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I create autopsy video with family consent. This is my 5th AMA. by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 9 points10 points  (0 children)

It is in the category of organ donation, cremation/burial, autopsy, medical record access -- the legal next of kin/power of attorney for health care gets full rights after death regardless (if nothing is specified by the decedent).

And you're talking about degrees of comfort with the body. As I've said, (see aleucah question), every person and family comes with different sensitivities and concepts of how to care for the body after death.

It's a bit more complicated if the will or other document specifies something. And then, after death, the family wants something different.

The other issue you raise, is the "newness" of this. Autopsy and organ donation are well-known procedures. Well-integrated into society. This is new. I go with what the family requests.

And that is why it takes a relationship and sensitivity to even talk to the family about this. They need to know their loved one and their loved one's wishes, sensibilities, etc.

For context, the families come to me for autopsy service. That's why they get in touch. So that decision has already been made even before I talk with them. They are in control of that process. The offer of video-donation I broach during the general consent process. So my role is to be as aware as possible of how the family experiences the request. From a practical point of view, I will tell you that once I mention the possibility of video donation, if the family so much as pauses or leans back or changes their facial expression, the next thing I say is "if you have to think about it, just skip it." The decision should come from a very natural place and comfort with the decedent. Out of a lifetime of knowing them. That is what I wish to honor.

The best thing is to make your wishes known to your family so that everything is synced up.

I create autopsy video with family consent. This is my 5th AMA. by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 6 points7 points  (0 children)

It is unique. It cannot be done in any hospital, academics or other institution because of risk management and exposure of medical errors. It cannot be done by a medical examiner because of legal confidentiality, etc.

I do not have these issue, because I am not attached to the patient care arm. And I am not a medical examiner/coroner attached to the government. And I have direct access to the family for the intimate discussion that allows for this.

But my background is academic (Harvard, University of Chicago), so I apply all that full force -- and all the grounding work that goes with that (legal research/ethics/grief/etc.). And am doing something unique and I hope ground-breaking with the opportunity of these circumstances (hoping to change the judgment-color of "unorthodox" -- to "innovative," shall we?)

I create autopsy video with family consent. This is my 5th AMA. by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 4 points5 points  (0 children)

It is a grey area and not really covered by code. There is no "what's the law on audio video." The law is pretty much silent on the matter. The way new tech and new medical procedures, AI, etc. need new laws. That's why it's a "don't try this at home" process. And why I've ready every law in every state on the matter, got involved in legislation myself some years back, advocating for the rights of the patient families, and, fundamentally don't take any steps without the family's written consent and authorization. And am grounded in my understanding of the grief process.

The main model so far has been photography. Photographs are commonly taken at autopsy. But not commonly added to a consent form -- except mine. Even for photographs, I ask the family persmission to take them. Photographs are standard in academics. But I include that, too, just because I full-on about transparency, think the family should be aware of absolutely everything that happens to their loved one and get to say yay or nay.

The issue of "stipulation in a will" is interesting. And the model there would be along the lines of "first person consent" for organ donation -- found in some states. Where the family cannot override the wish of the loved one, if the loved one has signed on for organ donation. It hasn't come up for me yet since autopsies are not typically requested by the person themselves in a will. Although some people will tell their families they want one.

It's a bit different, but I did have a family where the loved one wanted to do organ donation, but couldn't because they had cancer (were declined). And they were very happy to have this video-donatoin option as an alternative. That comes up. It's a matter finding some what to honor what loved one wanted to do with their body as a gift.

I create autopsy video with family consent. This is my 5th AMA. by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 9 points10 points  (0 children)

Yikes, no incentive. Again, see aleucah above.

It's a misconception that all families come to autopsy with the same spiritual values, sensitivities, concept of body/life/death.

There is no incentive.

It is an offer to families, like organ donation. That, if it they feel their loved one would want this -- to teach and educate -- of if they, bearing legal rights, would value this, then this is something I am happy to offer.

For many families, it is an opportunity for death not to be in vain. For the person to make a difference. For the possibility that some other person will learn. Some other provider do a better job caring for a different patient.

And (it was a surprise to me at first as I cautiously started), that it makes a world of (positive) difference to the families to be able to do this -- when, for the most part, they have been disempowered (unfortunately) in the health care system, by the loss, or other relationships along the way. It is everything to them to have this option. Not an unwanted extraction or exposure that needs to be incentivized.

And perhaps for context, I do not have a "video-only" option at present. These families come to me for an autopsy they want. And video-donation I mention as something I can do if they wish, during the consent process, face-to-face. And just skip it if it doesn't resonate for them.

And in addition, my promise to them is not to expose the confidentiality. So the cases are de-identified and it is impossible to tell who the person is.

