My Dead Body: The documentary marking the first public dissection in the UK in 180 years

Lealanhi WoUlfe

Anatomy is quite the peerless domain of academia. It is challenging to distinctly define which province it delineates to a greater extent; the bounds of art or the realms of science. Veritably, art can be defined as the human proficiency to synthesise form and beauty. By this delineation, anatomists are artists who amalgamate a comprehensive understanding of structure and form, with the aim of better appreciating the fortitude and interconnectedness of the human body. Unquestionably, a knowledge of the human body; its shapes, contours, and plasticity are indispensable to students of the discipline and to their ultimate goal of forming an integrated map of human tissues

It is a subject that is innate to our being and fundamental to how we move throughout the world. Yet, structural eccentricities between individuals can also be a source of great intrigue amidst the scientific community, as unfortunately can a multitude of pathological misfortunes. This is a subject that acts as the universal vernacular of clinical medicine, with a resilient and enduring legacy rooted within the practice of cadaveric dissection.

However, with the development of new technologies and teaching modalities, medical education has experienced a paradigm shift towards alternative teaching methods within contemporary problem-based or integrated curricula preferred by numerous medical schools. The discipline of anatomy additionally underpins the study of pathology and physiology alongside a myriad of other clinical specialties; including surgery and radiology. Thus, a thorough knowledge of anatomy is imperative for the development of salient transferable medical skills that include eliciting a patient history and examination in addition to clinical reasoning that would contribute to diagnostic acumen and patient management.

In June 2019, the Anatomy Laboratory at Brighton and Sussex Medical School (BSMS) was awarded a Human Tissue Authority Licence for public display (BSMS, 2019). There is no gift more valuable than body donation, yet this topic remains stigmatised within society. Undeniably, all life is precious and has a distinctive purpose. But in a courageous and selfless act, body donation enables decades of research and education to ameliorate the knowledge of a novel generation of clinicians and scientists, with the directive of enhancing the lives of countless individuals for years to come. This endowment transcends the value of life, to give ascendent meaning to one’s passing, however sorrowful this may be, without any expectation of remuneration.

Astonishingly, it has been more than 700 years since the first public dissection and almost 200 years since the first British cadaver was dissected publicly. This changed in 2022 when Toni Crews, a young British woman whom had suffered with a rare form of cancer in her lacrimal gland, audaciously waived her right to anonymity and became the first public display cadaver in the UK since records began 180 years ago as part of a groundbreaking documentary (BSMS, 2022).

The film poignantly follows Professor Claire Smith, Head of Anatomy at Brighton and Sussex Medical School, and her team as they dissect Toni’s body and chart the course of the disease from the initial diagnosis to her death four years later, exploring Toni’s incredible story before and after her death. By understanding exactly what caused Toni’s symptoms and building a timeline of how the cancer developed, this unique study will ignite decades of research for medical students and academics, inspiring a whole new generation.Through Toni’s donation and the documentary as a whole, the anatomy team at BSMS had the admirable intention to educate, not to directly identify a cure for cancer.

In the UK, ‘My Dead Body’ aired in December 2022. Professor Claire Smith, who lead the documentary and the dissection sessions undertaken at BSMS, agreed to an interview to discuss the resounding impact this film has made so far and to explore the unique situation of being permitted intimate access to personal information pertaining to Toni’s life and her decisions that would not typically be available with other donors.

“Toni died of a tumour in her lacrimal gland. She really was 1 in a million, if 1300 bodies are donated to science each year you are very unlikely even across the globe to get an individual with this type of cancer” Professor Smith remarked. The production demonstrated that the cause of her death was indeed the rapid and rampant spread of cancer around the body, and that the pain Toni suffered was caused by the myriad of tumours pressing on surrounding structures, triggering various baroreceptors throughout her body.

One repeated question that presented itself throughout the documentary, was positing whether there has been a novel interest in body donation as this feature has introduced body donation to a larger number of individuals, offering them the opportunity to pursue this option after their passing? 

