It was 1980 nor perhaps 1981; it is so long ago now that I cannot be sure. It was during my Internal Medicine residency at Brackenridge Hospital here in Austin. Down in the basement, in the bowels of the hospital, was the morgue. It was the province of our county Medical Examiner. Medical Examiners, in larger cities like mine, were typically Pathologists.
One of our medical school pathology mentors once told us that there was a place for each of us in the world of medicine. “If you like speaking with parents, you can become a pediatrician. If you prefer speaking with children, you can become an internist. If you don’t really enjoy talking with people, you can become an anesthesiologist – ‘My name is Bob, I’m your anesthesiologist, count back from ten to zero … ZZZZ.’ And, if you can’t stand to talk with anyone who isn’t at least as smart as you are, you need to go into pathology. The pathologist is the doctor’s doctor.”
During my residency, I think that I attended only one autopsy. The point of an autopsy, in case you don’t have a clinical background, is to try to understand, “What the hell happened?” Let’s say that a young child was admitted to the hospital with pneumonia. The child was treated with antibiotics and breathing medications but died unexpectedly. “What the hell happened?”
Or maybe a trauma victim was admitted to the hospital and treated for his injuries and complications – gradually improving over a couple of weeks until he suddenly collapsed and died on his way to the bathroom. “What the hell happened?”
I was in the basement with the medical examiner. The deceased was a middle-aged male. The autopsy began with a surgical incision into the abdomen. Samples of the liver, spleen, pancreas, and kidneys were taken. All of the organs were palpated, measured, and weighed. I took some deep breaths. Nothing out of the ordinary was identified. Next, the medical examiner took an electric bone saw and divided the sternum (the breastbone) in order to expose the thoracic organs – the heart and lungs. Again, each was measured, palpated, weighed, sectioned, and examined. The heart had clear evidence of recent damage to the anterior portion of the heart. The examiner took a section of heart muscle and of the Left Main coronary artery. The brain was scheduled for examination at a later date.
I know that I have mentioned it before, but I have always had a deep respect and affinity for my colleagues in the laboratory – the pathologists, the folks in the microbiology area, and all of their allies. In my practice I always found their work and insights invaluable in helping my patients.
If you have made it through all of this prose, you are probably asking yourself, “Why am I reading this crap?” Rightly so. I’m thinking about autopsies because forty years after this first autopsy, I found myself working for a state agency. This particular afternoon, some one hundred of my coworkers were gathered in an auditorium considering the catastrophic failure of an agency automation initiative. The question at hand was, “What the hell happened?” There were many opinions from senior and junior staffers alike. At one point, I offered that none of the opinions mattered; what was required here was a project autopsy. Nothing less would provide a plausible answer.
My recommendation was praised by all of the senior staff, and it was then most politely ignored. This shit happens all the time in state agencies. I hate it when that happens.
This evening, I watched the latest Jan 6th hearing. These hearings, to my mind, are autopsies. Their purpose is to answer the question, “What the hell happened?” I think that these autopsy hearings have been conducted thoughtfully, and with a laser focus on establishing the facts. They have been, for me, no less enlightening than the autopsy that I attended in 1981.
The only unanswered question, in my mind, is, “Will the findings be most politely ignored?”