Life in the Last Lane: An Autopsy Tour
It began as a fairly simple assignment: interview a county coroner about his job and find out what he does all day long to earn his share of the taxpayers' money. His name is Dr. Richmond Mason, a nationally respected pathologist with a predilection for research who chooses to live in the backwater burg of Santa Cruz, Calif. so he can pursue his muse in peace. We talked for an hour or so, and as he was packing up to leave, I asked Mason if I could witness the next autopsy. Asking the question wasn't that simple. The challenge was framing the request to appear more like a dedicated journalist than the thinly disguised, leering ghoul I felt like. Death is a hot item right now, what with souls and near-death experiences and angels hovering all over the pages of Time and Newsweek. The ethereal is all fine and dandy, but what I really wanted to know is, What happens to the meat we leave behind?I cringed after asking my question, waiting for the coroner's lip to curl like a venetian blind in disgust. Much to my surprise, he agreed to my tagging along. As a matter of fact, he said, a case was waiting to be dissected right then and I was welcome to observe.My acquaintance with death has been mercifully brief and distant. A summer job at a mortuary caught me studying a few casket-bound bodies when I was supposed to be typing and filing. That and an old boyfriend who ended up on view at a local funeral home via drug overdose were the extent of my sanitized view of death. With a little trepidation and more excitement than I care to admit, I headed down to the morgue to hook up again with my new coroner friend ... and a corpse.Movies and TV shows have made it clear that there is some federal law requiring all morgues to be hidden in basements deep beneath health facilities, and the one where we convened was no different. In contrast to movie morgues, this one was neither freezing cold nor dimly lit. It could have been any hospital room, except for the drain in the center of the floor and the walk-in freezer off to the side. Oh, and the one-gallon plastic buckets that lined the walls, hastily scribbled with names and body parts. "Those," explained Mason, "are previous specimens the county wants me to get rid of."For this virginal voyage through one of life's final passages, one couldn't ask for a better tour guide than Dr. Mason. A forensic pathologist for more than 20 years, he possesses one of those thoughtful, scientific minds complemented by mild, unassuming poise. His customers never comment, kibitz or ask questions, so I got the impression he rather enjoyed a living witness to his skills. We often take for granted the feedback and easy banter we engage in at our place of business, so imagine doing your best work day after day for clients whose appreciation will never be heard.Mason pulls the giant freezer door open and wheels the gurney holding his second customer of the day out to the middle of the floor. If one ignored the now-encrusted bloody nose and light-bulb pallor, our deceased guest could have been any older, chubby fellow who decided to strip down and take a nap. But he's not really a he anymore. He's not Fred or Tom or handy with a pipe wrench or good to children or any of the other thousands of things we are or do that uniquely define us as human. He is now an it -- a collection of tissue and organs that hold the final answer to the coroner's question: Why is this former someone splayed out here on a steel table and not out there doing what he used to do?Pulling out both a hunting and a kitchen knife, Mason begins to hone their edges on sharpening paper. "I've tried all sorts of things throughout the years, and these seem to work the best," he says. This case, he explains as he draws the blades back and forth, is an apparent suicide. An older man found dead in his living room, he had attempted suicide once before with notably less success.Satisfied after watching each razor-sharp knife effortlessly glide through scraps of paper, the doctor places them carefully on the cutting board balancing on the deceased's shins.The doctor suits up in scrubs and gloves, then tosses me a lab coat. We both don surgical masks. Besides the mess created by bodily fluids that will soon be freed from their corporeal wrappings, there is also some risk of infection from HIV, tuberculosis and hepatitis.As Mason shoves and tugs the corpse into position, the limbs flop loosely about. Our customer has been dead about six days now, long enough for the stiffness to disappear. Rigor mortis, explains the doc, takes about 12 hours to peak, another 12 to maintain and then another 12 hours to fully abate. Lividity's flowery pattern of red blotches created by noncirculating blood decorates one side of the body. Its presence tells