Jason saw right through me and, after I’d circled the body a third time like a hungry vulture, he was having none of it. ‘You don’t have to mark down every wrinkle on his ball-sack, hun,’ he said, handing me a PM40, the mortician’s main blade.
It was time.
I bent down over my patient and tried to concentrate on his neck and clavicle, the natural curve where I would begin the incision. But all I could see was the harsh light from the overhead lamp reflecting off my blade like a strobe as my hand shook.
Just then, that overhead light reminded me of something and I zoned out again. (See what I mean? Poor, patient Jason.) When we were children, my best friend Jayne and I would put make-up on each other, as many young girls do. At that moment, I had a sudden memory of lying back all those years ago with my eyes shut tight to the light above and feeling it warm my eyelids, feeling the soft stroke of the brush on my skin as Jayne applied the make-up, and thinking, ‘This must be what a corpse feels like’◦– which is probably something most young girls don’t do. I was specifically thinking of scenes I’d sometimes see in films or on TV where the deceased gets ‘beautified’ in the funeral home for the big day. In my defence, I had just seen My Girl, the wonderfully poignant Macaulay Culkin film from 1991. Dan Aykroyd plays a funeral director who employs the vivacious Jamie Lee Curtis to apply make-up to the dead. She made it look like so much fun, even glamorous, and it left a kind of positive impression on me, although the ending of the film certainly did not. Even now I feel traumatised if I see a mood ring or a willow tree.[1] With this mental image of myself as the corpse, feeling the gentle touch of the make-up brush, I suddenly imagined the anorexic dentist could feel me. Not my touch yet, but certainly my hyperventilating and my hesitating. I was sure that he wouldn’t want a blonde, uncertain neophyte waving a knife above him like a sushi chef so I firmly told myself, ‘Carla◦– get on with it.’
And I did.
I’d seen technicians make this incision many times before and I executed it almost perfectly. Starting on the right side behind the ear I slid the blade down the side of his neck, altering the angle slightly as it travelled over the clavicle and down in a ‘V’ to the breastbone, the skin parting with the ease of butter beneath the sharp steel. I repeated this from the left side, a slightly more awkward angle when using the right hand, and when I reached the point of the ‘V’ I took the blade in a straight line down his abdomen, just circumnavigating his belly button slightly. I stopped abruptly at the pubis leaving a fairly neat ‘Y’ shape, which is why we call it the ‘Y-incision’. There were a couple of slight deviations in the skin, but I defy anyone to cut open a human being for the first time with a blade that could take off your own finger and not falter just a little bit. Anyway, slightly wonky lines aren’t visible after they’ve been stitched back together during the final reconstruction.
I was quite proud of myself. I stood there breathing a sigh of relief, admiring my handiwork for an inordinate amount of time, until Jason spoke.
‘Come on, Edward Scissorhands, we’ve still got the rest of the PM to do.’
The next stage, at this point of my training, was to relinquish the blade and observe Jason for the rest of the process. Autopsy technicians tend to learn evisceration in stages, a bit like driving. For your first driving lesson you don’t get in the car, gun the engine then start parallel parking and doing five-point turns, and it’s the same with autopsies. It all happens step by step.
Once the incision has been made in the chest, and the breastbone◦– the sternum◦– has been removed, there are a few different methods for systematically removing the organs for examination. The most common is often called the Rokitansky Method, though in fact it was Maurice Letulle who created what is also known as the en masse procedure in which, as the name suggests, organs are removed in one large mass. This was to be the way I would carry out an evisceration for much of my career so I watched carefully as Jason proceeded.
First, some exploration, as he used his non-cutting hand to feel behind each lung for possible pleural adhesions◦– parts of the lung that may be stuck to the chest wall. They can be caused by previous trauma or diseases such as tuberculosis or pleurisy. The best-case scenario was that the lungs, pink, moist and healthy, would not be attached to the inside of the cavity by adhesions and after a brief manipulation◦– a scooping motion◦– would just fall back to their original position with a gentle, wet slap. With the condition of the lungs confirmed, he tackled the bowels next, their slick, curled lengths removed in one long string to be examined later, as they were not the most important part of the organ hierarchy when it came to establishing cause of death. The bowel removal created much-needed space in the crammed body cavity so Jason returned to the lungs, using the PM40 to detach them, again with another scooping motion and two long incisions, one on each side of the spine, to release each organ. Using a similar technique, he loosened each kidney and its surrounding fat from beneath the level of the stomach and liver, and sliced through the diaphragm, which separates the organs of the thorax and abdomen. He then used the blade to make a nifty slice across the top of the lungs which effectively severed the lower part of the windpipe and the food pipe◦– the trachea and oesophagus◦– from the upper part containing the pharynx and tongue, i.e. the throat. Then, with one hand he pulled the heart and lungs down and away from the spine, while gently easing the flesh away with the blade in his other hand if it was a bit too stubborn. He continued the motion down into the abdominal cavity. Soon, he was holding aloft a mass of dripping viscera which contained most of the organs from the body cavity: the thoracic components (heart and lungs) and the abdominal organs (stomach, spleen, pancreas, kidneys and liver). He lowered the mass into a huge stainless-steel bowl and placed it on the matching steel bench countertop with a metallic thump, ready for the examining doctor.
Jason then moved on to the bladder, which was still in situ deep in the pelvis. Because the deceased clearly hadn’t eaten or drunk much it was small and empty: it looked like a deflated yellow balloon as he removed it and handed it to me to place on the dissection board. I wasn’t sure what ‘bladder-holding’ etiquette was, so I pinched it between thumb and forefinger and held it at arm’s length as I transported it to the steel bench, just like a disapproving mother with a teenage boy’s dirty sock.
The next stage was for Jason to move on to the head. At this point in the evisceration the pathologist, Dr Colin Jameson, arrived in his maroon Volvo◦– we saw him slide the vehicle into the tiny car park through the frosted windows of the PM room; a bloody, moving smudge. We always mused about his choice of car, the Volvo, said to be the safest in the world. (In fact, the Volvo V40 is still the safest car you can buy.) Was it a deliberate choice? Had carrying out autopsies on so many victims of road traffic incidents◦– RTIs◦– made him paranoid, we wondered? I left Jason continuing his work on the head while I took off some of my PPE (gotta love those acronyms: this time ‘personal protective equipment’) and went to meet Dr Jameson in case he wanted a coffee before getting started. It was such a small building it took me only a minute to get out of my PM room clothes and into the office just as the bell rang.
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