Autopsy

[Matte Kudesai]

On a more serious note about autopsy......

It is truly an honor to be allowed to learn from those that have passed on.

I felt that I should balance the last thread I started with the ineffable realities of tending to the dead body.

We are recieving the vessel that was once filled with life, the hand that touched husband, wife, child, partner, friend.....

In many ways our work is a Holy act. We are as priests tending to someone's "holy of holies."

We write the last note and compile the last history.

The body that has surrendered to our inquiry and our invasion gives us a privelege never offered before.

I have really apreciated reading Yaah's experiences in his diary. Mine have been similar and I daily realize how awesome it is to be in this field.

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[yaah]

Well put. I always consider it a great privilege as well as a great responsibility to be put in the situation I am in. That's not to say you can't sometimes have fun in the morgue, but you should always be respectful. The human body is an amazing and complicated contraption, and yet despite all of the connections, interdependencies, and anatomy the human body is quite separate from the human being. Once death happens, most of what made that person what they were, what made them loved, respected, or even hated has disappeared. That is what amazes me the most. You can often look at their face or some of their features and get a read on what kind of person they might have been, but you will never truly know. I always am fascinated by reading clinical histories of patients I have to autopsy, reading about their complaints, their suffering, etc.

 

[b&ierstiefel]

By examining poo however, one can at least get an impression of what kind of foods the person ate.

 

[Matte Kudesai]

By examining poo however, one can at least get an impression of what kind of foods the person ate.

Hey Milakonis, Thanks for bringing me back down to third grade again. I needed that.

 

[b&ierstiefel]

Hey Milakonis, Thanks for bringing me back down to third grade again. I needed that.

Oops...I made that poo post thinking it was the "Autopsy and poo" thread...but I was mistaken. It wasn't my intention of bringing down the serious tone of this thread. Although in real life, I am pretty childish so that's where that came from

In any case, I remember when I was a first year med student after we had finished our anatomy course. Our school had a ceremony honoring those who had donated their bodies for the sake of our education. I'm not really a sentimental kind of guy but I have to say that talking to the families was really an awesome experience. In that spirit, I share your's and yaah's sentiments towards autopsies.

 

[yaah]

Yeah we had one of those ceremonies too - I actually gave a speech and even quoted Dickens. I do wonder though, has there ever been one of those ceremonies at a med school where someone has not mentioned, "Well, Mom always said she wanted to go to med school, and she finally did (sniff sniff)." It's a tired cliche but I guess it works so who am I to complain. The lady my group worked on 1st year sure as heck taught us a ton more than most professors, and she gave what many would consider to be the ultimate sacrifice. Personally, when I die they can do whatever the heck they want to do to my body as long as people aren't profiting off of it (I hate sleazy profiteers - modern day pirates and ghouls). Just wait until I'm dead! And don't bury me somewhere where I will be taking up space that can be better used for a park or something. I'll be dead, I don't need it.

It's very impressive to me though that a family is willing to give up the funeral and burial in order to allow an anatomical gift. Way to go, I say. Score more points for humanity.

 

[PathOne]

Not to be contrarian or denigrate the original post, but I for one don't see myself as a "priest". While it's certainly true that autopsies, and thus those who grant them, provide an essential service to the continued development of medical science, and that the body of a deceased should be treated with respect and dignity, it is still a carcass.

Those things that made a person special are gone with death, and what's left is the examination of that person's parts - important as they may be in giving clues to that person's life. Sadly, I feel that the taboo that still sorrounds death and the dead body (not to mention other docs fear of malpractise suits) is unnecessarily hampering what has always been, and will remain, a vitally important aspect of the practise of medicine.

Not only in teaching medical students in the functions of the body, but also in improving clinical care for the living. But "priests" we are not, nor should we be.

 

[Matte Kudesai]

Not to be contrarian or denigrate the original post, but I for one don't see myself as a "priest". While it's certainly true that autopsies, and thus those who grant them, provide an essential service to the continued development of medical science, and that the body of a deceased should be treated with respect and dignity, it is still a carcass.

Those things that made a person special are gone with death, and what's left is the examination of that person's parts - important as they may be in giving clues to that person's life. Sadly, I feel that the taboo that still sorrounds death and the dead body (not to mention other docs fear of malpractise suits) is unnecessarily hampering what has always been, and will remain, a vitally important aspect of the practise of medicine.

