Medical students honor donors' ultimate gift

Each time student Lauren Jenkins listens for a patient's heartbeat, she thinks of Gertrude, the venerable homemaker with perfectly manicured fingernails whom she knows so well and not at all.

As a first-year medical student at Drexel University, Jenkins, of Wenonah, dissected the anonymous woman's remains and even gave her a nickname.

Four years later, she often recalls the impression of the body that Gertrude gave her. "Every time you go forward in your career, it comes back to that," she said.

Students from Philadelphia's five medical schools will join at 1 p.m. Wednesday with the families of donors like Gertrude for a memorial at the University of Pennsylvania's Irvine Auditorium.

The annual event, with 800 expected guests, student eulogies, and performances from the schools' a capella groups, is the largest of a series held in the region giving students a chance to acknowledge their donors.

Memorials were held in Pittsburgh and Newark, N.J., earlier this year. Students with the University of Medicine and Dentistry of New Jersey - School of Osteopathic Medicine will gather Friday to read poetry and letters in a courtyard of the Stratford campus.

There were 5,050 medical students in Pennsylvania last year - more than any state except Texas and New York - and most of those were in Philadelphia, whose metro area is a major hub for doctors-to-be, according to the Association of American Medical Colleges. Each first-year goes through the indelicate work of dissection, finding ways to respect the donor's humanity and master his or her own emotions.

The students' task can seem macabre. But even those who start out weak-kneed say they end up exhilarated and feeling a sense of gratitude to the donor.

The dissection is "what they gave their body for," said Penn medical student Meredith Curtis, 25. "You kind of have an obligation to do as much as you can."

Demand for cadavers in the region is growing faster than the supply. A new medical school has just opened in Scranton, and Philadelphia professors frequently ask for more cadavers to accommodate bigger classes or advanced dissections.

In most states, including New Jersey, medical schools manage cadaver donations. In Pennsylvania, all cadavers used by the schools must come through the nonprofit Humanity Gifts Registry. The state-regulated group was created in 1883 to guard against grave-robbing.

It supplies between 600 and 650 cadavers yearly to schools in Philadelphia, Hershey, and Pittsburgh. That's down nearly 100 from a decade ago.

"People are living longer, thanks to medicine," said program manager Clariza Murray.

In her sparse Chestnut Street office, Murray sits across from a wall stacked high with boxes containing the names of cadaver volunteers, about 150,000 in all, including herself. Each has signed a pledge: "In the hope that I may help others."

When notified of a death, Murray pulls the donor card and arranges for transport to a school. The schools pay the nonprofit $500 per cadaver to cover operating costs. Families cover the cost of transportation, from a nominal fee to a few hundred dollars, and can request that ashes be returned to them.

Those that arrive at Penn's morgue are often accompanied by photos or religious items. Embalmer Dwayne Hallman sets the mementos aside before "fixing" the bodies with embalming fluid.

Later, he will put the items back, adding flowers and thank-you notes from students, before shipping the bodies to a crematorium.

Most years, one or two students will visit Penn medical professor Neal Rubinstein's office before dissections begin, unsure whether they can go through with it. He is sympathetic. After 35 years of teaching anatomy, the dissections still give him pause.

"The first time I walk in [to the lab], I have to take a breath and say, 'OK, I know why I'm doing this,' " he said.

Rubinstein takes the anxious students to see the cadavers before work begins. It can help at first to note the ways the bodies seem foreign: the stiffness of the tissue and the unnatural tone of skin bleached by embalming fluid.

Over 12 weeks, the students explore their anonymous donor, from the structure of the feet to the brain cavity.

They make the first cut across the torso and work their way through organ systems, removing the heart to see its inner workings. They tug at the thick strings of forearm muscles to see which fingers they control. Some practice with catheters and procedures to open a blocked airway.

At Penn, radiologists show pictures of how the body looks in cross section. Sports injury specialists explore knees and elbows.

The students uncover anomalies - a spleen tucked into the right side of the body instead of its usual place on the left, for example. They find knee replacements and pacemakers and sometimes discover that while the cause of death was listed as heart failure, the body was riddled with cancer.

The variation "brings the anatomy to life for them," Rubinstein said.

For Drexel University student George Heckert, 26, any queasiness had been squelched by the time his class reached the head, which was removed and cut open to examine the sinuses and brain cavity.

(Just those words on the page may turn a stomach.)

For Heckert, who will give a eulogy, the whole experience was "profoundly humanizing of other people." We are all "meat and bone," he said.

Being raised in a Buddhist household where the subject of death was not taboo helped Heckert navigate the dissection experience and appreciate the depth of the donor's gift, he said.

To volunteer her body, his donor - a slight 95-year-old astronomer he named Cassie, after the constellation Cassiopeia - had to imagine a world without herself in it, something few are eager to do.

There's been talk about moving toward computer simulators. But some professors say the software available is lacking. And, more than that, Rubinstein said, students would miss out on a critical part of the process.

"Students face this emotionally," he said. "We'd rather they face it here than over at the hospital."

Jenkins understands that some families might struggle with the reality that their loved ones are disassembled in the lab. Her whole family understands.

During Jenkins' days in the lab, she regularly relayed details of the dissection to her grandfather, Bob McWilliams, a Navy veteran who had encouraged her interest in medicine. He would craft analogies to the mechanical and electrical systems he was more familiar with.

When McWilliams was diagnosed with acute myelogenous leukemia, he decided to become a donor.

He died just before final exams in Jenkins' second year. When she was grieving and studying, she would visit a bench outside the anatomy lab each day where she knew another student would learn from him.

Jenkins' family buried the ashes of McWilliams at Arlington National Cemetery Tuesday and will attend the memorial Wednesday, where his name will be read among a list of donors.

Jenkins will speak about her grandfather and Gertrude, and hopes that other families will take comfort from their example.