My friend, Marc Fernandez, a 27-year-old internal medicine resident from the UK, arranged for an autopsy last week. Marc is working here for 6 months. His patient, a 33-year-old man with AIDS and hepatitis, had a very large liver. Ultrasonography had shown multiple liver lesions. An ante-mortem diagnosis of metastatic liver disease was made. Unknown primary malignancy.
He had called me in consultation several days earlier. I had recommended no surgery. The patient then suddenly died.
Marc saw me outside of the OR. “They’re starting,” he said. “Come on in.”
The Morgue table (slab) looked identical to those I had seen in the US. A dim light high overhead illuminated the room. In the US there was always a bright spotlight. The air conditioner was working and loud, but the room was warm. There were three young men in the room who I didn’t recognize. They were standing by the door, silent.
The diener (pathologist’s assistant who removes the organs from the body) was amazingly skilled. I recognized him as a man who usually works in the Sterilization room. Using a power saw and a large scalpel, he expertly opened the thoracic and abdominal cavities and removed the lungs, heart, liver, and other abdominal organs in one piece. Quick. Marc and I stood back.
The belly was distended with blood and the liver consumed with necrotic tumor. In fact, most of the liver was tumor. One of the tumors had ruptured, causing the hemorrhage. This was the direct cause of death. Other organs were normal. We suspect that the primary was in the liver (hepatoma), which is known to be associated with hepatitis. We sent a few slivers of liver for microscopic examination. (Some Florida pathologists do microscopic examinations for the hospital gratis. Results take 6 weeks.)
I had my camera in my fanny pack. “Should I take a picture?” I asked Marc.
“You could,” he said tentatively.
My eyes settled on the three men at the door. “Who are those guys?” I asked.
“Friends and family,” he answered.
I put my camera away.
