Hard bodies and hard questions

"You don't faint easily, do you?"

Actually, yes, I do. I've blacked out before breakfast on more than one occasion. But no need to make the doctor nervous. On the way to the plastination laboratory, the one place that could be considered creepier than a morgue, where I'll soak in the sight of fresh human cadavers, skinned and split open on steel slabs, I tell Dr. Ameed Raoof, "Well, I've been to funerals before ... and ... been fine?" The look on his face says that only professionalism keeps him from rolling his eyes.

Founded in 1989 as the only one of its kind in the country, University of Michigan's Plastination Laboratory permanently preserves dissected human bodies for education at U-M and Cleveland Clinic, Yale, Johns Hopkins and Columbia University.

Dr. Raoof has earned his white lab coat. Before he joined the staff in 1998, he'd already had experience as an anatomist. Born in Iraq, he's one of six children, all of whom are doctors. He has a doctoral degree in anatomy from University of Dundee in Scotland, and had worked in Britain and Saudi Arabia for some time before moving here. He's now director of the lab, as well as a lecturer and assistant professor in the department of medical education.

For at least 500 years, human cadavers have been studied by medical students and artists learning about anatomy. Galen, who was Emperor Marcus Aurelius' personal physician, performed public autopsies back in 150 A.D. As an article in U-M's medical school publication points out, it's been 156 years since "Moses Gunn arrived in Ann Arbor by stagecoach, accompanied by a long wooden crate carrying the first cadaver for study at the new University of Michigan Medical School." Dr. Raoof tells me that cadavers have always been a student's "first patient" and as such they're treated with great respect.

Dissection is how students experience firsthand the relationships of bones, organs and tissues. But as you know, anything that's ooey-gooey decays. The traditional method for preservation is soaking bodies and organs in formalin, a dangerous derivative of formaldehyde that, 30 years ago, doctors realized could be carcinogenic when concentrated. The search began for a less toxic alternative. In 1978, while working at the University of Heidelberg's Anatomical Institute in Germany, Dr. Gunther von Hagens invented a "silicone impregnation" process that replaces water and fat in tissue with silicone. The technique, which he called "plastination," was a success. He founded an Institute for Plastination in Heidelberg — and got started on his press release.

Millions of viewers

The U-M plastination laboratory is just down the hall from Dr. Raoof's office in the medical science building on campus, so we're almost there, but he hasn't given me any of that white cream you're supposed to swipe under your nose like Jodie Foster did in Silence of the Lambs. I'm thinking you taste with your nose. What if I taste corpse? If I breathe through my mouth, I could actually ingest it, right? These are questions I'd like to ask, but I keep my mouth shut. I already mispronounced vascular as vacular back in his office. I know nothing about science.

The scene is a lot to handle, and one glance at my notes proves that: Scribbled in the upper corner of my pad is something barely legible that reads Clasrelehna. We had to skin. We had to deshend. So we did it w/a fountain pen. First off, there's a bright yellow corpse wearing its own partially detached skin like a blanket. In another room, a doctor is digging into a corpse, working on a gallbladder that looks like an empty wet garbage bag. There are shelves of rubbery brains and hearts and lungs, not in jars. A big table has buckets of scissors, paper towel, black rubber gloves and a couple gallons of mysterious pink liquid. Organs are drying in tinfoil trays after a bath. The dry eraser board reads like a carnivore's grocery list:

Head and neck: 9 pieces

Lower limb

Upper limb

Torso

Still, the lab is a lot less ominous than I imagined. In fact, the paint job is strikingly similar to one I've chosen for my own home, a palette I can now describe as "surgical scrubs" green and concrete gray. A blue plastic lei hangs from the door, but the welcoming atmosphere has more to do with the graciousness of Dr. Raoof, as well as Dr. Heping Zhao and Dr. Longping Liu, who work in the lab. Dr. Zhao has clippers in hand. He holds the corpse's forearm; muscles, nerves, veins and bones are exposed, and he's plucking at a wet, beige nerve, removing some sort of sheath sticking to it.

Up close, the cadaver smells like a raw chicken, but more intense, like you've stuck your head in its cavity. Dr. Zhao is now cradling her limp breast in his hands, explaining that it's still in good shape, so they are going to save it. Then he waves his other hand back and forth over a massive pile of yellow jelly spread across her open chest and says, "American too fat! Make my job harder." He scoops some out to show me, and a morsel no bigger than a booger falls to my feet. Scanning up the body, I see frayed black string woven in and out of her belly, stitches in her thin but tough skin.

Despite the electrical hum of fluorescent lighting, several GE freezers and large tanks, visiting the university's lab is a much quieter experience — metaphorically speaking — than wandering through any of the traveling shows attracting millions of viewers worldwide to museums. Anatomical exhibits of preserved human bodies are hot right now. Step right up, folks, see actual human bodies.

The first exhibition of this kind was Body Worlds, developed and promoted by plastination pioneer von Hagens himself, in Germany in 1996. Back then, it elicited intense debate. It still does. But one decade, two sequels and a sweet spot in the latest James Bond flick Casino Royale later, the show has brought in more than $200 million. It's also spawned two copycat shows, including Bodies: The Exhibition and Our Body: The Universe Within.

