Bodies

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1:04When they come in, they can come in in all different states. They come from funeral homes or care homes or their home or hospitals. So it's just about taking their clothes off. We clean them. We shave their hair, take their tags off. So we take anything that has their name on off them and, yeah, put them into the freezers.

1:26Jenny Kleeman:I'm in a room surrounded by dead human bodies. They were sent here to Brighton and Sussex Medical School shortly after their death. Tomorrow, surgeons will use these bodies on a training course, learning techniques that will save people who've suffered life-threatening injuries. For the past five years, I've been exploring how and why people donate their bodies. Why, in an age of virtual reality and 3D simulation, does medical science still need those donations? It's taken months of negotiation to be allowed in this room. Camilla Ingram is the pro-sector here. She prepares the donors for use in the anatomy department.

2:10So we're coming into dissection room number one. It's got lots of teaching materials around the room. We've got potted specimens and skeletons and bones. And over there on those steel tables are the donors? Yes, they are.

2:22Jenny Kleeman:And they're covered. And we are only supposed to be in the same room as them when they're covered. Yes, that's correct. These donors have consented for anatomical examination. We have our students come in to do dissection. We have obviously our surgeons that come in and might do surgical procedures on them. And obviously you don't fall under that licence. They haven't agreed to have journalists look at their dead bodies. No, they have not. And you're getting them from the London Anatomy Office. Can you explain why that is? So the London Anatomy Office is a central bereavement office. So anyone within the south and southeast of the UK will send their consent form to the London Anatomy Office.

2:58And when they die, the London Anatomy Office will orchestrate where they go to.

3:03Jenny Kleeman:What do you know about these donors? I mean, we've got five here. Before I accept them, I'll know their sex, cause of death, and when they did die. From that information, I'll decide whether I can accept them into our care. Once we have accepted them, we get a little bit more detail, like if they've had a hip replacement or a knee replacement, or whether they have a pacemaker. Do you know their age at death? Yes, we do know their age. Are they all older people? Because I think a lot of people imagine that people who donate are older. Yes, they do tend to be older, probably 80s, 90s, sometimes 100.

3:36It's always sometimes a little celebration where we get someone who's over 100. It just feels really nice.

3:41Jenny Kleeman:Do you ever get any that are younger than 60, 50? Yes, we do. Yes, we do sometimes. What reasons would you not accept? So we can only accept if they are, sometimes I try and describe it as perfectly dead. So we can't have any open wounds, any trauma. How they died, sometimes we can't take them. So if we can't see the anatomy, because the severity of the cancer overloaded the body, we can't take that either. Shall we walk around and have a look at them? It's very bright, it's very clean. And quite calm. It doesn't smell though. Wouldn't expect it to smell. As we maybe open some cavities, there might be some more smell because you're sort of opening where they might decompose.

4:26Jenny Kleeman:Tell us what's going on in the background. We've got a technician from the Royal College of Surgeons coming in and actually setting up the instruments so this is what we can hear. Hello, my name is Ken Adigwe. I am the clinical skills and simulation technician from the Royal College of Surgeons of England. there's a plethora of different surgical instruments that we use for different types of procedures for example you'll have these bone cutters maybe a rider needle or you'll have maybe some debakey forceps so some of these things are for holding things open yes some things are for cutting and in a surgical theater you would have all of these same instruments but they'd all be sterile?

5:11These are all sterile, but they are shipped directly for the purpose of this course.

5:16Jenny Kleeman:Do they have to be sterile if you're doing the surgery on a cadaver? It's not a risk of infection, but for the respect of the cadavers, I believe we choose to have them sterile. So we go through the exact same process as you would normally go when you're turning over instruments in theatre. If you've ever thought about body donation, you've probably imagined a cadaver preserved with embalming chemicals for medical students to learn anatomy from over weeks and months. The bodies here today are different. They are fresh frozen. Fresh frozen would be a donor that has no preserving fluid in them and they've just been frozen to preserve them.

5:57And then once we get them out, they defrost and they become, I guess, fresh again. There's blood. It's just much more lifelike than if you use embalmed. Does that make it harder for you to work with? Yeah, 100%. I think embalmed, I used to say, felt like working with a model. I sometimes think like a Barbie doll. When we started doing Fresh Frozen, it was just a completely new experience to me. They're just much more malleable. If you were to pick up their arm, it would be floppy. They're sort of in a very relaxed position, as if someone is just sleeping. Yeah, it's much harder to work with.

6:30Jenny Kleeman:When you're working with these donors, do you think about who they are? Yeah, definitely. They come in directly from where they've died and I know that the family have just said goodbye and for us it is our time to say hello. It's a moment when I receive them and I know their name and I will say thank you to them and I will call them by name. Sometimes you can see sort of tan lines or they've had a ring on. There is definitely a moment right at the beginning where I do connect with the donors and they are really special to me. It's a big thing. We leave Camilla and her team to finish preparing for the surgeon's arrival tomorrow.

