all
that
remains

DEATH AND THE hyped-up circus that surrounds her are perhaps more laden with clichés than almost any other aspect of human existence. She is personified as sinister, as a harbinger of pain and unhappiness; a predator who haunts and hunts from the shadows, a dangerous thief in the night. We give her ominous and cruel nicknames – the Grim Reaper, the Great Leveller, the Dark Angel, the Pale Rider – and portray her as a gaunt skeleton in a dark, hooded cloak wielding a deadly scythe, destined to separate our soul from our body with one lethal swipe. Sometimes she is a black, feathered spectre that hovers menacingly over us, her cowering victims. And, despite being feminine in many languages where nouns have genders (including Latin, French, Spanish, Italian, Polish, Lithuanian and Norse), she is often none the less depicted as a man.

It is easier to treat death unkindly because in the modern world she has become a hostile stranger. For all the progress humanity has made, we are little closer to deciphering the complex bonds between life and death than we were hundreds of years ago. Indeed, in some respects, we are perhaps further away than ever before from understanding her. We seem to have forgotten who death is, what her purpose is, and, where our ancestors perhaps considered her a friend, we choose to treat her as an unwelcome and devilish adversary to be avoided or bested for as long as possible.

Our default position is either to vilify or to deify death, sometimes vacillating between the two. Either way, we prefer not to mention her if we can help it in case it encourages her to come too close. Life is light, good and happy; death is dark, bad and sad. Good and evil, reward and punishment, heaven and hell, black and white – our Linnaean tendencies lead us to neatly categorise life and death as opposites, giving us the comforting illusion of an unambiguous sense of right and wrong that perhaps unfairly banishes death to the dark side.

As a result we have come to dread her presence as if she were somehow infectious, afraid that if we attract her attention then she might come for us before we are remotely ready to stop living. We may conceal our fear by putting on a show of bravado or poking fun at her in the hope of anaesthetising ourselves to her sting. We know, though, that we will not be laughing when we reach the top of her list and she does finally call out our name. So we learn at a very early age to be hypocritical about her, ridiculing her with one turn of the face and then becoming deeply reverential with another. We learn a new language to try to blunt her sharp edges and dull the pain. We talk about ‘losing’ someone, whisper of their ‘passing’ and, in sombre respectful tones, we commiserate with others when a loved one has ‘gone’.

I didn’t ‘lose’ my father – I know exactly where he is. He is buried at the top of Tomnahurich Cemetery in Inverness, in a lovely wooden box provided by Bill Fraser, the family funeral director, of which he might have approved, although he would probably have thought it too expensive. We put him in a hole in the ground on top of the disintegrating coffins of his mother and father, neither of which will now hold more than their bones and the few teeth they still had when they died. He has not passed, he is not gone, he is not lost: he is dead. Indeed, he better not have gone anywhere – that would be most troublesome and inconsiderate of him. His life is extinct, and none of the euphemistic rhetoric in the world will ever bring it, or him, back.

As the product of a strict, no-nonsense, Scottish Presbyterian family where a spade was called a shovel and empathy and sentimentality were often viewed as weaknesses, I like to think my upbringing has made me pragmatic and thick-skinned, a coper and a realist. When it comes to matters of life and death I harbour no misconceptions and in discussing them I try to be honest and truthful, but that does not mean I don’t care, and it doesn’t make me immune to pain and grief or unsympathetic to that of others. What I do not have is a maudlin sentimentality about death and the dead. As Fiona, our inspirational chaplain at Dundee University, puts it so eloquently, there is no comfort to be had from soft words spoken at a safe distance.

With all our twenty-first-century sophistication, why do we still opt to take cover behind familiar, safe walls of conformity and denial, rather than opening up to the idea that maybe death is not the demon we fear? She does not need to be lurid, brutal or rude. She can be silent, peaceful and merciful. Perhaps the answer is that we don’t trust her because we don’t choose to get to know her, to take the trouble in the course of our lives to try to understand her. If we did, we might learn to accept her as an integral and fundamentally necessary part of our life’s process.

We view birth as the beginning of life and death as its natural end. But what if death is just the beginning of a different phase of existence? This, of course, is the premise of most religions, which teach that we should not fear death as it is merely the gateway to a better life beyond. Such beliefs have brought solace to many through the ages, and perhaps the vacuum left by the increasing secularisation of our society has contributed to the resurgence of an ancient, instinctive but unsubstantiated aversion to death and all its trappings.

