Working with Dr. Schweitzer

Chapter 11. The Autopsy

By Louise Jilek-Aall, M.D.
Since the essential nature of the spiritual is truth, every new truth means ultimately something won.

(Albert Schweitzer, My Life and Thought p. 65)

We stood around the bed of a dying woman. The loud sobbing of the grief-stricken relatives added to our feeling of helplessness and disappointment. We all had come to know and like this gentle young woman. The large crowd of relatives and friends who had accompanied her from their remote village testified to her popularity. She was unusually tall and heavy. Apart from a feeling of extreme fatigue, which had incapacitated her for a few weeks, there were no symptoms of grave illness. Blood-chemistry tests, however, were abnormal in a peculiar way. Before we had time to investigate further, the unknown illness turned out to be fatal.

On this morning, the friendly patient had thanked us warmly for all our efforts to save her life, and then she had closed her eyes, never to open them again. Sadly, we saw her part while we patiently endured the scorn of the mourning relatives. As usual when things went wrong, the Africans suspected we had not really wanted to help.

Albert Schweitzer joined us at the bedside and, seeing our distress, the old doctor tried to ease our feeling of failure. He told us that he had never seen a case of this illness before. We would still have to look for an answer to what had killed the young woman. We discussed it with him and came to the conclusion that an autopsy was unavoidable. Dr. Schweitzer had good connections with a medical laboratory in Europe, where he could send tissue samples for analysis. I did not think that it was of much use, since, due to the tropical heat where decay sets in immediately, and the long journey, the tissues were often too damaged to render any positive results.

This decision placed a heavy burden upon us. It would take hours of skillful negotiation with the reluctant relatives to get their permission for autopsy; and who was going to take upon himself the unpleasant task of performing the autopsy? I looked at the strained and fatigued faces around me and saw my colleagues recoil at the thought. I recalled the pathology theater at the university where the professor used to demonstrate autopsy techniques and felt confident that I would be able to do it; so I finally volunteered. There was silence; Albert Schweitzer looked at me searchingly.

“You are the youngest among us,” he said. “To perform an autopsy here in the tropics is not the same as doing it in the morgue of a European hospital. Are you sure you have the strength to do it?”

Lightheartedly and with a certain pride, I assured him that I was prepared. The others thanked me with relief and returned to their daily duties. Albert Schweitzer asked his trusted African helper, Joseph, to assist me, as he had assisted him on many occasions before.

It took the whole day and part of the next and finally strong persuasion by Albert Schweitzer himself, before the relatives gave in and allowed the autopsy to be performed. In their view, it was a repulsive violation of the dead. The corpse was then brought to a small hut that had been specially built for this purpose at a safe distance from the hospital. The relatives and friends of the deceased had gathered outside the hut when Joseph and I arrived in the early afternoon. Women were sobbing, children were crying, and the men muttered unfriendly words as I passed through the crowd. I was quite ill at ease when I entered the hut.

The body had been placed on a narrow, metal table. Bottles with formaline for the organ samples, a pair of surgical gloves, a scalpel, and a few other instruments were ready. The distended corpse of the fat woman towered like a mountain in front of my eyes. It is always a frightening experience to touch a corpse; how much more to operate on it! With the wailing crowd outside, a helper even more frightened than myself, and the vivid image of the living patient still in my mind, it seemed like a formidable task. My hands began to shake as I approached the table and put on the gloves. Sweat trickled down my back, but I forced myself to pick up the scalpel. I had promised to do it, so I had better get started.

Holding it firmly, I pressed the scalpel against the skin and drew the classic incision line from the chin, over the chest, around the umbilicus, and down the abdomen to the pubic region. In the sweltering heat of the tropical sun, decay had already set in and as soon as I opened the abdomen, a well of stinking fluid gushed out and a horrendous stench filled the little room. This putrid wave hit me like a solid thing and filled me with a sudden panic which I felt I could not control. Half-dazed, I put my hands inside the open abdomen. Grubbing around in the mess, I was unable to recognize any of the organs. This was Death in its most brutal manifestation, and my whole being protested against what I had to do. My work was with living human beings -- to prevent death. Once life was gone, I should not have to be involved.

Fear grips the heart at the smell of death; an instinct tells one to run away. My heart was pounding, cold sweat burned in my eyes, and a new wave of panic seized me as some of the foul liquid seeped into my glove. I knew that if I had the slightest lesion on that hand, it might be lethal. Quickly, I withdrew the hand.

