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Over my dead body 

Dissecting Colorado's shortage of anatomical donations

click to enlarge Dr. John Pigage brought the cadavers program to UCCS in the mid-1990s. Before that, cat carcasses were used to teach anatomy and physiology. - SEAN CAYTON
  • Sean Cayton
  • Dr. John Pigage brought the cadavers program to UCCS in the mid-1990s. Before that, cat carcasses were used to teach anatomy and physiology.

They are us, and they are not us.

Some lie face up on the stainless steel tables, the slits of their eyes strangely deep, splashes of embalming fluid pooling around their feet. Others are face down, the flesh of their noses folding under pressure. A few are largely intact, while others have been dissected to the point at which they are simply patterns of muscle, bones and organs.

They look plastic, but they are real — three men and three women. Yet, they are also, somehow, not real. It is startling to confront how little these dead bodies lying in two University of Colorado at Colorado Springs classrooms resemble us. All the things we connect with in a human being — the light in the eyes, the warmth of a hand, the flush in the cheeks — are absent in a corpse.

On the other side of one classroom, fresh-faced students sit at long black tables on rolling chairs, their eyes fixed on a screen showing closeups of kidneys. An instructor stands by as they busily scrawl. It's a test day. The cadavers, for now, are merely four objects in this room, no more distracting than the shelf of colorful backpacks, the models of organs, the skulls or the microscopes.

Shaved of their head hair, the cadavers, which are all Caucasian and old enough to be grandparents, are stored wrapped in plastic and enclosed in humidors — stainless steel, coffin-like contraptions with vents that suck vapors out of the room. Even with the vents, the bodies smell sour, chemically, and slightly putrid. Formaldehyde.

Their blood has been replaced with this chemistry lab staple, mixed with phenol, water, glycol and alcohol. The embalming fluid lends the cadavers' skin a slight shine, and turns it pale and yellowish in color. The inner tissues are also robbed of their once-vibrant hues, and are instead off-white, tan and light brown.

Over time, the bodies start to dry out. Skin shows the signs of this most obviously, sometimes darkening and breaking on the hands and feet, or folding into oddly sharp lines along the torso. But it is the drying of the inner tissues that poses the most problems for dissection and study, and the bodies must be sprayed often with preservative as they are carefully cut apart.

The six prized cadavers in this program, referred to in the field as "anatomical gifts," will likely each spend a year here in the UCCS biology labs, where they will help some 400 students learn anatomy and physiology. They have come to this school through no small effort on the part of professors; demand for these most-macabre of educational tools outpaces supply in Colorado.

Though it's logical that many would not donate their remains for use in such gruesome procedures — and one obvious candidate consulted for this story says he won't — the shortage isn't due to fewer people donating their bodies. That number has remained fairly steady in Colorado. It's the demand that's growing. Schools and programs continue to expand, and everyone from biology undergraduates to medical students benefit by learning from cadavers. There's also competition from for-profit companies that transfer bodies for research.

But, when it comes to learning about the human body, there's simply nothing like the real thing. And thus, these cadavers provide an invaluable tool for students, many of whom will go on to become doctors, nurses and other medical professionals.

The knowledge they have gained from the dead will be used to save the living.

Dr. Jon Pigage's office is what you might expect from a professor.

Huge bookshelves are overloaded with tomes, busts, photos and even a duck decoy. A large desk brims with papers, and some binders have been relegated to the floor for lack of space. Pigage began teaching anatomy at UCCS in 1996, when students were still getting most of their education by dissecting cats.

"And I said, 'no,'" he remembers.

With his help, UCCS began using human cadavers, starting with just one a year. The school now needs six. Every year, Pigage drives to Denver to pick up bodies for the biology department.

"We get them whole," he says, "and when we're done with them, there's basically nothing left."

Or, at least, nothing left intact.

Andrew Subudhi, Assistant Professor of Biology and the chair of the Department of Biology, says UCCS is lucky to get the cadavers.

"Not a lot of programs are able to run anatomy and physiology programs with human cadavers, and sometimes many places do it with cats; some will do it with fetal pigs," he says. "[Cadavers are] a really, really powerful learning experience. So we are eternally grateful to these people who have donated their bodies because you just can't deny how effective it is of a learning tool to actually be the one who gets to see something for real, not just in a book, or on a simulation, or on a computer program or whatever it may be."