Whatever we believe, life and death are unquestionably inextricably bound parts of the same continuum. One does not, and cannot, exist without the other and, no matter how much modern medicine strives to intervene, death will ultimately prevail. Since there is no way we can ultimately prevent it, perhaps our time would be better spent focusing on improving and savouring the period between our birth and our death: our life.

Herein lies one of the fundamental differences between forensic pathology and forensic anthropology. Forensic pathology seeks evidence of a cause and manner of death – the end of the journey – whereas forensic anthropology reconstructs the life led, the journey itself, across the full span of its duration. Our job is to reunite the identity constructed during life with what remains of the corporeal form in death. So forensic pathology and anthropology are partners in death and, of course, in crime.

In the UK, anthropologists, unlike pathologists, are scientists rather than doctors and are therefore unlikely to be medically qualified to certify a death or the cause of death. In these days of ever-expanding scientific knowledge, pathologists cannot be expected to be experts in everything, and the anthropologist has an important role to play in the investigation of serious crimes involving a death. Forensic anthropologists assist in unravelling the clues associated with the identity of the victim and may aid the pathologist to reach his or her final decisions about the manner and cause of death. Each discipline brings its own complementary and specific skills to the mortuary table.

On one such mortuary table, for example, a pathologist and I were faced with human remains in an advanced stage of decomposition. The skull was shattered into over forty jumbled fragments. As the medically qualified practitioner, her remit was to determine the cause of death and she was pretty sure it was going to be gunshot injury. But she needed to be certain. Surveying with dismay the multitude of fragments of white bone on the grey metal tabletop, she said, ‘I can’t identify all the pieces, let alone try to stick them together. That’s your job.’

The forensic anthropologist’s role is first to help establish who the person may have been in life. Were they male or female? Tall or short? Old or young? Black or white? Does the skeleton show evidence of any injuries or disease that might be linked to medical or dental records? Can we extract information from bones, hair and nails about their composition which might tell us where the person was living and the type of food they ate? And in this case, could we undertake a three-dimensional human jigsaw puzzle to allow us to reveal not only the cause of death, which was indeed gunshot injury to the skull, but also the manner of death? By gathering this information and completing the jigsaw we were able to establish the identity of the young man and to corroborate eyewitness testimony by confirming a ballistic entry wound to the back of the head and its exit from the forehead above and between his eyes. This was a close-range execution, in which the victim had been kneeling when the firearm was placed directly against the skin at the back of his head. He was just fifteen and his crime was his religion.

Another illustration of the symbiotic relationship between anthropologist and pathologist concerned an unfortunate young man who was beaten to death after confronting a group of youths intent on vandalising a car in the street outside his house. His body had been kicked and punched, he had suffered fatal impact trauma to his head and he exhibited multiple skull fractures. In this case we knew the identity of the victim, and the pathologist was able to determine the cause of death as blunt-force trauma, resulting in massive internal haemorrhage. But she also wanted to report on how his death was brought about and, in particular, on the type of implement most likely to have been used to kill him. We were able to identify every fragment of the skull and to reconstruct it, enabling the pathologist to confirm that there had been one primary blow to the head, made by a hammer, or something of similar shape, which had caused a focal depressed fracture and multiple radiating fractures leading to the fatal intracranial bleeding.

For some, the distance between the beginning and the end of life will be lengthy, perhaps over a century, whereas for others, like these murder victims, the two events will occur much closer together. Sometimes they may be separated only by a fleeting but precious few seconds. From the point of view of the forensic anthropologist, a long life is good news, as the longer it has been, the more scars of experience will be written and stored within the body, and the clearer their imprint on our mortal remains will be. For us, unlocking this information is almost like reading it in a book, or downloading it from a USB stick.

In the eyes of most people, the worst outcome of this earthly adventure is a life cut short. But who are we to judge what is short? What is not in doubt is that the longer we survive beyond birth, the higher the probability will be that our lives will end sooner rather than later: we are more likely, in most cases, to be closer to death at ninety than we are at twenty. And logic tells us that we will never again be further away from a personal acquaintance with death than we are right at this moment.

