Dying for an Autopsy

During my Pathology elective at Tufts Medical Center, I accidentally told the head pathologist that I was DYING to see an autopsy. Poor word choice. He gently reminded me that an autopsy means that someone did in fact die, and my learning would be at their demise. Pretty glum. My last day of the elective, I did get to see the autopsy that I was dying for, and I definitely felt like I had cursed the man that I met on the table.

Pathology, literally meaning "an account of suffering," is the study and diagnosis of disease. The pathologists work in a quiet little factory deep in every hospital, where no (living) patient can be found. The pathologists are handed body parts, organs, tumors, moles, lumps, and other unidentifiable pieces of humans and are tasked with figuring out what these pieces are and what went wrong within them. Pathologists can also become medical examiners, who do autopsies to determine cause of death. They run microbiology labs, run tests on your blood, and determine who you can get transfusions from.

The grossest (haha - pathology pun) thing that I saw was "pseudomyxoma peritonei," caused by a mucinous adinocarcinoma of the appendix. The specimen consisted of three buckets of mucous drained from somebody's abdomen, along with a mucus-covered spleen, a mucus-covered piece of bowel, and a mucus-covered piece of liver. I also got to dissect a teratoma, or a type of ovarian cyst that can sometimes contain bone, teeth, hair, sweat, or fat. The head pathologist mentioned that he once dissected a teratoma in which he found a little scull with hair coming out of it. He said that it looked like a troll. Human bodies are incredible, and while all of the diseases we diagnosed were sad, I was amazed that these things were coming out of real people.

 

The process: 

(1)   Get a specimen. Usually in a jar in a biohazard bag. Usually from a surgery or a biopsy
(2)   Gross dissection. Measure the specimen. Describe its color and consistency. Bread-loaf, or cut it into slices. This had to be done in a specific way, depending on what we were slicing.
(3)   Take samples. We would sample anything weird (like a dark spot, a mole, a tumor) and then take samples from different parts. Sometimes we sampled the whole specimen. Samples went into "cassettes" which we would fix in formaldehyde overnight. 

My placenta slide, the "cassette," and some views under the scope

(4)   Make slides. Histology techs would take over. They finished the fixing, embedded the samples in parrafin wax, cooled them, sliced them on a microtome, and adhered the slices onto slides. They would then heat-fix and stain the slides, add cover slips, and bring the freshly cut microscopic slides back up to the pathologists
(5)  Diagnose. The pathologists would then (rather impressively) look at the slides under a scope for maybe 10 seconds and make a diagnosis. All I saw were shapes, colors, lines, and maybe sometimes a familiar cell. But the pathologists would immediately know what tissue the slide came from and what the pathology was. Definitely a cool skill that I did not pick up during my two week elective.'


Thanks to a lot of begging and friend-making on my part, I got to attempt every step of this process, and made my own slide out of a placenta!! It took me forever to slice the tissue thin enough, transfer it to a water bath, and get it on a slide, but I DID IT!

 

The autopsy

I walked into the room and met our patient, a cadaver. Now I have taken gross anatomy and have seen a few cadavers in my day, but never one that was so life-like. I guess you could say he was fresh. He looked like he was sleeping. And he smelled like rotten fish. The deiner, a funeral home-trained body cleaner, started ripping him into pieces. I could get realllllly graphic right now, or I could just say that she ripped out EVERYTHING. And it wasn't graceful. Fluids everywhere. The worst part was probably when she eviscerated him. Or maybe when she took the skin off his head to saw off his scull cap and remove his brain. All while chatting about her life, no big deal. Just another day cutting dead bodies into smithereens!

Two and a half hours later, we were done. We weighed, analyzed, cut samples from, and inspected every organ in his body, from brain to testicles. The deiner put him back together like nothing had ever happened. The only evidence were two cuts - a Y-shaped cut from his chest to his abdomen, and one on the back of his head from ear to ear. Neatly stitched shut.

The head pathologist treated the case like a mystery; searching for signs of disease and figuring out how our patient's history during his life could explain his cause of death. Turns out that he died of heart failure and fluid overload. I was able to inspect his organs one by one and learn how heart failure changed the way his body functioned. And although I absolutely appreciate the experience, I won't be dying for another autopsy anytime soon.