Sabrina Gencarelli

The way that tissues are prepared to be viewed in sections under a microscope is a delicate process. The chemicals inhaled in a histology lab are health hazards, and the job is tedious. It starts with the fresh tissue sample being fixed in formalin. Usually tissues are left to fix from six to twenty four hours. After fixation, the sample is cut. A cecum sample, for instance, would have to be cut down by a physician’s assistant to pieces small enough to fit into a 7 mm by 7 mm by 7 mm embedding mold. The entire biopsy is not sectioned off, and the remainder of the excised tissue is stored in formalin, in case deeper cross-sections are needed. After the small samples have been fixed, they need to go through a dehydration process in order to be embedded in paraffin wax. This usually means leaving samples in a series of ethanol baths at varying concentrations. After the water in the sample is replaced with ethanol, the ethanol needs to be replaced with a hydrophobic compound so that it can interact with the wax. This step is called clearing, and it usually involves leaving the tissue sample in xylene. Finally, the tissue is infiltrated with paraffin wax. Hot paraffin is poured over samples in the small molds and allowed to cool so it solidifies into a block which can be cut by a microtome, which makes cross-sections about two micrometers thick. These cross-sections are so thin they can float on water, which they are dropped into, so that a slide can be placed under them, and they can be easily mounted. 

Any time a section of a body is excised, a segment of it has to be examined under a microscope. This is a routine procedure in the United States. Even if the sample taken is not suspected to be cancerous, or precancerous, it is sent to pathology to be looked at. I want to be a pathologist; I learned from my time shadowing during my sophomore year of college that this protocol is a double check for the surgeon. It’s important to look over what surgeons have excised because maybe they didn’t remove the entirety of what they were supposed to. There’s no point in cutting out cancer if you leave any of it in the body. 

Of course, often this process is diagnostic, but a lot of times it’s going, “Yeah, they performed a septoplasty, and this is definitely cartilage.” 

These samples are held onto for a while, per state regulations, so that people can obtain their own body parts if they want them. Sounds grim—but amputees, for example, may want their limbs to be held onto at a funeral home so that they can be buried with their whole body when the time comes. Several religious doctrines insist the body remain intact at burial—I don’t know why, but God won’t take you in pieces.

I was raised praying the rosary, stood in church in little floral dresses. Growing up, if my sister Samantha and I stayed with my nonna, after hours of being spoiled nonstop, Nonna would ask that we pray with her at bedtime. Before the light from the hot hurrican lantern was shut off, as I lay flat on my back, cocooned in blankets between Nonna and Samantha, small cool pearl beads rolled in between my little girl fingers. “O Maria, piena di grazie…” we muttered together. I stared at the shadows cast on the ceiling from the hurricane lantern, and we continued to mutter. Blades of grass streaked the white paint on the ceiling. Nonna would kiss us goodnight and turn off the lantern. These are still fond memories of mine, even though I eventually lost all my baby teeth, and listened to Mommy make comments about greed and the Catholic Church. 

One time our priest walked into Sunday Mass a half-hour late, and made a comment about all of the nice cars he saw parked outside. What a shame, he said, that his parish couldn’t give more to the church.  

Forgive me, Father, for I have sinned: Mom and I got up and left. 

We sped away from the full parking lot. Monsignor’s new Audi glimmered in front of the rectory. 

In the car going home, my mom told me the story of a time when I was small enough to be carried up to the altar in her arms on Ash Wednesday. She was greeted with a blessed smudge of, “Remember that you are dust, and unto dust you shall return,” and when she waited for the priest to smear soot on my tiny forehead, he told her no. None for the little one.

My mom turned to me, balanced on her hip,“That’s okay Nani, have some of Mommy’s,” she cooed. As she reached up to take off some of her own ashes and place them onto me, Father was quick to dip his finger into the powder, and bless me as well.

I looked at my mom after she told me this and asked, 

“Mommy, do you believe in God?”

“I do. I am just sick of the church. The money and the constant bitching and moaning. If you didn’t believe in God I wouldn’t be mad, but I would worry. I want you to believe in something,” she said, looking at the road. 

