Helpful Suggestions for Brain Cutting
1. When you get the folders look up each case in MARS or Powerchart – this goes for Medical
Examiner cases too:
 Look for history of neurologic symptoms.
 Look for evidence of potential major ischemic/hypoxic event such as shock or arrest and
note the time elapsed between event and eventual death.
 Look for any head imaging.
 If there is an underlying medical condition (e.g. lupus), investigate the literature for
potential brain findings in said condition whether or not you think they are related to
cause of death. Bring any references to brain cutting so that you look intelligent and
interested. (It helps to actually read the references first.)
 Based on the above, compose a 4 sentence neuro-relevant history and a short list of
things you will be looking for when cutting the brain.
2. Cut the brains (weigh first):
 Refer to your list when examining and sectioning brain – never cut anything without
some idea of what you may expect to find.
 Take gross photos of anything interesting/pathological.
 Take careful descriptive notes of findings and block list.
 Leave ME blocks in morgue for Jonette and take PHA blocks to gross room to be sent to
histology.
 While in the gross room , delete any blocks you did not use.
3. Manage your cases:
 It is helpful to have a flow list of all your brains including number, autopsy date, due
date, and check boxes for completion of various tasks e.g. cut, gross completed, slides
in, immunos ordered, immunos in, microscopic completed, final diagnosis/comment
completed. This will be invaluable when you have delegated several brains to various
residents or medical students. It could look something like this:
#
Aut date
Due Date
Cut
Gross
H&Es
Immunos
Micro
Final
Start looking for PHA and slides on Thursday after a Monday brain cutting.
 Start looking for CHA slides on Thursday after the Friday brain cutting.
 Call respective histology departments if slides not in.
 As soon as the slides are in, look them over. Now is the time to order immunos or show
the attending anything weird – NOT the day before the case is due. Now is also the time
to do any additional outside reading (to look intelligent) depending on what the slides
show.
4. Write the report as you go along
 You must compose the gross on the same day as cutting in order to eliminate the
trouble of composing long works of blasphemous fiction later on.
 Do yourself an enormous favor and compose the autopsy report in Word and then copy
and paste into Copath. The more complicated the report, the greater the probability
that Copath will crash after you have written your best prose. You can send your
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attending an email with the text or let them know when it is in Copath. You can also
email them updated flow charts.
By all means, use the quick text, but treat it as merely a helpful aid for remembering
what to comment on (or look at). Probably the most important thing to remember while
using a quick text is to delete any statement that does not apply to your case (e.g. the
normal spinal cord that was never there, the normal centrum semi-ovale that you just
described a huge infarct in, etc.). Signing out a quick text error will make your attending
look like a total boob. So keep your attending from public humiliation by composing
your own descriptions whenever possible.
It is often useful to enter microscopic findings into your word document as you are
looking at the slides – that way, if you get paged somewhere, you do not have to start
all over again. This is another reason not to use Copath until the bitter end.
Write up the final report, print it up, and give it to your attending along with the slides
and any pertinent/interesting literature. A printed report is helpful in order to preserve
your attending’s aging eyesight. You can also make notations on it regarding anything
you are not sure of.
Please, please, please do not give the case to your attending on the date the case is due.
If revisions are necessary, you will have a very grumpy attending working all night when
they should be making their kids supper.