So in between my work on the double homicide, I had another family come in who lost their sister in a car wreck. She hadn’t even been released from the medical examiner, and they wanted to see her RIGHT NOW.
It was 2pm. Medical examiner stops releasing at 3. The drive is an hour. A normal autopsy repair takes about four hours; this one would be far beyond normal. I hadn’t seen the body, but I saw photos of the wreck; a car overturned and flattened by a semi truck. If I got this body at 4pm and went to work immediately, I may not finish until midnight, and that doesn’t include the time for the chemicals to penetrate every cell membrane and stop any bleeding and leakage that typically occurs with all autopsies. What if all her limbs were broken? What if her head had been shaved? These are things I need to know before I can guarantee a viewing time.
One of the brothers told me that he would settle for coming in to see her after I had been working on her for two hours. “It’s ok; I’m a medic. I’ve seen everything.” Everything? Your little sister’s organs in a bucket on the floor? Her skull cut in half and her scalp pulled down inside out over her face? Her chest cavity flayed open and full of embalming fluid which will make your eyes water and your throat close up if you aren’t used to breathing it every day?
Here is what generally goes into an autopsy repair in a case with no trauma, and why you absolutely cannot view the body until the entire process is complete.
After one hour, I have received the body, identified it, unwrapped it and placed it on the table. Unwrapping is a chore in itself, since the medical examiner will double-bag bodies and usually both bags are full of blood. To avoid spilling it all on the floor, I cut the bags into pieces, pull the pieces off into the medical waste bucket, and then rinse off any blood that spills on the table. Then I place the body on positioning blocks – under the hips, shoulders, ankles and head. This is so I can easily clean the underside of the body. Then I remove the medical examiner’s sutures; typically the chest, head and stomach are cut open but I have to remember to check the spine and legs as well. I’ve been surprised a few times when it was time to dress and casket a body. Then I bend the arms, legs and fingers to break out the rigor mortis. If the deceased has long hair, I tie it out of the way. I remove the bag full of organs from the chest cavity and put it in a bucket into which I dump two bottles of a very viscous preservative fluid. Then I put strips of cotton along the edges of the ribcage so I don’t cut myself on the bones. Sometimes I use the person’s own breastplate as a cover for the genitals, because I’m weird like that. (Typically I only cover a person’s genitals if I am working during business hours, because I have to wash the entire body anyway.)
That just took an hour.
Next hour. I’ve probably set the person’s eyes and mouth. Luckily, most younger people have their own teeth, so I don’t have to mess with dentures or use a plastic face former for people who arrive with no teeth and no dentures. Additionally, many traumatic deaths result in a natural, unbreakable mouth closure, so I don’t have to suture the mouth closed. I might do some nasal aspiration in case any fluids have been left in the throat, and I’ll start preparing my embalming fluids. I usually use the same mix on every autopsy, and then vary the fluids according to the person’s skin color and condition. Then I look for major arteries. I’ve worked with some pathologists who are especially nice and will tie off the arteries for us, but so far in my state I haven’t ran across any like that. I use my dissecting tools to isolate the carotids, axillaries and iliacs, and tie them off. If I’m working alone – which I usually am – I’ll start embalming the head first, so that I can sew up the head while I’m embalming the rest of the body.
The head is very difficult because since the brain has been removed, every artery in the skull is open, and these must be clamped off to avoid spraying myself with fluid (and the fluid spraying all over the room instead of going into the tissues). Of course, clamping means that pressure can build up in the face and cause the eyes to swell, so the head and the fluid line must be constantly watched. In the case of a head with no trauma, it’s better to use too little fluid than too much. Too little can be fixed with external preservative creams, but too much can distort the face. I also coat the inside of the scalp with a preservative gel.
That’s it! Two hours gone right there and the body is in no way ready to be viewed. It’s still cut wide open and missing all its organs, and the floor and table are a mess. So am I. I remember when I had long hair, I would actually get pieces of fat and blood clots stuck in it. Now I have extensions and I try not to wear them to work, or if I can’t take them out then I wear a hairnet.
Next I’ll start injecting the legs and it usually gets easier from there. I can turn the machine on and ignore it, once I make sure the arteries are not damaged and that the fluid is actually going down the leg. Once I see the fluid flowing back into the body cavity, I’ll check the leg and see if it’s done – I look for distended veins, pink coloring (even a black person will show some) and firmness. Then I can move to the other leg. During this time, I can replace the skullcap with screws and then start sewing the scalp back into place. I can hide the sutures with the hair, but if there is no hair and it’s a man or the family does not want to use a wig, I can use wax to hide the sutures.
Then I inject the arms and I know I’m done when the nail beds turn pink. If the body has been dead for several days, they may never really lose that purple stain, which is easy to hide with nail polish on a woman. For a man I will have to use skin-tone makeup and the result isn’t as good. I wish someone would invent a nail polish for men, but in the meantime I’ve experimented with using several coats of a nude shade of polish and then going over it with a matte topcoat, with mixed results.
The last hour is used for suturing the rest of the body, after the treated organs are placed back into the cavity. Sometimes the intestines need to be cut to release gases, and blood needs to be aspirated out of the bag. And for some reason, even though the bag fit when I took it out, it never seems to fit quite the same way when I try and put it back. Sometimes there’s just no sewing the stomach over the bag and have to take out each organ; coat it in powdered formaldehyde; and fit it in the body wherever I can. Whether I have done this or not, I dump several cups of powdered formaldehyde (known as Viscerock) into the body before sewing it up. I also try not to forget the breastplate; I’ve done that more than once and then had to cut all my sutures and redo them.
So now the body is technically “done.” I’ll coat the face with a preservative cream or a moisturizing cream, wash and dry the body and wrap it tightly in a sheet with the arms folded. For obese people I will use a bandage to tie the hands together atop the body. Then I have to clean the table, floor and instruments; bag up the medical waste and put laundry in the hamper.
So no, you cannot come to view the body in the middle of my work. Autopsy repair is seriously messy and even though I have worked on a relative before, if she were autopsied I would gladly hand the task off to someone else. I remember when I was sixteen and we had to write a report for Career Day, I said I wanted to watch an autopsy and contacted the local police department, who told me absolutely not. Now I know why.