©This story is property of The
CyBurr, the online version of The Burr,
Final Exams
A look into medical
and forensic human dissection
Story by Mike Klesta
Photos by Mike Stump
Surrounded by death, he seems alive. Joe Bernard leads the way down the long hallways of the Northeast Ohio Universities College of Medicine, greeting each passerby with a smile and a “Hello.” He seems to know everybody, and they know him.
Heading down to the basement, Bernard says he handles all cadaver donations and is an instructor in human anatomy. He has worked at NEOUCOM for 23 years.
Bernard works with the dead in a way few others ever can, using them as teaching tools.
“If you look at HBO, you’ll see bodies hung up on hooks,” Bernard says, explaining that it doesn’t actually happen.
“Look beyond this as a teaching tool. This is somebody’s mother, somebody’s father,” Bernard says, noting the absolute importance of respect. Respect for the body. Respect for the sacrifice.
The morgue houses approximately 35 bodies that are kept on hand for dissections. The mothers, fathers, sisters and brothers are in bags, awaiting their chance to enlighten yet another med student.
They are like the ashen faces of snowmen glowing in the moonlight—cold yet beautiful.
After students are done with the two-term dissection, the school holds a memorial service where loved ones of the deceased can reflect and remember. Bernard says the service creates a sense of closure for the loved ones. The donated bodies are sent immediately to NEOUCOM with no time for a wake or funeral.
One student sees the dissection as a way to sort out the anatomy of the body.
“It really helps keep stuff straight,” says Trent Albright, a first year med student.
Albright is with a couple of friends studying in the library. They become animated and excited when Bernard walks by.
Bernard stresses the importance of human anatomy. When a patient points to the right side of the body, Bernard says it is imperative the doctor knows what is on that side.
The dissection begins in the first term with the back, goes on to the arm, the head and eventually the neck. Nick Shundry, first year med student, says this gradual process makes the transition easier to handle mentally.
Brains and bones are kept in jars and on shelves. The room is surprisingly warm. Refrigeration isn’t needed because the bodies have been embalmed to make them last three to four years, not for cosmetic reasons as done by funeral homes, Bernard says.
The dissection lab room contains countless stainless steel examining tables, sinks, chalk boards and lockers. It smells like dissection day back in high school biology.
Students are busy cutting away the skin and teasing the fat away from today’s lesson—the gluteus maximus region—to get a look at the pudendal nerve.
Delving into the incision, balls of yellow fat obstruct the muscle below. The fat leaves a greasy shine on gloves and instruments.
The students continually identify parts of the body, or at least try. Teaching assistants circle the lab and give the first-year med students much-needed help.
“You don’t have to be as careful as
you think,” Andrea Sims says, explaining that teaching assistants often come by
and use a lot of force to peel back skin or cut muscle. Sims finished her
undergraduate work at
Each subject has four med students learning from it. Sims says it’s better that way—in case a guy in the group is uncomfortable cutting at the prostate, for example, someone more comfortable can take care of it.
The class examined the head region weeks before. Sims says a teaching assistant would come around and use a power saw to cut through the skull. The crown of the head is cut in the fashion of a lobotomy, taking the top of the head off like a cap. A few groups improvise and use the leftover top portion of the skull as a basket to hold instruments, such as forceps, scalpels and scissors.
Gregory Harkey,
first-year med student, did his undergraduate work at
“The first time I came down here, I didn’t like it at all. I had to leave,” he says.
After three times, he says, most people don’t mind it.
Harkey continues to search for the day’s objective. His lab partner, Matthew Stonestreet, first-year med student, becomes frustrated while weeding through the fat and muscle in the gluteus maximus region.
“I’m cutting the shit out of something over here,” he says.
Melissa Hanek, first year med student, admits she isn’t big on blood.
“I can’t see surgeries. I just pass out. But this, this is nothing,” she says.
The body is drained of all fluids, including blood, during its preparation for dissection. This prevents rotting.