So why are we surprised when people die? Over 55 million of us around the world do it every year – two a second – and it is the one event of our lives that we know with absolute certainty is going to happen to every single one of us. This by no means diminishes our sadness and grief when it happens to someone close to us, of course, but its inevitability demands an approach that is both practical and realistic. Since we can’t influence the creation of our lives, and their end is unavoidable, perhaps we should be focusing on what we can regulate: our expectations of the distance between them. Perhaps it is this we should be trying to manage more effectively by measuring, acknowledging and celebrating its value rather than its duration.

In the past, when death was less easy to postpone, we may have been better at this. In Victorian times, for example, when infant mortality was high, nobody was surprised if a child did not reach its first birthday. Indeed, it was not unusual for several children in a family to be given the same name to ensure that it survived, even if the child did not. In the twenty-first century, infant death is more shocking, but to be stunned when someone dies at the age of ninety-nine defies all logic.

Society’s expectations are the battleground of every medical expert who aims to force death into a retreat. The best they can hope to do is to buy more time and expand the distance between our two mortal events. That they will ultimately always lose the fight should not stop them from trying, and it does not – lives are prolonged every day in hospitals and clinics around the world. Realistically, though, some of these medical achievements may amount to no more than a stay of execution. Death is coming, and if it wasn’t today, it might be tomorrow.

Over the centuries, society has catalogued and measured life expectancy, by which we mean the age at which we are statistically most likely to die – or, to look at it more positively, the length of time we are likely to spend living. Life tables are interesting and useful tools but they are dangerous, too, in that they create an expectation that will not be reached by some and will be exceeded by others. We have no way of knowing whether we are the average Joe who will conform to the norm or whether we will be an outlier at one end or the other of life’s bell curve.

And when we find ourselves to one side or other of the curve, we take it personally. We are proud of ourselves when we exceed our life expectancy because it makes us feel that we have somehow beaten the odds. When we don’t reach the age anticipated for us, those we leave behind may feel that they have been robbed of the life of someone dear to them and experience anger, bitterness or frustration. But of course that is simply the nature of the life curve: the norm is just the norm, and most of us will fall into the variations around it. It is unfair to blame death and accuse her of cruelty and larceny when she has always been honest in demonstrating that our life spans can be anywhere within the range of human possibilities.

The longest-living person in the world whose age could be verified was Frenchwoman Jeanne Calment, who was 122 years and 164 days of age when she died in 1997. In 1930, the year of my mother’s birth, female life expectancy was sixty-three, so on her death at seventy-seven she exceeded the norm by fourteen years. My grandmother fared even better: when she was born, in 1898, her life expectancy would have been only fifty-two. She lived to be seventy-eight, outstripping that by twenty-six years, which may in part be a reflection of the huge number of medical advances during her lifetime – although her cigarettes didn’t help her in the end. The prediction for me, when I arrived in 1961, was a life that might be seventy-four years long. That would leave me now with just seventeen to go. My goodness me, how did that happen so quickly? However, based on my current age and lifestyle, I can now realistically expect to reach eighty-five, and I may have another twenty-nine years or more to look forward to. Phew.

So, during the course of my life, I have gained the prospect of an additional eleven years. Isn’t that great? Not really. You see, I didn’t get those extra years when I was twenty, or even forty. If I am given them, it will be when I am seventy-four. Would that we could be granted more time in our prime, where youth continues to be wasted on the young.

The calculations of life expectancy given at birth are slowly becoming more accurate and we know that among the next two generations, those of my children and grandchildren, there will be more centenarians than have ever before existed in human history. Yet the maximum age to which our species is capable of living is not increasing. What is changing dramatically is the average age at which we die, and therefore we are seeing an increase in the number of individuals falling into the far right regions of the bell curve. In other words, we are changing the shape of human demography. The rapidly expanding health and social issues created by the growth of an ageing population are starting to give us a glimpse of the resulting impact on society.

While longer lives are for the most part to be celebrated, I do wonder at times if, in striving to stay alive for as long as possible at all costs, all we are in fact doing is prolonging our dying. While life expectancy may be variable, death expectancy remains unchanged. Should we ever actually conquer death, the human race and the planet would be in real trouble.

Working every day with death as my companion, I have come to respect her. She gives me no cause to fear her presence or her work. I think I understand her reasonably well because we choose to communicate in direct, plain and simple language. It is when she has done her job that I am permitted to do mine and, thanks to her, I have enjoyed a long, productive and interesting career.

