#postmortem procedure

[townpostin]

College Student Dies From Snake Bite In Patamda

Family Refuses Postmortem, Jeopardizing Government Compensation Local authorities attempt to persuade relatives as cultural beliefs delay legal procedures. JAMSHEDPUR – Tragedy struck in Patamda, East Singhbhum district, as 17-year-old Chintamani Hansda succumbed to a snake bite on Sunday, with her family refusing postmortem procedures crucial for government compensation. Chintamani, a student at…

[literaryvein-reblogs]

Writing Notes: Autopsy

Autopsy - dissection and examination of a dead body and its organs and structures.

The word autopsy is derived from the Greek autopsia, meaning “the act of seeing for oneself.”

Also known as: necropsy, postmortem, postmortem examination

Why is an autopsy done?

To determine the cause of death

When a suspicious or unexpected death occurs

To observe the effects of disease; when there's a public health concern, such as an outbreak with an undetermined cause

To establish the evolution and mechanisms of disease processes

When no doctor knows the deceased well enough to state a cause of death and to sign the death certificate

When the doctor, the family or legally responsible designee of the deceased person requests an autopsy

Who does the autopsy?

Autopsies ordered by the state can be done by a county coroner, who is not necessarily a doctor

A medical examiner who does an autopsy is a doctor, usually a pathologist

Clinical autopsies are always done by a pathologist

How is an autopsy done?

After the patient is pronounced dead by a physician, the body is wrapped in a sheet or shroud and transported to the morgue, where it is held in a refrigeration unit until the autopsy.

Autopsies are rarely performed at night.

Autopsy practice was largely developed in Germany, and an autopsy assistant is traditionally honored with the title "diener", which is German for "helper".

The prosector and diener wear fairly simple protective equipment, including scrub suits, gowns, gloves (typically two pair), shoe covers, and clear plastic face shields.

The body is identified and lawful consent obtained.

The procedure is done with respect and seriousness.

The prevailing mood in the autopsy room is curiosity, scientific interest, and pleasure at being able to find the truth and share it.

Most pathologists choose their specialty, at least in part, because they like finding the real answers.

Many autopsy services have a sign, "This is the place where death rejoices to help those who live." Usually it is written in Latin ("Hic locus est ubi mors gaudet succurrere vitae").

EXTERNAL EXAMINATION

The prosector checks to make sure that the body is that of the patient named on the permit by checking the toe tag or patient wristband ID.

The body is placed on the autopsy table.

Experienced dieners, even those of slight build, can transfer even obese bodies from the carriage to the table without assistance.

Since the comfort of the patient is no longer a consideration, this transfer is accomplished with what appears to the uninitiated a rather brutal combination of pulls and shoves, not unlike the way a thug might manhandle a mugging victim.

The body is measured.

Large facilities may have total-body scales, so that a weight can be obtained.

The autopsy table is a waist-high aluminum fixture that is plumbed for running water and has several faucets and spigots to facilitate washing away all the blood that is released during the procedure.

Older hospitals may still have porcelain or even marble tables.

The autopsy table is basically a slanted tray (for drainage) with raised edges (to keep blood and fluids from flowing onto the floor).

After the body is positioned, the diener places a "body block" under the patient's back. This rubber or plastic brick-like appliance causes the chest to protrude outward and the arms and neck to fall back, thus allowing the maximum exposure of the trunk for the incisions.

Abnormalities of the external body surfaces are then noted and described, either by talking into a voice recorder or making notes on a diagram and/or checklist.

OPENING THE TRUNK

The diener takes a large scalpel and makes the incision in the trunk. This is a Y-shaped incision. The arms of the Y extend from the front of each shoulder to the bottom end of the breast bone (called the xiphoid process of the sternum). In women, these incisions are diverted beneath the breasts, so the "Y" has curved, rather than straight, arms. The tail of the Y extends from the xiphoid process to the pubic bone and typically makes a slight deviation to avoid the umbilicus (navel). The incision is very deep, extending to the rib cage on the chest, and completely through the abdominal wall below that.

With the Y incision made, the next task is to peel the skin, muscle, and soft tissues off the chest wall. This is done with a scalpel. When complete, the chest flap is pulled upward over the patient's face, and the front of the rib cage and the strap muscles of the front of the neck lie exposed. Human muscle smells not unlike raw lamb meat in my opinion. At this point of the autopsy, the smells are otherwise very faint.

An electric saw or bone cutter (which looks a lot like curved pruning shears) is used to open the rib cage. One cut is made up each side of the front of the rib cage, so that the chest plate, consisting of the sternum and the ribs which connect to it, are no longer attached to the rest of the skeleton. The chest plate is pulled back and peeled off with a little help of the scalpel, which is used to dissect the adherent soft tissues stuck to the back of the chest plate. After the chest plate has been removed, the organs of the chest (heart and lungs) are exposed (the heart is actually covered by the pericardial sac).

Before disturbing the organs further, the prosector cuts open the pericardial sac, then the pulmonary artery where it exits the heart. He sticks his finger into the hole in the pulmonary artery and feels around for any thromboembolus (a blood clot which has dislodged from a vein elsewhere in the body, traveled through the heart to the pulmonary artery, lodged there, and caused sudden death. This is a common cause of death in hospitalized patients).