The producers of Bodies expect to pull in more than 17 million viewers before the touring exhibit runs its course.

The latest show, Our Body, which recently opened at Detroit's Science Center, has been packing in crowds for weeks now with another version at the Orlando Science Center.

Our Body is the least exploitative of the bunch, although it's a bit on the thin side, with only 20 bodies and 135 anatomical displays. The show identifies the skeletal, digestive, excretory systems and more, and includes a prenatal gallery. Dissected and cross-sectioned bodies, sliced like loaves of bread, introduce visitors to what lies inside each of us, including both healthy and diseased organs. The signage charts the body clearly, pointing out, for instance, the location of the lung arterial tree and the brachial artery, but it would be more helpful if it offered a better idea of what exactly all this stuff does. But at least in Our Body, there are no dead dudes playing poker, riding bareback or carrying their own skin over their shoulder, like they do in Body Worlds.

However, all the exhibits are controversial, especially because of questions about the origin of the bodies, which hail from China, a country without a well-established donations program and a reputation for black market trade in organs.

The road from China

Dr. Raoof wants to make it crystal clear that the university has absolutely nothing to do with these plastination shows. He's concerned that the anatomical donation program remains committed to high ethical standards. The university is very selective of which corpses they receive.

"They are going to be handled by students so we have to make sure they are free of communicable diseases, such as HIV," he says. Most of the deceased are from Michigan, and, to enter the program, either the donors themselves or family of the deceased must make the commitment. Not all the bodies the university receives are donated for plastination either. Some cadavers are used for other kinds of research, and then cremated and the remains given back to the families. However, the lab receives approximately 10 cadavers a year for "permanent" donation.

"We explain this to families thoroughly and carefully, that with plastination, they're not going to get ashes. However, we give them the option that, at any time, if they change their mind, even after 30 years, we'll give up the specimen and let it be cremated." Every September, the Department of Medical Education invites the faculty and families of the deceased to a memorial service so they can listen to students talk about how beneficial the donation was to their education.

"Dr. Thomas Gest, who's in charge of the donation program, ensures that each student signs a privacy agreement stating that they should respect the cadaver they are using and can never abuse the specimen," Dr. Raoof says. "They also receive an orientation. Cause of death is on the death certificate and clinical history is used to isolate the cause of death, the pathology, with the finding during dissection. Everything in the program is working just fine."

Because he's done it time and again, Dr. Raoof can easily explain the plastination process. A body or specimen is dissected and dehydrated in acetone, a drying agent used thousands of years ago for mummification. Then it's put in a large chamber for a silicone bath. When the pressure in the chamber is lowered to create a partial vacuum, the acetone evaporates and the tissue sucks in silicone. After a few weeks, silicone, which is a polymer, hardens and organic material is permanently preserved. The university's process varies slightly from von Hagens' approach; it's described as cheaper, faster, more efficient and done at room temperature.

At the university lab, organs are slimy and muscles sinewy, with the color and texture of turkey jerky. Every once in a while the doctors dump some green liquid chemical called Biostat on the cadaver to keep it wet and prevent infection. The degree to which the deceased had been beautified for Our Body stands in great comparison. Muscles have been brightened to a reddish brown and some specimens are downright pretty, especially those specimens and bodies with arteries and vessels that have been inked blue, pink, yellow, green or red to be distinguishable. The exhibit specimen, for instance, that showed the "Arterial System of the Human Body" is stripped of everything, including bone, to present only arteries — thin and thick — that guide blood through the body. Each tiny capillary is stained with bright red ink. Light as air, the arterial specimen floats as an elegant red ghost inside the acrylic case, like something H.G. Wells would think up, a model that could be easily admired in an art gallery.

Regarding such cosmetic alterations, Dr. Walter Hofman, medical consultant for Our Body: The Universe Within, says, "It all depends on what process you use and what you want to achieve. But at this show, there is no external cosmetic work done. And it's different from von Hagens' exhibit, in which the muscles are much more intensely red."

He prefers to focus on the educational aspects of the exhibit: "Unfortunately, the country is no longer as clean as it was, so you can't tell the difference between someone who lives in the country or the city. As people inhale more exogenous material, lungs have more difficulty keeping this garbage out of our systems. Certainly, at the show, you can tell the difference between damaged lungs and those that are healthy. Workers that have been exposed to asbestos or inhale dust by working with coal, granite or marble, develop pneumoconiosis. Their lungs become rock hard, so the specimens are either whiter and lighter or darker and heavier, because these materials are trapped in the lung tissue itself."

Dr. Hofman, who's based in the Philadelphia suburbs, also sees at least one specific benefit from the public's exposure to the exhibit: "It makes the public more aware of how important donations are for the sake of transplants. We are losing too many patients because we can't transplant organs to service them. The more we can educate people about human bodies and the benefits of donation, the better the purpose of this exhibit will have been taken."

