January 29, 2010
Case 1
SIGN OUT
Caucasian M, approx 60 YO
Autistic
Hx of cardiac issues
COD presumed from external inspection of body to be large GI bleed, probably due to impressively large inguinal hernia w/ presumed descended loop of bowel.
Case 2
Caucasian M, approx 45 YO
MVA
Victim was driving through a green light at intersection when hit (driver’s side) by car driven by a suspect fleeing police. Victim taken to ED, died despite care.
COD multiple fractures and bleeds due to collision
I was not directly involved in this autopsy.
Case 3
Caucasian F, approx. 25 YO
MVA
Victim rolled her car down an embankment. Came in from ED after bleeding out internally. Fracture of L humerus, multiple spinal fractures, severe multiple rib fractures, severed massive branch of lower aorta resulting in probable extremely quick death. Victim’s stomach had been cut open by trauma team, was packed w/ at least 8 gauze, 1 towel, taped over on receipt. Lacerations of most organs. Peculiarly severe cirrhosis of the liver, necrosis of part of bowel. Portion of spinal cord removed for inspection.
She was in the paper. Her accident. It’s strange to be on the other side.
Today we sang along with the radio again over the body, noting injuries on our little models, on our little clipboards. “Celebrate good times, come on!”
Sunday, January 31, 2010
Day 2
January 28, 2010
Case 1
Self-inflicted GSW to the chest.
Caucasian M, approx 35 YO
Single shot to center chest. Projectile was recovered.
I was not directly involved in this autopsy.
Case 2
Motor vehicle accident
Caucasian M, approx 70 YO
Complete open fractures of both femurs, one shin, one ankle, completely avulsed. Head completely detached from C-Spine, spinal cord, connected to body solely by skin. Broken clavicle, multiple fractured ribs, multiple skull fractures, multiple spinal fractures, severed aorta due to osseous pinch of collision.
Head-on collision w/ semi truck at 55 mph. Poss. Suicide.
The internal organs were almost pulped. The smell this time was worse, for the bowel was punctured. Greg was cutting, Dr. Gr. was in charge, Jen and I were helping out. We talked about our favorite fruits while picking bits of dashboard stereo and cell phone out of the mass of dirty, stringy, red muscle that constituted the legs. The feet were intact, separated from the main body by the avulsed, sagging mass of the lower limbs. The femur protruded spongily, whitely from the thigh, a large portion of marrow ripped from it and resting above.
I feel like I’ve been working here for weeks. Entirely comfortable. Everyone is cheerful and funny and takes everything in stride. Dr. Gr. and I discussed Latin origins of words while feeling the crepitus in the organs and slicing the lacerated, pulpy liver. Jen and Greg talked about concerts they wanted to go to while siphoning blood from the body cavity. The radio was on and Angie and Dr. A. were doing another autopsy across the room, the GSW, at the sink we were at yesterday.
It sounds as though we were being irreverent, but I must assure the reader that we were not. We were professional and thorough in the autopsy. When bending over the broken, pulpy body of a man who drove into a semi truck, you can’t focus on that. You can’t think about the guy on the table in a way that suggests you might end up that way someday. You can’t think of what you’re doing as cutting up a person with a dog or a cat or kids or a spouse. If you do, you leave after the day is over and every person you see, you can suddenly envision lying on that blue nubby table, blank-eyed and gape-mouthed, and you start to think of what you would look like on that table. If you’re lucky, it passes quickly. It’s disconcertingly easy to disassociate the gaping Y-incision and the floppy straps of the neck muscles from the face. The face, the head, the hands and feet, that’s the person. It looks like a person. The body, split and red and yellow, is just a body.
A song began to play from the radio, one everyone knows.
“Since you been gone,” we sang as we started to sluice water over the table and the body, “I can breathe for the first time!”
It seemed a little unfair to our patient.
We mopped the room to the strains of “Brown-Eyed Girl.”
Case 1
Self-inflicted GSW to the chest.
Caucasian M, approx 35 YO
Single shot to center chest. Projectile was recovered.
I was not directly involved in this autopsy.
Case 2
Motor vehicle accident
Caucasian M, approx 70 YO
Complete open fractures of both femurs, one shin, one ankle, completely avulsed. Head completely detached from C-Spine, spinal cord, connected to body solely by skin. Broken clavicle, multiple fractured ribs, multiple skull fractures, multiple spinal fractures, severed aorta due to osseous pinch of collision.
