Feb 18, 2012

More than you wanted to know about autopsies

Hola amigos. Autopsy's been pretty crazy this last week. There's an interesting split in pathology because there's more than one type of autopsy. There are baby autopsies, forensic autopsies, and medical autopsies. The babies tend to involve perinatal circumstances so more to find out why something went down either before birth but after 20 weeks gestation, or right after birth, and hopefully find something to give the parents some idea of how likely it is to happen again.

Forensic autopsies are what everyone things pathologists exclusively do, and also, people think they encompass way less than they do. Essentially, if you don't die in the hospital, you get a forensic autopsy. Homicides, the famous one, but suicides, car accidents, bike accidents, pedestrian accidents, old people found at home, boaters found in rivers, etc. Full spectrum. When you're not the lead on these cases, they're actually less of a pain in the butt then people would expect since mail off labs are the ones that have to do the extremely slow version of all that CSI stuff.

Medical autopsies are the ones that are most important to the residents, and constitute the most paperwork. They give you a benefit over forensic autopsies because you have all the hospital paperwork at your disposal. Unlike most forensic autopsies though, this complicates the course because people in hospitals don't tend to die of really straightforward things. So... what killed this person? Cardiac arrhythmias are a particular headache. If it's not caught on a monitor, we can't demonstrate it happened. An MI will leave evidence (sometimes) but the arrhythmia it triggers? Not so much. We were given a handout describing death not as a loss of structure, but of function, and since we get them after the cease of function, it can be something of a mystery.

An added aspect to medicals is unlike with forensics, unless the forensic has a really medical-ly component to it, is we have to explain it to their clinicians AND families in a write up. This is difficult. Laymen understand why getting crushed by a truck causes death. They do not generally know what an amniotic fluid embolism is, why their mortality rate is so high, why doctors couldn't really do anything about it, and what the mechanism of death is, all without using words like "disseminated intravascular coagulopathy", and I have to explain it without being callous. And cite references.

But it's all good, and ultimately, way less stressful than surgical pathology. My attendings are super cool, and one of them caused me to discover an autopsy scully doll that I didn't know existed, and sparked my long dormant desire (coupled with Slappy mailing me a Scully action figure to replace the one burned by a fire, and yes I am a complete dork) to collect X-Files things. I'm trying to temper it with a more normal grown up habit like buying nice shoes or purses, but damn that stuff is expensive. I feel like a yuppie tool every time I pay 80 bucks for running shoes (worth it) but I saw a pair of Gucci boots that I liked decently online and they were 1100 dollars. Noooooo.

What else... Oh! People have been sending me pictures! See???

My nudibranch from Monterey!

Grenada hash!

The Alps!!!

Soooo awesome. Great to have memories back.

Feb 6, 2012


I want to tell you all a story about a dead man and a penny.

We received a man in the autopsy suite. This is in no way uncommon. One of the things we do, part of our list of things to check off as certainly as the weight of the heart and lungs, is to inventory anything we receive. Clothes, money, drugs, all on a checklist.

As we carefully removed the man's pants, we heard a sound, a clank on the floor, and we observed a single penny, the culmination of everything he had, and something we had missed in our initial exam.

"Get it!" my attending said sternly, and I chased the penny around the floor until I had it, detailed its worth on the sheet, and placed it carefully in a bag of personal effects so that the penny could be returned to be distributed as the deceased had seen fit. That penny rightfully belongs to the next of kin. If this man has a will, he can be burned, buried, or shot into space with his penny, and no rational individual would contest it. No moral person would contemplate stealing the penny, nor denying the ownership of said penny.

And I didn't contemplate stealing the penny, nor throwing it away, nor anything else. Because the penny belonged to the dead man.

I'm telling you this story to tell you another story. I received a page from a transcriptionist that lives around the corner from where I used to live. She told me she'd seen bulldozers by my old place. I left work (on time) to try and get access to the building for what must have been the eleventh time, since no one had called me, despite assuring me they would, but when I got there, everything had been reduced to a pile of rubble. The house is functionally gone, and the contents inside are buried under tons of bricks, lumbar, and debris, and what is visible has been crushed into the ground by a large machine.