The body she is working on is far from rotting. She’s been working on it since September.
“This is from the first term. That’s why it looks like jerky,” Hanek says.
She and her lab partner, Stephen Cha, first-year med student, playfully argue over who found the larger artery in the upper thigh region, the femoral artery.
“Look. I found a bigger one,” Hanek says.
“Oh, hush.”
Bernard is continually making rounds, telling jokes and getting serious when it comes to the actual dissection.
Bernard is showing two students the difference between the greater and lesser femoral artery, jabbing his finger into both of the blood vessels for emphasis. The femoral artery supplies blood to the thigh region.
He seems excited and intent upon making others get it right.
“We’ve got more goodies over here,” he says, pointing to a wad of muscle tissue.
A student passes by, joking, “You’re a bastard, Joe.”
“Yeah, yeah.”
Bernard says the positive environment is key to making an uncomfortable class more interesting and more palatable.
“Back when I took anatomy, they didn’t let you talk,” Bernard says. “You can’t learn like that.”
Bernard says he’s had quite a few of Harkey’s relatives, including siblings. He gives them all a hard time, but for a purpose—to learn.
Bernard embalms the body himself, which includes removing all body fluids and injecting it with embalming fluid. The fluid contains ethyl alcohol, pine oil for scent, a little formaldehyde and a mold-preventing agent.
The dissection isn’t just about anatomy. It allows for the betterment of doctors, and in turn, all human kind, Bernard says.
In the university’s library, Bernard gestures to a large metal cylinder, an antique iron lung. The machine was used to help a patient breathe but would have to be operated manually when the power went out.
He shakes his head in disgust.
“They talk about the good old days. Know what? Give me the now days.”
Uncertain Death
Often working silently yet consistently behind the scenes, the county coroner’s office performs a vital task—it discovers how someone died.
Administrator Wayne Enders sits at his desk sporting a green “Portage County Coroner’s Office” shirt. He’s been at the county coroner’s office for more than seven years and has assisted in hundreds of autopsies.
“Anyone can be trained to eviscerate someone,” Enders says. “But you must be trained in the mind to find a diseased organ.”
Enders teaches photography at
Out of the 850 deaths
Autopsies are performed in suspected suicides, homicides or when a person dies unexpectedly but was in good health. An autopsy is particularly important in potential homicides.
“That autopsy will either prove they were involved in it or it will vindicate them,” Enders says, noting that an autopsy can explain if a person was murdered in the first place.
The majority of coroner cases involve males, possibly because they statistically don’t go to the doctor’s office as much as women.
“They go when they’re threatened. They go when they’re really sick,” Enders says.
He clarifies his point with a prostate example.
“Where a guy, man, if he feels like he’s sitting on a basketball, he can’t tell anyone because he’s embarrassed,” Enders says.
Enders has helped with more than 200 autopsies as an autopsy surgical assistant. He’s now in administration.
Enders says he enjoys his job—enjoys discovering the cause of death.
But some cases can be difficult to deal with, Enders says. He has helped with autopsies on people he knew in the community and kids he didn’t. Some pathologists refuse to tackle some of the more sensitive autopsy subjects and send them elsewhere—they call that a “punt.”
“I’ve had to do a couple of babies and discarded fetuses,” he says, his face slowly frowning.
He’s even performed one on a person he knew.
“I actually had my best friend in high school,” he says. “I happened to look at his toe tag and about freaked out.”
He takes people apart, but is able
to put others back together again with his ministry job. Enders is a minister
at the First Christian Church in
“I see this job as minister in comforting grieving families helpful,” he says.
The door opens and criminal investigator Tom Decker steps in with a brown paper bag, implying that there was something in the bag other than groceries.
“I could just shoot that person that did this,” Decker said.
“Don’t do that. You might have a coroner case,” Enders says, chuckling.
