By Birdstrike M.D.
“So, I grabbed up my suitcase, and took off down the road
When I got there she was layin’ on a coolin’ board”
– Son House, Death Letter Blues
Fourth year of medical school is great. Finally, I get some elective time. Last month was great: Dermatology, ahh…….Sleep, rest, low stress and drug rep lunches: Yum. I can still smell the delicious smoked ribs the rep brought for lunch, just last week. I’m already hungry as I drive to start my second elective month in a row. This month is going to be even more relaxed. The patients might have >gasp!< pimples and rashes like last month, but this time they probably won’t even move! After getting worked to death on 6 straight months with hospital call, this is the break I need.
I walk into the building and as I get close to the bottom of the stairs, I smell something. Is that ribs, again? Wow, drug rep food already? It’s only 9 in the morning. That’s weird? Oh, well. I guess life really is good on these elective months, when you’re not getting called at 2 a.m. for a patient who might be dying. I look at the clock. Shoot, I’m a few minutes late. I open the door.
A group of students and residents are standing around a table that is covered by a sheet. The smell of barbequed ribs hits my nose stronger. A bearded man on the other side of the table, waves to me to come over. That must be Dr. Black. I creep toward the others around the table as Dr. Black pulls the sheet off of the table. The overwhelming smell of smoke chokes my nose and as I see what is lurking under the sheet, I feel my stomach drop and my head get dizzy. There laying on the table is a charcoal-black human body, burned to a crisp, arms drawn up to the face in a fetal position. A few of the others turn away. I hear a gasp, and a few deep breaths as we look at each other. Oh my god, that smell! I feel like vomiting. It’s the smell of barbequed ribs, alright. Human ribs. Welcome to Forensic Pathology, I think to myself.
“One thing we always do with burn victims is to x-ray them. Does anyone know why?” asks Dr. Black.
“To identify them by dental records,” chirps Gunner Boy with the bow tie.
“No, although we do that occasionally,” says Dr. Black. “It’s to see if there is any lead in them.”
“Huh,” Gunner Boy seems puzzled. “This person died in a fire.”
“Are so sure? Why might such person have lead in them?” asks Dr. Black.
Now it’s my turn. “It’s because they’ll shoot them full of lead, then light the house on fire to try to cover up the evidence,” I blurt out.
“Yes sir,” nods Doctor Black.
Betsy, the mousy-haired girl that was in my Anatomy group looks at me disturbed, as if to ask, “How’d you know that?”
“Welcome to Big City Morgue, Betsy,” I shoot back.
I look down at the burnt corpse and despite the whole body being as black as a charcoal briquette, for some reason there’s a patch of skin on the right arm that’s completely unburned. It’s a tattoo that says, “Mom, I love you forever. R.I.P.” Below that is another tattoo that says, “Straight to Hell.” How unbelievably ironic, I think to myself.
We move to the next table. Dr. Black pulls back the sheet. It’s an 18 year old male. “Gunshot to the chest,” says Dr. Black. “All homicide cases are done by me and the fellow, because these require us to testify in court. Anyone is free to observe.”
We move to the next table. He pulls the sheet down. It’s a 10 year old female. She looks completely untouched, as if she is going to sit up and jump right off the table, with the face and body of an angel-sculpture. “Motor vehicle accident. No outward signs of trauma whatsoever. This will be a good case for you medical students.”
At the next table, there is what looks like only a white sheet in a pile. He pulls the sheet away, and there’s a severed foot. “Any idea what this is?” asks Dr. Black.
“A foot!” chirps out Gunner Boy, as a few people laugh nervously.
“Yes, thank you, young Doctor. You’re right it’s a foot, and partly decomposed at that. That’s very good. But what is the significance of this foot?” he asks.
“It’s dead,” says Gunner Boy, trying his best gallows’ humor.
“Let me take a wild guess. It’s another homicide,” I answer.
“You got it young Dr. Bird,” he answers, shaking his head. “You’ll find we have no shortage of homicide cases here at Big City Morgue. This one is going to take a little work from Big City PD to find the rest of Mr. or Mrs. Foot.” Gunner Boy laughs ghoulishly. No one else laughs.
We’re only 15 minutes into the month and I’m seriously regretting my elective choice. The smells. Oh my God, the smells! First, the smell of burned human flesh, then decomposing foot! It looks so cool and interesting on the crime scene investigation shows, but to see this stuff up close….Why did I become a doctor?