Head-on collision w/ semi truck at 55 mph. Poss. Suicide.
The internal organs were almost pulped. The smell this time was worse, for the bowel was punctured. Greg was cutting, Dr. Gr. was in charge, Jen and I were helping out. We talked about our favorite fruits while picking bits of dashboard stereo and cell phone out of the mass of dirty, stringy, red muscle that constituted the legs. The feet were intact, separated from the main body by the avulsed, sagging mass of the lower limbs. The femur protruded spongily, whitely from the thigh, a large portion of marrow ripped from it and resting above.
I feel like I’ve been working here for weeks. Entirely comfortable. Everyone is cheerful and funny and takes everything in stride. Dr. Gr. and I discussed Latin origins of words while feeling the crepitus in the organs and slicing the lacerated, pulpy liver. Jen and Greg talked about concerts they wanted to go to while siphoning blood from the body cavity. The radio was on and Angie and Dr. A. were doing another autopsy across the room, the GSW, at the sink we were at yesterday.
It sounds as though we were being irreverent, but I must assure the reader that we were not. We were professional and thorough in the autopsy. When bending over the broken, pulpy body of a man who drove into a semi truck, you can’t focus on that. You can’t think about the guy on the table in a way that suggests you might end up that way someday. You can’t think of what you’re doing as cutting up a person with a dog or a cat or kids or a spouse. If you do, you leave after the day is over and every person you see, you can suddenly envision lying on that blue nubby table, blank-eyed and gape-mouthed, and you start to think of what you would look like on that table. If you’re lucky, it passes quickly. It’s disconcertingly easy to disassociate the gaping Y-incision and the floppy straps of the neck muscles from the face. The face, the head, the hands and feet, that’s the person. It looks like a person. The body, split and red and yellow, is just a body.
A song began to play from the radio, one everyone knows.
“Since you been gone,” we sang as we started to sluice water over the table and the body, “I can breathe for the first time!”
It seemed a little unfair to our patient.
We mopped the room to the strains of “Brown-Eyed Girl.”
Day 1
Jan. 27th, 2010
First autopsy
Approx. 50 y/o M
COD undetermined, no apparent underlying pathology.
Gastric contents were homogenous, mucus-like and dk. yellow-green. No evidence of pills or any food; sent to tox.
Slight cardiomegaly
I got a little gray electronic key, gets me through any door in the building. I’m authorized personnel. I got scrubs, size small, yellow and cheerfully decorated on top, maroon pants. (I’ll have to get some plain ones, these are ill-fitting and tacky.) I got a desk and a microscope and a surprising amount of free time, freedom, and even respect.
The door is heavy, equipped with a little nook of a scanner for keys. It says MORGUE and AUTHORIZED PERSONNEL ONLY and BIOHAZARD.
We went in for the morning meeting. On the wall above the rusted plate scale was painted, muralled, a long section from the Ancient Egyptian Book of the Dead, and as a circle of doctors gathered in the room, I found among the illustrations, with a thrill, the weighing of the heart against the feather of truth, Nut, Set, Osiris, Anubis, the mummified body of the deceased on the lion-pawed and –headed table, the shaven-headed priests and the jackal-masked chief placing the organs in the canopic jars, and the jars and the mummy on the table in the papyrus-bowed and painted boat to the fields of paradise.
There was a quick circle of the room, doctors going over the bodies that had come in, the bodies in the fridge, and the bodies to be autopsied today and what had brought them there.
When I went back to my desk for my old shoes, the medical student, the other intern, (the real intern) was at her own, next to mine, already scrubbed. We talked. I liked her.
Back to the morgue. Greg, a stocky, powerfully-built sort of man with a shaven head, one of two autopsy techs (the other wasn’t in today but was also named Greg) and a thin woman with long, blondish brown hair I had seen earlier were taking record photos of a naked and very large black woman, obviously dead, lying on the big-wheeled steel gurney.
As I hung in the doorway, they turned her effortfully onto her side, and one held her there while the other took photos of the livor mortis that must adorn her back. They had turned her so that her front was half-facing me, and as I watched, brownish-red purge dribbled in a thin stream from her nostrils and half-open mouth, openly hitting the nubby floor and spattering alarmingly.
