08 Examination of the organs of the trunk (Autopsy - A Screenwriter's Guide)
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This article is from the Autopsy - A Screenwriter's Guide FAQ, by Edward O. Uthman uthman@neosoft.com with numerous contributions by others.
08 Examination of the organs of the trunk (Autopsy - A Screenwriter's Guide)
At the dissection table, the prosector typically dissects
and isolates the esophagus from the rest of the chest
organs. This is usually done simply by pulling it away
without help of a blade (a technique called "blunt
dissection"). The chest organs are then cut away from the
abdominal organs and esophagus with scissors. The lungs are
cut away from the heart and trachea and weighed, then sliced
like loaves of bread into slices about one centimeter thick.
A long (12" - 18"), sharp knife, called a "bread knife" is
used for this.
The heart is weighed and opened along the pathway of normal
blood flow using the bread knife or scissors. Old-time
pathologists look down on prosectors who open the heart with
scissors, rather than the bread knife, because, while the
latter takes more skill and care, it is much faster and
gives more attractive cut edges than when scissors are used.
The coronary arteries are examined by making numerous
crosscuts with a scalpel.
The larynx and trachea are opened longitudinally from the
rear and the interior examined. The thyroid gland is
dissected away from the trachea with scissors, weighed, and
examined in thin slices. Sometimes the parathyroid glands
are easy to find, other times impossible.
The bloc containing the abdominal organs is turned over so
that the back side is up. The adrenal glands are located in
the fatty tissue over the kidneys (they are sometimes
difficult to find) and are removed, weighed, sliced, and
examined by the prosector.
The liver is removed with scissors from the rest of the
abdominal organs, weighed, sliced with a bread knife, and
examined. The spleen is similarly treated.
The intestines are stripped from the mesentery using
scissors (the wimpy method) or bread knife (macho method).
The intestines are then opened over a sink under running
water, so that all the feces and undigested food flow out.
As one might imagine, this step is extremely malodorous. The
resultant material in the sink smells like a pleasant
combination of feces and vomitus. The internal (mucosal)
surface of the bowel is washed off with water and examined.
It is generally the diener's job to "run the gut," but
usually a crusty, senior diener can intimidate a young first-
year resident prosector into doing this ever-hated chore.
Basically, whichever individual has the least effective
steely glare of disdain is stuck with running the gut.
The stomach is then opened along its greater curvature. If
the prosector is lucky, the patient will have not eaten
solid food in a while. If not, the appearance of the
contents of the stomach will assure the prosector that he
will not be eating any stews or soups for a long time. In
either case, the smell of gastric acid is unforgettable.
The pancreas is removed from the duodenum, weighed, sliced
and examined. The duodenum is opened longitudinally, washed
out, and examined internally. The esophagus is similarly
treated.
The kidneys are removed, weighed, cut lengthwise in half,
and examined. The urinary bladder is opened and examined
internally. In the female patient, the ovaries are removed,
cut in half, and examined. The uterus is opened along either
side (bivalved) and examined. In the male, the testes are
typically not removed if they are not enlarged. If it is
necessary to remove them, they can be pulled up into the
abdomen by traction on the spermatic cord, cut off, cut in
half, and examined.
The aorta and its major abdominal/pelvic branches (the
renal, celiac, mesenteric, and iliac arteries) are opened
longitudinally and examined.
Most of the organs mentioned above are sampled for
microscopic examination. Sections of the organs are cut with
a bread knife or scalpel and placed in labeled plastic
cassettes. Each section is the size of a postage stamp or
smaller and optimally about three millimeters in thickness.
The cassettes are placed in a small jar of formalin for
fixation. They are then "processed" in a machine that
overnight removes all the water from the specimens and
replaces it with paraffin wax. Permanent microscopic
sections (five microns, or one two-hundredth of a millimeter
thick) can be cut from these paraffin sections, mounted on
glass slides, stained, coverslipped, and examined
microscopically. The permanent slides are usually kept
indefinitely, but must be kept for twenty years minimum.
Additional small slices of the major organs are kept in a
"save jar," typically a one-quart or one-pint jar filled
with formalin. Labs keep the save jar for a variable length
of time, but at least until the case is "signed out" (i.e.,
the final written report is prepared). Some labs keep the
save jar for years. All tissues that are disposed of are
done so by incineration.
A note on dissection technique: All of the above procedures
are done with only four simple instruments -- a scalpel, the
bread knife, scissors, and forceps (which most medical
people call "pick-ups." Only scriptwriters say "forceps").
The more handy the prosector, the more he relies on the
bread knife, sometimes making amazingly delicate cuts with
this long, unwieldy-looking blade. The best prosectors are
able to make every cut with one long slicing action. To saw
back and forth with the blade leaves irregularities on the
cut surface which are often distracting on specimen
photographs. So the idea is to use an extremely sharp, long
blade that can get through a 2000-gram liver in one graceful
slice. Some old-time purist pathologists actually maintain
their own bread knives themselves and let no one else use
them. Such an individual typically carries it around in his
briefcase in a leather sheath. This would make an excellent
fiction device, which, to my knowledge, has not been used.
Imagine a milquetoast pathologist defending himself from a
late-night attacker in the lab, with one desperate but
skillful slash of the bread knife almost cutting the
assailant in half!
Note on the appearance of the autopsy suite: Toward the end
of the autopsy procedure, the room is not a pretty sight.
Prosectors vary markedly in how neat they keep the
dissection area while doing the procedure. It is legendary
that old-time pathologists were so neat that they'd perform
the entire procedure in a tux (no apron) right before an
evening at the opera (pathologists are noted for their love
of classical music and fine art). Modern prosectors are not
this neat. Usually, the autopsy table around the patient is
covered with blood, and it is very difficult not to get some
blood on the floor. We try to keep blood on the floor to a
minimum, because this is a slippery substance that can lead
to falls. The hanging meat scales used to weigh the organs
are usually covered with or dripping with blood. The chalk
that is used to write organ weights on the chalkboard is
also smeared with blood, as may be the chalkboard itself.
This is an especially unappetizing juxtaposition.
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