Where do the bodies come from and where do they go after they are autopsied?

These are case from our practice at Autopsy Center of Chicago. Families come to us to request and autopsy for their own reasons (closure, inheritance etc.). During our consent process, we offer a variety of educational options and many families want to teach other people. So they'll consent. We don't push. After, it's like any case. The family has plans -- burial, cremation, etc. We leave the body back in the hands of the funeral home, etc. And the family's wishes go from there.

How does an autopsy affect inheritance?

Most commonly for a sense of inherited high cholesterol in sudden death in a young father. Families worry (as is reasonable) if the father dies from a heart attack at 40, the kids will be at risk. It can go two ways. There can be a lot of plaque in many vessels of the heart (points to inherited). Or a tiny amount in vessel and no plaque anywhere else -- although the tiny amount was enough was in the wrong place and caused a death. While both scenarios lead to the death, the second is much less likely an inherited condtion. It's the overall load that tells you. Very helpful to sort through. Not all heart attacks are the same.

Then, with dementia people worry it's inherited. Usually the most important thing is how old the person was when it started (younger more likely inherited) and family member also having it. Most Alzheimer's is what's called "sporadic" -- not inherited. And it can also help to rule out mini-strokes, where the risk factors (high blood pressure, cholesterol) can be modified in family members, even if there's some inherited component.

Other things like undiscovered heart conditions (here's my PSA -- look up bicuspid valve) can uncover inherited conditions. Bicuspid valve is a tricky one because it look like a heart attack -- typically a man in his 50's or older. So the family thinks there's inherited "heart attacks" but it's actually the valve. And there's treatment, valve replacements, monitoring, etc. I've had a case like that. We found out and got all six children tested. Saved their lives to do the autopsy.

People worry about inherited cancers, but those usually happen young. When cancer makes friends with older people, that's usually an accident of life. A bad one. But wouldn't run in the family.

Other things: Marfan syndrome is sometimes diagnosed at autopsy because (unfortunately) not commonly diagnosed enough in life (another one to look up).

And families often want to know about babies and fetuses. But the most common autopsy finding in a premature death is nothing. It help to talk about things like the cord or the placenta and the things that can go wrong there. So the mother can know there was nothing wrong with her baby or her - and that there's no reason she can't go on to be a mother of a healthy child. These families I uniformly refer to counselling. Post-partum depression is real and then post-partum depression on top of losing the baby, devastating. A sad topic.

That's a start.

what is the strangest/weirdest thing you found in a body?

Well of course it's the dildo but that was a pathology resident and an ER extraction. Beyond that, I'd say mold. Like you'd find on cheese in the back of the fridge. Inside the chest. An undiagnosed fungal abscess. Just white puffs of mold in a soup of pus near the lungs.

Is there anything that has occurred during an autopsy that made you think you should immediately stop streaming?

Yes. Many. Sometimes someone will walk into the room so we want to hear what they have to say, but let them do it away from 1000's of viewers. Or if we need to take photo or talk about the case and mention names or confidential stuff. And then, there's parts of the body that we need to access that might be near a tatoo or the face. We cover them up but if it's technically difficult we'll stop so we don't expose the confidentiality. Also, if I need to focus more and multitask less, I'll stop. Or if I have a student that isn't quite as ready as I thought and doesn't get the broadcast idea. On the other end, we we just started I accidentally left the live stream going in front of 1000's but didn't know it. After the case. Much to the enjoyment of the group. Until someone called in. I'm told I remained very professional. We were just cleaning up.

I was sure that said "stop screaming" and was very confused for a few seconds.

Lol

Can you conduct an autopsy of your own relative, family or friend? I have heard that the best of doctors, normally avoid their own kith and kin.

Never. Would never. If that ever happened I might have a long list of things I'd want the pathologist to check. But it won't be me in the room.

Are you a pathologist? What's your background?

Yes. MD. Board certified pathologist. Anatomic and Clinical Pathology. BA Harvard. MD Univ. of Chicago.

Do you have to pay to watch?

We do it either through our Autopsy App which is a one-time download fee from iTunes/Google play. Or Autopsy.Online which is subscription. We started on Facebook but the page got taken down several times (we pushed through) so it's safer to use the secure platform. I'm on the fence about it because I get the "general public/general interest" part. But it's a huge commitment so we're building it so schools/universities can join us and support it. I think later we can back to more public live streaming when we're funded more. We put some archived mini videos on Instagram @autopsychicago and a few on youtube. We're still sorting it through and it's not settled yet.