This book is not a traditional treatise on death. It does not follow the well-trodden path of examining lofty academic theories or quirky cultural variations or offer warm platitudes. Instead I will simply try to explore the many faces of death as I have come to know them, the perspectives she has shown me and the one she will ultimately reveal to me some time in the next thirty years or so, if she chooses to spare me that long. And it is, like forensic anthropology itself, which seeks to reconstruct through death the story of the life lived, as much about life as about death – those inseparable parts of the continuous whole.

In return, I ask only one thing of you: suspend your preconceptions of death for a moment, any sense of distrust, fear and loathing, and perhaps you will begin to see her as I do. You may even begin to warm to her company, get to know her a little better and cease to be afraid of her. In my experience, engaging with her is both compelling and fascinating, and never dull, but she is complex and sometimes wonderfully unpredictable. You have nothing to lose – and in your own encounters with her, surely it is better to be dealing with the devil you know.

FROM THE AGE of twelve, I spent every Saturday and all my school holidays for five years up to my elbows in muscle, bone, blood and viscera. My parents had a fearsome Presbyterian work ethic and I was expected to get myself a part-time job and start earning some money as soon as I was old enough. So I went to work at the butcher’s shop at Balnafettack Farm on the outskirts of Inverness. It was my first and only job as a schoolgirl and I loved every single minute of it. I was utterly oblivious of the fact that most of my friends, who preferred to work in pharmacies, supermarkets or clothes shops, considered it an odd choice, not to say vaguely distasteful. In those days I had no inkling that the world of forensic science was waiting for me but, looking back now, I see this as part of the pattern for my life that was hidden from me, and from them, at the time.

A butcher’s shop was an extremely useful training ground for a future anatomist and forensic anthropologist and a happy and fascinating place to work. I loved the clinical precision involved in the butcher’s craft. I learned a multitude of skills: how to make mince, how to link sausages and, most importantly, how to make regular cups of tea for the butchers. I learned the value of a sharpened blade as I watched them manoeuvre their knives swiftly and skilfully around irregularly shaped bones, paring away the dark red muscle to reveal the startling clean white skeleton beneath. They always knew exactly where to cut so that the meat could be rolled artistically into brisket or sliced evenly into stewing steak. There was something reassuring about the certainty that the anatomy they encountered would be the same every time. Or almost every time: I do remember the odd occasion when a butcher would curse under his breath about something not being ‘quite right’. It seems cows and sheep have their anatomical variations, just like humans.

I learned about tendons and why we cut them out; where, in the space between muscles, there are blood vessels that need to be excised; how to remove the confluence of structures at the hilum of the kidney (too tough to eat) and how to open the joint between two bones to reveal the glassy, viscous fluid of the synovial joint space. I learned that when your hands are cold – and they always seem to be cold in a butcher’s shop – you look forward to the delivery of fresh livers, still warm from the abattoir. For a fleeting moment, when you dipped your hands into the box, you could feel them again, thanks to the warm cow’s blood de-icing your own.

I learned not to bite my fingernails, never to place a knife on the block with the blade facing upwards and that blunt knives cause more accidents than sharp ones – although sharp blades leave a much more spectacular mess when a mistake is made. I still find it tremendously satisfying to see the neat array of anatomy on display in a butcher’s shop, always laid out precisely, cut and prepared the way it should be, and to catch that slight whiff of iron in the air.

I was sad when I had to give up the job. I idolised my biology teacher, Dr Archie Fraser, to such extent that whatever he said I should do, I did it. So when he told me I must go to university, off to university I went. As I had no idea what I ought to study, following in his footsteps and opting for biology seemed a good idea. I spent my first two years at the University of Aberdeen in a bored haze of psychology, chemistry, soil science, zoology (which I failed first time round), general biology, histology and botany. At the end of it all I found I was best at botany and histology, but the pro-spect of studying plants for the rest of my life made my eyes bleed. That left histology, the study of human cells. Having completed the histology module, I felt I never wanted to have to look down a microscope again – everything seemed to consist of amorphous blobs of pink and purple. It was, though, my route into anatomy, where I would be able to dissect a human cadaver. I was only nineteen and had never seen a dead body before, but for a girl who had spent five years of her life cutting up animals in a butcher’s shop, how hard could it be?

