by Sue Black
It all sounded too good to be true. But sometimes it isn’t necessary to go back to the drawing board yourself. Someone else may have got there before you, and all you have to do is tailor their work to your own requirements and develop it further – just as we had done with Tamassia’s vein-identification hypothesis. We don’t all need to be geniuses; some of us just need to be practical applicators and adapters. It is important that we are honest and do not take credit for ideas that did not originate with us.
I sent two members of my staff, Roger and Roos, over to Graz on a reconnaissance mission to check out the Thiel technique. They came back absolutely bouncing with enthusiasm for the possibilities it offered. They talked about the incredible flexibility of the cadavers, the duration of their preservation, the welcome absence of the stench of formalin that pervaded every UK anatomy department and the apparent resistance of the embalming fluid to any propensity to culture bacteria, mould or fungus. They had found no obvious downside. All this and it was, they said, no more expensive than formalin … except in one teeny, tiny, little area. It would require an entirely different mortuary set-up, and that meant capital costs: the very type of funding universities do not want to allocate to what they perceive as dead and dying anatomy departments.
That was a bridge we would have to cross when we came to it. First of all, we persuaded Sir Alan Langlands, the principal of our university, to give us a small amount of money, about £3,000, for research and development because we needed evidence from a proof of concept. We decided to trial the Thiel embalming on two cadavers, male and female, to whom we referred in-house as Henry and Flora. (Why do I always seem to name my male cadavers Henry? Maybe Gray’s Anatomy is so ingrained in my soul that it is subliminal.) As we didn’t have the necessary custom-built facilities, we would have to create a suitable mortuary set-up for the trial. Born into a generation that was glued to their television sets for every episode of Blue Peter and Dad’s Army, I pride myself on being able to devise a way to make almost anything out of sticky-backed plastic, washing-up-liquid bottles and cardboard toilet-roll tubes. What we couldn’t make, we would have to improvise, beg and borrow (but never steal).
We found an old giant fish tank that was being thrown out of a decommissioned zoology building and turned it into a body-sized submersion tank that would hold two cadavers cosily side by side. We borrowed tubes and pumps. We fashioned lids out of old doors and got our heads round some pretty basic bucket chemistry. We also had to persuade the local police that the nitrates we were buying in bulk were not for constructing bombs, just for embalming cadavers.
Henry was the first to be prepared for Thiel embalming. The fluid we had made was pumped gently through the veins in his groin region and a small cut was made on the top of his head to get into the venous sinuses, which drain blood from the brain. The whole process took less than an hour. He was then submersed in our tank, where he was joined by Flora a few days later. There they lay for two months. We checked them every day, turning them to make sure that all surfaces were exposed to the fluid. We looked for signs of decomposition or bloating. Nothing seemed to be happening that gave us any cause for alarm. What we did notice was that every time we turned them over, they remained flexible and hard to catch, a bit like wet fish in a barrel. This was an encouraging sign.
Gradually the pink colour of the skin paled and the top layer of dead skin sloughed away, as did all the hair and nails. Surprisingly, as the skin swelled a little, wrinkles started to disappear and Henry and Flora began to look younger. Sadly, though, I don’t think we discovered a new elixir of youth – the chemicals are too dangerous and lying in a vat of them for two months might be a bit inconvenient. As the weeks went by, nothing seemed to be going wrong. But we spent a lot of that time with our fingers and toes crossed.
We wrote to all our surgeons in the Dundee and Tayside area and asked them if they would be prepared to trial various surgical procedures using the Thiel approach and complete a feedback evaluation on what worked and what did not work from their point of view. They were generous with their time and advice. Roger and Roos planned the procedures like a military operation to make sure that the least intrusive were completed first and the most intrusive last, in order to make the most of Henry and Flora’s pioneering assistance. Every surgeon reported that the Thiel-preserved tissue was far superior to that embalmed in formalin and much more pleasant to work with than fresh/frozen, while offering the same advantages. Indeed, from their perspective, the only difference between the Thiel cadaver and an actual patient was that the bodies were cold and there was no pulse. Is this another gauntlet I see before me?
