Special to The Hawai‘i Herald
When World War II veteran Bernard S. Akamine died of pancreatic cancer on April 2, 2012, at the age of 89, there was no question what he wanted to happen to his body. For years prior to his death, Akamine, a 100th Infantry Battalion, Company B veteran, had made it clear that he wished to donate his body to the University of Hawai‘i’s John A. Burns School of Medicine, commonly referred to as JABSOM, to be used for medical education and research as part of the Willed Body Program. The program allows Hawai‘i residents to donate their bodies to help medical students, resident physicians and others learn about human anatomy and health.
“Back in 1988, a good family friend passed away, and he had donated his body (to the Willed Body Program),” explained Akamine’s daughter, Drusilla Tanaka. “And so Dad was very curious about this.” Akamine decided that he, too, wanted to donate his body to this program, so Tanaka helped him fill out the necessary forms to get the process started.
Akamine took the commitment seriously. He made sure that his family members and every doctor he saw knew his wishes. “He knew that his body would be put to good use,” Tanaka said.
Anatomy is the study of the structure and function of the human body and is considered one of the most important courses in the health care curriculum. “The study of anatomy comes early in the medical curriculum,” states the JABSOM website, “and serves as the foundation for other courses. In addition, physicians in residency training and those in practice often pursue special courses in anatomy to enhance their skills and learn new techniques.”
By studying the bodies of donors, medical students and researchers can improve their knowledge and skills so they can help their patients still living. As such, body donations are essential in providing a first-rate medical education.
Tanaka said her father was a lifelong admirer of John A. Burns, Hawai‘i’s governor from 1962 to 1974 and for whom the UH medical school is named. Burns is legendary among many Americans of Japanese ancestry in Hawai‘i, especially those of Akamine’s generation, because of the pivotal role he played in Hawai‘i’s Democratic political and social “revolution,” which improved the quality of life and social status of many Hawai‘i residents. It is well known that Burns, in turn, held a special place in his heart for the 100th and 442nd veterans, who selflessly sacrificed their lives fighting injustice at home and abroad.
In addition to his wartime service, Akamine also volunteered at the National Memorial Cemetery of the Pacific at Punchbowl for about 20 years and also served in various capacities with the 100th Infantry Battalion Veterans organization, also known as Club 100.
“He was one of the original docents at Punchbowl,” Tanaka said, “providing help to visitors on the weekend. He was really a community service-oriented guy.”
Because of her father’s volunteer work at Punchbowl, Tanaka said her father was familiar with the services afforded veterans who chose to be buried there. Donors to the Willed Body Program can opt to have their cremated remains — or “cremains,” as they are called — returned to their family or to have the program scatter them at sea at an annual ceremony. Akamine wanted to have his cremains returned to his family and even purchased a custom-made koa urn to hold his ashes for eventual burial at Punchbowl alongside his fellow veterans. He had the emblem of the 100th Battalion laser-engraved on the front of his urn.
He also had one made for his wife, Jeanette, who decided to participate in the Willed Body Program, too, although her urn has yet to be used.
Jeanette Akamine will turn 93 in November and, according to Tanaka, is familiar with the dignity and respect shown to terminally ill patients and those who have passed away because of her own past volunteer work.
“My mother was a hospice volunteer long ago when the first hospice organization started in Hawai‘i,” Tanaka explained. As a hairdresser, she would give haircuts to the patients in hospice. She also had longtime customers who liked their hair styled a certain way. Tanaka said they often asked her mother to style their hair after their death in preparation for public viewing, which was more common back then.
“So, she would go to the mortuary and do their hair,” Tanaka said, ensuring that her deceased customers looked presentable for their final viewing.
Because of her parents’ matter-of-fact approach to death and dying — her father even planned the details of his own memorial gathering — Tanaka said she was not uncomfortable with their decision to register for the Willed Body Program. Because her father was specific about what he wanted — and did not want — done after his death, she felt it was easier to carry out his wishes, knowing he had made those decisions clear beforehand.
The “Silent Teachers”
On the morning of April 8, hundreds of family members and friends turned out at the University of Hawai‘i’s Mänoa campus for the annual Willed Body Memorial Service. Even before reaching Campus Center, where the service was held, young men and women in white coats were stationed around campus, directing attendees to the memorial. The men and women in white coats were students at the medical school, whose main campus is in Kaka‘ako. They were there not only to provide directions, but also to honor and remember their “Silent Teachers,” as the willed body donors are called, and to thank the donors’ families for the gift of their loved ones’ bodies.
