By the time we had done a half
dozen autopsies or so we had a pretty smooth working relationship. I now understood what Jim was talking
about when he mentioned the 'fast way'.
While both methods achieved the same results, the 'fast way' was a good
deal less delicate than the careful dissection carried out by Dr.
McMurray. In fact it relied more on
brute strength than skill. After Jim
used the electric saw to remove the sternum and the anterior part of the ribs,
the technique consisted of tying off all the structures at the highest possible
level before cutting them. They were also cut just above the diaphragm after
being tied off there. No fine dissection
here. I just grasped all the structures
in both hands and then with all my strength gave a mighty tug, removing all of
the structures out of the chest cavity simultaneously.
Not very elegant, but effective. We then went on to examine and section the individual organs looking for pathology.
The extra stipend made a big difference.
Even after I gave Jim his twenty - five shillings, if we did a couple
of autopsies each week, it still added up to more than my regular paltry pay and I
certainly needed anything extra I could earn.
All the money that Irene and I had saved from playing at Dublin's Paradiso nightclub, (another story for another time!) and from selling
all our possessions, including her beloved piano was almost gone.
My old friend, from my undergraduate
days, Arthur, kept in touch and we went out for coffee once in a
while to compare personal as well as professional notes.
"Thank god I have that extra few
pounds a month coming in from the autopsies.
At least that keeps us eating and pays the rent."I said. Interns wages in those days, did't even cover the exigencies and we had a new baby.
"Sounds like a good
deal," responded Arthur, "I
know we are having a really tough time at my hospital as well, because of the
current acute pathologist shortage. I've heard some of residents complaining that
they're expected to do autopsies and that they haven't faintest idea about how to go about it. Maybe you
could come over and do them and I'd assist you and we could split the
fee."
"I could sure use the extra
dough," I said, "The extra I'm earning doing these autopsies just about make it
possible for us to survive."
"Yes, you had some pretty bad luck.
But don't worry, things will get
better."
Over the next few months,
Art called me several times to come
over and do an autopsy. By this time, I was starting to consider myself a bit of an expert at the autopsy game. As so often happens when one arrives at that conclusion,
events prove otherwise.
The midnight DOA (Dead on Arrival) patient had been scheduled
for postmortem at eight the following morning.
A forty-five year old man who had collapsed at home, just before
midnight, as he was getting into bed.
Attempts to resuscitate him in the emergency department failed. Jim and I went through the usual autopsy routine
without finding any cause of death.
"There has to be a cause of
death, Doc, you've got to find something.
This is a coroner's case and there's got to be a cause of death on the death certificate, otherwise the fella
can't be buried."
"You're right, Jim, but you saw
how carefully I've looked. This type of death
from heart attack is almost always due to coronary thrombosis. I've sectioned the arteries really carefully
and can't find anything that remotely resembles a clot."
"Then we'll just have to have
the coroner come over and see what he has to suggest." Jim said.
"Yes, I suppose so," said I.
I phoned the coroner's office, and spoke
to Dr. O'Carroll, the city coroner, both a physician and a lawyer.
"Did you section those
coronaries carefully?" he asked me. "Sounds
like a classical coronary thrombosis."
"Yes, I did," said I,
"and found nothing."
"Ah, it must be there," said the
coroner. I'll be right over."
Jim and I set out all the
specimens for Dr. O'Carroll's inspection.
About a half hour later, he arrived. A distinguished, gray-haired
man in his middle fifties, he lit a cigarette, pulled on a pair of rubber
gloves started examining the specimens.
"Make sure to send away the
gastric contents to be analyzed and make sure he wasn't poisoned deliberately
or accidentally. I don't see anything
much here," he remarked as he
examined the liver, kidney and spleen.
Let's take a careful look at those
coronary arteries."
He held out his hand for the heart.
I handed him the heart with its
neatly sectioned coronary arteries.
"I've looked really carefully,
sir, and can't see any abnormality."
Dr. O'Carroll took the heart in his hand looked at it for a while, and said,
"Let
me have that scalpel for a minute. I
don't think you've sectioned the coronary arteries quite closely enough."
He took the scalpel and started to
section the arteries with closer cuts.
"Ah, here it is, see it?" he exclaimed, pointing with the bayonet tip of the scalpel, at the lumen of the
anterior descending branch of the left coronary artery.
"No sir," I said,
"I don't see anything."
"Look man, right there,"
he said, somewhat irritably, jabbing the scalpel at an area in the artery. "I'll section another area there. Now you can see it?" he demanded.
I nodded miserably, looking at the sectioned mess not sure
that I could see anything out of the ordinary and feeling quite inadequate on that account.
"Now you can put on the death
certificate acute coronary thrombosis."
He peeled off his gloves and groped
anxiously through his pockets until he found his cigarettes. He stuck one in his mouth, lit up and took a
deep drag. He smiled benevolently, as
the tobacco alkaloids crossed the blood-brain barrier and produced the desired
effects.
"Good lad, Smith," he said kindly, "I hope that this has
provided a valuable learning experience for you. You'll know what to do the next time,
eh?"
"Yes sir," I said, and
never called the chief coroner again.
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