Students find using saws on a dead person’s head difficult. They say that it seems ‘brutal’, and as though they are ‘attacking it’. Students have described cutting through the head as ‘horrible’, ‘disturbing’ and ‘traumatic’, because they feel that they are ‘violating normal rules’, which of course they are. Since they are working close to the face, it is more obvious than ever that they are cutting up a person. On the other hand, like Bill Hayes investigating the hemihead, the trauma is interlaced with fascination and wonder. One student, holding a brain he had just carved out of a corpse’s skull, from a head he had hacked off using a saw, wrote:
… you realize that words fail to capture what an awesome and emotional experience it is to have just done what you’ve done, to hold what you’re holding, to be so intimately connected with a perfect stranger who made you the recipient of the gift of their body. Time stops and you go inward to your own history and your own unwritten future. Could you be so selfless? Could you be such a teacher? Where do we go when this machine shuts down? In the blink of an eye, you’re back in the present and you turn to a fellow awe-struck student and carefully, tenderly place the brain in their hands.
Most students who undertake the ‘head and neck’ class are seasoned dissectors in any case. They are learning to compartmentalize their emotional responses. As Hayes wrote of his efforts to dissect the back of his cadaver’s neck, ‘It is just one hour after morning coffee, and I am helping to perform what is awfully close to a decapitation.’ The head also becomes just another part of the body that must be learned.
The dissection room accommodates a strange mixture of dehumanizing and re-humanizing activities. The dehumanizing effects are mostly byproducts of other necessary procedures, like the need to maintain a secure and sterile environment. Wearing a gown and mask, ‘scrubbing up’, working in among rows of stainless steel tables on bodies that are carefully wrapped up, in among rows of tools and labelled boxes, behind locked doors and surrounded by warning signs: all these things can help to make the human body in front of you seem a little less human – not to mention the fact that the cadavers have been transformed by the preservation process. These people do not look like living people. Their skin is ashen, tough and leathery, like animal hide; their nose, cheeks and chest are often crushed; their hair is shaved off. It can be hard to tell the cadaver’s sex without uncovering his or her genitals. Students never know the name of their cadaver; instead, they are told its identifying number.
Dissectors quickly learn to treat their cadavers more aggressively, and to a certain extent this is encouraged by their lecturers. They may start tentatively, but they are told to cut, to tear and to tug at the human body, pushing and pulling its flesh and organs when necessary. As the weeks go by, students become bolder and more casual in their attitude, and the cadaver’s silence imparts a strong message. As one student said, ‘the cadaver never complained that anything hurt’. With the help of a patient who is already dead, students gradually learn to handle people’s bodies in a firm and socially privileged way.
Despite these practices, or perhaps partly because of them, medical schools do now frame the encounter between student and cadaver as a human relationship. The concept of the cadaver as the student’s ‘first patient’ is increasingly popular, and some lecturers give out the donor’s full medical history so that students can begin to investigate the cause of death, or the lifestyle and habits of their subject. Medical students on both sides of the Atlantic are often encouraged to write testimonials to their donor, or to express their feelings about human dissection creatively, through poetry or art. Schools hold a memorial service each year to which students and the donors’ families are invited. Meanwhile, students find themselves relating to their cadavers in surprisingly personal ways. Although they learn to detach themselves from their emotional responses in order to be able to undertake extraordinary feats like decapitations and head bisections, they often name their cadaver and develop an intense relationship with it.
Christine Montross, who attended medical school at Brown University, Rhode Island, named her cadaver Eve. Although the cadavers’ heads are usually covered up, Christine and her fellow student decided to look at Eve’s face on their first day in the lab, because, she explained, ‘It doesn’t feel right to cut her up without knowing what she looked like before.’ Later, they tried to protect her face while rolling her over on the dissection table. ‘Holding the cadaver’s chin does little to protect the body’s form, but as our actions render her less and less whole, it seems somehow important to preserve whatever human shape we can.’
Counterintuitively, the action of cutting a dead person up can engender an intense respect, even concern, for his or her humanity. The physical violence is laced with moments of tenderness. Students take care to cover their cadavers, to ask their permission, to hold them and move them as they would a living person. There are long, quiet hours in the dissecting room to meditate on the life that once animated the body beneath the knife.
We tend to assume that doctors need to put a person’s humanity to one side in order to perform their more invasive tasks, but it is not always the case. On the contrary, in fact, surgeons who perform deep brain stimulation surgery for sufferers of Parkinson’s disease interact with their patients while delving into their brains. Brains have no pain receptors, and a local anaesthetic is used to numb the scalp, so the patient feels no discomfort during the procedure. The patient is given general anaesthetic in order for a small, 1.5-centimetre hole to be made in the top of their head, and then they are woken up again, for up to two hours, so that the surgical team can talk to them and ask them to perform small tasks to help work out the correct placement of the electrode to relieve their symptoms. Then the patient is sent back to sleep so that the electrode can be anchored to the skull and the incision in their head stitched up again. Awake brain surgery is also performed to treat tumours and epilepsy, because it allows surgeons to operate without damaging those parts of the brain that control a person’s vision, language and movement.
