August 2004 Archives

Its about 10:00 in the morning and I'm heading up to the morgue.  I begin the drawn-out process of putting on my disposable protective gear: first the paper scrubs that go over the ones I am already wearing, then the long sleaved yellow paper gown, then the blue booties that just barely fit over my huge orthopedically enhanced shoes.  Then the plastic apron, followed by the nylon sleeves, followed by two pairs of gloves (one of which costs $15 a pair).  To complete the outfit I then put on a ventilator helmet which has a face sheild and a tube that attaches to a motor and fan on a bulky belt that I akwardly clip around my waist.  This get up is affectionately referred to as the moon suit.  It cuts down on the smells, which haven't been that bad, to be honest, and prevents me from getting tuberculosis.  I am starting to feel adept.

Appropriately suited, I approach the table.  This time, a young woman waits for me.  She is younger than I, though death gives her a timeless look that doesn't correspond to any age in particular.  She looks worn.  Her body is contorted from a dismal mixture of scoliosis and rigor mortis.  She has had a very hard life, suffering from numerous health problems that finally caught up with her.  Did she have a good life?  Was it all worth it? I hope so.  

I dictated the external examination, describing the appearance of her chest, abdomen, skin, extremities.  I comment on the presence and location of scars, the permanent record of distant pain.  I describe a funny looking mole, the color and length of her hair, and the fact that her teeth kind of stick out.  I follow a generic template that is used for adult autopsies, and for the most part I just fill in the blanks.  Its weird how if you read autopsy reports, every person kind of sounds the same because if you don't have any abnormalities, you get described as being "unremarkable."  As in "the ears, nose, and other facial features are grossly unremarkable."  Her face, the most defining feature of her as a person, and the window into her character and all her collective experiences, is unremarkable.  As is mine.  Even if you are the most beautiful person to have walked the face of the earth, on the autopsy table you are "unremarkable."  Autopsies: the great equalizer.

I finish the external exam slowly, because I am still unsure of myself and hestitate with words, as I have always done.  It is now time to open the chest cavity.  I won't go into details.  But as this process was beginning, the oddest thing happened.  The radio, usually tuned to some 80's station (yes, people listen to upbeat music while they cut up your loved ones) began playing the song "Mad World" from the movie Donnie Darko.  It is such an amazingly sad and beautiful song, a slow motion retrospection on the absurdity of life, and it suddenly seemed somehow to be a fitting accompaniment to what I was witnessing.  The end of a young girl's life.  And this part of death wasn't beautiful and dignified, it was gruesome and impersonal, an area of fascination to interested pathologists, a boring part of everyday work to the autopsy assistants, who were busy peeling back the skin from this girl's chest.  The whole thing seemed morosely ironic.  But kind of comforting in a way.  See?  Now you're dead.  Isn't it funny that after all you went through it ends like this?   And as they were cutting through her ribs...

I find it kind of funny, I find it kind of sad,
These dreams in which i'm dying are the best I've ever had,
I find it hard to tell you, I find it hard to take,
When people run in circles its a very very
Mad World, Mad World.

I need to buy that soundtrack.

Yesterday afternoon I somehow found myselft watching the final minutes of the show Andromeda.  You know, that horrible sci-fi space drama that is so many generations removed from the original Star Trek that it ends up being a rip off of a rip off of a giant piece of floating shit?  I have not actually ever seen the show, so I may be jumping to conclusions here, but I think you know the show I am refering to.  Even if you don't, it doesn't really matter.  

I'll set the scene:  The Captain of the space ship, who is that weirdly unattractive former star of Hercules who always looks like he has a mullet even if he doesn't, is standing at the "brig" watching colorful space formations float by on the main screen.  He is standing next to one of those sexy telepathic lady aliens with big hair and pointy ears, the kind  whose space uniforms seem to be chemically molded to their bodies, and whose words always seem to pierce right to the heart of the matter.  They are both staring forlornly at the giant space screen, as if they are perhaps watching someone fly away through the clouds of pink space dust.  Someone who Captain Hercules Mullet once loved.  Sexy telepathic alien says something insightful, in an oddly robotic voice (if she's so insightful, why hasn't she mastered the sublte human art of voice intonation?).  But her words, as always, pierce right to the heart of the matter.

Dramatic pause.  Slow zoom in to the face of Captain Hercules Mullet, who says, with the utmost sincerity, "We can only hope.  This universe is all about hope."  Fade to credits.

Are you kidding me?  THIS UNIVERSE IS ALL ABOUT HOPE?  What kind of ridiculously inane statement is that?  And the closing line of the show, no less.  Though, to be honest, I have always wondered what this entire vast universe in its infinite mystery is "all about".  Well, apparently, hope is what it is all about.  The whole universe.  Problem solved.