I found myself (oddly?) passive in the face of this, and as they turned her back onto her back and flopped the opened half of the white plastic body bag back over her to zip it, I entered the room, rounding the gurney and avoiding the rusty puddle of purge, to where the medical student was hovering around another body, this one on a rimmed blue table perpendicular to and shoved against a long set of sinks adorned with various trays, tools, and a large, stilted cutting board. The faucets had rubber tubing attached and a large scale was hung over the body’s feet, just in front of the sink basin. It was the kind that looks like a big double-sided clock with a metal bowl hung underneath, the kind you use to weigh fruit in the supermarket.
The man on the table was our patient. Jen, the other intern, the real medical student, introduced us. He was about fifty, a bit thin, with graying, pale red or mousy brown hair and beard. His rigor was set, and he was lying on the table in the position in which he had been found on his couch. He was pale and yellow-tinged where his blood hadn’t settled. In movies and shows, in books, people always say dead people look waxy, doll-like, unreal. It isn’t true. Dead people look exactly like living people, despite the blotchy purple spots of livor.
We went back together to the office-room outside the autopsy room, for neither Greg nor Dr. G. (the presiding doctor) was ready yet for the procedure. We waited there for quite some time, read a bit. Greg and Angie, the skinny, long-haired woman I had earlier seen, entered. Angie went off to the autopsy room and rattled around a bit, doing something or other. Greg told us it was time to get suited up and asked if I was excited to see my first autopsy. I told him I was excited to see it but perhaps not to smell it, and he told me that they had huge firefighters faint while witnessing autopsies simply due to the smell, and I could just leave if I felt dizzy. Don’t leave because when you leave and come back, the smell is ten times worse. Don’t lock your knees.
I wasn’t nervous anymore anyway.
We suited up. Small gloves, blue plastic gown, open in the back with thumbholes at the ends of the sleeves, stick your thumbs through those and glove again on top of it, the fine grade sterile gloves with the long, elegant wrists, folded neatly, Left and Right, in their little nest of tissue within the sterile packet. Next, elasticated booties, blue to match the gown but fabric rather than plastic, and last the mask, white side goes in, blue side goes out, bend the metal bit to fit your nose, and the elastic always gets caught on your glasses.
I stood to the side as people turned and prodded our patient, asked questions and noted minor scars and abrasions on the body. My feet wandered a little. I had already gotten used to the morgue’s distinctive smell, antiseptic, sweet, not bad but not great, and no specific derivative that I could name. As Dr. G. and Angie (who ended up doing the cutting because Greg was busy) and Jen wandered about the body, my eyes slid to the huge steel fridge door, which opened and disgorged Greg, with a gurney occupied by another white body bag for simple documentation. I returned my attention to our Patient, and watched as Angie turned him on his side and Dr. G. poked him sharply in the livor mortis spots with a pencil eraser, to check how much it faded with pressure. It only left faint whitish spots in the purple pools, and Angie turned him back to his original position. She lifted the arm nearest me to check it for distinguishing marks (Our Patient had several tattoos), and when she let it go. It flopped limply down, sending waves of motion across the thinnish body, just as it would have done in life.
I looked again at Greg, who was photographing and measuring the body he had just taken out. It was that of a very old woman, probably one who had come from the Medical Center. She had a wrap of gauze and pads around her wispy-haired head that nearly obscured her eyes, and several large band-aids scattered in other spots. She was very white, her pelvis protruded, and because she was on her back, her breasts had fallen or sagged to either side, under her arm-pits, completely obscured, pooling on the cold metal gurney under each arm. The flesh was so thin and the breasts so obscured, however, that the skin across the sternum was pulled against the ridges of bone there, and the body looked as flat-chested as a child, though disturbingly nipple-less.