Professor Smith disclosed “A really important thing about body donation, is that we do not advertise for various reasons, it is against the law to make any funds from body donation. Similar to organ donation, which is also licensed by Human Tissue Authority (HTA, 2020), we need to make sure that anything we do is for information not an advertising campaign. The documentary was a story about an incredible young woman, Toni, and her journey with cancer; but through its nature it highlights body donation as an issue for people.

There was not an explicit aim to publicly raise awareness for body donation, but we are aware that this has occurred just through the documentary. From the Human Tissue Authority’s website figures that have been shared with us, their website traffic has increased 400 fold during the month of December 2022.. Anecdotally, all of the bequeathal officers across the UK who teach at medical schools have received a larger than normal volume of requests for further information, extrapolating that there has been an impact”.

(University of Brighton, 2022) Filming during ‘My Dead Body’ 

Yet, colloquially there is still a stigma around body donation in the UK, even a miscomprehension to the extent wherein one believes the practise to be synonymous with organ donation. Body donation is the act of consenting to give your body to a medical school after your passing for the purpose of training and continued education, whereas organ donation is when one consents to donate one or more organs to another individual who may be able to use these organs following the donor’s death. One wonders how, if at all, the documentary has helped to educate the public about what body, not organ, donation actually entails?

“Misinformation is present in the public and within the medical profession. A study in New Zealand asked medical students if they had donated their body, and something like 40% agreed they had, but retrospectively the records were checked to show that no one had donated. This highlighted they had consented to organ donation. So yes, there is definitely miscommunication and misinformation… stigmas do still exist. It does not sit well with all religious or cultural beliefs, sometimes individuals may be doing this against their family’s practise. Sometimes people may worry that they may be seen to be doing this for the wrong reasons, financially, or otherwise”.

Professor Smith continued further to make reference to a survey that she performed with Dr Tom Farsides on the preferences of body donors' beliefs, which reported, for possibly the first time, that potential body donors’ motives did indeed include saving their relatives money and inconvenience (Smith, C.F et al, 2022 ).

Toni’s family, and indeed Toni herself through the technology of AI, emphasised that “she wanted a legacy, to leave something behind, she was not going to go out in vain”. Professor Smith expressed how unusual it was to learn about Toni’s personal life and wishes, although she did also inquire what symptoms Toni exhibited during her illness. In the UK, since 2006 the General Medical Council (GMC, 2013) has advised that in providing clinical care doctors must, wherever possible; “avoid providing medical care to themselves or anyone with whom they may have a close personal relationship, despite it still being permitted by the law”. To follow along a similar thread, one ponders whether as an anatomist one may feel internally conflicted about potentially knowing or establishing a relationship with an individual who may later decide to donate their body?

“It was really unique. Previously in my career I had been involved in patient care, but I have not been involved in living patient care for a number of years. It was about treading one step at a time when we had a conversation with the family. The family have given us that factual information that would have been quite transactional to get what we had needed for the documentary but as people they are incredibly inviting, warm, genuine and interesting people making the relationship I now have with them a natural extension. Still professional but also recognising that there are some parallels intertwining lives, they are also human. Working with them has made it very fulfilling in a different way”.

One must wonder, as this relationship to the family developed and one’s possession of personal insight expanded, whether Toni’s dissection felt more invasive than working with other donors with whom you would have had no acquaintance?

“Working with a donor who is younger than myself and had such a horrible experience with cancer was always going to feel quite personal and different. Any donor who had attributes… well like Toni had beautiful tattoos, it certainly adds to their story. I think the only times that were ever difficult were when you looked at her as a whole [being]. When you are into the anatomy detail and the science of what you are doing, the rest disappears as you are just in that focus. I think myself and the team treat all of our donors with the utmost respect. We do not always call them by name or know so much about them. That bond to her as a person was different. When you get down to scalpel time and what you are doing, it is the same as everyone else.”

