Dissecting The Scene: The Autopsy of Jane Doe

By Morguerat

If you love horror, the macabre, and are intrigued by human anatomy and autopsy – this is definitely a film for you! Let’s dive right in together and dissect The Autopsy of Jane Doe.

First off - are all autopsies the same? I’m sure you’ve probably guessed that the answer is a resounding *of course not!*, but before we dive into this particular autopsy portrayal, let’s distinguish between the two major categories of autopsies: hospital autopsies and forensic autopsies.

WARNING: SPOILERS AHEAD!

CONTENT WARNING: BLOOD, AUTOPSY IMAGES, DEATH

Hospital autopsies are performed when a person has been admitted to a hospital for a period of time (in most areas this means greater than 24 hours) and then dies in the hospital. These patients have typically already had some medical tests performed – such as blood work, x-rays, CT scans, or other types of imaging – that can be utilized in determining cause of death. We usually already have a pretty good picture of the person’s physiological state prior to death and have a timeline outlining different medical events and interventions prior to the time of death. These autopsies may be performed at the request of the family in agreement with the patient’s attending physician, usually due to questions regarding underlying contributing factors of an unexpected demise, or regarding any questions of a death resulting from medical malpractice.

Forensic autopsies are performed when a person dies outside of a hospital, unexpectedly, and possibly under unusual circumstances. These autopsies aim to provide a manner and a cause of death and can provide important clues and evidence in cases of foul play.

“Deaths that come to the attention of the office of the medical examiner or

the coroner generally fall into the following categories: violent deaths (accidents,

suicides, and homicides), suspicious deaths, sudden and unexpected deaths,

deaths without a physician in attendance, and deaths in an institution. There

are variations to these categories, depending on the local jurisdiction.”1

The autopsy of Jane Doe falls under the latter category, as this is a case of a young unidentified person found deceased and partially buried in a home.

In the beginning of the film, we are introduced to Tommy Tilden, coroner, and his son/assistant Austin. It is worth mentioning here that coroners and medical examiners are NOT the same thing, though either one can perform autopsies depending on the state they are located in. Some states run on a coroner system and some run on a medical examiner system. A medical examiner is a medical doctor who is board certified in forensic pathology. A coroner is an elected individual who may or may not be a doctor. Depending on the area, coroners may also be law enforcement officers, funeral home directors, etc., and they may or may not be required to have formal training in medical practice and autopsy. This, as you might imagine, is extremely controversial throughout the medicolegal death investigation community – but that is another discussion entirely.

In this case, we see that the coroner, Tommy, is also a funeral director operating out of his privately owned funeral home – this is something typically seen in small towns or communities. One night, Sheriff Sheldon Burke urgently wheels Jane Doe, our unidentified main character, into the morgue, claiming he needs a “full report” by the next morning. Fun fact – this is an impossible timeline. An autopsy itself may only take one to several hours to perform, but the autopsy report will, and should, take much longer to finalize. A preliminary autopsy report should be completed within two days, but a finalized report can take about 6 weeks on average. This allows time for laboratory testing, toxicology, microscopy, specialist consultation, etc.

So what exactly do we find in an autopsy report? What are the differences between cause, manner, and mechanism of death? I’m glad you asked.

⦁ The cause of death is any injury or disease that causes a physiological derangement in the body that results in the death

⦁ The mechanism of death is the physiological derangement that is produced by the cause of death

⦁ The manner of death explains how the cause of death occurred. Manners of death generally fall under five main categories: natural, homicide, suicide, accident, or undetermined.

So, for example, a self-inflicted gunshot wound causes a person’s death. The cause would be the gunshot, the mechanism would be massive hemorrhage, and the manner would be suicide.

So, on that note, let’s get to dissecting.

Tommy and Austin begin their autopsy with an external examination. During any external exam, the person performing the autopsy will make note of the following:

⦁ Clothing

⦁ Degree of rigor mortis (rigidity) and livor mortis (pooling of blood)

⦁ Appearance of the eyes, nose, teeth, ears, hair

⦁ Scars, tattoos, moles, identifying marks

⦁ Presence of fluid in the mouth or nostrils

⦁ Evidence of any congenital malformations

⦁ Evidence of medical or surgical interventions

⦁ Evidence of injuries

At the time of the external exam, photographs and fingerprints can be taken, as well as additional things requested for evidence, such as fingernail scrapings.