The abdomen is further opened by dissecting the abdominal muscle away from the bottom of the rib cage and diaphragm. The flaps of abdominal wall fall off to either side, and the abdominal organs are now exposed.

REMOVING THE ORGANS OF THE TRUNK

The most typical method of organ removal is called the "Rokitansky method." This is not unlike field dressing a deer. The dissection begins at the neck and proceeds downward, so that eventually all the organs of the trunk are removed from the body in one bloc.

The first thing the diener does is to identify the carotid and subclavian arteries in the neck and upper chest. He ties a long string to each and then cuts them off, so that the ties are left in the body. This allows the mortician to more easily find the arteries for injection of the embalming fluids.

A cut is them made above the larynx, detaching the larynx and esophagus from the pharynx. The larynx and trachea are then pulled downward, and the scalpel is used to free up the remainder of the chest organs from their attachment at the spine.

The diaphragm is cut away from the body wall, and the abdominal organs are pulled out and down.

Finally, all of the organs are attached to the body only by the pelvic ligaments, bladder, and rectum.

A single slash with the scalpel divides this connection, and all of the organs are now free in one block. The diener hands this organ bloc to the prosector. The prosector takes the organ bloc to a dissecting table (which is often mounted over the patient's legs) and dissects it. Meanwhile, the diener proceeds to remove the brain.

Another method is called Virchow method, which entails removing organs individually.

EXAMINATION OF THE ORGANS OF THE TRUNK

At the dissection table, the prosector typically dissects and isolates the esophagus from the rest of the chest organs. This is usually done simply by pulling it away without help of a blade (a technique called "blunt dissection"). The chest organs are then cut away from the abdominal organs and esophagus with scissors. The lungs are cut away from the heart and trachea and weighed, then sliced like loaves of bread into slices about one centimeter thick. A long (12" - 18"), sharp knife, called a "bread knife" is used for this.

The heart is weighed and opened along the pathway of normal blood flow using the bread knife or scissors. Old-time pathologists look down on prosectors who open the heart with scissors, rather than the bread knife, because, while the latter takes more skill and care, it is much faster and gives more attractive cut edges than when scissors are used. The coronary arteries are examined by making numerous crosscuts with a scalpel.

The larynx and trachea are opened longitudinally from the rear and the interior examined. The thyroid gland is dissected away from the trachea with scissors, weighed, and examined in thin slices. Sometimes the parathyroid glands are easy to find, other times impossible.

The bloc containing the abdominal organs is turned over so that the back side is up. The adrenal glands are located in the fatty tissue over the kidneys (they are sometimes difficult to find) and are removed, weighed, sliced, and examined by the prosector.

The liver is removed with scissors from the rest of the abdominal organs, weighed, sliced with a bread knife, and examined. The spleen is similarly treated.

The intestines are stripped from the mesentery using scissors (the wimpy method) or bread knife (macho method). The intestines are then opened over a sink under running water, so that all the feces and undigested food flow out. As one might imagine, this step is extremely malodorous. The resultant material in the sink smells like a pleasant combination of feces and vomitus. The internal (mucosal) surface of the bowel is washed off with water and examined. It is generally the diener's job to "run the gut," but usually a crusty, senior diener can intimidate a young first- year resident prosector into doing this ever-hated chore. Basically, whichever individual has the least effective steely glare of disdain is stuck with running the gut.

The stomach is then opened along its greater curvature. If the prosector is lucky, the patient will have not eaten solid food in a while. If not, the appearance of the contents of the stomach will assure the prosector that he will not be eating any stews or soups for a long time. In either case, the smell of gastric acid is unforgettable.

The pancreas is removed from the duodenum, weighed, sliced and examined. The duodenum is opened longitudinally, washed out, and examined internally. The esophagus is similarly treated.

The kidneys are removed, weighed, cut lengthwise in half, and examined. The urinary bladder is opened and examined internally. In the female patient, the ovaries are removed, cut in half, and examined. The uterus is opened along either side (bivalved) and examined. In the male, the testes are typically not removed if they are not enlarged. If it is necessary to remove them, they can be pulled up into the abdomen by traction on the spermatic cord, cut off, cut in half, and examined.

The aorta and its major abdominal/pelvic branches (the renal, celiac, mesenteric, and iliac arteries) are opened longitudinally and examined.

Most of the organs mentioned above are sampled for microscopic examination. Sections of the organs are cut with a bread knife or scalpel and placed in labeled plastic cassettes. Each section is the size of a postage stamp or smaller and optimally about three millimeters in thickness. The cassettes are placed in a small jar of formalin for fixation. They are then "processed" in a machine that overnight removes all the water from the specimens and replaces it with paraffin wax. Permanent microscopic sections (five microns, or one two-hundredth of a millimeter thick) can be cut from these paraffin sections, mounted on glass slides, stained, coverslipped, and examined microscopically. The permanent slides are usually kept indefinitely, but must be kept for twenty years minimum.

