I'm a pathologist and have performed over 500 autopsies. AMA.

1. What is the strangest body you ever examined / strangest phenomenon you ever found?

2. What death under suspicious circumstances has disturbed you the most?

3. Raw brains. Squishy? Do they have a unique (sweet?) smell?

4. What is the strangest thing you've ever found in someone's stomach contents?

5. What cause of death is the most difficult to deal with?

6. You get to choose how you die. How do you want to go?

7. You get to specify one way you DON'T want to die. What is it?

8. What is the most violent death you've ever dealt with?

9. What is the most unusual mode of death you've ever encountered?

And verification, please.

1. Recently I examined a fetus that had no heart, as a consequence the entire upper body did not develop. It was basically only legs.
2. In one case I could not find any cause of death during the autopsy, I reported it as an unknown cause of death. Days later, the police found out the deceased had been choked with a pillow by her granddaughter. Just to clear things up, I deal with non-violent deaths, the violent ones are done by police doctors, but sometimes a case comes in as a natural cause of death and during the autopsy (or later, as above) we find out that it was not natural.
3. The consistency is akin to a hard pudding or flan. Don't really smell like anything, but we use maks during the autopsy.
4. Nothing really strange in the stomach, but once I found a whole steak lodged in the trachea of a person who choked.
5. No particular cause of death, but corpses in decomposition are always bad.
6. I quote Tyrion Lannister: "In my own bed, at the age of 80, with a belly full of wine and a girls mouth around my c**k."
7. Suicide.
8. I've seen some cases of car accidents that were pretty nasty.
9. I saw a aneurism that burst to the lung and the person bled to death from the mouth/nose, that was pretty weird.

I can point you to an article to which I contributed if you'd like. I can also scan my Pathology Board Certificate, if it is required.

The consistency is akin to a hard pudding or flan

And I never ate flan again.

lol.

Upvote for the Game of Thrones quote.

Thank you, kind Lady.

once I found a whole steak lodged in the trachea of a person who choked.

A whole steak? I'm having trouble imagining how this scenario could have come about. I also didn't think that the human throat could hold such a large item. Maybe the T-bone I'm thinking of isn't what you actually found, but I can't get that image out of my head.

It was not a T-bone, lol. It was about 15x10 cm in area and about 1 cm thick. It was all folded up and molded against the walls of the trachea. And as my technician noted at the time, the man had no teeth. Pardon me the dark humor, but he bit off more than he could chew.

I bet a lot of people in your line of work have a dark sense of humour.

Everyone I think, lol

Thank you very much!

You're welcome.

[deleted]

Rofl! I guess, but probably not from a single man. The stomach capacity is about 1 litre, but it stretches a bit more, and the person would have to hold everything in without throwing up, so I'm guessing if your friend could hold down about 2 litres of smen, it could burst. Of course, stomach capacity varies from one person to another, so it could be more. I don't recommend it, but it would make a hell of an ER story.

I guess, but probably not from a single man

Wait, so only a married man can accomplish this. Please elaborate.

Lmao! Well played.

I only ask you this because I've been saving my ejaculate since 1988...

Then I'm sorry to tell you it doesn't work like that. You can't have 2 litres of sperm inside you, sorry.

I think he meant in 2-liter containers.

Yes, someone in this world is actually doing that.

Fun fact: it can ferment into a wine.

I'm definitely not drinking that.

So that means I can have a party?!?

I'm not sure how much sperm can a man store, but you can probably find it somewhere on the web. From that you can calculate how many guests would you need to burst a stomach with semen. But why would you want to anyway?

What can I do to make any autopsy that might be performed on my body a more pleasant experience for the pathologist? And I don't just mean proper hygiene, clean living and such. I was thinking of implanting a small piece of metal somewhere in my body that says, "Hello and thank you for performing this autopsy. Love, Willravel" or something.

Just tatto it on your chest :D. And being thin actually helps. Obese people are hard to fit in the examination table and the fat makes it harder to dissect the organs. You could also tattoo your medical history in your chest or other easy to read place, since most doctors do a crappy job filling out the autopsy requisition form.

I'm going to donate my body to science, and if I get early warning of dying I'm so going to tattoo funny shit on my skin! Maybe a few "cut here for autopsy" dashed lines, but subtly wrong, 'cause those damned students are supposed to be learning, right! I'm almost serious, can you suggest some such misleading 'cuting lines'?

You could make it slightly wavy so the cut comes out like crap and the student gets chewed?

Dead, still trolling...

Zombie trolling?

autopsy requisition form.

You could tattoo that, just not filled out.

