V 1 N. 24 Slices of Life and Death

 Please note:  This piece is not for the squeamish.  If you have just had lunch, you may wish to refrain from reading right now.

Slices of Life and Death

George Brose

            In 1977 I was exposed to a world I could only imagine while reading Mary Shelly, crime fiction, or watching some Brit TV series about forensic pathologists.  I was a graduate student at a college in rural Indiana.  Having completed my graduate degree in exercise physiology, I was offered a one-year contract to teach anatomy, physiology, and exercise physiology to undergrad students.  I was happy to get that job even though the pay was a pittance, because it enabled my French Canadian wife  Marie-Andree a chance to complete her graduate degree before we returned to Canada.

            While living in East Central Indiana Marie-Andree had become friends with Corrine,  the only other French Canadian in town.  Her husband Billy Bob was the local pathologist for the county, and knowing my limited experience in the field of anatomy, he offered me the opportunity to assist him in doing autopsies at a nearby VA hospital. Billy Bob also offered me the princely sum of $50 to assist with each autopsy.   Not only did I get to see fresh human cadavers up close, I got to help dissect them and remove organs and look for causes of death.  Admittedly, the cause of most of the veterans’ deaths was old age and combination of heart disease, emphysema, dementia, and ….well this list goes on.  We weren’t dealing with victims of crime.  Prior to this opportunity, my experience in dissection of a mammal was with a fetal pig. 

            It was a 38 mile drive north, just beyond  Gas City, IN where the veterans hospital was located.  There had once been an oil and gas boom in that part of the country and Gas City got it’s name from what lay under the earth’s surface.  The hospital housed hundreds of old veterans who had no homes or health insurance in their last days.  Some of them had been there from the time they had left the military.  I remember reading through one old gentleman’s records and discovering that on his way home from WWI he had gotten intoxicated in the Indianapolis railway station and been arrested for drunk and disorderly.  He was headed out west to Denver perhaps but was sent to the local veterans' hospital to dry out rather than the county jail.  He never left that hospital.  No family ever asked what happened to him, never came to claim him.  He had lingered in that place for almost sixty years.  Today we talk about the homeless veterans of Iraq and Afghanistan, suffering from PTSD.   Back then the story was the same, just the diagnosis was different.  It was shell shock or battle fatigue in those earlier wars.

            To dissect a member of one’s own species is something few of us will ever do.  It definitely leaves a lasting impression on one’s psyche.  Billy Bob had a defense to confront such work and that was humor.  I must admit that I rarely laughed so much on any job I performed.  Maybe it was Billy Bob’s way of protecting me as well as himself.  Our subjects had been dead only a few hours and were not in an advanced state of decomposition.  This made our task much more manageable.  It is a part of the job we never see portrayed in great detail on modern media.   However in most anatomy labs in university medical schools where doctors learn their trade, cadavers are not new and fresh.  They are usually floating in a tank of chemical preservative and fished out for a class of wannabee doctors to learn where the muscles lie in relation to connective tissue, organs, bones, and nerves.  Their color no longer resembles a human being and the smell of the chemicals often permeates one’s skin. 

            We usually began our work with a look at the thoracic and abdominal cavities.  This was accomplished by a long slice from the top of the sternum down to the top of the pubic bone.   The skin was pulled back and a rib cage exposed.  To get to the heart and lungs required removal of the front of the rib cage.  A pair of snips was used to cut through the ribs and eventually lift off a section of the chest the size of a dinner plate to expose the heart and lungs.  We would cut the aorta and  the pulmonary veins and arteries and lift the heart out of the chest.  We would then begin looking for blockages in the coronary arteries indicating that the patient had had coronary heart disease. Those arteries were on the outer surface of the heart. We could also look at the state of the heart valves  and thickness of ventricular walls to see if the heart had been under extreme stress.   From there the lungs could be removed again to look for blockages in pulmonary circulation or blood clots.   We might also look to see if there was an obstruction in the larynx and bronchial tubes for causes of a choking death. 

            I don’t recall doing a lot of searching in the abdominal cavity for causes of death as the patient  may already have been diagnosed with some type of cancer of the intestines, stomach, liver, spleen, kidneys, pancreas or adrenal glands.  But Billy Bob did give me a chance to do some exploring down there  to learn more about location and juxtaposition of the human organs. After all I was supposed to be teaching this information to undergrads.   If the patient had been diagnosed with diabetes, we often confirmed the effects which could be seen in the lower limb deterioration.  Some of the men had already had amputations of toes, feet or legs from that disease.