Perhaps my Saturday job prepared me in a very minor way for what lay ahead. The first experience of a dissecting room is, though, daunting for everyone. It is one of those moments nobody forgets because it assaults every single sense. There were only four of us in the class and I can still hear the echoes that reverberated round that vast, grand room which, with its high, opaque glass windows and intricate Victorian parquet floor, might have served in different circumstances as a conservatory. I can still smell the formalin, a chemical stench so thick you could taste it, and see the heavy glass and metal dissecting tables with their peeling green paint – forty or more of them, set out in regimented rows and shrouded in white sheets. On two of the tables, hidden under their sheets, were the bodies that were waiting for us, one for each pair of students.

It is also an experience that immediately challenges your perceptions of yourself and others. You feel very small and insignificant when it dawns on you that here is someone who, in life, made the choice to give themselves in death to allow others to learn. It is a noble deed that has never lost its poignancy for me. If ever I lose sight of the miracle of that gift, it will be time to hang up my scalpel and do something else.

At random, my dissection partner, Graham, and I had been assigned the cadaver of this selfless donor – a body expertly prepared for us by the anatomy technician that would be our world of investigation for a full academic year. Not knowing his real name, we rather unoriginally called him Henry, after Henry Gray, author of Gray’s Anatomy, the text that would come to dominate my life. Henry, a man who hailed from the Aberdeen area and was in his late seventies when he died, had elected to bequeath his body to the anatomy department at the university for the purposes of education and research. My education, and Graham’s, as it turned out.

It was sobering to think that at the time Henry had made his decision, I, his future pupil, was completely unaware of the amazingly generous act that would shape my entire life. I would have been busy bemoaning my lot of having to dissect rats in zoology, which I loathed.

When he died, I was probably cutting up another of the university’s apparently endless supply of plant stems to study their cellular structure, oblivious of his passing. Every year, when I talk to my first- and second-year students preparing to go into anatomy dissection in their third year, I tell them that the person they will study with, and learn from, is currently still alive. Perhaps that very day someone will be making the decision to bequeath his or her remains for the benefit of their education. I am always reassured when there are a few sharp intakes of breath as the enormity of that concept sinks in. There are inevitably a few who well up at the idea of a person they might have walked past on the street that morning ending up on their dissection table – and so they should. Such a huge gesture by a total stranger should never be taken for granted.

Henry’s cause of death was registered as myocardial infarction (heart attack) and his body had been collected from the hospital where he had died and then transported by the funeral director into the care of the anatomy department. Whether he had family, whether they supported him in his decision or how they felt about the lack of the normal ritual of a funeral, I would never know.

In a tiled, dark and clinically soulless room in the basement of the anatomy department at Marischal College, hours after Henry’s death, Alec the mortuary technician had removed Henry’s clothing and personal effects, shaved his head and attached four brass identification discs – each threaded with a piece of cord and stamped with a sequential identification number – to his smallest fingers and toes. These would stay with Henry throughout his time at the university. Next Alec would have made a cut in the skin of Henry’s groin, about 6cm in length, and dissected away the overlying muscle and fat until he could locate the femoral artery and vein in the region of the thigh known as the femoral triangle. He would then have made a small longitudinal incision in the vein, and another in the artery, where he inserted a cannula, securing it in place with some more cord. When a tight seal had been achieved, a valve in the cannula would have been opened and a solution of formalin would have perfused gently through Henry’s arborescent arterial system, driven from a gravity-feed tank above him.

The embalming fluid would have found its way via the blood vessels to every single cell in his body – to the neurons in his brain, where he used to think about all the things that mattered to him; to his fingers, which had held the hand of someone he cared about; to his throat, through which his last words had been spoken, perhaps only hours before. As the formalin solution slowly pushed its way onward, in an irreversible wave, the blood in his vessels would have been purged and eventually much of it would have washed away. After only two or three hours of this quiet, peaceful embalming process, his body would have been wrapped in plastic sheeting and stored until it was needed, maybe days, maybe months later.

In that short interval, Henry had been transformed, of his own volition, from a man known and loved by his family into an anonymous cadaver identified only by a number. That anonymity is important. It protects the students and helps them to mentally separate the sad death of a fellow human being from the work they are doing. If they are to dissect a cadaver for the first time without experiencing crippling empathy, they must, while remaining respectful and ensuring that dignity is preserved, be able to train their minds into viewing the body as a depersonalised shell.