I once again returned my attention to Our Patient, and observed closely as Jen, having obtained permission from Angie, withdrew vitreous fluid from each eye. Greg, at the margin of my attention, plunged a long fat needle into the lower stomach of the body in his charge and with a single fast pull on the plunger, sucked a splatter of blood into the bottom of the tube. Angie got a long stool from its place leaning against the wall, and, standing on it, lifted the body. Greg took a moment to push his blood sample into a test tube with an orange rubber seal, and then took a section of wood, a four-by-four perhaps two and a half feet long, the greenish brown kind used for fence posts, and placed it under the lower ribcage of Our Patient. With the chest pushed up thus, Angie produced a scalpel, and whipped it swiftly across the body’s chest, from right shoulder to mid chest, from left shoulder to mid chest, the top of the Y-incision. She finished the bloodless Y and pulled up the edges of the top cut, the point, to cut the gristle and connective tissue from under in order to pull it up. Our Patient lay upon his blue plastic table with a jacket and pointed scarf of surprisingly thick skin, striped red with muscle and yellow with the thin, globby layer of subcutaneous fat. It was as though she had cut butter, and not simply because of the quick, easy movements she had used. The fat is truly butter-yellow, or more accurately, margarine-yellow. The sliced skin looks like prosciutto and butter, pinky-red muscle, skin and fascia white, subcutaneous fat yellow,
She began to remove the organs as Jen attempted to draw blood from the femoral artery repeatedly and had a hard time getting it to flow. I was distracted again by Greg, who had put his first body away and brought out another, this one an elderly gent clearly in from the Medical Center, as he had a foley catheter placed and several other signs of recent treatment. His perineum was grossly swollen, bloodless, perhaps the result of a hernia. His hair was thin, but what I noticed most was his eyebrows—white, but missing their tails, so that he looked like a Vulcan.
Eventually, Our Patient was resting quietly on his blue, rimmed table with his organs around his feet and legs and his sternum resting between his thigh and hand. Angie lifted out the last looping curves of bowel, pink and yellow and shiny, butterfly-wing ruffles. I found myself gazing into the cavity where the organs had rested. It was filled with blood at the bottom, but the blood had little golden-yellow bubbles of oil floating in it, like soup broth. (It has to be said that an inordinate number of things having to do with dead bodies require food similes.)
I rounded the head end of the table again, noting with strange amusement that the body had not only its yellowy-red skin cradle from below, but had somehow acquired a splotch of red blood on his nose. Rudolph, the red-nosed reindeer.
As Jen and I weighed bits and pieces, Angie withdrew the urine and then went and retrieved the electric, strangely-shaped saw that she had used to open the chest and set it beside the body’s head. She made a cut like a halo around his scalp with the scalpel, then cleared connective tissue from the skull, pulling the scalp back from the bone and forward over the face, and then circled the skullcap with the saw blade. It was not neat, as it somehow appears to be when described in books. It’s like clumsily cutting wood, with a lot of jittery stop and start marks. As she rounded the head, starting to finish, blood began to flow from the cut, bright red, and it sluiced merrily, obscenely, down the curved, thick surface of the scalp and onto the table.
I was unaffected by this. I hardly noticed the smell. I held his heart and spleen and kidneys, soon his brain.
Jen turned to me, handed me the spleen. “I saw the coolest bladder stone with Dr. W. the other day!”
Near the autopsy’s end, I picked up the trachea. It had a lump of tissue attached that I did not recognize, until a second later, with a jolt—it was the tongue.
We use cutting boards at autopsy, the white plastic kind. We use scalpels, and tweezers, and pliers to pry the dura mater from inside the skull, and we use scissors and wide-bore needles and rulers, but we also use long graceful kitchen knives. The liver is the largest organ to make its way to the cutting board, and it is, when cut, porous. The slices are the size and shape of slices cut from a loaf of ciabatta bread, and the bile distends the gallbladder like a little balloon, browny-greeny-yellow and dark, and floods out glutinously when you cut it.
I peered into the open skull when Angie had finished wrenching out the dura mater, and she popped out the pituitary gland to show me, the size of a fingernail but so important, and plopped it into the sample cylinder, and I saw the optic and olfactory nerves and the bulges of the eyes and sinuses. The back half of the scalp sagged down and the short hair was drawn into black, curved spikes with blood from underneath. Throughout the entire thing, I was impassive, merely fascinated. The only part that truly bothered me, and this only for a moment, was the dandruff on the skin of the scalp and around the livored blue-purple lobes of the ears.
We could not determine COD.
Later in the day, Charity, the other investigator (Angie was the first I met) brought in a new body. He became “stinky guy”, for he was an old hoarder who had not bathed in months. Charity showed us the scene pictures and the house was unlivable, filthy, with crates of vodka scattered about. Apparently, since his chair was so comfortable, he had not wanted to get up and simply sat there for days at a time, urinating out onto his front porch and defecating in paper bags. Paper bags! It was unimaginable, and Jen and I were as horrified as Charity must have been.
