The following essay serves as the third chapter of One Grew Up in the Cuckoo’s Nest.
A day in my life as a Nurse’s Attendant working at Medfield State Hospital. I was eighteen years of age.
The Autopsy
Recollected and Written
by
Mark R. Ellsworth
The chance of a lifetime! The opportunity for my first employment was enhanced by my fate of having grown up on the grounds of Medfield State Hospital. After I turned sixteen, my Father hired me as a part-time farmhand, milking cows. I worked during my senior year in his barn on weekends. That was my first paying job at the Hospital ( See chapter Four, Cows Crooning to Donovan!) When I graduated from Medfield High School in 1967, three important events unfolded. These events would shape my life for the next five years. First, I received my draft card from the Selective Service. Secondly, I was accepted into the University of Massachusetts as an undergraduate. And thirdly, I was accepted for full time summer work in the Housekeeping Department at the State Hospital. That summer and some of the next summer I worked as a housekeeper on locked alcoholic wards. These wards were focused on all the stages of alcohol withdrawal and detox. Approximately 40 men lived in an open ward with a few private rooms set aside for the newly admitted who sometimes were ravaged by acute withdrawal symptoms. Across the hall the other ward was similarly structured for women. These wards were located on the second floor of the Clark Building at Medfield State Hospital. Both ward locked entrances were enhanced by a large wired glass window positioned half way up the door. (One poignant memory of the start to a summer work day is seared in my memory. That morning, key in hand, I reached to unlock and enter the male alcoholic ward. Looking up from the lock I encountered a man gazing sadly out the ward’s door across the hall into the other door’s window frame of the females’ ward. That door window was filled with an equally sad looking woman returning his gaze. As he stepped back to let me enter he explained that he hoped his wife was feeling better than she looked this morning.)
That second summer I was asked if I wanted to transfer into Nursing, I did and donned a new uniform of white shirt, black belt, white pants and dark shoes. New set of keys in hand, I was sent upstairs to begin orientation in the wards I was assigned to. During summers as an attendant, I was working, (for the most part), in locked wards for seriously disturbed adults, women always separated from men. Later years I would work the 11-7am shift on a couple of wards located farther back onto the State grounds. But the first wards I worked in were located on the fourth story of the Clark Building.
I have memories of so many dramas and situations that required quick teamwork between attendants, techs, nurses and doctors on duty. As a young adult I quickly learned to appreciate the professionals who were adept at listening, assessing and communicating while administering a therapeutic needle to calm a patient, other patients, and us, the staff. ( I was too naive to understand the following: There is a fine line between helping a distressed patient reach a positive therapeutic outcome short- term versus administrating a chemical restraint to said patient that could prove harder to remove than a cumbersome straight jacket! My forty-nine year career in mental, long term and acute healthcare ran concurrently with profound ethical discussions and changes in regulations. Regulations inspired by the urgent need to address the physical and mental harm inflicted on patients and/or residents with the over-use of chemical and physical restraints!)
For days, weeks and summers the scenes, dramas, and players were the same except for one day. That day the Head Nurse, who scheduled our daily assignments, called me into the Nurses Station and explained to me that I would be needed to assist, along with another attendant, a doctor scheduled to perform an autopsy mid-morning. As an eighteen year old I was attempting to learn how to act “cool”. The nurse, being able to assess every moment of her shift immediately, saw that I needed water! She took another moment to explain to me the doctor would be doing the heavy lifting during the procedure accompanied by laboratory staff. The other attendant was very experienced and would lead me though my duties. With that hopeful factoid I was excused from the Station so that I could finish my morning rounds and tasks before I was called to leave the ward on the fourth floor and “elevator button” myself down to the first floor, where the morgue was located in the Clark Building.
The area where the autopsy was to be performed was located in the back wing of the Clark Building. Picture if you will a four story building shaped like an H. To the left of the H, the main entrance, doctors offices, administrative offices and social service offices were located on that first floor. All supply and laundry rooms along with the staff lounge and elevators were located on the middle shaft/hall of the H. In the back hall of this H of the building, (as you exited the middle hall), a left was required to reach the morgue. Just before reaching the exit/entrance door of that back hall, the door to the morgue/ autopsy room was found on the left wall. The morgue’s door, the last door before the exit seemed an appropriate location to me. The last mortal step of the “left behind” body would have only one more door to pass through on its final discharge to a waiting hearse. Turning around and looking down that same hall the hospital laboratory entrance door was located about halfway behind me. I am not sure what floor the pharmacy was located on but I believe it was on the third floor of the Clark Building. I do remember the third floor had a large cafeteria for patients. Back to the morgue.