When the time came for Henry’s body to play its part in our first anatomy class, he had been placed on a trolley, brought upstairs to the dissecting room in the old, rickety, noisy lift, transferred on to one of the glass-covered dissecting tables and covered with a white sheet to wait, quietly and patiently, for his students to arrive.

Today we go to great lengths to make our students’ first dissection as memorable and atraumatic as possible. Most of them, like me, will never have seen a dead body before this moment. In 1980, when I embarked on anatomical dissection, there were no introductory sessions, no gradual process of getting to know the cadaver that would be our silent teacher for the next few months. We were four very scared third-year undergraduates who, on arriving that Monday morning armed only with our copies of Snell’s Clinical Anatomy for Medical Students, a dissection manual – G.J. Romanes’ Cunningham’s Manual of Practical Anatomy – and a selection of scary dissecting instruments wrapped up in a khaki-coloured cloth roll, were pretty much left to just get on with it, beginning at page 1 of the manual. We didn’t use gloves or wear eye-protectors, and our laboratory coats very soon became an utter disgrace as we were not allowed to take them out of the building to wash them. How times have changed.

On our table, Graham and I found an array of sponges, which we quickly learned were essential for mopping up excess fluid as the dissection progressed. They had to be wrung out frequently. Underneath it was a stainless-steel bucket for collecting pieces of tissue when our dissection was complete for the day. It is important that all the parts of a body remain together, even when they amount to no more than small bits of muscle or skin, so that when it is sent for burial or cremation it will be as complete as possible. Standing sentinel at our side, watching and waiting, was a second influential tutor: an articulated human skeleton, there to help us understand what we would see and feel under Henry’s skin and muscles.

The first thing to master was how to put on a scalpel blade without slicing your finger off. Lining up the narrow slit on the blade with the ridge of the handle, then guiding it with forceps until it clicks into place, takes some dexterity and practice. As does removing it again. I often think to myself that surely someone could come up with a better design.

If you cut into the cadaver and noticed it starting to bleed with bright red arterial blood, I was warned, just remember that cadavers don’t bleed. What you will have cut is your own finger. The scalpel blades are so sharp and the room so cold that you don’t feel them slicing into your skin. So the first indication that you have injured yourself will be the sight of scarlet living blood pooling against the pale brown of the cadaver’s embalmed skin. Contamination is not as much of a concern as it would be if we were handling unembalmed bodies because the process renders the tissue virtually sterile. Just as well, since dealing with fiddly little blades when your fingers are cold and slippery with body fat is not easy. These days we begin the academic session with a vast supply of sticking plasters and surgical gloves.

Once the blade is finally on your scalpel handle and your finger has stopped pumping blood, you lean over the table and immediately your eyes start to water from the formalin fumes. The manual has told you where to cut, but it doesn’t tell you how deeply, or what it will feel like. Nobody has given you explicit permission to ‘feel’ Henry’s anatomy so that you can figure out where to cut to and from, and none of it seems to make any sense. It is all a bit terrifying and faintly embarrassing. You pause for a moment to consider how you will make the incision down the centre of the torso, from the hollow of the sternal notch at the base of the neck to the lower border of the ribcage. Which of you will watch and which of you will make the cut? Your hand shakes. That first incision stays with every student, however blasé they pretend to be. If I close my eyes I can still remember what it was like, and how impeccably Henry tolerated our youthful ineptitude.

As your motionless teacher reclines in patient repose, waiting for you to begin, you inwardly apologise to him for what you are about to do, for fear you will make a mess of it. Scalpel in the right hand, forceps in the left … how deep do you cut? It is no coincidence that most students begin dissection with the thorax. The breastbone is so close to the skin that no matter how hard you try, there is little you can do wrong. You simply cannot go too deep. You lower the blade to the surface of the skin and draw it carefully down the chest wall, leaving a faint line in its wake.

It is surprising just how easily the skin parts. It is leathery to the touch, cold and wet, and as it separates from the tissue, beneath the blade you glimpse the contrasting pale yellow of the subcutaneous fat. Feeling a little more confident, you extend the incision from the sternum in the centre across both clavicles, out towards the tip of each shoulder and you have made your first ‘T’ postmortem cut. So much anxious anticipation and it is over in a moment. The world has not stopped. The relief is immense and only now do you realise that you have not breathed through the whole process. Though your heart is racing and your adrenaline is pumping, you are surprised to find that you are no longer afraid but intrigued.