I stood there in front of this silent but for a few profanities and saw a purple piece of fabric, and pulled, from the side of the lumbar, an intact blouse that was mine that had been untouched by fire, and had not been ruined by the water. It had been on my floor near my bed (I'm messy). Pulling a few nail-ridden boards out of the way, I saw the cane I had when I tore my plantar fascia, broken in half (because a bulldozer drove over it), but with every bit of plastic design on it unburned. This cane (which I didn't use) is notable because it had been leaning against the case of my solid top Takamine guitar, giving me reason to believe that my guitar was fully intact before being crushed under a building. I looked a bit further in and saw the splayed torn remains of a step 2 book.

There were things in there that were mine. That were driven over recklessly with no opportunity for me to access them because of the inconvenience of being on a second floor. Most of those things can be replaced. Many, I'm sure, were fully destroyed by the fire, including my back up drive, which contained all my pictures, and I'd fully come to terms with that. Some things cannot be replaced. They are memories and creations with emotional value. Now that the building has been reduced, anything that belonged to us now freely belongs to whoever risks looting the wreckage, including the owners of the bulldozer that brought it down.

I'd come to terms with the loss. I expected a complete loss after the fire due to seeing the skeleton of the building. I kept asking fire, police, anyone, if I would be allowed to see if I could recover anything, and I was treated like it was a crazy request that inconvenienced everyone, and ultimately, a futile one. My landlord was threatened with fines or imprisonment by the city of Charleston if he did not remove his arson-destroyed building from an area poorly served by police, and the eyesore was removed without much care to the people that lived inside of it.

It is reprehensible to steal from the dead. It is crucial to retain their memories so that their family and friends have items to remember that individual, or if nothing else, so that the individual's wishes can be enacted. And I'm all for that. But the contrast struck me. Why are the memories of the living in turn so valueless?

I apologize for having another dark entry so close to the last, and I am well aware that this is hardly why anyone would read this blog. I'm not wallowing in despair, I'm feeling happy most of the time, I'm moving on with my life, and I enjoyed the hell out of the Giants winning the Superbowl. This has been due *entirely* to help from friends and family, and I can say with certainty, *no* help to anyone representing the city or its offices. Well, the Giants thing more due to the Patriots' inability to catch a pass, but still.

I'm also in autopsy now, which is about half the hours and half the stress of surgical pathology, but is going to cause entries to take a pretty significant turn for the dark, and unfortunately, the still ambiguous. HIPAA applies to dead people too. Autopsy is also, already, giving me a raging case of weird insecurities and half-phobias.

A not case-related example: Back when I was doing a path rotation at Coney Island, I was looking through topics to present and came across vehicle vs pedestrian deaths and being a grisly lass, thought "perfect". Until I came to the chapter about dead people being found by the side of a road or interstate with a cause of death by a single blow to the head and no other injuries. Hypotheses collided... An extremely specific and weird gang initiation in which people leaned out of cars with baseball bats? Coconuts being dropped out of planes?

Or... buses and trucks have large side mirrors so they can visualize their blind spot, and if a stranded motorist is walking a little too close to the road, BAM! And the truck driver or bus driver may never know he hit anything.

"Neat", I thought morbidly. Until the next time a city bus pulled up to the stop and I jumped back like it was made of cockroaches and canned tuna. EVIL DEATH MIRROR.

The brief rule of autopsy is that absolutely everything *can* kill you. Some things like killing you more than others, popularly bullets, rapid decelerations, other cars, and bacon in your coronary arteries, but these are things we should already know to be paranoid about. If someone pulls a gun on me, I'm like "Uh oh, death possible", but thanks to the wonderful world of autopsy, I will eventually feel the same way about bus mirrors, bees, carnival rides, and hammocks.

Oh, and crabs. F- crabs, dude. If PETA had any idea, they'd be like "Animals are our friends. Except crabs. Eat them, wear them, torture them, but seriously... crabs are not your friends. F- crabs. PS, don't wear fur. Here's a picture of Pamela Anderson naked. Love PETA."