I met my fellow attendant in that back hall and we were the first to unlock the door to this sanctum of answers. Opening the door he let me know that he had worked many “cutups“, (his label for an autopsy). He went on to explain that we would be asked to glove up and sow the body closed after the “Doc” was done “sawing“. Bag the “dead-one” and put it back in the fridge; not to worry he knew the “ropes”. I was fascinated.
Entering through the morgue’s door my eyes had to quickly adjust to the sudden brightness. A light, hanging over a seven foot stainless steel table was bright enough, however that light was over shadowed by sunlight diffusing through large sandblasted milky windows that only permitted light to enter. No view in or out was allowed. To the left, said light reflected off a wall of closed stainless steel doors. I was told by my partner, the doors concealed refrigerated cavities with rollers and trays for bodies to rest on and in. A very bright room for a dark mission, (or so my dramatic teenage mind thought)!
The main feature of the room was a tub-like table dressed in stainless steel with railed rollers covering the breadth and length of the table. The head of the table was adorned with plumbing that was soon to produce water flowing down its sloped bottom to the tub’s drain. The aforementioned large light suspended over the table was attended by a microphone floating a few feet lower but within reach. This mic would record each move and body part that came to the doctor’s cutting attention. On the wall located to the right, as we entered the room, stood a waist high white cabinet with windowed doors. The cabinet housed a myriad of tools the doctor would use to carve the body of a former life. Again, all the preceding facts were shared with me by my experienced colleague while we waited for the laboratory technicians and the doctor.
My fellow attendant was in my opinion a professional attendant. A lifer. Where I viewed my work here as a pit stop on my journey to become a college graduate, he was working at the hospital for the long haul. He, in his youth, had been “institutionalized” at the Walter E. Fernald Developmental Center located in Waltham Massachusetts. It was a medical institution with a long history of it’s own. In our parlance it was known as the Fernald School and it’s residents were commonly tagged as “not quite right”. ( Again the cruelty of stereotypical condescending attitudes.) I found him and his twin brother, who was also an attendant, sincere and intent on being the best nurse’s attendants they could be. His life’s work, he often told me over the three summers I worked with him, was helping the doctors and nurses care for patients. I believe he and his brother knew every nook and cranny of the physical and policy cracks of the Medfield State Hospital.
A few minutes later the lab ladies entered the room. The laboratory technicians had known me since we moved to Medfield from Danvers. I was ten during the year of that move. Both ladies were friends with my parents and evidently their sense of humor was somewhat warped! They had brought their lunch into the room and used the top of the cabinet as their personal picnic table. They both smiled in my direction from across the room. I felt like they were waiting to see if I would join them for a desert of “tossed cookies”!
No time for desert, the Doctor entered a few minutes after the munching lab ladies and asked my partner and me to open door # (Something I can’t remember.) and bring the body to the table. I do remember him adjusting the microphone and laying out the tools he was to use on the body about to be presented after he gowned. We too were gowned, masked and gloved. I didn’t see but I heard the rustle of paper bags and imagined the ladies were quickly stashing any uneaten sandwich that might have existed when the doctor arrived.
In tandem we wheeled the stretcher to the side of the refrigerator door, opened it and viewed the body in a bag. The body was laying on a long stainless steel tray on runners. The runners allowed us to pull the victim and his tray out into the light of the room. We then raised the bagged body and tray onto the stretcher positioned at his side. Once on the stretcher we unzipped the bag and positioned him to remove the bag. I was surprised that he was clothed in wet over stretched clothes. If I remember correctly, this man was found that same morning having apparently docked himself on the river bank after riding the currents.
