Autopsy

Yesterday I had a strange new experience as a doctor. I have been taking care of a young (30s) man with spina bifida for the past 5 years. I had just seen him for a physical recently. A few minutes before leaving the clinic at the end of a busy day, I received a phone call from a pathologist. My patient, who I will call Steve, was found dead in his apartment. The cause of death was not known. An autopsy would be performed. I was stunned. I had just seen him a few days ago and things looked good. He had a chronic urinary infection, but with his neurogenic bladder and paraplegia, this was not new or unexpected. He was on prophylactic antibiotics for this. I asked when the autopsy was planned for and was told it would be done the following morning. Since I was not scheduled to work or be on call that day, I asked if I could attend. The autopsy was to be performed in another town.
Yesterday morning, I drove there and found the morgue. Present was the pathologist who would be doing the autopsy, the county coroner and a med tech. I was permitted to gown up and assist with the procedure.

It was a somewhat surreal experience to be standing before someone I had known and cared for for several years and had just examined a few days ago. He lay dead on the autopsy table. The autopsy proceeded in the usual fashion with a Y-shaped incision made on the chest. The ribs and clavicles were sawed to permit up to lift up the rib cage. Systematically, heart and lungs were removed and examined. Bowels were removed and examined. Liver and gall bladder were removed and examined. When we came to the urinary system, the cause of death became apparent. The right kidney was grossly enlarged with a large extra-renal pelvis. There was frank pus in the bladder. The cause of death was urosepsis. It was estimated that Steve had been dead for at least 24 hours before he was found in his apartment. Interestingly, a nurse from the clinic had called him in the morning to give him some normal lab results and his mother spoke to him at around 3 pm that afternoon. He must have died within 6 hours of that time. There was no warning. It is unusual for urosepsis to set in so rapidly with no symptoms manifesting even 6 hours before. Some element of mystery will always remain.

I called his mother from the morgue with Steve's splayed open body still on the table. She had come to his appointment with him as she usually did, just 4 days ago. I offered my condolescences. I said goodbye to Steve and walked away.

In one sense, it was interesting to see the very organs I had palpated, auscultated and percussed from the outside while he was alive. I was able to hold and touch the kidneys and lungs and other diseased organs. I was able to see his spinal fusion beneath the scars I had seen just 4 days ago. In another sense, it was sad -- I was looking at and in his corpse. As primary care providers we do not have to go to autopsies. I went because he was my patient and I wanted as much as anyone to know why he died and as my final act of care. Goodbye Steve. You died so young! I will miss you!