Now you need to expose the tissue underneath. You start to peel back the skin, picking carefully at the corner of the free flap in the midline above the breastbone, at the junction of the two limbs of the ‘T’. You grip the skin with the forceps, applying just enough tension to allow the blade to separate it from the tissue. You never really need to cut. The yellow fat appears and as this comes into contact with your warmer hands it liquefies. Holding the scalpel and forceps suddenly becomes tricky and the flicker of confidence you had a few moments earlier evaporates as the forceps slip off the skin and fat and fluid splash up into your face. Nobody has warned you about this. Formalin smells nasty but it tastes worse. You only ever make that mistake once.

Continuing to peel back the skin, you start to notice tiny red dots and realise that you have unavoidably cut across a small cutaneous blood vessel. Suddenly, the immense scale of the human form, and the vast amount of information it contains, hits home. The day before you might have been wondering how on earth it was going to take you a whole year to dissect a human body and why you needed three whole dissector volumes to instruct you. Now it dawns on you that a year will be nowhere near long enough to do much more than scratch the surface of your subject. You feel like the true novice you are. You despair that you will ever remember all you must learn, let alone understand it fully.

You put a little strain on the forceps and the sharp blade slices into the connective tissue with disconcerting ease, even though it seems to you that your scalpel is barely touching it. As the underlying muscles are revealed, the white transverse bony walls of the chest stand out starkly against them like a bleached toast rack. Your eyes trace the shape of the hollows and ridges of the skeleton at your side as you feel beneath your fingertips Henry’s muscle and bones. You begin to identify and name the bones and their constituent parts – the scaffolding of the human body – and before you know it, you are speaking an ancient language understood by anatomists all over the world: a language that would have been familiar to Andreas Vesalius, the fourteenth-century founder of modern anatomical study and my undisputed girl crush.

At first, the embalmed muscle appears to be a uniform light brown mass (disarmingly, slightly reminiscent of tinned tuna fish), but as you look closer, and your eye starts to attune to its patterns, you can make out the orientation of its fibres and the thin strings of the nerves that supply it. You locate the origins and the insertions of the muscle and deduce its action on the joint it crosses, captivated now by the wonderfully logical engineering you are examining. As a living person, you remain separate from death, but the mesmerising beauty of human anatomy has created a bridge into the world of the dead, one that few will cross and none who do will ever forget. The sensation of traversing that bridge for the first time is an experience you can never repeat. It is special.

The study of anatomy polarises its students: they either love it or they hate it. The fascination lies in the logic and order of the subject; the downside is the vast amount of information to be learned – that and the smell of formalin. When the fascination outweighs the drawbacks, anatomy imprints itself on your soul and you will consider yourself for ever a member of a privileged elite: the select few who have seen and been taught the secrets of human construction by those who have chosen to allow you to look inside their own bodies. We may stand on the shoulders of scholarly giants, Hippocrates and Galen, and their descendants Leonardo Da Vinci and Vesalius, but the real heroes are undisputedly those extraordinary men and women who choose to bequeath their mortal remains so that others may learn: the anatomy donors.

Anatomy teaches you many things beyond the workings of the corporeal form. It teaches you about life and death, humanity and altruism, respect and dignity; about teamwork, the importance of attention to detail, patience, calmness and manual dexterity. Our interaction with the human body is tactile and very, very personal. No book, model or computer graphic will ever come close to dissection as a means of learning our craft. It is the only way to do it if you are to become a card-carrying anatomist.

It is, though, a subject that has been much maligned as well as revered in its past. Since the glorious years of the early anatomists, from Galen to Gray, right up to the present day, it has been tainted periodically by nefarious characters who have sought to exploit it for profit. In nineteenth-century Edinburgh, the heinous deeds of Burke and Hare, who turned to murder to supply cadavers to anatomy schools, led to the passing of the Anatomy Act of 1832. As recently as 1998, the sculptor Anthony-Noel Kelly was jailed for stealing body parts from the Royal College of Surgeons in a case that cast a spotlight on the ethics of art and the legal status of human remains donated to medical science. And in 2005, an American medical tissue company was closed down after its president was convicted of illegally harvesting body parts and selling them on to medical organisations. It seems that anatomy is not immune to the economics of supply and demand, or to the criminal acts of a few racketeers with no regard for decency, dignity or decorum. It is right therefore that we defend our donors and that they are protected by an Act of Parliament.