While there isn’t much we can do to raise the temperature of a cadaver, we have since had a go at giving them a partial pulse for one of our surgery courses. If we restrict an area of the arterial system, we can fill it with a fluid of the same consistency as blood and hook it up to a cyclical pump, producing what is technically a pulsatile blood flow. We can then simulate a haemorrhage and set a timer to count down the number of seconds the surgeon would have in a real-life situation to stem the flow before the patient would be lost. It is just the most amazing learning experience, with direct and immediate significance for patient survival and surgical skills, especially in combat surgery, where time is absolutely of the essence. We also found that we were able to hook the cadavers up to a ventilator so that we could simulate breathing. This makes ‘operating’ much more realistic but I have to admit that even I was a little bit unnerved at seeing a cadaver in my dissecting room ‘breathe’ for the very first time.
The entire project was a resounding success. We wrote to Walter Thiel, who was becoming quite frail by that time, to tell him that we had managed to emulate his fantastic achievements. Once again, we had developed nothing new: we had just listened to some old records and picked up the tunes. I was invited back to a meeting of the University Court to report on the outcomes of our trial. There was unanimous agreement that we should start planning for a full conversion from formalin to Thiel as soon as was practically possible. We saw no value in half measures and the university recognised the worth of becoming home to the only Thiel cadaveric facility in the country. It would make Dundee UK leaders in the field.
Once the decision had been made, we hit them with our tiny snag: our existing mortuary was not fit for purpose and it was too small. It barely met our current needs, let alone what we had planned for the future. As we couldn’t possibly cease body intake while we renovated it, we would have to build a new one. In the meantime, Her Majesty’s inspector for anatomy entered the fray. Our current embalming facility, the inspector said, was in desperate need of refurbishment and the university would need to consider updating it as a priority if they wished to continue to teach dissection-based anatomy at Dundee. This slightly orchestrated pincer movement was a bit naughty, I know, but the university undoubtedly had some decisions to make and this concentrated their collective mind. Should they maintain dissection-based anatomy teaching at Dundee? If so, should they refurbish the old mortuary and stick to formalin like everyone else, or should they fasten their Superman cloak around their neck, pull their underpants over their tights and make the giant leap of investing in a clear opportunity to claim a leading role in anatomy in the UK? Naturally, I happen to think that the decision they made was the right one.
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The new build would come with a hefty price ticket of £2 million. The university was prepared to meet half the funds but it would be up to us to raise the balance. Where on earth do you find money to fund a mortuary? A bag-pack at a supermarket or rattling a tin at the local railway station wasn’t going to cut it and, let’s face it, without a carefully thought-out campaign, an appeal for a new mortuary was unlikely to tug at the heartstrings of our generous and compassionate public in the same way as many of the charitable causes with which we would have to compete. We would simply have to get creative again and think way outside everybody’s box.
I consulted a good friend of mine, Clai
re Leckie, who is a very experienced charity fundraiser. She suggested I compile a list of all the people who had ‘used’ my services over the years, because maybe it was time to call in a few long overdue favours. Who had, for example, picked my brains in the past, and could they help me now? When I started jotting down names I realised it was quite a long list, but one leaped out: the celebrated crime writer Val McDermid.
Val and I had ‘met’ on a radio programme over ten years before, when she was in Manchester and I was in the Aberdeen studio. While waiting to go on air we had been chatting and, on the spur of the moment, as is my wont, I had said to her, ‘By the way, if you ever need any forensic-science advice, feel free to give me a call.’ She did indeed call, many times, and it led to a warm and genuine friendship of which I am deeply proud. I knew that if anyone was brave enough, and bonkers enough, to help me with this, it would be Val.
We put our heads together to hatch a scheme and eventually came up with the wonderful ‘Million for a Morgue’ campaign. The new mortuary would need a name, and we agreed that it should be one that would resonate with the public and the media. But while an Olympic cyclist or an artist would consider it an honour to have a velodrome or an art gallery called after them, who would want to be linked with a mortuary? The answer was staring us in the face. The perfect fit would be a crime writer. And why not use the naming of the building to raise the profile of the campaign, and boost its coffers, by inviting the public to choose the recipient of this dubious honour?
