Might need some help? (4th year on a pathology rotation, autopsy experience...)

[alpinebrook]

Hello all! I am doing a pathology elective as I prepare to apply for residency (in less than a month!).

The other day I witnessed my 2nd autopsy. The first one I dealt with much better (middle aged patient who had been ill for awhile, so it was less of a tragedy). The second case was of a young man...

Let's just cut to the chase. I know this is probably very unethical, but I looked him up on Facebook. And it's caused me some distress. Confirming what I already knew but still needed to see -- he was a real, living person. Not the corpse that we tore up to shreds.

His security settings are pretty high so there wasn't much to see, but in many ways it was too much. It's just so sad! He didn't know he was going to die.

So what I want to know... Is this like really disturbing? Or is this a reasonable emotional response for a rookie? I am going into pathology for many reasons, but not because I dislike patients. That's why I am a bit worried now, that I might always feel like there is a void. I am truly inspired by pathology's critical role in patient care, and how the field works to advance medical knowledge, but at the end of the day I have plenty of emotions and compassion. I just hope it doesn't go to waste.

I feel like I can't discuss this with the attendings / other residents because I don't want to be seen as a creepy cyberstalker, and because the attending in charge just laughed her way through the case. Didn't really seem to acknowledge and respect the patient as much as I would hope and expect.

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[Over9000]

That's the thing about autopsies...they're a bit vile. Once you realize that the body was once a human with a life, its even more difficult. Kids and young adults are the worst.

I never got used to doing them. The most I could do was detach throughout them (my forensic rotation started and ended, and I don't really remember the middle of it), and negotiate hospital autopsy requests to either get cancelled or limited to one organ. I like to think the true point of autopsy in residency is learning the art of negotiation.

I can't recommend pathology due to the professional situation the field is in, although it is a very interesting field. Don't let autopsies dissuade you from that. Know that once you are in practice, its your choice whether you want to do autopsies or not ( I don't). They're so going out of favor that I doubt they'll be done at all in 20 years time.

Finally, I have always found it more disturbing to see someone who was alive and talking to you one day dead the next, or even worse code and die in front of you. Way worse than an autopsy. Maybe you need to do some ICU or emergency rotations to feel the difference.

 

[tiredguy]

The feelings you are having transcend autopsy and have more to do with accepting death and suffering that surround us in medicine. Pathologists are much more removed from that since we rarely see live patients suffering and/or dying compared to other physicians. In some way, pathologists benefit from being removed from irrational, emotional ties to patients and that allows us to perform our work more objectively. Autopsy is only a very small part of pathology training, yet you will be reading about many unfortunate patients when you receive their malignant biopsies or resections, etc.

If your curiosity to learn more about a patient leads to some sort of emotional or intellectual fulfillment and closure, it could be a good thing. If it just causes you grief, then I would recommend suppressing those urges to be curious and to focus on the work at hand in a more objective manner. More than likely you will just get used to it...we all have cases that bother us more than others, and the living, suffering patients bother me more than the dead ones.

 

[alpinebrook]

You both bring up very good points. Also, thank you for taking the time to reply.

Finally, I have always found it more disturbing to see someone who was alive and talking to you one day dead the next, or even worse code and die in front of you. Way worse than an autopsy. Maybe you need to do some ICU or emergency rotations to feel the difference.

Very true. I would say I have received a good education (in terms of variety, breath and depth), but I never had a patient die while I was doing my clerkships in 3rd year, so I "cannot feel the difference." During my internal medicine rotation, we rounded on a patient who ended up dying (her room was empty the next morning), but I had not been involved in her care at all. In 2nd year I spent a day with a hospice nurse doing house calls, so I met people who were on the verge of death, but again, I was basically just shadowing for a few hours.

The feelings you are having transcend autopsy and have more to do with accepting death and suffering that surround us in medicine.

I also agree completely with this.

An obituary is now online for the patient I witnessed the autopsy on. Even though it makes me sad, I am glad I read it. It does give me some closure. About the ethics of it all, I do not feel that bad looking him up, because I think if he and his family knew, they would be appreciative that I cared enough to consider who he was.

Some other points --

I am interested in pediatric pathology, so I will definitely have to get used to doing at least some autopsies on babies and other young people. I can be very rational about things, and that helps me get through it. I just attended a NICU M&M conference in which the autopsy findings had a huge impact. The clinicians, parents, and others had been agonizing over whether a C-section would have prevented this baby from dying. Pathology was able to demonstrate that the baby had severe brain damage dating back to at least before 20 weeks of gestation, so a C-section would have made no difference. I think that is a huge, important piece of information and speaks to the importance and value of autopsy.

I did not think autopsies would be going away any time soon... I thought they are becoming less popular, but still very useful... no?

 

[Mace1370]

I feel like I can't discuss this with the attendings / other residents because I don't want to be seen as a creepy cyberstalker, and because the attending in charge just laughed her way through the case. Didn't really seem to acknowledge and respect the patient as much as I would hope and expect.

I wouldn't be so quick to judge the attending. Many people cope with having to do autopsies (which are terrible) by detaching themselves from the situation and through humor. When you do your medical examiner rotations, you may notice that dark humor is very popular among forensic pathologists. Laughing at the situation is a way to make it feel less real.

 

[oldfatman]

Wait until you have to sign out a case as cancer on someone you know, and then watch them wither away and die. You're supposed to feel this way. It means that you are still human.