I watched a few brief videos on your instagram, and was instantly rendered nauseous from it. How to you train yourselves to get over that reaction? Does it just take multiple exposures and you get desensitized?

It's process. It's very different without a context. I know my families and I know why I'm there -- to get that information that helps them with closure. So I have a focus. It's like changing a diaper -- if it's your kid you do it and you love your kid. If it's someone else's kid -- yuck, poop. These are my families and I'm there as a medical professional.

Have you ever begun an autopsy and then sometime during it you thought/found something that made you think it was not a natural death, i.e murder?

Yes. Strangely after. But there was not enough evidence to have acted on it anywhere along the way. I had a case where the family simply did not want to request toxicology testing, although I offered, for completeness. A young woman in middle age. There wasn't any suspicion of foul play or something that told me I should report the case to the medical examiner. But the wife had a psychiatric condition on top of medical ones. And, in my practice (and legally) the family decides what the autopsy consent entails. It would not have been legal for me to do the testing without their authorization. The husband's phone call ("well that's that") after the case was so odd I had this lingering eerie feeling that there might have been more to the story. Maybe in the toxicology testing....I might write a story about it some day. It was more of a feeling or impression. We'll never know.

Can't you do a toxicology testing and not release it to them because they didn't request it? Or consent means consent to work on the body regardless of requested results?

The second. I have reported cases to the FBI and would need to partner with authorities and other legal requirements to override the medical practice act and all the consent/confidentiality in my field. If I'm that suspicious that I want to do testing, I would need to report the case to authorities. Or I would have to build in a "testing at doctor's discretion" into the consent to work it out beforehand, which I can do. But did not in this case.

Do you ever regret not trusting your gut on this case? Also do you think families ever decline a toxicology report because they would rather the death be listed as natural causes when suicide is a possibility?

No. I trusted my gut all the way through. Who knows what this was. I'm just saying the final call was evocative. There wasn't enough there before hand to suggest. And I would have broken the family's trust if I had pushed earlier. They requested they case. They didn't have to. Do no harm.

Aspiring medical examiner here! Currently majoring in forensic science and pre-med. Any advice for someone like me? Something you wish you'd done differently? Edit: I'm also located in Chicago! Haha

Come intern with us. (Make sure you're hep b vaccinated). AutopysChciago.com/contact No - do you. Explore a lot and find out what you like and who you are and do that. -your dad

Have you ever gone into an autopsy expecting one thing and the complete opposite thing was found/happened? Or are most pretty straight forward?

Yes and yes, usually but keep your eyes open. You have your hypotheses based on what you hear of the history, but keep an open mind. And follow procedure so you don't miss anything. And watch out, if you think it's a straightforward case of an elderly person in a "natural death," that's when it ain't.

Why?

I presume you mean, why live stream. We have been amazed at families interest. Of course, families not comfortable with autopsy/working on the body after death, we don't see. But many want the death to "not be in vain." So if someone can, learn means a lot to them. It's been amazing to see. We take questions during the case, etc. It's been an eye opener for us and viewers. We get calls from moms telling us their teen wants to go into medicine etc.

Been going for a couple hours. Anybody know how to close the live AMA? Thanks for joining me. I'll try and go through the questions I didn't get to. I'm beat! Was fun. Will do it again.

Although you always ask the family first, Have you ever have any legal problem because of the streaming?

No. Written consent is the foundation. We operate under the medical practice act and the Illinois Autopsy Act and, in some sense, under the anatomic gift act. It's not different from taking photographs to a degree.

You ever wonder what the inside of your own body looked like? Don't imagine it'd be anything particularly too different from other bodies, but if you could, would you do an autopsy of your own body?

Strangely (or not?) I never think about the inside of my own body. Unless I'm wondering why I don't and then just realize I have that stuff in there too. But I don't go around thinking about that at all. Too much fun stuff to do out there.

What is a case that is so sad that it's stayed with you?

Teenager died trauma vs. natural. Devastated the family. Have peace of mind now, but was a big part of my life for a while.

I don't have access to the videos, but how much does one have to smoke to get lungs like the ones in Case 3, Part 7?

Oh you found us. I need to look. One sec. You're on Autopsy.Online and must see a thumbnail image. Give me a minute.

That's not a smoker's lung. It's dark because it's full of blood and a little decomposed. Patient died of heart disease.

How did you get into your job? Had you always wanted to work in the field that you’ve found yourself in?