There is money in death, and where there is money to be made there will always be those prepared to cross ethical boundaries to make more of it. Given that the sale of human remains is legal in many countries and that a good number of institutions around the world will pay a hefty price even for an articulated human skeleton, perhaps it should not surprise us that the ancient crime of grave-robbing persists in modern-day forms. When I was a student in the 1980s, most of the teaching skeletons used in dissecting rooms were imported from India, long regarded as the world’s primary source of medical bones. Although the Indian government outlawed the export of human remains in 1985, a global black market still thrives there today. In the UK, we have rightly become intolerant of the sale of bones or any other body parts.

What is or is not considered acceptable in terms of the treatment of human remains fluctuates, like all social attitudes, and can sometimes change quite markedly in the course of a single lifetime. The skeletons currently used to teach UK anatomy students are more likely to be plastic replicas, and although human ones can still be found in the dusty old cupboards of school science labs, GPs’ surgeries and first-aid training facilities, many organisations that possess them quite legally are uncomfortable nowadays about holding on to them. Some opt to donate them to a local anatomy department and in return they might be offered an artificial teaching skeleton as a replacement.

Unlike our predecessors, contemporary anatomists can take time over dissection and thus gain far more value from our cadavers in our study of the infinitesimal detail of the human form, thanks mainly to centuries of research into ways of preserving the human body and halting the process of decay. Since the early days of dissecting corpses freshly cut down from the gibbet, anatomists have striven to preserve cadavers for as long as possible by following the techniques developed by the food industry, learning how to pickle in alcohol or brine or how to desiccate and freeze.

After Lord Nelson’s death in the Battle of Trafalgar in 1805, his body was stored in a vat of ‘spirit of wine’ (brandy and ethanol) for his journey home to a hero’s funeral. Pickling alcohol remained the preferred method of preservation until the discovery of a nasty chemical called formaldehyde later in the nineteenth century went on to transform the field of anatomy. Formaldehyde is a disinfectant, a biocide and a tissue fixative and works so well that its aqueous solution, formalin, is still the most commonly used preservative worldwide.

But in sufficient concentration formaldehyde is a hazard to human health and recent decades have seen alternatives being considered. These include fresh-frozen cadavers, where the body is dismembered into parts that are frozen and then thawed as required for dissection, and soft-fix methods that leave the body more supple and closer in texture to a living human. In the 1970s, the anatomist Gunther von Hagens pioneered plastination, whereby water and fat are removed under vacuum and replaced by polymers. These body parts have eternal life. As they will never decompose, we have succeeded in designing a new environmental pollutant.

Whatever advances there may be in the technology we use to preserve bodies or to investigate them through medical imaging, anatomy itself, of course, does not change. What was seen in the cadavers dissected by Vesalius in 1540 or by Robert Knox in 1830 was, in essence, no different from what Graham and I saw during the academic year we spent with Henry. However, as Vesalius and Knox were obliged to dissect fresh remains, the very limited time they had with a cadaver probably did not engender the same bond of trust and respect between the dissector and the dissected that I was fortunate enough to be able to establish with Henry. Or maybe it is just that social and cultural attitudes have changed down the years.

For me there can never be another Henry, and for every anatomist their own Henry will be special. I learned so much in that year about myself as well as about the human form. At those stages in our lives when we look back to pinpoint the times that made us happy and fulfilled, my search will always lead back to Henry. There are few moments in that year that I would trade, but I would be lying if I said there were none. I hated cutting through the beds of his fingernails and toenails as I always felt, irrationally, that it would hurt. And to be honest, nobody enjoys flushing out the digestive system.

But for me the rewards to be gained from the study of the dead far outstrip those less palatable moments, and the gut-wrenching fear that kicks in when you become properly aware of the sheer volume of what you need to master: over 650 muscles must be committed to memory, along with their sites of origin and insertion, their nerve supply and their actions; more than 220 named nerves, their root values and whether they are autonomic, cranial, spinal, sensory or motor; hundreds of named arteries and veins that spread in an arborescent pattern from the heart and back again, their origins, their divisions and the related soft-tissue structures. Then there are the 360-plus joints, and don’t get me going on the three-dimensional relations of the developing gut, tissue embryology, neuroanatomy and its tracts.