Thursday, October 23, 2003
Copyright © Las Vegas Mercury

The gift of life

How cadavers help save lives

By Joseph Allen

Tracheostomy on the fly. Before the paramedics lift the crash victim into the ambulance, one cuts a passageway the shape of a cat's pupil in the victim's obstructed throat and inserts a breathing tube. He saves a life in the time it takes to read to the fifth paragraph.

Learning the procedure takes infinitely longer. Winging it during an emergency is out of the question, so the doctors, nurses and paramedics who treat trauma patients rehearse on those for whom time is irrelevant--cadavers, sometimes called "anatomical gifts" or "willed bodies."

"It's an extremely effective teaching method for people who require life-saving skills," says Dr. John Fildes, 48. "Knowing how to perform procedures quickly and effectively can mean the difference between surviving and not surviving."

Fildes is director of the Trauma Center at University Medical Center, and since 1996 has been a professor at the University of Nevada School of Medicine surgery department in Las Vegas, where the cadaver workshops take place.

During the workshops, a critical operation--insertion of a tube in the throat or chest, draining of fluid around the heart or lungs--is first demonstrated, then practiced by students. Professors divide students into rotating groups to learn the techniques crises would preclude, Fildes says, and design an education program based on cadavers' availability.

Bob Hamann determines that availability. Curator of the medical school's human anatomy lab in Reno and committee member of Nevada's anatomical donation program, Hamann has worked with cadavers for nearly three decades and emphasizes their value.

"Even though [students] learn off dead bodies," he says, "all the knowledge will be applied to saving lives. ... People should focus on this rebirth. Life, not death."

Under Hamann's guidance, Palm Mortuary of Las Vegas has transported cadavers to and from UNLV for the past three years, says Bart Burton, vice president of Palm's preparation room and crematorium. The medical school pays the mortuary a fee of less than $600 to transport, embalm and cremate a cadaver, he says. Cadavers' families pay for nothing.

"We're basically covering our cost," Burton says. "We make no money on it."

The role of Palm Mortuary in Nevada's Anatomical Donation Program is relatively small. While Palm provides cadavers only for the UNLV surgery department, Walton Sierra Chapel in Reno performs the same function for the medical school's main campus at UNR, the UNR Biology Department, Washoe Medical Center, Truckee Meadows Community College and Western Nevada Community College in Carson City.

The program has attracted more than 1,800 people statewide, according to Hamann. Most are older than 65, he says, and the majority live in the limited radius of Northern Nevada--about 3 percent of the Truckee Meadows' older population. Similar programs are buried within university administrations in all 50 states, Washington, D.C., and Puerto Rico. The New York Mortuary Service, for example, picks up cadavers-to-be as far north as Boston and as far south as Baltimore, says General Manager Tim O'Brien. From that overpopulated span, he retrieves only 500 corpses per year for Cornell, Mt. Sinai, New York University and other institutions. In comparison, the 30 cadaver trays in the UNR morgue have never reached capacity.

Federal law allows that states may design their own cadaver programs; because of that, peculiarities have arisen. University of the Pacific in California, where Hamann used to work, salvages the unclaimed dead from the city morgue--the homeless and such. He said Nevada's medical school technically could accept unclaimed bodies and even prisoners, but volunteers have never been in short supply. The University of Florida spreads cadavers' ashes over the Gulf of Mexico, which would have been a poetic end for cadaver Ivy Browne, who swam in Santa Cruz, Mexico.

Browne was the poster octogenarian for physical fitness. She probably swam far enough to have circled the globe. The world record for the 10K open-water swim still belongs to her. She held eight national records in the 1980s and adorned her mobile home's entire living room wall with medals she won--nearly 500 in swimming and track and field.

1934: On a dare, the fiery-haired Browne became the first person to swim San Francisco Bay. Her picture appeared in Life magazine, and her record stood for 46 years.

2002: Her death from acute leukemia was reported on "CBS Sportsline" and by the Associated Press. As her donor card requested, her body was expressed to Walton's Sierra Chapel and then to UNR.

Browne's son and daughter-in-law, Marvin and Betty Mendonca, knew nothing about the Anatomical Donation Program until a few months before Browne died. Sitting in her mobile home in downtown Reno, a baroquely ribboned wall behind them, she told the Mendoncas of the arrangements she'd made.

Marvin and Betty say they admire Ivy for contributing to future doctors' knowledge. "I might even do something like that myself," says Marvin, 63.

Despite the achievements that won her national acclaim, Browne's drive to contribute was typical of donors. Most are "ordinary citizens," says Bonnie Coker, who signs up the philanthropists, the widows, the destitute, the ones who think science might benefit from preserving their peculiar ailments or deformities. Half of the medical school's donors sign from nursing homes or hospitals in their twilight days and usually find out about the program from physicians or attorneys. Others have been in the program 20 years. A handful are under 20 years old; the youngest is 18.

Regardless of their differences, cadavers hold certain traits that set them apart from those who go straight into the ground. Dr. Terence Smith, director of the Anatomical Donation Program, has said that donors are "strong and independent spirits" who seek to "confront life fully" and contribute their corpses in this "last meaningful and unselfish act."

Browne once expressed her satisfaction that she "helped science help others" by volunteering in hospital experiments. She and hundreds of other Nevadans have continued that endeavor posthumously, and every life saved by paramedics or in the UMC Trauma Center is a reiteration of Browne's sentiment.