Fluff Alphabet!

Inspired by the NSFW Alphabet by @fairy-tail-babes.

Feel free to use for your own writing Blogs!

A ctivities - What do they like to do with their s/o? How do they spend their free time with them?

B eauty - What do they admire about their s/o? What do they think is beautiful about them?

C omfort - How would they help their s/o when they feel down/have a panic attack etc.?

D reams - How do they picture their future with their s/o?

E qual - Are they the dominant one in the relationship, or rather passive?

F ight - Would they be easy to forgive their s/o? How are they fighting?

G ratitude - How grateful are they in general? Are they aware of what their s/o is doing for them?

H onesty - Do they have secrets they hide from their s/o? Or do they share everything?

I nspiration - Did their s/o change them somehow, or the other way around? Like trying out new things or helped them overcome personal problems?

J ealousy - Do they get jealous easily? How do they deal with it?

K iss - Are they a good kisser? What was the first kiss like?

L ove Confession - How would they confess to their s/o?

M arriage - Do they want to get married? How do they propose? What would the marriage be like?

N icknames - What do they call their s/o?

O n Cloud Nine - What are they like when they are in love? Is it obvious for others? How do they express their feelings?

P DA - Are they upfront about their relationship? Do they brag with their s/o in front of others? Or are they rather shy to kiss etc. when others are watching?

Q uirk - Some random ability they have that’s beneficial in a relationship.

R omance - How romantic are they? What would they do to make their s/o happy? Cliché or rather creative?

S upport - Are they helping their s/o achieve their goals? Do they believe in them?

T hrill - Do they need to try out new things to spice out your relationship? Or do they prefer a certain routine?

U nderstanding - How good do they know their partner? Are they empathetic?

V alue - How important is the relationship to them? What is it’s worth in comparison to other things in their life?

W ild Card - A random Fluff Headcanon.

X OXO - Are they very affectionate? Do they love to kiss and cuddle?

Y earning - How will they cope when they’re missing their partner?

Z eal - Are they willing to go to great lenghts for the relationship? If so, what kind of?

So: Send me a character and one/several letter(s) and let’s get started!

Writing Notes: Autopsy

Autopsy - dissection and examination of a dead body and its organs and structures.

The word autopsy is derived from the Greek autopsia, meaning “the act of seeing for oneself.”

Also known as: necropsy, postmortem, postmortem examination

Why is an autopsy done?

To determine the cause of death

When a suspicious or unexpected death occurs

To observe the effects of disease; when there's a public health concern, such as an outbreak with an undetermined cause

To establish the evolution and mechanisms of disease processes

When no doctor knows the deceased well enough to state a cause of death and to sign the death certificate

When the doctor, the family or legally responsible designee of the deceased person requests an autopsy

Who does the autopsy?

Autopsies ordered by the state can be done by a county coroner, who is not necessarily a doctor

A medical examiner who does an autopsy is a doctor, usually a pathologist

Clinical autopsies are always done by a pathologist

How is an autopsy done?

After the patient is pronounced dead by a physician, the body is wrapped in a sheet or shroud and transported to the morgue, where it is held in a refrigeration unit until the autopsy.

Autopsies are rarely performed at night.

Autopsy practice was largely developed in Germany, and an autopsy assistant is traditionally honored with the title "diener", which is German for "helper".

The prosector and diener wear fairly simple protective equipment, including scrub suits, gowns, gloves (typically two pair), shoe covers, and clear plastic face shields.

The body is identified and lawful consent obtained.

The procedure is done with respect and seriousness.

The prevailing mood in the autopsy room is curiosity, scientific interest, and pleasure at being able to find the truth and share it.

Most pathologists choose their specialty, at least in part, because they like finding the real answers.

Many autopsy services have a sign, "This is the place where death rejoices to help those who live." Usually it is written in Latin ("Hic locus est ubi mors gaudet succurrere vitae").

EXTERNAL EXAMINATION

The prosector checks to make sure that the body is that of the patient named on the permit by checking the toe tag or patient wristband ID.

The body is placed on the autopsy table.

Experienced dieners, even those of slight build, can transfer even obese bodies from the carriage to the table without assistance.

Since the comfort of the patient is no longer a consideration, this transfer is accomplished with what appears to the uninitiated a rather brutal combination of pulls and shoves, not unlike the way a thug might manhandle a mugging victim.

The body is measured.

Large facilities may have total-body scales, so that a weight can be obtained.

The autopsy table is a waist-high aluminum fixture that is plumbed for running water and has several faucets and spigots to facilitate washing away all the blood that is released during the procedure.

Older hospitals may still have porcelain or even marble tables.

The autopsy table is basically a slanted tray (for drainage) with raised edges (to keep blood and fluids from flowing onto the floor).

After the body is positioned, the diener places a "body block" under the patient's back. This rubber or plastic brick-like appliance causes the chest to protrude outward and the arms and neck to fall back, thus allowing the maximum exposure of the trunk for the incisions.

Abnormalities of the external body surfaces are then noted and described, either by talking into a voice recorder or making notes on a diagram and/or checklist.

OPENING THE TRUNK

The diener takes a large scalpel and makes the incision in the trunk. This is a Y-shaped incision. The arms of the Y extend from the front of each shoulder to the bottom end of the breast bone (called the xiphoid process of the sternum). In women, these incisions are diverted beneath the breasts, so the "Y" has curved, rather than straight, arms. The tail of the Y extends from the xiphoid process to the pubic bone and typically makes a slight deviation to avoid the umbilicus (navel). The incision is very deep, extending to the rib cage on the chest, and completely through the abdominal wall below that.

