Tag: Autopsy

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It’s Fine Until Someone Gets Slapped

When people find out where I work, their reaction is usually the same. First, it doesn’t completely register. “Oh, interesting.” And then the follow-up question: “What do you do there?” After I tell them that I x-ray human remains, it takes another second for that to sink in. “Oh. OHH!”

I’ll admit that this reaction is a little unusual to me, but that’s because I’ve spent so long researching this line of work that the connection just seems obvious. You work in the morgue, therefore you work with the dead. At least in some capacity.

What usually follows the “ah-ha” moment is one of the following statements:

  • “But you’re so small”
  • “But you’re so nice”
  • “But you’re so quiet.” (My personal favorite.)

I can see why people would think my size influences my ability to work with the dead, but my sound level? I don’t quite understand that one.

Even after all of that, a lot of people still don’t really understand what it is I actually do in the morgue. In this post, I’ll walk you through a typical day.

Elevator pitch: Got dead people? Then you need x-rays! Shave minutes off of autopsies with your very own set of radiographs! Locate bullets faster. Age fractures more accurately. Is that a nickel in the right lung?! No problem!

Heh.

More accurately, I assist pathologists pre-autopsy by providing images of pathologies and traumas. X-rays offer a helpful roadmap in cases where foreign objects or bullets are involved. They also help determine the age of injuries: is this a new fracture or an old one? If new, did it contribute to the person’s death? Additionally, x-rays provide valuable legal documentation, which is important in homicide and abuse cases.

I’ve mentioned previously that we have certain protocols to follow when it comes to determining which bodies warrant x-rays. The first thing I do is read through all the investigation reports to learn the initial details surrounding an individual’s death. As I’ve said, every suspected homicide gets x-rays. This includes gunshot wounds and stabbings. Other cases needing x-rays include falls, motor vehicle accidents, drownings, fires, unknown bodies, and decomposing bodies.

We work in teams of two and each one has a specific role. One person is the “driver” and the other is the “runner”. As the driver, you operate the equipment and make sure everything is loading properly in the computer. You’re also responsible for annotating all of the images and keeping track of the number of x-rays taken and any bullets or foreign objects found.

As the runner, you’re responsible for tagging all of the bodies in the body cooler. This lets the pathologists and their techs know which individuals are going to x-ray. It also makes it easier for you to find the next case. Gunshot wounds take priority and get a red card, while everything else gets a yellow card.

I find this process unsettling at times. Usually it’s just you alone in the body cooler. At any given time, I’d estimate that there are close to 200 bodies in there. Many of them are being stored or awaiting transport to a funeral home. Only about 20-30 are actual cases for the day. You’re literally surrounded by death. It’s a heavy realization so early in the morning.

A co-worker likes to use this time to introduce herself to our cases. I’ve, on occasion, will say good morning to the cooler’s occupants. Sometimes talking while in there calms my nerves. Other times it makes me irrationally worried that I might hear a “good morning” in return.

The runner also transports the bodies to and from the x-ray room and positions the body for imaging. Obviously the runner is much more hands on with the bodies. This doesn’t usually bother me, but some cases are more difficult to stomach than others. More on that later.

By default, every individual requiring x-ray will get at least one skull and one chest image. Most cases will get the standard protocol: skull, chest, abdomen, pelvis. Any area of trauma will also be imaged. In the event that the person is unknown, in addition to the standard protocol, we will take an x-ray of every long bone in the body: hands, forearms, arms, thighs, legs, and feet. All of these are performed with the body lying supine (on the back). These are called AP views.

When there are bullets involved, we look for entrance and exit wounds. We cross our fingers for exit wounds because that means the bullet is no longer inside the body. This is good because we don’t have to do additional x-rays, and the pathologist doesn’t have to remove a bullet. But when there is no exit wound, we have to turn the body and get lateral views, meaning that the x-rays enter the right side of the body and exit the left side. This is different from the AP views, which enter the anterior (front side) and exit the posterior (back side).

When you’re the runner, positioning for the lateral views falls on you. Most of the time it will require both technologists because many of the bodies are large. Let’s say someone was shot in the chest and they’re still holding a bullet. A lateral view will help a pathologist determine if the bullet is closer to the anterior or posterior surface. In order to get an unobstructed lateral view of the chest, the arms must be pulled above the head.

Did you read my post about decomposing bodies? If you did, then you know that most bodies on my x-ray table are in the rigor mortis stage of decomposition. This means that their muscles are severely contracted and moving extremities is very difficult. Nevertheless, it must be done. This is my least favorite part of the job. Not only do I feel like I’m always losing a very strange arm wrestling contest, but as the arm is pulled, there are cracks and pops. Occasionally you’ll dislocate a shoulder (theirs, not yours). And in cases where there is a lot of trauma to the arm, pulling it over the head can worsen the damage.

When the arms are successfully over head, they don’t always stay there. When you break rigor mortis, the muscles become more pliable. So when you put a body part somewhere, say an arm, it doesn’t always stay. Smart techs will use rope and sandbags to hold them in place. I? I am not a smart tech.

During a recent case, we had just taken a lateral chest x-ray. I was holding the body up on its side until the x-ray appeared on screen. You don’t want to move a body out of the lateral position until you’re sure you got the image. “All clear.” So I began to roll the body onto its back. As I did, the right arm began to leave its overhead position and swung down to slap me in the face.

F-word.

