Just follow the yellow brick walls, Dorothy. That’s how I knew I was getting close to the morgue. The art deco facade of the consumer-friendly hospital stops once you get closer to the places consumer/patients rarely go to - the living ones at least. That’s where you see what the hospital was originally made of.

The big shiny metal door. The door to every morgue ever. The same door they use for refrigerated walk-in storage in restaurants. To keep that freshness locked in?

I knock on the adjacent security door. No answer.

Knock knock.

Who’s there?

Body.

Body who?

There better be a body in there or else.

The door opens and a diminutive female with cropped hair, spectacle-magnified eyes, and crooked teeth smiles, “Hello.”

“I’m here for the autopsy?” I answer in faulty Jeopardy format.

“Oh. The pathologist is running a little late. I’ve already paged him a couple of times,” the perfectly cast autopsy assistant explains.

“Do you think he forgot?”

“Oh no. I doubt it. He’ll get here eventually. Most times.”

That’s pathology - what’s the rush, it’s not like someone’s going to die … twice.

I call Amy; I’m going to be later than I thought.

This is the autopsy of a patient of mine that died overnight. Autopsies are rare. Most families don’t want them, but this case was a real mystery. The patient came in and quickly suffered massive organ failure in every organ system. The family decided to let her go when it was clear that being kept alive by machines wasn’t quite the Bionic Woman story As Seen On TV. I wanted to see for myself what the problem was. Ironically, in internal medicine you rarely get to actually see the true internal aspect of the disease processes you’re treating. It’s all labs, and scans, and external signs and symptoms, and deduction. They should call it External Medicine.

Lucy the Tech and I keep each other quiet company in the little brick room outside of the autopsy room. We comment on the weather and our jobs. The tech is like Dante in Clerks - she’s not even supposed to be here today. I’m like Ally Sheedy in The Breakfast Club - just here out of sheer morbid curiosity.

An hour later, Dr. Deglover arrives. Lucy the tech prepares the lighting and tools in meticulous anticipation. He’s pretty much how you would expect an old pathologist - cynical wrinkles, resigned eyes, older than death. His hands have a slight tremor as if to register feelings his soul no longer has use for.

Lucy gives me a sterile gown and offers sterile gloves if I want to assist. I decline. Dissecting someone I was trying to keep alive yesterday is just a little too Kevorkian, even for me.

Dr. Deglover examines the fat corpse lying belly up on the stainless drain table. I never saw her, the corpse, awake or talking. She was unresponsive since she hit the ER doors. He touches the face, eyes, mouth — touching everything with his gloveless bare hands. Looks under the arm. Frowns.

“Certainly no lack of tissue here. She’s a big girl now,” he says dryly. Something dark inside smiles; this is the show I was waiting for.

He fills out his clipboard and says, “Tell me when you’re done, Lucy.”

I’m a little shocked. Lucy isn’t even a nurse; she’s a hematology tech. She’s not even supposed to be here today. How’d she get this gig anyways?

Little Lucy has to climb up on portable steps just to get over the belly eclipsing her. With scalpel in hand, she cuts a “Y” incision from neckline to pubis. The skin splits effortlessly like wet tissue paper. It reminds me how frighteningly fragile humans are. The pale cover opens up thick tomes of intensely yellow volumes of fat beneath. The colors of the outside world pale in comparison to the vibrancy beneath our own skin.

She pulls the fatty flesh off the chest to reveal the skinny red muscle beneath, the proverbial thin person inside. A giant breast dangles over the side of the table. A strong iron-laden odor of raw meat hits me through my mask. This isn’t the smell of death that policemen and soldiers describe; this is still relatively sterile. It lacks the sickening odor of bacterial breakdown and decomposition that can make you vomit instinctively. This is just meat.

Next she gets what looks like hedge clippers and snaps the ribs apart one at a time. She removes the front of the rib cage like a breastplate. A dull red heart sits between two purple spongy lungs. The sacs around them filled with the fluid I have only seen on X-rays.

Lucy starts slicing through the copious yellow fat with zeal, muttering, “Agh, this is going to take a while.”

Eventually she calls the pathologist over when organs are in view. She keeps scooping back the avalanche of fat against her chest as it keeps slipping under her arms. It looks like she’s wrestling with a greasy yellow sleeping bag. The pathologist looks inside the gaping maw of the abdomen and starts removing organs. The mass of intestines. Stomach. Strip of aorta. Rack of human.

He cuts quickly, mercilessly. None of the dainty meticulous slices of a surgeon. No one cares if you cut a nerve or blood vessel when they’re dead.

Dr. Deglover sets up the various organs on a nearby drain table and notices the spotlight above.

“Lucy, why do you insist on lighting this room like a coliseum? Do you actually think I couldn’t see the table without a spotlight?”

“Just trying to make your work easier, Dr. Deglover,” she replies. The nature of their relationship is almost hyperbole - mastermind and henchman, Abbott & Costello, doctor and … nurse.

“I could do these autopsies in the dark,” then as an aside, “These days I’d prefer doing them that way.”

“When in Rome,” he looks up at me with a smirk, “So are you the resident who took care of this one?”

“Oh, I’m the attending.”

“What’s the story with her?”

