by Sue Black
Whatever the viewpoint, choosing when to die should, in my opinion, be a personal matter, not a decision controlled by the state. Perhaps the adoption of a less pessimistic and mistrustful approach to the wishes of those who seek the freedom to decide the manner and timing of their death can be seen as an indication of a responsible society. It is probably no coincidence that those countries and states where assisted dying is legal usually have a higher investment in palliative care and are generally more open about death and end-of-life options. I for one would prefer to be part of a society that allows people to have greater control over their own lives and deaths.
I respect Arthur and his determination to die on his own terms, and I share his resentment that at present, society forces him to consider undertaking this alone because it is unable, or unwilling, to find the flexibility of legislation that would allow him the dignified exit he so desires. His determination to bequeath his remains to an anatomy department mercifully rules out the most violent means in his case: as he wants to avoid a postmortem, he doesn’t want to ‘disrupt his body’.
He has spoken to us of avoiding Christmas and the New Year, when the university is closed, asking which days are likely to be most convenient for anatomy departments. I feel a heightened sense of anxiety when he talks this way, but I also know that there is nothing I can do to dissuade him, because we have had these conversations many, many times. I will not aid him but I cannot stop him – that is not my right, nor is it an option he gives me. I count it a privilege that he feels he can talk to me and I will not interfere, just allow him to rehearse his rhetoric, testing how comfortable and reasonable it sounds, to both himself and others.
Arthur was deeply saddened when, even after taking all this into consideration, he approached another anatomy department to seek their views on his plan, only to be told that his body would not be accepted by them if he were to commit suicide. He found it difficult to reconcile this stance with his understandable wish for a ‘good death’ and his genuine ambition to assist in the education of others.
He has thought of just about everything. He has given me a code word only he and I know, which he says he will leave on the answering machine in my office over a weekend so that it is waiting for me on the Monday morning. This will be the signal for me to alert the necessary authorities so that they can begin to arrange for his wishes to be followed. He will not tell me in advance when he is going to die, to protect me from any suggestion of involvement and also because he doesn’t want me to try to stop him. It is, in an odd way, a kindness, but it has led to me developing a very healthy antipathy to the flashing red message light on my phone, especially on Monday mornings. So far it has never been an indicator of a message from Arthur and I hope it never will be. While I must acknowledge the possibility that he will one day execute his plan, my hope is, of course, that when the time comes he will experience a peaceful, swift and natural end that both accommodates his wishes and allays society’s current fears and restrictions. In case I am on holiday or not in the office, Viv has also been briefed. Arthur has us both totally wrapped around his little finger.
It is hard to put into words how grateful I feel to Arthur for his strong support for bequeathal and anatomical education, and for sharing his most personal wishes with me, but I also feel a tremendous weight of responsibility for ensuring that they are respected while all legal requirements are upheld. The moral conundrums are heavier still. This is where the real wrestling is done, late at night when he pops into my mind and I wonder what he is doing. Is he lonely? Is he well? Is he scared? Is he putting together the different parts of his exit equipment? Can I stop him? Should I stop him? Although he has my phone number, I do not have his. I have no idea when he intends do this, if he ever does, and by the time he has done it, it will be too late for me to intervene. So all I can realistically do is to keep talking to him.
I am not sure if I want him to change his mind, if it means leaving himself at risk of the kind of death he so emphatically rejects, but I feel that if I keep asking the questions I am at least prompting him to continually reassess his decision. He gets quite cross with me at times for my persistent poking and prying. I tell him my questions are coming ‘from the loving place’, at which he usually grimaces dismissively and says, ‘It’s not a very nice place, that loving place.’
He has a habit of throwing in some curveball questions himself, it must be said, outlining theoretical situations that make you pause and take stock. He does so with a devilish twinkle in his eye. Quite some time ago now he asked if he could look at our dissecting room and watch some dissection. I gasped. Never before had we had a bequeather requesting to see what goes on in our dissecting room. But why was I knocked off centre? Who are we protecting? You can buy a ticket to walk around the Body Worlds exhibition and see a whole array of dissected humans in different poses. You can go to a surgeons’ museum and peer into glass cases containing spine-chilling pathologies and anomalies of all sorts excised from human bodies, examine the gruesome and the grim embalmed in formalin and mounted in a glass pot. On the internet you can call up all manner of images associated with the dissection of human cadavers. You can pop into a bookshop and pick up an atlas of human dissection, or watch the procedure on television. Arthur seemed to have no qualms about seeing the dissecting room; I, on the other hand, was inexplicably and massively conflicted. Was it just too personal for me to handle, or too big a responsibility?
One day Arthur will be a cadaver in someone’s dissecting room, if he has his way, and I don’t doubt for a moment that he will. As he aspires to be a cadaver, it was perfectly reasonable that he might want to see what he may look like on the inside, and the type of environment where he might spend several years. When prospective students come to visit the university, they are permitted to view the dissecting room, so why not prospective donors, who are, after all, the other half of this symbiotic relationship? Maybe, thinking back to my own first experiences in a dissecting room, I was afraid it might frighten or disturb him. There was just no way of knowing whether it was more likely to be an unmitigated disaster for him or a tremendous success for his peace of mind.
