The autopsy is the moment of truth for all medical care and the time of reckoning to improve the care of the patient... It becomes a stimulus and incentive for better care and increases both empathy and science in medicine... It crystallizes errors, exposes abuses, and points out fads and fancies.
—Alfred A. Angrist, Bulletin of the New York Academy of Medicine, 1971.

AIDS . . . Legionnaires’ disease . . . toxic-shock syndrome . . . lung cancer from secondhand smoke . . . child-abuse syndrome . . . viral hepatitis . . . the Tylenol poisonings . . . mitral valve prolapse. What do these conditions have in common? They’re all included on a long list of afflictions discovered or explained by autopsies.

Thinking about death and autopsy is not high on most people’s lists of things to do. Most of us, in fact, avoid this topic at all costs—until we are confronted with the issue after the death of someone close to us.

When loved ones pass away, should we, or should we not, allow them to undergo autopsies after they are no longer able to make their own choices? What is the purpose of the procedure, and does it benefit the survivors? Who pays for it? Will funeral plans have to be delayed or altered, and can the body still be viewed?

These are questions that many people will have to answer, yet most of us—even those who work in hospital environments—don’t understand or are misinformed about this physician-performed, surgical procedure that has greatly enhanced medical knowledge, as well as given tremendous comfort to grieving—and sometimes frightened—families.

Many medical students today go through their entire training without ever observing or participating in an autopsy procedure. This is not the case at UAB. According to pathologist C. Bruce Alexander, M.D., director of the autopsy service at UAB, medical students begin their careers as students of disease—a study for which autopsies are invaluable tools. "A cause of death can be confirmed in 95 percent of autopsies," he explains. That figure alone may not sound particularly impressive—that is, after all, the goal of most autopsies. But fully 40 percent of the autopsies performed in the United States reveal major, unexpected findings that may have contributed to the death of patients.

"In order to wage the best fight against any disease, you have to answer five main questions," says Alexander. "You have to determine the diagnosis, the cause of the disease that has been diagnosed, the extent and severity of the disease, the prognosis of the illness, and whatever treatments may exist." But there are times when one or more of those questions cannot be answered based on medical tests alone. In those cases, Alexander says, an autopsy greatly increases the chances of answering these questions.

As an example, Alexander cites the poignant case of a man whose death was thought to have been caused by Huntington’s Chorea, which the children assumed they would inherit from him. At autopsy, it was discovered that he died of a myocardial infarction; his brain atrophy, thought during his life to be caused by Huntington’s, was actually caused by hypertension. His two daughters were ecstatic to hear this news, as they had both recently married and wanted to have children—a dream they both had forsaken for fear of passing along this terrible disease of the central nervous system.

At UAB, autopsies are performed at no cost to the family; families of patients outside UAB may request that an autopsy be done here for a fee. County medical examiners in Jefferson and Mobile Counties, as well as elected lay coroners in other Alabama counties, have the authority to decide whether or not an autopsy should be conducted in cases of sudden, unexpected, violent, or unnatural deaths—those caused by falling, automobile accidents, shootings and stabbings, and suicide, for example. Often, though, it is the deceased’s family who requests an autopsy.

A new postmortem facility at UAB—which includes offices, conference and demonstration/teaching rooms, three autopsy suites (including one with a special negative-pressure system for highly contagious or contaminated materials), and a morgue—is "second to none," Alexander says proudly. He is particularly pleased with the private room where physicians and families can meet to discuss whether or not an autopsy should be conducted.

"Of course, under no circumstances have we asked our chaplains to be anything but neutral on whether somebody gives permission for an autopsy. We just want clergy to be well informed, because they spend a great deal of time with grieving families."

Situated between The Kirklin Clinic and the new hospital, the post-mortem facilities can be accessed through the fourth-floor parking deck or through a covered crosswalk over 20th Street that connects with The Kirklin Clinic. "The location is optimal for our physicians," Alexander says. "We believe it to be the finest facility in the United States."

More than 21,000 autopsies have been conducted at UAB since 1948, yet only about 20 percent of patients who die at UAB facilities actually undergo autopsies. Nationally, only 10 percent of hospital deaths undergo postmortems. "By granting permission for postmortem examinations, families have contributed to our understanding of disease, as well as to the education of medical students, residents, and faculty," Alexander says. "While we are extremely grateful that 20 percent of families grant permission, we want all families to understand the positive features of autopsy.

"Postmortem examinations truly shape our understanding of diseases—their causes, extent, and prognosis," he says. "All of us who receive medical care today are the beneficiaries of autopsies that have been done in the past, because they have refined our concepts of disease."