7:10Jenny Kleeman:Most of the donated bodies Brighton and Sussex Medical School receives are used for surgical training rather than anatomical education. It's one of only a few in the country which runs courses like this. Over the last academic year we delivered 14 such postgraduate surgical courses. Claire Smith is Camilla's boss. She's professor of anatomy at Brighton and Sussex Medical School and she oversees the surgical training courses they run here. She says nothing can replace the unique experience of working with a donor who was once a living human being. I think every individual surgeon anatomist connects to the person, the deceased person that they are working on, on a different level to what you would do with a plastic or a 3D simulation.

7:58You can't get over the fact that the person in front of you might have tattoos or nail paint, looking at their face. They were a person and that is their human body. Do you have enough donors? Not always. And that's when I have to either approach other UK resource centres or we have to import from providers in the United States, which isn't our preference because the ethics the laws are not quite the same as they are in the UK. What do you mean? I don't want to think of it as rose-tinted glasses but I know from speaking to our donors in life and the families that they've made an informed decision with full information.

8:42The information that's provided through those USA companies sometimes is quite full but in none of them do they explicitly say that your body could be flown in the hold of an aircraft and distributed to medical schools around the world and that you'll never come back? And that makes me wonder about what they wanted. Is it true informed consent that they have given?

9:10Jenny Kleeman:Claire and her team would rather receive donations from within the UK. In America, bodies can be provided for profit, with companies sometimes advertising for donors in funeral homes. That can't happen in the UK, where donation is more tightly regulated under the Human Tissue Act. And it's actually, I think, really nice to know that all of the donors that we work on are here because they wanted to be whatever their motive was, to help others, to be a resource. I really take comfort from knowing that that was their choice. How much do you know about why people donate? We have undertaken a survey of just under 1 ,000 potential body donors and their primary motivations for donations is never just one thing.

10:00It's often about wanting to give back something. Sometimes it's just about their belief that their body is a vehicle and it's not needed. And if it could be useful to someone else, why not? we currently have a piece of research to understand what the public think about body donation

10:20Jenny Kleeman:what we might do with the body who might use it and why is it important to know what the public at large think and want about body donation because we haven't had that type of large media campaigns we we put our information on probably hidden web pages we rely on people talking and giving that information so actually how can we develop our practice how can we make sure that medicine and surgery is as safe and efficient as it can be and yeah we need that help. Would you donate yourself? I often get those questions and I have to say yes because I would but I'd also feel really awkward for the staff and the students and everything that know me.

11:05Would I come here to Brighton? Would I go to London? Everyone probably still knows me there So I would, but I don't know if that would put my colleagues in a very strange situation.

11:16Jenny Kleeman:Clearly, staff at the medical school think deeply about who the donors are and care about their wishes. But how do the surgeons who are about to cut into them feel about them? The following morning, at 8am, we joined the Definitive Surgical Trauma Skills course. Welcome to ESTS. This is probably the pinnacle course in surgical training, I will suspect. It's pretty intense. It's phenomenally educational. Around 20 surgeons are milling about in a seminar room over coffee and pastries. They've each paid£1 ,500 out of their own pockets to be here, so they've arrived eager to learn. This course covers emergency surgery, the kind that involves quick decisions and bold action.

12:13Jenny Kleeman:The first session of the day will be spent on thoracic trauma, how to save the life of someone with a serious chest injury, like a stab wound to the heart. I've taught this to our course and six weeks later one of the registrars phoned me and said, thank you. I was in ED, code red, and I ended up opening the chest and sewing up the heart. And the patient survived. He'd never done it before. He's never done it since. But he was able to do it. He could remember what I'd said. He knew the basic steps. He knew, he knew the basic steps, which is what this course is all about. It may be six months, maybe six years before you do it for real but somewhere in the back of your mind you'll know that course I did.

13:07Just be something that will trigger your memory in a time when you're so phenomenally stressed that you need all the help you can get.

13:16Jenny Kleeman:Jeff Garner is a consultant colorectal and general surgeon at Rotherham General Hospital. He was in the Royal Army Medical Corps for 25 years. He's the course director today. I will probably teach one or two trauma courses a year. I will probably teach one or two abdominal wall reconstruction courses a year, which again use cadaveric donations. Who takes these courses? This particular course is full of trainees, higher level trainees coming towards the end of their training who are aware of perhaps their deficit in knowledge that you know they perhaps don't know as much trauma as they might need to as you approach the end of your training you become a bit more it's almost like becoming aware of your own mortality you you realize that there's a whole heap of stuff that you don't know that very soon you are going to be on top of the tree and they're going to be asking you so you make some efforts to find out and I have to say this course is absolutely fantastic at doing that you've just got to be able to go and act largely without scans guidance it's just going in and dealing with what you find.

14:34Jenny Kleeman:So this is incredibly serious life-saving surgery? Absolutely you know this is the the end of the road and if you don't intervene then people will die. What causes the sorts of injuries you're learning to treat in this course anything really i mean largely we divide into blunt or penetrating so penetrating is being stabbed being shot blunt is being hit by blunt objects so in in the uk scenario it's largely road traffic collisions could you teach this without cadavers and donors i would say no the muscle memory that you gain from actually physically doing it on a human cadaveric specimen is irreplaceable.