I tried to brush away his request with a glib remark, but he wasn’t going to let me get away with that. I was told politely but firmly that he wanted to do this with me because he knew and trusted me, but if I wasn’t comfortable with it, he completely understood. He would go to another department and ask them. Such a little blackmailer! I heard somebody somewhere say, in my voice, that I would check with the authorities that it would be OK, and so it seemed I had agreed. Reluctantly. I have always been unable to say no to Arthur and I am not quite sure why. Maybe it is because I like him so much and am so proud of the work undertaken in my department by staff who are utterly committed to donors, family, students and education. If our ‘silent teachers’ are ‘teaching’, then they are staff. Perhaps, at a stretch, I could think of Arthur as a prospective future member of an anatomy teaching team. I knew that if I ran that one past him, he would chortle with disdain and probably accuse me of exploiting him as cheap labour.
I checked with Her Majesty’s inspector of anatomy, and he had no problems with this arrangement as long as it was a controlled visit. So, on the appointed day, Arthur and I met in my office and talked again about bequeathal and what it meant to him, to me and to our students. We discussed his plans for his death, I did my best to get my views across and, as always, they fell on conveniently deaf ears. I explained the embalming process and he questioned me on the chemical reactions that occur at the cellular level. He asked about smell, touch and sight. We looked through some textbooks and he commented that the muscle tissue didn’t look as red as he’d expected. He told me he’d been imagining it as a similar colour to the meat you’d see in a butcher’s shop rather than the pinky grey it actually is. It was good for him to see these pictures to prepare him for what he would encounter in the dissecting room.
We chatted about the skeleton that hangs in t
he corner of my office and the colour-coded markings painted on it to identify where different muscles originate and insert. We handled the skulls that sit on my bookshelf and discussed how the bones grow and how they break. Over a cup of tea, we talked about life, death and learning. I let him set the pace.
When he was ready, we made our way up from my office to our museum. Arthur was already getting on by then and very bent, and the steps were difficult for him, but he managed, gripping the rail with one hand and his walking stick in the other. We stopped for a moment and I pointed out our Book of Remembrance in its glass case at the top of the stairs. Arthur remarked on the number of people who donate their bodies to us and theorised about their motives. We spoke of our memorial service in May of each year and he asked about the ages of the youngest and oldest donors in the dissecting room at that time. Did we have more men or more women? I answered all his questions honestly and openly.
As we moved along the corridor we passed the amazing work done by our talented medical and forensic art students and talked about the ancient relationship between anatomy and art, with particular reference to the glorious Dutch masters, who had a morbid fascination with anatomical dissection.
Our museum is in a bright room, furnished with rows of long, white tables where our students study and compare prosected specimens with the illustrations in their textbooks. Arthur took a seat at one of these tables. I showed him the sagittal, coronal and horizontal sections of human bodies, displayed in heavy, Perspex pots, which allow us to teach anatomy in slices that relate to the images produced by CT and MRI scans. I hauled one pot over to the table where he sat, informing him that this was a horizontal section through the chest region of a man. ‘How do you know?’ he asked. I pointed to the hairs poking out of the skin, and we both chuckled.
I indicated the position of the heart, the lungs, the major blood vessels, the oesophagus and the bones of the ribs and vertebral column. Arthur was utterly intrigued. He expressed surprise at the diminutive size of the spinal cord, which carries all motor and sensory information around our body, and the oesophagus, remarking that in future he would make sure he ate his food in smaller mouthfuls. He commented that seeing how delicate some of these structures were made him realise just how fragile life is. He looked at the coronary vessels in the heart, and the widow-maker artery (the anterior interventricular branch of the left coronary artery), and asked me to identify the chambers of the heart that were visible. He was amused by the chordae tendinae, colloquially referred to as the heart strings, which sound so romantic. In reality, they looked to him, he said, like miniature guy ropes holding down a Lilliputian tent. He asked how old the specimen was and how long it would survive.
I was easy in my mind that this elderly gentleman was completely comfortable with what he was seeing and discussing. I detected no apprehension, except perhaps from myself. There was no fear in his rheumy eyes, no tremor in his voice and no shake in his hands. Time for the big one. I left Arthur perusing the pot for a moment and popped into the dissecting room, a light, open space full, as usual during working hours, of chatter and students going about the normal business of an anatomy department. I scanned the room for a table of more mature students. Finding a group that fitted the bill, I told them about Arthur and asked if they would be willing to talk to him. It was clear that they were unnerved by the prospect of having a conversation about dissection with a trainee cadaver – especially while they were standing over someone else’s body, scalpels and forceps in hand, in the middle of opening up the shoulder joint. But they mulled it over, discussed it among themselves and decided they were up for it. A spokesperson was elected.
