By Emma Yasinksi
BU News Service, Spring 2015
It’s a good thing Jim Stone, M.D., pHd., doesn’t like the sunlight. His light, clean-shaven skin is untainted by UV rays. The windows of his office are lined with stacks of thin, white boxes blocking any natural light that might have crept through the opaque, gray blinds. The boxes contain microscope slides with tiny slivers of tissue, obtained from patients of the Massachusetts General Hospital, both dead and alive. The rows of boxes frame him on either side, as he sits in the center of the room, right leg crossed over his left, and politely asks me about the weather.
The Massachusetts General Hospital is one of a few remaining hospitals in the country that still has an autopsy suite, and Stone directs it. Many smaller hospitals, and even some larger, have discontinued their autopsy programs in an effort to cut costs. Stone is proud to say that his hospital currently autopsies 15 percent of patients who die there, three times the estimated national average.
Four decades ago, pathologists autopsied 50-60 percent of the patients who died in hospitals, but the numbers declined because hospitals needed to cut costs, and insurance doesn’t cover dead people. Many hospitals will pass the financial burden ranging from $3000-$5000 on to the patient’s family. Moreover, families don’t always agree to an autopsy. At the Massachusetts General Hospital, the hospital itself funds autopsies. Stone won’t say it, but according to an analysis by Dr. Elizabeth Burton, a visiting professor at Johns Hopkins University, many clinicians fear litigation if an autopsy identifies a misdiagnosis.
As Stone describes the process to me, he uses his finger to demonstrate incisions on his own body. “You cut a ‘Y’ shape” His finger traces diagonally from his left shoulder down to his sternum, then straight down to his belly button. “And peel the skin back.” His hands open toward me like double doors leading me to his organs. His blue-grey eyes widen behind his thin-framed glasses. “Then you cut the ribs, and take off the chest plate.”
While many hospitals have discontinued their autopsy programs, the one at Massachusetts General Hospital has been growing since Stone took over. Doctors come from around the world to watch and learn from the autopsies done here. Beyond searching for cause of death, doctors use the autopsies to research ways to improve cancer treatments. By conducting several biopsies while the patient is living, then finally an autopsy upon death, pathologists are able to sequence genes in tumor cells, and begin to see exactly what changes within the cells make them resistant to drugs. They also evaluate whether all the tumor cells throughout the body have mutated, or just the ones in certain areas.
The most exciting autopsies are those ones that identify a misdiagnosis, or an unidentified complication of treatment, Stone told me. These discrepancies show up in about 18 percent of autopsies.
As we walked across the hospital, Stone’s gray collared shirt blended in with the painted-gray cement brick walls. Finally, he opened a weathered wooden door that revealed a staircase surrounded by dark, red bricks. We descended through a silent hallway to the morgue. The center of the room holds two L-shaped, metal tables. Half of each table is visible, and pierced with holes, about two inches in diameter. That’s where pathologists lay the body, so the fluids can drain. The other half of each table is covered in labmats, absorbent sheets nestled to create a soft-looking bed of blankets. “This is where you put the block of organs when you remove it from the body.” Stone said.
On the right side of the room, next to the metal sink, are stacks of small, white plastic buckets labeled, “Lung,” “kidney,” “lung.” Behind them, a giant post-it note on the wall listing the names of organs, each associated with a different number. “spleen-54R, 51L,”thyroid-L7, R8.” Stone explained that he can tell a lot about a person’s state of health by weighing his or her organs. Sometimes young people will die without a clear cause. For example, if their heart is heavier than a normal teenager’s, the doctor can deduce that the individual died of Hypertrophic Cardiomyopathy, a disorder characterized by thickening of the heart muscle, which leads to sudden death in teenagers and twenty-somethings.
After retracing our steps through the maze of white, tile floors, Dr. Stone shakes my hand and wishes me luck, leaving me outside of his office. I wander across the street to Starbucks to collect my thoughts. As I sip my decaffeinated mocha latte,I feel a little extra grateful for its warmth today.