But, of course, there is usually some initial trepidation. When students first encounter a cadaver in the classroom, Pigage says they are allowed to approach it on their own timeline. Some come eagerly up to the table, others hang back. For a lot of students, this is their first experience seeing a dead body. The university generally keeps a cadavers' hands, feet and head wrapped to start, to allow students to adjust.

"If they see the hands and they've got fingernail polish on them, that's somebody's mother," Pigage says. "And students — we're talking 19-, 20-year-old kids — they kind of freak out a little bit on that, and it takes them a while to get over that."

The bodies come from other cities in an effort to reduce the chance that they might be recognized. That's only happened once in his years of teaching, Pigage says, but the student dropped the class.

There are two main classes that use the bodies: Human Anatomy and Physiology 1 and the upper-level Human Anatomy and Physiology II. (Graduate courses also make use of the cadavers.) The lower-level class is looking at basics like skin, bones, muscle and nerves, while the upper-level class spends more time on organs and the endocrine, cardiovascular, lymphatic, immune, respiratory, digestive, urinary and reproductive systems.

As Subudhi explains, "We structure the class to work from the outside [of the body] in, and we also work from extremities toward the center, so there's just a plan there to help maximize the longevity of the cadaver."

click to enlarge SEAN CAYTON
  • Sean Cayton

Dissection also has to be scheduled carefully so that 400 students, broken up into labs of 24 people each, can simultaneously use them as learning tools.

"It's not easy to coordinate," Subudhi says. "It's like a big game of Tetris."

Instructors do most of the dissecting, since the cuts must be exact, revealing layers of structures within the body. The process isn't what most people expect. There is no blood, only embalming fluid, which also causes the body to harden and change in appearance. James Adrian, a young lab instructor with a halo of curly hair, notes that the muscles of cadavers are cream-colored.

"It's supposed to be this beautiful vibrant bright red," he says. "And the same thing if you saw any tendons or ligaments. The tendons are supposed to be this beautiful almost translucent, sparkling — almost have a diamond-like quality to them. Kind of shimmering. But now they just look kind of white or off-white."

Differences aside, the bodies provide a wealth of information. Adrian says he usually begins his classes with a lecture, followed by hands-on examination of the cadavers. Often, numbered paper flags attached to pins are placed in the bodies to identify the different structures.

Cadavers aren't the only learning tools in these classes. The lab itself is evidence of this. It's home to a variety plastic models, buckets of sheep brains sit on the floor, and bags of sheep eyeballs and hearts fill lab sinks. And actually, a sheep brain or heart is quite similar to a human's — it's the way that the systems of the body work together that's radically different.

The muscles of the arm, for instance, can be difficult to grasp without a cadaver to demonstrate how they attach and move together.

"The cadavers, by far, are the best benefit of this program," Adrian says. "Where [structures] are in the body in relation to other structures really helps them get a good sense of the body, really helps prepare them clinically. Because if everything is on the cadaver then we just have to point to structures, and we can bring in clinical significance of different conditions."

Students also get a chance to see evidence of medical conditions and treatments in the bodies. Females have often had hysterectomies. Pacemakers are common. And Adrian remembers one cadaver that had a heart that was four times the normal size.

The school is allowed to keep many of the medical devices found in cadavers. Pigage has a drawer full of pacemakers, replacement hips and even a morphine pump and a glass eye. He also has a container full of gallstones.

The items are interesting to students and most likely wouldn't be cremated with the remains anyway.

"Pacemakers you have to take out because they would explode in cremation," Pigage says.

Kevin Berning, 23, is in his first semester as a graduate student at UCCS, studying sports medicine and athletic training. Berning received his undergraduate degree at North Park University in Chicago. But this is his first time working with cadavers, and he says it's been enlightening.

"Being able to see how it works on the body, and how we deal with injury to every muscle that we've learned, and how to rehab that, is so interesting to me," he says. "When you look at the actual muscle on the body it's a whole different ball game."

Once a University is finished with a cadaver, it goes back where it came from: the Colorado Anatomical Board.

Created by state statute in 1927 and housed in the School of Medicine at the University of Colorado Anschutz Medical Campus, the board's function is to receive, handle, monitor and dispose of bodies donated for the purpose of education and research. The board is made up of deans of the Schools of Medicine and Dentistry and chairs of the Departments of Surgery and of Cell and Developmental Biology. As one might expect, the board follows stringent guidelines for how the bodies are handled.

