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I can't remember when I last wrote about the autopsy on this blog. It has certainly been a long time since I've thought of it and a few years since I last attended one. The post-mortem examination has historically been a very central part of medicine. Only a few generations ago, advancement of medical knowledge depended greatly on examination of bodies after death. Even now, in most medical schools, gross anatomy and dissection represent a rite of passage and core part of the curricula.

Although I sometimes neglect to do it, I believe asking for a post-mortem is an important part of death in the hospital for any patient. I never push families to do it, but if I remember, I will always ask. In an autopsy, a pathologist (who many don't realize is a physician) examines a corpse to determine the cause and manner of death as well as diseases and injuries present. It is a professional and specialized procedure that achieves specific aims while giving a body the utmost respect.

As an ICU fellow this year, I find myself saying "we are at the limit of our medical knowledge and ability" quite often. Because we deal with the sickest patients, the extremes of physiology, the worst of diseases, we often find ourselves in uncharted territory, making diagnoses based on exclusion and indirect evidence or offering hail-Mary treatments when all else has failed. The autopsy may be the only way to know something for certain. I will readily admit that we may miss diagnoses or misappropriate treatments. It is the nature of medicine, especially medicine practiced at the brink of death. The post-mortem examination is one of the few ways we get feedback. It is critical to determining the cause of death and the state of health of a patient before he died, and it is critical for us to better our practice.

The number of autopsies performed has steadily declined over the years. But I personally think the importance has not diminished. Today I attended the autopsy of a patient I cared for for weeks in the intensive care unit. After examining the gross organs and slides under the microscope, I discussed the case with the chair of pathology and learned a great deal about the case. Even though the autopsy confirmed a diagnosis we knew, it taught me about the time course of events, the severity of the disease, and excluded the possibility that we missed something else. The post-mortem examination made a difference for the treating physicians.

Image of Autopsy by Enrique Simonet (1890) is in the public domain, from Wikipedia.