Within dissection, when you are focused on an individual area your viewpoint is quite attenuated and narrowed down. This translates to mean that when you do eventually take a step back it hits you more acutely, as this may be the first point in time that one is able to appreciate their donor in their full totality.

Powerfully, Toni’s dissection commenced at the end of her journey, in a quest to define the tumours that killed her from the surrounding repository of her brain. This idiosyncratic odyssey made for an incredibly moving observation. Within the audience’s mind, a query came to light to ask whether all dissections follow a standardised framework, to begin with the brain; or alternatively along a similar protocol of working backwards? If not where do most dissections embark from and is there a regulated procedure that must be followed for all cadavers?

“There is not any norm to work from. For undergraduate medicine, we plan out our dissections based on the overall structure of the curriculum, these discussions are good for mapping out areas for students to start on... the thorax is a really good place for students to start on. The brain is quite difficult if you were to walk into medical school and start there. They are mapped depending on what you want to do. For surgical teaching, dissections are planned to follow particular surgical routes… in recent teaching for the Royal College of Surgeons that began with a clamshell thoracotomy and moved into other areas peripherally following the course of a blast bomb injury elsewhere. With Toni we had to start somewhere, but where do you start in a body that has so much cancer? It was either start at the beginning or start at the end. Starting with the eye did not feel right for us. We wanted to start at the cause of death and work backwards”.

It was a very elegant trajectory to take that was, almost symbolically, rather poetic. One of the anatomy demonstrators remarked at the rare opportunity to have a clear and discreet tumour in the brain. This astonishment was especially palpable, does that imply that this deviated from the norm and that tumours typically spread in a messy pattern that is arduous to isolate?

“With regard to the brain a few of the pots in the DR room have tumours in them, taken from harsher and older fixed specimens, seen as hard structures. Toni had been frozen after death and soft-fixed embalmed. Bruno (one of the anatomy demonstrators) had expertly edited the embalming we needed to get a good fix that was still moveable. The brain tumours were absolutely beautiful because they were soft and mushy as they would be if you were operating in a patient, but in a way that was fixed enough to still identify surrounding grey matter and white matter, without going to mush. You can see tumours like that in some of the donors, but it does depend on the fixing we have done”

Dr Malcolm Johnson presented a PET scan from 2020 that had been performed on Toni. This was clearly a valuable asset in investigating Toni’s personal journey. Are images similar to these normally available to the anatomy team, and how was this useful for identifying the peregrination of tumour metastasis during the dissection?

“They are not available. It would be amazing if the NHS system joined up in a way that the physical or digital records of an individual followed them into their time in anatomy. That does not happen at all. Obviously the digital NHS system has come on leaps and bounds in the past five years, so hopefully it will happen in the future. Currently we rely on next of kin sending in anything they may have, sometimes we may have absolutely no information about an individual apart from their cause of death. Sometimes, as the relatives know a great deal about an individual they may send us X-rays and old medical scans, or things like that. With some donors we do take scans but we do have to independently source funding to arrange for those. With the case of Toni we had to secure that funding and the time in the scanner. It would have been really helpful to have the records of these donors available, but we would have to have some method to anonymise these to make it suitable for students to see. It would be great when you are looking at your donor to see if there are any medical records related to the area you are dissecting”

Within anatomy there has been an evolution with time. At BSMS cadaveric dissection is now integrated with living anatomy and ultrasound sessions, in addition to virtual reality experiences. Why do you believe that dissection continues to be an essential part of the curriculum, and with time do you hope that this can be maintained, or do you fear that it is at risk of becoming a lost art?