In a packed ballroom with approximately 400 attendees, medical students shared what it meant to them to learn about human anatomy from their Silent Teachers. The students who spoke expressed deep gratitude and respect. They demonstrated their gratitude and respect by learning from their Silent Teachers with the intention of returning that knowledge to the community as medical doctors when they complete their studies.
It was clear from their reflections that the students did not think of the donors as simply cadavers to be dissected. They knew their Silent Teachers’ first names and a little about their lives. The Silent Teachers had health conditions that students need to learn about if they are to become good doctors to the living. The students spoke compassionately about the connection they felt to their Silent Teachers and the memories they continue to have for them after becoming so intimately familiar with their bodies.
It’s one thing to read about atherosclerosis — a hardening and narrowing of the arteries — but to actually see it up close and feel the arteries between your fingertips is a totally different experience, said one student. She described the first time she was able to feel the plaque within the arteries — something she could only have done because a Silent Teacher made the decision to donate her body to the program.
Michael Tom, a medical doctor and JABSOM Class of 2013 alumnus, referred poignantly to his first Silent Teacher, “Margaret,” who helped teach him about the human body by choosing to donate hers after death. “I’m forever grateful for what Margaret did,” Dr. Tom said. “I wouldn’t be here today if it weren’t for people like Margaret.” He plans to specialize in geriatric medicine, a field in need of specialists, where he will undoubtedly meet patients like Margaret. He said the memorial gathering was not just to celebrate memories of loved ones, but also to celebrate the choice they made to donate their bodies for medical education and research.
JABSOM students from the Class of 2020 performed a hula tribute to the music of Keali‘i Reichel’s “Ka Nohona Pili Kai,” followed by a slideshow tribute put together by the Class of 2019 for the Silent Teachers and their loved ones from the past year. Both smiles and tears filled the faces of those in attendance as the students expressed their gratitude in dance, music and photographs as the service neared its conclusion. Listed in the printed program under the heading, “In Honorable Memory” – the Silent Teachers from 2016,” were 152 names. As their photos appeared on the large screen at the front of the ballroom, it was clear to see that the donors came from all walks of life. With each advancing slide, the impact of their collective donations deepened.
Later in the day, members of the Anuenue Canoe Club took the cremains of donors who chose to be scattered at sea to Magic Island for a canoe launch from shore. About 200 attendees paid their respects at the afternoon ceremony with the sound of Celtic pipes and drums in the background, an annual tradition that began when a bagpipe player decided to add his music to this touching send-off.
The Willed Body Program
“Tactile learning,” or learning by touch, is the term Steven Labrash uses to convey one of the ways Silent Teachers help medical students understand anatomy. The students get to actually touch the different parts of the body, hold a human heart in their hands, for example, and closely examine it.
“It’s an incredibly powerful way to learn,” Labrash said.
Labrash has directed JABSOM’s Willed Body Program since 2004. The 1991 graduate of Cypress Mortuary College in California is a certified funeral service practitioner and enjoys the educational aspects of heading JABSOM’s Willed Body Program. Under his direction, the program has grown not only in the number of donors — the 152 Silent Teachers in 2016 was the largest number to date — but also in the number and type of students who benefit from the program. In addition to the JABSOM medical students, other student groups and health professionals come to JABSOM to learn about anatomy, and Labrash regularly receives invitations to speak about his area of expertise to groups off campus. Mari Kuroyama-Ton, a former hospice and Project Dana volunteer, administers the program.
On an afternoon in April, a group of Advanced Placement science students from a local high school was visiting the Willed Body Program’s facility located in a secure building on the JABSOM campus. Labrash and his colleague, Michael Andrews-Newman, welcomed the students and oriented them on the program before ushering them and their teachers into the spacious, air-conditioned lab where the close study of donor bodies occurs.
The students listened and observed as Labrash and Andrews-Newman discussed human anatomy in detail and were even invited to touch and hold specific organs with their gloved hands. They could feel the texture of the organs, the weight, the density and all the other details and nuances that are not possible when only seeing photographs or drawings of these organs in a book or on a video. While observing the organs still inside the body, they could see for themselves how different parts of the human body work together to enable life.
Despite the profound emotional impact that this experience may have had on the students, they conducted themselves with remarkable poise and deference. Scientific knowledge from their high school classroom was now being reinforced by the Silent Teachers (with guidance and questioning from Labrash and Andrews-Newman). Because Labrash believes that “learning through touch” is an “incredibly effective way to learn,” the students were invited to put on gloves and learn through touch. If they just wanted to observe and listen, that was fine, too.
