Tuesday, January 14, 2014

Down the Drain [Warning: Graphic/Disturbing]: Part 2 of 2

At about 10am the trainer looks at his watch and says, "Okay, kids...wanna go watch an autopsy?" People chatter and shift in their chairs at this.

"How many of you have seen an autopsy before?" he asks.  Three or four of the 50 or so rookie cops in the room raise their hands.  "Well, this should be fun, then."  The trainer walks toward the door and continues to speak.  "Follow me.  If you start to feel sick or dizzy, raise your hand and somebody will escort you out of the post room."  People start following him out the door.  "Oh," he says, "and don't forget to breath through your mouth."  He has a wicked gleam in his eye as he says it.

Core looks at me and rolls his eyes.  "I'm going back to the office," he says.  "I had to assist with autopsies at my old job and I don't need this."  He waits a beat.  "You coming?"

I shake my head.  "Nah.  It's always fun being there when people watch their first autopsy.  Plus, I might learn something new."

Core shrugs and breaks off from the group, heading back toward the Investigations division.  So, me and a whole lot of nervous young men and women walk through Intake and pause outside one of the three autopsy rooms.  We put on masks and booties and then push through the heavy double doors.  There are six stations set up in each room and they are all occupied.  One body is already up on blocks, the chest cavity elevated and open in the usual Y-shaped incision.  The chest piece has already been removed and is lying on a drain board next to the sink.  Another body, that of a wizened old man, lies naked on a tray being photographed by an autopsy technician.   Still another body, this one very tiny, lies under a sheet in one corner.  My heart squeezes and I look away.

We barely file in when two young men turn on their heals and walk back into the hallway.  Hmmm, I think to myself, forgot to breath through their mouths, I bet.  There is a huge chunk of olfactory information that you just can't get from watching a true crime or forensics show.  That, in addition to the visual assault of seeing mutilated bodies, can be too much for some people.  Smells have a way of triggering us on a visceral (har har) level.  They stimulate parts of the brain that would otherwise lie under the surface of our conscious control.  There is something primitive and maybe even terrifying about the smell of human blood and decomposition that often catches people off guard.  For me, it's such a strong instinct that, to this day, I can't walk through the meat department at a grocery store without feeling a strong sense of aversion.

Half the group is in one suite and half is in the other.  I walk through the breezeway between the rooms to see what's happening on the other side.  There is a cluster of observers around a table in the far corner.  I walk around the edge until I'm almost behind the pathologist.  On the table is a small woman.  She's a very young and very pretty girl with Hispanic features...medium skin, dark eyes, dark hair.  She's got multiple inexpensive, possibly homemade tattoos all over her body and it occurs to me that she's very young to have accumulated that much ink.  They haven't started the post yet, so her nude body is only marked by the injuries that brought her to the Big City morgue.

I see a laceration about two inches wide running from the outside of her right eyebrow and into her temple.  It's an ugly wound but would not have killed her.  The bone in that part of the skull is very thick and it looks like the blade glanced off of it.  I look at her left hand and see that her middle and index fingers have deep defensive wounds in them, as if she used her hand to try and block the blade coming at her face.  Again, a serious injury, but not something that would kill her.  As I am thinking this, the doctor, who is noting all of these injuries carefully on a body chart, asks the autopsy tech to roll her over.

As her body is unceremoniously turned, I see an inch-long gap between the ribs on the left side of her back...just under her armpit.  The wound is an elongated tear-shape, which tells me the knife used had a single sharp edge.  The location of this stab-wound gives me a few good guesses as to what probably happened.  Either she was stabbed through the heart, stabbed through a lung, or stabbed through a major blood vessel.  Even a small wound to the heart might fill the space between the pericardium and the heart with blood...building up pressure until the heart can no longer beat (cardiac tamponade).  And, of course, a larger wound can cause exsanguination (the medical term for bleeding out) within moments.  In a similar manner, injury to the lungs might cause the pleural space to fill with blood and prevent the lungs from expanding.  And if a major vessel was hit, she would have bled out.

I ask the doc, "So, what's her story?"  The doctor looks over to me and says, "She was at a party last night.  Nobody told the police much about what happened after the fact, but 911 was called because a fight broke out."  I think about that for a moment.  "Was the weapon recovered?" I ask.  The doctor nods.  "It was a kitchen knife."

