February 2005 Archives

I was just perusing the blog of my good friend Ritchey (http://www.urbanhonking.com/regarding) when I came across an entry that was entirely dedicated to my recent "M" word story. I was suprised to see that she described my dear Adventures in Medical School, the online journal into which I have poured all my hopes and dreams, as "a major league gross-out blog." While I take no offense at this description - indeed, I heartily agree with it - the urge to post even more gross things is becoming unquenchable. Therefore, I impart to you the following tale...

Today while waiting for the microwave to warm up my lunch of chili dogs and olives (actually it was just a veggie stirfry with peanut sauce) I got to talking with one of the autopsy assistants. This guy has worked at the Medical Examiners office for like 20 years and he is very nice. We were discussing my vegetarianism and I made a jokey comment about not eating meat because I have seen too many autopsies. This made my colleague think of an observation that he has made over the years.

He has come to notice that after participating in an autopsy on a particularly rancid body, one that has been sitting out for a while and has progressed quite far along the path of putrefaction, he gets ravenously hungry. This is something that he has noticed time and time again, and that some of the ME's experience as well. Apparently there is something about rotting flesh that triggers some of those ancient scavenging instincts.

Then he proceded to tell me about one time where they were doing an autopsy on a burn victim. But this person hadn't been charred like many of the burned bodies that they see (the so called "crispy critters"). Instead it had been kind of cooked. And he said it smelled exactly like filet mignon, or a really nice steak, and that he started salivating profusely. Against all his reason and logic, and with the very clear knowledge that he was standing in front of a dead person, his body had an intense involuntary reaction of hunger, as if he was preparing for a meal. His body wanted him to eat that person!

Ok, so clearly this was not as gross as the whole maggot business. And I think i will not share gross stories about child abuse because it makes me very very mad. Oh my god. So horribly angry. And sad. But i bet this story has got you thinking about eating a dead person - and that's got to count for something.

Today I helped put a human skeleton back together. The forensic anthropologist, this awesome girl named Nici who also happens to ride a scooter (is it just me, or are all girls who ride scooters incredibly cool and hot?), let me hang out with her while she was going through some human remains. These remains consisted of bones that were found fairly recently after having sat out in the woods for several years. They arrived in several paper grocery bags, and she was in the process of laying them out in a human-shaped arrangement, so as to make a note of what was there and what was missing.

I "helped" her do this. If repeatedly dropping the vertebrae and being unable to identify the fibula counts as helping. Honestly, I forgot what the name of the fibula was - only one of the three bones in the leg, and I totally could not think of what it was called. It was a huge wake up call to review the old anatomy. The fibula? Come on, Fiona.

It brings me back to the first few months of medical school when I had my school-issued box of human bones sitting in the apartment (my "bone box"). I'm sure mike really appreciated having a human skull and a femur sitting on the dining room table. Back then, not only could I name all the bones, I could tell you what every little protuberance and indentation was called. Not anymore. It goes very very fast.

Today I learned how to "side the ribs," aka to figure out whether they come from the right or left side of the body. The inferior aspect is sharp - that's the key. I also learned how to tell the difference between thoracic and lumbar vertebrae - the thoracic ones look like a giraffe face and the lumbar ones look like a moose face. Trés scientifíc. I ALSO learned how to tell the difference between a bullet hole and an animal bite. The bullet hole has bevelling. This skeleton had both.

My life is getting more and more like a tv show everyday.

Today was kind of an awesome day.

Awesome thing #1 - I decided to ride my scooter out to the ME office this morning. Now, the ME office is located in Clackamas, a bit south of Clackamas Town Center, which just happens to be a one and a half hour bus trip from my apartment in NW. Well, to be honest, its a 1 hour bus ride and a 25 minute walk. That means I have had to catch the bus at 6:27am in order to get there by 8:00 am. Which sucks. But not this morning. My and the Storm Trooper made it there in like 35 minutes, and got to explore all sorts of deep southeast streets like SE 72nd, King Blvd, Sunnyside, and, of course, the unforgettable SE 82nd.