Additional small slices of the major organs are kept in a "save jar," typically a one-quart or one-pint jar filled with formalin. Labs keep the save jar for a variable length of time, but at least until the case is "signed out" (i.e., the final written report is prepared). Some labs keep the save jar for years. All tissues that are disposed of are done so by incineration.

A note on dissection technique: All of the above procedures are done with only four simple instruments -- a scalpel, the bread knife, scissors, and forceps (which most medical people call "pick-ups." Only scriptwriters say "forceps"). The more handy the prosector, the more he relies on the bread knife, sometimes making amazingly delicate cuts with this long, unwieldy-looking blade. The best prosectors are able to make every cut with one long slicing action. To saw back and forth with the blade leaves irregularities on the cut surface which are often distracting on specimen photographs. So the idea is to use an extremely sharp, long blade that can get through a 2000-gram liver in one graceful slice. Some old-time purist pathologists actually maintain their own bread knives themselves and let no one else use them. Such an individual typically carries it around in his briefcase in a leather sheath. This would make an excellent fiction device, which, to my knowledge, has not been used. Imagine a milquetoast pathologist defending himself from a late-night attacker in the lab, with one desperate but skillful slash of the bread knife almost cutting the assailant in half!

Note on the appearance of the autopsy suite: Toward the end of the autopsy procedure, the room is not a pretty sight. Prosectors vary markedly in how neat they keep the dissection area while doing the procedure. It is legendary that old-time pathologists were so neat that they'd perform the entire procedure in a tux (no apron) right before an evening at the opera (pathologists are noted for their love of classical music and fine art). Modern prosectors are not this neat. Usually, the autopsy table around the patient is covered with blood, and it is very difficult not to get some blood on the floor. We try to keep blood on the floor to a minimum, because this is a slippery substance that can lead to falls. The hanging meat scales used to weigh the organs are usually covered with or dripping with blood. The chalk that is used to write organ weights on the chalkboard is also smeared with blood, as may be the chalkboard itself. This is an especially unappetizing juxtaposition.

Another example using the Virchow method:

After the intestines are mobilized, they may be opened using special scissors.

Inspecting the brain often reveals surprises. A good pathologist takes some time to do this.

The pathologist examines the heart, and generally the first step following its removal is sectioning the coronary arteries that supply the heart with blood. There is often disease here, even in people who believed their hearts were normal.

After any organ is removed, the pathologist will save a section in preservative solution. Of course, if something looks abnormal, the pathologist will probably save more. The rest of the organ goes into a biohazard bag, which is supported by a large plastic container.

The pathologist weighs the major solid organs (heart, lungs, brain, kidneys, liver, spleen, sometimes others) on a grocer's scale.

The smaller organs (thyroid, adrenals) get weighed on a chemist's triple-beam balance.

The next step in the abdominal dissection will be exploring the bile ducts and then freeing up the liver. The pathologist uses a scalpel or other similar tool.

After weighing the heart, the pathologist completes the dissection. There are a variety of ways of doing this, and the choice will depend on the case. If the pathologist suspects a heart attack, a long knife may be the best choice.

In the example: The liver is removed. The pathologist finds something important. It appears that the man had a fatty liver. It is too light, too orange, and a bit too big. Perhaps this man had been drinking heavily for a while.

The pathologist decides to remove the neck organs, large airways, and lungs in one piece. This requires careful dissection. The pathologist always examines the neck very carefully.

The liver in this example weighs much more than the normal 1400 gm.

The lungs are almost never normal at autopsy. In the example, the lungs are pink, because the dead man was a non-smoker. The pathologist will inspect and feel them for areas of pneumonia and other abnormalities.

The liver is cut at intervals of about a centimeter, using a long knife. This enables the pathologist to examine its inner structure.

The pathologist weighs both lungs together, then each one separately. Afterwards, the lungs may get inflated with fixative.

The rest of the team continues with the removal of the other organs. They may decide to take the urinary system as one piece, and the digestive system down to the small intestine as another single piece. This will require careful dissection.

One pathologist holds the esophagus, stomach, pancreas, duodenum, and spleen. He opens these, and may save a portion of the gastric contents to check for poison.

Another pathologist holds the kidneys, ureters, and bladder. Sometimes these organs will be left attached to the abdominal aorta. The pathologist opens all these organs and examine them carefully.

Dissecting the lungs can be done in any of several ways. All methods reveal the surfaces of the large airways, and the great arteries of the lungs.

Most pathologists use the long knife again while studying the lungs. The air spaces of the lungs will be evaluated based on their texture and appearance.

Before the autopsy is over, the brain is usually suspended in fixative for a week so that the later dissection will be clean, neat, and accurate.

If no disease of the brain is suspected, the pathologist may cut the brain fresh.

The kidneys are weighed before they are dissected.

It is the pathologist's decision as to whether to open the small intestine and/or colon. If they appear normal on the outside, there is seldom significant pathology on the inside.

One pathologist prepares the big needle and thread used to sew up the body.

When the internal organs have been examined, the pathologist may return all but the tiny portions that have been saved to the body cavity. Or the organs may be cremated without being returned.

