When my mother, Erin O’Connell, was diagnosed with a rare and aggressive cancer in late 2022, one of her first thoughts was: “What will I do if I can’t work?”
At the time, she was 62 years old and working as a physical therapist in Portland, Oregon, where she had recently moved to live closer to me and my family. Reluctantly, she filed for short-term disability from her job and paused her training to become a volunteer search and rescue EMT.
My mom was 40 when she started physical therapy school. I was already a teenager. Despite her newfound stress, I remember how deeply it affected me to watch her fall in love with her work. The year she took anatomy lab she told my sister and me – and anyone who would listen – that dissecting a real human body was the coolest thing she had ever gotten to do, and when she died, she wanted to donate her body to science, too.
I spent so much of my childhood wanting nothing more than my mother’s hard-earned approval, and here she was, utterly devoted to a dead body. On some level, I was jealous of that cadaver.
Now here I was, 25 years later, with my mom’s illness progressing, printing out the paperwork from the nearest med school: “Enrollment Form To Bequeath a Body On Behalf of an Individual”. And all I could think was how jealous I would be of the students who would dissect my mother – who would get to do what I never could, crack her open and peek inside.
This paperwork, though, was its own form of clarity. My mom was going to die, too young and against her will, but we had a plan – an easy, free, meaningful one at that.
Of course, the reality ended up being more complicated and more absurd than I imagined.
After her death, my mom’s body was transported to Oregon Health & Science University (OHSU), just across the river from where we had both lived in Portland.
I worried that, in my grief, I might drive to campus to find out where she was. Would I be tempted to wander the halls, looking for her? Better not to dwell on it, I decided. Instead, I imagined she had been shipped elsewhere, used for something vaguely embarrassing like rectal science or dentistry.
Every year, roughly 25,000 Americans sign up to donate their bodies to science after death. But demand far outstrips supply. According to Tamara Ostervoss, director of OHSU’s body donation program, “it remains an unpopular choice,” partly because so few people even know it’s an option. In Oregon, she told me, only about 1% of people choose to donate their bodies.
For my mom, the registration process was simple: a two-page consent form, signed in front of two witnesses. My mom agreed that her family would not profit from the donation or any discoveries that resulted from it, and that we would have no say in how her body was used. She chose to have her remains cremated and mailed back to us. Eighteen months later, they arrived in a red, white and blue US Postal Service box marked “HUMAN REMAINS”, with an illustration of an urn on the side.
By the time I spoke to Ostervoss, the remains were safely in my closet – and I had a darkly funny story about my awkward visit to the post office to prove it.
Still, talking to the woman who had overseen my mom’s donation was emotionally fraught. As Ostervoss likes to say, your life dictates how you go on to teach others. Thanks to the progression of her cancer, my mom was missing so many internal organs by the end that I joked she would have given some poor anatomy student a pretty limited education.
It’s a credit to Ostervoss’s professional, respectful demeanor that she didn’t laugh so much as smile warmly, with pity in her eyes.
I didn’t tell her that, when my mom was still alive, I had asked her how she would feel if she ended up sold to one of those Bodies exhibits from China. Would my kids recognize her without her skin on?
She laughed, then shrugged. “What do I care? I won’t be there.”
But I will be, I wanted to say.
You can decide what happens to your body after you die, if you’re willing to plan ahead. But that doesn’t necessarily mean that, once you’re no longer there to insist, your family will follow through with your plans.
If your loved ones are firmly opposed to body donation, they can simply call a funeral home instead. Which is why, if you’re considering donating your body to science, it’s a conversation worth having while you’re still alive.
Most families, though, fall somewhere in the squeamish-but-accepting middle. “We’ve had families where they might not choose it for themselves, but they really want to honor and support their loved ones’ wishes,” Ostervoss said. “So they’re more along the lines of, “I don’t want to hear anything about it, I don’t want to know about it. I just want to support my mom.”
For me, the mild unease of never knowing exactly what happened to my mom’s corpse at the university was peanuts compared with the prospect of being upsold a coffin by a funeral director while I waded through grief. According to the National Funeral Directors Association, the average cost of burial in our home state of Oregon is $7,895 and the average cost of cremation is $5,812 – numbers that don’t even include a funeral or memorial service.
With body donation, you can always do a memorial later, but in the meantime there are no grief-stricken decisions about embalming or viewings. No deciding what goes on the gravestone, no grave. What does happen is a brief phone screening (in our case, by a hospice nurse), followed by a brief, in-person physical assessment. Then, voilà, off my mom went to fulfill her destiny as, in the language of the body program, someone’s first patient.
The reality is that about 25% of registered donors don’t meet the eligibility requirements at the time of death, per Ostervoss’ estimate. “It’s like medical school,” she said, “Not everyone gets in.”
A common disqualifier is high or low body weight, and privately my sister and I feared my mom had lost too much to be accepted. When she was, I found myself literally jumping up in the air to cheer. “She passed her final test!” I wrote to her sibling group chat, triumphantly. “PTL!” her sister wrote back. Praise the Lord!
Was it odd to feel jubilant on the same day I watched my mother take her final breath? Absolutely, but it was also a gift. It really did feel like her version of a med school acceptance, I told Ostervoss.
Those 150 bodies who do “get in” are able to go on to teach approximately 5,000 learners across the state of Oregon, encompassing not just the first-year medical students you might think of, but surgical residents and practicing doctors, dentists and other healthcare workers.
For students, the benefits of learning about human anatomy and practicing procedures on the real thing, with no risk of hurting them, are intuitive and obvious – the difference between a flight simulator and piloting an airplane. Think of all the variation in vasculature and body size. In reality, no surgeon would see the same internal organs twice. It’s the kind of thing that can’t be replicated, not even with advanced 3D models with haptic feedback.
