Guide To Observing Your First Autopsy
By Abby Norman
I work in a hospital filing in the medical records department. Because I’m student-aged and am considerably curious and intelligent, I often strike up conversations with people in other departments. The short of it is, I wound up being offered an opportunity to observe an autopsy — every biology nerds dream, no? — and it was the most challenging experience, both academically and spiritually, of my life. Here are a few things I learned.
1. The first few minutes are going to be weird. No matter how chill you think you’re going to be upon walking into the morgue, the initial shock is going to send you into a very bizarre type of consciousness. Seeing someone in an open casket at a wake does not prepare you for the morbid imagery of the autopsy experience. You have to go into it knowing that, really, there’s no way to prepare, and you can’t be 100% sure of how you’ll react. The toughest med students often faint or puke in the first minute.
2. You very faint and/or puke. Don’t worry about what the pathologist thinks of you: they’ve seen it all. Part of the job is having students observe and they’ve seen everything. The best way to respect them — and the other people in the room with you (alive or not) — is to be aware of what’s going on in your body so that if you’re going to yak everywhere, you can quickly exit the room to the bathroom or, if you’re stubborn and won’t leave in time, at least find the nearest bin. Don’t puke in the sink, they’re going to use that to rinse body parts. If you’re feeling faint, don’t psych yourself out: part of it is from the chemicals in the room and the fact that you’re probably wearing a surgical mask that makes it hard to breathe. If you can, sit down on a stool or chair for a few minutes while you adjust. If there are no options for seating (as was the case when I observed) position yourself with your back on the wall so that if you pass out you’re body will just sort of crumple to the corner and not get in anyone’s way. Seriously, fainting medical students can be extremely dangerous in a room filled with sharp tools and body fluids.
3. Take it easy before and after. I didn’t get a chance to prepare before the observation because autopsies occur infrequently at the hospital where I work, instead, I was called about five minutes before it started and had to run down to the morgue without much time to mentally prepare. In some ways, I think it ended up working to my advantage because I tend to over think things, but if you have advance notice of when you’ll be attending an observation, take the day before very slowly and try to chill as much as possible. Eat a healthy — not heavy — breakfast. Don’t drink too much coffee, or take any stimulants. The adrenaline that will kick in naturally, because you’re a human being face-to-face with death, is going to be very intense. If you’re already hyped up when you go in, you’ll probably end up in an adrenal crisis by the end of the autopsy.
It’s also important you take good care of yourself after. You’ll be on a high for a few hours, and you may have trouble sleeping. Drink plenty of water, have a snack, do something to decompress. Write down what you remember in vivid detail for later reference — and then put on an episode of Community and hang out. If you feel anxious and unnerved, talk it out. You’re going to be processing it for a few days.
4. Ask questions, but don’t be chatty… or weird. The pathologist — and the body — are there to teach. If you have legitimate questions, ask them, but be as succinct as possible. The pathologist, no matter how skilled, is doing some serious multitasking. They’re trying to discern cause of death while keeping an eye on a room of wide-eyed people who are lobbing questions in their direction. Be respectful, don’t crack jokes (leave that to the goofy assistant who “irrigates the entrails” — if they want to make a joke, let them, because that job must really, really suck), and don’t waste the pathologist’s time with obvious quandaries. If you have less specific questions, save them for the end. During the autopsy itself, keep your inquiries based on what’s happening right in front of you.
5. Yes, it’s as gross as you think. Your senses are going to get assaulted, even with full garb and a mask; autopsies are messy, and you never know what’s going to turn up once you get in there. The pathologist has no way of knowing — hence why the autopsy is being performed — so don’t assume that you’re going to see a bunch of normal organs. You might see tumor covered stomachs, black lungs, atrophied brains, and lots of blood, bile and poop. Everything smells. The smell of blood is what you’d expect, but the viscera itself is more earthy, almost muddy. The bile from the gallbladder smells very sour and acidic, as you would expect, and that’s actually what bothered me the most. When they cut into it, prepare. The poop is actually not that bad — it’s not like you haven’t seen and smelled poop before. You’re also going to experience a lot of chemical scents, and frankly, the formaldehyde (preserving fluid) was what had me feeling light-headed.
6. The more organs that get removed, the easier it gets to watch. There’s a pretty standard sequence for removing innards: the ribcage is lifted off, lungs taken out, then heart, then liver-stomach-intestines, kidneys, gonads, etc. The more organs that are removed, the less you can look at the body on the slab as though it’s a person. Because you never forget, not even for a moment, that the cadaver in front of you was alive just a few days ago. But the more you look at it separately — “This is the heart, these are the lungs” — the more you can detach yourself from the personal element. And that is essential to the experience. The pathologist has to detach in order to decimate a human being. The organs are not only removed, but cut up so they can look for abnormalities. By the end, everything is piecemeal and that’s a little bit disturbing. It’s probably helpful, then, that by the time the skull is ready to be sawed into for brain extraction, you’ve temporarily detached yourself from the spiritual element of things.
7. Watching the brain come out is an ordeal. This usually takes the longest, sometimes upwards of an hour. The hair and scalp are sliced through and the skin of the forehead (cut as far back as Zooey Deschanel’s bangs) is folded down over the face, while the back part is folded down toward the neck, exposing the skull. Think for a moment of how hard your skull has to be to protect your brain. You can’t just saw into a skull with a normal skill saw, you need serious power tools. And essentially, that’s exactly what happens. There is an enormous, loudly whirring saw that the pathologist uses to cut off the top of the skull. She also may use a hammer to help the skull “pop” off, revealing the brain. Even once the bone is removed, there are still meniges to cut through, all the while being very mindful of the delicate tissue just below. The brain itself can only be examined minimally when it’s first removed; it will have to be soaked in preservation fluid for two weeks before it will be ready to section and examine more deeply. It’s because of this that autopsy reports always include, “results pending”, because the brain takes the longest to examine, and many times that’s where the cause of death lies. So, the other organs are returned to the body before it’s sewn up so that the body is complete as possible for burial. The brain, however, is off to the lab.
8. You will never forget the name of the person, their story, and how they died. I won’t share the details with you, but I will never forget them.
9. Your paradigm is going to shift, big time. In addition to having some foods suddenly look weirdly unappetizing and feeling like you have x-ray eyes and can perfectly imagine what everyone’s insides look like, you’re going to have some new feelings about life. Being right next to death, and seeing a person be reduced to a dilapidated pile of skin really changes your perspective on things. You might really start thinking twice about all the shit you eat, or the packs of American Spirits you smoke per day. You might suddenly lose interest in binge drinking. You may decide that it really is time to lose that last ten pounds. You will likely be very grateful that you are young, healthy and full of happily functioning organs. You will also be quite pleased that you aren’t dead, because it’s actually quite a sad affair.
10. You will become highly critical of every autopsy scene in every television show, movie or instructional video. Suddenly you’re going to feel like you’re the fucking expert in forensic pathology, because you know, seeing one autopsy be performed is clearly the equivalent of 15 years of medical school. Crime shows will seem a little silly, the bloody bits fake and discolored. The squishy sounds will be overstated and comical. You’ll even judge their tools, because every pathologist knows that “the single best way to remove the ribcage is with a set of hedge clippers from Home Depot.” Even though your hands never held a scalpel the entire time, you’ll never be able to watch CSI again without saying, “Psh, they aren’t using a proper enterotome to cut through those intestines.”