The document summarizes an internship the author completed in spring 2016 with a forensic pathologist. During the 180-hour internship, the author assisted with autopsies at a hospital morgue and coroner's office, learning to recognize causes of death. The author established goals around understanding autopsy procedures, determining causes of death, and operating record systems. Through various duties like brain removal and organ examination, the author gained experience and met all internship goals.

1. Savanna Altman
Spring 2016
Forensic Pathology
Internship

2. In the Spring semester of 2016, I completed a 180 hour internship
with a forensic pathologist Dr. James Fulcher M.D. During my time with
Dr. Fulcher and his associate Dr. Michael Ward M.D. I worked at the
Greenville Memorial Hospital morgue and at the Greenville County
Coroner’s office. This presentation elaborates on my experiences from this
internship.

3. Goals
1. Recognize common physical signs of morbidity and mortality
during an autopsy or when observing histology.
2. Outline the general procedure for concluding manner of death
as natural, accidental, or criminal.
3. Describe how Greenville County Medical
s document and process medical evidence of cause of death.
4. Operate a web based record system.
5. Better articulate how I feel about a future in surgery.
At the beginning of my internship I established goals and
objectives to achieve these goals. I successfully met each one.

4. Morbidity & Mortality
• Despite the many differences presented in each decedent there were
several primary causes of death that were commonly observed.
• We received a high number of heart disease patients, gunshot
wounds, and traffic fatalities.
• Through outer examination of bodies, observing organ dissection,
removing brains, examining histology, and asking the Medical
Examiners questions I learned to recognize several causes of death.
• In the same manner, I also learned how to determine if a malady
resulted in fatality, acted as a contributing factor, or was simply an
ailment.
• Reviewing hundreds of case reports also aided in the
development of this skill.

5. Examples
• Recognizing if a myocardial infarction has occurred when examining heart
muscle grossly and microscopically (images from studyblue.com and
pathcases4u.blogspot.com).
• Distinguishing between entrance and exist wounds from a bullet based on the
type of damage to local tissue.
• Bone beveling, stellate tearing, suit, and burn marks.
• I learned that a person may have had a heart attack while driving causing
them to wreck, but the severe blunt force trauma from the crash caused their
death before the cardiac episode could have.

6. Medical Evidence
• Identification is done in multiple ways including: hospital documents
(toe tag etc.), finger printing, dental x-rays, blood and hair samples,
and external features (height, weight, eye color, etc.).
• Injuries such as lacerations, bruising, broken bones, and gunshot
wounds are documented by location and size on a body diagram as
well as photographed.
• The Medical Examiner records the mass of each internal organ as well
as any signs of injury or disease.
• Sections of each organ are taken and stored in formaldehyde and
smaller sections of damaged organs are prepared for microscopic
examination.
• Toxicology reports are produced from samples of visceral fluid,
blood, and urine.
• X-rays are typically taken to locate a bullet.

7. Examples
Left: Ink roller and finger press used to obtain finger prints from
decedents.
Right: Some of the materials used to collect urine, blood, visceral fluid,
and any useful stomach contents (pills).
Images taken by myself at Greenville Memorial Hospital morgue.

8. Manner of Death
• The manner in which a person dies is classified as: natural,
accidental, suicide, homicide, or undetermined.
• This is concluded based on medical evidence, forensic evaluation of
the scene, and any witnesses or history.
• Some evidence of criminal activity would be wounding from
defensive action (hands), the angle in which a bullet enters the
body, and the pattern of fracturing from a fall.
• I most frequently encountered natural, accidental, and suicide cases
while working in the morgue and when reviewing case reports.

9. Database
In order to rectify reports to the Medical Examiner’s online database, I
created a set of steps to insure accuracy and efficiency.
• Using Microsoft Excel I made a list of the case numbers that were
missing from the database.
• By searching the database and then case files, I located the missing
cases.
• The missing cases were either transferred within the database,
corrected within the database, or created as a new file in the database.
• Overall I rectified 184 cases to the 2014 report and 20 cases to the 2013
report.
• Since some reports had to be corrected or created in the database I
spent a lot of time reading reports and became familiar with medical
terminology as well as with the information documented when
someone dies.

10. Duties
• Printing x-rays
• Weighing bodies
• Preparing bodies for autopsy
• Taking pictures of the decedents
• Brain evisceration
• Observing organ dissection
• Refreshing supplies
• Sanitizing the autopsy suite at the end of the
day.
Each day at the morgue I assisted the Medical Examiner and
the autopsy technicians by:
Picture taken by Sharon Knight at
Greenville Memorial Hospital morgue

11. X-rays
• One of the first things I do
when I arrive at the morgue is
take any x-ray cassettes to the
radiology department to be
printed.
• Generally x-rays are taken to
locate bullets.
• Bullets may be lodged in a
bone, muscle, or soft tissue.
They may also embolize if
they enter a large vessel,
which can make them tricky
to find.
Picture taken by Sharon Knight at Greenville
Memorial Hospital morgue.

