“Well I don’t know why I came here tonight, I got the feeling that something ain’t right,” the song hummed through the speakers of the DC medical examiner’s office.
Something definitely is not right, I thought as I watched the pathologist and his assistant begin the first autopsy of the morning. With rough strokes, the assistant dissembled the body before us. Unlike the cadavers we had dissected one year previously, this figure displayed obvious signs of recent life: a garnet river of blood flowed over rippling folds of brick-red muscle, the tissues appeared spongy and fresh to the touch, and odors hit the nose sharp and pungent, with no trace of formaldehyde astringency. For us second year medical students, this was a new experience. Wide-eyed and restless, we gripped our notebooks and worked to maintain composure.
“Clowns to the left, jokers to the right, here I am, stuck in the middle with you,” the music continued from above. The stark contrast of the song’s tone and the dissection going on feet away gave me pause. What was I doing confronting death on a drizzly Wednesday morning?
One component of the second year medical education is to witness an autopsy, analyze the pathophysiology of disease, and reflect on the experience. Historically, the autopsy has been a critical method of understanding how illness impacts the body. By visualizing the gross structures and examining tissue through microscopy, we are forced to draw connections between outward presenting symptoms and the anomalies that lie within. Slowly we compile a picture of the cellular changes that alter tissue composition to ultimately manifest as a typical patient profile of the disease.
In our quest to find a cause of death, my classmates and I scrawled down the weights of each organ dropped into a hanging scale. We peered closely at vials of fluid, looking for unexpected crystals, cloudiness, or color change. A calcified artery was brought to our attention and we whispered excitedly about a recent lecture on atherosclerosis.
As we worked, I saw how the autopsy presented more than a simple profile of disease. In searching through layers of flesh and blood, we were gaining an intimate introduction to the human being whose life ended so recently. The stent in the right coronary artery showed more than heart disease; it reflected a time of fear and pain. The accumulated liver fat suggested too many nights indulging in alcohol. The scars on the skin revealed a lifetime of minor traumas. It became overwhelmingly apparent that personal dramas and vulnerabilities were etched into this man’s very tissue.
Bodies are veritable storybooks of suffering and experience. Just as diseases and infections produce external symptoms, human actions are capable of transforming internal structures. With time, my thoughts turned inexorably to my own body. Missed sessions at the gym, extra glasses of wine, and near infinite scoops of ice cream — I often imagine that my desires and choices are locked within my mind and memories, but here was proof that they could be carved into my body as well.
The word “autopsy” comes from the Greek autopsia, “to see for oneself.” In observing a postmortem examination I saw for myself the fragility of the body and the impact of one man’s lifetime of experiences. Nonetheless, it is the job of clinicians to imagine the interior, unseen morphology that accompanies outward indications and information gleaned from histories. My next challenge will be to make the connections without peeking inside.
Natalie Wilcox is a medical student who blogs at The Doctor Blog.