The doctors don't fill it well on paper, why would they fill in a tattoo?

what's the most ironic death you've seen? for example, someone with a tattoo saying "hard to kill"

I don't recall any case particularly ironic in itself, but once I did 2 autopsies in a day. Both patients complained of heartburn and chest pain, then suddently died. The first was attended by a cardiologist who thought it was a heart attack and the second by a gastroenterologist who thought it was an ulcer. The first patient had a peforated ulcer and the second had a heart attack.

Do you think they would have lived if they had been under opposite doctors?

Hard to tell, but if they switched doctors, maybe. If the guy with the ulcer went to the gastroenterologist, his diagnosis would have been correct, but he might still have died. Both died soon after arriving at the doctor, who knows?

Peforated ulcers, isn't that really far into the development of an ulcer? Could you seemingly have no symptoms and then have an underlying ulcer perforate the next day? I thought that for one to perforate the symptoms of the ulcer would have been so bad that you would have gone to a doc long before the perforation actually happened.

Some people don't like going to the doctor, they take some pepto bismol or something and push on, until the ulcer perforates.

I recently lost a friend to a heroin overdose. Could you tell me what happens? Did she die in pain?

It's not really my area of expertise, but I guess not. Heroin depresses the central nervous system, so I'm guessing that she just kind of slept.

Thanks for a great AMA, very interesting answers!

Anytime :D

Any bodies that have insects/eggs inside?

Any women who still look pretty eventhough they're dead?

Ever see a body twitch or move?

1. Yes, when they are decomposing it's unavoidable, there is always some maggots, bugs and eggs. But I have also performed an autopsy on a man who had fly larvae in a ulcer in his groin when he was alive.
2. It's hard to judge, ocasionally you see a woman who might have been pretty when she was alive, but that's just the thing, dead people are just different, they could have been supermodels when they were alive, dead bodies are just dead bodies I guess. Maybe I'm just desensitized.
3. I've never seen a body move, but before my time, there was a case in which after the organs in the torso had been removed, when they were opening the head to remove the brain, the body jerked violently. The professor performing the autopsy and the resident that was with him burst out of the room in panic. Turns out the saw the technician was using was short-ciruting and had sent an electric jolt throught the body. The technicians still laugh about the look on the professor's face.

I've never seen a body move, but before my time, there was a case in which after the organs in the torso had been removed, when they were opening the head to remove the brain, the body jerked violently. The professor performing the autopsy and the resident that was with him burst out of the room in panic. Turns out the saw the technician was using was short-ciruting and had sent an electric jolt throught the body. The technicians still laugh about the look on the professor's face.

NOPE

I don't know. It's one of those stories.

The "NOPE" comment is usually made by someone who is terrified of the aforementioned occurring. I don't think he thinks you're making it up, just that he/she would not want to be present to see a dead body moving.

thanks for clearing that up, lol

"NOPE" can be used as a verb. As in, "I'd nope pretty hard if I saw a body move."

TIL

Just FYI it's not used in everyday speech, the only people who use it are those who spend too much time on the internet.

That much was a given lol

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I once overlooked a breat tumor in a biopsy. Luckly for me the attending physician got the repport before the patient did and called me to tell me he was sure the tumor was in the specimen he had sent me. And indeed, when I went back to the specimen, it was there. I started paying much more attention on gross examination after that. I still feel bad about it though. Luckly for the patient, the margins were free and it was a low grade tumor, but it's still no excuse.

ever found anything strange up someone's butt?

Nope. But a friend of mine found a zuchini, it was so big the guy perforated his colon with it. He said he slipped and fell on it.

what is the biggest penis you have seen?

I once saw a pr0n movie where a guy a huge one. But in the autopsy room? I don't know, I guess we don't really pay attention to things like that, most people don't die because of their penises.

Can you check for me next time?

Sure...

Most shocking death you've seen (the aftereffects of, that is)?

Also, would you consider yourself completely desensitized to gore and violence?

Car accidents are usually the most gory ones, you see heads smashed in, dismemberment and stuff like that, but really, I'm quite used to it. The gory part doesn't really affect me anymore, but the smell of decomposing bodies is still very nasty.

The gory part doesn't really affect me anymore, but the smell of decomposing bodies is still very nasty.

Well we're biologically hardwired to have our stomachs flip and feel a need to vacate the area when we smell rot and decomposition. Back in the hunter gatherer days it would have prevented the spread of contagion.

Makes sense.

Does a person's lung that smoked for his whole life really look that disgusting as in some anti-smoking ads?

It could, but the ads push it a bit, they show the worst of the worst they could find.

