Pathology/Forensic Pathology - Emotion

[jena2lsu]

My questions is directed to both pathologists and forensic pathologists.

When conducting an autopsy, scene visit or reviewing the details of a death, how do you keep from becoming emotionally involved in the case? Or, even feeling "sadness" from the circumstances surrounding a particular case?

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[TMZ2007]

Here's my quick and dirty response. When I see a dead body, that's all it is: a body. Whatever made them "human", their thoughts, feelings, etc., either no longer exists or has gone on somewhere else (a different discussion). That body is just another hairless ape.

That being said, I might feel differently if it was someone I knew or was personally connected to.

 

[lipomas]

You get used to it. It doesn't make you any less of a caring individual. I get annoyed by people who think they are so special and emotional that there is no way they could ever handle doing autopsies. And they could "never get used to it." How precious! How caring! Here's the thing: Very few people like death. Pathologists are just as emotional as everyone else. People who really end up not being able to stand autopsies usually hate them because they are too messy, or too smelly, or too much paperwork, or too much medicolegal exposure. Very very few people end up hating them because there is too much emotional involvement. Obviously this changes if it is someone you know, but you could always find someone else to do the case for you if that happened.

It is ok to feel sad. It is ok to feel emotional. It doesn't have to interfere with you doing your job. I have done autopsies on 5 year old children and it is sad. But the sad truth is that the child is dead. You have to do your job, which is to help discover the cause of death or anything else significant.

 

[KluverB]

You get used to it.... It is ok to feel sad. It is ok to feel emotional. It doesn't have to interfere with you doing your job. I have done autopsies on 5 year old children and it is sad. But the sad truth is that the child is dead. You have to do your job, which is to help discover the cause of death or anything else significant.

I agree with the latter, but disagree with the former...

Although, the above statement may hold somewhat true for residency. You can suck it up, get your 50 cases, move on and not worry about it.

But, if the OP is in fact considering forensic pathology as a career and they don't have the stomach for it (and I mean that in the non-emotional-attachment sense not because it's messy, bloody, gory, etc.) the OP should possibly reconsider, gain a lot of exposure before considering this as a career, or simply to stay away.

There are people out there who should not go into forensics, just as there are people who are out there who should not be going into pediatrics, surgery, law enforcement etc. If the OP has a tendency to get emotionally involved with his/her patients/decedents then he/she may not stay objective. A pathologist's (forensic or otherwise) primary function is to remain objective and to report facts and interpretations based on the supporting facts. Someone who gets emotionally involved easily may lose that objectivity, and perhaps allow their judgment be clouded, and they could start making up "findings" or reporting interpretations that simply aren't there in the hope of stacking the evidence against a potential perpetrator. And that doesn't do anyone any good.

 

[yaah]

Agree with the above - some people just don't like autopsies for whatever reasons. There are a lot of people, however, who either assume that they won't like autopsies (because they feel they are too sensitive or emotional) or can't get past the personal/emotional angle. Many of these would end up being perfectly fine and would come to do well in the career, but some won't.

As far as the OP, you don't go to scenes or do autopsies for emotional reasons. You do them because it's your job. That takes a lot of the emotion out of it.

 

[HbyHA]

as someone going into FP, i get this question all the time. Even from some of my pathology colleagues! sure a lot of the stories are sad and some of the cases stick in my mind in particular, but you get over it. i think what eases my mind a bit is that these people are not actually suffering in front of me. the experience that i had that sticks with me over the worst forensic case is the time i was doing a pheresis in the MICU and the patient died 17 minutes into the procedure. in front of their entire family. who were screaming and crying.

awful. worse than the most gory traffic accident or dead kid.

 

[gbwillner]

I would say there are certain cases that stick out in my head as being particularly sad. Having done my 50 autopsies, there are those few cases that I constantly remember the details of, although not always for being sad. People get old, they get sick, they die. You get to figure out how/why. I think that is pretty cool. The best thing about autopsy is that it is the ultimate gestalt of medicine (IMHO). But occasionally a case comes along where you just felt that it was extrememly unfortunate/unlucky, and you do feel sad for the patient.
I remember a case of a 35/45 YO, recently married woman (there were 2 ages in her chart for whatever reason, and she looked 25), who was in perfect health when she started to have bad headaches. She went to her PCP, and after a few visits they thought it was bad enough to warrant imaging. A CT showed many lesions thoughout her brain. They told her she was boned and to follow-up with oncology at my institution. She started to have vomiting, nausea, and AMS. She was admitted, but died soonafter. I did the autopsy- there lay a perfectly healthy-looking young woman, her whole life (or half of it) ahead of her. Turns out she had cryptococcal meningitis that fooled everyone, with no obvious risk factors. Ouch.

Still, I don't think it was nearly as emotional as having to tell a young couple that their infant was dying of a metabolic disorder, or telling someone they had terminal cancer. But you get used to that too.

 

[danaphosaurus]

I think the hardest thing at the ME's is the child abuse cases- Those make me a little sad but you know you (the forensic pathologist) needs to do a good job to help put the murderer behind bars-
On another note, the only case that made me really upset on the hospital side of things, was a three year old who died suddenly- At our hospital, it is common practice for the nurses to dress the kid in their street clothes- I had to remove all his little kid clothes, even his socks- That made it a lot harder for me because he seemed more real-

 

[ABC789]

My questions is directed to both pathologists and forensic pathologists.