“Why?” I asked.

“Because, you have a lot of your life ahead of you, and when things get tough—which they will at some point—I would want for you to have a god to console you.” 

Feeling discontent with the Catholic Church did not have to mean abandoning faith; it meant not subscribing to the extra fees, and burdens. It meant not having to be patronized through a screen for sins that we all commit—Catholics love third party interactions and judging. It meant not having to speak through someone to speak to God, and it meant not feeling less than somebody else. It meant to me that I could be religious without affiliation. Throughout high school, I would pray to God and not go to church, but I was sure that He could hear me. 

I remember when I knew I wanted to do science. I was in twelfth grade in Mr. Richter’s AP biology class and we were learning about transcription and translation. The central dogma. The body relies on protein interactions in order to stay alive. To get proteins, a cell starts with DNA, from that it makes RNA, and from that it makes proteins. I was excited to read my textbook, excited to look at double helices, and excited to talk peptide bonds. I ended up pursuing science in college, and every time I took another biology class in undergrad they started us back with what made me want to be there: first DNA has to be transcribed to RNA. But they built on it. So many little signals have to be aligned just right for us to survive, and the genome has to have all of these sequences of nucleotides…and it’s all so much intricate bullshit. 

The more I thought about this intricate bullshit, the more I had to consider the ramifications of loving it. What did that mean about religion? In making us, did God make cellular machinery? Did He create the principles of physics and organic chemistry that allow protein interactions to occur? When body cells divide mitotically, one little base pair switch could be a carcinogenic mutation—did God know that? If He invented man in His divine image, I feel like He would have worked out the kinks a little better.

When I declared my major in biology, I unsubscribed from religion. 

I didn’t always want to be a pathologist, but I did always want to be a doctor. For a long time, I had my heart set on oncology: cancer. I thought that this would be a good idea, because I was fascinated by cellular machinery, and how the development of cancer can be boiled down to the dysfunction of those very tiny pathways. 

I am thankful I was able to shadow a doctor in the oncology ward—it was my least favorite thing ever. 

The oncology and hematology wing glittered with brand new bamboo wood floors and LED lights. The wing is a far walk from the main body of the hospital and something about it is always reminiscent of Christmas time—the energy and the lights, I think. This may seem like a stark contrast to how a cancer ward should be, but honestly, there are so many happy moments. Looking at a patient’s chart and seeing that their blood cell counts have improved from the week before, and the week before that, is the happiest you can feel for another person. I can feel my heart flutter when I think about the decrease in white blood cells that I got to see in the charts of lymphoma patients. 

Coupled to the amount of happiness was a large amount of human suffering—because killing cancer cells means killing body cells. That is why so often patients lose hair, mucosal membranes, skin, and sometimes hope. 

I knew I couldn’t be an oncologist the day that I saw a patient my age being refused chemotherapy due to risks associated with the side effects that their treatment had on their body. I never saw them again and I never wanted to deal with oncology again. It’s fucked up. 

I don’t think a god would do a thing like that.

What’s nice about pathology is that you get to study all of the cellular machinery and care for patients without seeing them suffer. It is rare for a pathologist to encounter a patient, and a lot of people don’t even know they have a pathologist working on their case, until they get the insurance bill.

Seeing people suffer bothers me—bodies don’t. 

When I was fourteen, my sister and I went to Bodies: The Exhibition in New York City. At the time, I was unaware of the controversy surrounding the exhibition, and was just intrigued by anatomy. I was under the impression that these displayed bodies were from people who donated their bodies to science. That’s a noble thing to do: giving your body for observation and education. Giving your body to the government so someone with my interest in anatomy could learn more about the body is beautiful, I think, though the bodies were not beautiful. They are not works of art. They were not to be romanticized—they were human bodies. Someone had to lose their loved one for me to observe their anatomy. I did not separate from this fundament as I gazed, curious, at plastinated lungs. They were suspended in liquid in a glass case, and they have no surrounding tissue, they were just capillaries. I looked up at them, amazed.