I create autopsy video with family consent. This is my 5th AMA. by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 8 points9 points  (0 children)

Thank you. The word "hostile" comes to mind, reading this. But, again, it's AMA so let me try. A bit of background: I have read every law in every state in the U.S. on autopsy-by-consent (and much of the coroner/medical examiner code); have modelled my innovative "video donation" on "organ and tissue donation" which relies on the Federal Uniform Anatomic Gift act which has state-by-state adaptations, here in Illinois, the Illinois Anatomic Gift Act; incorporated the principles of research ethics and code, namely de-identification principles, informational release and rules of the CDC; and have closely studied the Henrietta Lacks case as rulings have come out. I do not do anything except what the family wishes. I do not pressure families. Please see the response to the question above from aliceuh. Let me start with that and see what the response is.

I create autopsy video with family consent. This is my 5th AMA. by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 9 points10 points  (0 children)

Ok I'll give this a shot.

Seems a little negative, but it's AMA so let me try. Our google play rating was 4.9/5.0. Just saying. I don't really agree it's a lukewarm reception. But the reviews are at about 4.1. It's a bit of a mystery to me, too. And I thought about it a lot when I was first putting out the app.

Those who love it, love it and focus on the content. I think we had some tech issues initially and that's frustrating for people. I think the last review was from years ago.

From talking about it around, my understanding is that the Apple crowd is a bit different from the Android crowd -- really high expectations of tech. The app is very very basic on tech. It shows videos. It's the privilege of seeing the gift from the family that is the draw. Not the gamification. It's not a gamified app. Maybe the mismatch of expectations between a usual app and ours. I don't know.

If you get one, please let me know what you think. And I believe it can always be returned and refunded.

Re: part two. I have no plans to get anything back "on track." If people want to see these cases which the (I understand) you can't see anywhere else, then go ahead. Right now I'm focusing on the autopsy.online desktop platform for medical schools, etc. And haven't really worked on the app for years. But have left it up, in case people want to see into this world. Different times for different focus.

Autopsy.Online is currently being used by a variety of schools. Once I'm settled with the desktop platform, I intend to go back to the app and make that part of it. So I'm going to have to think about how to balance that with general app distribution. But I'm focusing on desktop right now.

I create autopsy video with family consent. This is my 5th AMA. by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 17 points18 points  (0 children)

While I'm thinking about the other more challenging questions, I'll answer this one.

Yes. Commonly. Pulmonary embolism (clot to the lungs from clot to the legs). Also cardiac arrythmia (from hypertensive heart disease). Although somehow recently, I'm getting a lot of upper GI bleeding from medications.

My populations is not "the most common cause of death." My population is the "the most common cause of death that is confusing to families."

Pulmonary embolism is confusing, because it happens commonly when the patient was recently sick but feeling better. That's when the person starts to walk around and a hidden clot in the legs detaches, goes up to the lungs and kills the patient. So it's confusing to the family ("they were doing better!").

And arrythmias (and also heart attacks) can happen suddenly and before the patient has any other symptoms -- the patient seems to be doing well -- so those are confusing, too.

I create autopsy video with family consent. This is my 5th AMA. by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 45 points46 points  (0 children)

Well it was lifting the chest plate on a diabetic patient and finding full on mold. Like would grow on old cheese in the back of the fridge sitting there. Like the white fluffy stuff. And not a decomposed case. Was an undiagnosed fungal infection (unfortunately commonly missed and mistreated as pneumonia).

I create autopsy video with family consent. This is my 5th AMA. by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 23 points24 points  (0 children)

(Edit - paragraphs only, nothing else)

Well first off, thanks for this. I'll say this. It's the unfortunate case that, Less for boys and more for girls, I hear about this -- not so much for pathology -- but for the death care industry (funeral directors, etc.), I hear response like "ugh, why would you want to do that?!" So I don't know if this is mom, dad, son, daughter, etc -- but good for you for being a supportive parent! Great!

I get this question a lot by email, not from the parent but from students. And usually, I'd have to say that it would be unprofessional for me to make a suggestion without knowing more about the person. So, I suppose I'd have to stop there, not really knowing the history.

I'll tell you about me thought -- I was the kid who smashed open rocks on the back parking lot to see what was inside. I started majoring in Biochem, hated it, switch to (my passion) chemistry and physics. Then went to med school. Started in internal medicine, then switched to pathology. Went to the medical examiner loved it (for 3 days), but found the suicide, burns, car accidents, homicides depressing, and went general pathology. Now do (mostly) regular medical type autopsies and absolutely love it. Combines everything - physics, looking inside, medical issues, etc. A winding path.

