City of the Dead

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“There are very few amenities observed in the autopsy room, ladies and gentlemen.” Konig stands bathed in a cone of white light at the center of an amphitheater on the ground floor of the University Medical School. The course he is teaching is Forensic Medicine 320. He has taught i now for nearly a quarter of a century to a generation of medical students, most of whom had little altitude or interest in the subject, having had their eyes on more lucrative specializations, and there only because the University made it obligatory for them to be there—at least for a year.

One hundred and fifty youthful, intent faces peer down on Konig now as he whips back, magician-like, the sheet covering the waxen cadaver of a rather handsome middle-aged man.

“Everything is reduced to its most basic and elemental,” Konig continues, “and unlike the diagnostician, who deals in the luxury of hypotheses, the pathologist deals only in final truth. The cause of death is all that is at issue here.” His eyes sweep up and down the length of the cadaver as he speaks, encompassing in one glance a multitude of detail.

“All we know about this pleasant-looking gentleman,” Konig continues, “is that he was forty-five years of age with no prior history of cardiovascular disease. There is no history of hypertension, seizures, or convulsions. He was not diabetic and he was on no medications. He had an annual checkup, the last of which took place three weeks ago, was pronounced fit as a fiddle by his internist, and the last time his wife spoke with him, two days ago, he was in a cheerful frame of mind.” Smiling, Konig gazes around at the bright young faces of his audience, then nods to an assistant. “Well, ladies and gentlemen, I believe we are now ready to begin.”

With a nine-inch-long scalpel, Konig makes three lightning-swift incisions. Two proceeding from each tip of the scapulae, bisecting at a point above the sternum, and from that point plunging straight downward to the pubic symphysis. The three deft slashes form a large letter Y—sort of a cosmic-joke-of-a-Y to denote a man already marked by fatal destiny. Like the Y that stands for YOU.

Several more slashes of his blade and Konig flays open the neck and chest. With bone cutters, he severs the cartilage joining ribs to sternum, tears asunder a series of small clavicle joints, and then, with a queasy ripping sound, yanks away the whole front of the chest. In no more than a minute, the livid, rigored thing on the table has been split apart like a chicken with all its internal organs gleaming brightly there in place like a bowl of fruit.

Blood has begun to seep into the small trenches lining the table and collects there in tepid little pools. Konig swings his scalpel round through the inside of the lower jaw, disconnecting the tongue. He tugs sharply downward on the muscle, releasing the larynx behind it, then pulls it out through the yawning neck. Another stroke severs the gullet and two or three more free the heart and lungs. Next he hauls the whole grisly concatenation of things out, holding them up by the windpipe for all his audience to see—once more the cosmic magician producing rabbits from a hat There’s an audible gasp of admiration and some scattered applause as he drops the whole business into a steel bowl held out to him by an assistant.

The bowl is now held under the tap, the spigot turned on, and while the stream of water is played over the organs, Konig commences his examination of them. He cuts into larynx and tongue in order to detect signs of vomiting or hemorrhage. He rotates the heart in his hand, exposing its chambers, rinsing out the blood, testing each valve for signs of defect. Lastly, he takes a pair of scissors and snips his way up the arteries, searching there for plaque and emboli, as well as in the blood vessels of the heart itself.

“Nothing remarkable here,” he proclaims.

Returning to the body, he proceeds to remove the viscera, examining each organ in the same meticulous fashion. He draws off a sample of gastric contents into a small jar, as well as a sample of urine by merely pressing the bladder. He then turns these over to his assistant. “A little something for the toxicology lab, just in case of foul play.”

A few more deft motions and he has lifted out spleen and liver, sliced them up like a fresh loaf of bread, and dropped sections into several nearby cardboard buckets used for storage and transport of internal organs. “Still looks good,” he cries out.

The steel sink is now nearly full of organs submerged in roseate water. Konig is now ready for the coup de grâce—a single sweep of the blade across the top of the head that opens the scalp from ear to ear. Several additional slashes and the scalp becomes a pair of flaps which he yanks down over the man’s face in much the same way one might pull off a pair of gloves.

With the saw blade he then cuts around the skull slightly above ear level and at last lifts off the calvaria—the skullcap—like the lid of a cookie jar. Gleaming there in the cold white light are the membrane sacs containing the brain. Slashing these open, he then works his rubbered fingers under the frontal lobes of the brain, at last lifting it out, whole and intact, from the base of the skull. It is only a matter of moments until he separates the medulla oblongata from the spinal cord, then lets the entire brain slither into a steel bowl, examining it closely as he sluices water over it from the spigot.

“All appears quite normal, ladies and gentlemen. This is a bit of a riddle,” he announces, although it is really no great riddle to him. The diffuse hemorrhage at the base of the brain has told him all he needs to know. He proceeds to slice the brain into neat sections. “Ah—I beg your pardon. Not so much of a riddle, after all.”

He holds up a section of cortex dripping with blood. “Ruptured saccular aneurysm in the circle of Willis—a blowout, ladies and gentlemen. No more, no less.”

With small knives he carefully dissects out the damaged section of artery at the base of the brain, pointing out the weakness in the wall, a small point of fatal rupture about the size of a pea. “A tiny but lethal flaw in an otherwise very capable machine.” He casts a smiling glance around his audience. “Thus fate makes monkeys of us all.”