The appropriate laws, and the wishes of the family, are obeyed.

The breastbone and ribs are usually replaced in the body.

The skull and trunk incisions are sewed shut ("baseball stitch").

The body is washed and is then ready to go to the funeral director.

These notes do not show all the steps of an autopsy, but will give you the general idea. 

During the autopsy, there may be photographers, evidence technicians, police, hospital personnel, and others.

In the example, the pathologists submit the tissue they saved to the histology lab, to be made into microscopic slides.

When these are ready, they will examine the sections, look at the results of any lab work, and draw their final conclusions.

The only finding in this sample autopsy was fatty liver. There are several ways in which heavy drinking, without any other disease, can kill a person. The pathologists will rule each of these in or out, and will probably be able to give a single answer to the police or family.

CLOSING UP AND RELEASING THE BODY

After all the above procedures are performed, the body is now an empty shell, with no larynx, chest organs, abdominal organs, pelvic organs, or brain. The front of the rib cage is also missing. The scalp is pulled down over the face, and the whole top of the head is gone. Obviously, this is not optimal for lying in state in public view. The diener remedies this problem. First, the calvarium is placed back on the skull (the brain is not replaced), the scalp pulled back over the calvarium, and the wound sewn up with thick twine using the type of stitch used to cover baseballs. The wound is now a line that goes from behind the ears over the back of the skull, so that when the head rests on a pillow in the casket, the wound is not visible.

The empty trunk looks like the hull of a ship under construction, the prominent ribs resembling the corresponding structural members of the ship. In many institutions, the sliced organs are just poured back into the open body cavity. In other places, the organs are not replaced but just incinerated at the facility. In either case, the chest plate is placed back in the chest, and the body wall is sewn back up with baseball stitches, so that the final wound again resembles a "Y."

The diener rinses the body off with a hose and sponge, covers it with a sheet, and calls the funeral home for pick- up. As one might imagine, if the organs had not been put back in the body, the whole trunk appears collapsed, especially the chest (since the chest plate was not firmly reattached to the ribs). The mortician must then remedy this by placing filler in the body cavity to re-expand the body to roughly normal contours.

Ultimately, what is buried/cremated is either 1) the body without a brain and without any chest, abdominal, or pelvic organs, or 2) the body without a brain but with a hodgepodge of other organ parts in the body cavity.

FINISHING UP

After the funeral home has been called, the diener cleans up the autopsy suite with a mop and bucket, and the prosector finishes up the notes and/or dictation concerning the findings of the "gross exam" (the part of the examination done with the naked eye and not the microscope; this use of the term "gross" is not a value judgement but a direct German translation of "big" as opposed to "microscopic").

For some odd reason, many prosectors report increased appetite after an autopsy, so the first thing they want to do afterwards is grab a bite to eat.

The whole procedure in experienced hands, assuming a fairly straightforward case and no interruptions, has taken about two hours.

Complicated cases requiring detailed explorations and special dissections (e.g., exploring the bile ducts, removing the eyes or spinal cord) may take up to four hours.

AFTER THE AUTOPSY

Days to weeks later, the processed microscopic slides are examined by the attending pathologist, who renders the final diagnoses and dictates the report.

A final report is ready in a month or so. The glass slides and a few bits of tissue are kept forever, so that other pathologists can review the work.

Only the pathologist can formally issue the report, even if he or she was not the prosector (i.e., the prosector was a resident, PA, or med student).

The report is of variable length but almost always runs at least three pages. It may be illustrated with diagrams that the prosector draws from scratch or fills in on standard forms with anatomical drawings.

The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), which certifies hospitals, requires the final report to be issued within sixty days of the actual autopsy.

The College of American Pathologists, which certifies medical laboratories, requires that this be done in thirty days.

Nevertheless, pathologists are notorious for tardiness in getting the final report out, sometimes resulting in delays of years.

Perhaps the non-compensated nature of autopsy practice has something to do with this. Pathologists are otherwise very sensitive to turnaround times.

THE BRAIN-CUTTING

The examiner returns to the brain left suspended in a big jar of formalin for a few weeks. After the brain is "fixed," it has the consistency and firmness of a ripe avocado.

Before fixation, the consistency is not unlike that of three-day- old refrigerated, uncovered Jello.

Infant brains can be much softer than that before fixation, even as soft as a flan dessert warmed to room temperature, or worse, custard pie filling. Such a brain may be difficult or impossible to hold together and can fall apart as one attempts to remove it from the cranium.

Assuming good fixation of an adult brain, it is removed from the formalin and rinsed in a running tap water bath for several hours to try to cut down on the discomforting, eye-irritating, possibly carcinogenic formalin vapors.

The cerebrum is severed from the rest of the brain (brainstem and cerebellum) by the prosector with a scalpel.

The cerebellum is severed from the brainstem, and each is sliced and laid out on a tray for examination.

The cerebrum is sliced perpendicularly to its long axis and laid out to be examined.

Sections for microscopic processing are taken, as from the other organs, and a few slices are held in "save jars."

The remainder of the brain slices is incinerated.

