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  • Writer's pictureAlyse Gray

A Forensic Autopsy

I work for a group of pathologists that provides pathology services to multiple hospitals. I am usually based at one location, but will travel to other sites to do autopsies. A few months ago, a cluster of autopsies occurred on the same day. We were short-staffed at my hospital, and could not get to the other location to do the autopsy there. We learned that the hospital requested that only the heart and lungs be examined. They were looking for a pulmonary embolism-no other patient history was provided. It sounded fairly simple, so we asked the pathologist on-site if they could perform the physical examination, and then have an autopsy tech remove and send the heart and lungs to us for further examination and sectioning.

This was an unusual situation where I didn't know anything about the patient. Typically before conducting an autopsy, I will discuss the case with the pathologist to ascertain what they are looking for, and get an idea of the patient's history. I also like to review the patient's chart, if that is available. In this case, I didn't have any of that information.

When I received the body diagram and specimens, I immediately suspected something was awry. The patient was in their 30's. The pathologist noted that their arms were covered with scars, and that they had a chest tube scar(chest tubes are often associated with sudden, unexpected traumatic injuries or chronic illnesses). My spidey senses tingled. Something was off. I said aloud to my techs, "30-somethings don't just die. Something isn't right." Although I hadn't seen the body, the arm scars on the diagram caused me to wonder if this was a drug overdose. Long term IV-drug users often develop track marks, or scarring on their arms due to repeatedly injecting foreign substances their veins.

Drug overdose deaths are the domain of the medical examiner in my state. In hospital autopsies, we do not perform toxicological testing, which is an essential component in determining which drugs were in the decedent's system.

Upon examining the specimens, I noted that the patient's lungs were badly scarred, with numerous adhesions(where the lungs become stuck to the chest wall, often as a result of the scarring). Further evidence of something very wrong. 30 year old's lungs shouldn't look like that. I took some sections of the lungs, and set the heart aside to dissect when I had more time, since we were busy with additional autopsies and specimens from living patients.

Several days later, before I could examine the heart, we got a call from the medical examiner's office asking us to send them any specimens we had taken from the patient. This case should have been theirs. They informed us that the patient had been shot some years ago, and they believed this could have resulted in their death. There is no statue of limitations in my state, meaning that if a person shot someone years ago, they can still be convicted of murder.

I don't know if this information was in the patient's medical record, or if the pathologist who examined the body would have known this. I also don't know why the medical examiner didn't take the body right away. Hospitals are required to report such deaths to them, but somewhere along the lines, something wasn't communicated properly. Had I seen the body, I would have asked questions, but the time I received specimens it was too late to ask them. This serves as yet another lesson in questioning everything.

I sincerely hope that our examination did not interfere with the investigation. We were following standard autopsy procedures, but one never knows what could be brought up in court years from now.

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