As admirable as that is, suspicion lingers about who these bodies belong to, and whether or not the deceased are being exploited for profit. New York Times reporter David Barboza writes there are more than a handful of "body factories" in China, in which medical students are "re-engineering" cadavers, readying corpses to be shipped in polystyrene to Europe and the United States for the international museum show market. Barboza writes that there have been accusations back and forth between body-show producers of trafficking in human bodies and copyright theft, among other claims.

When questioned where the bodies come from, Dr. Hofman says it's a legitimate institute or foundation in China whose name he has forgotten. Mark Horwin, general counsel for the Universe Within Touring Company, and Todd Slisher, the Detroit Science Center's vice president of programs, say the institution prefers not to be disclosed out of respect for the individuals whose bodies are displayed. But published reports have indicated the Beijing-based company's name is Life Sciences Project.

"Much ado about nothing has been made," says Dr. Hofman. "They are not bodies that have been stolen, not the bodies of someone murdered. They are legally acquired bodies in China. There has to be provenance. This is no different in a piece of art work."

More to the point, though, is the question of what exactly "legally acquired" means in China — because it doesn't necessarily mean donor consent, according to some reporters who've tried to follow the money and bodies. For example, in a National Geographic News article about Bodies: The Exhibition, John Roach reports that Premier Exhibitions, Bodies' producer, obtained their bodies and parts from China's Dalian Medical University of Plastination Laboratories. They are "unclaimed or unidentified individuals from China. As such, neither the deceased nor their families consented to the use of the corpses in the exhibit."

Dr. Roy Glover, who founded U of M's plastination laboratory and is a professor emeritus of anatomy and cell biology, is now chief medical adviser and spokesperson for Bodies. In the National Geographic News article, Glover states, "It is standard legal practice in both the United States and China that unclaimed or unidentified remains are made available for medical education, which is one of the key goals of our exhibition." He states that "since the bodies were either unclaimed or unidentified, obtaining consent was impossible." People who die in hospitals or accidents in China could end up at research facilities or legally displayed in exhibitions.

In Michigan, laws were revised in 2006, allowing the state to turn over unclaimed human bodies for "the purpose of instruction, study, and use in the promotion of education in the health sciences in this state." Michigan State University, Wayne State University and the University of Michigan are the only institutions allowed to receive the bodies for instruction and research.

Phil Douma, executive director of Michigan Funeral Directors Association, says, "If no individual comes forward to take care of the arrangements, the matter is handled by the county public administrator, if willing to act, or the fall back is the county medical examiner. The most typical result would be to bury or cremate the body. They would also be able to donate the body, but the new statue constrains that it can only go to one of those three medical schools. The legislative language was worded that way to allow the body to be used only by medical and mortuary schools."

Culture in denial

Whatever the law in China, exhibiting the bodies of those who did not issue their consent raises ethical questions, especially when millions of dollars are being made from it. At the Detroit Science Center, it's hard to look at these cadavers and not want to know one name. At the gallery's entrance, visitors write out their thoughts about the show. A couple are as you'd expect, such comments as, "It will make me never eat meat again!" and "I will never smoke!" But one visitor queries: "I wonder how old this person was."

Thomas Lynch is a best-selling essayist, poet and funeral director of Lynch & Sons funeral home in Milford, and he frequently writes for The New York Times, The Boston Globe and The Times of London. He asks questions about how our culture responds to mortality.

"Why is it the plasticized spectacles of stranger's corpses, in various poses, ridiculous and sublime, are easier to take in than the deeply human events of dying, death and family bereavement? Why is it easier to attend a gallery of splayed corpses of strangers, than the wake and funeral of our neighbors and family? And why is it that, coincident with these spectacles, the culture is moving away from dealing firsthand with the actualities of death?" Lynch writes in an e-mail, parrying my questions about the exhibit with questions of his own. He believes those are questions all of us should ask ourselves.

"Note that the president disallows the images of dead soldiers, even of their properly coffined bodies being returned home from war," he continues. "Note also that more and more the wake and funeral are being replaced by 'memorial' services to which everyone but the dead are invited. The finger food is good, the talk is uplifting, the music is purposefully 'life affirming,' someone (usually the clergy) can be counted on to declare 'closure' (usually just before the merlot runs out). The corpse has gone missing, disappeared by cremation or quick burial, without witness or rubric or any attention, and at the same time we are happy to attend (by channel surfing and remote control) the virtual funerals of dead popes, princesses and presidents whom we 'knew of' but never really knew. It is safe, arms-length, faux reality, very much like the plasticized corpses of poor Chinese. We call it art or 'history' — anything but reality."

At the university's lab, the cadavers don't look too much like actual human bodies anymore. Technically, I guess, the folks on the table are no longer even "naked." The elderly woman has only got one eyeball, but she's got two eyebrows of short, soft white hairs. Still, somehow, they're very human, and it has to do with the attention these doctors pay to their "patients."

Dr. Zhao instructs me to look down at her thigh, as he pats her muscle. Dr. Raoof chimes in, "You can tell she didn't have diabetes because the femur artery isn't clogged." They tell me her thighs were — that they still are — real strong. It's an education you can get from just gawking. I picture her as a spitfire, someone who used to pound out the pavement around the block. Out of everything I see at the lab, I take that attitude with me as I walk into the Science Center.