by Lane Baldwin, MS4

Mr. B died suddenly in his sleep on a Monday morning.  I had met him only a couple of times, but I knew that he was my Dad’s age, enjoyed Turkish food, loved to travel, and spent at least several days a week climbing the Colorado mountains just beyond his backyard. Meg, his daughter, was one of my best friends in college. I received the news of his death in a text message from her the night before an exam. I took 5 minutes to acknowledge her loss, sputter some hopefully comforting words, and went back to studying for my dermatology final. Later, I received the details: there would be a funeral, and there would be an autopsy. How interesting, I thought. I was about to observe an autopsy for a school requirement later that week. I nearly mentioned this irony to Meg, but that seemed insensitive.

I had been dreading the autopsy experience all year. My only prior experience with death was my first year anatomy course.  I distinctly remembered the first day of anatomy lab, showing up to a sterile, fluorescent room full of body bags. After changing into a stolen pair of surgical greens and a borrowed lab coat in the bathroom, I took a quick second to indulge my vanity and look at myself in the mirror. Dang, I look like a real doctor. As uncomfortable as I was anticipating the next several weeks in the cadaver lab, maybe if I looked the part I would eventually adapt.

When prompted to unzip the body bags, I remember retreating to the wall behind me, allowing its cinderblock support to help me stay vertical while we examined the body. She was an obese African American lady who bore an uncanny resemblance to my old next-door neighbor. Our instructor had encouraged us to identify the cadaver’s scars, painted fingernails, and other subtle indicators of who she was as a person prior to death.  Shortly after taking a second to acknowledge that a human life had once occupied our specimen, we started to cut. It was only after this initial incision that I felt comfortable stepping away from the wall.  I did so because I was expected to partake in this exercise to pass the course, but also because I was curious about what lay beneath her skin. Like being expected to don my first pair of scrubs, I felt like cutting into her skin was like accepting an invitation to an elite and mysterious world, wherein I got to learn intimate secrets that only a privileged few are allowed to know.  With that, a fascination and obsession with the macabre developed over the course of the semester. I got comfortable with the constant scent of formaldehyde in my hair and loved sharing what I had seen in the lab with my parents and roommates over dinner, taking sick pleasure in the fact that I derived joy from something they found so abhorrent. I expected that my autopsy experience might be similar: a brief moment of discomfort, ultimately overshadowed by the gruesome curiosity that I have since come to accept as an important part of my initiation into the medical field.

Once inside the State Medical Examiner’s Office on autopsy day, we were shown to a locker room and instructed to change into scrubs.  As on that first day of anatomy, the group of students I was with gleefully commented on how much we looked like the “real doctors” we were so much closer to becoming, now almost halfway done with medical school.  After changing, we were ushered into another sterile, fluorescent laboratory room, where our specimen lay resting in a body bag. Once we had all filed in, the autopsy technician gave us a brief history: “The patient is a 31 year old male who was discovered dead in his apartment by his wife. He had a history of substance abuse, and several beer cans were discovered at the scene.” Next, the body was removed from the bag.  Actually, more to the point:  the physician shook the body from the bag.

Let me digress.  Much to my chagrin, most of medical writing is done in the passive voice. As any self-respecting English major will tell you, this is the grammatical cardinal sin.  As much as adapting this dialect fills my formerly literate self with sadness, I have enjoyed indulging my analytical side to theorize on this convention. The passive voice is rooted in dissociation. When thinking about a medical write-up, the purpose for this dissociation is multi-fold. On both a pragmatic and emotional level, there are scenarios that we dictate in medicine where it is critical to remove the doctor from the narrative. Borrowing the succinct words of an especially eloquent physician mentor, “shit happens.” And when it does happen, it’s important to remove yourself from fault that isn’t yours. Especially in a field where life, death, discomfort, and a slew of misfortunes are all too often intrinsic to a doctor’s good work, the passive voice acts as a linguistic analgesic, numbing the painful implication of responsibility while reminding the dictator of his or her limited scope of control in a random and unpredictable world. Perhaps this is overly analytical, but it has helped me come to terms with my place in this career path.

As such, I have become relatively comfortable embracing the passive voice. My actions sometimes veer uncomfortably close to causing harm to another: needles have painfully penetrated skin and corpses have been maimed by the work of my hands. However, this was all done in homage to Hippocrates’s pursuit of doing no harm: providing a vaccination, learning pathology on a deceased body so that I can one day save a life.

The beginning of this autopsy transcended the initial discomfort that I had in anatomy, and crossed into the territory of violation. There was something unnatural about the brutal, violent action of this peaceful man—I’ll call him “Joe”—being thrust from a body bag, his dead weight falling with a sickening ‘thud’ on a metal table, his underwear and chest wall being nonchalantly ripped off of his body and tossed aside. I finally had a very graphic visual of what “beating a dead horse” must look like, and I kept thinking of Mr. B and how I didn’t want anyone to do this to him.

The rest of the autopsy (or at least what little I could stand to watch) proceeded in a similar fashion: organs were thriftily removed from the body cavity as Joe was sectioned off and gutted. After being removed, his organs were weighed and documented. I remember very little about the rest of this process, as I was very actively trying to stay vertical with the assistance of a metal table, on which Joe’s plaid Hanes underwear had been thrown. However, I do remember that his brain weighed 1501 grams, which struck me as an oddly poetic number. Apparently, 31 years of thoughts, memories, and feelings weigh in at 1501 grams.

After exhaustively analyzing the evils of the passive voice earlier in this piece, it seems hypocritical to offer no strong conclusion to this experience. While I acknowledge the literary misdemeanor, I also feel the need to reflect the reality of the situation. After two hours in the pathology lab on a Thursday morning, I still don’t know why a woman came home to find her 31 year-old husband dead. Nor can I explain why I still take pleasure in mutated pathology specimens, but cannot get the vacant, desperate, dead stare of this patient or the sickening, shiny ease with which his organs slid from of his body out of my head. I do know that brain size has nothing to do with intellect or life experience, but I also know that I am oddly comforted by the fact that an average human brain postmortem weighs 1300 grams, and my patient’s brain weighed 1501. The scientist in me knows better, but I like to imagine otherwise; that perhaps that extra brain weight was due to what for Joe was the equivalent of a love of ethnic food, travel, and mountains.