Although medical students are the primary beneficiaries of the Willed Body Program, other groups benefit from the program, as well, including surgeons and medical researchers. Although body donations are up, Labrash said the program would welcome more Silent Teachers. They do not advertise for new donors, relying largely on word-of-mouth communication about the program. Interestingly, although perhaps not surprisingly, he has noticed that many former UH faculty members choose to donate their bodies to the program. For example, Kiyoshi Ikeda was among the 2016 donors. A retired UH-Mänoa sociology professor, Ikeda is known for, among other things, disseminating social science research on the people and institutions of Hawai‘i through the long-running academic journal, “Social Processes in Hawaii.” He retired from the university in 2000 and died in February 2016 at Kuakini Geriatrics Care Center, where he was being treated for his Parkinson’s condition.
Continuing to Serve
Bernard Akamine, the World War II veteran mentioned earlier, passed away in the evening, but his service to his community did not end there. His daughter, Drusilla Tanaka, said her father was receiving hospice care at the time of his death. The hospice nurse came to his home and contacted the doctor, who approved the release of Akamine’s body to the medical school, just as he had wanted. A short time later, a transporter arrived to take his body to JABSOM.
Tanaka remembers that the transporter was very professional and sensitive. He introduced himself and his assistant, expressed his condolences and explained what would happen next. Her father’s body was wrapped in a sheet and was going to be placed on a metal gurney. However, in the process of preparing to remove Akamine’s body, the transporter realized how light he was and instead lifted his body into his arms, as if cradling it, and carried it to the transport vehicle. It is an image that remains with Tanaka and her mother, seeing their loved one carried away with such compassion. The Willed Body Program later contacted the family to let them know that Akamine’s body had arrived and to thank them.
Tanaka asked when they might expect to receive her father’s cremains. She remembered the response of the kind voice on the other end of the phone. “Oh, when he’s done teaching here.”
As it turned out, Bernard Akamine’s cremains were returned in less than two months. His tissues were harvested and preserved. Tanaka learned that there was a special seminar at JABSOM the weekend after her father died. “His tissue was used for that presentation. Neat, huh?” (The length of time a donor’s body is kept by the program varies. The bodies are anatomically embalmed, so the tissues can be preserved for years, if necessary.)
Akamine did not want a religious service after his death. Instead, he wanted his friends and family to gather at Club 100 and enjoy catered food and talk story time. Nothing formal or fancy. The Buddhist and Christian ministers present were his friends. His obituary read in part: “Always thoughtful and ready to serve, he willed his body to the University of Hawai‘i John A. Burns School of Medicine, where he is now teaching a new generation of medical professionals.”
Tanaka still reflects on her father’s decision to be part of the Willed Body Program. He lived the motto of the 100th Battalion veterans organization: “For Continuing Service” — words that were also etched on his grave marker.
“I think even though he didn’t have a connection with a religious denomination, I feel that he really had a spiritual foundation,” said Tanaka.
Bernard and Jeanette Akamine weren’t strangers to the JABSOM campus. Their grandson, Grant Sato, currently a chef instructor at Kapi‘olani Community College, opened the café at the medical school. According to Tanaka (his aunt), Sato introduced the garlic potato chips there. The Akamines made several visits to the café, bringing along friends and family. When they were there, Sato made sure to bring them some garlic potato chips.
Another connection to JABSOM was a yonsei relative of the Akamines who had been accepted to the school. When Bernard told the relative that he had willed his body to the medical school, she jokingly asked him not to die until she completed her studies. It was a memory Tanaka recalled in good humor.
The Circle of Life
The Willed Body Program contacted the Akamine family when Bernard’s cremains were ready to be picked up. Her father was done teaching. When Tanaka and her mother went to the medical school to pick up Akamine’s cremains, they decided to stop by the café for a bite to eat before heading home.
They noticed that the garlic potato chips that Bernard Akamine liked were still being sold. “So, the three of us — Dad’s ashes were on the seat next to me — enjoyed ourselves.”
For some families, the decision to participate in the UH’s Willed Body Program is a private matter. However, Jeanette Akamine gave her daughter Drusilla permission to share their story with Herald readers. Mrs. Akamine felt that her husband would want their family to help educate readers about donating one’s body for medical education and research.
“Thank you for helping to spread the word about the Willed Body Program and for using Dad’s story,” Tanaka wrote in an email. “I like to think that even now, he’s still teaching.”
For more information on the Willed Body Program, call (808) 692-1445 or email firstname.lastname@example.org. A website with detailed information and forms can be visited at https://jabsom.hawaii.edu/donors/willedbody/.
Kevin Kawamoto is a longtime contributor to The Hawai‘i Herald.