Yesterday marked the first day of rotation number 4 in the Medical Examiner's Office in Morgantown. I expect these next few weeks to be filled with exciting autopsy cases that I didn't get to experience while on my hospital autopsy rotation in Pittsburgh. On this rotation, I will get to see and assist on cases that are "suspicious" in nature and do not fall under death due to natural causes. These cases are typically classified as accidents, suicides, or homicides. The office does do hospital autopsies as well for Ruby Memorial, but a majority of the cases performed are medical examiner (ME) cases. The ME cases are performed on Monday and Tuesday's and the rest of the week is set aside for hospital cases.
So far this week, I have been able to observe and take part in four cases, which included a drug overdose, a work-related accident, drowning, and a stabbing. In comparison to hospital autopsies, ME cases have a larger emphasis on the external and internal gross examinations and toxicology results rather than the microscopic examination. However, the latter can be important in some cases. As for toxicology, femoral blood, heart blood, bile, vitreous, and gastric contents are taken to be sent off to be tested for drugs, alcohol, electrolyte levels, etc. to help in determining a cause of death or contributing factors to the death. The external examination is extremely important in all the cases and can be correlated to the internal gross examination, especially in cases of trauma, gunshot wounds, or stabbings. Extensive photography is also utilized in these cases to document all findings to be used as evidence in court hearings. For identification purposes, a headshot, fingerprints, and occasionally a DNA sample are taken for all cases. After all of the external steps have been performed, the body is opened and the organs are removed one by one, which is known as the Virchow method. These organs are then prosected and examined for any additional abnormalities, with focus on the lungs, heart, and kidneys since this is where most systemic diseases lie. Sections are submitted for each of these organs for histologic examination. As for the remaining organs, including the brain and tongue, sections are kept in a stock jar in case it is needed in the future.
From what I have gathered in my first two days, ME cases have a much more systematic approach in comparison to hospital autopsies, which is understandable with the nature of them. If the pathologist is to go to court to present their case, it is helpful to have performed every autopsy the same way so it is easier to explain and present all imperative findings. I'm excited to see what the next 2.5 weeks have in store for me!
