My phone rang at 9:02 AM and pulled me from my 4th snooze cycle of the morning. Guess what, it was my group's turn to observe an autopsy...at 10:30 AM. So we gathered our group up and trudged through the frigid NY morning to the ME's office. After a very brief history of what had happened and what we were expected to record and write up, we entered the morgue...the other worldly place that you see on CSI or Law and Order.

Now being a second year medical student, you're not really used to seeing naked dead people on a slab. You're not used to the smells of a dead body. You've maybe seen a handful of patients, most of them semi-clad and in pretty good shape, all things considered. Sure you saw your cadaver in anatomy and hacked it to bits over the course of 4 months, but that guy was drained of bodily fluids and smelled pleasantly of fixitive and fabric softener (we used a mix of Downy and water to keep things moist). However, this was a living, breathing human being not more than 8 hours ago, and now he's D-E-A-D in front of you, on a slab, still kind of warmish. It was kind of an eerie feeling to be standing there looking at a complete stranger dead in front of you. You almost feel that you should be mourning the passing of this poor soul, or comforting a family member. But it's just you, the dead body and some creepy guy holding a HUGE scalpel.

So you take it all in stride and begin looking at the outward appearance of the body. Standard things like height, weight, eye color, pupil diameter, scars/identifying marks, lividity, just a general survey of what's going on with him. Then that creepy dude in a surgical gown and face shield comes in an makes the standard Y-shaped incision in about 2 seconds. He then dissects the layers of flesh and muscle from the rib cage so he can make a merciless series of cuts through the ribs and clavicles with his little reciprocating bone saw, being sure to shred the subclavian vessels thereby pouring about 2 pints of blood into the now open body cavity. Seeing this can make even the manliest of men feel queasy and I watched one of my group members run out the door to get some fresh air. Blood has never bothered me too much, and my first cup of coffee had put me in a good place gastrically so I just stood there about 2 feet from the body taking notes. Elapsed time: 5 minutes.

Once the chest cavity is opened, the tech goes about systematically removing each organ piece by piece, recording the weight of every organ. Then, one by one, the organs are dissected by the pathologist and sliced serially to see if there is any pathology happening. Every detail is carefully organized, noted and dictated. It's a tedious process, but a necessary one when you have no prior medical history to go on and are essentially screening for EVERYTHING that could possibly go wrong with a person who suddenly dropped dead in front of their family. I actually saw that it is possible to access every bodily cavity with a strong arm and a 16-gauge needle...I was floored. Samples of every bodily fluid imaginable are sent for analysis and toxicology. Several tissues are also sent for toxicology.

Total time to completely turn a body inside out and look at every organ thoroughly: 90 minutes. It was basically anatomy on speed, with a whole lot more gore and stench. If you think that you learned a little too much about your cadaver in Anatomy lab, I can tell you what my autopsy patient had for dinner a few hours before he died (rice and black beans). I highly recommend that everyone see an autopsy at least once in their medical training as it will give you a perspective on pathology that you've never experienced before. It will also make you think that being a pathologist might be cool for about 30 seconds. But then you get a whiff of the contents of the small intestines and you realize that you really don't want to eat very much for the rest of the day.


M said...

You have no idea how much that entry just floored me.

I'm itching to watch an internal examination in real life. Like you said, there's only so much "perspective" prepped cadavers and video footage can give you.

Bostonian in NY said...

It was probably one of the single coolest events in med school for me...especially since you don't think about how all of those pictures in Robbins were taken while you're reading. Cadavers are great and all, but the unfixed body looks completely different.

The Lone Coyote said...

LOL. I love your description. I have now seen multiple autopsies and even done one myself, and I am not a huge fan. Most pathologists get through the few required months in residency and rarely do it again. And the medical examiner v. hospital autopsy are two completely different birds. Think surgical rounds get it done style (medical examiner's) v. internal medicine linger over details for intellectual masturbation sytle (hospital academic autopsy). I am glad you got to see one.