Stiff

by Mary Roach

  Zugibe’s theory holds that the nail went in through Jesus’ palm at an angle and came out the back side at the wrist. He has his own brand of cadaveric evidence: photographs taken forty-four years ago of a murder victim that showed up in his lab. “She’d been brutally stabbed over her whole body,” Zugibe recalls. “I found a defense wound where she had raised her hand in an attempt to protect her face from the vicious onslaught.” Though the entry wound was in the palm, the knife had apparently traveled at an angle, coming out the back of the wrist on the thumb side. The pathway of the knife apparently offered little resistance: An X-ray showed no chipped bones.

  There is a photograph of Zugibe and one of his volunteers in the aforementioned Sindon article. Zugibe is dressed in a knee-length white lab coat and is shown adjusting one of the vital sign leads affixed to the man’s chest. The cross reaches almost to the ceiling, towering over Zugibe and his bank of medical monitors. The volunteer is naked except for a pair of gym shorts and a hearty mustache. He wears the unconcerned, mildly zoned-out expression of a person waiting at a bus stop. Neither man appears to have been self-conscious about being photographed this way. I think that when you get yourself down deep into a project like this, you lose sight of how odd you must appear to the rest of the world.

  No doubt Pierre Barbet saw nothing strange or wrong in using cadavers meant for the teaching of anatomy as subjects in a simulated crucifixion to prove to doubters that the miraculous Shroud of Turin was for real. “It is indeed essential,” he wrote in the introduction to A Doctor at Calvary. “that we, who are doctors, anatomists, and physiologists, that we who know, should proclaim abroad the terrible truth that our poor science should no longer be used merely to alleviate the pains of our brothers, but should fulfill a greater office, that of enlightening them.”

  To my mind there is no “greater office” than that of “alleviating the pains of our brothers”—certainly not the office of religious propaganda. Some people, as we’re about to see, manage to alleviate their brothers’ pains and sufferings while utterly dead. If there were ever a cadaver eligible for sainthood, it would not be our Spalding Gray upon the cross, it would be these guys: the brain-dead, beating-heart organ donors that come and go in our hospitals every day.

  8

  HOW TO KNOW IF YOU’RE DEAD

  Beating-heart cadavers, live burial, and the scientific search for the soul

  A patient on the way to surgery travels at twice the speed of a patient on the way to the morgue. Gurneys that ferry the living through hospital corridors move forward in an aura of purpose and push, flanked by caregivers with long strides and set faces, steadying IVs, pumping ambu bags, barreling into double doors. A gurney with a cadaver commands no urgency. It is wheeled by a single person, calmly and with little notice, like a shopping cart.

  For this reason, I thought I would be able to tell when the dead woman was wheeled past. I have been standing around at the nurses’ station on one of the surgery floors of the University of California at San Francisco Medical Center, watching gurneys go by and waiting for Von Peterson, public affairs manager of the California Transplant Donor Network, and a cadaver I will call H. “There’s your patient,” says the charge nurse. A commotion of turquoise legs passes with unexpected forward-leaning urgency.

  H is unique in that she is both a dead person and a patient on the way to surgery. She is what’s known as a “beating-heart cadaver,” alive and well everywhere but her brain. Up until artificial respiration was developed, there was no such entity; without a functioning brain, a body will not breathe on its own. But hook it up to a respirator and its heart will beat, and the rest of its organs will, for a matter of days, continue to thrive.

  H doesn’t look or smell or feel dead. If you leaned in close over the gurney, you could see her pulse beating in the arteries of her neck. If you touched her arm, you would find it warm and resilient, like your own. This is perhaps why the nurses and doctors refer to H as a patient, and why she makes her entrance to the OR at the customary presurgery clip.

  Since brain death is the legal definition of death in this country, H the person is certifiably dead. But H the organs and tissues is very much alive. These two seemingly contradictory facts afford her an opportunity most corpses do not have: that of extending the lives of two or three dying strangers. Over the next four hours, H will surrender her liver, kidneys, and heart. One at a time, surgeons will come and go, taking an organ and returning in haste to their stricken patients. Until recently, the process was known among transplant professionals as an “organ harvest,” which had a joyous, celebratory ring to it, perhaps a little too joyous, as it has been of late replaced by the more businesslike “organ recovery.”