They did a pretty good job on the external exam in this case. Austin takes photographs while noting Jane Doe’s apparent age and hair color. He states that there are “no outward signs of bruising or bleeding, no scarring, no distinctive external markings”. He makes a guess at the eye color, which immediately grabs the attention of his father Tommy, who notes that “you don’t see clouding like that unless a body’s been dead for days”. This is true. The longer an individual has been deceased, the cloudier the eyes become, which can be useful in trying to determine an estimated time of death. He also notes that there is no apparent lividity or rigor mortis. Lividity can be used in determining someone’s position around the time of death, as blood will pool with gravity. Any areas that are resting against objects may be free of blood pooling – so much so that the color patterns can even outline the shape of an object that a body has been resting against. It is very odd indeed to find no lividity pattern whatsoever. Rigor mortis, however - which is usually strongest in the joints of the arms, legs, and jaw - will pass over time and the body will become less rigid. This can also be useful in estimating a time of death.

They take some fingernail scrapings and continue their external exam to find that Jane Doe’s wrists are ankles are fractured and her tongue has been severed. They make it a point to note that the nasal passages are free of fluid – this is important because the presence of fluid such as vomitus or foam in the nasal passages can give clues toward cause of death. They finish the external exam by examining the genitalia for signs of trauma and take a vaginal swab. This can help determine what may have happened to the individual and can also aid in identifying a perpetrator.

Now we move on to the internal exam. I’d like to take a moment now to highlight the four major autopsy techniques that can be utilized, because not every internal exam is performed in the same way.

⦁ Virchow: This method involves removing the organs one by one

⦁ Letulle: This technique involves removing all of the organs “in toto” or “en bloc” – meaning all together as one piece – from the larynx all the way down to the rectum

⦁ Ghon: This method involves removing the organs in blocks of regional or functional groupings

⦁ Rokitansky: This technique involves in situ dissection – i.e. dissecting the organs without removing them from the body

Each technique or method has its pros and cons, but the Virchow and Letulle techniques are most commonly used. Once the organs are removed from the body they are weighed, measured, dissected, and examined.

Let’s take a look at how the Tildens performed their internal exam (at least before the crazy supernatural stuff takes over). They start off with a typical Y incision and Austin collects some blood runoff in a vial, presumably for later testing. This blood would be running out from superficial vessels and running over the surface of the skin, picking up contaminants along its path (not ideal for testing). On that note, there are several bodily fluids that are collected for testing during a forensic autopsy – including vitreous fluid from the eyes, blood from the heart or major vessels, urine, bile from the gallbladder, gastric contents, and sometimes cerebrospinal fluid.

Tommy then cuts down through the skin and subcutaneous tissue and dissects the flaps open to expose the ribs. This is accurate; however his incision is much too small (the tips of the Y incision are usually extended out to the shoulders), so he does not get good exposure. The skin and soft tissue flaps should be dissected out all the way to the sides of the body to expose the ribs enough for cutting. If you put your fingers on your anterior hips (the part of the hip bones that you can feel jutting forward) and then trace vertically up to your ribs, that is about where you would want to cut the ribs. He ends up cutting the ribs so narrowly it’s a wonder he can really access anything! What he uses to cut the ribs, however, is accurate. Instruments akin to garden shears are used to cut each rib individually, as well as the collarbones, to pull the chest plate off and gain access to the thoracic cavity.

They go on to examine the lungs and take a piece of lung tissue to fix in a liquid (presumably formalin – diluted formaldehyde) for later processing so that the tissue can be examined under a microscope. During an autopsy, pieces of each organ are typically taken for formalin fixation in order to preserve the tissue for later microscopic examination if needed. Tommy then pulls the heart out to examine it. In real life, the heart sits within a sac called the pericardial sac, which is a tough membrane that holds fluid inside it in order to lubricate the heart so that it can beat without rubbing up against surrounding tissue and causing friction. In this case, perhaps because of some supernatural reason, the pericardial sac is apparently nowhere to be found. Chalk it up to that or to the fact that it’s a movie and, understandably, these things are hard to simulate. Things do really take a spooky turn here though, because they note that the internal trauma they are seeing doesn’t match Jane Doe’s pristine external appearance.

