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.