It is also possible for people to operate on family and friends. Sky Gross, a lecturer in medical ethics at Tel Aviv University, has written about her experiences witnessing the brain surgery of a friend. She had befriended Omer, a brain cancer patient, during the course of her research, and when she accompanied him into the operating theatre, and watched as the skin of his head was cut and pinned to the sides, opening up a fist-wide cavity at the centre of the wound, she writes, ‘I remained standing over the orifice, surprisingly experiencing little awe or disgust. What seemed to take over me was rather an acute sense of curiosity.’ As the surgeons removed pieces of his skull bone, Omer was simultaneously the centre of attention and completely absent. Gross realized she could form a relationship with Omer’s brain that was separate from Omer the person, and this was despite the fact that, unlike the doctors alongside her in the operating theatre, she had no training in clinical detachment.
I knew how the brain looked, but imagined Omer’s would look as if it was Omer’s. After all, this was not the anonymous brain you would see in anatomy class: this was the brain with which I had these I–Thou relations and intersubjective exchanges. This was the brain that cried, laughed, told stories. But as a brain without a person to personify it – it was just meat, sick meat. I was deeply disenchanted.
Gross had expected to feel different because Omer was her friend, but the particular rituals of the operating theatre – the complex routines of scrubbing up and wearing sterile theatre gowns and masks; the fact that Omer was completely anaesthetized and inert and only partly visible under surgical drapes; the lighting, machines and tools; and the strict choreography and hierarchy of the operating theatre – all helped to transform Omer from a person into an ‘operable body’. Anaesthetized bodies, like dead bodies, do not behave like people, and so it is easier to treat them like things.
Of course, watching a friend’s brain surgery is very different from performing a post-m
ortem on a loved one, particularly a post-mortem that requires decapitation or dissection of the head, but these stories make even that unthinkable situation seem a little less extraordinary. As Montross has written, all dead bodies resemble themselves less and less, even those of the people we love. There are rare examples of doctors dissecting members of their own family. George Coombe, the phrenologist, dissected his brother’s brain, and the seventeenth-century anatomist William Harvey dissected the bodies of his father and his sister. In 2010, a doctor in Karnataka in southern India dissected his father’s body in front of a group of students, according to the terms of his father’s will. ‘Whatever emotions I have, I control them,’ he said, and his actions were fully supported by the rest of his family. Aware of the shortage of donors in India, his entire family intend to donate their bodies to medical research.
There is a classic ‘cadaver story’ that circulates among students who are new to the anatomy class, which tells of a rookie dissector who discovers, when the gauze is pulled back from his cadaver’s head, that he has ‘hacked his mother to pieces’. It is a horrific joke, that plays on the emotional vulnerability of students and their ability – or inability – to distance themselves from the humanity of their ‘first patient’. (It also neatly reiterates our acceptance that a person’s head is their identity in a way that their body is not.) Medical students do not actually fear having to dissect one of their relatives, but they do fear that their cadaver will remind them of someone – if not of a person they know, then of the human form in general.
Students’ anxieties about dissection centre on the fear of their own response to seeing, and cutting up, a dead body. Initiates are scared that they will faint, or vomit, or cry, partly because they know that these reactions would raise doubts in their colleagues about their capacity to be a physician. For most new students, the actual experience is less daunting than the experience they had imagined, and anxiety drops markedly in all students after their first dissection class. Even a group of students at a university in Paris whose very first dissection was the head and neck found the smell more memorable than the sight of the cadaver’s face, and almost half were not shocked by the experience, or were less shocked than they expected to be.
The vast majority of students find dissection an enjoyable experience and see it as essential to their training. Many choose to go to particular medical schools precisely because they offer a course in human dissection. Dissection can be traumatic, but ordinary young people get on and do it nonetheless, and find it fascinating work. This matter-of-factness, in itself, can be a source of horror.
Not only is the prospect of cutting off a dead person’s head disturbing to medical students, so is the fact that they can do it. As Jennifer Kasten, a research fellow at University of California, Los Angeles, remembered about her medical training, ‘We worried there was something defective about us, that we were so easily able to go about cutting up a person into his constituent parts in a methodical, emotionless way.’ Kasten, like all other medical students, knew that ‘our new normal really was very abnormal’. The same could be said of surgical procedures like cutting people open and disembowelling them on the operating table, which become so mundane to surgeons that they are practically boring. Sociologist Harry Collins has noted, ‘The terrible thing is that what to outsiders is routine cruelty, to insiders is merely routine.’ It is another reminder that, given the right cultural context, people can perform brutal procedures, just as they can watch bloody executions or boil people’s heads to clean off the flesh. It is not only what doctors have to do to people’s bodies that is shocking, it is also the fact that doing those things is unremarkable.