“Dissection is not the only way to teach anatomy. There are many excellently qualified healthcare and allied professionals who have not had the opportunity to dissect, it is not the be all or end all. What you get from dissection is an opportunity to practise touch mediated perception to improve spatial ability and manual dexterity skills. I think you get the motivation by actually having the real individual there. There is a real clinical link. Students get the opportunity to learn about pathology and natural variations that are not present in any of the textbooks or complete anatomy style models. There are a lot of other values…humanist approaches and empathy, that come with this also. It will stay in the curriculum but may shift over time as trends do, from the undergraduate to postgraduate level. But we are busier than ever, particularly in the post-graduate field. If an individual has not had great experience at the undergraduate level in certain fields… as an example surgery, anaesthetics, trauma they need that teaching and chance later on in their career”

For decades students have relied upon venerated textbooks like Gray’s or Netter’s Anatomy. Is there an intensifying concern that these may become redundant owing to the ever improving capacities of software like Complete Anatomy (which permits students to manipulate and identify anatomical structures working in a three-dimensional plane)?

“Yes and no. I think the shift from textbooks to eResources has already happened but sometimes there are so many different ways for students to use these resources in their learning. Often people need a curated resource that is to their level and demonstrates what they need to focus on. Any student could pick up a full Gray’s…but the motivation to learn everything in that book is probably not going to be there. If that curation of material , say to X student , is tailored to what they need to learn and focus on  then I think that will remain. Whether this is the move from 2D to 3D, we know our brains can handle four to eight key views of a three dimensional object. So, even if you can spin things around, which I was doing while teaching the Royal College of Surgeons, it was beautiful to move around to different views. But when you come back in your own mind to question… how I know a particular branching structure, my mind returns to an anterior view of it, so therefore textbooks images from certain perspectives will probably stay. This may be because it is similar to the way you see a patient or a particular image. A classic example is a uterus, a clinician's view is not an anterior view, it is normally through a laparoscope. The view from a laparoscope includes the ovarian ligaments and the ovaries from a superior view. Sometimes in our teaching, depending where medical practice is at, we may need to alter the key views that we teach to reflect this.”

In this transition from textbook to eLearning, early anecdotal evidence suggests that students’ grades are improving with a greater integration of modern approaches to anatomy teaching, is this something you have witnessed compared to traditional teaching modalities?

“No, that is what is great. There is not any evidence that shows if you learn through dissection, prosection or the use of no human cadavers at all that there is any learning gained. If you do a very small trial: one person using static images and another with the ability to rotate things, some studies show that there is a small gain while others show that there is no benefit at all. You have to put this in the context of the expectation of learning. If you are given a new mode of learning that is very exciting and will help you to learn better, the chances are that you may learn great anyway. If I got a very old book off of the shelf and told students this is the way to learn they would probably do very well. We need to return to what we know learning is and what students have been brought up learning with; the rehearsal of knowledge, repetition, making connections, applying context and importantly a motivation to it.”

Anatomical terminology is not always the most useful in delineating physically where certain structures lie. The so-called ‘Angle of Louis’ is far more likely to provoke quizzical stares that its counterpart denomination of the sternal angle. In addressing this transmogrifying progression while contrasting past and future, what role does traditional terminology and the use of eponyms have within medical education?

“I politically and heartfeltly believe that we should be moving away from the use of eponyms. They have a limited use in our teaching, we have been working at BSMS over the past 3-4 years to remove them from our curriculum and have only been placing them where there is no alternative, or where we know students will only come across this terminology in a clinical context. As an example, McBurney's Point. There is an international body called Terminologia Anatomica (Allen , W.E., 2009) who produces the world definition on the language used in anatomy. The GMC and other recognised medical bodies give reference to this, to promote the move away from eponyms in recent years”.

To return to the documentary, this exhibited that Toni really was 1 in a million, it is few and far between for one to come across an individual with this particular egregious form of cancer. Often, it may be testing for medical professionals to reach a suitable diagnoses during video or telephone consultations when they do not have the opportunity to examine their patients first-hand, and must instead rely largely on anecdotal evidence. Do you think anatomical education should be expanded into broader public education campaigns to enable patients to confidently articulate where they think a problem or affliction may be emanating from?