I specialized in autopsy working in a hospital and then wanted more so opening my practice.
No -- I did some training in the medical examiner office and loved it -- for 3 days -- but it was too depressing - rape and suicide and burning to death and children. And so I went away back to regular pathology. But I'm really good at "regular bereavement" - heart attack/stroke and can help those families. Criminal death is incredibly painful and sad and it's own special skill. I'm good with families looking for basic closure or have questions about course of disease, what happened in the hospital, etc.

Could someone sign up to be a cadaver for you when they die? Since it appears to be streamed for learning/teaching purposes. Or do you just get the people whose families are trying to figure out why they died?

We want to do that. Right now we offer it to families who request an autopsy for some other reason. It would have to be like organ donation -- we would never charge a family to make and "educational donation" -- so we would need to fund it. If/when our Autopsy App and the Autopsy.Online subscription platfom get off the ground, that's the idea. We're not ever going bring in advertisers for funding.

Has any family member want to cut something off the. BOdy so they can keep it?

Ha. Yes. Sort of. We had one family who wanted us to give them the brain when we were done. Of course no. We always take the requests seriously, because there's a reason behind it. We could do a cremation, but that powder is from bones. The brain would leave nothing after cremation. And then, not uncommonly, locks of hair. Once -- the patient's gold teeth. Something I would never do. Not as a physician. And knowing about Nazi doctors. Never. Not my job.

Would you consider doing one with a cadaver who is morbidly obese? I remember HBO has something like that. It defiantly made me see the importance of good lifestyles in terms of exercise and good eating habits.

Edit: It was the BBC but the picture look different than i recall. The question is pertains-to other disease states caused y life style changes. Do you think people see that would promote better lifestyle changes? Smokers, cardiovascular problems ect

Of course. We do that all the time. And people who watch those live streams (another benefit!) report making life style changes as a result. A little bit of "driver's ed scare 'em" going on. I had a case once -- 400 lbs. "Mommy, I don't each much" his mother reported him saying. You laugh.... He had undiagnosed hypothyroidism. Thyroid was the size of a cheeseburger 70 grams (normal maybe 15 for those of you familiar). No one had caught it and was the cause of his obesity -- an undiagnosed medical condition. Very sad as he died from heart failure. And what he said was likely true to a significant degree.

> And watch out, if you think it's a straightforward case of an elderly person in a "natural death," that's when it ain't.

​

So what may it be instead?

Lot's people say, oh it was just a heart attack or a stroke. Why do the case? Watch out for elder abuse. Or an undiagnosed cancer, etc.

Is there any particular type of illness/condition that there is a need of bodies for studies?

Oh many. Cancer is a big one. Because the tumors that won't respond to chemo don't get biopsied again and we need to see what's different about them. We're starting a "tumor donation program" so patients with cancer can donate their tissue to research if they wish. autopsychicago.com/research

What are the standard things that get sent to be tested during autopsies in say an unknown non suspicious death and for what? Like what standard drugs and levels are tested for in blood, or parts of certain organs?

I wanted to be a pathologist once upon a time but I know now I wouldn’t cope well with the gore and the sadness. You are doing a good thing and I admire people who do that type of work, bringing closure to families and also learning and teaching for future cases.

All organs get sample for histology (microscope). We don't skip anything unless is partial autopsy by consent. Blood testing is separate and a judgement call. We're not like coroners and it's fee for service so we don't throw costs at the family. It all gets talked through. The families (uniformly awesome and dedicared to their loved one) often know a great deal of the story. While they don't decide how I diagnose, I sort through what information is reliable and come up with a plan.

Is there anything you can't eat because it reminds you of your profession?

No. Although sometimes I prefer to eat out because I have tools in my hands all day and then I don't want to have them again in the kitchen. It's not about the body, it's just about taking a break from the same motions.

Do you have any interaction with your viewers? If so, are you ever aware of necrophiliacs or people with other sinister motivations watching? How do you deal with these people?

Yes. We take questions and I monitor all the responses. I don't know about sinister. But some people describe sex acts. Our motto is "We ban fast." Some of it is "shock value" because comments give people a platform. Some it is horrifying and we get rid of that.

I use your autopsies for Buddhist meditation on death and the vileness of the body. Thank you. Have you heard of people doing this? Asubha bhavana is what it is called.

No, but we have a number of people who regularly watch the autopsies before going to sleep because they say it relaxes them. It means something different to everyone.

What made you want to join this profession?

My personal background give me a lot to offer the families. I know what they go through and love seeing them feel better. Also, I was a chemistry/physics major so I like thinking about body as a puzzle.

Is there a certain special personality traits of working as an autopsy pathologist? I assume most of the pathologists are super calm.

