The Autopsy: A Lesson in Distance and Empathy

I have participated in my fair share of cadaver labs. Aside from the smell of formaldehyde, I wasn’t bothered by the experience. I’d often boast that I felt so comfortable inside of a cadaver lab that I could (and did) eat my breakfast in there.

During my first week at the morgue I was allowed to observe a couple of autopsies. By observe, I don’t mean in a comfortable and well-ventilated space outside of the autopsy room. I was in there, next to the pathologist, smelling the stomach contents and hearing the cracking of the ribs. At one point, I was handed a clipboard and asked to record the weight of various organs. How’s that for audience participation?

The autopsy itself didn’t bother me. Honestly, I didn’t expect it to. The thing that didn’t sit right with me was the nonchalant attitudes of the pathologists, residents, and photographers working in the room. This isn’t a bad thing. Not once did I get the impression that these professionals were being disrespectful. Rather, it felt like I was observing a conversation among coworkers around a water cooler—that just happens to be a steel table with a dead body on it. For them, this is just a normal part of their work day. The body on their table is probably the fiftieth, hundredth, or thousandth body they’ve worked on. The shock and novelty has worn off and muscle memory has taken over.

It’s one thing to read about autopsies, but it’s a whole other experience to actually watch one. Where I thought they’d surely struggle, they worked masterfully. Is that a weird thing to say about someone cutting open a human body? I hope it’s not inappropriate, but it reminded me a lot of a chef preparing an elaborate meal. Every cut planned and expertly executed. The process was extremely efficient, no doubt from years of practice. Are you thinking of Hannibal now? Fava beans… Sorry.

I was engrossed. I couldn’t take my eyes off of the resident’s hand. I have spent years studying the human body, so there was something morbidly satisfying about seeing muscles and organs only hours after blood flowed through them. The thing about cadaver labs is that everything is lifeless. That’s not to say things are lively at the morgue, but the bodies are, well, for a lack of a better word, fresh. There’s color, contrast, definition, and volume. In cadavers, bodies have already been embalmed. They’re drained, beige, brown, and flaccid. It’s very easy to forget that there was once a person in there. But at the morgue, there’s no doubt. If not for some discoloration and stiffness, you’d think the person on the table was sleeping. Okay fine. No one sleeps with their chest flailed open, but you know what I mean. Right?

My experience working at the morgue, so far, has been that of a game of tug-of-war. I am constantly fighting with myself to remain disconnected enough to not let what I see affect me too strongly, but empathetic enough to understand that there once was life here. This is someone’s someone.

What happened during my most recent shift is a perfect example of this. While reading the case reports, as we do at the start of every shift, I saw a self-inflicted injury on the list. Knowing we’d have to x-ray this person, I checked for scene photos. I like to know what I’m getting myself into, especially with suicides. In the picture on the screen, a middle-aged man lay face down, gun nearby. This is going to be messy. And I was right. There were six evidence cards scattered around the body. I was confused at first because the report said self-inflicted. There shouldn’t be six gun casings. There weren’t. The cards were indicating pieces of brain tissue.

When I finally got the body on my table, I reluctantly opened the bag because I knew this would be difficult to see. The man had shot himself in the head with a big enough gun to remove more than half of his brain. As I looked into the bowl that was once his skull, I was angry. How could he do this to his family? Why would he leave this horrific scene for them to come home to? But I didn’t dwell. There’s no room for emotions at the morgue. I quickly switched gears and my curiosity took over. Exactly how much of his brain was missing? Do we have all of the pieces? Where exactly did he put the gun to make this sort of wound? Is it possible for him to have an open casket at the wake? A tug of his neck here, a push of his body there, and just like that, the x-rays were done. I zipped him back up and wheeled him out to the cooler, saying nothing other than “I’m sorry” because I got his cart stuck between the wall and the freezer door.

Side note: I’m convinced that every body I x-ray is accompanied by their spirit and it’s watching me perform their exams. In the event that it’s true, I don’t want any angry spirits coming home with me because I couldn’t control the cart properly. So I apologize in hopes of appeasing an invisible entity that likely doesn’t exist. “Hey Jenn, tell us how you cope with working at the morgue because surely you’ve got to be a sane person to do that.” Sigh. But of ALL the places to be haunted, I mean, come on. I’m not crazy in thinking that we’re not alone in the cooler.

I digress.

The true test came when I had to x-ray not one, but two babies, neither of which were older than a couple of months. As I said in a previous post, when it comes to children, we handle them differently. They’re smaller and easy to carry. Why bring a giant metal cart if we don’t need to? As I unwrapped the body bag folded around this baby, my partner and I were commenting about intake’s folding skills. “This is how you should wrap a baby in a body bag.”

I’m not a mother, so I can’t even begin to fathom what it must be like to lose a child. When I saw this tiny human on my table, something inside of me hurt. I grabbed its tiny hand and squeezed, half-heartedly expecting to feel a squeeze in return. Every move was careful and delicate, despite being told again and again, “They can’t feel it”. With the x-rays done, I wrapped up the baby, folded the body bag around it, and carried it like I would a newborn. I rubbed its back and told it I was sorry that it didn’t have a chance to really live. I gently placed it back on its cart inside of the cooler, and then I left.

Do you see what happened with those two stories? With the gentleman who had killed himself, I acknowledged him. I referred to him as a “him”. In fact, in the x-ray room, I even called him by name. I almost always do, which really throws off the pathologists because they refer to everyone by medical ID number. But with him, I kept my distance emotionally and didn’t let myself get sucked into his story. However, with the child, I used terms like “baby” and “it,” yet I most definitely got emotionally involved. It’s a constant tug-of-war between distance and empathy. It’s interesting to see how this disconnect manifests itself. The heart and mind have very subtle ways of protecting themselves.

I have gotten way off track. I guess what I am trying to say is that while observing the autopsy, I also got to observe a brilliantly choreographed dance by the pathologists. There didn’t appear to be a jerky struggle between emotions, but rather a fluid waltz from cut to cut. Again, there’s no doubt in my mind that this is from years of experience. That said, they’re not impenetrable. They know that better than anyone.

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I created a new Instagram account: @afistfulofneurons. I get that not everyone who follows @bottlethecrazy wants to hear about my early mornings at the morgue or adventures at surgical science museums. My new account is private, but please follow along if you’re so inclined.