When Greg opened the flap on the body bag, which had bulged with the occupant’s weight, a palpable wave of stench rolled out. It was not decomp. The man had died not a few hours before. It was the stink of an unwashed body, and it revolted all of us far more than the sweet, meaty, thick smell of autopsy. Jen was more daring than I, for she got close enough to inspect the body as Greg undressed it.
“Oh my god,” she said. “He has mold between his toes, under his toenails.”
I edged closer. The nails were over-long and yellowed, and under them and between the toes, even on the soles of the feet, were spots of black and green mold or mildew, fuzzy. Jen checked the mouth as Greg took pictures. He hadn’t brushed his teeth in weeks. Possibly years. Possibly ever. He had EKG pads on each forearm, puzzlingly, that the paramedics had not placed there.
As luck would have it, Stinky Guy was a sign-out, a body with no suspicion of foul play and known to have had prior conditions. The family had requested no autopsy.
First autopsy
Approx. 50 y/o M
COD undetermined, no apparent underlying pathology.
Gastric contents were homogenous, mucus-like and dk. yellow-green. No evidence of pills or any food; sent to tox.
Slight cardiomegaly
I got a little gray electronic key, gets me through any door in the building. I’m authorized personnel. I got scrubs, size small, yellow and cheerfully decorated on top, maroon pants. (I’ll have to get some plain ones, these are ill-fitting and tacky.) I got a desk and a microscope and a surprising amount of free time, freedom, and even respect.
The door is heavy, equipped with a little nook of a scanner for keys. It says MORGUE and AUTHORIZED PERSONNEL ONLY and BIOHAZARD.
We went in for the morning meeting. On the wall above the rusted plate scale was painted, muralled, a long section from the Ancient Egyptian Book of the Dead, and as a circle of doctors gathered in the room, I found among the illustrations, with a thrill, the weighing of the heart against the feather of truth, Nut, Set, Osiris, Anubis, the mummified body of the deceased on the lion-pawed and –headed table, the shaven-headed priests and the jackal-masked chief placing the organs in the canopic jars, and the jars and the mummy on the table in the papyrus-bowed and painted boat to the fields of paradise.
There was a quick circle of the room, doctors going over the bodies that had come in, the bodies in the fridge, and the bodies to be autopsied today and what had brought them there.
When I went back to my desk for my old shoes, the medical student, the other intern, (the real intern) was at her own, next to mine, already scrubbed. We talked. I liked her.
Back to the morgue. Greg, a stocky, powerfully-built sort of man with a shaven head, one of two autopsy techs (the other wasn’t in today but was also named Greg) and a thin woman with long, blondish brown hair I had seen earlier were taking record photos of a naked and very large black woman, obviously dead, lying on the big-wheeled steel gurney.
As I hung in the doorway, they turned her effortfully onto her side, and one held her there while the other took photos of the livor mortis that must adorn her back. They had turned her so that her front was half-facing me, and as I watched, brownish-red purge dribbled in a thin stream from her nostrils and half-open mouth, openly hitting the nubby floor and spattering alarmingly.
I found myself (oddly?) passive in the face of this, and as they turned her back onto her back and flopped the opened half of the white plastic body bag back over her to zip it, I entered the room, rounding the gurney and avoiding the rusty puddle of purge, to where the medical student was hovering around another body, this one on a rimmed blue table perpendicular to and shoved against a long set of sinks adorned with various trays, tools, and a large, stilted cutting board. The faucets had rubber tubing attached and a large scale was hung over the body’s feet, just in front of the sink basin. It was the kind that looks like a big double-sided clock with a metal bowl hung underneath, the kind you use to weigh fruit in the supermarket.
The man on the table was our patient. Jen, the other intern, the real medical student, introduced us. He was about fifty, a bit thin, with graying, pale red or mousy brown hair and beard. His rigor was set, and he was lying on the table in the position in which he had been found on his couch. He was pale and yellow-tinged where his blood hadn’t settled. In movies and shows, in books, people always say dead people look waxy, doll-like, unreal. It isn’t true. Dead people look exactly like living people, despite the blotchy purple spots of livor.
