Hello, E. It is, in fact, a pathologist. The following is excerpted from a description of the process:
THE ROUTINE AUTOPSY -------------
The Procedure Related in Narrative Form
A Guide for Screenwriters and Novelists
Ed Uthman, MD <uthman@neosoft.com>
Diplomate, American Board of PathologyPURPOSE
The purpose of this paper is to make available to
screenwriters, novelists, and other interested individuals
an authentic detailed narrative account of a routine
postmortem examination (autopsy) as performed by a
pathologist on a patient who has died in hospital. I have
based this on my experiences as a practicing pathologist in
both academic and community practice settings in several
U.S. cities. I have deviated from the dispassionate,
unbiased language of my profession to present a more
subjective, sensorial view, which I think should be of
greater benefit to those using this information for the
purposes of entertainment.BACKGROUND
Most patients who die in the hospital do not undergo
autopsy. In recent years, there has been a decreased
interest in the autopsy in the medical community. When an
autopsy is requested, it is either by the attending
physician or the patient's family. The hospital's
pathologist performs those cases of the former type for the
educational benefit of the medical staff. Cases requested by
the family are best left to an independent pathologist hired
by the family. Autopsies performed by the hospital
pathologist do not result in cost to the patient's estate;
rather, the cost is absorbed by the hospital and the
pathologist. "Private" autopsies hired by the family
generally cost between US$1200 and US$2500.
After the patient is pronounced dead by a physician, the
body is wrapped in a sheet or shroud and transported to the
morgue, where it is held in a refrigeration unit until the
autopsy. Autopsies are rarely performed at night, but they
are typically performed between 8 am and 4 pm every day,
including weekends and holidays. In medium-size and large
hospitals, the autopsy is done on the premises in a autopsy
suite, which is either within or adjacent to the morgue.
Small hospitals that do not have autopsy suites may arrange
for autopsies to be done at a larger hospital. Yet other
hospitals out in the country can only offer autopsies by
having them done at funeral homes. Doing an autopsy at a
funeral home is one of the most dreaded things a pathologist
has to face, as a funeral home typically is not as well
equipped as a hospital autopsy suite.DRAMATIS PERSONAE
Immediately before the autopsy, the body is removed from the
cooler by a morgue attendant who will help with the autopsy.
This individual is called a DIENER (DEE-ner), which is
German for "servant." Most dieners do not realize the
derivation of this word and would probably object to being
called "diener" if they did. Dieners are not formally
trained, but many have some background of employment in the
funeral industry. For some reason, in the southern U.S.
anyway, about ninety per cent of dieners (my estimate) are
African-American. I would estimate that less than ten per
cent of dieners are female. Dieners tend to work at their
job for decades. I think this is because 1) management types
don't know what goes on in the morgue, and would not care to
mess around with its staffing come belt-tightening time, and
2) dieners are pretty much left alone by management and
enjoy a much greater degree of autonomy than most workers at
their pay grade and level of education. My own impression of
the "diener personality" is that they are somewhat secretive
and cliquish, and one gets the idea that they have a lot
more going on in their lives than they tend to let on. It is
not uncommon for them to receive a variety of strange
visitors in the morgue, some of whom have a less than savory
appearance. For fiction writers, I think there is a lot of
character development potential for dieners.
There has been a general belief that some dieners also take
payment under the table for notifying funeral homes of
deaths in the hospital (so that the funeral home can send an
agent out to approach the family), but I am not aware of any
cases where this allegation was proved. From my own
experiences, I know that in some cities the funeral home
business is extraordinarily competitive, and I am aware of
one case where agents of two funeral homes got into a
physical altercation in the morgue over the disposition of a
body that each claimed.
The other individual directly involved in the autopsy is the
PROSECTOR. This is the individual who is in charge of the
actual dissection. In small hospitals, the prosector is a
Board-certified pathologist, an MD or DO (osteopath) who has
undergone a four- or five-year residency in the specialty of
pathology, specifically anatomic pathology. In university-
based hospitals with teaching programs, the prosector is a
pathology resident (a physician who is training to be a
pathologist) or a medical student taking an elective
rotation in pathology. In larger non-university-based
hospitals covered by large pathology groups, the prosector
may be a pathologist's assistant. The "PA" is typically a
graduate of an associate or baccalaureate program which
provides training in several areas of pathology, especially
those that involve "hands-on" activities, such as autopsy
dissections, dissections of specimens removed at surgery,
specimen photography, and video applications. PA's enjoy
excellent pay and benefits (US$40,000 to start) in their
little-known area, and the demand for PA's continues toexceed supply.
Other individuals may be present at the autopsy, usually for
educational opportunities. These may include the attending
or consulting physicians, residents, medical students,
nurses, respiratory therapists, and others involved indirect patient care.
The prosector and diener wear fairly simple protective
equipment, including scrub suits, gowns, gloves (typically
two pair), shoe covers, and clear plastic face shields. Some
facilities have sealed-environment "space suits," but I
think one is more likely to infect himself as a result of
the clumsiness lent by these suits than if he were dressed
more lightly in the interest of nimbleness.THE EXTERNAL EXAMINATION
The body is taken from the cooler by the diener and is
placed on the autopsy table. Experienced dieners, even those
of slight build, can transfer even obese bodies from the
carriage to the table without assistance. Since the comfort
of the patient is no longer a consideration, this transfer
is accomplished with what appears to the uninitiated a
rather brutal combination of pulls and shoves, not unlike
the way a thug might manhandle a mugging victim.
The body is then measured. Large facilities may have total-
body scales, so that a weight can be obtained. The autopsy
table is a waist-high aluminum fixture that is plumbed for
running water and has several faucets and spigots to
facilitate washing away all the blood that is released
during the procedure. Older hospitals may still have
porcelain or even marble tables. The autopsy table is
basically a slanted tray (for drainage) with raised edges
(to keep blood and fluids from flowing onto the floor).
After the body is positioned, the diener places a "body
block" under the patient's back. This rubber or plastic
brick-like appliance causes the chest to protrude outward
and the arms and neck to fall back, thus allowing the
maximum exposure of the trunk for the incisions. The
prosector checks to make sure that the body is that of the
patient named on the permit by checking the toe tag or
patient wristband ID. Abnormalities of the external body
surfaces are then noted and described, either by talking
into a voice recorder or making notes on a diagram and/orchecklist. |