  In H’s case, one surgeon will be traveling from Utah to recover her heart, and another, the one recovering both the liver and the kidneys, will be taking them two floors down. UCSF is a major transplant center, and organs removed here often remain in house. More typically, a transplant patient’s surgeon will travel from UCSF to a small town somewhere to retrieve the organ—often from an accident victim, someone young with strong, healthy organs, whose brain took an unexpected hit. The doctor does this because typically there is no doctor in that small town with experience in organ recovery. Contrary to rumors about surgically trained thugs cutting people open in hotel rooms and stealing their kidneys, organ recovery is tricky work. If you want to be sure it’s done right, you get on a plane and go do it yourself.

  Today’s abdominal recovery surgeon is named Andy Posselt. He is holding an electric cauterizing wand, which looks like a cheap bank pen on a cord but functions like a scalpel. The wand both cuts and burns, so that as the incision is made, any vessels that are severed are simultaneously melted shut. The result is that there is a good deal less bleeding and a good deal more smoke and smell. It’s not a bad smell, but simply a seared-meat sort of smell. I want to ask Dr. Posselt whether he likes it, but I can’t bring myself to, so instead I ask whether he thinks it’s bad that I like the smell, which I don’t really, or maybe just a little. He replies that it is neither bad nor good, just morbid.

  I have never before seen major surgery, only its scars. From the length of them, I had imagined surgeons doing their business, taking things out and putting them in, through an opening maybe eight or nine inches long, like a woman poking around for her glasses at the bottom of her purse. Dr. Posselt begins just above H’s pubic hair and proceeds a good two feet north, to the base of her neck. He’s unzipping her like a parka. Her sternum is sawed lengthwise so that her rib cage can be parted, and a large retractor is installed to pull the two sides of the incision apart so that it is now as wide as it is long. To see her this way, held open like a Gladstone bag, forces a view of the human torso for what it basically is: a large, sturdy container for guts.

  On the inside, H looks very much alive. You can see the pulse of her heartbeat in her liver and all the way down her aorta. She bleeds where she is cut and her organs are plump and slippery-looking. The electronic beat of the heart monitor reinforces the impression that this is a living, breathing, thriving person. It is strange, almost impossible, really, to think of her as a corpse. When I tried to explain beating-heart cadavers to my stepdaughter Phoebe yesterday, it didn’t make sense to her. But if their heart is beating, aren’t they still a person? she wanted to know. In the end she decided they were “a kind of person you could play tricks on but they wouldn’t know.” Which, I think, is a pretty good way of summing up most donated cadavers. The things that happen to the dead in labs and ORs are like gossip passed behind one’s back. They are not felt or known and so they cause no pain.

  The contradictions and counterintuitions of the beating-heart cadaver can exact an emotional toll on the intensive care unit (ICU) staff, who must, in the days preceding the harvest, not only think of patients like H as living beings, but treat and care for them that way as well. The cadaver must be monitored around the clock and “life-saving” interventions undertaken on i
ts behalf. Since the brain can no longer regulate blood pressure or the levels of hormones and their release into the bloodstream, these things must be done by ICU staff, in order to keep the organs from degrading. Observed a group of Case Western Reserve University School of Medicine physicians in a New England Journal of Medicine article entitled “Psychosocial and Ethical Implications of Organ Retrieval”: “Intensive care unit personnel may feel confused about having to perform cardiopulmonary resuscitation on a patient who has been declared dead, whereas a ‘do not resuscitate’ order has been written for a living patient in the next bed.”