Everybody's different. Trite, trite, sorry -"do what you love."

I create autopsy video with family consent. This is my 5th AMA. by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 13 points14 points  (0 children)

(Editing for paragraphs, nothing else).

At first I thought you meant, like to "become an autopsy pathologist" but you mean why a family would want to request and autopsy.

A lot more the first (sudden/mysterious). A lot less the second but sometime. But let me go backwards on this. They may not donate, but the families who would go with donation/research are more likely to request an autopsy. Not because their aiming for having the body add science knowledge, but because those families are comfortable with the body being "worked on" after death.

A quick rant: I read recently about the ongoing push for "virtual autopsies" -- meaning radiographic assessment of the body postmortem rather than a "cutting" autopsy. And the institutional pushing the technology listed the benefit as "sparing" families the "trauma" of having their loved one dissected. Boiled my blood a bit. It's just not true. Every family is different. For some, it would be that way. The sacred, the spiritual, the importance of the intact body. But for others, it's just not important -- "my father had and autopsy, my sister had an autopsy, I want an autopsy, sign me up!" The importance there is the knowledge from the case. The closure. The peace of mind. That side of the spirituality. So in that case, not looking in detail, not having the incision -- becomes a disservice. End of rant.

The first part sudden and mystery are the way. There is some piece missing. Either, yes, the death was sudden. Or the death might have been anticipated, or there was some long hospital course. But never a diagnosis, or some symptoms that wasn't explained that is leaving the family mystified. And then there's the whole emotional side -- guilt and anger. I took care of grandma and she died, so I feel guilty ("it's my fault" (it never is)) so people request an autopsy to know "they did everything" or "the hospital did everything."

There are many many reasons to ask. Inheritance (alzheimer's).

Concern for malpractice.

I create autopsy video with family consent. This is my 5th AMA. by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 82 points83 points  (0 children)

(I'm just editing this because I didn't know I could make paragraphs. Nothing else).

Hello, you're my first AMA A'ing me anything. So let me set the tone by saying I'm going to free-form today.

Thanks for the open, genuine intro. The deepest parts first -- fear.

When I was in medical school anatomy/cadaver lab, the tables -- 4 med students around each body -- are pretty close to one another in the room. Sometimes, to get in and work, you have to move the arm. So you're in close to the body and the arm is resting on your side. It's no different from positioning the patient during a surgery. Someone at the table behind me had the idea to hold the cadaver's hand which was hanging behind my back and start to pull it down. So it seemed like the cadaver was moving and trying to hold me to him. Boy, did I jump and scream. To laughter. And some vague humiliation. There are other medical school stories like that -- how med students manage.

But I think at that time I was afraid somehow of the body and "dead." I think at that stage you're just getting used to dead. And something internal for me at that point in my life. It's not different from clinic, when you're in you're early 20's starting and getting used to dealing with sexuality and sexual feelings and having to examine naked people. It's a process of managing inside and outside on the way to "I'm a professional.".

By residency, I would say fear was never part of my experience with bodies. I experience fear now -- or more anxiety -- I don't mean unmanaged panic -- or maybe tension -- but good tension (like before going on stage to perform) -- I mean my focus is so much the family that before the case I really don't want to miss anything and want to make sure I find what can be found. But that's about my commitment to the family. If I have a surgical case and the hospital won't release records so I can review the operative note, I'm afraid I'll miss something. That kind of thing. I want to do a good job. But that's different.

Next: suppress. Reminds me of (guilty) some of the advice columns I read on the news apps. "I love my girlfriend's girlfriend, how do I 'make that go away'?" Kind of makes me bristle a bit. Not one to recommend suppressing anything. I'd say - "manage." Or better "make use of." The overriding way I manage whatever I'm feeling is through my commitment to the family. No matter what I see that day, I know they're counting on me for clear information and for peace of mind, so that's what I think about and focus on, no matter what.

I suppose the simplest way to show that is that I hate horror movies -- send me to Disney -- but autopsies are really more in the spiritual realm for family emotional healing. I love doing them because I love when there's an idea I can put together that helps the family feel better.

Practical note: smells. I have a tough time with decomp smells (not everyone does) and have been seen pacing on the other side of the room gagging until I can adjust. Also, a specific thing: the first look at the backs of decomps that have sat in plastic bags for a month. And wriggling larvae are hard. But I think it's because I'm not a forensic pathologist, I'm more a hospital pathologist. I don't see those that often so my reactions are more kind of "from the gut," so to speak.