Positioning the body, tray and stretcher along side the large table with the water now running and the Doc standing at the far side of the table, he asked us to transfer the body and tray onto the table. My experienced partner stood at the head while I stood at the feet. Tray and body now on the water table, we tipped and held him on his side. I remember there were two reasons why this was done. My partner produced huge scissors and began to cut his shirt in a straight line down his back. Belt removed, the straight cut followed suit down the rear to the pant’s crotch. Next while I continued to steady the victim on his side the tray was removed and put back on the stretcher. Both of us gently lowered the body on his back. I don’t remember removing his cut clothes. I believe the Doctor did that slowly while he intently looked at the body’s newly exposed skin. We both stepped back to the windowed wall and waited. I looked back across the room to the far wall. I was relieved to see the ladies had indeed stashed their earlier lunch and were now fully gowned, masked, and gloved..
Before I continue here I have to mention how my senses were assaulted when we opened the bag, held and transferred the body. Oh, the smell! Not a rotting smell of death! Instead a wet earth smell escaped from his bloated body. The Doctor explained into the hanging microphone the victims identification and diagnosis. I only remember depression and the explanation that his body was bloated due to residing in the river water for enough time to act like a sponge. No talk about how he entered the water which made sense to me. If he stood on the bridge or a railroad trestle he was unseen until he came up on the bank down here by the Hospital. In any case the cause of death was the Doc‘s job.
As I review my notes, written over two decades ago, I see many details of the next steps of the procedure, but I am hesitant to share them here. I will share that the doctor started with the body’s head. In my notes I scribbled “Why?”; did he figure to see the word depression, displayed billboard style? I remember the sound of an electric saw, the doctor’s voice, the lab ladies suddenly stepping to the head of the table. The saw’s task now finished. After a few minutes of attention to the results of the saw, a large scalpel appeared in the Doc‘s hand. With that knife he produced a large cut shaped like a Y. These cuts started at each shoulder and connected down just below the chest. A single cut continued down over the abdomen, in effect the bottom stem of the Y. That cut terminated just below the body’s waist. Next, I remember the doctor reaching out with both hands. Our view was suddenly blocked by the lab technician ladies as they stepped down to the legs and waist with small clear bags in hand.
The next sound startled me; a crack not once but twice! Cracks as sharp and distinct as the sound Tony C’s bat as it connected with misplaced fastballs! The doctor quickly cut and lifted out pieces of organs. After a once over he handed them to the Lab Ladies. They labeled and bagged the cut pieces. My attendant partner and I were still standing in front of the frosted windows about six feet away from the procedure. Through out all this, the Doc continued to narrate each step in a low monotone. The mic his attentive audience. My notes do not reflect what he said about the lungs but I believe they were, unsurprisingly, full of river water.
As quick as it began it was over almost as quick. Each quick second seared into my memory. While the doctor and his picnicking colleagues took off their scrubs and washed, we were given needles with a twine like string almost the size of rawhide. The unused organs were placed back inside and I remember the doctor closing the ribbed doors to the body’s chest. We stepped forward and silently stitched the the Y cut closed. The wet earth like blue skin my final memory. I cannot remember leaving that room.
I do remember this. That autopsy was my wake up call to the transient nature of life in the physical. We all know the cliche, one’s immortality is a youthful trait, (or something to that effect.) Another point I hope is understood. There are many details I remember that I will not publish. This body of a man was the family member of someone, maybe a husband, a father or a son, he deserves dignity and some privacy. I include him here in these essays because he shared a gift with me that I will share with you in a moment. Also as I finish this essay I want to be clear, the lab technicians were very professional! As soon as the body was presented and the autopsy began they had already returned to the table area, gowned and gloved.
The doctor was very direct, supportive, and patient of my rookie status in this room. So the metaphor I am about to use is simply my attempt to share how I rationalized my teenage conclusions, nothing more.
To me the autopsy was performed as if the doctor was a mechanic tinkering with an auto that was no longer running. However this mechanic did not have the goal of getting the car running again. This mechanic was looking at a non-running car trying to figure what had made the driver drop dead!
Weeks, months and years later, as I reflect back on the autopsy, I realized for all the life and drama I had witnessed at the State Hospital, it was a dead man who had spoken to me the loudest. His message was clear. His body was simply the vehicle that he drove in his life time to get here from there. From that moment to this day I have had a growing flicker of courage of faith that there is more to come after the morgue’s cold door closes once again.
Next month’s chapter in this series is titled, Cows Crooning to Donovan! Thank you for reading.
Be in peace and joy!
Mark