15:20I've taught trauma courses where they've got effectively a plastic simulation model and you can cut into those but again it's incredibly artificial. Well in a cadaveric specimen it looks like what it's supposed to look like. The blood vessels are where they're supposed to be.

15:40Jenny Kleeman:You've done a lot of these courses and you've probably done a lot of training yourself i mean could you estimate take a guess at how many cadavers how many donors you've worked with in in the course of your career um probably approaching a thousand when you're working with someone who's donated their body do you think about why they donated i do i do sometimes um and i'm very grateful that they did would you do it Very interesting question. And the honest answer, I guess, is probably not. I think it's an enormously altruistic act, which quite frankly, I'm not sure I am that altruistic. This is summer at its peak.

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17:30This is the bit that routinely every course enjoys the most and the bit that scares most people. So we'll go up, get changed, go into the lab and then we'll start going through some scenarios.

17:45Jenny Kleeman:Once they've put on their scrubs, our surgeons head into the anatomy room alongside the Royal College of Surgeons faculty members who will teach them. They each take a space around one of five stainless steel trolleys. The cadavers are covered for now. So this is the fun bit. Now, has everyone found their table? The course is starting now, so we are being taken into a side room. We're behind a partition. We are not allowed next door into the anatomy room when the donors aren't covered, but Professor Claire Smith is and so she has offered to go in and do a bit of recording for us ask a few questions whilst the delegates here, the surgeons are working with the donors

18:34It's just a through and through on one side of the budget and that's going to be the other side and you've got a double arm needle so why don't you take this just to suture the heart from the way to towards Can you talk me through Kerry? He's coming through the cardiac muscle using a suture with a needle on both ends. Then we use these pledgets, which are these little buffering bumpers. So when we tie the suture down, it does not tear that delicate heart muscle. Beautiful look like that. You don't need that anymore?

19:05Jenny Kleeman:Good. That's it. That's pledging a heart. While hearts are being sutured in the next room, teachers and trainees alike come over to tell me what they're learning from the donors. and how they see them. My name is Mohamed Amir. I'm a colorectal trainee from Ireland. I came here for the course, especially for this trauma surgery course. You came all the way over from Ireland for this course. And how many years is it since you qualified as a doctor? It'll be 11 years. So you're quite experienced. Yes. Why come to this course? It's a final touch just before to be a consultant, so just to be sure that I can provide the best trauma care as much possible to my patients.

19:47When do you think you'll be putting these skills into use? After I finish the course, I'll be back again. If I have a chance, I will be doing this.

19:54Jenny Kleeman:In terms of working with a cadaver, working with a donor, do you think you could learn all of this in any other way? In medicine, you can watch anything on the videos. You have hundreds of YouTube videos. If you want to be a surgeon with videos, everybody can be a surgeon. But it never gives you a feel and touch Unless you operate on a patient, you don't know. When you're doing the dissection on the cadaver, do you think of them as a person? I'm not seeing him as a cadaver at the moment. I feel them as a patient. I identify them as a patient. And what will I be doing if he is in real life in front of me?

20:31Very thankful for the people who donated. They have gone from this world and still they're trying to help. And this is a great thing. Would you do it? I will, of course, yes. Yes. I'm dead. I have no senses. Why I can't save the people. It's the best thing you can do. So, the next task, open up the right side and then a real tour of the thorax. When you get to that point there, you can put a finger in underneath of it. Exactly what you're doing, yeah. Because you're going to be going all the way up. Keep going, keep going, keep going. And then what you've got exposed is the right heart. Now you can get your hand around the back of the heart to do cardiac massage if needed.

21:11Can I quickly ask you, Matt, when did you last do one of the patients? Oh, yeah, it would have been within the last year. Probably we had a couple of patients who came in all from a road traffic accident where we ended up opening the chest. So it's sadly not an uncommon thing to have to do. And certainly when I was in London, it would be a weekly occurrence, if not monthly. My name is Mark Edwards. I'm a vascular and major trauma surgeon And I teach here for the Royal College of Surgeons on the Definitive Surgical Trauma Skills course.

21:41Jenny Kleeman:It seems to me, and certainly from having heard the lecture downstairs, that as a surgeon you have to make decisions very quickly and you have to do some stuff that most human beings would never dream of wanting to do. How much of this is about making you feel psychologically ready as well as giving you those hands-on skills? I mean, it's a large part of it. You can learn the anatomy, you can learn the steps, you can watch it online. There's plenty of different resources for that. but being confronted with the reality of you're in the moment you've got to make a decision and do something and believe that you can do it and quite absolutely knowing and controlling yourself remember as a trainee surgeon you become more acclimatised, desensitised and this provides people with a window into that desensitisation process it's the start of it the general public would want to know that people had rehearsed and prepared for that first real-world contact in a protected environment where they could explore what it was to feel perhaps not so confident about doing something.