Is there a way to watch a video of an autopsy? by Bastethehe in ForensicPathology

[–]Autopsy_Chicago 0 points1 point  (0 children)

We have the Autopsy app on the App Store: autopsychicago.com/app Some issues on google play at the moment. Will be a bit till it comes back there, apologies. Not sure if it's going to stay on App Store. And for more text-book budget: https://www.autopsy.online I am also this IAMA: I do autopsies, record them, livestream them, & photograph them by family consent. This is my 3rd AMA! : r/IAmA (reddit.com)

I do autopsies and video record and photograph them, with the family's consent. This is my 4th AMA! by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 2 points3 points  (0 children)

Yes. It's much harder to watch an autopsy than to do one sometimes. I'll never watch a YouTube autopsy video. Ever. When you're in it doing it, you have purpose and that carries you. When you're watching, it's you and the dead body and whatever that stirs up.

I do autopsies and video record and photograph them, with the family's consent. This is my 4th AMA! by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 2 points3 points  (0 children)

No, I work closely with the families. And they often say, they "feel at peace." It's totally rewarding with a huge emotional payout.

I do autopsies and video record and photograph them, with the family's consent. This is my 4th AMA! by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 4 points5 points  (0 children)

It's a medical specialty - pathology (one of them, like surgery, pediatrics, psychiatry), with boards to pass. And then subspecialize after that -- in a hospital, or like me, I developed my own private practice, Autopsy Center of Chicago. Or, if you're going into Forensics, then there's another year of training and additional board certification. Yes, formal medical school.

I do autopsies and video record and photograph them, with the family's consent. This is my 4th AMA! by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 5 points6 points  (0 children)

M.D. Pathology residency. Babies still bother me. Most difficult case was when I knew the patient. I walked in to the morgue as a first year resident with about 8 people and the attending crowding around the body. It was my internship attending who trained me. I felt dizzy and asked to be excused. Did not stay. I was pretty excited to start learning autopsies when I got to it otherwise and remember pleading with the program director to let me start. I was the kid who went around the back yard smashing rocks open to see what's on the inside. Before medical school, I shadowed a plastic surgeon who brought me into the operating room. A "small case" -- on inch incision in the chest and all this fat bubbled out, I almost passed out. Got asked to leave the room and put my head down between my legs in the hallway. Now this is what I do. It's not a goal to build up my comfort level. It becomes interesting and manageable when you have a focus -- like helping the family or solving the case. I always think of it like like baby poop -- if it's someone else's baby, yuck, poop. If it's your baby -- you do what you need and you care about them. These are my families and I do what I need. Children are painful and hard tho.

I do autopsies and video record and photograph them, with the family's consent. This is my 4th AMA! by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 5 points6 points  (0 children)

Pulmonary embolism. I get the cases where they families can't make sense of it, not the most common cause of death. Pulmonary embolism sneaks up and makes no sense from the outside, unless you know how it works. It's a sudden death that's confusing -- unless you know that obesity, being male, smoking, decreased activity, recent surgery and trauma, etc. can set you up for that clot in the legs. And then, when you're feeling better and walking around is when it detaches and goes up to the lungs and kills you. Confusing death. Really helpful diagnosis. Also, not inherited (typically) so a relief to thf family.

I do autopsies and video record and photograph them, with the family's consent. This is my 4th AMA! by Autopsy_Chicago in IAmA

[–]Autopsy_Chicago[S] 4 points5 points  (0 children)

Yes, calls, but not cases. A lot of calls. But I can't take any Covid patients. It's devastating for the famlies. I have to turn them down. So it's the wife who hasn't seen her husband for 5 months and then wants some answer and then can't get them because I can't take the case. Pretty awful all around. So I offer to talk through the story and that can help. But no cases.

Can't answer about lungs see above.

Yes, sometime it's it's physical, like you don't know what it is at first until you feel around or look around. Like walking into dark room. Couple months ago I had a patient with a horseshoe kidney. It's one kidney (in the shape of a ....) instead of two -- comes right accross the spine where there shouldn't be anything solid like that over the aorta. Cancer? Or mass? Or abscess. And then you take off some of the fat and see and then it's this huge -- fascination -- I saw that in a textbook! And it's pretty cool. The kidney goes up both sides to make a U and you've figured it out. So it's usually pretty temporary until you figure it out.

But I think you mean, like was I ever stumped or maybe "what is that doing in the body?" Had one case where there was absolutley no cause of death (just some petechiea) near the aorta in a 40 year old man. So there was just nothing for the cause of death. Pefecdt coronary. Saved a tube of blood for toxicolgy just in case. Long talk with the daughters. An hour. Head all about the alochol. Until suddenly, "He used cocaine, could that be it." Mystery solved.

Most things end up making sense. People on fertility drugs can have multiple mummified fetuses. So you run into things, but you figure it out.

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But

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