investigators what position the body was in at death, thereby offering telltale clues if it has been moved or tampered with since.Mason carves a giant Y onto the trunk with the incision beginning at each shoulder and meeting at the belly. As the blade slides through the flesh, I'm prepared to be nauseous, shocked or repulsed. Instead, I am merely curious, as though watching a good friend unwrap a present. Mason flips the "V" of chest flesh from the topmost incisions over the body's face where it hangs cowl-like, releasing a tiny rivulet of blood to trickle slowly down the chin and pool into the ear.Mason grabs each flap left by the long belly incision and, pulling with one hand while sawing with the other, loosens the flesh from the rest of the ribcage. It's just like watching Julia Child de-boning a chicken breast. Our client obviously had been a member of the Clean Your Plate club and offers abundant testimony that fat is even less appealing from the inside than from out.Reaching for a miniature buzz saw, the good doctor warns, "This is where you might want to step back." Within minutes the top of the ribcage has been removed, exposing a belly full of organs. Mason lays the bony section next to the body, giving our pal the appearance of a fallen -- very fallen -- Roman soldier with his breastplate beside him.Although death resulting from drug overdose is presumed in this case, proof is to be found by examining and sampling each organ and fluid. As Mason moves his way down the cadaver, most pieces will end up in one of three containers. Small tissue samples will be clipped from organs and dropped into a canning jar filled with formaldehyde, and major organs will temporarily rest in a steel mixing bowl. Linings, intestines and miscellaneous chunks will be tossed into a five-gallon jug lined with a plastic "gut bag."We begin with the liver, which Mason informs me is the largest solid organ in the body. For someone whose hands-on experience with livers is limited to chickens and, once a year, turkeys, this human liver appears enormous, almost the size of a newborn baby. The doctor uses his kitchen knife to cut the purplish mass into several thin slices that will reveal any growths, tumors or abnormalities. This "breadloafing" technique is employed with most of the organs and demonstrates considerable carving skills that can only be attained from conducting about 8,000 autopsies.Of course, I have to find out if Mason is elected to carve the turkey every Thanksgiving. "Everyone always asks me that," he sighs good-naturedly without answering.Evening has begun to close in outside, and the only light reaching through the windows comes from the street lamps in the county parking lot. "This is my best time to do autopsies," Mason informs me. "I can concentrate without being interrupted by phone calls." I try to imagine what kind of calls come pouring into the autopsy room of the morgue, then give up.Mason gestures with his kitchen knife for me to move in closer to the body. Too many horror movies refuse to budge from my subconscious as I glance at the light gleaming off that blade and I remember that no one is left in the building this late at night. Silently damning the Wes Cravens of this world, I edge in until my surgically masked nose is about a foot from the stomach cavity.As a child I lived in the countryside of France, where horsemeat was as popular as hamburger is here. With Proustian clarity, I am once again standing on the sidewalk that runs beneath the bronze horse heads signaling the boucherie chevaline, from whose front door escapes this same overpoweringly sweet odor of lightly aged meat.Forgetting both France and the possibility of mild-mannered Dr. Mason morphing into a bloodthirsty psychopath, I stare closely at the rest of the organs that, like Musical Chairs, have shifted to take up Mr. Liver's empty space. Few things look in life (or death) like they do in the pictures, but surprisingly, guts are one of them.The lungs and the heart and the long intestine look just like they do in those brochures left laying around in doctors' offices that we read only out of desperation because somebody walked off with People magazine.The long intestine -- which Mason snips and removes, still coiled up -- is indeed long, about 30 feet. "In hospital autopsies," Mason explains, "they normally split the intestine, remove the contents and examine the inner lining." But that is not on the morgue schedule this night. With the intestines out of the way, we get a good look at the inside of the aorta, the giant artery that runs down the middle of our trunk. Congealed blood resembling black pudding is smoothed out of the way to study the tiny nicks and fissures that mark the beginnings of arteriosclerosis, more commonly known as hardening of the arteries.Judging