Lessons From An Autopsy (Warning: Graphic)

[LovingNurse, BSN, RN]

I pretty much knew what to expect as far as the autopsy process, so I felt prepared for the format I would see. I did not know what type of case I'd be seeing and just hoped it wouldn't be something that "hit too close to home" in my personal life. I knew my interest was a clinical one, but I also refused to allow myself to forget that my "educational experience" was also some family's horribly sad loss.

The case was a 30-year-old woman who was 2-weeks s/p excision of a suspicious lesion of her right great toe. While at home, she had a sudden onset of severe dyspnea and a witnessed collapse. The emergency crew was unable to resuscitate her. She had a reported history of calf tenderness x 3 days... so this was a suspected P.E.

First was the external body exam, belongings inventory, and photographs. Her ECG leads were still in place, as were the defibrillator pads and a surgical shoe on the post-op foot. Toxicology samples were obtained from the vitreous humor of each eye (which I chose not to witness) and blood from a femoral artery. Apparently, the vitreous humor provides a more accurate toxicology sample than does blood.

The autopsy technician did much more than I had expected. He did all the prep work, opened the skull, chest, removed the brain & many of the organs for an exam, etc. The forensic pathologist was on one side of the table and the technician on the other. They had very clear tasks and worked in tandem so quickly and methodically, that I literally couldn't watch both at once.

Intestines were tied off and removed, then each major organ was weighed, examined and sectioned. Tissues samples were taken. In the middle of all the (wet) tasks the technician was performing, he also jotted pertinent info down on a white slate with a grease type pencil.

In the process of removing the brain, the scalp had been pulled forward & down, covering the woman's face. This was actually helpful to me. Not seeing her face helped me focus on the clinical task at hand; determining what robbed this young woman of her life. When her face was exposed, my thoughts often veered toward the emotional aspects of the situation...Thinking about what her poor family must be going through, someone's wife, mother, daughter. I pondered what a gift life is, and how she was probably frightened about the malignant skin lesion, but never thought surgery on her toe would lead to her death... How different a day makes in the life of many people. How just 17 hrs ago she was very much alive...How sudden her death was...No time for "I love you," kisses, or goodbyes.

I felt a sense of validation and thankfulness about how my own family has a firm habit of giving kisses and saying "I love you" when we part each morning; for we truly never know when we will have shared our last opportunity to do so.

My thoughts drifted back to clinical thinking... How long did that calf hurt? Did she seek medical attention for it? The small incision was on the side of her toe...was it painful enough to immobilize her that much? Did she have an underlying clotting disorder? Was she on birth control pills or anything else that put her at increased risk for clots? Etc... etc...

The autopsy was a speedy process. Each organ was fascinating. The form and function of our anatomy is something that will never cease to amaze me.

Most of her lung tissue was dark black. The pathologist was not surprised when he opened the pulmonary vasculature and found a very large (and very long) "saddle embolus" straddling the two main pulmonary branches. Smaller emboli were found within each lung. Only a very small corner of lung tissue had retained the normal appearance of healthy lung.

Lastly, they turned the body prone and dissected the calf, where they found remnants of a long DVT still in place. After all tissue samples were prepared, the calf was sutured. The biohazard bag (containing her organs) was placed inside the chest cavity and the chest was closed. Skull closed. (

I left, not just with sadness for this woman and her family, but also with a huge amount of respect for what I'd just witnessed and gratitude for the lesson I learned through her tragic death. I've had patients with DVT and family with DVT, and have long been aware of the risks and need for prevention and/or intervention. Seeing her PE first-hand turned all the risks into images of sad reality. I have her face to put with the risk and diagnosis now. I know this will increase my vigilance when I care for my patients. I will not forget her. I will think of her when I encourage ambulation, apply SCD's and TED hose, give Lovenox, and check for Homan's sign. I will think of her when I educate my patients on risk factors and prevention, being extra sure they demonstrate an understanding of the warning signs and the need for prompt medical attention.

I have grown from her tragedy.