Awesome thing #2- everyone was really impressed by the motorcycle helmet that I carried jauntily under my arm upon my arrival.

Awesome thing #3 - I got to go with one of the deputy ME's to assist on an autopsy at a local hospital. And this is the young, hip, kind of cute medical examiner who rides a motorcycle, as I discovered today. So we put on our "leathers", hopped on our respective "hogs" and rode over to the hospital in true motorcycle gang fashion. Very awesome.

Awesome thing #4 - When we got to the autopsy suite, the attendants there offered us protective gear. And for some reason, when I mentioned that I would just put something on over my clothes, the autopsy assistant got out a giant plastic white suit. Not just scrubs or something. And she took it out of its plastic bag, so I felt like I couldn't refuse it. Picture this. Everyone else in the room is wearing blue scrubs, blue long sleeved gowns, and blue shoe covers. They look like medical professionals. And then there's me: full-body oversized white plastic suit with footies (like those pajamas you used to wear). And this thing was so big that the foot parts kind of dangled out in front of my shoes, so I had to shuffle around the room with these big, floppy, white plastic feet. Instead of looking like a medical professional, I looked like I a joke industrial spill worker/ clown/ beastie boy stand in. That, in addition to being funny, was also incredibly awesome.

Awesome thing #5 - Going back to the office and chatting with the State Medical Examiner and hearing her repeatedly say "He can just go blow" when referring to people she doesn't like.

Awesome thing #6 - People at the ME's office have started calling me Fifi.

Awesome thing #7 - Leaving early because there were no cases in the afternoon and scooting home in the beautiful warm sunshine.

Awesome thing #8 - The fact that it is 4pm and still sunny and warm and beautiful. I might go for a hike.

Ok. What's the grossest thing you can possibly imagine? You might be able to think of something theoretical, or conjur up disgusting images from some horrible violent british gang movie called Gangster Number 1, or maybe you have a very vivid imagination... but have you ever physically SEEN the grossest thing you can think of? I officially have.

I may be exaggerating for the sake of drama. But only slightly.

I recently observed an autopsy on a body that had been dead for between 2 and 3 weeks. Now, while there is a bit of an odor, and a slight green tinge to things, and a good deal of bloating about the abdomen, this is not as awful as one might think. No goopiness or rotting. I learned that there are basically two routes that a body can go after it expires: putrefaction or mummification. The former occurs in warm, damp environments; the latter in dry. Fortunately, the one I observed had taken the mummification path, which involved a lot of very hard, yellowed skin and some shrunken facial features.

So I am hanging out looking at this body, listening to the Medical Examiner dictate the external exam, when I happen to glance down at the body bag. Or maybe it was that something had caught my eye, some slight, subtle movement on the white plastic. And oh my god. Maggots. "M" STANDS FOR MAGGOTS!. That has got to be one of the more disgusting words in the english vocabulary. Maggots. And we are talking very large maggots - about an inch long - and they were very mobile little guys. Soft and sick and horrible.

So this is where our forensic entomology comes in. These are larvae of the blowfly, which is always the first bug on the scene. They are there in minutes to hours (sometimes arriving before the person actually dies). Some kind of amazing sense of smell or something. And they go for the dark, damp, enclosed areas to lay their eggs. The... private... areas. And that's exactly where they were on this body. Wriggling and spilling out of... ugh.

I know, right? Pretty effing gross. I am not one to be physically affected by "gross" things. I have seen many a bloody, gory, mess withough flinching. I have looked at pictures of gunshot wounds to the head while eating lunch. But I must admit, when I sat down that day to eat my lunch, which conveniently enough was a lovely rice dish, I couldn't do it. When I found myself scrutinizing each bite to make completely sure that the grains of rice were not actually dead maggots, I knew it was time to just put the fork down.

I'm pretty sure, though, that Cabel, Nicole, Noby, and Kaori appreciated hearing this story later that night while we were eating sushi.