Val persuaded a number of her big-hearted crime-writing colleagues to join her in supporting us, including Stuart MacBride, Jeffery Deaver, Tess Gerritsen, Lee Child, Jeff Lindsay, Peter James, Kathy Reichs, Mark Billingham and Harlan Coben. We launched an online competition in which crime-writing enthusiasts could vote for the mortuary to bear the name of their favourite author in return for a small donation. We all had a tremendous amount of fun and the writers’ generosity and ingenuity knew no bounds.
Jeffery Deaver exhorted readers to vote for him on the basis that he was the one who looked most like a cadaver. I could not possibly comment, but nobody disputed his claim. A talented musician, he donated a CD of his private work to be auctioned to raise funds. Our only worry was what we would do if Lee Child won the most votes, as christening the new building the ‘Child Mortuary’ would hardly be sending out the right message. Lee, ever the gentleman, came to our rescue by suggesting that if he won we could call it the Jack Reacher Mortuary instead, after his most famous character. I have not yet exploited the connection to Tom Cruise, but I have tucked that away for future use.
The magnificently creative Caro Ramsay put together a ‘killer cookbook’ featuring recipes contributed by her fellow crime writers, which was sold in aid of the mortuary. Never before had a cookbook been associated with an anatomy department – for several very good reasons. That took a little bit of careful advertising, I can tell you, but it was a great success. We held tasting nights and cookery demonstrations all round the country and it was even shortlisted in the 2013 World Cookbook awards.
Other authors put characters in their forthcoming books up for auction. Winning bidders could choose to become a bartender, say, or an innocent bystander in their favourite crime writer’s next novel. Stuart MacBride hosted tours around the Aberdeen locations immortalised in his Logan McRae books. Stuart also donated to the campaign the proceeds of The Completely Wholesome Adventures of Skeleton Bob, three children’s stories he had originally written and illustrated for his nephew, Logan, recounting the adventures of a skeleton with a pink knitted skin who gets into all sorts of trouble with witches and his father, the Grim Reaper. We were touched and honoured that he entrusted them to us and allowed us to publish them on his behalf.
For a full eighteen months, we worked our socks off for the Million for a Morgue campaign. We did signings at crime-writing festivals from Harrogate to Stirling. We gave lectures and interviews, we talked about our mission on television and in newspaper and magazine articles. We arranged and participated in discussion panels. And we did it. We raised what was needed to fund the shortfall and to enable construction of the new Thiel facility to begin.
Focused as we were on building and equipping our new mortuary, we were completely taken aback by one unexpected side-effect of our campaign. Back in Dundee, Viv, our bequeathal manager, complained that after every event in which I took part there would be a surge in bequeathal inquiries from people who, until hearing about Million for a Morgue, had never realised that anatomy departments still required bodies for teaching and research. They went on to sign the donation forms in their droves, not just to Dundee, but to other anatomy departments across the UK.
We had never envisaged our campaign as a kind of a recruitment drive for the dissecting room, but it seemed that this was proving to be a very positive and welcome by-product. Indeed, long after the end of the fundraising activities, the interest still continues. Today we have more than a hundred donations annually, almost all from the Dundee and Tayside region, with which we have built such a strong bond of trust.
We hadn’t been appealing for anything other than money to help us build the new facility, but perhaps we should have been. Why do we always think the public needs to be wrapped in cotton wool when it comes to death and that people won’t want to talk about it? All those who contacted us were relieved to find that there was a matter-of-fact discussion to be had and a third option for them to consider, as well as burial or cremation, when the time came to decide what should happen to their remains after they died. They showed no reluctance to talk about death or to ask direct questions, and no difficulty dealing with direct answers.
