When my classmates find out what I chose for my two week advanced science selective I usually get a grimace in response and “How’s that going?” or a grunt and “I’m sorry.” For the amount of time we have spent third year with sweaty, infectious, and self-soiled bodies one would assume that my peers would be more or less accustomed to the various odors a body can generate and its numerous liquids. Because the person is dead--not merely close to death--there is some psychological negotiation that occurs that makes them conclude that the blood in a living patient is more pristine than the blood in a dead patient. Perhaps it’s a matter of degree. In a surgery the fluids are minimized and the environment kept sterile; it is almost militaristic in the discipline and order it demands of its participants. A bowel is exposed and excised but only slowly, gradually while all else remains hidden. In autopsy when the bowel is exposed the chest plate is already removed with heart and lungs openly ready for extraction. When the elderly are admitted to the hospital, sometimes there is the recognition that he or she may never leave. In a sense we are all decomposing but some more quickly than others. That these corpses are so much closer to dust than any living being (no matter how questionable that degree of life is) may act as an affront to our own mortality.
The renowned philosopher Julia Kristeva discusses in Powers of Horror the idea of abjection and the reaction that takes place (vomit, shock, fainting) when confronted with the breakdown in meaning due to the loss in distinction between the subject and object. In other words there is a breakdown in symbolic order and distinctions between other and self start to disappear. One particular example that she uses is when a person first sees a corpse. “Corpses show me what I permanently thrust aside in order to live. These body fluids, this defilement, this shit are what life withstands, hardly and with difficulty, on the part of death. There, I am at the border of my condition as a living being...The corpse, seen without God and outside of science, is the utmost of abjection. It is death infecting life. Abject.” When we see a human corpse our own eventual death is made that much closer, that much more of a reality. The state of being dead encroaches into our state of living and is what we find so revolting.
However, in my own experience of observing autopsies, I would say that it is different now that I have completed my third year than when I completed my first year. Two years ago I mentally equated the autopsies I saw at the medical examiner’s as fresher versions of what I had seen in my anatomy course. Having spent significant time on the wards and seen people at the border between life and death, autopsies have a stronger emotional as well as medical valence. Bodies are the manifestation of normal and aberrant physiology and anatomy. But these anomalies and normalities are also indexical of the life they lived. A shrunken kidney with significant nephrosclerosis might simply indicate uncontrolled hypertension and years of dialysis. A cirrhotic might indicate years of alcoholism, which one can think of as an isolated disease process or a symptom of larger societal issues. Pale substangia nigra is not simply Parkinson’s disease but also the 72 year old man who went to clinic every week at Bellevue to have his Sinemet adjusted before he was finally hospitalized and passed.
As someone who plans to go into Pathology, I’m sure the Autopsy will continue to evolve for me. I’ll probably be able to elucidate and connect more of the pathophysiology with the anatomical findings instead of being overwhelmed with the idea that I’m helping to cut a dead person’s pancreas or that my gloves are stained in blood and bile. It’s a part of medicine and medicine is rarely ever glamorous.