The emotional side of the student experience is another story. Facing your cadaver for the first time as a new med student has always been a rite of passage, but as western life expectancy increases and our end-of-life rituals become more and more sanitized, anatomy lab is more and more often students’ first encounter with a dead person.
Historically, med school programs have dealt with this by cultivating what the writer Mary Roach calls “a sort of sink or swim mentality about dealing with death”, a kind of future doctor hazing ritual that encouraged future providers to desensitize themselves.
Roach talked to the director of the medical anatomy program at Vanderbilt University, Art Dalley, who says that, “There was a time not all that long ago when students were taught to be insensitive, as a coping mechanism.” In the past, she writes: “Humor – at the cadaver’s expense – was tolerated, condoned, even.”
Not so in our current era. Instead, I received an invitation to a gala in the mail.
At OHSU, the anatomy class culminates in what Ostervoss calls, “the body ceremony”, a 25-year tradition where students plan a memorial to honor the donors and families who have made their education possible.
The service was created to honor the donors, but it’s also important emotionally for the students who are encouraged to have conversations with the families at the reception afterward.
After a year of almost willful dissociation on my part, it was a bizarre experience to be welcomed in. The invite explained that the service would include a slideshow of the 100 or so donors who had given their bodies that year. Students would show their gratitude through performances and reflections they had programmed themselves.
It sounded bizarre but earnest, like a talent show for death. I was thrilled.
Once we were in the auditorium, my eyes darted over to the section of nervous future doctors in new blazers and kitten heels. There was a kind of aura of promise about them, and I felt almost maternally proud. It was clear that families and students had a wild interest in each other and my heart raced as I scanned the rows, looking, as I imagine they did, for some glint of recognition.
I leaned over to whisper to my sister, a note of hope in my voice. “Do you think they’ll recognize us?”
“Meaghan,” she shushed me. “No.”
“But maybe our height?” (My mother, like us, was around 5ft tall with shoes on.)
Lauren just gave me a look and I went back to studying the program.
In accordance with HIPAA laws, no one would tell us who dissected whom. It was clear what a bizarre human exchange we had been party to, despite never having met. It had to be acknowledged, ritualized. Otherwise, it made no sense.
Not that a collective death talent show made a whole lot of sense either. As the students took the stage to share their talents – someone played Taylor Swift’s Bigger Than The Whole Sky, a member of the school of dentistry’s class of 2028 sang Sweet Creature by Harry Styles – I wanted to feel something like closure, but all I could muster was affectionate bemusement.
Who were these children, I wondered, and what did they know about death?
When two svelte near-adults took the stage in spandex (their leggings a respectful shade of black) and did what I can only assume was aerial yoga accompanied by Debussy, I had to avoid eye contact with my sister to avoid laughing. Still, as they balanced on each other’s shoulders and knees in midair, I had the urge to text my mom, to tell her how weird it was. I wished I believed she could see it. I know she would have thought it was cool.
When a chaplain got to the podium. “We know that your loved one’s participation in this program has probably complicated your grief, and prolonged it.” She talked about how when someone dies, there is a human need for closure, and we families probably hadn’t quite gotten it yet. They wanted to acknowledge the sacrifice we had made.
Truthfully, I hadn’t thought of it as a sacrifice at the time, more like a “get out of jail free” card, but I was beginning to understand. The chaplain’s words reminded me of the recurring dreams I had had after the two polite, somber men had taken my mom’s body away in a sprinter van. In real life, my sister and I had watched her take her last breath. When it happened it was so obvious, on an almost existential level, that to check her pulse would have been absurd. We didn’t need a nurse to come out. We declared her dead ourselves.
In sleep, though, my subconscious had its say. In recurring dreams, my mom would show up, back from the morgue and on her doorstep again, a little worse for the wear. She would push past us to get inside, clearly miffed we had sent her away prematurely.
After enough of these dreams, I came to understand why we bury our dead. Sure, no one wants the finality of loss but maybe the brain has a hard time moving on without it. It wasn’t until the chaplain alluded to this that that I realized that the lack of closure was exactly what I wanted. I didn’t want to move on. The ambiguity, the mystery even, meant the story of my mother wasn’t over yet.
Near the end of the ceremony, families were invited up to speak. When it was my turn, I gripped the podium, shaky-voiced but not crying. I remember knowing for certain what my mom would want me to say.
I told the students about my mom’s own experience in anatomy lab, all those years ago. The way our dining room had been overtaken by her schoolwork – the table strewn with flash cards and textbooks, colored-pencil anatomical drawings papering the walls. Those years we would find candy corn and York peppermint patty wrappers in the couch cushions – Mom’s study snack of choice.
She was more scatterbrained and short-tempered than ever, but I loved watching her find something she loved, something that was only hers. She learned a kind of devotion, then, an awe that would stay with her even in the darkest days of her illness.
I told them that they would have this, too.
A few weeks ago, after getting up the nerve to ask Ostervoss, I signed a HIPAA form and a media release to find out how my mom’s body came to be of use after she died. Five days later, a media relations specialist from the university forwarded me the answer in the body of an email. It read:
During her time with us, Erin played a crucial role in teaching spine anatomy, associated surgical techniques, and stereotactic and functional neurosurgery skills at OHSU. Through these educational experiences, neurosurgery and neurology trainees gained greater foundational knowledge that will inform their patient care throughout their careers.
After supporting these learners, she went on to teach in several orthopedic residency training courses.
In total, 121 learners directly benefited from your mother’s gift. Her legacy will live on through countless patients cared for by the healthcare professionals she helped educate.
Reading it, I felt the thrill of new information, of something happening in the world of my mother.
Then came the pang of loss, knowing that the one person who would truly appreciate this information was necessarily not available to receive it.
She would think it was so cool. She would have loved to know all of it.