I don't know how it works for most specifically in autopsy. Most pathologists are pretty diagnosis-oriented. My wish is a lot of compassion for the family because every detail of the results means something for their closure -- and how the pathologist treats them makes a world of difference.

What do you promise the families to get them to consent to their loved ones corpse being streamed on the internet? Why are loved ones even authorized to consent to something like this? What’s in it for them?

The autopsy consent is not an exchange like that. We don't push it. In fact we push against it. For some families, the feeling of helplessness is so great, "anything to make a difference" brings peace of mind. It's like organ donation. To know you've helped someone. People learn and the family feels like maybe someone else will be spared what they suffered through by learning about their loved one's experience. Same whole idea as reddit. There's also a "posterity" part that their loved one will "live on" through the gift of education.

I’m a senior in college and doing my first cadaver dissection. There are so many parts to remember! How did you manage to learn so many details about human anatomy? What’s the trick?

I liked anatomy (probably obvious). I'd draw everything out and see if I could do it away from the book. No tricks. Few pneumonics (cranial nerves). We're looking for people to give us feedback on our autopsy video platform, autopsy.online. I'll contact you in messaging.

Other than paying for the app, is there any way we can support this?

Thank you for doing this.

Subscription to Autopsy.Online. But I think you mean, not financially. I suppose getting the word out. We have a brain donation program through the NIH. People (even healthy donors) can donate their brain to research. We have a high school program called Live from the Morgue.

What is the medical term to describe people who faint when they try to watch something like a surgery or an autopsy?

I don't know I had to look it up. Vasovagal syncope sounds good.

Favourite medical TV Series?

Don't watch em. Do it all day. Rather go see Disney. "How far I'll go..." Moana!

Are you worried about a sort of voyeurism from this, with people viewing it as "cool" rather than focusing on education, similar to the popularity of True Crime books over an understanding of criminals and crime?

We know their's a range. We can't control that. Our target is the view who's there to genuinely take it in a learn with healthy curiousity (whatever that means). And we protect the space in the comment section. Our motto is "we ban fast." And we consider the platform. It's part of why we use our own platform and a paid one -- so our viewers know want to be there and will show the basic commitment to our work with a couple bucks on the app store. I thought about it a lot at the beginning, but it became quickly clear that most viewers by far and away are genuine medically-curious learners. And we see how valuable this is to them. The rest is a "life tax" we manage as best as we can. And then there's the in between view who's been socially shamed into thinking it's not ok to be curious. We want to remove the taboo where it helps and build up a comfort level. I think it's fascinating. I do it for a living. And people are even uncomfortable talking about end-of-life issues. That's a subtext -- how can we increase the comfort level a notch. I hope we'll have a role and do it respectfully.

Do you ever get emotional when you cut into people ? Like I know you’re a professional and have done this hundreds if not thousand times but don’t u ever stop and get really sad about the person you’re cutting into ?

No. I have a job to do and as you go along, the case becomes a mystery that draws you in. When I process my day later, it can come out then, but not during the case. That being said, the first unzip of the body bag, or lift of the sheet for babies and children is extremely difficult. But then you do the case and look for ways you can make it better for the family, which make me happy. Either information, or a question they needed to know you can tell them the answer to that will give them some peace. It's a pretty profound experience.

Is there anything during your job that has made you stop&reassess your situation?

Yes, occasionally I'll go to a show or hear a band live and, standing there in the crowd by the stage suddenly think, oh, I'm around living people! (a joy). So it tells me I've spent too much time at work. Just a reminder to keep the balance. Always looking for that.

What does a good/bad day at work look like? Your customer can't complain, so....

I got deliberately looking in funeral home prep room with a decomposed body once by a psycho funeral director. They had a guest next door and it was their way of making sure the guest was not distrurbed. So they locked me up and didn't tell me. I discovered when I tried to open the door. I almost called the police but, fortunately escaped. They got an earful from me. Not a place I'll go back to. Yikes. Ok yes I'm planning to write a book. If I live to tell about it...

I want to go into the field you're in, can you tell me the gist of it all? Looking it up and researching doesnt get me as far as I'd like. Plus, getting to see an AMA for this is beyond my luck. So If you have the time can you tell me about it?

Be compassionate. Most training focuses on diagnosis. But each piece of the process means layers to the family. Go live life and get a deep world view that appreciates what people go through and what it means to lose them. Everything else is book learning. Good luck. -Your autopsy guru

Dr Garavaglia in her book said don't do cocaine (as it sometimes can be fine, other times randomly eff with your electrical system and drop you dead) and the usual don't smoke; eat better so you don't get heart disease- what's your advice for postponing the slab based on what you have seen?

