surgical cases-explanted kidneys, colon segments filled with tumor, hernia sacs, mastectomies-- and I cut them up into small pieces and give them to technicians who process the tissues into glass slides so we can get a microscopic diagnosis.

My favorite part of my job, though, is autopsy.

I love being able to find the answer to questions nobody could answer while the patient was still alive. I love the fact that in spite of old-school bedside physical exams, digital stethoscopes, PET scans and diffusion-weighted MRI, the girl with the knife and the skull saw is the only one who really knows what that metastatic colon cancer looks like and how far it really went. And I love being elbow deep in guts.

Most people confuse pathologist and mortician. Morticians are funeral directors trained and licensed in the art of body restoration. Pathologists are medical doctors trained in macro-and microscopic diagnosis of disease. At autopsy, we follow a procedure by which we



remove most of the body’s organs, including the brain. Then we crudely sew up the body and send it to the funeral home, where the mortician cleans up the body and restores it for viewing.



People often tell me they would love to see an autopsy. Hospital autopsies are surprisingly boring. First we incise the skin-some institutions use a standard Y incision, others use a sort of U-shaped chest incision going around the outside of the breasts, with a vertical abdominal incision. The flap of skin and subcutaneous tissue over the chest is cut away from the ribs and pulled out of the way over the face. We use a saw to cut the ribs and remove the chest plate, exposing the heart and lungs. The abdomen is opened and we cut all along the intestine to remove it in a single, long tube. Starting just above the thyroid, we cut away loose connective tissue along the spinal column and around the diaphragm. This allows us to remove the heart, lungs, stomach, liver, spleen, pancreas, kidneys and bladder all in one block. Then while the technician sews the body back up, the resident separates the chest block from the abdominal block by cutting through the inferior vena cava with a scissors. Then we cut the heart away from the lungs, and the lungs are filled with formalin (preservative containing formaldehyde and a bunch of other crap). With the abdominal block, we cut away the liver from the stomach and slice it with a knife. Sliced human liver looks exactly like the cow’s liver on the Styrofoam trays at the grocery store. I can never eat liver again. We find the adrenal glands on top of the kidneys. We cut down the entire small intestine and colon, usually