by the girth of our subject, neither diet nor exercise held his attention for long. But according to the doctor, some signs of hardening -- fatty deposits and calcium buildup -- are generally hard to avoid as we get older, no matter the miles we jog or triathlons we win. In other words, the old buggy's gonna wear out, no matter how diligently we change the oil and check the tires.Most of the major organs have been shuttled from the body cavity to the mixing bowl, where Mason begins to retrieve them, one by one, for closer inspection. The right lung is weighed, then the left. As a bit of participatory journalism, I am allowed to jot the weights down on a form for the doctor. One lung is considerably heavier than the other, and Mason deftly reduces it to a series of thin slices to discover why."Pneumonia," Mason says, pointing the tip of his knife to the little white pustules and edema-filled ringlets clustered throughout. "He probably laid around in a coma for a day or two before dying. That's when the infection set in." A slight chunk is clipped off and dutifully joins the other tiny slivers of appendix, pancreas, liver and flesh that will be studied by the toxicology specialists.The heart, weighing in at a hefty 390 grams, is next on the cutting board. Mason is kind enough to slice a cross-section of it in order to let me better view one of poetry's favorite organs. There are the much-discussed arteries, which, like the tires on the aforementioned jalopy, are pretty road-weary. To demonstrate how the mitral valve functions, Mason inserts his fingers through the two major openings, momentarily giving this muscle the appearance of a mushy, purple puppet poised to introduce itself.Mason towels the blood off the outer stomach lining before splitting it open and pouring the contents into a separate specimen jar. The kidneys are disgorged from their bed of fat and palpated. The gallbladder is similarly prodded and manipulated and eventually yields a gallstone hidden within. Mason deposits it with the other bits and snips floating in the formaldehyde solution, where it bobs and floats like a bright green olive in some gothic martini.The windpipe needs to be examined, so Mason reaches up into the throat cavity and clips out the tubes that lead to the stomach and lungs. Attached is the vocal box, officially known as the larynx and affectionately called the Adam's apple -- "what separates us from the other animals," Mason says with a note of awe. He holds this ordinary piece of human tubing up to the light and demonstrates how it opens and shuts with the movement of air. Along with a few other evolutionary details, he explains, this inch or two of knobby tissue has moved us beyond squeaks and growls so that we might talk and laugh and pray and sing and lie.A gaping crater remains where most of the major organs once called home. Mason folds the flaps of skin back together, where they sag into the vacuum, draping around our overdose victim like an ill-fitting coat.There is one major organ left to examine, and it is at this point in the exercise that my palms get sweaty. Mason carves an incision from one ear to the other across the back of the skull while tiny droplets of blood bead up on the body's unkempt, reddish-gray hair. Using the same carving and tugging motions he employed removing flesh from the ribcage, Mason peels the scalp away from the skullbone. One flap folds under the corpse's neck while the other is pulled over the face, mingling scalp hair with the body's wiry beard. Again, I step back as Mason picks up a small rotary saw and bears down on the gleaming egg. Smoke rises in the air as a pile of bone chips and sawdust mix with the blood that has collected on the table beneath the head. Eventually, a shiny, white helmet joins the breastplate to perch on the gurney next to our warrior.As Mason turns to hang up his saw, I move in to study this organ that caused its host so much anguish. Clipping it from the stem, Mason pulls the brain out and places it on the cutting board. Patiently, he tours me through the corporeal neighborhoods we hear so much about yet rarely see.For one thing, there is no mistaking the right brain from the left. Although attached, a deep fissure runs down the middle clearly separating the analytical side that tells my brother there is a rational answer for everything and its intuitive twin that insists my friend read auras and trust crystals for healing energy. Mason spears a tiny piece of meat and holds it up on the tip of his blade. This, he informs me, is the pituitary gland. When this little guy doesn't work right, its host can grow up very, very tiny (dwarfism) or very, very large (gigantism).Like the rest of its compatriots, the brain submits to Mason's razor-sharp slicing and soon resembles a platter of