The board is not the sole purveyor of bodies used in research and training; there's a separate, for-profit industry that provides bodies for such purposes as well, though those businesses mostly deal in fresh (not embalmed) body parts.

The board handles about 150 to 170 bodies each year, distributing them to Colorado colleges and universities. But while donations have been steady, the need for them has increased as schools continue to expand programs. Colorado is lucky in some ways. Some states' anatomical boards can't come close to fulfilling demand, and undergraduate programs don't receive any bodies. Other states, such as Maryland, usually have a surplus, and programs in less-fortunate states can contract for their excess cadavers.

click to enlarge SEAN CAYTON
  • Sean Cayton

There is a pecking order for which schools receive bodies first in Colorado, with priority given to health professional programs. Those that train doctors have first dibs, followed by schools of dentistry, physician assistant programs, physical therapy programs, residency programs on the CU Anschutz campus, and finally undergraduate programs like the one at UCCS.

Because of this, UCCS sometimes gets fewer bodies than it asks for. This year, for instance, it received only four but was able to procure two more from Washington State University in St. Louis.

The bodies that come from the Colorado Anatomical Board cost universities $2,300 apiece. The charge isn't for the actual bodies — it's illegal to charge for a cadaver — but rather to cover the costs of transporting, processing and storing them.

Dr. Michael Carry, Professor of Cell and Developmental Biology in CU Anschutz School of Medicine and Secretary-Treasurer of the Anatomical Board of the State of Colorado, says the board always encourages families to donate organs if possible.

"If you can help save somebody's life, that's a more pressing need," Carry says.

Andrea Smith, communications director for the federally designated, nonprofit organ-procurement organization Donor Alliance, says she doesn't see a conflict between body donation and organ donation.

"Any time you can help other people through donation, it's a good thing," she says. "Certainly, we concentrate on donations for transplantation purposes; however, not everyone is eligible."

If a person or family does opt for organ donation, the board can no longer accept the body as an anatomical gift. The same goes for those who died from traumatic injury or recently had surgery (because their bodies can't be properly embalmed); those with a contagious disease such as AIDS or tuberculosis (for safety reasons); those who are morbidly obese (they don't fit in the humidors); and those who are extremely emaciated (the bodies dry too quickly and the muscles are sometimes atrophied, making them difficult to dissect).

Due to the limitations, and the fact that most people die later in life, most donations come from older people.

There are two ways bodies can end up with the anatomical board. First, anyone over age 18 can sign up for the program ahead of his or her death. Second, if the person has already passed, the next of kin can sign the paperwork. Either way, the board won't accept the donation if any immediate family members object.

"If the family isn't in agreement, then typically problems arise," Carry says. "It's just sort of a thing where a situation is uncomfortable."

No organization is charged with helping the board procure bodies, and the board doesn't advertise, other than occasionally connecting with a journalist to tell a personal story of a donor or to discuss their annual memorial service. It does, however, work with hospitals and hospices, which provide information about the program when end-of-life decisions are being made. That's where most donations come from. Once the board is notified of a donation, the body is immediately transported to CU Anschutz, where it is embalmed. Since the body must be removed swiftly, a traditional funeral often isn't feasible. Many families opt for memorial services instead.

The process of preserving a cadaver takes about six months — to ensure that the embalming fluids have a chance to work their way through all the tissues of the body. Then the receiving school makes arrangements to pick up the body. Schools agree to a strict set of guidelines about who can view the body and how it must be treated and stored. For instance, photography of the cadavers is forbidden, as is keeping any part of the body.

click to enlarge Medical devices removed from cadavers — from dentures to pacemakers. - SEAN CAYTON
  • Sean Cayton
  • Medical devices removed from cadavers — from dentures to pacemakers.

When dissection is complete, the remains are cremated at no cost to the family. Ashes are returned to the board, which notifies the family, who can opt to keep the ashes or have them sent to the board's burial site at Fairmount Cemetery in Denver (again, at no cost). Students at the medical school also organize a yearly memorial service for donors to thank them and their families for the gift.

"They do quite a nice job," Carry says, "and the families are quite appreciative of it."

A few years ago, Pat Bates attended her first memorial service at the anatomical board.

Her beloved husband had lost his nine-year battle with cancer in 2012, and had followed through on a commitment he had made more than 20 years before to donate his body to science.

