I’ll start this post with a big thank you. Thank you to everyone recently for your support, and in fact, a huge thanks to everyone for all your love and kindness in what is now pretty much a year since this all kicked off and the world changed. I remember being really tired of the word unprecedented when the first wave and lockdown happened. Absolutely everything was unprecedented, to the point where that in itself was ‘precedented’. Very recently, and by that I mean the last three days, I have had some really lovely poeple reach out and ask me if I’m okay, which can only mean I have been unknowingly outwardly showing some kind of signs that I am not. Truth be told, I don’t know how I am feeling but I do know I will be okay. I’m known for being very open about my feelings on here, but it’s very hard to be open about something I don’t fully understand myself quite yet. I need to take a while to process the things I’ve done, seen and experienced in the past year while things seem to be getting better. While I might seem quite cynical too, I do hope so very much that things are actually getting better.
With the slow shifts back to pre-pandemic normality in some areas of life, it feels like a good time to start exploring some different aspects of my work again. My brain is letting me think about some different areas too which is great! Within our post-mortem work, sometimes as APTs we can figure out how someone died as soon as we begin the evisceration or while we are carrying it out. As I improve and hone my skills, I am getting better at noticing these things and being able to point them out to the pathologists we work with. We often come across what are known as ‘catastrophic events’, those which will kill someone quickly and, are the clear cause of death. These events fascinate me, and there is something that feels like privilege in being the person to discover what happened. This feeling has influenced me to think about starting a new series in the different causes of death we can recognise and what they might look like. Here’s a taster of the kind of things I’ll cover, be sure to let me know if this is the kind of thing you would be interested in reading.
After the initial incision we remove the individual’s sternum using rib shears, we then from this expose both the lungs and the heart nestled in between the two. The heart sits inside a sac made of double walled fibrous tissue known as the pericardium which usually contains a little bit of fluid. This fluid acts as lubricant so the heart can move freely inside to happily push blood around the body. Sometimes the heart can become adhered to the pericardium in places but this would not generally cause many issues. However, also sometimes we might notice that the pericardium to look at is very blue or purple in colour. This occurs when the pericardium has filled with blood, the blood forms what is known as a cardiac tamponade which eventually forms pressure on the heart and prevents it from beating. One resource I found said to think of tamponade in relation to the word tampon, something that prevents blood from moving and collects it. It is the tamponade and the blood loss caused by this event which kills the person, while this can be survived in some circumstances, the extent of these that we see in the post-mortem room are very fast events leading ultimately to death. At my mortuary, and I’m sure many others, we can call these HPs for short or sometimes ‘blue bags’ which is very much a say-what-you-see kind of term.
There are a few causes of this condition which are noted. Generally we tend to see that the reason this happens is due to a a dissection, a kind of rip or tear, of the aorta (main artery) close to where it leaves the heart to take oxygenated blood around the body. Even a very small tear can cause blood to escape the aorta into the pericardium. If the aorta was to dissect at any other place, this would be an aneurysm which is another catastrophic event I will explore in a future blog post. Other causes can be an error in anticoagulent medication or any kind of chest trauma which could cause the tamponade, including the insertion of cardiac device wires. I often like to think of the circulatory system as a kind of intricate plumbing system, events like this are where the plumbing has gone very wrong.
In terms of analysis for the pathologist, the tamponade would be removed from the pericardium and measured. Usually the amount of blood in the case of clotted blood can be measured in a jug in millilitres or weighed and measured in grams. They would also locate the point of the aorta where the dissection is a describe this alongside measure it. Generally, the pathologist would continue the post-mortem examination and look at the other organs for thoroughness but sometimes they may decide to ask us not to open the skull of the person and remove the brain as they already know what has caused the death.
The reason why I kicked off this with the HP is that it is one of my favorite things to see and unofficially diagnose for no particular reason whatsoever. I hope you have found it as interesting as I have. The more I think about the next series, I wonder if covering some common causes of death and what they look like anatomy-wise might be a good idea. I will be sure to have a think about what direction to take this in!
For now, thank you for reading and get in touch if you have any requests or feedback. I’ll be sure to spend the next week trying to get back into some kind of bearable headspace.