Dr. Brand (not his real name) was an aggressive young surgeon nicknamed 007" because he was licensed to kill.
No case was too difficult, no patient too frail for surgery because a chance to cut is a chance to cure."
During residency, the elderly man whose examination was one of my first autopsy rotation assignments was Dr. Brand's
The dead man's yellow skin was sprinkled with tiny red dots indicating blood was leaking from innumerable skin
capillaries - a sign of overwhelming infection.
He'd been fed by a tube in his stomach, hydrated by tubes in his veins, oxygenated by a tube in his throat, medicated
through tubes in his arms, his fading blood pressure was monitored by a tube near his heart and his urine was drained
by a tube in his bladder.
Blood oozed from needle sticks and catheter sites. His legs had swelled so massively that, to prevent the skin from
bursting, Dr. Brand made long, deep incisions, packed them with antiseptic-soaked gauze and left them open to relieve
The surgical incision on his belly was massively infected. The inflamed flesh couldn't heal, and the incision had come
apart at the seams, exposing his organs. This, too, was packed with betadine gauze.
The problem that brought this man to such a state was a leaking aortic aneurysm. (An aneurysm forms when a weak place
in the wall of a blood vessel balloons under pressure and thins until catastrophic rupture is imminent.)
Old, frail patients rarely survive the surgery to replace a leaking aneurysm with a graft, but Dr. Brand was determined
to try. Without surgery, his patient had hours at most. With it, he survived - in a coma in the intensive care unit -
for almost a month.
When Dr. Brand demanded to attend the autopsy, the staff pathologists rolled their eyes.
Concerned that dealing with him was beyond the skills of a wet-eared resident, Dr. Clark, one of the senior
pathologists, performed the autopsy while I watched.
Dr. Brand, a tall, beefy man, strode into the autopsy suite, fixed Dr. Clark with a glare and demanded to know the
exact site at which the fatal infection had entered his patient's body.
Glancing with disbelief from Dr. Brand to the body with its open incisions, innumerable tubes and oozing catheter
sites, Dr. Clark, a much smaller man, laughed in his face.
Even as a resident, I knew a determination like that was impossible. Germs swarm through every break in the skin, and
they do so regardless of antiseptics that only marginally cut down on their numbers. Only a vigorous immune response
(which the old and infirm often can't mount) prevents a lethal, spreading infection.
Faced with the scorn of a much older and more experienced doctor, Dr. Brand beat a flustered retreat.
Dr. Clark bent to his task, shaking his head. What an idiot," he muttered.
Pathologists know autopsies can't answer all questions. I have such cases all the time.
It's always a disappointment.
Dr. Carol J. Huser, a forensic pathologist, has served
as La Plata County coroner
since January 2003.