When conducting an autopsy, scene visit or reviewing the details of a death, how do you keep from becoming emotionally involved in the case? Or, even feeling "sadness" from the circumstances surrounding a particular case?

Sounds like a research questionnaire.

 

[pathgrrl]

When conducting an autopsy, scene visit or reviewing the details of a death, how do you keep from becoming emotionally involved in the case? Or, even feeling "sadness" from the circumstances surrounding a particular case?

Every human being finds it odd to see dead human beings; I would find it unusual to not feel some emotion. However, that emotion for me is usually not sadness -- it is more like uneasiness. As a professional, you recognize this and move on, focus on the job you have to do.

I often continue to see/smell cases the evening after I have had a particularly shocking or smelly case. It's just the way the brain works -- we spend time reprocessing our experiences in order to create short term memories.

Much more disturbing to me emotionally were my medicine clerkships -- patients that are still living, suffering, and unable to afford/access care or medicine provokes much more sadness than a dead body. Dead and mangled bodies are just odd.

 

[HbyHA]

Much more disturbing to me emotionally were my medicine clerkships -- patients that are still living, suffering, and unable to afford/access care or medicine provokes much more sadness than a dead body. Dead and mangled bodies are just odd.

i completely agree. my two weeks on inpatient peds (rehab unit AKA kids being kept alive mechanically) was the most emotional and ethically disturbing experience i've ever had. i almost quit because of it...

 

[jena2lsu]

Thanks everyone for your replies.

 

[PunkRockDoc]

As someone who is going into FP (and has a background in clinical medicine), I just never forget that the person on the table in front of me is still a patient, and I am simply the last doctor that they are going to see. As such, it is my job to determine their final diagnosis, so to speak, and they have every right to that as any living patient in the hospital. It's kind of difficult to explain what goes through my head, but taking this approach has helped me deal with my own emotions and biases, and made me a more vigilant (future) forensic pathologist.

 

[mlw03]

My questions is directed to both pathologists and forensic pathologists.

When conducting an autopsy, scene visit or reviewing the details of a death, how do you keep from becoming emotionally involved in the case? Or, even feeling "sadness" from the circumstances surrounding a particular case?

i don't have a simple answer to this, but in general i just detach myself from the situation while doing autopsy and think about the pathologic findings. afterwards i often find myself considering how sad the situation may have been, but it doesn't affect my work. it is sad when a pedestrian is hit by a drunk driver, or a young person has such emotional problems that they hang themselves, and all the FPs i've met do generally recognize the sadness of those situations. but while doing the examination you focus on your job as a professional ought to do, and do that job to the best of your abilities. in my opinion, that is the best way to respect the decedents that we examine.

 

[HbyHA]

I just never forget that the person on the table in front of me is still a patient, and I am simply the last doctor that they are going to see.

that's how i think about it too and is one of the reasons i get really annoyed when people (especially the dozens of med students that would troop through every week at one of the offices i've been at) keep referring to cases as "cadavers". i would correct them and explain that a better, less depersonalizing term to use is "decedent". they would then roll their eyes at me like whatever weirdo FP girl, who cares its a dead guy. i appreciate that the individual before me is just that, someone who has a life story, loved ones, etc and should be respected as such.

 

[KCShaw]

I agree with those who have said the "emotion" of dealing with the living can be at least as confronting and difficult as that of dealing with the dead.

While saying that we deal with cases because it's our job is true, I'm not sure it tells the whole story. As an outsider looking in, it's very easy to lose track of the data-gathering and analytical aspects of going to a scene, performing an autopsy, or simply reviewing a report. The more involved you are in the final product -- be it responsibility as a student for answering questions about the case to your attending, as a resident or fellow for answering questions to attendings or sometimes family/police/etc. depending on the case and your supervisors, & preparing reports, or as an attending who is expected to have an answer for everything for everyone -- then the easier I have found it to focus on what I need to figure out rather than getting sidetracked on emotional things.

With the living, I think it's easier to reach a point where you know you can't do anything else EXCEPT get lost in the emotion OR learn to move on to the next patient you CAN help.

In both cases, experience helps. The first few forensic cases I was involved with as a junior medical student, I was somewhat startled at how it affected me -- for me, I could sense a little inner balance tilting back and forth between over-objectifying the process and being weirded out emotionally, until after a few cases I felt comfortable both at the autopsy and after I walked away.

It just so happens that medical school offers much more experience with the living than with the dead -- entire classes devoted to giving patients bad news, convincing a pre-teen to trust you enough to tell you they might be pregnant and what to do when that happens, and treating the terminally ill -- so most students all the way to senior attendings are more comfortable with life, all the way TO but not quite AFTER the end of it.

That's not to say that I don't get emotional about cases, to some extent or other. But, I have a lot more to do than dwell on the parts of the case that would normally make me sad, disgusted, or even angry, were it a personal acquaintance or family member.

 

[JaneDough]

Acquire the art of detachment,

the virtue of method, and the

quality of thoroughness,

but above all the grace of humility



Sir William Osler

'nuf said