done. In here there are giant, expensive European models of lung systems, heads, brains, etc. There are also tens of boxes filled with different preserved body parts. Brains, hearts, thoraxes, hands – these are called "pro-sections", and it takes a skilled hand to prepare them.
In the case of the hand, a highly trained person must cut the right places to expose the relevant tissue, tendons and muscles. They are fascinating to look at and even more so to hold in your hands, as are the brains, the part of the body that changes most after the embalming process, becoming much heavier.
Does being surrounded by so much death, even in this clinical environment, bother the people working here?
"I can't speak for anyone else, but for myself it was strange to begin with, and not in a sort of ghoulish way – what people would imagine, or being scared of being surrounded by cadaveric material – it's more a fascination," the centre manager told me.
"And then, very quickly as you start the job, it becomes a routine sort of exercise: you are there to look after the pro-sections, you're there to look after the cadavers, but you must be respectful to the cadavers. Both staff and students are told that someone has donated their body – it's a privilege that they're going to be performing an anatomical examination as per the wishes of that particular donor."
The next time I visited the school there was a class in session. Around 20 students were in the dissection room, about five or six students to a cadaver, and were working on trying to find nerves and vessels in the gluteal area. I was told that, for most of the students here, it was their first time with a cadaver.
It was proving a bit much for Gemma, 23.
"It's actually a bit of a shock for me personally. I'm maybe struggling a bit more than I thought I would. I think you have to be able to detach the person from the body, and I don't know that I'm quite there yet. I'm getting there!" she giggled nervously.
The smell was quite upsetting, but it wasn't a smell of rot, rather one of the chemicals used to embalm. Formaldehyde is still the main chemical used in the fluid, while the anti-fungal chemical phenol has been removed as it poses a potential exposure threat.
Though there were some reported instances of queasiness and upset, most of the students – who varied in age and were all graduates working towards qualifications that would allow them to work in a variety of medical professions – looked excited by it.
"I feel like I've reached a new level of understanding just in the last hour or two," smiled Oscar, 23. "It's made it feel very real as well. I'm quite interested in becoming a surgeon sometime in the future. I mean, I'm keeping an open book; I'm not making any commitments now – but it's really made me feel how important what we're doing is for the future."
I asked him if he would, having now seen what happens to bodies once they're donated, gift his viscera to future doctors and surgeons when he's done with it.
"I already wanted to donate my body to medical science or medical teaching, because from speaking to junior doctors and other medical students, I was well aware of just how much influence it made on their knowledge. So, yeah, I think for sure I'll be donating my body to medical science."
The importance of donating your own body to the furtherance of human understanding cannot be overstated, and the respect and reverence afforded to those who decide to give themselves to science was palpable on each one of my visits.
Thinking about it now, I'm struck by how brave a decision it is to fully relinquish yourself after death, to perform one last charitable action, to sacrifice something you hold dear, the thing you've been operating your entire life in. You get to know your body so intimately – you're really closer to nothing else – and to bequeath that part of you for the benefit not only of the medical students who will use it, but to those who doctors of the future will be helping with skills garnered from it, is a beautiful thing.
From start to finish, the people involved in the process of body donation are close to death. Of course, it becomes par for the course after a while, but the sense of privilege they feel to be working with people who have made a last noble act seemed ever-present. I'm still in two minds about whether I want my gluteus maximus cut up by some eager-yet-cautious young doctors-to-be, but I hope one day I can emulate the fortitude of these body donors and choose to make a difference long after I've drawn my last breath.
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