We went back together to the office-room outside the autopsy room, for neither Greg nor Dr. G. (the presiding doctor) was ready yet for the procedure. We waited there for quite some time, read a bit. Greg and Angie, the skinny, long-haired woman I had earlier seen, entered. Angie went off to the autopsy room and rattled around a bit, doing something or other. Greg told us it was time to get suited up and asked if I was excited to see my first autopsy. I told him I was excited to see it but perhaps not to smell it, and he told me that they had huge firefighters faint while witnessing autopsies simply due to the smell, and I could just leave if I felt dizzy. Don’t leave because when you leave and come back, the smell is ten times worse. Don’t lock your knees.
I wasn’t nervous anymore anyway.
We suited up. Small gloves, blue plastic gown, open in the back with thumbholes at the ends of the sleeves, stick your thumbs through those and glove again on top of it, the fine grade sterile gloves with the long, elegant wrists, folded neatly, Left and Right, in their little nest of tissue within the sterile packet. Next, elasticated booties, blue to match the gown but fabric rather than plastic, and last the mask, white side goes in, blue side goes out, bend the metal bit to fit your nose, and the elastic always gets caught on your glasses.
I stood to the side as people turned and prodded our patient, asked questions and noted minor scars and abrasions on the body. My feet wandered a little. I had already gotten used to the morgue’s distinctive smell, antiseptic, sweet, not bad but not great, and no specific derivative that I could name. As Dr. G. and Angie (who ended up doing the cutting because Greg was busy) and Jen wandered about the body, my eyes slid to the huge steel fridge door, which opened and disgorged Greg, with a gurney occupied by another white body bag for simple documentation. I returned my attention to our Patient, and watched as Angie turned him on his side and Dr. G. poked him sharply in the livor mortis spots with a pencil eraser, to check how much it faded with pressure. It only left faint whitish spots in the purple pools, and Angie turned him back to his original position. She lifted the arm nearest me to check it for distinguishing marks (Our Patient had several tattoos), and when she let it go. It flopped limply down, sending waves of motion across the thinnish body, just as it would have done in life.
I looked again at Greg, who was photographing and measuring the body he had just taken out. It was that of a very old woman, probably one who had come from the Medical Center. She had a wrap of gauze and pads around her wispy-haired head that nearly obscured her eyes, and several large band-aids scattered in other spots. She was very white, her pelvis protruded, and because she was on her back, her breasts had fallen or sagged to either side, under her arm-pits, completely obscured, pooling on the cold metal gurney under each arm. The flesh was so thin and the breasts so obscured, however, that the skin across the sternum was pulled against the ridges of bone there, and the body looked as flat-chested as a child, though disturbingly nipple-less.
I once again returned my attention to Our Patient, and observed closely as Jen, having obtained permission from Angie, withdrew vitreous fluid from each eye. Greg, at the margin of my attention, plunged a long fat needle into the lower stomach of the body in his charge and with a single fast pull on the plunger, sucked a splatter of blood into the bottom of the tube. Angie got a long stool from its place leaning against the wall, and, standing on it, lifted the body. Greg took a moment to push his blood sample into a test tube with an orange rubber seal, and then took a section of wood, a four-by-four perhaps two and a half feet long, the greenish brown kind used for fence posts, and placed it under the lower ribcage of Our Patient. With the chest pushed up thus, Angie produced a scalpel, and whipped it swiftly across the body’s chest, from right shoulder to mid chest, from left shoulder to mid chest, the top of the Y-incision. She finished the bloodless Y and pulled up the edges of the top cut, the point, to cut the gristle and connective tissue from under in order to pull it up. Our Patient lay upon his blue plastic table with a jacket and pointed scarf of surprisingly thick skin, striped red with muscle and yellow with the thin, globby layer of subcutaneous fat. It was as though she had cut butter, and not simply because of the quick, easy movements she had used. The fat is truly butter-yellow, or more accurately, margarine-yellow. The sliced skin looks like prosciutto and butter, pinky-red muscle, skin and fascia white, subcutaneous fat yellow,
She began to remove the organs as Jen attempted to draw blood from the femoral artery repeatedly and had a hard time getting it to flow. I was distracted again by Greg, who had put his first body away and brought out another, this one an elderly gent clearly in from the Medical Center, as he had a foley catheter placed and several other signs of recent treatment. His perineum was grossly swollen, bloodless, perhaps the result of a hernia. His hair was thin, but what I noticed most was his eyebrows—white, but missing their tails, so that he looked like a Vulcan.
