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What Lies Beneath: Sacrifice and Unequal Gratitude : Emergency Medicine News


whole body donation, corpse journey, EP life


The villains aren’t just the villains of literature. These are the characters whose actions stem from motivations to serve themselves rather than others. They are driven by their inextinguishable ego, happy to ravage others in their quest for self-advancement. Heroes, on the other hand, are those who, whatever their faults, are motivated by the greater good above their own.

Heroism takes many forms. Sometimes it takes a keen eye to see it.

Last month, I led a one-day course on cadavers. We taught the high-stakes, low-frequency procedures that ER doctors are desperate to perform. You know them: lateral canthotomy, surgical and needle cannulas, resuscitation thoracotomy, emergency hysterotomy, burr holes. We had a ratio of two participants to one corpse, evolution fortunately giving us symmetry for educational purposes.

This was a great opportunity for us relics of emergency medicine to offer up some of the tips and tricks for performing these procedures, our crusty old trade secrets. Lateral canthotomy: First crush the tissue with forceps, recognize the canthal ligaments by their guitar sound. Needle cricothyroidotomy: Everything works best if you rest the heels of your hands on your throat.

Surgical Airway: The surefire way to make sure you’re in the trachea is to use your gloved finger. No instrument does a better job than the haptics of your hand. The Burr Hole: This is the time to put the grunt in there and drill like you’re carving your name on an eggshell. This kind of things. There’s nothing like having the ability to practice on a patient who won’t budge and can’t sue you if things don’t go perfectly.

But I’m kidding, and I shouldn’t, because that’s what this column is about.

Soften the horrors

I was first in the lab because I was the facilitator, there before the candidates arrived, responsible for injecting saline into the eyeballs to re-inflate them for canthotomie fidelity. Like all corpse labs, this one was cold; the air icy and filled with formalin, still, steely and white.

Five bodies under drapes. Removing these curtains takes a moment of preparation. Bodies long dead and preserved will always face for me. It takes me a while to adjust to the departure of life, to the hollow, waxy shapes left behind, to the folds of their skin, now thick and yellow.

The temptation was strong to joke around the situation. That’s what we do, after all. The humor of the gallows to soften the horrors, our safety mechanisms, our relief. But not here. Candidates were instructed to treat the bodies with reverence, and of course they did, but the odd gag crept in, increasing as the day went on as we grew weary of the tasks. I’m a recalcitrant delinquent when it comes to inappropriate jokes as an outlet, but here in the silent cold of this room, I couldn’t bear to witness even the most subtle of smirks.

The weight of what these people had done, had sacrificed, in giving their bodies to science, was overwhelming. Their naked bodies, these companions for life, have been sawed off, plumped to be opened, pierced, filled with false matrices, regardless of gender. I became more moody as the day progressed. I couldn’t imagine being so heroic myself.

I got short with all the contestants making light. I was the cantankerous old parent, totally unable to relax. I couldn’t express myself, how piercing the awareness of what these people had done for us was. Sure, you could say their donations made it easier to train young doctors so they could go on to save the next patient. It’s obviously a huge part. He felt, however, that the balance of karma was not even.

I didn’t realize this until after the day was over, with the organs from the gutted bodies and the remains taken away by the silent lab staff, and I was at a party that night wondering if I smelled the conservative. I was horrible company and had no way of expressing the complexity of what I felt for the lab and the disturbed and uneven gratitude I felt for these anonymous humans.

I decided to quietly thank the heroism of these ordinary people. I vowed to myself to do even better next time, to be more eloquent in my explanations of this great privilege, and gentler in my touch in demonstrating what needed to be taught.

The magnificent Nobel Prize-winning poet Wisława Szymborska wrote in 1986, about death: Oh, he has his triumphs/but look at his countless defeats/misses/and repeated attempts! Sometimes he’s not strong enough/to crush a fly from the air./Many are the caterpillars/that have passed him. All those bulbs, pods/tentacles, fins, windpipes/breeding plumage and winter fur/shows he’s fallen behind/with his half-hearted work.

I take it that death may not be up to par, certainly not up to the living who need to go on. But also a reminder that, as always, it is the teacher who learns the most.

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Dr Johnstonis a certified ER doctor, so the same as you but with a weird accent. She works at a trauma center in the old fashioned end of Perth, Western Australia. She is the author of the novel dust fall, available on his website, She is also a regular contributor to the Life in the Fast Lane blog at Follow her on Twitter@Eleytheriusand read its past columns at