I have since learned that this exhibit in particular was controversial, because the source of the bodies on display was questioned.  There have been allegations claiming that the bodies belonged to execution victims, and were sold to the museum without the consent of the person who used to wear the body. If this is the case, I regret giving them money; bodies should be used to educate, not marketed against their will.

The ethics surrounding human bodies are funny in a way—we argue about whether or not there is an afterlife, yet we give autonomy of the body to the person who used to own it. Once their soul goes wherever the souls go, their body does not belong to anyone they didn’t approve of when they were alive. We should challenge folks who don’t respect a person’s last wishes, but I don’t think the admiration of anatomy and preservation techniques are synonymous with ogling at gore. When I look at the lung system, the fascination I feel is not about the gas exchange that once allowed a person to breathe through their first words, kiss, or math test. These vessels did serve that purpose for someone once, but now they serve a different purpose. They educate and they teach. They will never decompose because plastination is permanent, and that’s what I ogle at.

To plastinate tissue, a formaldehyde-preserved corpse is soaked in acetone, so the body will dehydrate. This takes a few months, and a few acetone baths. Once all the water in the body is replaced by acetone, it can be vacuum-forced out of the cells and replaced with silicone—a process called impregnation—which preserves the body and the integrity of the musculature. The body can then be placed into an airtight chamber and hardened with gas, preserving it forever. 

The plastinated bodies were positioned in different ways in order to display different muscles, organs, ligaments, and tendons. The museum was sectioned into different body systems, and each room gave special attention to different organs. It gave you a chance to observe the different body systems, and their constituent parts. There was one room which held one body that was encased in glass, and segmented into several thin sections. The sections were probably only a millimeter thick and filled with plastic. A lot of people found this unsettling. 

I was raised to be considerate of the dead. My mom never left me outside of wakes when I was a kid. When a family friend lost their daughter in a car crash, I was probably eight years old, and I remember standing in silence in the back corner of the viewing room with my sister, while my mom paid her respects to a closed casket. She wasn’t a “wait outside” kind of lady; my mom was a “children should be seen and not heard” kind of lady. She never hid death from us, and she expected us to know how to behave in serious situations. 

When my nonno passed away, I cried and I prayed with my family. On the first day of viewings, a Wednesday, I remember seeing him in an intricately carved casket—with Jesus Christ on all of the corners, and a red baby-rose rosary strung up on the white satin lining of the interior of the open casket above him. I followed my mom and my nonna up to the lip of my nonno’s carved casket, and leaned toward him, kissing his face goodbye—something that puts most Americans off. I don’t know if that is a cultural difference, but my European upbringing taught me that death was a terrible part of life. Dying didn’t suddenly make him any less my nonno. That same man held me in his lap to hug me on a big leather recliner, and cried happy tears when I turned ten. I remember him saying “dopie cifre!” over and over again. To me, seeing him there, he looked healthy and asleep—like his capillaries could finally gas exchange. Emphysema kept him from taking nice deep breaths. The sound of his nebulizer used to bring me so much comfort. If I heard a nebulizer that meant it was almost bedtime, and that if it was in the winter that we would be roasting chestnuts, drinking espresso, and playing Briscola. My nonna, nonno, sister, and I would all huddle around Nonna’s vinyl-clothed kitchen table, each of us with a coffee cup and a hand of cards. The kitchen was warm from the roasting chestnuts, and yellow-lit by a small stained glass chandelier. Nonno would peek at my cards and point at the ones to play, while still hiding his hand and keeping his nebulizer to his mouth. 

These memories didn’t go away because his body went away. They are alive and well because I am alive and well, and one day when I am not, they will go with me. 

I don’t think that my memories or soul will ever end up someplace otherworldly together. I don’t think that I will ever reunite with my nonno’s spirit. I wish I did believe that, because that would be so nice. When you don’t believe in a higher power, death is scary. It is the end to everything beautiful in our lives, like language, temporary tattoos, pizza, and driving aimlessly with people we love. With Nonno it was an end to coy smiles when he saw me doing something we both knew would make Nonna mad, like fishing for trout barefoot on the rocks upstate. It was an end to never ratting me out—my buddy. An end to last-minute runs for prosciutto, and him speeding down the Taconic with his zippy little BMW sedan. Now I drive that car, and I zip around in it waiting for someone to pull me over, and wondering if I’ll get mad the way he used to.

