Sunday, March 16, 2014

10 Autopsy FAQs

It’s hard to believe that we are starting the 5th week of the autopsy rotation. I’ve come a long way since the first body I eviscerated. My hands and muscles have developed motor memory and I feel much more confident in my evisceration skills.  During these last few weeks our goal is to pick up speed (my personal record for complete evisceration and head dissection is about 2 hours); we know what to cut, it’s just a matter of not wasting time and second guessing ourselves.

For this post I thought I’d answer some frequently asked questions about the autopsy process:

What kinds of deaths require an autopsy?
  • Violent deaths (accidents, suicides, and homicides)
  • Suspicious deaths
  • Sudden and unexpected deaths
  • Unattended deaths (physician is not in attendance and can't sign the death certificate)
  • Deaths in custody
  • Consented hospital deaths

Is there some sort of permission for an autopsy to be done?
The first step of any autopsy is making sure that you have the right paperwork and consent for the body. Hospital autopsies require the consent of next of kin or the medical power of attorney.  However, most U.S. jurisdictions do not require consent for medicolegal autopsies.

What is the purpose of an autopsy?
  • For hospital cases: to confirm a suspected cause of death, for teaching purposes, or to assess effectiveness of a treatment
  • For medicolegal cases: to determine the cause and manner of death, collect trace evidence from the bodies in criminally related cases, and to positively identify a body

What are some examples of causes of death?
The cause of death is defined as “the underlying disease or injury that begins the pathophysiological train of events that culminates in the electrical silence of the heart and brain”1. Examples of cause of death include gunshot wound to the head, atherosclerotic coronary artery disease, carcinoma of the pancreas, pulmonary embolism, etc.

Are all autopsies completed the same way?
Most autopsies, on adults and children, are completed by making the “Y incision” - an incision from the left and right acromion process (shoulders), which meet at the xiphoid process of the sternum, and is continued down the torso to the pubic bone. After the Y incision is made, the skin and soft tissues are reflected and the chest plate is removed.  This allows for the organs to be viewed and subsequently removed. Typically the autopsy also consists of dissection of the head and neck. If there is suspected pathology (ex. deep vein thrombosis) or identifying material (ex. serial number on hip replacement hardware) in the limbs, a limb dissection can be completed as well.
However, in hospital autopsy cases the extent of the autopsy may be limited based on the next of kin’s request.  For example, the next of kin could request brain and lungs only, which means that we cannot eviscerate any of the other organs.  

Are all the cases like the ones I’ve seen on CSI shows?
In real life, autopsies take way longer than 10 minutes and the cause of death isn’t always clear-cut and doesn’t get stated with a background of dramatic music. In West Virginia the majority of the medical examiner cases are drug overdoses; these bodies look essentially “normal”. The autopsy doesn’t reveal much and the pathologist will have to wait for the toxicology screen to come back before determining cause of death.  Occasionally, you do see some weird and interesting things that may be television worthy.

How quickly does the autopsy get done?
The time it takes to complete an autopsy varies from case to case. The fastest I’ve seen one done has been one hour and the longest being around six hours.  I’d say on average they tend to take about 2-3 hours.

Doesn't the smell bother you?
Personally, the smell doesn’t bother me too much, but I also try not to consciously think about it.  Olfaction is a quickly adapting sense; our receptors adapt so that the system can respond to new odors despite old odors still being present.  You wouldn’t want your nose to be hung up on the smell of dead body and miss the smell of smoke from a nearby fire.  Therefore, the smell may get to you for a couple of seconds, but then you’ll be used to it and carry on as normal.

However, does opening the bowel smell pretty terrible? – yes (such a glamorous lifestyle- taking poop out of a bowel). And can you sometimes figure out the decedent’s last meal by smelling the stomach contents? – yes and it’s revolting. Luckily, in West Virginia, the decomposed bodies (which smell way worse than freshly deceased bodies) go to the OCME in Charleston, WV, so we typically don’t have to work with the really smelly ones.

What happens to the organs when they are removed? Do people get buried with them?
Once the organs are removed from the body, we section through them to look for any tumors, lesions, pathology, etc.  A piece from each organ is put in a save jar so that the pathologist is able to go back to them later if needed.  We also submit histologic sections from particular organs or any pathology present so that the pathologist can evaluate the organs on a microscopic level.  Whatever we don’t save or submit as histologic sections is packaged up with the body and gets buried/cremated with the decedent.

How many autopsies are you doing in a day? What do you do when there aren’t any autopsies to be done?
At WVUH’s autopsy suite there are two autopsy tables, so two cases can be worked on simultaneously.  The most autopsies we’ve ever done in a day (9am-5pm) was six.  On average I’d say we usually do 2-3 per day.  Whenever there aren’t autopsies we stay on-site and study or work on any autopsy reports until 2:30pm or a body comes in (whichever is first).

1Guidelines for Reports by Autopsy Pathologists, Vernard I. Adams, 2010.

1 comment:

  1. Hi! I just came upon your blog searching for information on pathology and I have to say its very informative, especially this post. I've always wanted to be a pathologist and have decided this year to actively pursue it (yayy medical school!). Reading through the questions and answers of this post has opened my eyes (and mind) up to a lot. The question about smell was one I have always wanted answered so thank you a million for that. Of all of the blog I've read containing any sort of medical jargon this is the best. Keep on writing!