One lovely lady seeking to donate her body to Dundee was calling from Brighton on the south coast of England. Viv, as professional etiquette demands, quite rightly pointed out to her that there were medical schools much closer to her than ours. We could, of course, accept her donation but her estate would have to meet the transport costs. She said she didn’t care about that. She wasn’t interested in going to a local medical school because she wanted to be a state-of-the-art cadaver – she wanted to be ‘Thieled’. Walter, who passed away in 2012 and therefore sadly didn’t live to see the opening of our new mortuary, would have been so proud and endlessly amused to learn that he has become a verb.
At one of the fundraising dinners we held with the crime writers we met a very conflicted woman. She was terminally ill and determined to donate her body to anatomy but her husband was very much against it. While she did not want to upset him, she did want him to respect her wishes and to agree to fulfil them. During our lengthy conversation, it became clear that her inability to make her husband see how much this meant to her was a source of some distress. He was understandably afraid that we did unspeakably disrespectful things to cadavers and his sole concern was the responsibility he felt to protect her dignity and decency in death. She asked if I would be prepared to write to her explaining exactly what we do and why we do it in the hope that such a letter could be used as the starting point for a less fearful marital discussion.
It was a hard letter to write and it took me a long time, but it had its reward in her response. She said her husband thought he ‘got it now’ and that, although he still ‘wisnae happy’, he had agreed to respect her decision. I can only hope that she got her last wish, that her body resided for a while in an anatomy department somewhere in the central belt of Scotland and that her husband has been able to draw some small comfort from knowing that what she has taught a generation of students will go on to benefit the sick and dying for longer than she could ever have imagined.
Whether our donors come to us in Dundee, or we can help smooth their path to another anatomy department to fulfil their final request, it is an honour and a privilege to assist them with their plans for ‘being dead’. Whatever their job or station in life, whether they are rich or poor, tall or overweight, riddled with disease or arrive with a full manicure and new hairdo, whether they die too
young or at a great age, these amazing people are united in their decision to donate their remains for the common good of priceless education.
We consider it our duty as licensed teachers of anatomy to speak on their behalf, to stand up for the principles they represent and to preserve their dignity. Mercifully, long gone are the days of comic films in which routines involving cadavers bundled into taxis, or fingers found in someone’s breakfast, portrayed the dead as a prop in the capers and high jinks of disrespectful medical students. I tolerate no disrespect in my dissecting room, and neither will Her Majesty’s inspector for anatomy. Contravening the Anatomy Act can carry a custodial sentence. Quite rightly, given how much faith and trust our donors place in us and our students to do our jobs.
It is this sense of responsibility that underpins my personal views on the public display of cadavers and the tipping point at which this can no longer be justified as educational and becomes nothing more than ghoulish voyeurism. Charging a high admittance fee in the name of education to bring in the public to gawp at cadavers posed as if they were playing chess or riding a bike, or vulnerably exposed in their third trimester of pregnancy, does not make such an exhibition educational. I find the showmanship element distasteful and cannot think of any circumstances in which I would ever support such a commercial venture. With the permission of our inspector, we have been allowed, from time to time, to place embalmed specimens – the ones we have mounted in glass or Perspex pots – in special exhibitions at science centres and other such venues where there are no entrance fees and where the focus is truly on education. But we can’t, and won’t, do it just for the sake of entertainment. There has to be a distinct educational purpose to it, and this will always make fundraising an uphill struggle for anatomy.
For us, our subject is very far from being either dead or dying. It is alive and kicking in pockets around the world where its adherents remain passionately committed to its survival and its growth – and nowhere more so than in Dundee. I am so proud of all the donors, the staff, students and the many supporters who have made this phenomenal educational and research facility one of the best in the world. In 2013, we were honoured to be awarded the rare and prestigious Queen’s Anniversary Prize for Excellence in Higher and Further Education for our research in human anatomy and forensic anthropology. And the forward thinking goes on. At the time of writing, we were planning to mark 130 years of teaching anatomy at Dundee in 2018, and gearing ourselves up for another campaign to raise funds for adding a new public engagement centre to our building.