Tommy continues his exam and soon cuts himself on a rib (probably because he didn’t give himself enough room in there to work) – but this is a real hazard that one has to be cautious of when performing an autopsy! Usually some sort of gown or jacket and two pairs of gloves are worn, and getting cut on rough bone edges or foreign bodies is always a real risk! Speaking of personal safety – this is a good time to mention that neither of the Tildens have been wearing masks or face shields during this autopsy. Some people choose to wear the bare minimum of protection, for whatever reason, but I myself prefer a bouffant cap, a mask, and some sort of eye protection or face shield. It is not uncommon to get bodily fluids, bone debris, or pieces of tissue flung into the air and possibly right into your eyes, nose, or mouth if you aren’t wearing some proper protective equipment! He does the right thing though and immediately rinses the wound and makes it bleed. Next steps he would want to take (if not for the impending supernatural interference) would include some blood testing to see what the deceased individual may have in their blood that could potentially infect him.

Tommy continues on with his autopsy by cutting into the stomach. Remember when I mentioned autopsy techniques? Looks like Tommy’s preference is the Rokitansky method – since he is dissecting the organs in situ without removing them from the body. He finds a strange and remarkably intact flower in the stomach. The intact state of the stomach contents is unusual, but not unheard of – I once found several whole, intact shrimp inside a stomach! Usually, though, what is found is chunky, partially digested food, or perhaps not much at all, depending on how recently the person had eaten.

Some spooky and supernatural events start really interfering with the autopsy at this point, and after some failed escape attempts, calls for help, and fighting against the other deceased individuals in their freezer, they decide that they need to burn Jane Doe’s body. When this doesn’t work (because of course it doesn’t), they decide the only way to make it all stop is to finish the autopsy. This brings us to the final part of our autopsy – the brain.

They start by making a lateral skin incision across the top of the head from ear to ear and pulling the skin forward over the face. This is accurate. The skin of the scalp is very mobile. A fibrous membrane known as the galea aponeurotica is really the only thing between the scalp and the skull on the top of the head. If you touch a point on the top of your head and move the skin around, you will feel how mobile it is. This is why “scalping” someone is fairly easy to do. During this part of an autopsy, the incision is made down to the level of the bone, and from there it is easy to peel the scalp off and forward over the face to about the level of the eyebrows. This allows us to pull the skin back into place over the skull cap after the autopsy and sew it together far enough back that the incision can be concealed by hair or a hat. This way, the deceased individual can be viewed at their funeral without any visible incisions.

The Tildens then use a bone saw to cut the skull bone (their cuts are a little far forward, but the general idea is correct) and remove a skull flap to expose the brain. Austin takes a quick look at the brain and states “the brain is normal”, which is quite an overconfident statement to make when you haven’t even removed or dissected it. Then, just like that, they decide that’s all they need to see, and they put the skull flap back in place.

Thus, the autopsy is essentially over, and they continue to try to solve the endless mysteries of Jane Doe. Spookiness ensues, and unfortunately, I can’t say it has a happy ending.

So, with that brief analysis, here are my personal ratings for The Autopsy of Jane Doe:

Accuracy: 6/10

The Tildens did a fairly good job with the external exam, but everything starts to fall apart from there. They did not remove, weigh, or dissect essentially any organs for examination. They did not collect any fluids for testing, save for the one vial of contaminated blood runoff from the initial incision. I am going to give them some benefit of the doubt that the supernatural interference prevented them from doing a more thorough exam, but I still have the feeling they would not have quite gotten there – and for goodness’ sake, wear some face protection!

Entertainment Value: 9/10

This was an extremely entertaining movie. Even through my loud and constant complaints about medical inaccuracy, I still hung on to every moment and found it to have an interesting premise and a very eerie and creepy overall vibe!

References:

⦁ DiMaio, V., & DiMaio, D. (2001). Forensic Pathology, 2nd ed. CRC Press LLC.

⦁ Connolly, A. et al. (2016). Autopsy Pathology: A Manual and Atlas, 3rd ed. Elsevier, Inc.

⦁ Sheaff, M., & Hopster, D. (2005). Post Mortem Technique Handbook, 2nd ed. Springer-Verlag London Limited.

⦁ Waters, B. (2009) Handbook of Autopsy Practice, 4th ed. Humana Press. DOI: 10.1007/978-1-59745-127-7