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Saudi Journal of Kidney Diseases and Transplantation
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DOCTORS DIARY Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 1  |  Page : 142-143
Post Mortems and I

Division of Nephrology, Hypertension and Renal Transplantation, King Abdulaziz Medical City, Riyadh; Clinical Professor of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

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Post mortems or autopsies are essential part of medical undergraduate training. This article reflects on the author's memories as a medical student at University College Hospital Medical School, London.

How to cite this article:
Al Sayyari AA. Post Mortems and I. Saudi J Kidney Dis Transpl 2008;19:142-3

How to cite this URL:
Al Sayyari AA. Post Mortems and I. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2020 Nov 23];19:142-3. Available from: https://www.sjkdt.org/text.asp?2008/19/1/142/37455
Call me peculiar, but one of the things I enjoyed most as a medical students at University College Hospital Medical School, London (now joined together with the Royal Free Hospital as the Royal Free and University College Medical School, UCL) was going to the post-mortem sessions.

These were held daily after lunch. We stood on a podium. On the other side of the podium stood Professor Peters the patho­logist, who was a real performer. That post­mortem room was his stage and we were the audience but we were not just passive audience; we were there to contribute to his after lunch enjoyment.
"You there" he once asked one of the students. "What do you think this is?" He was pointing at an organ he was holding up in his gloved hands.
"It looks like a liver sir?" the student said not at all happy that he was picked for the professor's entertainment that afternoon.
"Is it a liver or does it just look like a liver?" he asked.
"It is a liver." The student said now realizing for sure that he has been selected as that day's fun object.
"What year are you at?"
"I am second year clinical student, Sir."
"God help us, this means you will soon be unleashed to do much damage to the un­suspecting society as a doctor. Are you sure this is not a brain? "
"Yes I am sure it is not a brain," the student said with confidence.
"I am glad you can tell the difference bet­ween a brain and a liver" Professor Peters retorted sarcastically. "Young man, any fool could tell it is a liver. I expected you to tell me what is wrong with this damned liver?"

The student was at a loss what to say. This clearly made Professor Peters even happier.
"Did you clerk with Dr. Stokes"-Dr. Stokes being a great clinical generalist with parti­cular interest in liver diseases. His ward was full of liver cases.
"Yes I did sir."
"In that case either Dr. Stokes is losing his touch or you are in a persistent vege­tative state. I will give you a clue, son. This patient worked in Her Majesty's Diplomatic service for 40 years and he is known to have Dupuytren's contracture. Does that help you? I will tell you what, since I am in a good mood, having had a good lunch of roast beef and Yorkshire pudding I will give you another clue. His blood count showed an MCV of 102. Now I cannot fairer than this, can I?"

The student had no clue.
"Can somebody help the poor lad?" asked Professor Peters.
"It is a cirrhotic liver, probably alcoholic in view of the Dupuytren's contracture and high MCV. I note that it looks fibrotic and shrunken" said the nerd of the class.
"Excellent" said the Professor. "Can you explain my reference to him working for Her Majesty's Diplomatic service for 40 years?"
"Yes sir," said the nerd. "They get a lot of free alcohol and attend a lot of alcohol rich diplomatic dinners."

Normally the person who gets the brunt of Professor Peter's sarcastic remarks is the poor houseman (intern) who normally stood behind the professor and the body and who gave the clinical history and diagnosis before knowing the post-mortem diagnosis.

I had my turn at the receiving end of the professor's wrath when years later, I became houseman to the professorial medical unit.

In one of those famous after lunch sessions, it was my turn to stand behind him with the new generation of students in front of us.
"So why did you do a lumbar puncture on this patient" he asked me.
"Actually it was the registrar who asked me to do that."
"Do you always do what you are asked without querying it?"
"No. She had disturbed sensorium and neck stiffness."
"OK. What happened next?"
"Immediately after the lumbar puncture she dropped her BP and became more stuporose."
"So what do you think happened?"
"I think she must have coned" I said
"What if I can definitely tell you, having examined her brain, that there is no evidence of coning or bleeding or meningitis? What did you do when she dropped her BP?
"I gave her fluids and her BP picked up."
"What does that tell you?"
"Well," I said as I began to sweat. "She might have been volume depleted. But her haemoglobin was OK and her pulse was only 76."
"Did you do a PR (per rectum) examination on her?"
"No I did not. I did not see the need."
"I am sure you must have read in Bailey and Love that if you do not put your finger in it you will put your foot in it."
"Yes I did read this, sir. I suppose this means that she had a GI bleed and her low BP was due to the bleeding and this will also explain the improvement when she was given crystalloids. But why was her pulse rate low and haemoglobin unchanged despite the bleeding?" I said defensively.
"Remember she was on digoxin and the drop in haemoglobin needs time to show" replied the Professor.

Yes, I did learn a great deal from these post­mortem sessions which stayed with me all my professional life. This is something we missing desperately in the medical\schools in many Arab countries, not to mention the number of times we miss the diagnosis with­out realizing it simply because we have no resort to post-mortems.

Correspondence Address:
Abdullah A Al Sayyari
Saudi Journal of Kidney Diseases and Transplantation, Saudi Center for Organ Transplantation, P.O. Box 27049, Riyadh 11417
Saudi Arabia
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PMID: 18087145

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