The body is repositioned on its back and a block of wood is placed under the shoulder blades to elevated the upper chest and draw the head back so the chin is pointing to the ceiling.  A Y-shaped incision is made from shoulder blades to the top of the sternum and then down to the pubic bone.  The tech does this while the doctor continues writing notes.  The tech then flays back the skin with a scalpel and exposes the ribcage.  He walks to the edge of the station and picks up a bone saw.  It makes an ugly sound as it cuts through ribs.  I watch as a couple more people walk out of the room.  As the breastplate is removed, it's clear there's a lot of internal bleeding.  Her whole chest cavity is full of blood.  The doctor notes this and the tech uses a tube to suction off the excess blood and the gurgling sound of the suction sends a couple more people out to the hallway.

The doctor peers into the chest cavity.  She uses her hand to push the lungs and heart aside so she can see the path of the knife.  She pushes her finger through the entrance wound and watches where it enters into the chest.  She nods to the tech and he begins removing organs, placing them on a cutting board at the end of the station.  The doctor examines the heart first.  I am struck by how very tiny this heart is.  It's only slightly larger than a golf ball.  I look at the woman again and realize that she's only maybe 4'10" tall.

The doctor looks over at us and says, "There is no injury to the heart."  She then examines the left lung.  There is a puncture wound.  She tells us that it could have killed her if she lived long enough after the stabbing but that she didn't believe it was the immediate cause of death.  Then, she goes back to the chest cavity and examines the blood vessels branching from the ascending aorta.  One, the left subclavian artery that feeds the left arm, was almost completely severed.  It must have been a really long knife and it must have been angled upward from where it entered under her armpit.  This, the pathologist declares, was the cause of death.  Exsanguination.

Despite already having determined what killed the girl, the autopsy continues.  Each abdominal organ is brought to the board, sectioned, and pieces dropped into formalin or into cards to be sealed in paraffin.  These specimens will be prepared and then examined under a microscope later.  Sectioned organs are placed in a five gallon bucket that is lined with a red biohazard bag.

The tech asks the doctor if he should open the head and she nods.  He first takes a scalpel and draws it from ear to ear up over the crown of the cranium.  Then, similar to a mask, the scalp...hair and all...is peeled back to the eyebrows and down to the neck.  One more guy leaves the room.  Then the bone saw comes out again and a 90 degree wedge is made from about where the hairline would be to the crown.  A tool is used to pop the cranium from the rest of the skull and the bone is set aside.  Her brain looks normal.  Pink and tan.  Very mooshy, as is common in young people.

The doctor takes a look at the membranes surrounding the brain to check for hemorrhaging or fractures.  She nods to the tech and he draws back the frontal lobe so he can cut the two optic nerves just before they cross at the optic chiasma.  Then he carefully removes the brain and hands it to the doctor.  She drops it onto the cutting board and walks over to the empty skull.  Again, she examines the meninges to determine if there were any hemorrhages or fractures.  She nods to the tech and walks back to the cutting board.  She first removes the cerebellum and brain stem.  She sections them, checking for anything abnormal.  She does the same with the cerebrum, checking the ventricles and taking specimens of the hypothalamus and cortex for  later microscopic examination.

While the doctor does this, the tech uses a pair of pliers to grasp the membranes that are adhered to the inside of the cranium and tear them loose.  The ripping sound that it makes is my least favorite part of an autopsy.  Sadly, we lose one more rookie cop.

The sectioned brain is scooped into the bag with the rest of the organs.  The brain cavity is filled with rolled sheets of cotton, the cranium repositioned, and the scalp drawn back over the skull.  The tech uses a needle and twine to stitch it closed.  The tech then suctions out the body.  The red biohazard bag is tied closed and placed inside the abdominal cavity.  The breastplate is replaced and the Y-incision is sewn back together.  The tech pours a cleaning solution over the body and rinses blood and tissue from the surface.  He dries it off and moves it to another tray that's lined with a body bag.

As we leave the room, I watch as he closes the bag around this young woman who was alive and vibrant not 12 hours earlier.  I wonder if she was caught up in gangs.  I wonder if she got into fights often or if she was just in the wrong place at the wrong time.  I wonder if she has parents that are mourning her.  I wonder a lot of things.  Most of all, I'm sad.      




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