The sun was shining mercilessly on the tin roof of the windowless little hut, making the heat unbearable. A wave of nausea turned my stomach; I was ready to give up. As I went to the door, the lamenting cries of the people outside reached my ear and I hesitated. What would they think and what might they do if I opened the door and they could see the woman's body cut open like that? They would feel that I had murdered her all over again. I could not possibly quit now. Had I not boasted in front of Albert Schweitzer and the others that I could do this autopsy? Was my fear stronger than my will?

Nothing had gone wrong as yet, but if I did not hurry up, the suffocating heat and stench would certainly make me faint, and then everything would go wrong. I tried to pull myself together and to think clearly so that I could plan my action; but the panic which had gripped me so fiercely would not let go. Slowly I was drifting into a dream-like state.

Then it was as if one part of my mind had become a slave driver and my will became his whip; my hands were the slaves that could be ordered around. My movements became deliberately slow as the slave driver angrily urged the “slaves” to search for the scalpel--which I had lost among the intestines. There was no necessity to do a full autopsy, the slave driver decided; we only needed a small piece of the liver, the kidney, the heart, and the lungs. Of course the slave driver was obeyed and the liver found; here it was! Now he ordered my hands to cut off a piece and to put the bloody tissue into one of the bottles with formaline.

Mechanically my hands returned into the cavity. The fumbling slaves were whipped around mercilessly in the dark until they hit upon something hard: a kidney. They were ordered to cut it free so they could get hold of the particular part needed for the sample. That, too, landed safely in a bottle. The piece of lung tissue created no problems, although I, myself, was hardly aware of what the hands were doing.

The room did not seem to exist anymore; I did not seem to hear, see, or smell anything at all. The slave driver lifted his whip; what about the heart? A few courageous cuts and it, too, was lifted from the bloody cavity.

I stared at the magnificent organ: Strange it is to hold a human heart in one's hands! I too have a heart, I feel it throbbing right down to the tips of my fingers. Yesterday this cold and silent heart now in my hands had also been warm and beating. ‘Forgive me, sister, for touching your heart. I have to molest it for the sake of....’ Oh well, I do not remember why, but my mind commends my hands to cut into this architectural masterpiece. ‘Sister, I open your heart with reverence!’ Like the marble columns of a gothic cathedral, the tendon chords arch into the bloody cavity. I see the strong bundles of muscles boldly modeling the hollow of the chambers. In splendid harmony, they twine together, forming the apex of the heart. They lend strength and endurance to the pump that must never stop as long as life is to reside in the body.

A deep sigh and a cough from my helper Joseph suddenly brought me back to reality. Quickly placing a piece of the heart into the waiting formaline, I stepped aside. The awareness of the heat and the stench hit me again with full force. I gasped and made a sign for Joseph to take over. It was his job to sew up the body. To my dismay, I saw him drop the heart into the abdomen and the kidney into the chest. But I swallowed my protest; surely the Creator would forgive our human shortcomings and the relatives would never know.

I waited impatiently for Joseph to finish; it seemed an eternity before he had stitched up the body, washed, and wrapped it in a blanket. As soon as my full concentration and willpower were not needed anymore, my strength drained away. With one last effort, I pulled off the slimy gloves. Then everything blackened before my eyes; I held on to Joseph. He quickly opened the door and the fresh air from outside helped me muster enough strength to collect myself and face the reproachful countenance of the relatives as we slowly walked away from the scene.

Never before had the air a scent so sweet. I clearly distinguished the aroma of the grass, the flowers, and the trees. A cool breeze gently caressed my burning face. I took a few deep breaths to chase away the stench of death from every last corner of my lungs. How long ago had it been since I had last enjoyed this world of brightness and colors, how immensely rich was the air between heaven and earth. I was again here amidst the seething life, with all its vitality and beauty.

Thoroughly washed and cleaned up but still shaky and pale, I appeared late for the evening meal. Dr. Schweitzer looked at me across the table. “Are you feeling all right?” His voice was worried. “Did it turn out well?”

I looked down at my plate.

“I managed,” was all I could say. I could not tell him about the nightmare I went through in that hut. But I suddenly knew that Dr. Schweitzer's concern and the perfect beauty of the human heart I had held in my hand would help me to overcome the horror of death and decay. I lifted my head and met the old doctor's knowing eyes unflinchingly.

Copyright © 1990 Louise Jilek-Aall
Reprinted with permission

[Previous Chapter]     [Contents]     [Next Chapter]

to top

Internet Mental Health ( copyright © 1995-2011 by Phillip W. Long, M.D.