Book Review

Stiff: The Curious Lives of Human Cadavers

N Engl J Med 2003; 349:2473-2474December 18, 2003

Article

Stiff: The Curious Lives of Human Cadavers
By Mary Roach. 303 pp. New York, W.W. Norton, 2003. $23.95. ISBN: 0-393-05093-9

Mary Roach certainly has an eye for the offbeat (and a stomach for the grisly). In Stiff: The Curious Lives of Human Cadavers, Roach, a columnist for Reader's Digest and the online news magazine Salon, surveys the uses to which corpses have been put over the centuries, along with some odd contemporary proposals.

A selection of chapter titles and subtitles gives a flavor of the book's content and tone: “A Head Is a Terrible Thing to Waste: Practicing Surgery on the Dead” (surgeons training on cadaveric heads), “Dead Man Driving: Human Crash Test Dummies and the Ghastly, Necessary Science of Impact Tolerance” (the use of human cadavers for crash-safety testing), “Out of the Fire, Into the Compost Bin: And Other New Ways to End Up” (a company that plans to use human remains for compost).

Roach strives to be clear-eyed and matter-of-fact. “If you are inclined to donate yourself to science, you should not let images of dissection or dismemberment put you off,” she says. “They are no more or less gruesome, in my opinion, than ordinary decay or the sewing shut of your jaws via your nostrils for a funeral viewing.” The overall effect, though, is deflationary. There comes a point for all of us, Roach reminds us, when our bodies are no longer ourselves (the Boston Women's Health Collective notwithstanding). The well-being of the living depends in part on making use of bodies after death for physician training and the like.

Roach's tongue-in-cheek approach to this material, however, makes it difficult to know why she has written the book and who her intended audience might be. This is not a scholarly treatment or the sort of book that one would take to the beach or display on a coffee table. Is she just out for laughs? Or does she have some more serious purpose in mind?

Some of the material is informative, in a grim sort of way. For instance, the chapter called “Beyond the Black Box,” about injury analysis, explains that studying the bodies of plane-crash victims may help determine the cause of the crash. Because the bodies of victims of the wreck of TWA Flight 800, which mysteriously blew apart in the air and crashed into the Atlantic Ocean off Long Island in July 1996, were found to be largely intact, a bomb was thought to be highly unlikely.

Other chapters, though, seem designed mainly to fill out the book or to play for cheap laughs. “Eat Me” focuses on what turned out to be a shaggy-dog story about cannibalism in a restaurant in Taiwan. It might have made more sense as a cautionary tale about why one should not necessarily believe what one reads on the Internet. In “Just a Head,” about a series of weird attempts to transplant animal heads, Roach offers the following advice: “My recommendation to you is that you never eat baba ghanoush or, for that matter, any soft, glistening food item while carrying on a conversation involving monkey brains.” You get the idea.

It is not wrong to try to make a joke out of these matters. From Shakespeare to Philip Roth, comic artists have mined the graveyard for bitter laughs. Death is inconceivable; illness, among other things, often absurd. What physician has not felt an (embarrassed) need to guffaw about some dreadful event or condition? What these sorts of understandable responses call for, though, is an effort to get beyond dark comedy to some real emotional engagement. For instance, Sherwin Nuland's 1994 How We Die: Reflections on Life's Final Chapter (New York: Knopf), although filled with graphic accounts of painful and undignified deaths, sought to advance a humanistic understanding about an experience that had been overly medicalized.

Roach's style, by contrast, seems sensationalistic. She correctly notes, “pus and snot, slime and gleet. We are biology.” But composting human remains? Perhaps that is briefly amusing, but isn't the idea also just slightly bizarre, if not repulsive? I'm afraid that the author needs to come up for air.

For Roach, “dignity is all in the packaging.” Why the deep cynicism? Considerate care of human remains is not just about “the application of a well-considered euphemism.” Human lives have significance beyond the mere sum of their biologic parts. Roach touches on the cross-cultural taboos against mistreating a corpse primarily as an opportunity to exercise sarcasm.

Roach does regard with approval the thoughtful awareness that medical students display while dissecting. “Medical schools have gone out of their way in the past decade to foster a respectful attitude toward gross anatomy lab cadavers,” she writes. “With no prompting on my part, the students spoke of gratitude and preserving dignity, of having grown attached to their cadavers, of feeling bad about what they had to do to them. . . . No one made jokes the afternoon I was there, or anyway not at the corpse's expense.”

Surprisingly, given the author's determined efforts to appear cool and unsentimental, Roach's care for her dying mother appears to have at least partly motivated this project. “I find the dead easier to be around than the dying,” she admits. “They are not in pain, not afraid of death. . . . The half hour I spent with my mother as a dead person was easier by far than the many hours I spent with her as a live person dying and in pain.”

What I suspect Roach is admiring in the medical students she observed is a sort of unsentimental reverence for the human body. The same sort of reverence, the sense that we owe one another a certain intrinsic respect, may have sustained the author through those troubling hours with her dying mother and may right now be helping those medical students in the difficult task of being present to the sick.

Alan B. Astrow, M.D.
St. Vincent's Comprehensive Cancer Center, New York, NY 10011
aastrow@salick.com