“Sixty year old came in unresponsive. Massive organ failure in all systems - liver, congestive heart, kidneys. We couldn’t keep her blood pressure up despite max vasopressors. History of –”

He interrupts out of loss of interest and plops the heart into the scale.

“The average female heart is 200 grams. Hers is over 500,” the pathologist holds up the body’s most vital muscle, “this is a monster heart.”

He starts slicing into the heart vessels. “Dammit. The blade broke. Lucy, could you –”

“There’s an extra scalpel to your right,” she tells him while peeling the face off of the cadaver.

“What have we …. she has coronary stents?” he asks me.

“Yeah, a few years ago.”

“Found another stent and there goes another blade,” the pathologist says and tosses his second scalpel, “Stents don’t allow themselves to be cut. Which is too bad, because if I could section one, we could see if a heart attack did her in.”

He slices the heart open. Old blood and clot pours out. He shows me areas of scarring within the thickened heart muscle, sites of old heart attacks.

The liver is speckled with an orange and brown pattern. “Nutmeg liver from passive right-heart congestion,” the pathologist states. Many pathology terms are named after food for some reason. I have no idea what actual nutmeg is or looks like though.

The gallbladder is a vile green. No stones inside though. The bile drains out as sinister emerald at first but it becomes more like golden oil as it thins toward the drain - the same color it turns your skin when your bilirubin gets too high. The stomach is kind of a rustic tan color (it’s more pink in the endoscopy pictures, like the inside of your mouth, colon, or rectum). He shows me dark pinpoint spots in the lining.

“Just a little stress-induced gastritis. Was she on IV steroids?”

“Yeah,” I answer, “Part of the sepsis protocol.” I’m a little surprised the steroids could do that in less than two days though.

The aorta is a long strip, dark and rubbery. He pulls out clot that makes a cast of the connecting blood vessels.

“Post-mortem clot. Not what killed her,” he says.

I think he likes having someone here to share his findings with in person.

“But it looks more ragged, and –” he examines it closer and then rolls his eyes. “Sloppy. Post-mortem trauma.”

“Trauma? But she wasn’t CPR’d. The family made her DNR,” I answer.

“Post-mortem trauma as in…,” he says pointing his scalpel at Lucy while she starts up the bonesaw to cut open the skull.

I can’t hear anything while the bonesaw is on, so I wander over and watch Lucy cutting the skull. I can see the face pulled down under a towel, the eyes sockets are empty like a mask. The towel covers the skinless degloved face. I remember what Dr. Deglover said about Lucy being sloppy and step back a few feet.

The exposed brain is a soggy Humpty Dumpty after a few too many falls. Dark blood vessels fissure the surface. She pops it out of the base of the skull too easily after cutting the stem.

Back with Dr. Deglover, he’s sliced open the lungs. Deep purple, fluid soaked. I add my clinical findings,

“We had a hard time getting her oxygen levels up on max ventilator settings. She also had this ball-like mass on the chest X-ray in the left lower lobe.”

“Interesting,” he says, and squeezes part of the open lung, “No cancer there, but … you can feel it … it’s harder than the surrounding lung tissue. It’s also darker.” He pulls a string of clot out of the central lung vessels. It’s stringy and elastic, reminding me of the symbiote Venom suit in Spider-man 3.

“Massive bilateral pulmonary emboli,” he shows me, “The spot on the chest x-ray was lung infarct from the clot.”

In medical school, you always read about the “wedge sign” that can show up on x-rays, but in the real world, we never see it. But there it was, only it wasn’t a wedge, it looked like a ball. Even the pulmonologist was fooled.

It all made sense. That’s what made it so hard to oxygenate her. That’s why all of her organs failed so quickly. The sheer amount of clot in her lungs prevented blood from getting to the rest of her body, even though her heart seemed to be pumping fine. We couldn’t have gotten a C.T. scan on her because that would have finished off her kidneys. Blood thinners were out of the question too because of some bleeding she had.

“This explains a lot,” I nod. I lost track of the time. It’s past eight. I thank them both and leave quickly for home. Tomorrow I’d inform the family and send them a condolence card. The pulmonologist will want to hear what that mass on the x-ray was too.

There’s a joke I heard as a resident once. Four doctors go out on a duck hunt. The internal medicine doc sees a bird in the sky, aims his shotgun, and goes down his list of possible diagnoses, “Rule out goose, rule out hawk, rule out swallow…” and it flies out of range. Next the psychiatrist sees a bird, aims and ponders, “I know it’s a duck, but does it know it’s a duck?” and it flies out of range. Another bird flies out and the surgeon shoots it out of the sky immediately, and turns to the pathologist, “Can you tell me if that was a duck?”

I wash my hands before I get home. I hug my kids and put them to sleep. Try to cleanse my retinas with the image of their smiles half-wondering if they can see the after images of what I’ve just beheld.

I lie in bed and think about my chosen career. I have a hard time seeing myself running around as a stressed-out hospitalist when I’m 50. I feel pretty burned out after just ten days in a row. I ponder if sometime between now and then I could withstand a pathology residency.

It takes another day and a half before I get the smell of old blood and freshly sliced organs out of my nose. That part I didn’t like so much.