Although I periodically pledge to use the word “No”, it rarely sticks, which is why I find myself writing a blog post on Stiff: The Curious Lives of Human Cadavers, by Mary Roach (W. W. Norton, 2003). Later today I will lead a discussion of Stiff with a group of local high school honors students who are visiting my university for the day. We don’t have a medical school, so the campus bioethicist is going to have to suffice.  Luckily, a forensics expert has been booked after me, so I don’t have to say much about the science.

Stiff, an outgrowth of a Salon.com column, is Roach’s first book. She has since published three humorous popular science books, Spook (about the afterlife), Bonk (sex), and Packing for Mars (space travel). Stiff investiates what happens to human cadavers, whether they are donated to science, buried, cremated, or lost in airplane wreckage. It’s a gross, illuminating, and entertaining read, widely praised, and widely bought (it’s a New York Times bestseller).

Stiff is organized into chapters, each of which investigates a different cadaveric fate:

Table of Contents

1. A Head Is a Terrible Thing to Waste:  Practicing surgery on the dead
2. Crimes of Anatomy: Body snatching and other sordid tales from the dawn of human dissection
3. Life After Death:  On human decay and what can be done about it
4. Dead Man Driving:  Human crash test dummies and the ghastly, necessary science of impact tolerance
5. Beyond the Black Box: When the bodies of the passengers must tell the story of a crash
6. The Cadaver Who Joined the Army:  The sticky ethics of bullets and bombs
7. Holy Cadaver:  The crucifixion experiments
8. How to Know if You’re Dead:  Beating-heart cadavers, live burial, and the scientific search for the soul
9. Just a Head: Decapitation, reanimation, and the human head transplant
10. Eat Me:  Medicinal cannibalism and the case of the human dumplings
11. Out of the Fire, into the Compost Bin:  And other new ways to end up
12. Remains of the Author:  Will she or won’t she?

Some chapters were weaker than the rest, but if you find yourself getting bored you can skip ahead, since there is no thematic unity to the Stiff, beyond the subject matter. The chapter titles give away the book’s abundant humor, not all of it successful. Perhaps because the topic is so inherently unsettling, Roach tends to shoot for irreverence. Roach has a “bloggy” writing style, feeling free to insert herself into the proceedings at random, sometimes to great effect, sometimes distractingly. What also makes the book feel “webby” is her amassing of factoids culled from so many different sources: historical, present day news accounts, her own interviews or research. This makes for a snappy read, with bits of odd information coming at you with every new sentence.

This is an undeniably gross  book. I think I have a pretty sturdy stomach, but even mine turned at times, as when Roach describes a corpse lying in the grass outside a U Tennessee facility that studies decomposition:

Squirming grains of rice are crowded into the man’s belly button. It’s a rice grain mosh pit. But rice grains do not move. These cannot be grains of rice. They are not. Entomologists have a name for young flies, but it is an ugly name, an insult. Let’s not use the word “maggot.” Let’s use a pretty word. Let’s use “hacienda.”

Arpad explains that the flies lay their eggs on the body’s points of entry: the eyes, the mouth, open wounds, genitalia. Unlike older, larger haciendas, the little ones can’t eat through skin. I make the mistake of asking Arpad what the little haciendas are after.

Arpad walks around the corpse’s left foot. It is bluish and the skin is transparent. “See the [haciendas] under the skin? They’re eating the subcutaneous fat. they love fat.” I see them. they are spaced out, moving slowly. It’s kind of beautiful, this man’s skin with these tiny white slivers embedded just beneath its surface. It looks like expensive Japanese rice paper. You tell yourself these things.

Of course, Roach’s question is hardly a “mistake” — it’s the whole point of her book, and her frequent deflating references to her investigative skills will seem either cute or needlessly self-deprecating, depending on your point of view.

Why would a reader not deeply intrigued by biological science want to know all this? I’m not sure. While Roach is never disrespectful of her nonliving or living research subjects, I confess that the episodic nature of the book and the tongue-in-cheek approach made me feel as if the book appeals mostly to the morbidly curious.

Roach writes:

We are biology. We are reminded of this at the beginning, and the end, at birth and at death. In between we do what we can to forget.

So, I suppose one effect of reading  Stiff – which is resolutely materialist — is to nudge us to remember that we don’t need our bodies when we’re dead, and to encourage us to make some decisions about what to do with our corpses to minimize harm and maximize benefit for society. But that can’t be right, since Roach herself says that while we can certainly let our loved ones know what we prefer, they are under no obligation to do what we ask, since it is they, and not us, who have to live with the consequences. Moreover, as Roach indicates with regard to obtaining consent for organ donation, sometimes more information (like, that if you donate your body to science, you might end up a head in a tray for a plastic surgeon to practice a facelift on, or you might end up full of maggots in a grassy field) makes consent harder to obtain, and I can honestly say that “giving my body to science” never seemed so dreadful as it now does. Am I less likely to make that choice? Maybe.

