The Dead Speaks

Part of the benefits of a physician practicing in a teaching hospital is that there are regularly scheduled academic conferences and meetings where you can attend and learn something.

This morning I attended the Medicine Grand Rounds which was a clinical and pathological presentation of an interesting case.

A senior medical resident talked about a woman admitted in our Intensive Care Unit several weeks ago, who came in very ill. Her condition deteriorated quite rapidly that she died in less than 24 hours after admission despite of all the efforts to save her. An autopsy was requested from the family, to know what caused the patient’s demise, and in addition it was felt that the information from it would help us care for future patients.

After the history and the hospital course was presented, the Pathologist revealed his findings. He showed pictures of the gross and microscopic features of the autopsy. He then gave the verdict on the cause of death. And it was something unexpected. At least for me.

For all the medical specialists, it is the pathologist that always have the correct and final diagnosis. When I was still in medical school, which was more than 20 years ago, I have heard this saying:

“Internists know everything but they don’t do anything.” (Meaning internist like me have all the knowledge but don’t open up and explore the patient to intervene.)

“Surgeons don’t know anything, but do everything.” (Meaning, even though they don’t know yet, they open up and explore the patient to find out.)

“Pathologists know everything, and they do everything, but it is too late.”

Though in fairness to the surgeons, nowadays, with the advent of all the high-tech imaging modalities, like CT scan and MRI, they almost always have all the information they need before they cut open the patient.

I would say that part of a doctor’s learning is from the morgue. In fact, when we have a patient that died and we were granted permission for an autopsy, I make it a point to have my medical residents rotating with me, to come down to the morgue during autopsy and learn what the findings of the pathologist were. I think this is essential for a good training.

I am not trying to gross you out, but that’s the reality of our line of work. Though with all the TV shows, like CSI and NCIS, anybody can witness an autopsy, whether it is real or imagined.

My first exposure to a real autopsy was when I was a 4th year medical student in University of Santo Tomas, in the Philippines. I was rotating in Forensic Medicine at Fort Bonifacio. There was a victim with multiple gunshots, and two pathologists were performing the autopsy. It takes a lot to gore me out, so it was no big deal to me. Plus we have been exposed and even dissected cadavers in our Anatomy class. By the time we got used to it, we can even eat our lunch in the Anatomy Hall.

While the autopsy was underway, an army sergeant walked in into the morgue with several new army recruits in tow. The sergeant told the recruits to stand in the corner and watch the autopsy so they know what would happen to them if they were killed.

As the pathologists extricate the internal organs one by one to examine them, I have noticed that the new army recruits who were standing in attention started to sway. Their stoic faces started to grimace. Well, who wouldn’t? I guess it was a sort of cruel initiation for them.

Since then I have witnessed several more autopsies over the years, not including what I watched in NCIS. It is not that I enjoy them, but I have to admit, I learn from them.

However I have maintained my utmost respect for the deceased. These bodies that were cut open for us to study were once living individuals. They were persons. They have a name. A purpose. A life. But now gone. Yet in these hallowed halls, they still speak.

Inscribed over many entrances of morgue, medical examiner’s office and anatomy hall is the Latin maxim, “mortui vivos docent,” meaning “the dead teaches the living.” Yes, indeed.