As I thumbed through the first few inches of the more than foot- thick chart, it became apparent that this was a case in which things didn’t quite add up. The chart described the medical ordeal of a 35-year-old man, George Decker, a nonsmoker who had worked as a laborer in a local metal shop. He had been in perfect health until three months earlier, when he suddenly developed pneumonia in both lungs. Pneumonia can be defined as any inflammation of the lungs that causes white blood cells and cellular debris to collect in the air sacs, a condition that makes breathing difficult. In practice, most pneumonias are caused by some sort of microorganism. Yet in Mr. Decker’s case, repeated cultures of the sputum he coughed up--cultures examined for bacteria, fungi, or viruses--had all come back negative.
Other causes of inflammation had been ruled out as well: as far as Mr. Decker knew, he hadn’t inhaled any toxins or parasites or breathed any fluid into his lungs. His doctors eventually resorted to an open-lung biopsy to see if they could uncover the pathogen, but they found only tissue injury and repair. Over the next three months they watched helplessly as Mr. Decker’s lungs thickened, steadily undermining his ability to breathe. Eventually, after months of tests, of ventilator support, of failed treatments, and of desperate acts, he slipped away for reasons unknown.
Now it was my job to find out why. I’m a pathologist, one of the odd birds of medicine. Although we’re best known for performing autopsies (à la Quincy), we actually spend most of our time peering through microscopes at tiny snippets of tissue--called biopsies--in an attempt to understand a patient’s problem. Our role is that of final arbiter: to decide if a lump is benign or malignant, if a disease is a rare infection or a weird genetic disorder. This day my job was to piece together into a coherent diagnostic whole the story of this man’s demise.
I checked the toe tag, snapped a blade into a handle, and with strong strokes cut through the skin, down to bone. I made three such cuts: one from each shoulder diagonally to what is called the xiphoid process, a bit of cartilage found at the bottom of the breastbone, and a third from there down to the pubic bone. This opened up the whole torso. I peeled back the skin and removed first the ribs and then the lungs. As I held them cool in my hands, it was obvious that his had been a hopeless plight. The lungs, usually as light and airy as cotton candy, were as heavy and thick as liver.
