Coping with the autopsy

Dear Dr. Neimeyer,

My son John, died just 14 months ago at 31 years of age. The Coroner’s findings were that he died from Mixed Drug Toxicity, Drug Induced Cardiomyopathy and Chronic on Acute Pancreatitis. John was also Hep C+ve. His father died from a long and complicated course of illness that extended through John’s childhood and early adolescence, and John developed significant learning difficulties and ADHD, and I’m sure there were many other undiagnosed problems that compounded his poor self-concept/esteem. John was experimenting with various illicit substances probably as young as 12 years of age. During the course of his father’s illness, John’s drug taking escalated. By the time his father finally died, John was on heroin.

This may sound strange, but my instinct told me that even when John was a little boy, he had so many problems that I knew he would go down the drug path and die an early death. The years after his father’s death were nightmare years and there were times I didn’t know whether he was dead or alive. I did everything possible to keep him alive in the hope that he would eventually be able to live some sort of semi-normal life. He lived on the streets or couch-surfed. It is a long story, and one filled with many turbulent relationships and family crises. Even so, I was shocked and numbed when I got “the call” from one of his friends to say that John was dead. It was the most horrible moment of my life, after so many attempts to save him.

My main reason for writing now is that I’m starting to see John on the table at the morgue over and over again, whereas, for a long time, I couldn’t bring that image up for longer than a few seconds. I’m feeling angry that no-one asked permission to cut into Joel’s body when the autopsy was performed. I thought I could handle reading the full autopsy report, but didn’t realize how graphic it was and I read it once and that’s where the horror part comes in. I keep getting pictures of the entire procedure. He was my child, I carried him, I nurtured him, I tried my hardest as a mother to keep him alive.

It doesn’t matter that he was an adult when he died, he was still my child and I feel he was totally violated when they sliced him open and did what they do at an autopsy. I know it doesn’t happen this way, but I feel someone should have asked me if it was okay to cut him open like that. It’s taken me this long to get to this point, and I’m wondering do other parents feel this way? Why didn’t anyone consider a parent might feel this way on finding out their child has been cut open and then sewn back together again? It’s all wrong and I suppose some of the numbness is starting to wear off and I’m starting to feel and think more.

My question is, what can I expect will happen with this terrible imagery, and what can I do about it?

Jeanmarie
Dear Jeanmarie,

Your letter makes visible to others who read it the awful images and preoccupation associated with your son’s tragic death, compounded by the coroner’s investigation of its causes. Even if the latter is mandated in cases where the cause of death is ambiguous, and for good legal reasons, your horror and heartbreak are surely understandable to every bereaved parent. As a great French poet once said, “The heart has its reasons of which reason knows nothing.”

But to acknowledge that your reaction is understandable is not to say that it is inevitable or one that you can sustain across a lifetime. Ideally you would have been accompanied by a compassionate and knowledgeable professional as you gradually digested the autopsy report in a way that helped you take in, one step at a time, what it had to tell you or teach you about John’s death. For example, I have helped clients integrate the content of autopsy reports by silently reading a part of the document, perhaps a paragraph at a time, describing in very general terms its content and then assessing the mourner’s readiness to hear more (e.g., “This section describes the scene of the death, and the position of his body when he was found. Do you have any questions about that? Would you like me to summarize it, or read it aloud and discuss it with you?”). Taking in the reality of the death is extremely painful under any circumstance, but doing so alone and often in an unbuffered way can make it even more surreal and clinical, rather than couched compassionately and with assistance in “dosing” the report and making sense of the hard parts.

Of course, you did not have this opportunity, and so the question is now what can be done about the imagery of the autopsy and the associated emotions it triggers. Simply suppressing them is not an option: Both research and clinical experience suggest that this is not possible for long, and that the unwanted images often come back with renewed force. More useful might be to accept, or even invite the images, but under “safe” conditions of high support, perhaps with an experienced trauma and grief therapist. Slowly reviewing, talking through and making sense of the images, just a bit at a time, with ample opportunity to breathe mindfully through the related feelings as they arise and subside, can be a helpful step, and one that might be repeated until you can confront them with less reactivity.

Many people also find it helpful to use expressive arts techniques to give shape to the imagery and distance from it, putting it “out there” on paper–even in simple drawings–rather than have it live only in their minds. This can also lead to the use of healing imagery, slowly, deeply, and repeatedly imagining or drawing yourself caressing or healing John’s broken body, perhaps even “magically,” although you cannot restore it to life. These and other practices described in some of the books on grief therapy featured elsewhere on this site (such as using artist’s renderings or photos of John in a healthy state, to display in your home) might help a therapist guide you through these procedures toward a less horrific way of holding the imagery, and gradually to overwrite it with more sustainable pictures of the John you want to remember. Along with broader therapeutic work on the other “unfinished business” of a complicated relationship, it could help restore your sense of being a mother who did all she could to care for a son whose own experience of tragic loss ultimately led him down a dark path.

Dr. Neimeyer