– Story by Caleb Daniloff
– Photos by Kalman Zabarsky
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Robert Bouchie (far left) leads a moment of silence in the anatomy lab before a body is cremated and returned to the donor’s loved ones. The pine box also contains notes of thanks from the students.– Video by Devin Hahn
Robert Bouchie will never forget the day he was forced to value a human body at $0.
As the newly hired head of BU’s anatomical gift program and manager of the School of Medicine anatomy lab, Bouchie (SMG’92) was following protocol. A family had called about the ashes of their loved one. Typically, after medical programs are finished with donated bodies, the remains are cremated and mailed to the family by certified mail.
For insurance purposes, however, the Post Office requires that a value be stated.
“Declare the value?” Bouchie says. “What should I put? It’s a billion dollars, and that’s not enough. If someone’s life is changed because of any damage that’s done to this package, what is the value of that? It’s immeasurable. And that’s what the Post Office said: ‘You have to put zero because it’s impossible to replace.’”
Bouchie tells this story during a drive to Rockport, Massachusetts, on a warm July afternoon. Belted into a child’s car seat in the back row of his GMC Yukon is a blue package. Inside are the remains of Elizabeth Berninger, who was ninety-four years old at the time of her death from a cerebral hemorrhage last year.
Bouchie is bringing her home.
“It means a lot to me,” he says. “She was a part of my life. It’s a ceremonial step where I’ll finally say thank you to the family on behalf of BU and hand her over.”
Each year, 345 Boston University medical and dental students dissect and prosect some forty bodies — eight students per cadaver, four on each side. Bouchie would like to see a ratio closer to four to one, but BU is one of four medical programs competing for body donations in Massachusetts. Harvard leads the pack with upwards of 140 a year (Tufts University and the University of Massachusetts are the others). Nationally, it’s estimated that 20,000 bodies, from 115 whole body donation programs, are used each year to help prepare future doctors and dentists.
Unless the donor’s next of kin is beyond driving distance, Bouchie delivers the ashes himself. He has returned as many as four sets of remains in one day.
For this delivery, he is wearing dark slacks and a powder blue shirt and tie, with a dab of cologne, respectful but not somber.
“I usually don’t hand over the cremains until I’m ready,” he says. “I’ll keep the box on my lap while we talk. I like for it to be a special thing. Not just for me to hand them over and have the action just take place.”
Today, he is meeting with Berninger’s daughter, Marjorie Schell.
Fourth-year OB/GYN students observe the prosection of a ninety-three-year-old woman’s pelvis. Donated bodies are also used by BU’s dental students, as well as by the FBI for fingerprint-lifting techniques.
A Rite of Passage
This past academic year, Berninger spent many hours on a stainless steel table on the tenth floor of MED’s Instructional Building. Like all of BU’s willed bodies, Berninger’s was embalmed by Bouchie.
“For ninety-four, she had good muscular definition, a defined vascular system,” he says. “Her organs were hardy, and overall she was a great candidate.”
Body dissection is a critical part of a medical education, a rite of passage, in fact. Many students see their cadaver as their first patient. Over five months, they examine every detail, from skin to skeleton. Their first cuts are to the back and the limbs, followed by dissection of the abdomen, chest, and pelvis. Finally, students remove the heart and then the brain, peeling the skin from the face and examining the vessels and tissues of the head and neck.
“When they pull back the muscles in the chest cavity and finally take the heart from the body, it’s just an amazing thing, because it’s such a big part of a human’s life,” Bouchie says. “And the brain, the same thing. It’s very stimulating to hold that in your hand.”
The age of donors ranges from fifty to ninety, although Bouchie has received cadavers as young as nineteen. Within twenty-four hours of death, he must qualify and embalm the body, so his cell phone is always on and he always answers. Unless candidates had suffered gangrene or had a
contagious disease like AIDS or hepatitis, he will usually green-light the donor, even amputees.
“If you had to stereotype people who donate, they’re all very similar,” Bouchie says. “At Christmastime, they are the last ones to open their gifts, because they want to be the ones giving, they want to see your reaction. They just feel better spiritually giving than receiving.”
Bouchie knows the public is still hazy on willed body programs. Organ and tissue donation has a higher profile — the direct connection from one human being to another helps, as does the possibility that a life may be improved or saved; plus, the body stays intact and can be interred in a timely fashion. The goal of whole-body donation is more abstract. And there’s the occasional scandal that can tarnish the endeavor. UCLA temporarily suspended its willed body program after the director was caught, and eventually convicted, in an embezzlement and conspiracy scheme to sell body parts to pharmaceutical and medical research companies.
