By Walter M. Robinson
Editor’s Note: This essay includes graphic descriptions which might be disturbing to some readers.
His head bends backwards across a wooden block four inches square. This unevenly varnished pillow levers the base of his neck up to thrust his chin and chest up off the steel gurney. His arms flop at unnatural angles, his legs too straight, held together, I now see, by a wide white ribbon tied in a knot.
His eyelids are half open, with dull dry eyes visible when I look closely. That mythic gesture in the movies, a hand fully closing the eyes with a gentle downward swipe, doesn’t work. I’ve tried it on other bodies.
I am used to seeing him on his back in a hospital bed, his head on the rough pillows of the intensive care unit, his whole body panting, pale and sweating with the effort to breathe, but now his skin is waxy, a shade of blue-white that living bodies never are, and in order to keep my composure I have to keep reminding myself that this isn’t the boy who had been my patient, that this isn’t John the blond terror who had consumed my days and nights for the past ten days, that John is dead now and not just resting here uncomfortably.
The boy and the body keep oscillating in my mind. This isn’t him, this is a body, an assembly of parts, an object; this is him; this is the boy whose life I had tried to hold together long enough to get the transplanted lungs, the boy I promised resurrection. But the new lungs never came, and the boy is gone. The diagnosis and I survive.
I asked the older doctors, when I was in training, why anyone would need an autopsy on a cystic fibrosis patient. What’s the point, I asked, since we all knew what killed them? How little I understood then. The point of the autopsy is to show the family that the disease had advanced beyond hope of any further treatment. The family needs proof of the ravages of the disease, especially if their child had died, as Johnny had, at age 12.
He was supposed to die at thirty. That’s the number everyone has in mind, an age far enough away from childhood to claim a kind of victory, an age that could be wished forward by our constant treatment advances, by our cheerleading about gene therapy, by our push to enroll children in research protocols that were always hopeful at first. We let an average become a promise.
Families don’t need to see the autopsy. We wouldn’t be so cruel as to suggest that. I am here as a proxy for them. The autopsy is the final ritual of respect for the disease.
I am here today to see in open light what I had only imagined by listening with my stethoscope or looking at years of x-rays. And so as the pathologist goes through the procedure, I look.
Here are the damaged lungs, filled with solidified mucous, a damp and congealed mass, ruinously bloated and stiff. Here is the annihilated pancreas, hard even to find, withered and tucked up against the duodenum.
Here is the shrunken and swollen patchwork liver with its filigree of white scars. Here is everything else—kidneys, spleen, heart––quietly untouched, normal islands of anatomy left standing like unscathed houses after a wildfire.
I can go now, having seen what I need to see for the report to the parents. I will let them write their own story of these findings—perhaps they will say that through their hard work he lived longer than he might have, or that he was a fighter, or that God called him home, or that he is in Heaven now, whatever story they can live with.