12:03 pm.  I just finished doing the autopsy on my first official case, the 29 week fetus.  Dr. Stenzel, the attending pathologist who works closely with the residents on autopsy, had opened up the tiny thing yesterday and had taken out the organ block.  "The block" is what comes out of the chest and abdominal cavities when you sever the trachea, esophagus, and great vessels up top and the rectum down bottom.  Everything is pretty much connected and comes out as one big unit - heart, lungs, liver, diaphragm, stomach, intestines, kidneys, bladder, all sitting together on the table, looking exactly as it would if it were in the person.  And on this little patient, eveything was in miniature scale.

She had the cutest little heart I have ever seen - it weighed only 9 grams, about the size of a big acorn, and I spent way longer than was necessary trying to make it look pretty.  I dissected out all the great vessels so you could see the little aorta coming out and twisting down towards the abdomen.  And you could see this little structure connecting the aorta and pulmonary artery, the ductus areriosus, which usually disappears soon after birth.  Because the growing fetus is getting its blood pumped from the mom through the umbilical cord, and because it doesn't need to send blood to the lungs in utero, the fetal circulation is kind of reversed.  The ductus arteriosus bypasses the lungs, and along with many other structures unique to the fetus, keeps the circulation going until birth, when everything changes and the baby has to suddenly do it all for itself.  It was so awesome to see all these structures in their funtioning state, before they regress to insignificant ligaments in the adult. Instead of looking at poor quality cartoon diagrams in some text book, with bright blue for venous flow and cherry red for arterial flow and little arrows indicating the direction of everything like an oversimplified traffic map, it was all right there in front of me.    

There were other cool things in that little dude- she had this huge liver compared to all the other abominal organs, because that's a major site of blood cell production in a fetus, before the bone marrow totally takes over.  She had a massive thymus, this gland located over the heart that is almost completely replaced by fat in an adult, because that's where all her T cells are maturing.  I have never seen a thymus before.  And then there was her tiny uterus and ovaries, busy making the millions of eggs that would have been stored until menopause, if she had made it.  So fascinating.  She had perfect anatomy, without being obscured by layers of fat or contaminated by a bursting bowel full of bacteria.  It was a great anatomy lesson.

And that rounded off my first week on autopsy.   They say I have a "white cloud" because when I came onto the service the bodies stopped coming.  Last week they were swamped, but my presence has apparently mellowed the scene.  People stopped dying of mysterious causes.

I now will hop on my bike (I've been biking to school these days) and fly down the hill to a meeting at this small clinic where I used to volunteer.  I am going to be one the student coordinators for next year, which will probably just be one big scheduling nightmare.  But right now I am very excited for it.

Today is my third day of autopsy service, and so far it has been really interesting, albeit intense. I just got out of a lecture given by a young medical examiner about sharp versus blunt wounds.  It was sooo CSI.  Its really pretty amazing how much you can piece together about a case from examining the smallest things.  The margins of a wound can tell you what kind of blade made it, whether it was sharp, dull, double-sided, or serrated and how it was thrust into its victim.  You can tell by the amount of hemorhage if it was a cut made before or after the person died, and you can determine if it was a suicide or a homicide by the presence of defense injuries or hesitation cuts (a series of shallow, tentative cuts near the main wound that were made as the person was working up the courage to deliver a fatal slice).  All of this was really fascinating, and I got kind of excited about the intellectual detective work involved in the field of forensic pathology.

And then he presented the case of a mother and her two children whose hearts were cut out by an enraged ex- boyfriend.  He was angry that they left, angry that she was with somebody new, so he snuck into their house after the new boyfriend left for work, went into their bedrooms, and cut their hearts out.  Only he missed the mom's heart and cut out the left upper lobe of her lung instead.  The presenter showed us a slide of this piece of lung, sitting next to these two small child-size hearts, one belonging to a 5 year old, and a tiny, delicate little heart belonging to a 3 year old.  It was awful. I decided while looking at that image, that I would stop thinking about forensic pathology as a career option.  I couldn't bear to deal day in and day out with the results of such horrible human carnage.  People do the most disgusting, unthinkable things.  

The resident I am currently working with on autopsy told me of a news item she read on the CNN website: 4 young guys broke into the house where 6 people were sleeping and brutally murdered every single one of them with baseball bats and kitchen knives. They even beat the dog to death.  They felt this was the appropriate response to the fact that one of the girls living there had found them squatting in her grandparents summer house and had taken the X-box they left behind when they were turned out.  Three of these guys were 18.  How could anybody partake in such a brutal, disgusting, unconscionable act? How could anyone ever think that killing 6 people for no reason was a good idea?  It makes me sick.  And very very sad.

And returning to the suprisingly less morbid world of autopsies... today I am to do an autopsy on a 29 week old fetus.  Well, it would be more accurate to say that I am to assist on the autopsy.  But I will be dictating the case, and it will have my name on it, so it's still very very important.  After finding multiple brain anomalies on ultrasound, the parents decided to induce labor to terminate the pregnancy.  Yesterday, while examining this tiny human I found that I was not grossed out or really that disturbed by it.  What I felt was more of a fascination tinged with a little bit of... i don't know.  Sadness?  Not really.  More of a heaviness. The weight of knowing that the forces that brought this tiny creature to the cold metal table in front of me have changed a family's life forever.  Heavy.