Sources: 1 2 3 4

If these notes help with your poem/story, do tag me, or leave a link in the replies. I would love to read them!

[witchdisk]

Skin Removal Sep 17 Postmortem

A few days ago I performed another skin removal procedure. (See #skin removal for more) Here's a writeup of some of the things we learned this time.

The #10 scalpel blade is useful for long+thin removals because the blade is longer. This lets us do the sort of "long, loving cuts" while pulling up the skin, under tension, using the full length of the blade. This is faster than the #15, but you still want that one for precision at the beginning and end.

For this design, there were certain cuts which we wanted to be along the same line, like the edges of the eyelashes:

When doing the procedure, I did each of the eyelashes separately, so I did these cuts at different times. I should have used the sterile ruler that comes packaged with the surgical skin pens and made these cuts all at the same time. This would have helped make sure they're in line.

This time I used sterile dermal curettes to even out the depth after removing the skin. This was a great idea and it made this step so much easier. I used the 4mm curette for this procedure, and I only needed one. I will be recommending this going forward. Here's the tool and me using it:

Have multiple sets of splinter forceps!! (Or whatever your main forceps are.) I had backup adson and hemostatic forceps, but I was acutely aware the procedure would get a lot harder if I dropped my tools. This isn't relevant if you have a flash sterilizer, but those are kind of expensive.

Ask your subject what kind of communication they want from you! This time, xe said "if you had told me [we're halfway done] I don't think I would have been able to finish." Good thing I didn't do that!

EMLA cream (lidocaine 2.5%/prilocaine 2.5%) is quite useful to help those with a lower pain tolerance. It pretty much eliminated the pain from the cutting, but not all the sensations (e.g. skin being pulled up, felt sense of something wrong ("felt like something i could not perceive but my body was reacting to"). I have some prescribed because I've been scared of needles, and the numbing helps with getting blood drawn.

We already know this, but just to reiterate: it's important to get the correct depth on the guiding lines. The skin should separate, like this:

Using sterile bordered gauze + hydrogel for the wound dressing did not work this time. It dried on the wound, and removing the bandage to clean resulted in mechanical debridement. This hurt a lot and irritated the wound in ways that we hadn't planned for. Using tegaderm initially, like we did two times ago, was also not ideal because it resulted in a big gross bubble of exudate. Something in-between these is required, but I'm not sure what. It should stay moist, but still be relatively absorbent. Tegaderm+pad, for the occlusiveness? Recs here appreciated. Pigeon reported it used a bunch of saline to soak the area to help with this, but there were still some issues.

The lines ended up thicker than in the design. We think this is mainly because skin tension pulled the cuts open. This may be mitigated by wound contraction during healing; we will measure how it ends up vs the desired width to determine that. See this video of me removing a full section to see what I mean.

The loupe glasses!! As seen below. These were some cheap ones I got off amazon, but were actually super helpful. They didn't really improve my posture, and my back still hurts >.< However, they did help me see details a lot better. If I keep doing this I will consider getting a better pair. They gave me a headache after about 30 minutes while practicing, but were totally fine during the procedure. Unsure why!

I need to work on my aseptic technique. I was not adequately monitoring for reaching over the sterile field. My gloves should have covered my sleeves, but there was bare skin exposed. My gown was not sterile (haven't found sterile ones for a reasonable price) and it probably touched the drape a few times. The sterilization pouches I used were difficult to use for the bowls I had - difficult to get them out easily, difficult to load in the pressure cooker. I should really look into getting a secondhand rigid sterilization container. Last I remember, the difficulty was finding filters for these. Maybe I wasn't looking in the right place, or maybe I could make my own (tyvek? like the mushroom growers use...).

My informed consent notes mention the risk of keloid scarring, with a note this is 15x more likely on darker skin. I don't have a source cited for this, and so I don't know how this applies to black vs brown skin. This would have been useful to know!

Needed to print/laminate the handwash/handrub posters.

Re-affirmed a lot of things we already learned. Full-depth removal is the way to go. Ensure guiding lines are deep enough. #11 blade for short/straight lines, #15 for removal, and having separate scalpel handles for each is good.

Dumb one, but having a bunch of tiny individually wrapped gauze pads is annoying as hell. I picked up some bigger ones, we will see if those are what is needed or if I need to find packs of multiple smaller ones.

I'm gonna give it one more go, but I don't actually think pig skin is ideal to practice on, mostly due to the lack of blood/lack of elasticity. Much more difficult to determine the appropriate layer to separate skin at, compared to live human skin. Would appreciate other recommendations here for practice materials...

Okay, I think that's about all the thoughts I want to write out now! I will meld these notes with my existing ones soon, and get those published. As always pls hmu if you want to talk about this, especially if you have experience.