Decker sits down, his gruff voice cutting through the warm air. He just looks like a cop—and he is. As chief investigator, Decker deals with the medical side of the investigation, not the criminal, he stresses.
The bag contains the belongings of a deceased individual that were supposed to be sent to the funeral home but were accidentally sent to the coroner’s office.
“I don’t go in there and slice and dice like he does,” Decker says, gesturing toward his counterpart in the coroner’s office, Enders. “My job is to find out manner and mode where somebody dies.”
Decker, chief investigator at the coroner’s office, looks at evidence at the scene of the incident to try to distinguish the cause of death. He takes photographs and notes.
After gathering the information he
needs, Decker arranges to transport the body. Because he doesn’t like to tie up
The body is first taken to the morgue, where it is looked over to see if an autopsy is necessary. The county coroner has the final say.
Sometimes, it’s quite clear to determine a cause of death.
“If you have anyone with blood coming out of their ears, it’s a closed head injury,” Decker says, explaining that his son used to ride bulls and was once thrown off. He had the tell-tale blood coming out of his ears and had to have titanium plates put in his head. His son is fine now, but he sustained some facial fractures in the accident.
Decker looks over the scene of death and then the body is transported and the coroner determines the cause of death. Decker often breaks the news to the family. He says the hardest part is telling parents.
“It’s not cool to tell someone a person died over the phone,” he says.
Instead, he tries to go to the individual’s house with a police escort to break the news. He says the response to the death is pretty unpredictable.
“I’ve had people break dance, hit walls and pass out when I’ve told them,” he says.
Dr. Lisa Kohler is the chief medical examiner at the Summit County Medical Examiner office, which is equivalent to a county coroner’s office.
She has done extensive work in forensic pathology.
“I’m more in tune with the investigative portion,” she says, comparing herself to the pathologists. “They’re bright people, but most haven’t had forensics training.”
Kohler has been the chief medical examiner in Summit County since 1998 and interned there while an undergraduate at the University of Toledo.
Kohler says she first was interested in law enforcement and science.
“I looked at the crime lab initially, but I found out I didn’t like chemistry,” she says.
The toughest cases to determine cause of death are when young people are involved. They are typically healthy and haven’t had a chance to show long-term health symptoms, she says. Other times, there are two possible causes of death – a heart attack sustained in a car wreck for example—and when it is impossible to determine the initial cause of death, she says.
Back in
Stating a simple, yet heart-felt mantra, he says, “We live in an imperfect world.”
Sidebar 1:
There are six general steps to an autopsy:
1) Initial gross viewing
The subject is first viewed wearing the clothes they came in with. Marks on the body are noted, and the subject is stripped and viewed head to toe once more.
2) Surgical procedure
Then the person is opened up and all organs from the hyoid cartilage in the Adam’s apple to the groin are examined thoroughly for deformities, cuts, contusions, disease and anything else abnormal.
3) Tissue samples
Organ tissues are usually taken to a lab to be further studied. Enders says they take about a coffee can full of parts out of the corpse that need to be analyzed. The rest is put back in the body cavity and the cadaver is sewn back up and taken to the crematorium or funeral home.
4) Toxicology
Samples of blood, urine and eye fluid are taken from the body and studied in the lab.
5) Cultures
Bacterial cultures are grown to check for the possibility of septicemia, the presence of bacteria in the blood.
6) Psychological autopsy
Though not a formal step in the autopsy process, a member of the autopsy team spends time talking to family members and witnesses to a suicide. The team attempts to find out if there were signs to the suicide.
Sidebar 2:
Criminal investigator Tom Decker follows four general steps to distinguish cause of death:
1) Who found the body? The area always has to be treated like a crime scene.
2) How did the person who discovered the body have to enter the room? Was the door kicked in because it was locked? Was a window broken?
3) Was there any visible trauma to the body?
4) The environment where the body was found is then combed over, looking for blood spots, weapons, etc.
©This story is property of The
CyBurr, the online version of The Burr,