Maybe you were one of the 11.7 million people who watched when, on House M.D., the genius diagnostician Gregory House is roused in the middle of the night by a pounding at the door. A man he just gave a clean bill of health has collapsed and died. House and his colleague Eric Foreman decide to perform an autopsy themselves. Eager to see the man’s heart, House pushes Foreman to plunge a whirring saw into the patient’s sternum. They peer down: Blood seems to be trickling from the wound. “That’s odd,” says Foreman, “almost looks like he’s … bleeding?” There’s a beat. Then the man’s eyes open wide and he screams.
If you missed this particular episode, you’ve surely seen something similar. Autopsies play a starring role on CSI, Bones, and many other prime-time dramas about medicine and forensics. They may very well be the medical procedure that Americans have been most exposed to via their screens, and yet among the most misunderstood. The way these shows depict autopsies is so disastrously wrong that they not only discourage families from opting into these vital procedures; they even diminish doctors’ understanding of how autopsies work.
On television, autopsies happen in dark rooms with blue light. They involve scalpels, bone saws. Jaded techs in lab coats discuss ligature marks and defensive wounds. Doctors frown at something mysterious and disturbing. Many (but not all) of the pathologists performing autopsies are maladjusted weirdos; the nonspecialist doctors, like House, do things that would cause them to lose their medical license. In one episode of Grey’s Anatomy, Sandra Oh’s and Katherine Heigl’s characters carry out an autopsy in direct contravention of the patient and family’s orders, which is, need I say, illegal; in another, the autopsy pathologist callously chews gum and makes a dinner reservation while cutting. In just about every single episode of CSI, techs wearing no protective equipment whatsoever stand in rooms lit like dive bars, feeding slivers of human tissue into machines that whir briefly and spit out a neat list of every foreign substance in the body.
Most Americans will never see a real autopsy, so our impressions of them are formed by TV portrayals. That’s how it was for me, until I spent two weeks observing autopsies in a hospital in Pittsburgh as part of research for a novel. In real life, autopsies are performed in brightly lit rooms. (Forensic autopsies must sometimes be completed in the field if, for example, a body cannot be safely moved.) The autopsist begins with a Y-shaped incision into the sternum and works methodically through the body. Sometimes the internal organs are inspected in situ, but more typically they are removed, washed down, and dissected on a water table. The autopsist doesn’t just pick up an organ, look at it, make a diagnosis, and plop it back in; rather, they catalog as many of the body’s pathologies as possible, whether or not they’re suspected of causing death. They also take care to make sure that none of the evidence of this inspection would be visible in an open-casket funeral. It’s slow, comprehensive work that rarely involves fancy electronics.
By Samuel Ashworth
Perhaps the most subtly ridiculous aspect of TV autopsies is the lack of personal protective equipment. In real autopsies, the people involved wear head-to-toe PPE—surgical scrubs, armguards, booties, an apron, a face mask, a splash shield, and a cap—because, when you open a human body up, all the blood, bile, and other fluids that a person had in life are still in there. Blood can still ooze from a wound, even when it’s not being pumped through the body. Did the writers of that House M.D. episode think the human body spontaneously exsanguinates when the heart stops?
Errors like these in TV depictions reduce autopsies to ghoulish spectacles, when the procedure is in fact a respectful and uniquely useful tool for understanding how a person lived and died. Families might decline an autopsy for a number of reasons: cultural taboos, simple squeamishness, a sense that the decedent has suffered enough, a desire to take possession of the body right away. But a death need not reach some threshold of suspicion or mystery to merit investigation; many teaching hospitals, where residents might observe autopsies to deepen their understanding of anatomy, will perform an autopsy for free on any patient if the family asks. Anyone can get one, and more people should.
Autopsies, even in cases where death was expected, can serve a real purpose to the living. They help present a full narrative of disease, which can help doctors treat other patients and—if communicated well—allow grieving families to move toward acceptance. Autopsies can catch hereditary illnesses that doctors tend to miss, such as signet-ring-cell carcinomas, and reveal causes of dementia that may have been misdiagnosed as Alzheimer’s. Even in suicides, where the cause of death is usually obvious, autopsies can reveal underlying problems that might have contributed to the deceased’s distress.
Despite how useful autopsies are, they have become an endangered species. In one survey conducted at Massachusetts General Hospital in the mid-2000s, residents overwhelmingly said they had never watched an autopsy, much less performed one. And doctors aren’t always comfortable discussing them with patients’ families. Autopsy rates more than halved from 1972 to 2007, plunging to a measly 8.3 percent. In many other countries, the rate is even lower.
Not all hospitals provide autopsy services; in many of those that do, asking the family of a deceased patient whether they would like an autopsy falls to residents, many of whom lack the training to properly describe and clarify the process. In that moment, there’s little to stop the grieving family from calling up all the lurid images they’ve likely seen on TV. Take, for example, a 2020 episode of The Good Doctor literally called “Autopsy.” Shaun Murphy is operating on an ER patient, an unhoused Jane Doe, when her carotid artery “blows out” and she bleeds to death in a matter of seconds. Over the next 40 minutes of screen time, the following things happen:
The hospital denies Murphy permission to do an autopsy. (Apparently, arteries explode every day.) So he tracks down the woman’s estranged son, who also denies him, inspiring Murphy to attack the man’s car, shrieking at him. Nonetheless, the head of pathology (who just broke up with Murphy) allows him to do the procedure. He conducts the autopsy himself, in a dark room and wearing no PPE beyond a cute little apron, while the pathologist stands indulgently behind him. He plucks out the woman’s liver and regards it briefly, then puts it back and exits, without sewing her up or taking a tissue sample. Finally, he shows up at the son’s house to say that his mother had Ehlers-Danlos syndrome, which is hereditary, and that the son must get treatment. All is forgiven.
This is an episode that makes a case for autopsies. The only remotely realistic thing about the episode is the son’s reluctance to consent. And after watching that gruesome exercise, would you?
On these shows, the stark truth of a dead body is either milked for shock factor or smoothed over with holograms. Each chemical in a person’s body can be identified with a machine, and each story has a satisfying ending. Everyone knows life isn’t like that. We need to accept that death isn’t, either.
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