After reading most of the questions it seems to me this job has desensitized you. Was there any autopsy in which you were affected by enough where it changed/affected you or your life?

No, I don't recall any single one being a life-changing event. But I learn something from all autopsies I perform, and some affect me emotionally, like kids and teenagers, I'm always saddened by the loss of potential, you know? Like, they could become so many things and that is wasted. But so far I haven't performed any autopsies powerful enough to bring about an epiphany.

to be honest I just don't know how you can eat lunch or dinner after doing what you do, especially when the person is really decomposed. Are you like some guy in the movies and when it's lunch break you just put the sammich on top of the body and keep working?

Nah, that's just disgusting. I eat at home. And maggoty rotten corpses do spoil my apetite, but only for a while, I have to eat eventually, right?

What's a typical day for you?

What's the most interesting or weirdest autopsy you've had experience with?

How often do you get stumped--as in, you just can't figure out what killed your subject?

1. I work most days at the hospital with biopsies, so I wake up and go to the hospital and work all day behind a microscope. But once a week I work on the autopsy service I mentioned, on home call. I get called in whenever a body is brought to the service, I go in, perform the autopsy and go back home.
2. The most interesting autopsies from a medical point of view are the unusual presentations of disease. I mentioned the aneurism that burst into the lung already, but other interesting cases include a heart lymphoma (it's pretty rare) and a huge melanoma metastasis to the liver, the liver weighted over 7 kg (it usually weights about 2 Kg).
3. Every once in a while we get cases where we can't figure out what happened. It's usually old patients who probably had some type of heart arhythmia, since you need to see the heart beating to diagnose that, when they get to me, I'm pretty stumped. I'd say 1 in 10 cases or something around that.

I read an article last year that suggested that a high amount of people who die in car accidents have small, undiagnosed tumors. Have you seen any truth to this?

It's probably true. There are several types of tumors (benign or malignant) that are asymptomatic. This is one of the reasons full body scans are not recomended, you may find tumors that would never give any problems to the person.

What about if you are having wacky symptoms but all of your blood work comes back clean?

What is your opinion of Dr G?

1. Then the question was wrong. Someone once said something like "to know the answer first you need to know the right question". Blood work should be used to confirm a clinical diagnosis, it should not be used to diagnose problems. Many diseases might not have any specific results on blood tests. Talking to your doctor usually helps A LOT, if your doctor doesn't want to take his time in talking to you and examining you properly, then perhaps you should find another doctor. I know it's hard to know which doctors are good or not, but that's a tip. Good doctors take their time listening to history and examining the patient before ordering a huge number of tests.
2. I have never watched the show, so I really don't have an opinion.

Anyone ever wake up while you were doing your job?

Nope. The bodies take a few hours to get to our service usually and by that time they are cold, rigid and presenting hypostasis, so we're pretty sure they are dead.

My mom apparently was pronounced dead on arrival from a car accident before I was born but woke up and was trying to find a place to take out her contacts when a nurse came in and promptly freaked out. Didn't know how frequently things like that happened.

I've heard of cases like that, but I've never actually seen one. I hope no one ever wakes up on me. lol

And that's why you you keep a hammer and a wooden stake!

Shh... That's supposed to be a secret...

Weirdest thing you've found in a persons body?

The whole steak in the trachea I mentioned above I think. There was also a surgical pad that was forgotten inside the body of a patient years ago. It had formed a huge mass in the abdomen that was clinically diagnosed as a tumor. The patient died of unrelated causes (pneumonia, I think), but it was still weird.

How is it that objects are forgotten in patients? Shouldn't there be an inventory check before, during and after?

There should be, but people fail.

Who requests autopsies? Are those normally ordered by the government for police investigations, by private individuals who want to learn more about the death of a loved one, or by some other group?

It varies according to local legislation. Here in Brazil there are 2 types of autopsies, for medical purposes and forensic autopsies. Medical autopsies are requested by doctors who don't know the cause of death of a given person. Forensic autopsies are requested by the police in cases of violent/suspicious deaths. I believe in the UK and other places this works differently.

What drew you towards pathology as a specialty?

I thought about doing forensic medicine and figured pathology would be a good start, before doing anything specific on forensics, but during the residency, I realized that I liked surgical pathology better, so I'm just a pathologist now. But I still like the forensic stuff lol.

What is the most disturbing thing you have seen? You must have seen a lot of crazy shit.. Whats one that sticks out in your mind?

The weird stuff usually becomes anedoctes to tell other pathologists. What really sticks is the sad deaths. Last week I performed an autopsy on a 15 y/o girl who died wearing a wristband for Nossa Senhora do Bonfim, before you tie that wristband you make a wish, and when the band breaks it comes true. That wish will never come true.