[galwednesday]

This week's deep dive rec is a book by Mary Roach, one of my favorite nonfiction authors, who has a knack for imparting a lot of deeply researched information conversationally and accessibly. Stiff: The Curious Lives of Human Cadavers goes deep into what happens after we die (very specifically, what happens to our bodies?):

For two thousand years, cadavers—some willingly, some unwittingly—have been involved in science’s boldest strides and weirdest undertakings. They’ve tested France’s first guillotines, ridden the NASA Space Shuttle, been crucified in a Parisian laboratory to test the authenticity of the Shroud of Turin, and helped solve the mystery of TWA Flight 800. For every new surgical procedure, from heart transplants to gender confirmation surgery, cadavers have helped make history in their quiet way. Stiff investigates the strange lives of our bodies postmortem and answers the question: What should we do after we die?

(If you're not sure if this book will be too grisly for you, check the list of topics covered and let that be your vibe check.)

[killed-by-choice]

“Phyllis Roe” (USA 1970–1972)

A study published in the Obstetrics and Gynecology medical journal documented 10 cases of maternal death from legal saline abortions in New York City. All of the women in the study had undergone their abortions thanks to New York’s pre-Roe legalization and had died between July 1, 1970 and June 30, 1972.

While nine of the cases appear to match some of those documented in another study, the person who was given the designation “Case 3” did not appear to match any known report. (She is given a pseudonym here to avoid dehumanizing her by reducing her to a number.) In addition, her postmortem findings were found to be suspicious considering the listed cause of death.

“Phyllis” underwent her saline abortion at approximately 18 weeks pregnant. The hazardous method was performed by a New York City hospital, apparently as an outpatient procedure. After receiving the hypertonic saline injections, she was discharged.

The next day, Phyllis returned to the hospital with a fever of 104 degrees. After delivering her dead child, she continued to bleed. Vacuum aspiration was performed and the hospital began treating her for septic shock and abnormally decreased urine output.

Even though she had been healthy with no history of serious illness, Phyllis died in three days. Her postmortem report showed peculiar results which may cast doubt on whether or not her complications had been diagnosed and treated correctly.

Even though Phyllis’s diagnosis during her hospitalization had been septic shock, her blood cultures showed no growth at all. Cervical cultures were reported to have grown “multiple organisms,” but did not list what organisms, whether or not they were infectious or which species were likely to have caused her death. Her uterus, which would most likely have been the site of initial infection, had “no gross evidence of infection” and there was a note that “microscopic preparations were not available”.

Phyllis had both air and fluid in her pleural space. She had been suffering from generalized tissue edema which was stated as “being suggestive of fluid overloading.” Despite all of these findings (and in some cases lack of them), her cause of death was still given as sepsis.

The study that later recorded Phyllis’s death regarded the autopsy findings with some degree of skepticism. While the study listed the diagnosis of sepsis as her cause of death, the authors wrote that “the description of [her] uterus must be considered as questionable.”

Analysis

What really happened to Phyllis? While at this point it may be impossible to know for sure, there are several possible explanations for the suspicious postmortem findings. One is that she really did die of sepsis, but that the lab work was mishandled. If, as the study noted, the description of her uterus was questionable, it could be possible that it was simply poorly examined.

Another possibility is that Phyllis was misdiagnosed and that the hospital decided to list her cause of death as a match for her initial diagnosis to avoid suspicion of malpractice. That may explain why important microscopic preparations were reportedly “unavailable.”

The findings of the autopsy may also indicate that Phyllis may have suffered another complication from saline abortion: hypervolemic hypernatremia. Hypernatremia, an electrolyte imbalance from dangerous levels of salt in the body, had already been well-established to have killed saline abortion clients by the time Phyllis was killed. If this had been the case for her, it could have caused hypervolemia as her body desperately tried to hold onto fluids to regulate her osmotic levels. This is highly consistent with the observations of generalized edema and fluid overloading and could also have explained her abnormalities in urine output. She also suffered disseminated intravascular coagulopathy or DIC, a well-documented symptom in many abortion deaths involving saline in the bloodstream.

(Considering that the same hospital had been responsible for the abortion and for treatment during Phyllis’s last days of life, there is a possibility that they would have an additional incentive to give her cause of death as sepsis. While still avoidable, sepsis could also have happened after birth, stillbirth or miscarriage, making a death from abortion-related sepsis seem more of an “acceptable” risk to some. However, death by hypernatremia after a massive dose of hypertonic saline in the bloodstream would not have occurred naturally for any of these, making her death without a doubt the result of the hospital’s actions.)

Yet another possibility combines some of the others: that the diagnosis of sepsis was correct and that Phyllis was suffering from undiagnosed hypernatremia. A study conducted decades after her death found correlations between hypernatremia and risk of developing sepsis. Both sepsis and hypernatremia can also cause similar problems such as kidney dysfunction, so it is possible that Phyllis died of a combination of complications. Her DIC could be explained by saline in the bloodstream, sepsis or both.

At this point it may not be possible to know for sure which exact complications killed Phyllis. What was never in doubt, however, is that she and her baby were two more preventable deaths from pre-Roe legalized abortion in New York City.