At the end of Montross’s anatomy course, she has to dissect Eve’s head. During the ‘head and neck’ class, one student leaves the room suffering from a panic attack, not because he is afraid of his actions, but because he is overwhelmed by the enormity of the scene before him:
[T]he fear comes from the fact that he is in a room full of otherwise relatively normal people, his friends, his colleagues, and we are all engaged in taking the faces off dead human beings. Some cut through lips with scalpels. Others pull off masks of skin so they are holding in their hands the obvious oval of nostrils, whiskered cheeks, eyebrows …
It is the horror that ordinary people can do these things with ease, to cadavers they have come to know and respect even as they render them unrecognizable through their chopping, slicing and emptying. The face, more than any other part, is the person’s identity, but that, too, can be anatomized.
During their final lab, Montross and her friends have to mark a line around Eve’s head and use a bone saw to cut open her skull. Then they use a hammer and chisel to open up the crown of the skull. They have to take a break because they are tired and irritable. They carefully twist the chisel in the crack they have made to prise off the top of the head, and the bone groans in response. Once the bone has been removed, they are called to another room by their teacher, but there is no respite, because they are greeted by a prosection – an expertly dissected and preserved example – of the severed head of a man who has had the two hemispheres of his brain removed. The instructor uses the remaining strip of skull running across the top of the man’s head as a handle to carry it while he points out various structures to the students. Then they return to their cadaver to remove Eve’s brain. Even when all the arteries and nerves have been cut loose, they have to tug hard at the brain to get it out. Montross described the experience as ‘surreal’. Later she had to sever Eve’s head and saw it in half lengthwise, creating the kind of ‘hemihead’ that Hayes had encountered in his anatomy class.
After removing Eve’s brain, Montross went home and took a scalding shower to try and rid herself of the smell of the bone saw. She felt ashamed. But she was not ashamed of her actions, she was ashamed at the disgust she felt. ‘I feel ashamed, because I understand the unthinkable gift I have been given and how it deserves to be met with steady appreciation and reverence. I am ashamed to feel disgusted. But I am.’
Sky Gross was disappointed that her friend Omer’s brain had been reduced to little more than ‘sick meat’ in the operating theatre, while Christine Montross felt ashamed of her unsteady emotions while dissecting Eve’s head. One had hoped for more compassion, the other for less. Navigating the emotional landscape of the medical profession is fraught with difficulties on both sides of the human/object divide. In the dissecting room, the cadaver is never an object like any other object. Students learn to study and handle it like an object, but it occupies other worlds too. Objectification is a constant process, not a given state, and students have to work hard to ensure they are able to treat their cadavers like inanimate things. It helps that they are in an environment where otherwise violent activities are made to seem reasonable and routine, but there are moments when their efforts fall short and they struggle to maintain their dispassionate gaze.
Dissecting a person’s head may be more of a struggle than dissecting any other part of the body because of the physical demands it makes on the dissector, as well as the emotional ones, but it has delights to offer too. Perhaps you cannot have the delights without the struggle, since the reason cutting through a person’s head feels like an act of unrivalled personal desecration is the same reason it is so fascinating to see inside. Our heads are crammed with a vast number and range of intricate features, eyes and ears, tongue, nerves and arteries and glands, muscles and bones and teeth, and that is before you have even started on the brain. Everything is densely packed and highly integrated. As one student said, ‘You’d be awed by what simply surrounds the eye and allows you to blink or squint.’
The one great difference between human dissection today and what it was like one hundred years ago lies in the identity of the corpse on the table. Before the Second World War, almost all bodies dissected in the UK were those of the poor who had been requisitioned from public institutions like Poor Law infirmaries and mental hospitals. During the twentieth
century, however, the number of bequeathed bodies rose steadily and in 1961, the Human Tissue Act in the UK ruled that all body parts used for medical purposes must be governed by a consent procedure. There is a great difference between cutting open a person who has chosen to donate their body to science, and cutting open a person who had no choice.
The arteries of the head and neck, engraving by Charles Bell, 1811.
Medical students today feel intensely grateful to their donors, and they are expected to treat cadavers with respect and admiration, but this, of course, has not always been the case. In earlier days, human bodies on the dissecting bench had little significance to doctors beyond their physical properties, and were often treated without any respect at all.
Historian Ruth Richardson has noted that references to the conditions of the Victorian dissecting room are notably absent in the literature. Even dissection manuals, aimed at students who were facing their initiation at the bench, did not mention the nature of the activity or its moral implications. But doctors acknowledged that it was ‘a dirty source of knowledge’ and many did not particularly enjoy it. Work spaces were often cramped and smelly; rodents were attracted to ‘the mass of offal, and the putrid vapours to which they give rise’; and dangerous chemicals were used to preserve specimens. The bodies of the poor were routinely treated badly, and occasionally medical practices were castigated in the press, but the profession maintained almost complete silence on the subject. Like Frankenstein’s fearsome ‘workshop of filthy creation’, loathed and yet utterly engrossing, the world of the anatomist was largely hidden from the rest of society.
Severed: A History of Heads Lost and Heads Found Page 21
