Essays by Charles Bardes, M.D.

April 24, 2008 7:29 AM

Awaiting autopsy, the newly deceased lies supine, naked, on a metal table. The head is positioned as if the closed eyes were looking straight up. The arms are at the side. The knees and elbows are straight. The ankles are bent forward, not to the side, at an angle of about 45 degrees. I have seen the bodies this way of persons I had known, persons I had spoken with the previous day. And sometimes a live patient, consulting me for a physical examination, will lie the same way on the examination table, naked, looking up, arms at his side; and my thoughts turn to the autopsy suite. I wonder if I will someday see him too lying this way, recently cold, and I wonder about the complicated awful predicament of the physician.

Short essays by Charles Bardes, M.D. on the practice of medicine. An appreciation of Charles Bardes by Sven Birkerts.
posted by Kattullus (15 comments total)

This is a doctor, a man of science, speaking to us with compassionate intimacy, taking as his revolutionary premise that the truth of what happens to us is found outside the narrowed bounds of specialization; that the operations of the body are not only literal grist, subject to measurement and diagnosis, but also metaphorical, informing our imaginings, and crowded with suggestions of banished spirit.

Good stuff Kattullus. Reminds me why I did not follow in my father's surgical footsteps. I too "wonder about the complicated awful predicament of the physician."

And sometimes a live patient, consulting me for a physical examination, will lie the same way on the examination table, naked, looking up, arms at his side; and my thoughts turn to the autopsy suite.

How can people think like this and do this job? Not me.

Patients think they want compassion, when what they need - in particular with surgeons - is the cold, dispassionate, view of an auto mechanic. I don't want my doctor getting all deep and philosophical on me and I don't want her thoughts turning anywhere except to the repair manual and the job in front of her. Unfortunately, this is impossible except for the biggest of assholes. Fortunately, there are plenty of them in medicine.
posted by three blind mice at 7:54 AM on April 24

Unfortunately, this is impossible except for the biggest of assholes. Fortunately, there are plenty of them in medicine.
posted by three blind mice at 10:54 AM on April 24

I believe that the purpose of the 80 hour/week residencies and the 48 hour no-sleep shifts is precisely to break down the doctors and dehumanize the process. Only a psychopath could care about someone and then crack open their ribcage or tear apart their skull with a bone saw. The more disconnect the people doing the drilling are from the fact that they are drilling into a person, the better off we all are.
posted by Pastabagel at 8:26 AM on April 24

I believe that the purpose of the 80 hour/week residencies and the 48 hour no-sleep shifts is precisely to break down the doctors and dehumanize the process.

They call it "continuous patient care" and there is some definite merit for residents to follow an admission for 48 hours. It may not be best for the patient. Recent studies have shown that "mandated work-hour restrictions have had a dramatic [positive] effect on resident and staff surgeons involved in the care of injured patients."

On the other hand, when my ex was going through residency at Grady Memorial Hospital in Atlanta, it was pretty clear that the main result of continuous patient care is that none of the residents cared about the patients as people - their only goal was to turf them - which was also the goal of every patient so it sort of worked out sort of fine.
posted by three blind mice at 8:51 AM on April 24 [1 favorite]

The funny thing about doing autopsies, especially forensic autopsies, is the atmosphere around the table. Usually I can be found cracking jokes, making wholly unprofessional observations (especially if none of the clinicians have shown up to see their former patient's autopsy), and generally having a good time. If the clinicians are there, you can make them really nervous (especially the surgeons) if you can make them think that they did something to cause the patients death - in today's medical climate you can really get folks to fall for that one. You have to make it fun, because truthfully, performing autopsies is kinda boring and highly repetitive. Cut out organs, weigh organs, look for pathology. Boring - especially since we generally know how people die these days (advanced imaging, etc). Just have to be professional on the report of course.

In general, autopsy techs (dieners), are some of the funniest people that you will come across in life. Most of the ones in the forensic setting are crazy funny. The ones that I worked with most recently had a long-running joke going with most of the police detectives who were assigned suicides/homicides (and came to observe the autopsy) - how good-looking is the widow?

Of course, put a kid up on the table and everything changes.
posted by i_am_a_Jedi at 9:19 AM on April 24 [4 favorites]

Steady on here. I want my surgeon to be compassionate but with the skill of an expert auto mechanic if I'm on the operating table - autopsy, it doesn't matter so much.
posted by tellurian at 9:23 AM on April 24

i_am_a_Jedi: Of course, put a kid up on the table and everything changes.