12. Brain Evisceration
• During complete autopsies I
removed the brain.
• I begin by cutting and peeling the
scalp back to expose the skull.
Next I use the bone saw and skull
key to open the skull. With the
scalpel I cut the optic and other
nerves, tentorium, and brain stem
so that I can remove the brain.
The leftmost tool is used to strip
the dura from skull.
• I was responsible for informing
the doctor if I noticed any
anomalies on the surface of the
brain such as subarachnoid
hemorrhage or congestion.
Picture of the tools I used taken by myself at
Greenville Memorial Hospital morgue

13. Observation
• When I finished with the brain I
observed the Medical Examiner
dissecting each organ.
• My discussions with the doctors
during this time have
contributed to my intellectual
growth most significantly.
• I began to notice when there was
damage to an organ and could
often name the disease or event
that caused the damage. For
example: Myocardial infarction,
stroke, cirrhosis, and
hypertrophy of the heart.
Picture of the organ examination area taken by
myself at Greenville Memorial Hospital morgue.

14. Sanitation & Safety
• Between each autopsy we rinsed
off the table and supplies that we
used. After the final autopsy we
cleaned surfaces, supplies, and
the floors with sanitizers.
• All trash was placed into
biohazard bags and sent off for
disposal.
• Each person performing autopsy
wore personal protection
equipment including: scrubs,
shoe covers, particle mask,
glasses, disposable apron, nitrile
gloves, Kevlar (cut proof) gloves,
and latex gloves.
Picture taken by Sharon Knight at Greenville
Memorial Hospital morgue.

15. Additional Activities
In addition to my work at the morgue, I was fortunate to be involved
with other aspects of Dr. Fulcher’s career.
• Examine histology
• Interact with medical students
• Work with accreditation documents for the National
Association of Medical Examiners
• Rectifying case reports to an online record system
• Ride along with a deputy coroner
• Attend court when Dr. Fulcher served as an expert
witness.
• Observe and interview pathologist assistants
• Attend events at the medical school

16. Histology
• On a few occasions I got to
examine histology with Dr.
Fulcher and Dr. Ward. I was
usually able to identify the
tissue we were viewing and
learned a lot about
histological pathology.
• I most notably remember
learning to recognize
inflammation, vascular
plaques, emphysema, and
aneurism rupture.
Picture of me looking at histology taken by Dr.
Mike Ward at the Greenville Coroner’s Office

17. Relevant Courses
Many of the classes I have taken at Clemson were imperative to
my success in my internship. The most useful was Human Anatomy and
Physiology because it allowed me to understand what the Medical
Examiners and autopsy technicians were talking about. Cell Biology,
Biochemistry, and Body Responses to Health Behaviors were all very
helpful in learning about how and why certain diseases occur as well as
how the body responds to different events that result in death. The study of
Epidemiology was also of use because large organizations like the CDC use
information that we collected to determine the health of the nation. This
class helped me recognize patterns in the types and causes of death that I
observed and made me think of ways they could effectively be prevented.

18. Weaknesses
My biggest weaknesses throughout the internship were learning to remove
brains and creating a system for quickly rectifying the database. The amount of skill
and strength needed to remove a brain was very overwhelming for the first few
weeks. Since I am a small person the bone saw was very hard to control and I would
leave very tired and sore everyday. I overcame this by persevering and starting a
weight training program. It took a while to create a system for rectifying the database
because I had to discover all of the reasons why files were not showing up in the
report. After a couple of weeks I knew each area to check and the process became
much faster.

19. Strengths
My strengths were all more intrapersonal than my weaknesses. The
most important aspects of my success were perseverance, enthusiasm, and
engagement. Though I faced many challenges becoming proficient in my
duties, I did not quit trying to improve. Enthusiasm about the opportunity to
work directly with the human body and doctors helped me persevere through
each challenge because even the difficult things were very interesting to me.
Engaging with the Medical Examiners, medical students, and the autopsy
technician made me feel comfortable asking questions about what I saw and
asking for help when I needed it. I was glad to build friendships with my
supervisors as they are great people and it helped us all enjoy work even on the
busiest days. Combining all of these traits resulted in taking initiative when I
saw the opportunity to help or learn.

20. My Future
My experiences with the forensic pathologists and their
coworkers showed me that I am a good candidate for a career in
surgery. Working hands on in the morgue this semester greatly
improved my confidence and enthusiasm about working with the
human body. My internship also furthered my understanding of
how all aspects of a person’s life affect their health. I will be
applying to physician assistant programs this year and and plan to
become a surgical PA. I look forward to continuing my education
in the medical field and helping others achieve health.