Not only in teaching medical students in the functions of the body, but also in improving clinical care for the living. But "priests" we are not, nor should we be.

Hey PathOne don't get hung up on a metaphor or simile that makes sense to me but not necessarily to you.

Alot of things are perspective or ontological supposition based.

To me the autopsy is a holy with a small h act.

When the ghost leaves the machine I want to be more than the mechanic, the cataloguer, and junk pile comptroller.

You can see yourself as anything you want to..... from carrion parser to bowel splitter.

When I perform an autopsy on a perfectly formed prematurely born infant, and will be one of the ones looked to, in the team that answers the most difficult questions for the parents.....I see undeniable parallels to priestly functions.

In my opinion "doctors are in the same category as priests whether I like it or not".....


But that is a whole other discussion that I do not wish to have on this chat site.

 

[PathOne]

I'm not hung up on a methaphor, and you're certainly fully entitled to your point of view.
I'm merely pointing out, that the stigma of performing autopsies prevent many from being carried out, which I think is sad. Because they DO serve an important function, both for the relatives and for other medical professionals. It's the completion of patient care, so let's be as open about it as other medical procedures, and stop treating it as something which is sacred and somehow vastly different from other medical procedures.

PS: In my experience (2000+ autopsies, reviewed or assisted a further 3000+) I find that it's certainly interesting, but nowhere near as perfect in answering those "most difficult questions" as you imply. Yes, it's interesting that 16% of patients didn't really die from what they were treated for (which is why clinicians should pay far more attention to autopsies than they generally do). But remember, that in more than 30% of deaths with undetermined cause of death no amount of postmortem examination can uneath the cause of death. And that includes an awful lot of premature infants, btw.

 

[Matte Kudesai]

I'm not hung up on a methaphor, and you're certainly fully entitled to your point of view.
I'm merely pointing out, that the stigma of performing autopsies prevent many from being carried out, which I think is sad. Because they DO serve an important function, both for the relatives and for other medical professionals. It's the completion of patient care, so let's be as open about it as other medical procedures, and stop treating it as something which is sacred and somehow vastly different from other medical procedures.

PS: In my experience (2000+ autopsies, reviewed or assisted a further 3000+) I find that it's certainly interesting, but nowhere near as perfect in answering those "most difficult questions" as you imply. Yes, it's interesting that 16% of patients didn't really die from what they were treated for (which is why clinicians should pay far more attention to autopsies than they generally do). But remember, that in more than 30% of deaths with undetermined cause of death no amount of postmortem examination can uneath the cause of death. And that includes an awful lot of premature infants, btw.

On the contrary PathOne, I do not think it should be treated differently than other medical procedures.

I defer to your abundant experience. Also I agree that there is a need for more autopsies.

This was not the point of the initial statement in the thread. I was merely thinking about the approach to the patient whether dead or alive in my context and in relation to the OATH.

I appreciate the Stats. We are working within our department to help the clinical staff on the floors to present the opportunity for autopsy more effectively.

I think if someone feels that their loved one is being treated respectfully... its possible that the stigma of autopsy may diminish.
Thanks

 

[yaah]

I think if someone feels that their loved one is being treated respectfully... its possible that the stigma of autopsy may diminish.
Thanks

I think one of the reasons why autopsy rates are down is that families believe that by the time their loved one has passed on, they have suffered enough, and an autopsy would only add to this. A lot of times, the ones who do request autopsies are families who have disagreements with medical care or have specific questions they want answered. Autopsies almost always reveal something unexpected - usually this isn't a significant contributing factor to death, but it is still often important.

 

[PathOne]

Agree wholeheartedly with the last two posts. Autopsies is one of the few medical procedures which is performed in ever declining numbers in the western world. In the US, autopsies are increasingly seen as a tool in medicolegal/malprac. cases, and in Europe, reasonable demands that next of kin gives permission is unfortunately generally unreasonably implemented, by requiring a PGY-1 or similar to ask for permission from beraved relatives immediately after the death of a loved one. (and requiring ever more complex questions answered: Can we examine the brain? May we retain organ or tissue specimens? May we conduct research? Can we use the corpse for training? - tough questions to pose at a tough time).
Personally, I think that the decision to perform an autopsy, like the decision to become an organ donor, should be made by the individual while (s)he is alive, and not be a burden on relatives.
Hopefully, attitudes can be changed in the future. thanks.