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Wed Mar 28 15:21:25 BST 2007

Pret

Not true regarding craniotomy - most autopsie techniques strip the scalp from the rear of the head and therefore the face is mostly intact. The craniotomy is done and the brain removed, but the calvarium is usually replaced, so when the skin is closed the face looks surprisingly  normal.

As far as getting consent for an autopsy goes, try explaining to the family that it will help all concerned to understand how and why the loved one died, rather than to just to clear the Hospital of error or wrong-doing. I am in the fortunate position of a national rule of all unnatural deaths getting a "police-PM", with the Medical Schools providing specialist-forensic pathologists to do the autopsies together with the CSI's

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Bjorn, Pret
Sent: Wednesday, March 28, 2007 2:14 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Autopsy Requests: Scripting & Best Practices

Thanks for this.  Very heartfelt, and obviously aimed precisely at my
concerns.  I like your ideas, except that I think "non-invasive" is
counterfactual.  And in the limited cases where craniotomy is involved,
open caskets might be more difficult - or at least more expensive.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Paula Bailey
Sent: Tuesday, March 27, 2007 8:41 PM
To: trauma-list at trauma.org
Subject: RE: Autopsy Requests: Scripting & Best Practices

When I was young I lost my mother.  I was not in the medical field at
the time, neither was anyone in my family.  An autopsy was performed on
her.  We were told by a friend that my mother was chopped into parts in
order to do the autopsy.  My father and I were horrified!  Needless to
say when the doctor called us a week later to ask how my father was
doing, he was shocked to hear that my father didn't want to talk to him.

He (the doctor) was kind, soft spoken, and eloquent.  He told me (before
I even let him talk to my father) that we were completely mistaken, that
my mother was wholly intact and could have had an open casket (we had
her cremated because of our misunderstanding).  

My point is this: people who do not understand are afraid.  

If you could gently counsel the family, explaining that it will give
them closure and not make their loved one any more hurt than they
already are (I know, it's silly, but I kept telling myself "Mom, I'm
sorry but they said they had to give you this autopsy").  It's hard to
"let go".  

Maybe if you had a paper explaining what an autopsy actually involved
might help.  Key phrases?  Non-invasive, helpful in getting closure,
depending on the trauma, of course, the person would be capable of an
open casket?  Just those simple words would have given us so much help
and understanding.  

Regards.  Paula

________________________________

From: "thomas konig" <tomkonig at hotmail.com>
Reply-To: "Trauma &amp; Critical Care mailing list"
<trauma-list at trauma.org>
To: trauma-list at trauma.org
Subject: RE: Autopsy Requests: Scripting & Best Practices
Date: Tue, 27 Mar 2007 13:38:14 +0000
Does anyone use Post mortem CT? This is a possible way around the
problem.
Tom

>From: Clive Leach <clive at cdleach.wanadoo.co.uk>
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: Trauma &amp Critical Care mailing list <trauma-list at trauma.org>
>Subject: RE: Autopsy Requests: Scripting & Best Practices
>Date: Tue, 27 Mar 2007 01:02:03 +0200 (CEST)
>
>hi
>here in england if anyone dies suddenly and it is unexpected a post 
>mortem is peformed .. this has been the norm for many years and since 
>a certain dr shipman murdered so many a few years back it is even 
>more important now.
>regards clive
>
>
>
>
>
>========================================
>Message Received: Mar 26 2007, 01:01 PM
>From: "Bjorn, Pret"
>To: "Trauma & Critical Care mailing list"
>Cc:
>Subject: Autopsy Requests: Scripting & Best Practices
>
>Maine is a state like many in the U.S. WITHOUT mandatory autopsy for
>trauma deaths -- there simply isn't the money for it. As such, 
>deaths
>are referred to local Medical Examiners (mostly general medicine 
>folk),
>who have a look at the record and the corpse and determine whether a
>necropsy would help -- for lack of another motivation -- to 
>determine
>foul play. In short, if you can make it look like accidental
>blunt-force injury, you can probably get away with murder around 
>here.
>
>My hospital provides autopsy (gross post mortem only) for trauma 
>deaths
>where the cause is unknown, or when performance issues are in play.
>Problem is, these are voluntary and subject to consent of the 
>family.
>Getting consent is a neat trick, though. I wonder if anyone out 
>there
>is in the same boat, and suffers varying responses from loved ones 
>to
>the option of autopsy.
>
>Specifically, I'd be very grateful for any advice on how to present 
>the
>issue to families in the most productive manner possible. Is there 
>any
>winning script, or are there key phrases that maybe we haven't 
>thought
>of?
>
>I think our surgeons are very sensitive and encouraging, and quick 
>to
>point out that the service is underwritten by the hospital (should 
>be
>obvious to families, but isn't); but there's a predictable visceral
>reaction to the request that we haven't been able to overcome.
>
>Thanks for your thoughts and advice.
>
>Pret Bjorn, RN
>Bangor, ME USA
>
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>trauma-list : TRAUMA.ORG
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>
>
>
>
>Regards Clive
>--
>trauma-list : TRAUMA.ORG
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