Cutting corpses

The decision to post this translation was a bit more complicated.

On November 20, 2012 a medical student with a blogger name Kainaloinen kana posted an entry on her blog Elimiä ja eläimiä. It described her experiences, in a somewhat lighter manner, with the autopsies that are part of her medical studies. She has not directly revealed her identity in the blog, but there is her picture. The feedback was mostly very positive, but she also received to a comment to remove the post from six senior staff members incl. the vice dean; I include that comment in the end. This caused some uproar in social media against such censorship simply to uphold professional status and respect and made the post all the more public (Streisand effect). The dean of the faculty approved this censorship. I do understand that making light of such morbid matters can be also offensive. However, the incident prompted numerous people to volunteer their remains for education and science. In the end the blogger ended up removing the post. But it remains available – Janne Paalijärvi reposted the blog entry on his website with many of the early comments.

For me, it is definitely among some of the more important writings I have read in Finnish in that last few years, and, in part, because of the absurd reaction, I feel, it got from her senior colleagues.

There has been other articles on autopsies in Finland, none of them have sparked any real controversies: Helsingin Sanomat, 2013: Leikkauksia harjoitellaan vainajilla Tampereella;Kaleva, 2008: Tällä pöydällä ihminen on paljaimmillaan; Jylkkari, 2006: Arkinen päivä ruumishuoneella, page 9. There are also many informative websites in Finnish on autopsies.

Edit 4/9/14: Some minor corrections were made to the text.


Autopsy slab in the pathology department of Tampere University Hospital. Picture by Reijo Hietanen.

As a medical student you often get questions like: “Do you really cut real bodies?” and “Isn’t it pretty discusting?”

Yes, we do dissect dead people and yes, it can be gross at times.
Warning: graphic detail to follow.

 

Dissections

There are two types of autopsies we do: dissections and obductions.

Dissections begin in the spring of your freshman year as a part of the highly recommended, though not obligatory, anatomy course. The cadavers for dissections are embalmed with intravenous formalin. The cadavers are the earthly remains of those who have volunteered their bodies and that fit certain criteria (e.g. having no serious infections).

In previous decades there were more autopsies performed and the bodies where those “buried in government sponsored funerals”, that is, alcoholic hobos and prisoners.

Currently, the bodies the freshmen dig their hand in have been in the morgue for close to a year. They have been disemboweled by second year students and they often switch the places of the organs when putting them back to mess with the freshmen.

Autopsy rooms have a stuffy odor that sticks with you for a long time and is impossible to wash off your hands if you happen to break your thin rubber gloves that are long past their use-by date. The corpses are cold, gray, completely flat-faced (having been placed face down), partly rock-hard, partly full of formaldehyde solution. Plenty repulsive, really. On the other hand, what made it easier for an easily-rattled person such as me, was that the cadavers look very much dead and not very human.

Dissections are pure teaching; there is ten or more people working on one body and they try to peal it layer by layer and recognize all the anatomical structures. Every cadaver has their own green garbage bins were anything loose is tossed to make sure that each part ends in the cremation of the right cadaver. You wouldn’t believe how difficult it is to tell fatty tissue from back muscles or differentiate between nerves and veins. All this is much easier with the fresh and less stiff cadavers used in obductions.

Dissections are great motivation for healthy living, as you literally see how much fat even just slightly chubby person has when you are trying to find something in or under all that fat.

Obductions

Obductions are scheduled for the end of second year and the fall of third year studies at the Helsinki University. These are official medical autopsies in which actual cause of death is to determined but they also serve a teaching purpose.

Most Finns get an autopsy, mainly legal autopsies. These are performed if the death occurred when not under medical care, the death was sudden, or a crime, medical malpractice or an occupational disease is suspected. The non-legal autopsies are performed by the pathology department.

Personally, I much preferred obductions over dissections. The bodies don’t smell quite as bad (except the bowel), the rigor mortis hasn’t settled in, and the organs are more clearly defined. In addition, dissections focus a lot on minutia: “Hold the tweezers like a pen.” “Sorry, I think I cut the nerve and now I can’t find it.” “First, incision from anterior superior iliac spine along the cranial side of inguinal ligament in the medial direction and towards tuberculum pubicum.” In the obduction room the tools of the trade include a circular saw and a huge sword-like knife. However, you plenty tired of trying to find the thyroid gland for weighing or using tiny scissors to cut a path through calcified coronary arteries.

Obductions were also somewhat cleaner. Sure, there is blood and some organs begin to resemble more of a puddle after two hours of prepping (“I had the stomach here just a minute ago – just wait, I’ll find it from this mush.”) but the protective gear is better and the body usually doesn’t spill unidentified fluids on you.

Anatomical theatre (the dissection table), Palazzo dell’Archiginnasio, Bologna, Italy

Moreover, the actual autopsies are very educational – you see healthy and sick organs and you had to think about possible causes of death. (No worries; it isn’t the students that write the final patient reports.) You actually get to see more autopsies than you do yourself in special demos, from videos of autopsies and in the 1700s Enlightment-style autopsy amphitheater.

Something that will be forever imprinted on my mind is seeing a nine-pound liver of an alcoholic; it is bright yellow and actually fills a half of the abdominal cavity extending from one side to the other. It also leaves a nasty greasy ichor on the scalpel.

I enjoyed quite a bit all the cutting we have done. It is nicely practical and makes all the lectures feel that much more concrete. Nevertheless, I am not ashamed to admit that I felt queasy for the first couple of times. But you get used to it surprisingly fast.

I used to be afraid to watch films with any violence. Now I am the one cynically commenting on a slasher scene: “It doesn’t really look like that.”


The comment by six senior staff members of the Faculty of Medicine at the University of Helsinki:

The doctor-patient privilege for a physician or a medical student is not meant solely to protect the identity of the patient from outsiders. All public discourse must show respect to all persons, living or dead.

The blog entry “Cutting corpses” on November 21, 2012 by blogger Kainaloinen kana is a tongue-in-cheek description of autopsies, but the tone of the writing is such that many people can perceive it as offensive. For this reason we ask the author to remove the entry.

Pekka Louhiala
Anne Pitkäranta
Pauli Puolakkainen
Heikki Hervonen
Hanna Jarva
Kaisu Pitkälä

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