(All above images are from the study)

[onlyhurtforaminute]

EXHUMED-POSTMORTEM PROCEDURES

[tsaricides]

tell us about the very specific paper about autopsies 👀🫀

the paper (or rather a chapter from the book liminal lives <- brilliant scholarship on literary narratives of western biomedicine) is actually more on transplantation, or rather specifically postmortem organ retention. it's where i first learned that autopsies became significantly less popular, and that their decline was hugely motivated by casual organ theft and disposal as "biowaste." the practice was first revealed to the public in the uk and it was investigated because of what is best described as recreational organ retention: the alder hey scandal:

following this case, a committee was formed and it was found that around 105,000 organs were kept at med schools and hospitals all around the uk. it was also quickly uncovered that it was typical for hospitals to sell the organs of the dead without consent. 

needless to say, the general attitudes toward autopsy were affected and a once standard procedure became viewed as desecration. there's an interesting fragment on it in an NYT article (in which the author claims that autopsies also became less popular because they force doctors to face the crushing rate of misdiagnosis that lead to patients' death):

[lets-donate-a-kidney]

Quick facts about my kidney donation:

When did you donate?: December 27th, 2023!

Who did the kidney go to?: Two people! Surprise! I'm a non-directed donor, so the National Kidney Registry was able to set up a small transplant chain. There were actually four surgeries and two kidneys moved that day!

I don't know who the recipients were, and chose not to contact them. But I do know the transplants were successful and they're doing well now.

Wait, you can just do that?: Yep! You sign up online, pick a hospital that does transplants, and then go through a few months of screenings so they can check that you're healthy. If you still want to donate, and they approve you, they'll find a recipient for your kidney. All the medical screenings and procedures are free, and you can even get reimbursed for any time you take off work.

What's life like now?: Kidney donors aren't supposed to take NSAIDs, so I take Tylenol instead of ibuprofen. That's literally the only change. Well, that and my badass scars!

Was it hard?: Physically - yeah, for the first two days. It is a major abdominal surgery, and I spent the first night afterward in the hospital. But I was walking after 24 hours, pain-free after a week, and my strength was back to normal in about 3 weeks. I have no pain or side effects now. From what I've read, this is a typical recovery for kidney donors.

Emotionally - I think at first I felt a little scared, but the more I researched, the more my fear seemed irrational. The complication rate and long-term cost for kidney donors is extremely low, and the benefit to another person is very high. The National Kidney Registry will also give donors and their loved ones priority in the event y'all ever do need a kidney, so that addressed that concern, too. I decided I didn't want to be ruled by my fear. From that point on I never doubted my choice.

Why would you do this?: I realized I was very lucky to have good health, and the ability to take time off for surgery and recovery. Not everyone has those things. And I couldn't have gotten where I am today without people who were kind to me. So...I wanted to give back in some way, pay it forward, you know?

Should I donate a kidney, too?: If you want to! A transplanted kidney can literally save someone’s life. It means a great deal to their friends and family, too. But organ donation is a very personal choice, and if you don’t think it’s right for you, there are other ways you can help! For instance, you could sign up to be a postmortem organ donor so that your body won’t be affected at all while you’re alive.

[nazmedsms]

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[naturalist-doctor]

Y'know, I'm also fairly certain that eating the remains of the deceased isn't standard procedure for a postmortem examination. Don't you worry about contracting an infection or something?

[ I'm immortal. Antibiotics will cure me, at worst. ]

[swigogamedevqut]

Week 9

Postmortem on Turbo Track Racers

After several weeks of development, it’s time to reflect on the journey of creating Turbo Track Racers. This top-down racing game presented numerous challenges and learning opportunities. One of the key aspects of development was refining the car physics and controls to ensure a smooth and enjoyable racing experience. Balancing the difficulty of the tracks and implementing various power-ups added depth and excitement to the gameplay.

However, there were also hurdles along the way. Optimizing performance, especially with multiple AI opponents on screen, proved to be a significant challenge. Additionally, fine-tuning the AI behavior to provide a challenging but fair competition for players required careful iteration. Despite these challenges, the end result is a fast-paced and engaging racing game that I'm proud to have developed. This project has not only improved my skills as a game developer but also taught me valuable lessons in problem-solving and iteration.

Final Design Summary for Scrap Pile Survivors

Scrap Pile Survivors has evolved significantly since its inception. The final design encompasses a captivating gameplay experience set in a procedurally generated scrapyard filled with challenging obstacles and enemy drones. Players navigate their ships through the debris, battling waves of enemies and collecting power-ups to survive. The addition of multiple unlockable ships with unique abilities adds depth to the gameplay and encourages strategic decision-making.

The game's visuals and sound design contribute to its immersive atmosphere, with detailed environments and dynamic sound effects enhancing the player experience. The progression system, which allows players to upgrade their ships and unlock new abilities as they progress, provides a sense of achievement and replayability. Overall, Scrap Pile Survivors is a thrilling and challenging space shooter that promises hours of entertainment for players of all skill levels.

[mediaevalmusereads]

Stiff: the Curious Lives of Human Cadavers. By Mary Roach. Norton, 2003.

