By Emily Hagen
As Dr. W, the pathologist, ushered my peers and me in, he made sure that we were properly wearing our masks, gloves, cloth gowns, and expressions of respect. He encouraged us to speak up if we felt too nervous to walk further inside. The morgue smelled of formaldehyde and goose bumps formed on my skin as my body sensed the frigidness of the room. I was more excited than scared to watch Dr. W perform an autopsy on Ms. S, our ninety-four-year-old “patient.” As a pre-medical student at the time, little did I know how much this experience would significantly shape my understanding of the practice of medicine. And it would imprint on me an appreciation for the autopsy.
Before we entered the morgue, Dr. W delivered a riveting presentation to us about the history of the autopsy and its importance to medicine. He explained how the autopsy is a valuable tool for understanding the pathogenesis of diseases and identifying potential treatments. I was captivated by his examples of current medical knowledge gained from postmortem findings. Our knowledge about cancer, the disease that took my own father’s life, has improved through autopsies. The American Academy of Pediatrics’ “Back to Sleep” movement of 1994 was informed by autopsies on babies who died from Sudden Infant Death Syndrome. I also realized that the autopsy could truly confirm a patient’s cause of death, as it has the potential to identify discrepancies between clinical diagnoses and a coroner’s findings. Dr. W worried aloud that the procedure has lost its preeminence as a powerful tool in evidence-based medicine. Technological advances combined with the unwillingness of insurers to cover autopsies threaten their existence as a practice. I found this intriguing and perplexing.
At the morgue, I observed Dr. W meticulously examine Ms. S’s organs. Never before had I recognized the direct clinical relevance of the biology and chemistry I studied. The autopsy progressed and a clearer picture of the possible causes of Ms. S’s death emerged. As the autopsy unfolded, more details about Ms. S’s life surfaced. She had given birth and developed uterine cancer during her life. She was not just a body with a puzzle of pathology trying to be solved.
I thought about how I could not wait to call my uncle, a physician who has been a mentor to me, to tell him about my day. In our subsequent conversation, I learned that he spent his first summer of medical school working on a pathology project and observing autopsies. My uncle shared with me that that even decades after these experiences, he still remembers the details of the first autopsy he observed, and that he took those clinical pearls with him into his future patient encounters. This highlighted to me that patients, whether in the context of an autopsy or otherwise, are invaluable sources of learning and growth for a physician.
Having studied medical ethics, I naturally began to consider the ethical and social dimensions of the autopsy. It was so moving to hear Dr. W explain that he strives to provide the family members of patients with the most truthful depiction of the deaths of their loved ones while tactfully addressing the difficulties of these conversations. Also, as Dr. W performed the autopsy, he convinced me of the importance of handling a patient’s body with the utmost respect and professionalism. These values will guide me through my life in medicine.
The morgue was far from scary. Any initial trepidation was transformed into deep curiosity. The sense of appreciation that I felt for Dr. W and Ms. S for all that they taught me was overwhelming. I saw for myself how valuable the autopsy is, and I encourage others to see it in this light as well. Autopsy in fact means, “to see for oneself.”
The importance of the autopsy seems to be evident now more than ever. The procedure has advanced our understanding of COVID-19’s pathophysiology, which can inform future treatments and perhaps a vaccine. The autopsy also informs mortality statistics and epidemiological data. Research and healthcare policy decisions regarding COVID-19 can consequently be more effectively shaped. Additionally, the autopsy allows us to further explore current public health issues, such as the opioid epidemic. It simultaneously teaches physicians about what happens to bodies stricken by opioid addictions. I believe we do a disservice to both medicine and society at large when we overlook the utility of the autopsy. Therefore, I am, and will continue to be, committed to making the autopsy a more prominent part of medicine.
Emily Hagen is a second-year medical student at the Loyola University Chicago Stritch School of Medicine. She is participating in the Bioethics & Professionalism Honors Program and looks forward to integrating her passion for bioethics into her future practice as a physician.