  The confusion people feel over beating-heart cadavers reflects centuries of confusion over how, exactly, to define death, to pinpoint the precise moment when the spirit—the soul, the chi, whatever you wish to call it—has ceased to exist and all that remains is a corpse. Before brain activity could be measured, the stopping of the heart had long been considered the defining moment. In point of fact, the brain survives for six to ten minutes after the heart has stopped pumping blood to it, but this is splitting hairs, and the definition works quite well for the most part. The problem, for centuries, was that doctors couldn’t tell for sure whether the heart had ceased to beat or whether they were merely having trouble hearing it. The stethoscope wasn’t invented until the mid-1800s, and the early models amounted to little more than a sort of medical ear trumpet. In cases where the heartbeat and pulse are especially faint—drownings, stroke, certain types of narcotic poisoning—even the most scrupulous physician had difficulty telling, and patients ran the risk of being dispatched to the undertaker before they’d actually expired.

  To allay patients’ considerable fears of live burial, as well as their own insecurities, eighteenth-and nineteenth-century physicians devised a diverting roster of methods for verifying death. Welsh physician and medical historian Jan Bondeson collected dozens of them for his witty and admirably researched book Buried Alive. The techniques seemed to fall into two categories: those that purported to rouse the unconscious patient with unspeakable pain, and those that threw in a measure of humiliation. The soles of the feet were sliced with razors, and needles jammed beneath toenails. Ears were assaulted with bugle fanfares and “hideous Shrieks and excessive Noises.” One French clergyman recommended thrusting a red-hot poker up what Bondeson genteelly refers to as “the rear passage.” A French physician invented a set of nipple pincers specifically for the purpose of reanimation. Another invented a bagpipelike contraption for administering tobacco enemas, which he demonstrated enthusiastically on cadavers in the morgues of Paris. The seventeenth-century anatomist Jacob Winslow entreated his colleagues to pour boiling Spanish wax on patients’ foreheads and warm urine into their mouths. One Swedish tract on the matter suggested that a crawling insect be put into the corpse’s ear. For simplicity and originality, though, nothing quite matches the thrusting of “a sharp pencil” up the presumed cadaver’s nose.

  In some cases, it is unclear who was the more humiliated, patient or doctor. French physician Jean Baptiste Vincent Laborde wrote at great length of his technique of rhythmic tongue-pulling, which was to be carried out for no less than three hours following the suspected death. (He later invented a hand-cranked tongue-pulling machine, which made the task less unpleasant though only marginally less tedious.) Another French physician instructed doctors to stick one of the patient’s fingers in their ear, to listen for the buzzing sound produced by involuntary muscle movement.

  Not all that surprisingly, none of these techniques gained wide acceptance, and most doctors felt that putrefaction was the only reliable way to verify that someone was dead. This meant that corpses had to sit around the house or the doctor’s office for two or three days until the telltale signs and smells could be detected, a prospect perhaps even less appealing than giving them enemas. And so it was that special buildings, called waiting mortuaries, were built for the purpose of warehousing the moldering dead. These were huge, ornate halls, common in Germany in the 1800s. Some had separate halls for male and female cadavers, as though, even in death, men couldn’t be trusted to comport themselves respectably in the presence of a lady. Others were segregated by class, with the well-to-do deceased paying extra to rot in luxury surroundings. Attendants were employed to keep watch for signs of life, which they did via a system of strings linking the fingers of corpses to a bell* or, in one case, the bellows of a large organ, so that any motion on the part of the deceased would alert the attendant, who was posted, owing to the considerable stench, in a separate room. As years passed and not a single resident was saved, the establishments began to close, and by 1940, the waiting mortuary had gone the way of the nipple pincer and the tongue puller.

  If only the soul could be seen as it left the body, or somehow measured. That way, determining when death had occurred would be a simple matter of scientific observation. This almost became a reality, at the hands of a Dr. Duncan Macdougall, of Haverhill, Massachusetts. In 1907, Macdougall began a series of experiments seeking to determine whether the soul could be weighed. Six dying patients, one after another, were installed on a special bed in Macdougall’s office that sat upon a platform beam scale sensitive to two-tenths of an ounce. By watching for changes in the weight of a human being before, and in the act of, dying, he sought to prove that the soul had substance. Macdougall’s report of the experiment was published in the April 1907 issue of American Medicine, considerably livening up the usual assortment of angina and urethritis papers. Below is Macdougall describing the first subject’s death. He was nothing if not thorough.