This is not unusual. In fact, it’s somewhat of an initiation for x-ray techs in the morgue. I hear the other is to have a body fall off the cart. I pray to the powers that be that it never ever happens to me.

Ever.

What made the slap worse was that it happened on the day I decided to take my mask off because every time I breathed it made my glasses foggy. Sigh.

Laterals are usually saved for last because of the likely chance that you’ll get a hand to the face. Or boob. Or ass. Death has no boundaries.

When we’re finishing up our x-rays, the pathologists are just starting their autopsies. We return to the radiology office and hang out until the autopsies are done, just in case a pathologist requests additional views or asks for help locating a bullet. When that happens, the pathologist will bring a body back to the x-ray room. I hate this because the body has already been dissected. Their chest and abdominal cavities are open, void of all their organs. Often times the skin around the skull has been pulled back and the brain is missing too.

It’s an odd feeling. Hours ago, there was a complete person on my table. Aside from whatever trauma they came in with, they were intact. They were whole. Now the shell is broken. The weight of the job is something I still struggle with. The separation of the person from the body doesn’t always happen instantaneously. Instinctually, I feel bad because the body is missing the parts that made it go: the heart and the brain. But I have a job to do so I must quickly flip the switch, disconnect, and see just a vessel. Not a person.

When all is done, we clean up the room. Any blood that reaches the floor stays there until the janitor comes through after our shift, but we wipe down the machines and our table so it’s ready for tomorrow’s guests. We return to our office, sometimes in silence, but usually in conversation, trying to shed the emotional weight. It’s weird. Some days are easier than others. In the beginning, it was difficult not to bring any my work home with me (not in the literal sense). I’d close my eyes while in bed and see the faces of the day’s cases. It was very unsettling.

Talking about it helps. Writing and working through my feelings is cathartic. I’m getting better at creating and enforcing emotional boundaries. Viewing it as a learning experience also helps. I don’t know how long I will be able to work at the morgue. It’ll be a constant challenge and will require a continuous balance of empathy and distancing. For now, it’s just too damn interesting to quit. So we’ll see what happens.

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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?

Torn

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.

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Down Among the Dead Men

My interest in the medical field began in high school. Junior year to be exact. My anatomy class took a field trip to a chiropractic college to see a cadaver dissection. While we couldn’t get hands-on, I immediately took an interest in the topic of body donation and working in the medical field. (Side note: I have been meaning to write a post about my decision to donate my body. Hold me accountable.) It wasn’t until nearly six years after that class that I really began taking steps to make a career in health care a reality.

Long story short, in 2015 I enrolled in a 20-month radiography program—which is the reason why this blog has been quiet for so long. I graduated this past May and immediately began working. I purposely sought out part-time and temporary positions for a few reasons. One, because as a new grad, I had realistic expectations about my hireability (Is that a word?). Two, because I was interested in many modalities/settings and didn’t want to spend all of my time in just one. And finally, I hadn’t found the job yet.

But in July, I found it. The local morgue was looking for a part-time x-ray tech. I’m not talking hospital morgue. I mean the morgue that serves the second largest county (in terms of population) in the U.S. It was the least-desirable shift, but I had to apply. For years I had researched careers in forensic and pathology fields. I strongly considered going to medical school to become a medical examiner. I even toyed with the idea of mortuary school. I worked for an autopsy company and read dozens of books by pathologists, pathology assistants, crematorium and funeral directors, and so on. I had to get this job.

The tricky part was figuring out how to show my enthusiasm without coming across as creepy. I mean, I’d be working with dead bodies. No one should be that excited. But I really wanted this. I wanted it because I had to know if I was cut out to work in this field. I went in to interview, and at the end of it they asked if I wanted a tour. A tour of the morgue? Um, yes please. Unfortunately the autopsies had ended for the day, but I still got to see the rooms and the giant refrigerator where all the bodies are stored. I stood there asking question after question, trying to contain my excitement and solidify the fact that I’m most definitely a normal person with a very healthy curiosity.

Morgue
[source]

It turns out my questions didn’t scare them away because a few weeks later I was offered the job. It took weeks of background checks, medical screenings, and paperwork before I received my start date. In that time, my emotions ranged from excited to terrified to overjoyed to nervous to perplexed. I was happy that I had the job, but I was nervous that I wouldn’t be able to stomach it. Sure, I’ve worked with cadavers before and that never bothered me, but this is different. These people, some of whom have suffered horrific and tragic fates, are not embalmed. Not only that, but I’d work with bodies before they’re cleaned, before bullets have been removed, bodies that are in pieces or decomposing. What do bullet holes look like? What does a decomposing body smell like? Will I throw up? How will I emotionally handle murder and child abuse cases?

Panic set in. My anxiety took over and I began imagining every terrible scenario I could think of. Maybe I’d get locked in the body cooler. Or perhaps a body bag would start moving. I’d bump into the pathologist and mess up their autopsy. I’d vomit on the x-ray control board. Would I start questioning my own existence? If I see tragedy first-hand, would it weigh heavily on my soul? I thought I was ready, but the fear of the unknown had taken hold and there was no rationalizing it. I needed to get through my first day. I needed to smell the smells and see the sights. I wanted to see the worst of the worst so I’d know if this was something I could handle.

Ask and you shall receive. I’ll cover what my first week at the morgue looked like in my next post. Right now, I really need a shower because my hair smells like dead people.

**Unless specified (and granted permission) none of the pictures included in these posts are from my workplace. They’re found via Creative Commons.**