My First Autopsy

The importance of seeing the reality of death
MAR 2019
Jordan
H.
Harvard-MIT Health Sciences and Technology

As the autopsy technician split the cadaver’s chest open with a scalpel, a part of my identity that I had wrestled with since my undergrad finally settled into focus.

I have absolutely no desire to become a doctor.

This has not always been the case. Like many of my peers, I had started my undergraduate career at Cornell on the pre-med track, intending to pursue an MD-PhD with the long-term goal of becoming a physician-scientist. Also like many of my peers, these pre-med dreams were laid to rest during my sophomore year of college upon the realization that I was more interested in building new tools for the clinic than in practicing medicine (it may have also had something to do with a strong dislike of organic chemistry).  Curiosity surrounding some aspects of the medical school experience lingered in the back of my mind, but I was content to leave them there.

My interests led me to the Medical Engineering and Medical Physics PhD at the Harvard-MIT Health Sciences and Technology program. As students, we are enrolled at both Harvard Medical School and MIT, and have the opportunity to engage with some of the greatest researchers and physicians of our time. The program has a strong clinical focus, allowing us to participate in many rites of passage typically reserved for MD students, such as clinical rotations and wearing those fancy white coats.

Yet somehow, in all of my research and excitement around applying and being admitted to this program, it never occurred to me that I would have to perform an autopsy.

That is, until I walked into my  first day of Pathology, and learned that doing so comprised 20% of my grade.

"Perform" is a strong word. In reality, I had to be present while someone else performed it, with the option to assist where needed if I chose to. However, I'd never seen a dead body before, let alone poked around inside one. Watching crime dramas like CSI and Bones growing up had led me to expect that it would be a gory and emotionally taxing process of understanding how someone was violently killed. Also, everyone would be really attractive, no one would wear face masks or safety glasses, and there would be 3D holographic reconstructions of exactly what happened to the person, down to the street corner where they died.

I would soon learn that this was not exactly accurate.  

For the record, we weren't thrown into the deep end without any preparation. The course had a dedicated lecture on how and why autopsies were performed, as well as a visit from the former Chief Medical Examiner of Massachusetts to discuss some of the autopsy cases that he worked on. We were broken up into small groups, with a mix of MD and PhD students in each one. My group was near the end of the list, so I was able to talk to fellow PhD students about their experiences, which were all extremely positive, and occasionally involved listening to the Mamma Mia soundtrack as they collected leftover fluids from the abdominal cavity. We poked and prodded at hearts and lungs and brains from real people on a regular basis, so if you put it all together, I’d already seen the worst of it.

In spite of that, from the first pathology lecture to the day that our pager went off, I found myself oscillating between excitement and mild terror. On one hand, the curiosities in the back of my mind would finally be explored! On the other hand, it was the first time in my life that my education had necessitated the death of another person, and that idea weighed heavily on my conscience. I had dreams about what it might be like, and often had to consciously force myself to focus on something else when my imagination would get the best of me. Of all of the challenges of being a first-year PhD student, nothing stressed me out like this did.

I was surprised to find myself calm and collected when I first walked into the autopsy suite. For the sake of brevity, your stomach and HIPAA, I won't go into the details, but I can definitely say that it was a positive experience. We started by checking the wrist and toe tags on the body to make sure we were working on the right person, something that I’d never thought about but which obviously made sense, and writing down any initial observations about the skin. From there, it was a whirlwind of making that initial Y-shaped cut, peeling the skin away from the ribs, and removing the organs for inspection and weighing.

Both the resident and the autopsy technician talked us through each step in the process, and I found myself fascinated as much of the information that I had learned in my pathology class was being connected in front of me. While our autopsy did not involve listening to showtunes (which was probably the only part that truly disappointed me), it did help me better understand and respect one of the fundamental parts of life that is rarely discussed — death. It’s hard to say exactly why, but I think most of us can agree that there has always been something unfathomable about the idea of dying. Having the opportunity to stare down death and unravel the process that had led to it left me feeling a bit better about that uncertainty.

I still have absolutely no desire to become a doctor, not only because pathology residents have to perform 50 autopsies over the course of their education, but because my passion for technology has led me down a different path. This was a unique experience in my education, and I am content to keep it that way. However, as someone who wants to develop technology that has the potential to save lives, I think it’s important to see the reality of death.

Of course, this isn’t the last time I’ll poke and prod at organs, limbs, or bodies. Next semester? Brain dissections.