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Autopsy and Medicine
June 14, 1999

Case of the Month: The Rest of the Story

Randy Hanzlick, MD; Mario I. Mosunjac, MD; and the Autopsy Committee of the College of American Pathologists
Arch Intern Med. 1999;159(11):1173-1176. doi:10.1001/archinte.159.11.1173

A 78-YEAR-OLD woman with hypertension presented with a gangrenous foot that had kept her from ambulating. During the surgical closure following above-the-knee amputation she developed precipitous hypotension followed by cardiopulmonary arrest and death.

The pathology resident on call to perform autopsies received an authorization to perform an autopsy that had been completed by the patient's physician and the legal next of kin. In the area of the form for notation of restrictions (such as "autopsy to be limited to chest and abdomen only") were the words "please do not disfigure the face." Because the face is almost never disfigured during an autopsy (unless dissection is required in a forensic autopsy for medicolegal purposes or special needs have arisen during a hospital-based autopsy and permission has been granted by the legal custodian of the body), the wording caused the resident to wonder whether the physician understood and conveyed to the next of kin the nature of routine autopsy procedures. A review of other autopsy authorization forms showed that similar wording was common, such as "keep the head intact," "be gentle, would like open-casket funeral," "keep facial features natural," and "be careful to do nice surgical incisions."