A Moving Experience
Bouchie’s tenth-floor anatomy lab is hardly the tiled basement room with dripping pipes and sticky floor drains that TV viewers are likely to expect. It is spacious and impeccably clean, with seven rows of stainless steel tables. More than a dozen large windows let in plenty of natural light and reveal a carpet of city rooftops, with Commercial Point in the distance. The air in the lab is changed several times an hour and spritzed with deodorizer to minimize the likelihood of adverse reactions to the smell of formaldehyde.
Bouchie shaves the heads of the cadavers so they are uniform and don’t remind students of any elderly people in their own lives. But, he says, students are naturally curious about their donors. While Bouchie doesn’t reveal their names, he does tell students their age, the cause of death, and their occupation. “Just that little bit of information gives these people an identity,” he says, “and relationships can build between the students and the donors.
“I had a woman who was an author of children’s books,” Bouchie recalls. “The students really wanted to know who this person was, to read her books, to see her prose.” He called the family, who didn’t want her named. “They told me they were a private family, that she was very humble. But I needed to make this call so I could at least tell the students. They were very disappointed to say the least.”
Erkeda Derouen (MED’12) says her first encounter with the body she worked on was more moving than she’d expected. “We wrapped her hands and feet because we’d be examining those later in the semester,” she says. “It was very emotional. We had to put lotion on her hands, so it was like we were shaking hands. It was a life-changing experience.”
How has Bouchie’s line of work affected his views on spirituality?
“I consider myself a nondenominational person regarding religion,” he explains. “But the more exposure I have to different religions and the more people I know in my life, the fact is I really don’t know what I am. I’m not certain there is an afterlife. I just want to do right while on this earth.
“When I’m dissecting a body, am I thinking that twenty-eight souls are hovering around and scrutinizing what we do? Absolutely not. When a body is dead, it’s dead. It’s a vessel — that’s all it is. I don’t believe in ghosts.”
But Bouchie does believe in the dignity of human life. To that end, he conducts an in-lab ceremony at the end of the program, where students and faculty move dissected cadavers from the lab tables into pine boxes before the bodies are cremated. Notes of thanks and personal reflections are tucked in, too, just before Bouchie hammers down the coffin lids.
Keeping the Body Whole
In one corner of the anatomy lab, Bill Pearson (MED’10) is taking measurements for his dissertation on dysphagia — the inability to swallow. On a surgical tray in front of him lays a head that has been removed from a nearby body and bisected, a petite Japanese woman’s face, blank eyes, small ears. She died eleven months ago, at age eighty-one. Her neck has been removed except for the trachea and esophagus, narrow ropes of twisted muscle pierced with colored pins. Pearson is analyzing how muscles pull and with what force. To take the head off is highly unusual, Bouchie says, but he OK’d Pearson’s request, believing the doctoral candidate’s research could be important for stroke victims, Parkinson’s sufferers, and patients with cancer of the head and neck.
In another part of the lab, anatomy instructor Ann Zumwalt, a MED assistant professor of anatomy and neurobiology, and a group of OB/GYN students are gathered around a table. On a blue plastic sheet lies a ninety-three-year-old woman who died last year of cardiovascular disease. Her pelvis and torso have been opened and the thick, yellowed skin peeled back, revealing to an untrained eye a heap of brown and beige innards — rendered that color, Zumwalt explains, by lack of blood. The head has been hemisected, the brain removed by fourth-year clinical anatomy students. The lungs and thorax, too, have been taken out. Removed organs are labeled and kept with the body, either at the foot of the body bag or in a container beneath the table. At the end of the program, all organs, even the skin and fat, are anatomically restored to the torso.
“We receive the body whole,” Bouchie says, “we return the body whole.”
Wearing white coats and goggles, fresh-faced students, not the slightest bit fazed by the scene, gather around the body, paying close attention to Zumwalt’s tour of the female pelvis and asking questions. Bouchie, in blue scrubs, looks on. Zumwalt pulls back parts and lifts others with forceps, pointing out the uterus, the bladder, the broad ligament, the ovaries, the Sampson artery, the uterine artery. She explains how to clamp off blood flow during a hysterectomy and how to anesthetize.
“The lab is our lifeblood,” Zumwalt later says, with no trace of irony.
Bouchie packages up the cremains of a donor. Whenever possible, he hand-delivers the ashes to the family. He is one of the few anatomical gift coordinators in the country who goes to these lengths. “I’ve spent months with this person,” he says. “It’s closure for me, too.”
Doing More for Families
With a youthful face, an easy smile, and an outgoing manner, Bouchie defies the stereotype of the anatomist as a pallid, creepy old man with an unhealthy fascination with dead people. The father of two young children, he stands over six feet two, weighs 260 pounds, and was a defensive linesman on BU’s gridiron in the mid and late eighties. An avid biker growing up, he had a serious motorcycle crash as an undergraduate, landing in the hospital for two weeks. The accident left him without a sense of smell — a real advantage, he says, when you’re working with bodies.