“100%, I think we should look to improve the health and education knowledge of the public. The how of this task is a massive challenge, there is a lot of outreach work such as the documentary, in addition to science events where everyone with the understanding has an appropriate role to correct the available misinformation. With our Valentine’s Day heart dissection, the aim is to demystify and educate the public. There are some great studies out there doing this, related to anatomical landmarks, including the campaign for prostate cancer. It was a scary figure of how many people did not actually know where the prostate gland is located. This means it is also about the branding and marketing of health related conditions to help educate the public and raise awareness. We may not need to provide patients with the language to talk to a healthcare professional but to be able to describe or have a good understanding of what is correct, and to overcome this information would be an achievement”.

In Toni’s own words, as enunciated by AI, do you think Toni’s case although very rare, will make individuals experiencing early onset symptoms similar to herself (for example blurred vision or swelling around the eye) more likely to come forward and seek medical intervention at an early stage when intervention options are likely to have a greater chance of success?

“We know 1.5 million people watched the documentary. For that, at least one person had a symptom, not necessarily related to blurred vision, who went and got checked out as a result. We have received many emails disclosing that someone experienced something similar or even with different cases, where people are asking for advice with their symptoms about what they should do. So we have some evidence that the documentary has helped to inform people. How you get at the numbers or figures of this impact is difficult. It is quite striking that blurred vision and headaches are quite common symptoms. Even if an individual had experienced this and it turned out needed to get their eyes checked for a new prescription of their glasses, this still makes a difference ”

But one life saved it still one life. This is especially resounding, not just to the individual but to their families and loved ones, their colleagues and the value they imbue within wider society overall. Toni was such a rarity and her donation and the experience of the workshops at BSMS was quite unique compared to other DR sessions students may have participated in. What was it about these humbling sessions that stood out to the students or the anatomy team who were involved?

“There was no requirement for anyone to turn up. But these sessions were oversubscribed, they were very busy. People wanted to be there. It was humbling that there was an overwhelming desire to learn. It felt different because there was no assessment, the motivation was learning for wanting to learn. It was really nice to have medical student helpers, as there was a sense of a real shared gaol. Some sessions had cameras, some did not but this did not really affect things. They were very good at staying to the sides. But there was a real sense of discovery, we did not know what we were going to find which meant that we did not know what we were going to do next. In our teaching sessions we follow things. If one donor you are working on has something very different to the next we can take five minutes out to have a look and explore further. With one donor, everyone is focused upon that donor. If a mistake is made or a wrong cut is placed, it can mess things up for everyone. If this happens in your teaching sessions, it is usually ok because there are another twenty donors.”

The anatomy team reached the decision to retain Toni’s brain, her heart (which was surprisingly normal) and lungs, liver (which was enlarged with visible tumours), and her lower leg (as an example of amazing normal anatomy). Will these be used to teach medical students or will they be reserved for special teaching sessions?

“They have been used to teach medical students, maybe without medical students even realising that was Toni's heart. We track the specimen usage of every specimen that comes out so we know how many teaching sessions they are used for. We will continue to do this for Toni’ s specimen, they are not saved for anything special. The prosections are mapped to specific learning outcomes, so we decide to use the best prosections to demonstrate examples best suited for these goals”.

(BSMS, 2022) - Professor Smith during filming of My Dead Body documentary and workshop series

With thanks to Professor Smith and the Anatomy team at BSMS for facilitating this interview. My Dead Body is available to watch online in the UK via the All 4 platform at: https://www.channel4.com/programmes/my-dead-body. 

It was produced by 141 Productions, part of Objective Media Group, an All3Media Company. Directed by Sophie Robinson, with Executive Producers Hannah Brownhill and Toby Stevens for 141, and Anna Miralis for Channel 4.

For more information related to body donation, please visit the Human Tissue Authority for further direction and guidance: https://www.hta.gov.uk/guidance-public/body-donation/how-donate-your-body.

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