It should be no surprise that most people, even most doctors in training, think autopsies are gory. The surprise to me is quite a few of my colleagues take offense when somebody says so.
Dr. John Biemer, a former journalist who left his field for medicine and is currently a first-year pathology resident in Chicago, wrote an article for the online news site Salon.com that describes his experience as a trainee in autopsy pathology.
He wrote he’s “hit with a wave of anxiety” every time the body bag is unzipped. He’d prefer not to look at the “pale, lifeless faces” that have appeared in his dreams, but “there’s no way around it” because he was taught to measure the pupils and check for abnormalities of the eyes.
He described the stench of the bowels, the sound of the bone saw and the feel of pneumonia. He expressed understandable distaste for the “running of the bowels” – opening the entire length of the intestines to remove their contents and examine the lining for polyps or cancer.
Biemer said he was drawn to pathology as the most scientific of the medical fields, but he clearly doesn’t like autopsies.
“I just focus on the task at hand and re-enter the land of the living as fast as I can,” he wrote.
Much of my colleagues’ discomfort seemed to be based on a combination of disapproval of Biemer’s public portrayal of the autopsy as a nasty, messy, undignified procedure and on the perception his article displayed contempt for their profession.
Biemer is in the early stages of his training as a pathologist. He’s chosen to portray for the general public what that’s like. I see nothing wrong with that. I commend it. I think it’s good for people to know something about what doctors in training go through.
He doesn’t like every aspect of pathology. I don’t, either. He says autopsies aren’t pretty. When I was a medical student studying obstetrics, I didn’t think all the blood and pain I saw in the delivery room was pretty. But a woman’s labor is beautiful for what it achieves.
From reading his article, it doesn’t appear he’s ever worked in a medical examiner’s office. If he ever does, he might come to see that autopsies are beautiful for what they can achieve.
Like Biemer, I didn’t like hospital autopsies. In hospitals, autopsy techniques are taught by rote. There’s too much emphasis on procedure and too little on critical thinking.
Residents are taught to measure pupils – a meaningless observation after death. They’re taught to run the bowels every time. Why? Who cares if somebody shot in the head had a colon polyp?
Forensic pathology emphasizes the importance of anticipating and addressing unique questions raised by the individual case. It demands an awareness of the uncertainties inherent in the science. It teaches us humility, respect for the dead and reverence for what they can teach us.
I love it.
firstname.lastname@example.org Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland.