Autopsy Shadowing

A few years ago I had an internship with the Prince George’s County Evidence Unit (Maryland).  One of our duties was to go to the OCME in Baltimore and view the autopsies for each of our cases.  We were there to fingerprint the deceased individual, to collect their nail clippings and blood card, and to collect their clothing and personal items.  While we waited to collect all the evidence, we were able to watch them do the autopsy.  I had no idea what they were looking for when they removed the organs and took sections of certain things, but I was fascinated by it. Ultimately, this experience is what led me into the field of pathology.

Last week I observed an autopsy at West Virginia University Hospitals.  WVUH does around 500 medical examiner cases per year.  Two second-year students were on their rotation at the time and they were very helpful at explaining what they were doing and why. Although I have already observed autopsies before, I now have a better understanding as to what I will be doing during the autopsy process as a PA.

Steps of an Autopsy:

First, the weight and length of the deceased individual are recorded. Then photographs are taken and any clothing items are removed. The pathologist then documents any external features (tattoos, scars, lacerations, bruises, etc.). 

Then the Y-incision is made, the rib cage is removed, and the organs are exposed.  Specific fluids (blood, urine, vitreous fluid) are then taken for toxicology purposes.  The PAs proceed by removing the organs. Once all the organs in the thoracic and abdominal cavity have been removed, the PA starts the tedious process of the neck dissection.  You have to be very careful when cutting in this area because it is very easy to slice through the skin (families will not like seeing this at the funeral). Also, the funeral home uses certain neck vasculature to embalm the facial structures, so cutting these leads to an unhappy embalmer. Once the thyroid and tongue are removed, it is time to remove the skull and take out the brain.

All the solid organs are weighed and each organ is serially sectioned and grossly examined.  Sections of certain organs are put in cassettes and submitted to histology. The bowel gets cut and examined (this part smells AWESOME), the stomach contents are collected, and a tissue from each organ is placed in a jar and saved for any later tests.  When all of this is done the body is sewed together and you’ve completed an autopsy!

*This procedure may vary depending on pathologist’s preference, location, and each specific case.