Can I ask how she died?

He went into shock, I'm still not sure why. She had a large tumor in her chest, which could be the reason, but I'm still waiting for blood tests to arrive and the slides for the histology.

What's the training like?

You go through pathology residency, where you learn how to examine the organs (how to dissect and cut them) and how to analyse the microscopy slides afterwards. In Brazil it takes 3 years, I understand that it varies according to the country.

Any crazy deaths?

Define "crazy deaths". I did perform autopsies on (deceased) psychiatric patients, if that's what you mean. But really, no, I don't recall anything unusual enough to qualify as crazy.

I'm talking freak accidents. Anything that might win a Darwin award.
http://en.wikipedia.org/wiki/Darwin_Awards

Well, I remember only one Darwin Award worthy event, a was a guy who climbed in a sugar cane grinder to clean it, because some stuff got stuck inside, but did not unplug it first. While he was cleaning, the cane or whatever came loose and he was sucked in. It wasn't pretty. There was not much to perform an autopsy on.

If the cause of death is pretty apparent, like in this man's case, what is the purpose of his autopsy? Why was it ordered in the first place?

All violent/suspicious deaths go through an autopsy for legal reasons. They need to have it on record for trials, etc. In this case it was a work accident, the family might claim the employer of the guy didn't provide him with necessary protection/training, etc. The autopsy report is part of the evidence in the case. In natural deaths, when the cause of death is apparent an autopsy is not needed.

So what did you do if there wasn't much to cut open/look at?

I didn't perform the autopsy, I was just there when the guy arrived, it was performed by the police doctor, but he just noted down the several lacerations, dismemberments, etc the guy had suffered and signed the death certificate. It's pretty standard procedure for them. They observe and report (I think it's a legal medicine motto).

What is a preventative health step that many people overlook that performing autopsies has motivated you to adopt?

For example: drinking less alcohol after seeing distended diseased livers, eating healthier due to seeing arterial plaques, etc.

On the other hand are there some health recommendations that you think are less important because you don't see many deaths related to them

Obesity and smoking are probably the top two things I see in the autopsy room that are related to the causes of death. I'm trying to quit smoking and I'm thin(ish), but honestly, autopsy room shows you that you could go any moment, so on the other hand it makes you think you should enjoy life while you can

Love this IamA. Couple questions that I've always wondered about this.

1. Have you ever done an autopsy and came to zero conclusions?
   
2. Why perform autopsy's on people when it's extremely obvious why/how they died? Is it a "law" thing?
3. Ever had to do an autopsy on someone that you knew? If not, what happens in that scenario?

1. Yes. Those cases end up as "Unknown cause of death". According to the literature it might happen in up to 20% of the cases.
2. In natural causes of death, it's not necessary, if the cause is obvious, the attending physician can sign the death certificate. In violent/suspicious deaths, it's necessary because the autopsy report could be needed in trial or for investigation.
3. Never happened to me, but I imagine I would ask a colleague to perform the autopsy.

What is something that you'd be able to find during an autopsy, but couldn't find while the person was alive? I only ask this because of the modern imaging techniques and the huge battery of tests that can be run in modern hospitals.

In the autopsy room itself, I can't think of anything like that, but there are tumors that are misdiagnosed through imaging techniques and can be better diagnosed just by actually looking at them on gross examination. Histology is still better than imaging exams for detecting several types of disease, but really, one supports the other, the information from the imaging exams helps us make better diagnosis. And you wouldn't want to waste a lot of money performing expensive imaging techniques on a body anyway. And it's way harder to make the contrast circulate after you're dead.

How often do you find undiagnosed genetic abnormalities - single ventricle, dextracardia, stomach in the chest, etc.?

In stillborn fetuses it's quite common specially small heart malformations. In adults it's quite rare.

Whend odes rigor mortis set int? In various CSI shows the stiffs are not stiff at all...

1-2 hours after death

This is kinda weird, but have you ever gone home and realized you may have tracked some guts or fluids into your car/home/person that may have gotten underneath your scrubs?

I once dropped some blood on my shoes, just a few drops. But that's about it, and I was a resident, so I was still kind of sloppy. I usually try to keep my workspace as clean as possible. We have a water hose next to the examination table and a constant water flow on the table, to wash the blood, fluids, etc away, so it's reasonably clean.

Have you discovered any murders or suicides that were unsuspected before the autopsy?

Is it your job to put the bodies back together when you're done?

How common are autopsies in Brazil? Only for deaths where the person is young or the cause is uncertain or suspicious? Can doctors or families request them?