Half way through the autopsy of the 10-yr-old girl we’ve found nothing. The girl’s heart, lungs, chest, pelvis and all major organs are completely intact. Even her brain is without injury.
“What killed this girl?” asks Dr. Black.
We all look with a blank stare.
“There’s only on last thing it can be. Any ideas?” Nobody has a clue. Dr. Black points at me. “Young Dr. Bird, why don’t you move the head side to side, and see what happens.”
“Uh…okay,” I answer. I take my gloved hands and put one on each side of the girls head and move side to side. I barely move them and her head slides back and forth like a bobble head doll, as if completely detached except for only the skin.
“It feels almost like she’s been decapitated internally,” I say, again feeling as if I’m going to throw up, or cry, I don’t know which. “A broken neck. Atlanto-occipital dislocation.” This is someone’s daughter I think to myself. Holy crap. Somewhere this girl’s parents are probably still sobbing, in tears, yet here we are with their daughter on a gurney. It also happens to be two days after Christmas. “When did this happen?” I ask.
“Take a wild guess,” says Dr. Black robotically, with the emotions of a corpse himself.
“Two days ago? On Christmas?” answers Betsy, looking as if she’s about to cry. Dr. Black nods emotionlessly.
We move to the final case of the day. It is a woman, 45-yr-old with no previous medical history. She had died suddenly, having dropped dead without sign or warning. We go organ by organ doing the post mortem autopsy, seemingly finding nothing.
“What’s this?” asks Dr. Black.
“It looks like a uterus,” I answer.
“Yes sir,” says Dr. Black. “Does it look normal in size to you?”
“No,” I answer.
He cuts into the pink, fleshy organ. He leans forward bending his glasses down and says, “Look here.” We all lean in looking at this organ. It looks like a fruit with a seed inside.
“Is that a fetus?” I ask.
Dr. Black smiles for the first time today. “Yes, it is a tiny one; first trimester. You don’t see this every day at the morgue.”
How could this guy possibly have smiled at that? Seriously? Now I know why I’m not sending out applications to Pathology residency. Geez.
“That’s so sad. But what does it have to do with why she died?” asks Betsy.
“That’s a very good question,” says Dr. Black. “Look here.” He points to her veins; the pelvic veins. We continue on with the autopsy.
“What’s this?” I ask. It’s a firm and dark knot-like thing inside one of her veins.
“That’s why she died,” says Dr. Black.
“A blood clot. Wow,” I exclaim.
“Yes sir,” says Dr. Black. “Pelvic vein thrombosis. This lady died from this blood clot, part of which broke off and went to her lungs. She died from this complication of pregnancy before she ever knew she was pregnant. It usually doesn’t happen this early, in the first trimester. This is a great case for you guys,” he says, this time with no smile.
The day is finally over, and I’m as much or more emotionally drained and exhausted than on any clinical rotation I ever had. When I get home I pour myself a 16-yr-aged, Lagavulin single-malt scotch, neat in a snifter the size of a fish bowl. I take a sip, and get lost in the oaky, smoky flavor, hoping that I just might sleep tonight. What the hell was I thinking, in picking this elective? Man, I definitely didn’t want to be up all night taking call, but geez this is too much. I must admit it’s extremely interesting but I don’t know how I’m going to get through this month. I guess it can’t be too bad. At least I don’t have to worry about anyone “dying.” Just please, no more burned bodies, please! I figured it could be no worse than gross anatomy where you dissect a mannequin-like embalmed corpse. But for some reason, these “corpses” seemed much more real, more life-like, and more like “people.” They were fresh, so recently living, and still had families at home thinking of them, still planning funerals. Each came with one final story to needed to tell, and they needed someone willing to listen. Each came with a name, a face, and it felt like, a soul.
(Click here, in case you missed: Medical School in the Big City, Vol. I: Blood in the Streets)
This author does not divulge protected patient information or information from real life court cases. Any post that appears to resemble a real patient, real person, real co-workers or trial can only be by coincidence. This author does not post, has not posted and will not post factual identifying information about real patients. To the extent that any post is based on the real life experiences of the author, names, dates, ages, sexes, locations, diagnoses, and all other factual information are routinely changed to the extent that they are fictional, and certainly HIPAA compliant. Artistic license can and will be used liberally as needed. If you want boring scientific cases presentations, read a peer reviewed journal. Any opinions expressed here are of the author alone and not those of Dr. WhiteCoat, my employer or any of the hospitals with which I am affiliated.