I remember reading an interview with or an article by Britain's main forensic pathologist, but I can't seem to track it down. I'm pretty sure it was in The Guardian and made into a MeFi FPP. It made for hard reading.
posted by Kattullus at 9:31 AM on April 24

In general, autopsy techs (dieners), are some of the funniest people that you will come across in life… how good-looking is the widow?
I take back my 'it doesn't matter so much'. You joke* about my partner or daughter and I'm coming back in spirit form to haunt you (because one will be my widow, the other my kid).
*What sort of jokes - in particular, what sort of crazy funny good-looking widow jokes do autopsy technicians make?
posted by tellurian at 9:51 AM on April 24

Awesome stuff. Would love to read more. Anything about Osler is fascinating.

Also Pastabagel I think your comment is spot-on but the grueling residency is also an old institution designed to separate the wheat from the chaff. But maybe that's too obvious to warrant stating.

Reading Sherwin Nuland often makes me wonder how on earth a man so obviously sensitive could perform surgery. Imagining Oliver Sacks in the ED running a code would be a sight too.
posted by inoculatedcities at 10:26 AM on April 24

What sort of jokes - in particular, what sort of crazy funny good-looking widow jokes do autopsy technicians make?

Generally the type of low-brow, juvenile humor that you'd expect from jaded middle-aged multiply-divorced, almost-misogynistic guys. The kind that probably makes most mature listeners cringe and that I shouldn't find funny (but I do). Ahem.
posted by i_am_a_Jedi at 10:36 AM on April 24

Enjoyed the essays. Working with people when they are ill can be so immediately intimate and personal and he captures some of those moments well.

My dad was a neuro pathologist and he and his coworkers did make a lot of weird jokes in and out of autopsies. He always cut birthday sheet cakes in a Y as if it were a chest incision. He laughed and laughed at this every time. And he would tell classmates our family stored brains for dissection in the bathtub. Dumb and juvenile like the Jedi says. But the kids on the work table did change things. I remember him coming home on those days; he would make us swear to never do whatever it was that teenager did that caused that fatal head injury that progressed rapidly before anyone recognized something was seriously wrong. Other times he would come home from work and not say anything about the day, but we could tell the weight of something was lingering and we probably didn't want to know the details.

I think that generally the weird jokes are absolutely necessary for people in the field to cope with what they see and absorb. Death and irony are part of life and sometimes it really is insanely funny. I'd guess that the meanest jokes come from the emergency room anyway. The stuff staff said there sometimes was down right cruel, but I must say laughing made it tolerable again.
posted by dog food sugar at 10:49 AM on April 24 [2 favorites]

Ah, now I am remembering why I didn't go into forensic pathology, as much as I find it fascinating. Even with bad jokes, I wouldn't cope.

(That said, i_am_a_Jedi, should I ever wind up on your table, for the love of all that's right and holy, get a good laugh out of me. I'm the eternal straight woman in life -- might as well keep that up :) )
posted by kalimac at 11:54 AM on April 24

Other times he would come home from work and not say anything about the day, but we could tell the weight of something was lingering and we probably didn't want to know the details.

I heard that. And I hope no one got me wrong. I have total respect for those who can handle this and do their job. I knew from a young age that person wasn't me and repeated exposure to it just confirmed that. I got no problems with blood and injuries and gore - doesn't bother me in the least - but I could never separate it from the human factor and that does bother me. A lot. I don't think anyone really can separate the two. Even the "asshole" doctors who I admire to no end because they somehow manage it. Bad jokes only go so far.
posted by three blind mice at 1:40 PM on April 24

He always cut birthday sheet cakes in a Y as if it were a chest incision.

Now that's funny.
posted by Faint of Butt at 1:53 PM on April 24

Generally the type of low-brow, juvenile humor that you'd expect from jaded middle-aged multiply-divorced, almost-misogynistic guys. The kind that probably makes most mature listeners cringe and that I shouldn't find funny (but I do). Ahem.

In first-year uni, my friends doing pathology used to say the same thing about the techs in the dissection room, although weird and crazy were more commonly used terms.

Apparently, they used to try to make get a reaction out of the squeamish students - send them to get things from a particular room without warning them that a body was being embalmed in there, shock value stuff.

I still remember the story of one person asking one of the technicians the best way to examine the posterior aspect of the knee, since the cadaver was lying on it's back. "No Problem" - technician fetches a big saw, cuts the leg off, promptly turns it over and says "There you go". Had the desired result, because the next sound heard was a loud bang as one of the students had fainted and hit the table on her way down.
posted by kisch mokusch at 5:50 PM on April 24

Haha. We generally make the med studs 'run the bowel.' Which is just as disgusting as it sounds. Always a crowd pleaser.
posted by i_am_a_Jedi at 7:21 PM on April 24