Rating: 3.5/5 stars

Genre: pop science, pop history

Series: N/A

Summary: For two thousand years, cadavers—some willingly, some unwittingly—have been involved in science’s boldest strides and weirdest undertakings. They’ve tested France’s first guillotines, ridden the NASA Space Shuttle, been crucified in a Parisian laboratory to test the authenticity of the Shroud of Turin, and helped solve the mystery of TWA Flight 800. For every new surgical procedure, from heart transplants to gender confirmation surgery, cadavers have helped make history in their quiet way. Stiff investigates the strange lives of our bodies postmortem and answers the question: What should we do after we die?

***Full review below.***

CONTENT WARNINGS: descriptions of corpses in various states (decay, dismembered, car accidents, etc), blood, gore, animal testing, cannibalism

What can I say? I was in a morbid mood and this book was available, so I picked it up.

If you're like me and are interested in all things related to death, this book might not present any new information to you. It is, after all, more than two decades old, so some statistics and other data might be outdated in addition to some things being relatively old news in today's post-CSI, internet savvy age.

But that's not to say the book is worthless. I very much enjoyed the way Roach conveyed information with humor that was morbid yet not disrespectful; it helped the overall tone of the book be light and positive rather than dour. I also think there's a lot to learn from the history and the anecdotal parts, as those are not likely to change (much) over time.

I also appreciated the frame that Roach takes. While humorous, the book is very clear that cadavers are the superheroes of science: animal testing is one thing, but animals aren't people, and cadavers have allowed us to make real, important advances in various scientific fields.

But I don't think I'd recommend this book to everyone. Not only do you need to be able to handle various descriptions of corpses being used for various purposes, but there are also some vivid descriptions of animal testing that honestly upset me more (due to most of them being alive).

TL;DR: Stiff is a morbidly funny yet deeply sincere look at how human cadavers have enhanced our understanding of science. While dated, it is still a nice introduction to the use of human remains, though some people might have a hard time with some of the descriptions of animal testing.

[killed-by-choice]

“Stella Roe,” 21 (USA 1972–1975)

“Stella” went to an abortionist’s office for a first-trimester surgical abortion. She didn’t know that the abortionist would kill her along with her child.

Right before the abortion was going to begin, Stella was injected with lidocaine for a paracervical block. The abortionist intended to dilate her cervix and then begin operating, but never even got that far before things went horribly wrong.

Stella went into convulsions. After several of these, her heart stopped and she was no longer breathing. The abortionist gave her diphenhydramine (the active ingredient in Benadryl) and then had an ambulance take her to the hospital. However, nobody at the hospital was able to resuscitate Stella and she was pronounced dead.

Stella’s autopsy revealed that her death was the result of malpractice. Her blood level of Lidocaine (taken after death) was 9 ug/ml, which was 6 times the reading for appropriate use. This reading was taken from postmortem blood samples, and because of the way Lidocaine is metabolized, doctors noted that the levels before Stella died may have been even higher. There was also a paracervical soft-cell hematoma at the injection site. This indicated that the abortionist may have injected that unknown amount of Lidocaine directly into her vascular system.

Thanks to this toxic dose, Stella suffered pulmonary edema, convulsions and cardiorespiratory arrest. It should be noted that any amount of anesthetic that is administered to anyone undergoing surgery should be carefully measured and recorded. There is no excuse for giving a massive overdose apparently without exact measurements.

The CDC counted “Stella” as a maternal death from legal abortion. In the year that she died, the CDC was still at least trying to gather comprehensive abortion data (although these attempts were incomplete at best). Over the years, US abortion data reporting systems became voluntary and increasingly flawed, leaving many others like her uncounted.

Other abortion clients in America subjected to overdose or other misuse of anesthesia include:

Stacy Ruckman (intentionally given an overdose to speed through the abortion procedure)

Karnamaya Mongar (killed by the infamous Kermit Gosnell)

Kelly Morse (dosed with a drug she’d repeatedly told the facility she was allergic to, then turned blue while her killer proceeded with the abortion anyway)

Diane Watson (anesthetic injected directly into her vascular system)

Carole Wingo (overdosed on Demerol by facility unprepared for resuscitation)

Ying Chen (given a toxic overdose after being made to sign “consent forms” in a language she did not understand)

Ta Tanisha Wesson (overdosed on anesthesia, then left to choke to death on her own vomit)

Robin Wells (overdosed on anesthesia and improperly resuscitated according to lawsuit)

Dawn Ravenell (13-year-old who was not told to not eat, given wrong dose, woke up on the table and vomited into her lungs, then left unattended to drown in her vomit with pieces of her dead baby left inside of her)

Gina Gardner (not given informed consent, overdosed to death on anesthesia while already sedated)

Delores Jean Smith (left unattended with IV anesthesia still running, died at 15 without ever learning she hadn’t been pregnant)

“Elise Roe,” (died at 18 from massive overdose)

“Abigail Roe” (comatose and then dead at 23 after anesthetic was injected directly into her vascular system)

“Roxanne Roe” (overdosed to death at 17 years old)

There are many others.

[memoriae-lectoris]

When death is due simply to old age and it is known that the deceased desired to bequeath their body, the recorded cause of death will inevitably be reasoned and educated supposition. The only way to establish it for certain would be to perform a postmortem which, as this procedure renders the body useless for dissection, would contravene the wishes of the donor.