Off North Road

"A little bit of immortality"

By Russell Hoxsie - February 23, 2006

The phone rang at 10 pm in our one-room basement apartment off Central Park on West 89th Street. At $50 a month, it was a steal and we overlooked the unlocked front door swinging in the breeze and the odd persons in and out of rooms on the upper floors of the old brownstone. I was a second-year medical student at Cornell in 1949 and this particular week I had received notice that I was in line to observe the next autopsy at New York Hospital. I waited with apprehension, recalling my near-faint after the single other autopsy I had observed while in the Army. A soldier in that instance had fractured his neck in a trampoline accident. Each evening when we went to bed my bride of only a few months would wonder if we would get the call that night as if she were to don a white coat and accompany me. I had seen three other dead persons in my life: a teen-ager sprawled on a river bank where he had been pulled from the water after a lethal dive off a nearby bridge; my grandfather in his casket at a funeral parlor; and my next-door neighbor, not much older than I during high school, who died of sewer gas inhalation while working down a man-hole. The undertaker had arranged him suitably dressed on his living room sofa at home. My girlfriend and I whisked through the front hall past the casket to the kitchen where an active wake progressed. We left as early as courtesy permitted.

As far as my 10 o 'clock call, I suspected this was additional training for rising at night no matter how tired to attend medical business. Sleep in the eyes, I kissed my wife another good-night and hailed a cab for the East Side pathology lab. Everything seemed too bright in the morgue: white walls and lights, spotless floor, and gleaming stainless steel cabinets and equipment. The atmosphere was eerie, quiet, restrained. Only one physician, his assistant, another student and I waited for the "post" (short for post-mortem) to get started. I don't remember any conversation. Perhaps everyone was sleepy.

When the patient's attending physician entered, the pathologist at the table began. It is hard for me to recall the exact feelings I had at the time. I'm sure they were centered inward toward me as much as for the procedure at the table. Frankly, I had no interest in learning the techniques of performing autopsies, but, of course, I had seen the patient in life for a few weeks, knew something of his illness and suffering. I awaited the end of this evening with great interest; especially, would I escape fainting? The large "Y"-shaped incision made from shoulders to abdomen to pelvis was a critical moment. Of course I had lived with my cadaver, Joe, in anatomy lab for weeks on end the previous year, but this was different: moist, glistening, soft, bright with color and, of course, only recently sentient. Importantly for me this time, I was OK. The doctor moved with precision, removing organs one by one, which I think was a surprise. Somehow I had not anticipated this in quite the way it happened, more like a butcher's shop, each piece of my patient removed, weighed and stowed in a metal or glass pan nearby. Talk was routine and brisk. The prosector, the physician actually performing the "post," dictated his findings as he went along and pointed them out to those of us observing: the enlarged liver and spleen, many swollen lymph glands in the back of the abdomen and in the central cavity of the chest. The blood, which was constantly suctioned away from the cavity and flowed down the gutters of the table into buckets below, was paler than in healthy life. And the smell was something I would forever after associate with the autopsy room, even death itself. It was not the horrible stench of decomposition but simply the inevitable marker of extinguished life.

The decedent was a large man in his 60s who had died that evening after a long fight with lymphatic cancer, specifically lymphosarcoma. Newly minted chemotherapy of the 1940s had prolonged his life a bit, but I could not testify to an improvement in its quality. As it happened, the autopsy was an anti-climax. Studies during his illness had documented with accuracy his condition. No surprises jumped out (except for the weighing of organs). Review of the microscopic slides prepared later from tissues removed from the body revealed an uninteresting, if not boring, uniformity in wide sheets of dark-centered white blood cells, perverted lymphocytes infiltrating nearly every organ. In health they fought infection and promoted wellness; in this case they had turned deadly.

As I reviewed my patient's clinical record for the last time during the next week I realized I had entered a confusing jungle, these lymphatic cancers called lymphoma. Some killed quickly and others lived inhospitably with its victim for years. However most would kill. My patient's life had probably been prolonged a bit - not without a downside, I thought - but therein lay the hope that future chemotherapy would eventually dominate this form of cancer. My patient became one of the uncountable cogs in the wheel of research progress which now promises cure for some and worthy palliation for many. The fight goes on.

In a later column I will share some acquaintance with "The Curious Lives of Human Cadavers," the subtitle of an incredibly well researched and readable book entitled simply "Stiff," by Mary Roach. She writes with as light a touch as one can, considering the morbid subject she pursues, while preserving dignity, even reverence, for the individual in his "little bit of immortality."