It falls to a pathologist to communicate that knowledge to the doctor.
“People don’t realize the pressure,” Olevian, the first-year resident, says. “It’s a final thing, too. It’s almost scary. No one has any clue what anything is. They pull it out or sample it and you say, ‘This is what it is.’”
“That’s a lot of power,” I tell him.
* * *
In the room, they’re examining the organs from inside the abdominal cavity. Nine shows Mosch which type of scissor is best for cutting hollow viscera. A hollow viscus is any organ that isn’t solid: The liver doesn’t count, for example, but the intestines do. “Think of it like manicotti for the body,” advises one post in an online forum for medical students. “It can be stuffed with things.”
Mosch: “He’s got a lot of, like… something goin’ on here.”
Nine: “A lot of like something goin’ on, huh?”
Nine lets the students take the lead, but when he does step in, his expertise—he’s performed more than 4,000 autopsies—is apparent. When Mosch has to make less-routine incisions to the heart because of a surgery the patient had, Nine shows him how to do specific cuts, maneuvering the scalpel with precision.
Every organ is weighed as it’s examined, plopped onto a hanging scale just like the ones for produce at grocery stores, and Nine and the students call out their weight estimates each time. Nine has a reputation for guessing right just by eyeballing. According to the “NORMAL ORGAN WEIGHTS” table, laminated and taped to the wall, the average male heart weighs 400 grams. But this one is oversized, hardened and ballooned from multiple heart attacks.
“All right, I’ll take 850,” one of the PAs says.
“No, I’m going 900,” Nine replies.
“901!” says Mosch, “Just like The Price is Right.”
The PA grabs the heart, plunks it down in the scale, watches the hand tick across the scale face. It weighs exactly 900 grams.
Midway through the autopsy, two PAs prepare to remove the brain, turning on an electric saw to make incisions into the scalp. Immediately, the saw blade falls to the tiled floor with a crash—it’s not fastened on tight enough. Nine says this happens sometimes. One of the PAs re-fastens it and begins to cut into the head, Mosch talking over the loud whirring across the room, his voice slightly muffled by the splash shield covering his face. He shows me the bowel, which he winds into a roll with two wooden sticks, like pigs in a blanket. At the same time, Nine and the other PA go into a side room to take photos of abnormal tissue they’ve carved out that might be significant for the case file.
Hours pass like this, the four of them pacing around each other taking samples, making cuts, asking questions, typing and jotting notes. The body, though it’s the object of investigation, becomes almost superfluous, literally dead weight in the room. After a while, it’s easy to become absorbed in the details of the work, to forget the larger context of where we are or what we’re doing. To forget death is a presence at all.