Where do you have your lunch on a typical day?

1. In one case, I couldn't figure out the cause of death and I reported it as unknown cause. Days later, the police found out the granddaughter the choked the woman with a pillow. But there was nothing in the autopsy suggesting it, which is strange because asphyxia usually leaves some clues. In another case, we found a massive hematoma associated with a skull fracture in am elderly man. I don't know what the investigation concluded, but it was definetly not a "natural cause" of death.

2. We put the organs inside the body after the examination and sew it up. We deliver the body clean and "closed", but it's the funerary home that makes the body "pretty" for the wake with make-up, flowers, etc.

3. Most big cities in Brazil have an autopsy service, but many places still don't. Some places don't even have regular doctors, let alone pathologists. So I'm guessing it's not very common in Brazil as a whole, but it's improving. Autopsies are supposed to be performed only when the cause of death is unknown, suspicious or violent. We perform autopsies for natural causes of death and the police performs the autopsies on suspicious/violent cases, sometimes we pass our cases on to them if we find something strange and vice-versa. Usually doctors request the autopsies, but if the family wants it, it can ask the doctor to forward the case to us. But usually, the families just want to mourn the person, so the quicker they can get the death certificate, the better. And that means no autopsy.

4. I usually have lunch at home, since I work on home call. But if you're wondering if we eat on the autopsy room, then the answer is no. That's just gross. lol

I volunteered in a Medical Examiner's office during college, and our ME would take about 45 minutes to do a complete autopsy. I'm currently in medical school, and it seems that 45 minutes is absurdly fast to look for everything that could cause death if you had no clues to start with.

If you had a fresh body with no trauma, no clues to begin, what is your jumping-off checklist of things to look for?

We examine the major organs, most deaths come from some problem in one of them. I usually begin by opening the trachea to make sure the person hasn't choked (it's more common than you'd think) then we weight the organs in the chest and abdomen and examine them all. Then we move on to the brain. Most causes of death leave some morphological "clue" behind. When we can't find any, we sign it as an unknown cause of death. Sometimes histology helps, but usually if you can't find anything in the autopsy room, you won't find anything later. After a while, examining the organs becomes pretty automatic, it goes fast.

What is the most interesting thing you found inside a person and where was it?

You guys really like the strange objects inside people lol. As I said, probably the whole steak I found lodged in the trachea of a body or the surgical pad in the abdomen.

How many autopsies do you perform in a typical workday?

Usually 2-3 autopsies. We only perform autopsies on people who die in our city (about 600 thousand inhabitants). The smaller towns in our region are handled by another service which does a little less than us (about 1-2 autopsies per day).

What is the most disgusting thing you've seen at your job?

Again, decomposing bodies. Once I saw the technicians scooping out buckts of maggots out of a body. That one takes the "most disgusting" award for sure.

Why did you decide to become a pathologist?

Initially I wanted to work in forensic medicine and I thought pathology would be a good background. During the residency I liked the work as a pathologist better and gave up on forensics. I still like the forensic part of the job, though, I guess that's why I keep working in an autopsy service (and working from home once a week doesn't hurt either, lol).

what is the largest tumor you have ever seen someone with? have you found any crazy parasites living inside of people? what is the strangest cause of death you have ever seen?

The largest tumor was a melanoma metastasis in the liver wheighting at 7 kg and about the size of a basketball. A colleague found an ovarian cyst weighting 18 kg, but that was before my time. No crazy parasites, but I have seen tapeworms, roundworms, fly larvae and cysticercus. Strangest causes of death would be the whole steak lodged in the trachea and the aneurism that burst to/inside the lung and the person bled to death from the mouth/nose.

What is medical education like in Brazil?

Why did you decide to become a pathologist?

Do pathologists commonly perform autopsies?

How long does it take to do an autopsy and how detailed is an autopsy report for every organ system?

1. We have good schools and bad schools, I guess it's the same everywhere. In Brazil the best schools are in public universities. Private ones are only after profit, so they'll basically let anyone get a diploma as long as they pay. The medical board tries to close that type of school down, but doctors are not good as good as university owners at lobbying I guess, lol.
2. Most pathologists don't perform autopsies, they usually work in labs with biopsy material. I don't know exactly how many do in Brazil, but very few for sure.
3. Depends on the case, but usually around 40 minutes to 1 hour. I usually describe all changes I see in the report, but some colleagues just report the important changes concerning the cause of death. As long as the report clearly contains the necessary information, I guess it's just a matter of personal preference. But our report form has room for describing all organs, histology findings and addicional tests.