Week Two at West Virginia Deputy Chief Medical Examiner's Office

I can't believe that it has already been two weeks since I've returned to Morgantown and started this rotation. Time seems to be flying fast. I've resettled in with my former landlord and life here is snug as a bug. At least, as snug as a bug can be in winter.

This new rotation is exposing me to another side of pathology that is not often talked about in textbooks but is still an important function needed for society. That is the role of the pathologists' assistant in the morgue.

As you are probably already familiar, the morgue is the place where death investigations occur. There are two types of autopsies that are performed here. A body may be brought in as a 'medical examiner's autopsy' or as a 'hospital autopsy'.

If you've ever watched any crime show on TV, then you're probably already familiar with the 'medical examiner's autopsy'. Usually somebody discovers a body, the police get involved and want to know all about the cause of death. Despite all of the violent crimes that can be found on TV, the bodies that come into the morgue aren't all homicide victims with explicit gunshot or stab wounds. In fact, many show no external trauma at all. More often than not, only a thorough examination from head to toe and into the body can offer the clues as to how a person had the misfortune of coming to the morgue.

The hospital autopsy cases are where a person dies while at the hospital, usually of a long illness and the family members request an autopsy to document the extent of the disease. In these cases, the family members can limit how much and what the medical examiner does. The family members may request that the autopsy be limited to just opening the skull, for example.

Despite using our knowledge of the human body, the working environment of the morgue is quite different from the surgical pathology laboratory. In the lab, you are spending most of your time at a bench and dissecting a single specimen at a time. A great deal of focus, careful handiwork and attention to minute details are required. On the other hand, in the morgue you are on your feet and using your whole upper body. The bodies need to be moved from table to table, bones need to be cut through with saws, organs need to be picked up, weighed and so forth. There's a lot of upper body movement and you're using your torso and elbows to get at just the right angle to do the job.

Perhaps this is one reason why I've found the morgue to be more challenging than the laboratory. All throughout my life I have been a very meticulous, methodical and thorough worker. I always need to look at all of my options available and think long and carefully before coming to a decision. Every action has a calculated purpose. The morgue requires the opposite of all of these. In the morgue, time is more important than grace. The body in front of you is already dead, so there's no fear of hurting the body by handling it too strongly. A person needs to work quickly to eviscerate the body and remove its organs so that the next case can be looked at. I personally prefer to work slowly, carefully and methodically so working in the morgue is not just in opposition to my normal mode of work but also to my personality. I have been told more than once by the medical examiners that "You need to go faster. Just cut through it. Why are you making baby cuts? Just grab it and get at it.", but I am always concerned that if I go too fast I'll make a cut that I shouldn't have. I've never liked making mistakes and it is my fear of making a mistake that keeps me from working faster. I can only hope that in the coming weeks that I become more proficient and work more quickly without hesitation.

Another aspect of the morgue is the human side of each case. In the laboratory, you never have a face to put to your specimen. You are only given a name and medical record number. In the morgue, you are exposed to the entire person, all the way from the expression on their face to the last meal that they had. There is a very real human aspect to each case and you can't help but put yourself in their shoes. Upon looking at each body laying on that cold metal table, a wave of pity comes over myself. Whether they are young and athletic or old and frail, each one is reduced down to it's very naked basic self. It's a reminder that deep down inside, we are literally all made the same. Hearts, livers, lungs, kidneys, intestines, stomachs, brains etc... This is all that our bodies are when we pass on. One cannot help but feel a renewed gratitude for being alive after having worked in the morgue.