“Santa Donna Madonna!” 

It wouldn’t sound as good if I said it, but I get to see the world through the same green eyes he saw the world through. 

I don’t know what he thought about God. Nonno was religious but he passed away before I was old enough to challenge the ideas of the church. After his passing, I felt like I knew what my mom meant about looking to a higher power during the times when life was hard—things got tough sometimes, and the Lord brought comfort. I think that’s selfish of us in a way. I felt better that Nonno passed away under a system of beliefs that said I’d be able to reunite with him someday—that he wasn’t really gone. Humans are insatiable, and we want to believe in forever. The plastination of bodies is how people stay on earth forever. It can’t save souls, but it can preserve people and what they looked like. If there is nothing after our lives, I think that makes preservation pretty neat. 

A nice thing about not believing in Heaven is not believing in Hell. Where do I end up if I’m wrong? If one day I find out God is real I feel like He won’t be too happy with me—He might let me burn. I think humans invented that idea though: Heaven and Hell. Heaven is where you go when you’re good, because you’re entitled to a reward after goodness. I think I dropped that after I dropped Catholicism. My mom taught me to be a good person without needing something in return.

It was never, “Sabrina, be soft if you want to get into Heaven,” it was always, “Sabrina, be soft. You don’t know what they’re going through.”

She never told me I had to be nice to spend an entire afterlife with her and God; she just taught me to be nice. 

Plastination would be the only way any of us lived forever, even though we like to think that we are untouchable—that we are of a higher order than all of the other beings on the earth we share, who didn’t invent road signage. When you look at us, we are only elemental. We are DNA that is transcribed to RNA that is translated into proteins. 

I don’t think we should run and plastinate bodies either, especially without the consent of the body’s owner. If someone touched my nonno’s lungs I don’t know what I would do to them. If my nonno donated his lungs though, I think that would be a cool thing. It would keep a part of him here, and probably teach someone a great deal about emphysema, and the dangers of working with cement like my nonno did. 

We should put our loved ones to rest and be content with the times we had with them, but it is fascinating that we can preserve tissue forever. I think it is humbling to realize that the laws of physics and organic chemistry are what allow us to live the lives that we do. Those laws allow us to replace the water in our bodies with xylene or with silicone. We are made up of elements that can be turned into plastic. A lot of what happens to our health and our bodies is out of our hands. That is comforting to me—it means that the events in our lives are out of our control. I like knowing that there is order in our universe; it’s not random bullshit. When things get hard, which they eventually will, my body will still be metabolizing sugars, firing action potentials, and transcribing DNA into RNA, to translate into proteins. I am content with that being all that holds us here. 

If there is a god with his hand in all of this, I have a few questions to ask Him like, “God, why did you let that patient get so far into their recovery, before taking it all away from them?” 

I have a sneaky feeling a god wouldn’t have invented hydrophobicity and hydrophilicity which let us replace a body’s water with silicone—especially not when the process is called impregnation. Maybe that’s just me. 

One time when I was a kid, my nonna wanted to bring flowers to her mother-in-law, who had passed away about a year earlier. I can remember walking between the rows of grave plots, and feeling frightened. I can’t recall how Nonna knew I was afraid, but I can remember her telling me that the people in the ground aren’t the ones I should be afraid of. 

“Those people,” she said, pointing to the wet grass sprawled in front of the headstones, “they can’t touch you. They can’t do anything to you. Look around Nani, the people walking are who you need to worry about.”

People who can breathe are the only people who can hurt you. Aging changes the way that we view some things. At the time I believed all of those people were in Heaven, and I was clutching my nonna’s hand walking in between the bodies that used to hold them. 

I still clutch Nonna’s hand these days, and we talk about Nonno; I wonder if his soul is happy, or if it went anywhere. 

And as selfish of me as it is, I hope his soul went somewhere.

Sabrina Gencarelli graduated from Geneseo in May 2021 with a degree in Biology and a concentration in English.