Arriving at the exact cause of death is a process that unfolds over time. You’re on your way, now that you’ve prioritized your differential diagnosis. The next step is to start drafting the Autopsy Report for the Herren case. I’m attaching an initial draft for you to build upon. You’ll see that my assistants already handled a lot of the standard parts of the draft Autopsy Report. And everything looked normal when I reviewed their findings, so don’t worry about editing anything they’ve written.

Your job

What I want you to do is complete the areas of the internal examination that relate to the differential diagnosis – the cardiovascular, respiratory, and nervous systems. Then, I’d like you to write the Pathologic Diagnoses and the Opinion sections.

Since you’re new to all of this, I took the time to annotate the draft Autopsy Report that you’ll be building on. I made comments in the document to explain what the sections of the report are about. You can review it to better understand the parts of the report that my assistants already completed and to get a sense for what I expect you to include as you complete the sections of your draft.

I’m also sending the first draft of an autopsy report from a case a colleague of mine worked on recently. I marked it up a bit - - use my comments to guide you as you work on your initial draft of the Autopsy Report for the Herren case.

Evaluate the autopsy photos

I’m attaching photographs from the Herren autopsy. To complete the initial draft of the Autopsy Report, you’ll need to examine the photos of the decedent’s heart, lungs, and brain to determine what’s normal and what’s abnormal. You don’t need to worry about weighing the organs; they’ve already been recorded on the decedent’s photos for your reference.

I attached organ worksheets for the relevant organs, which I often use to keep track of my findings. I thought you might like to use them, but you don’t have to. Later, you can incorporate your notes and observations from the worksheets into your draft report.

There are a few things worth noting that may be hard to tell from the photos alone. No particular areas of the brain seemed unusually soft; when we opened the skull, there was no blood between the dura mater and the arachnoid membrane; and the heart had an overall smooth texture. One more thing - - my assistants also took a look at the base of the decedent’s brain, the cerebellum and the brain stem. The circle of willis looked fine; you’ll want to consider those findings as you draft the Autopsy Report.

Document your findings

When you are done assessing the organs, record what you saw as thoroughly and clearly as possible in the appropriate sections of your draft Autopsy Report. Include anything that looks significant in the autopsy photos- - making sure to write an accurate summary of what you see.

Then take a step back and try to draw some initial conclusions regarding Nick’s cause of death based on what you know at this stage in the autopsy process. Capture those thoughts (informal notes are fine for now, as long as they clearly reflect your reasoning so I can analyze your work) in the Pathologic Diagnoses and Opinion sections of the draft report.

A work in progress

Keep in mind, the Autopsy Report is a draft document which will evolve over time. We’ll use it as a communication tool that we can pass back and forth until you are ready to draw your final conclusions. In particular, we’ll continue to fine tune the Pathologic Diagnoses and Opinion sections as we delve deeper into the case. In the end, our goal is to have a polished, final version of the Autopsy Report that can be easily understood by non-medical professionals - - especially Nick Herren’s family. Your initial draft of the Autopsy Report will be the first step in that direction.

I look forward to reviewing your work.

Regards,

Cameron Wood, M.D.

Chief Medical Examiner

Highland Medical Examiner’s Office