  At the end of three hours and forty minutes he expired and suddenly coincident with death the beam end dropped with an audible stroke hitting against the lower limiting bar and remaining there with no rebound. The loss was ascertained to be three-fourths of an ounce.

  This loss of weight could not be due to evaporation of respiratory moisture and sweat, because that had already been determined to go on, in his case, at the rate of one-sixtieth of an ounce per minute, whereas this loss was sudden and large….

  The bowels did not move; and if they had moved the weight would still have remained upon the bed except for a slow loss by the evaporation of moisture, depending, of course, upon the fluidity of the feces. The bladder evacuated one or two drams of urine. This remained upon the bed and could only have influenced the weight by slow gradual evaporation and therefore in no way could account for the sudden loss.

  There remained but one more channel of loss to explore, the expiration of all but the residual air in the lungs. Getting upon the bed myself, my colleague put the beam at actual balance. Inspiration and expiration of air as forcibly as possible by me had no effect upon the beams….

  After watching another five patients shed similar weight as they died, Macdougall moved on to dogs. Fifteen dogs breathed their last without registering a significant drop in weight, which Macdougall took as corroborating evidence, for he assumed, in keeping with his religious doctrine, that animals have no souls. While Macdougall’s human subjects were patients of his, there is no explanation of how he came to be in the possession of fifteen dying dogs in so short a span of time. Barring a local outbreak of distemper, one is forced to conjecture that the good doctor calmly poisoned fifteen healthy canines for his little exercise in biological theology.

  Macdougall’s paper sparked an acrid debate in the American Medicine letters column. Fellow Massachusetts doctor Augustus P. Clarke took Macdougall to task for having failed to take into account the sudden rise in body temperature at death when the blood stops being air-cooled via its circulation through the lungs. Clarke posited that the sweating and moisture evaporation caused by this rise in body temperature would account both for the drop in the men’s weight and the dogs’ failure to register one. (Dogs cool themselves by panting, not sweating.) Macdougall rebutted that without circulation, no blood can be brought to the surface of the skin and thus no surface cooling occurs. The debate went on from the May issue all the way through Decem
ber, whereupon I lost the thread, my eye having strayed across the page to “A Few Points in the Ancient History of Medicine and Surgery,” by Harry H. Grigg, M.D. It is with thanks to Harry H. Grigg that I can now hold forth at cocktail parties on the history of hemorrhoids, gonorrhea, circumcision, and the speculum.*

  With improvements in stethoscopes and gains in medical knowledge, physicians began to trust themselves to be able to tell when a heart had stopped, and medical science came to agree that this was the best way to determine whether a patient had checked out for good or was merely down the hall getting ice. Placing the heart center stage in our definition of death served to give it, by proxy, a starring role in our definition of life and the soul, or spirit or self. It has long had this anyway, as evidenced by a hundred thousand love songs and sonnets and I bumper stickers. The concept of the beating-heart cadaver, grounded in a belief that the self resides in the brain and the brain alone, delivered a philosophical curveball. The notion of the heart as fuel pump took some getting used to.

  The seat-of-the-soul debate has been ongoing some four thousand years. It started out not as a heart-versus-brain debate, but as heart-versus-liver. The ancient Egyptians were the original heart guys. They believed that the ka resided in the heart. Ka was the essence of the person: spirit, intelligence, feelings and passions, humor, grudges, annoying television theme songs, all the things that make a person a person and not a nematode. The heart was the only organ left inside a mummified corpse, for a man needed his ka in the afterlife. The brain he clearly did not need: cadaver brains were scrambled and pulled out in globs, through the nostrils, by way of a hooked bronze needle. Then they were thrown away. (The liver, stomach, intestines, and lungs were taken out of the body, but kept: They were stored in earthen jars inside the tomb, on the assumption, I guess, that it is better to overpack than to leave something behind, particularly when packing for the afterlife.)