Cocaine spasms the coronary arteries so they pinch closed. The blockage is no different from a plaque. Heart attack is just the same.

1, #2 and #3 Smoking weight (no) exercise

Inheritance you can't do much about.

The most horrible situation you have ever faced?

Usually it's the living. There's a basic "togetherness" my families have when they call. They have to be able to be emotionally able to make the call, talk about the case and plan. That's functioning right after death that tells me I'm working with someone who's pretty stable.

Rarely, it's not so clear. Usually when families can't follow basic instructions for boundaries. (Why are you calling me after 9:30 when I said all calls need to before then? … and then telling me how the hospital threw you out for fighting. Or multiple calls to misuse the connection for emotional purposes). That's not an appropriate use and beyond my skill set. These families I limit access to my practice, tell them I won't take the case, or refer to counseling. Not being able to respect professional boundaries is a clue I need to set up some limits or cut off the relationship.

What is it that brings joy to people watching an autopsy?

I don't know if it's joy. But it's fascination and curiousity and satisfaction. Also, there's a big taboo on it and yet often that comes from people's own discomfort the project onto other people. And yet it's a fascinating procedure. So when people who know their interested have permission to be interested, it's nice to feel like it's ok. We have a lot of people who comment "my boyfriend thinks I'm crazy for watching." And then someone else says "mine, too!" And two people have found one another. But it's really the boyfriend's discomfort. People can be interested in whatever they want. And we teach all the way through. It's educational not to shock.

One simple question. How does this not violate HIPAA privacy?

Family consent. If you chose to share your medical record with someone it would not be a HIPAA violation. We don't do this unless it's what the family asks us to do. If you're asking this you must have missed the part about written authorization. See the opening header. Also, on top of it, we don't disclose the patient identity, protected information (tattoos, names, dates, ages, location of live streaming, etc.). Think of medical specimen photography in medical journals. Now bring that into the 21st century. The family decides. That's like asking how is organ donation not assault? No one removes an organ without consent. We don't live stream behind the patient's back. It's by informed consent. See prior comments. Does that help?

What’s the (your definition) saddest case you’ve had to work on?

Children. Preteen old who was invited by other preteens/early teens to go driving before any had a license. Parent handed over the keys to one of them. They all flew into a tree and he snapped his spine. And aorta. And inferior vena cava. Sad among many sad. But good interaction with the mom. Always something to do to make it better when the bad thing has happened. In medical school they say, what can you do when the patient is dying in bed? You can always turn the pillow so it's a little cooler behind the neck for just a few more moments.

Do you ever sew the body back, all is fine and dandy, and then you notice an organ you forgot to mount back and you don't know where it goes?

No. And if we did we would undo the sutures and carefully replace it with the rest of the organs. And we would know exactly what it was. I know those bodies inside and out from doing the case. I'd never be confused about what an organ is or where it came from.

How do you usually go about asking the families? Is it in person, via email, etc? Or do they usually contact you? And have there ever been negative reactions from the family if/when you ask them? Or are most people okay with the idea?

It's not the hospital where after a pronouncement, the health care provide will ask the family. We are resource. Families initiate the contact and the request.

Rarely, I will reach out privately on the back end when a family has been very public about a terminal diagnosis, posting and seeking input, -- to let them know we can offer, say, tumor donation if the diagnosis cancer. Patients with cancer can't do regular organ donation and don't know there are empowering end of life choices like the ones we offer. It's very "take it or leave it" and gentle and carefully worded. Responses have been appreciated.

But we don't approach families typically. We're just very available should they call. Also, I'll say I take about 1/3 of the cases that call. It's because my job is not do "do the autopsy" but to help the family make the best choice. Sometime they need to talk, or go back to the clinician, or their kids are pressuring them and they don't want to do it. So I listen first and then if makes sense to take the case, we can discuss. But often I'll turn the case down or the family will just want to talk it through was we really ready to move on. Just need to process a little.

Do you ever go "Oh, gnarly!"?

Rarely. Decomposed bodies. And the smell. Haven't thrown up. But it can be tough.

Why not Twitch?

I contacted them. They have pretty strict "community guidelines" We went through hell with FB (multiple bans) until we go our "graphic notice" up and all that. Just safer on our own site right now.

Why would you profit off dead people?

We don't profit off dead people. It's a medical service like any other and we work with families when they request an autopsy. Live streaming is completely separate and not something we ever charge the family for. We do it out of our own cost. Live streaming is a gift like organ donation (or educational donation) we would never charge the family for us to do it.