sushi'd cauliflower. I bend down to closely study the landscape of tiny gray mountains and valleys. Mason is busy explaining the difference between the outside layer of brain from the creamy white inside, but I am trying to figure out where the emotions were hidden and in what nook self-awareness resided. I wonder if there was a particular cranny that radioed this man and told him that life was no longer worth living. If there was, it forgot to mention that ending up with your scalp around your chin is not necessarily a prettier alternative.With the last of the organs examined and a souvenir removed from each, the mixing bowl is now empty and the gut bag is full. As he has done periodically throughout the autopsy, Mason runs a hose over the table and sweeps the remaining fluids into the sink. Like a good sous chef, he carefully washes and wipes his blades clean. The mixing bowl is rinsed out and set aside to dry as Mason next scrubs down the cutting board.The body, accompanied by its jug full of entrails, is wheeled back into the meat locker. An assistant will arrive tomorrow morning to place the full plastic bag into the body cavity before sewing everything back together. Within days our intimate acquaintance will be reposing peacefully inside a satin-lined coffin, looking none the worse for wear.Although Dr. Mason will be staying another hour or so to finish up his notes and findings, he takes the time to walk me across the dark, deserted parking lot to my car. We say goodbye and I watch him trot back to his basement.Before I climb into my car, I take a minute to breathe in the chilly night air and glance up at the stars. Sometimes I forget to appreciate the little things.SIDEBAR: Interior Motives: Dr. Richmond Mason discusses insect pupae, backsplatters and tricks of the coroner's trade.As Told to Kelly LukerIn some ways, forensic pathology is renaissance medicine because it cuts across the spectrum of disciplines. There are so many other aspects that get involved. For example, we look at the insect predation on a cadaver to figure out how long it's been exposed to the elements.There are certain types of flies that are programmed to alight on a cadaver within 30 minutes of death to lay their eggs. They will go for the nose, the corner of the eyes, the mouth, ears or underneath the body. There's a predictable life cycle for the flies, which ranges from 10 to 14 days. The eggs hatch out as maggots, which continually enlarge in size. Finally, at the last stage, the skin of the maggot hardens and forms a cocoon-like device called a pupa and the adult fly emerges from that.If, in examining the body, you see these pupal cases, then you're dealing with a body that has been lying around for at least a 12- to 14-day period. There are also beetles and other types of insects that come in during the later stages of decomposition.In order to more closely determine how long a body has been dead, you need to know your locale. A buried body will be better preserved than one that's left on top of the ground. Even one that's in water will be better preserved then one left on the ground. To determine foul play, you look at the victim and his environment. If I don't actually get to do that, then hopefully I'll have fairly good photographs.People make a big deal of blood splatters and the size of the droplets and where they are in relation to the body. If you have firearms injury there may be some backsplatter. Say, if it was a shotgun, there may be powder residue. Or, there may be an intermediary target that the bullet passed through before entering the victim. You try to do a global reconstruction of the whole thing, and if something doesn't fit then that immediately arouses your curiosity. It's a lot like hunting: You follow disturbances in the environment over an extended distance, and you get a good idea of where somebody has been and what they were doing.Probably the decomposed case is the most challenging. Those and the burn cases where the body is actually black and charred. If you get really bad decomposition, it's necessary to remain in the presence of, essentially, 200 pounds of rotten meat for seven or eight hours while you literally dissect it down to the bones.When I first started, it used to be sort of a Zen exercise to tune out the obnoxious odors. It's like perfume -- you aren't aware of it if you're around it for a long period of time. If the body has been out for many, many months and is in really bad condition, it may be necessary to strip every bone out of the body. At that point you stray over into physical anthropology.There have been a lot of high-tech advances in our field, like DNA sampling and toxicology studies. But I don't think anything can substitute for a 200-year-old dissection knife and the basic approach to examining a body.