I don’t know who was more scared – the students, Arthur or me. I still had no clue how this was going to turn out. Would it be a colossal mistake? Arthur got to his feet very slowly and walked with me into the dissecting room. You could have heard a pin drop. The cheerful banter of a few moments before was gone, replaced in an instant by respectful silence and diligent attention to work. It is amazing how, as if on some unspoken command, the entire atmosphere in a room can change in a split second. There is a sudden collective awareness that someone outside the close-knit team is present and a uniform modification of behaviour ensues. We see this all the time in mortuaries, where there is an unwritten rule that when a stranger enters, you adjust your conduct and demeanour until you have a good idea of who they are and what they are doing there. All the students in the dissecting room did this without being given any warning or instruction. I was so proud of them all.
Arthur approached the table a little hesitantly. The lead student introduced himself and joked nervously that perhaps shaking hands wasn’t appropriate given the work on which they were engaged. The other students around the table then introduced themselves. They were so pale and nervous that I thought one or two of them might pass out. Arthur pointed at the table and asked, ‘What is that? Why have you cut it that way?’ I stepped back and watched the most amazing miracle unfold in front of my eyes: Arthur and the students, far from being separated by death, becoming united by it through the glorious world of anatomy.
The chatter level in the room began to rise again as he was accepted into the circle. Arthur talked to his dissection team for a good fifteen minutes or more. Once or twice I heard relaxed laughter at something he said. Feeling that a quarter of an hour was long enough for all of them, and for Arthur to be on his feet, I moved in to shepherd him away. He thanked the students for their professionalism and they, in turn, thanked him for the priceless gift he was planning to make. I sensed a genuine reluctance on both sides to end the conversation. Mind you, I also noticed the students’ collective sigh of relief when Arthur turned and started to slowly walk away. They had been really afraid of offending him or upsetting him. But they understood the importance of what they had done for him and, indeed, what he had done for them, and would do for future students.
For Arthur, it was back to my office for that obligatory restorer of comfort – more tea – and a little chat. He was enthused, animated and more determined than ever to see through his plans to donate. His only regret, he said, was that he would be on the wrong end of the scalpel. He had found his encounter with the dissection process so fascinating that I wonder if, had his life followed a different path, he might have made a great anatomist himself.
It was an intense experience and it had an incredible impact on everyone involved. So would I ever do it again? Good grief, no.
CHAPTER 6
Dem bones
‘There is something about a closet that makes a skeleton terribly restless’
Wilson Mizner
playwright, entrepreneur and raconteur (1876–1933)
A facial reconstruction of Rosemarkie Man.
AT WHAT POINT does your death cease to matter personally to someone somewhere? In his poem ‘So Many Lengths of Time’, Brian Patten suggests that ‘a man lives for as long as we carry him inside us’, and that certainly strikes a chord with me. So often, as I grow older, I open my mouth and my father’s sayings fall out. We cannot die as long as there are people on earth who remember us.
By that yardstick, we have a potential ‘lifespan’, or should that be ‘deathspan’, of probably no more than four generations, though echoes of us can live on for longer, in the memories of relatives, family stories, photographs, film and other records. In my family, my generation is the last to remember my grandparents, and my children are the youngest to remember my parents as my grandchildren never knew them. It saddens me that when I die, so, at last, will my grandmother. Yet I find it apt and comforting that we will die together, I in my body and she in my mind. It is likely that I will cease to be remembered when my own grandchildren have gone, though there is a distinct possibility that I may be lucky enough to survive in corporeal form long enough to see great-grandchildren grow to an age where I will be established in their memories. Now that is scary. How did I get to be so old so quickly?
In legal terms, a body is
unlikely to be of forensic interest if the individual died more than seventy years ago. At the present time, seventy years takes us back into the middle of the Second World War. It is sobering to think that my great-grandparents, none of whom I ever met, are now technically archaeological skeletal samples and that my grandmother will be archaeological in less than thirty years from now – quite possibly within my own lifetime. Would I feel a sense of violation if someone chose to dig up my grandmother or great-grandmother to study them as archaeological specimens? You bet I would.
I wouldn’t be too happy, either, about anyone poking about with the remains of my great-great-grandmother. Although the ties with our more distant ancestors are less strong and less visceral, in the minds of most of us, a blood bond still exists. So responsibility for treating archaeological remains with decency and dignity, and observing the sanctity of the need to leave a body at peace, must extend beyond the memories of our own lifespans. These are not just heaps of old bones, they are somebody’s relatives, people who once laughed, loved and lived.
Recently I ran a workshop for some young people at Inverness College, in which we decided to take a closer look at a teaching skeleton that was hanging in their science laboratory. By the end of the day, once they knew they were actually face to face with a young man, no older than most of them, who was 5ft 4ins tall, had anaemia through poor diet and had probably come from India, they saw this skeleton in an entirely different light. They were no longer happy about him being put back in a cupboard and wanted him to be treated with greater respect. The anonymity of human remains deadens our empathetic responses but such is the power of forensic anthropology that it can reinstate identity and rekindle the human instinct to care and protect. I had hoped this was how they would react and they did not let me down. They were an incredibly mature and responsible group of young people.