            Our next area of research was the head.  This may make the reader a bit queasy.   They don’t show  much about head forensics on the tv shows.  Our interest would focus on blockages in blood vessels in the brain that might be contributing to the cause of death.  First we had to get to the brain and that meant cutting through the scalp down to the skull and then removing enough of the skull to then remove the brain.  First things first, an incision needed to be made across the top if the head from top of one ear to the top of the other.  Doesn’t matter which side you begin on, but you do have to go deep enough to reach the skull on that incision.  If the person was bald, it meant a lot more work for an undertaker to cover up that incision with make up.  Once that cut was complete, the investigator must pull the front of the scalp forward over the face.  The scalp comes off quite easily and is pulled forward about to where the eyebrows are located.  Then the rear section of the scalp is pulled backwards to expose the rear portion of the skull.  The skull is now the only thing between the investigator and the brain.  But how to get through all that bone?  A saw is needed.  Today a modern cutting tool with a small circular blade is used and the top of the skull is circumnavigated until it can be lifted off the top of the head.  Once that is done the front of the brain can be lifted up and then in the back side of the head the spinal cord can be cut and the brain lifted out of the skull.  There are also a few nerves at the front underside that may have to be severed as well such as the optic nerves from the eyes so that the brain can be removed.  The pathologist in those days was required to remove the pituitary gland from the underside of the brain and send it to a lab for extracting pituitary growth hormone for treating patients with dwarfism.  Today that hormone can be synthesized.  Then the brain would be sliced like a loaf of bread from one side to the other.  Once that was done the pathologist could look for signs of deterioration from Alzheimer’s disease as well as cerebral vessel blockages.   This would pretty much be a wrap on our autopsy.   Then we had to put Humpty Dumpty back together again.   Any organ which indicated a cause of death was preserved in some kind of pickling solution to be sent to another office.  The pituitary gland was forwarded to a lab. And then all parts went back to their original resting place.  The top of the skull replaced and the skin lifted off the face and pulled back to the top of the head.  I think Billy Bob stitched it back in place.  Heart and lungs replaced, the rib cage and sternum set back in place and skin pulled over the chest cavity and stitched back.  They often show that part in the tv dramas. 

            Did  I mention earlier that I laughed a lot during these sessions?  “How could he possibly laugh?” you must be thinking.  What is the old saying? “Laughter is the best medicine?”  Well the initiate and the expert often need some humor to get over what they have been doing, especially knowing that someday they may be the one lying on that table being dissected by a medical student or a crime scene investigator, or just a regular old pathologist looking for answers to supply to statistical research files.   I remember Billy Bob sometimes singing a parody of the old song Y.M.C.A.    “Young man are you looking for a home.  I said young man,   Y.M.C.A."   He would change some of the song to "----- VA"  instead of "YMCA".  He would regale me with stories from pathology journals about bizarre cases.  He did confess that a pathologist cannot work on someone he knows.   He told me that once he pulled back the sheet from a cadaver, and it turned out to be one of his former high school teachers.  He completely broke down and had to leave the job to someone else.  Once too he had been called in to do an autopsy on a victim of a mob execution.  The guy had been floating in a pond for several days and was very ‘ripe’ to put it mildly.  They had to work outside in an open garage and everyone there was given a strong cigar to smoke to overcome the smell they were enduring.

            Ten years later on our way to a job assignment in China, we stopped to see Billy Bob and Corrine where they were then living in northern New England.  When we arrived Billy asked me if I would like to do an autopsy with him for old times sake.  Especially as the client was Chinese and we were heading to China.  Well, how could I resist?  When we got to the clinic,  we learned that the deceased had swum out to a boat at the marina and had a few beers and attempted to swim back but didn’t make it.  He had drowned apparently.   There was the guy on the slab.  Billy found that the clinic scale was not functioning.  He asked me how much I thought the man weighed.  I said I had no idea.  Billy Bob replied, “Well pick him up.”  I complied.  I said, “about 140 pounds.”   That weight went into the official records.  We completed the autopsy.  The lungs were full of water.  It was clearly a death by drowning.   No other signs of trauma.  A blood sample was taken to be analyzed for alcohol content.  Our work was observed by a deputy sheriff who was himself a case for another story.  All I care to say at this time was he was not a person who should have been on a police force.  He had recently taken the job in northern New England after years work in an Ivy League town in the East.  He said he just got tired of busting heads.   We now refer to  him as Deputy Kowalski. with no intent to stigmatize the Polish culture.   Then Deputy Kowalski went on to tell us his worldview.  He said that he for a long time thought Koreans were the dumbest people in the world until he moved to his current town on the Quebec border.  Now he was certain that French Canadians were the dumbest people.  Billy Bob and  I told him that was an interesting viewpoint as we were both married to French Canadians.  Years later in a correspondence with Billy Bob I asked him if he had had any later encounters with Deputy Kowalski.  He said the deputy wasn’t in the department anymore.  Apparently he had stopped someone for speeding out in the county and left his squad car parked on some railway tracks.   While he was writing a ticket, the 8:15 came by and wiped out his cruiser.  The sheriff decided that Deputy Kowalski’s services were no longer needed in Northern New England.

Comments:   Sometimes they are better than the text.

First, Billy Bob, really?  No one is named Billy Bob that isn't a character in a TV series set in rural Alabama.

Before reading this my day was planned around an afternoon delight session with Molly.  Provocative videos that will provide incentive to travel the path I've selected are set.  Two full length mirrors are stationed next to the bed to reinforce her recent discovery that "I like to look at myself having sex". Her arrival in six hours was greatly anticipated.

After reading this, I am curled up in a ball, sucking my thumb and rocking back and forth. Jesus H. Christ, you did this and are comfortable sharing the details?  Do you have any idea how difficult it is to type while rocking back and forth?  The first couple sentences of your next offering will be read slowly and carefully, a sort of sticking my toe in the water before jumping in maneuver, and then only after I have repeated the "You can do this, you can do this, you can do this" mantra.

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