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 its 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[26] 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….
26
I read on a Web site somewhere that this was the origin of the saying “Saved by the bell.” In fact, by one reckoning, not a single corpse of the million-plus sent to waiting mortuaries over a twenty-year period awakened. If the bell alerted the attendant, which it often did, it was due to the corpse’s shifting and collapsing as it decomposed. This was the origin of the saying “Driven to seek new employment by the bell,” which you don’t hear much anymore and probably never did, because I made it up.