Eventually, Our Patient was resting quietly on his blue, rimmed table with his organs around his feet and legs and his sternum resting between his thigh and hand. Angie lifted out the last looping curves of bowel, pink and yellow and shiny, butterfly-wing ruffles. I found myself gazing into the cavity where the organs had rested. It was filled with blood at the bottom, but the blood had little golden-yellow bubbles of oil floating in it, like soup broth. (It has to be said that an inordinate number of things having to do with dead bodies require food similes.)
I rounded the head end of the table again, noting with strange amusement that the body had not only its yellowy-red skin cradle from below, but had somehow acquired a splotch of red blood on his nose. Rudolph, the red-nosed reindeer.
As Jen and I weighed bits and pieces, Angie withdrew the urine and then went and retrieved the electric, strangely-shaped saw that she had used to open the chest and set it beside the body’s head. She made a cut like a halo around his scalp with the scalpel, then cleared connective tissue from the skull, pulling the scalp back from the bone and forward over the face, and then circled the skullcap with the saw blade. It was not neat, as it somehow appears to be when described in books. It’s like clumsily cutting wood, with a lot of jittery stop and start marks. As she rounded the head, starting to finish, blood began to flow from the cut, bright red, and it sluiced merrily, obscenely, down the curved, thick surface of the scalp and onto the table.
I was unaffected by this. I hardly noticed the smell. I held his heart and spleen and kidneys, soon his brain.
Jen turned to me, handed me the spleen. “I saw the coolest bladder stone with Dr. W. the other day!”
Near the autopsy’s end, I picked up the trachea. It had a lump of tissue attached that I did not recognize, until a second later, with a jolt—it was the tongue.
We use cutting boards at autopsy, the white plastic kind. We use scalpels, and tweezers, and pliers to pry the dura mater from inside the skull, and we use scissors and wide-bore needles and rulers, but we also use long graceful kitchen knives. The liver is the largest organ to make its way to the cutting board, and it is, when cut, porous. The slices are the size and shape of slices cut from a loaf of ciabatta bread, and the bile distends the gallbladder like a little balloon, browny-greeny-yellow and dark, and floods out glutinously when you cut it.
I peered into the open skull when Angie had finished wrenching out the dura mater, and she popped out the pituitary gland to show me, the size of a fingernail but so important, and plopped it into the sample cylinder, and I saw the optic and olfactory nerves and the bulges of the eyes and sinuses. The back half of the scalp sagged down and the short hair was drawn into black, curved spikes with blood from underneath. Throughout the entire thing, I was impassive, merely fascinated. The only part that truly bothered me, and this only for a moment, was the dandruff on the skin of the scalp and around the livored blue-purple lobes of the ears.
We could not determine COD.
Later in the day, Charity, the other investigator (Angie was the first I met) brought in a new body. He became “stinky guy”, for he was an old hoarder who had not bathed in months. Charity showed us the scene pictures and the house was unlivable, filthy, with crates of vodka scattered about. Apparently, since his chair was so comfortable, he had not wanted to get up and simply sat there for days at a time, urinating out onto his front porch and defecating in paper bags. Paper bags! It was unimaginable, and Jen and I were as horrified as Charity must have been.
When Greg opened the flap on the body bag, which had bulged with the occupant’s weight, a palpable wave of stench rolled out. It was not decomp. The man had died not a few hours before. It was the stink of an unwashed body, and it revolted all of us far more than the sweet, meaty, thick smell of autopsy. Jen was more daring than I, for she got close enough to inspect the body as Greg undressed it.
“Oh my god,” she said. “He has mold between his toes, under his toenails.”
I edged closer. The nails were over-long and yellowed, and under them and between the toes, even on the soles of the feet, were spots of black and green mold or mildew, fuzzy. Jen checked the mouth as Greg took pictures. He hadn’t brushed his teeth in weeks. Possibly years. Possibly ever. He had EKG pads on each forearm, puzzlingly, that the paramedics had not placed there.
As luck would have it, Stinky Guy was a sign-out, a body with no suspicion of foul play and known to have had prior conditions. The family had requested no autopsy.
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