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To See for One’s Self

The art of autopsy has a long history and an uncertain future

Darin L. Wolfe

On a gray November morning during my pathology internship, I stood alone in the morgue of Indiana University Hospital amid the gentle buzzing of fluorescent lights and the steady drip of a faucet into a stainless steel sink. A recently deceased woman lay on the metal table, her skin pale yellow and smooth. She still wore earrings, a wedding ring and makeup. Plastic tubes and IV lines protruded from her body—the last throes of medical intervention.

2010-05WolfeF1.jpgClick to Enlarge ImageWith a sense of awe and excitement, I readied myself to perform the ancient ritual of autopsy. Although I had seen dying patients as a medical student, I had not been the lone person in a room with a dead body since dissecting a cadaver in my first year of medical school. There is the stillness of inactivity, and there is the manic stillness one experiences at these moments. Adrenaline amplified the physiologic responses of my body. I became aware of my breathing, the rushes of warm air crinkling my paper surgical mask, and the thumping of my heart as its pace increased. Although the body before me was now as unfeeling and inert as any other inanimate object in the room, I sensed the life this woman had lived, as a young wife, daughter, perhaps sister or mother, now mourned after a long battle with disease. I struggled to let go of my innate aversion to death, accept its finality, and separate the person from the body that remained.

Focusing on my task, I performed the standard external examination, the pathologist’s counterpart to the traditional physical exam a family doctor, internist or surgeon might perform. While preparing my opening cut, I found a prominent, grapefruit-sized lump where the shoulder meets the upper chest. I steadied my hand and pressed the blade against the skin, puncturing the epidermis and deep soft tissue until the scalpel hit bone. The skin retained enough elasticity to recoil from my blade, and I quickly completed the series of cuts to create a Y-shaped incision on the chest and abdomen. I examined the tissues of the chest wall, which revealed a fleshy mass of disorganized white tissue that extended from within the breast into the underlying skeletal muscle and ribs with an implacable grip.

This was the nature of cancer, perfectly illustrating the etymology of the word, from karcinos, crab. The name was coined by the great Greek physician Hippocrates, based on the tendency of infiltrative malignant tumors to spread in stellate, finger-like projections that resemble a crab’s legs and claws. The word autopsy, from the Greek meaning “to see for one’s self,” expressed my experience here, developing my understanding of malignant tumors with my own eyes, a skill I would cultivate for the remainder of my career as a pathologist. It was a humbling episode to see such a personal, flagrant and advanced display of this illness in a woman of my own age. I felt honored to be the only one to lay eyes and hands on the very substance of the disease that had brought this woman to her death. I also felt a sense of connection with the physicians of eras long past who took the leap from merely observing the surface of a body to seeing what was within. Such discovery is the purest form of medicine, when a clinical condition can be directly linked to observed physical manifestations. And although the gross and microscopic features of cancer and other diseases have likely had a similar appearance in humans over time, the ways in which we discover and interpret their causes have changed dramatically.

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