Other very intense things that I have done this week:
- Read a suicide note
- Stuck a needle in someone's eye to remove the vitreous fluid (something that is done on every body for toxicologic exam)
- Gone with the medical investigator to a scene of death

On monday I started my new rotation at the Medical Examiner's office. The Medical Examiner= the doctor who does autopsies on people who die of questionable deaths. They are employed by the state. They practice "forensic medicine" and have to determine cause of death. They are like the attractive African American lady on CSI. They see some intense shit.

My job there is to observe the autopsies and learn things by reading "Spitz and Fisher's Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation."

So far I have witnessed the following autopsies:
1 homicide by gunshot
2 suicides by gunshot
2 deaths by natural causes
3 drug overdoses
1 accidental strangulation

Needless to say, this has been a very weird experience. Forensic autopsies are very fast and very brutal. The ME's are looking for a very specific thing, and they don't pause to dabble in the finer points of human anatomy that we agonize over in the academic autopsy setting. These pursuits are unecessary and superfluous when trying to determine cause of death, especially when that cause is obvious (aka someone shot the person in the chest). They are in and out in a few minutes, yanking out organs, sectioning them rapidly, their well trained eyes searching for things such as pulmonary embolisms, coronary artery thrombi, intra-cerebral hemorrhages, bullet tracks. I just stand by, in awe, occasionally asking simple questions and running my hands over lifeless organs.

Intense things I have done:
- put my finger in a bullet hole
- seen a bullet
- held a brain that was still warm
- talked to police officers

Chapters I have read in "Spitz and Fisher's Medicolegal Investigation of Death":
- Injury by Gunfire
- Asphyxiation
- Forensic Entomology and its Use in Dertermination of Time Since Death (did you know that the blowfly is the first insect to colonize a body after death?)
- Sudden and Unexpected Death from Natural Causes in Adults (I'm halfway through this one)

This will be a very cool month. I think I will learn a lot, and this will be an experience that I never ever forget. I don't think I would want to do it as a career, though. It is NOT like CSI.

You guys heard of Creutzfeld-Jacob disease? You know, the human equivalent of mad cow disease, where ingestion of contaminated meat products is presumed to cause a rapid and invariably fatal dementia?

Well, yesterday they did a brain-only autopsy on someone who had it! Some little old guy from Oregon. They cut the skull open and took the brain out, so as to study it and stuff. In the autopsy suite! Where I work everyday! Needless to say, I was a bit concerned that by merely entering into the same room where, just the previous day, a brain with this horrible infection was jostled about, I was exposing myself to an astonishingly horrible fate. So I had to look into it a little bit.

As you may know, CJD, as well as mad cow disease (bovine spongiform encephalopathy), chronic wasting disease in deer and elk, and a few other rare entities, is caused by an infections particle known as a prion. "Prion" stands for PRoteinaceous Infectious Particle (or something else with an "on" at the end). It is an infectious protein that is able to change the conformation of normal, benign proteins in the brain. These proteins somehow become "deadly" and are then able to attack other normal proteins and make them nasty as well. This wreaks havock in the brain, causing widespread cell death and necrosis of cells. This causes microscopic holes to form in brain tissue, giving it a spong-like appearance, hence "spongiform."

What I find so fascinating about prions is that they are not living entities. They are not like bacteria which have certain requirements in order to be able to sustain life. They are kind of like alien, inanimate objects that are somehow incredibly destructive. But all they are is a chain of amino acids! Just one big molecule. How could that wreak so much havoc?? Very weird. And very creepy.

Sooo Andromeda Strain.

The theory is that you get CJD from ingesting meat contaminated with brains from an animal that had a prion disease. CJD has some links to deer and elk. Some folks in Europe have contracted mad cow disease in the same way. But apparently, and by that I mean HOPEFULLY, this disease is not transmissable. It is highly infectious, but not communicable. One cannot get it from being around a person with CJD, or from being around the brain of a person with CJD, unless one accidentally happens to eat a piece of that brain.

That was my funny joke today. "Dr. Nixon, Its ok if I *ate* some of that brain, right?"

There are no proven reports of anyone getting it from an autopsy or anything. So I am officially in the clear. You can all sleep soundly tonight. But Creutzfeld-Jacob has been dutifully added the list of Disease Not to Get.