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.

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