Dennis "Denny" Bates was a wonderful, cheerful man. A retired printer for the Rocky Mountain News, and before that The Gazette, he had loved music, traveling and dancing. He and Pat had met 17 years before his death through their shared love of dance, and together had performed in a show troupe for about 15 years and taught dance classes all around the Denver area. Pat remembers that he once went dancing with her while he was wearing a chemo drip. When the pump fell out accidentally, he laughed and cracked a joke about it.

"He taught me so much about life," Pat says. "He was never a complainer; he was never a negative person."

Pat says she understood her husband's choice to donate his body, though she felt that in some ways it was difficult to have closure until she had his ashes. Dennis had felt that since he had no further use for his body, someone might as well get some use from it. And his four stepchildren, who had always loved and respected him, had no problem with the donation.

Still, she says, she didn't fully get on board with the idea until the memorial service. Hearing from the students, who were so grateful for the bodies, made her change her mind. Her husband's body, she learned, had been many students' "first patient" — someone they'd always remember.

"The amount of respect and gratitude is just almost unbelievable to me," she says.

After that, she began attending every memorial service and speaking to students about the experience. She also signed up to donate her own body, as did two of her aunts who also attended the service. One aunt has since passed and is currently in the program.

Pat has never seen a dissection and says she really doesn't want to, but she doesn't think viewing it would change her mind about donation.

"I've been with several people that have passed away and it is, to me, so obvious that they're not there anymore," she says. "They're gone."

Just as medical information is closely guarded in life, the identity of donors is kept secret in death, and thus, their motivation for donating their bodies is also not publicized. But through the Colorado Anatomical Board website, we can catch brief glimpses into the former lives of at least a few donors in a feature that describes an annual memorial service. One donor, for instance, was "a breeder of schipperkes;" another "an elementary school teacher who received a new heart from a 10-year-old boy 16 years before she died;" another "a poet and business owner who once played trumpet for the Queen of England in World War II, endured five types of cancer, an angioplasty and, at the age of 91, a cranial surgery."

The latter's daughter is quoted as saying, "He was hoping that you weren't hoping to see normal human anatomy. Science was always one step ahead of him, and he was so grateful for that."

Of course, it's obvious that some people might be interested in the program. Asked if he would donate his own body, Adrian is enthusiastic.

"Oh, definitely," he says. "I'd love to donate my body, because I'm not going to be needing it and I don't have any attachment to it after I pass — and it can go towards helping students to learn, to create a new generation of doctors and nurses, PAs and physical therapists."

Adrian expounds at length. Perhaps his body would be dissected in a lab such as those at UCCS. Perhaps it would go to medical research. His friend, he says, is working on designing spinal implants. It's exciting, groundbreaking work that has a chance to make a difference in people's lives. He'd love for his remains to be a part of such work.

Pigage feels differently.

"Every year the students ask me that," he sighs.

The truth is, he's not up for being dissected and studied. He wants to be cremated and have his ashes scattered over Yellowstone National Park. Asked if it's because of how his family members feel about it, he says "no."

"I think it's more that I've seen how the students treat the bodies," he adds.

click to enlarge Models, like these skulls, also serve as learning tools. - SEAN CAYTON
  • Sean Cayton
  • Models, like these skulls, also serve as learning tools.

While many students are quick to express their gratitude for donations, dissection undoubtedly is a brutal process. The body becomes an object, a learning tool for hundreds of students. And for many of us, it's too difficult to imagine our bodies undergoing such trauma.

Asked if students ever joke about cadavers or give them names, Pigage says, carefully, "I don't like that." The bodies have to be treated with respect, he says. It's something he discusses with his students and a requirement for continuing to receive the cadavers. (Berning, for his part, says students are strictly respectful of the corpses, adding, "I don't see any horseplay or messing around with it at all.")

It might seem outrageous that such a warning is even necessary. But whatever assumptions you have about the dead fly out the window when you see corpses laid out on metal tables in various states of deconstruction. You can blur your eyes a little and see something clinical — a medical dissection. But when you stare into their faces, you're liable to start wondering about their lives. Was he a good father? What did she do for a living?

It's jarring to let your eyes wander from those faces to the exposed muscle and organs. You feel sorry for them. But you also feel sorry for yourself. We all know death is inescapable, but few of us will ever be faced with our own mortality in this unblinking fashion. And when death is staring you in the face, any response can seem natural — fear, shock, laughter, sadness.

They are us and they are not us. For now.


  • Dissecting Colorado's shortage of anatomical donations

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