“The tone of our program totally changed when Rob came,” says Todd Hoagland, a MED assistant professor of anatomy and neurobiology and the school’s anatomy course director. “He was a pretty young guy when he started, so a lot of the students thought of him as a big brother. Whenever they had problems getting used to the lab or with death and dying or just personal problems, they would gravitate towards him. Most people who run body donation programs don’t have outstanding interpersonal skills. Rob really is a wildly gregarious guy.”
Born and raised in Gloucester, Massachusetts, Bouchie’s interest in pathology was spurred by his work as a pharmaceutical salesman. To better understand his product, he observed cardiovascular surgeries. “People were passing away in front of me, and it didn’t bother me the way it did other people,” he recalls.
A friend offered him an apprenticeship at his funeral home, and Bouchie earned a degree in mortuary science. A casual conversation with the administrative director of pathology during a body pickup at Children’s Hospital Boston led to a job offer, and before he knew it, Bouchie was running the hospital’s morgue, where he directed the autopsies. At the same time, he began helping embalm anatomical donors at MED. In 2001, he was offered the position of anatomical gift coordinator and anatomy laboratory manager.
Since he’s signed on, donations, both financial and physical, have gone up notably. In 2001, the program received thirty-one whole body donations. Today, that number is closer to forty-five. Donor families have been known to request in their loved ones’ obituaries that contributions be made to the program in lieu of flowers. And this past spring, Bouchie’s colleagues recognized his work with twenty-one nomination letters for a Perkins Award, given annually to three outstanding nonfaculty members of the BU community. Not surprisingly, he was selected.
“He doesn’t need this job,” says Mark Moss, a MED professor and chair of the anatomy and neurobiology department. “He could have another career, make a lot more money as a funeral director. He does this for the love of being here.”
Since taking over, Bouchie has made memorial services an integral part of the gross anatomy course, inviting family members to attend and meet the students who worked on their loved one.
“I always feel like I want to do more for the families,” he says. “We pay for transportation and cremation, but I want to do more. I want these people to have closure. We need to help them out.”
The students perform music, read poetry and personal reflections, and hold a candle-lighting ceremony. In her reading for the service, Tanya Donahou (MED’12) compares her team’s donor to a seed that bears fruit to nourish many.
“You are an exponential gift, from one man to eight future doctors to hundreds of patients to the multitudes that make up their family and friends,” she says. “You gave us access to the wonder that is human life and challenged us to discover all the intricate parts working together to make one man.”
Buddy Ferreira, of Falmouth, Massachusetts, says attending the service, four floors above the anatomy lab, and meeting the students who worked on his mother gave him closure. He was so moved that he plans to amend his donor card.
“I was an organ donor and now I’m going change it,” he says. “I’m going to donate my body here, no question. Witnessing the students today and how important this is to them — that changed my mind.”
In fact, several times during the reception after the service, Bouchie runs downstairs to fetch paperwork for family members who have decided to donate their bodies to BU. The simple forms constitute an agreement, not a binding contract. Ultimately, it is up to family members to follow through with the wishes of their loved one.
Advertising for bodies, of course, is a delicate proposition. It’s not like Bouchie can stake out nursing homes or make cold calls. It’s mostly word of mouth.
“I would love to get a billboard on Route 1 that says, ‘You want to donate your body? Please investigate it. Here’s our Web site and telephone number.’" But it wouldn’t be tactful to do so,” he says, “and there’d be a lot of fallout.”
Upon arrival in Rockport, Schell meets Bouchie, the blue package tucked under his arm, on the porch. In the living room, she pours a round of lemonade. Near a bookshelf stands an orchid from the memorial service. Bouchie made sure every family left with one.
He tells Schell the students who worked on her mother were thrilled to meet Schell.
“They were really magnetized by your mom and built a relationship with her. In a way, at the memorial service, they were meeting her through you.”
Bouchie reminds Schell, who has also decided to donate her body to BU, that her mother’s arteries had hardened from high cholesterol and that she should make sure to have regular physicals. Then Schell brings Bouchie to the foyer to look at a collage of photos of her mother, a moment that plays out on most deliveries.
“This is closure for me, too,” Bouchie tells Schell, at last handing over the blue package. “I’ve been with your mom, from the moment she passed until this moment. Even though, like you said, it’s a vessel, it is important for it to be in the right spot at the right time. Undamaged. That’s the most important thing to me — that this box gets to you undamaged.” ■
For information on how to make an anatomical gift, visit BU's Department of Anatomy and Neurobiology.