The other effect of reading Stiff might be lauding the unlauded: the people who donate their bodies, and the researchers who do the gruesome and difficult work of studying them so we can have better trained physicians, safer cars, and answers to important questions about what makes a plane crash or when a murder took place. After all, Roach refers to the cadavers are “our superheroes”:

They brave fire without flinching, withstand falls from tall buildings and head-on crashes into walls.You can fire a gun at them or run a speedboat over their legs, and it will not faze them. Their heads can be removed with no deleterious effect. They can be six places at once. I take the Superman point of view: What a shame to waste these powers, to not use them for the betterment of humankind.

But that can’t be it, either, for a couple of reasons: one, Roach comes very close to making fun of these people and corpses herself (of corpses: “Being dead is absurd. It’s the silliest situation you’ll find yourself in. Your limbs are floppy and uncooperative. Your mouth hangs open. Being dead is unsightly and stinky and embarrassing, and there’s not a damn thing to be done about it.”) and two, because the quacks, eccentrics, and sadistic researchers (the body snatchers, the creepy or greedy morticians, the guy who crucified bodies to determine whether the Shroud of Turin was a fake) get equal time with the good guys.

The word “dignity” appears fourteen times in the text (and in most reviews of the book, come to think of it). Preserving the dignity of the cadavers is major concern of many of the people Roach interviews. In Stiff’s first, very compelling chapter (one that would work well for pre-med undergrads), Roach marvels at the dignity with which medical students and professionals treat their cadavers (draping their faces, naming them, moving their limbs with gentleness, holding a memorial service for them). But, in a later chapter discussing the environmental benefits of composting dead human bodies, dignity seems less important:

To a certain extent, of course, dignity is in the packaging. When you get right down to it, there is no dignified way to go, be it decomposition, incineration, dissection, tissue digestion, or composting.

And, indeed, Roach has already said of cadavers at the start of the book, “Their fundamental feature is that they lack dignity.”

Not everyone who reads this book is going to approach it the way I would, but to me, this kind of tension cries out for exploration. Roach talks about “her first cadaver” — her mother. She says, emphatically,

My mom was never a cadaver. No Person is. You are a person and then you cease to be a person, and a cadaver takes your place. My mother was gone. The cavader was her hull.

So, why bother with dignity? Whose dignity is at issue? Certainly not the “hull’s”. Is it the researchers’ dignity? The dignity of surviving loved ones? The dignity of the person who once “inhabited” the hull? Part of the sense of the absurd that comes from dealing with our dead is this very issue of the moral status of the corpse, and it would have added a deeper dimension to the book if Roach had at least raised the issue.

Roach seems very clear in the quote above — “you are a person and then you cease to be a person”, but in a later chapter (Eight, which  would work well for undergraduate bioethics students), this simple story gets complicated. I very much regret that Roach used the term  “beating heart cadavers” instead of the more widely used and appropriate “brain dead cadavers”, but her point is still well taken: brain death looks a lot like life, what with the breathing and the heart beating, and the warm skin, and the ability to gestate a fetus, and… you get the idea. What does it mean that we remove vital organs from brain dead bodies? What allows us to say the death occurred when the brain stopped functioning, instead of when the heart stopped? The determination of death by neurologic criteria is still relatively new and, in cycles, controversial. Exploring what makes it so would have been worthwhile*, but perhaps would have sacrificed the “coffee table” book feel of Stiff.

Since I am looking at ethical issues, I’ll just throw out one more: the treatment of non-human animals. For many researchers, animals are a poor second best to the use of human cadavers, but they can get away with things using animals that would never pass an IRB, such as the whole head (whole body? Another philosophical question!) transplants discussed in chapter nine. Without moral judgment or comment, Roach recounts a veritable catalog of horrors visited upon animals (live vivisection being perhaps the mildest) performed for the purpose of answering questions meant to benefit humans (sometimes the “benefit” is mere satisfaction of curiosity). To me, this cries out for at least a paragraph of comment. Why should we preserve the dignity of a dead human body, but feel free to execute animals in every fashion imaginable?

To sum up, Stiff is a quick read, with lots of interesting information about a subject few know well, but perhaps should. It’s not particularly deep or thoughtful, but it’s fun, and often funny, and it could certainly serve as a springboard for the kinds of questions a more analytical person might want to ask.

*Actually, exploring nonheartbeating organ donation (cases in which the patient is taken off life support, the heart is allowed to stop for a few minutes — a mere three in some places –  the patient is declared dead, and then everything is started up again so the organs can be maintained and removed) would have been worthwhile, too, as it raised many of the same questions about when life really ends, the balance between social good and individual life, etc.