With the Y incision made, the next task is to peel the skin, muscle, and soft tissues off the chest wall. This is done with a scalpel. When complete, the chest flap is pulled upward over the patient's face, and the front of the rib cage and the strap muscles of the front of the neck lie exposed. Human muscle smells not unlike raw lamb meat in my opinion. At this point of the autopsy, the smells are otherwise very faint.

An electric saw or bone cutter (which looks a lot like curved pruning shears) is used to open the rib cage. One cut is made up each side of the front of the rib cage, so that the chest plate, consisting of the sternum and the ribs which connect to it, are no longer attached to the rest of the skeleton. The chest plate is pulled back and peeled off with a little help of the scalpel, which is used to dissect the adherent soft tissues stuck to the back of the chest plate. After the chest plate has been removed, the organs of the chest (heart and lungs) are exposed (the heart is actually covered by the pericardial sac).

Before disturbing the organs further, the prosector cuts open the pericardial sac, then the pulmonary artery where it exits the heart. He sticks his finger into the hole in the pulmonary artery and feels around for any thromboembolus (a blood clot which has dislodged from a vein elsewhere in the body, traveled through the heart to the pulmonary artery, lodged there, and caused sudden death. This is a common cause of death in hospitalized patients).

The abdomen is further opened by dissecting the abdominal muscle away from the bottom of the rib cage and diaphragm. The flaps of abdominal wall fall off to either side, and the abdominal organs are now exposed.

REMOVING THE ORGANS OF THE TRUNK

The most typical method of organ removal is called the "Rokitansky method." This is not unlike field dressing a deer. The dissection begins at the neck and proceeds downward, so that eventually all the organs of the trunk are removed from the body in one bloc.

The first thing the diener does is to identify the carotid and subclavian arteries in the neck and upper chest. He ties a long string to each and then cuts them off, so that the ties are left in the body. This allows the mortician to more easily find the arteries for injection of the embalming fluids.

A cut is them made above the larynx, detaching the larynx and esophagus from the pharynx. The larynx and trachea are then pulled downward, and the scalpel is used to free up the remainder of the chest organs from their attachment at the spine.

The diaphragm is cut away from the body wall, and the abdominal organs are pulled out and down.

Finally, all of the organs are attached to the body only by the pelvic ligaments, bladder, and rectum.

A single slash with the scalpel divides this connection, and all of the organs are now free in one block. The diener hands this organ bloc to the prosector. The prosector takes the organ bloc to a dissecting table (which is often mounted over the patient's legs) and dissects it. Meanwhile, the diener proceeds to remove the brain.

Another method is called Virchow method, which entails removing organs individually.

EXAMINATION OF THE ORGANS OF THE TRUNK

At the dissection table, the prosector typically dissects and isolates the esophagus from the rest of the chest organs. This is usually done simply by pulling it away without help of a blade (a technique called "blunt dissection"). The chest organs are then cut away from the abdominal organs and esophagus with scissors. The lungs are cut away from the heart and trachea and weighed, then sliced like loaves of bread into slices about one centimeter thick. A long (12" - 18"), sharp knife, called a "bread knife" is used for this.

The heart is weighed and opened along the pathway of normal blood flow using the bread knife or scissors. Old-time pathologists look down on prosectors who open the heart with scissors, rather than the bread knife, because, while the latter takes more skill and care, it is much faster and gives more attractive cut edges than when scissors are used. The coronary arteries are examined by making numerous crosscuts with a scalpel.

The larynx and trachea are opened longitudinally from the rear and the interior examined. The thyroid gland is dissected away from the trachea with scissors, weighed, and examined in thin slices. Sometimes the parathyroid glands are easy to find, other times impossible.

The bloc containing the abdominal organs is turned over so that the back side is up. The adrenal glands are located in the fatty tissue over the kidneys (they are sometimes difficult to find) and are removed, weighed, sliced, and examined by the prosector.

The liver is removed with scissors from the rest of the abdominal organs, weighed, sliced with a bread knife, and examined. The spleen is similarly treated.

The intestines are stripped from the mesentery using scissors (the wimpy method) or bread knife (macho method). The intestines are then opened over a sink under running water, so that all the feces and undigested food flow out. As one might imagine, this step is extremely malodorous. The resultant material in the sink smells like a pleasant combination of feces and vomitus. The internal (mucosal) surface of the bowel is washed off with water and examined. It is generally the diener's job to "run the gut," but usually a crusty, senior diener can intimidate a young first- year resident prosector into doing this ever-hated chore. Basically, whichever individual has the least effective steely glare of disdain is stuck with running the gut.

The stomach is then opened along its greater curvature. If the prosector is lucky, the patient will have not eaten solid food in a while. If not, the appearance of the contents of the stomach will assure the prosector that he will not be eating any stews or soups for a long time. In either case, the smell of gastric acid is unforgettable.

The pancreas is removed from the duodenum, weighed, sliced and examined. The duodenum is opened longitudinally, washed out, and examined internally. The esophagus is similarly treated.

The kidneys are removed, weighed, cut lengthwise in half, and examined. The urinary bladder is opened and examined internally. In the female patient, the ovaries are removed, cut in half, and examined. The uterus is opened along either side (bivalved) and examined. In the male, the testes are typically not removed if they are not enlarged. If it is necessary to remove them, they can be pulled up into the abdomen by traction on the spermatic cord, cut off, cut in half, and examined.

The aorta and its major abdominal/pelvic branches (the renal, celiac, mesenteric, and iliac arteries) are opened longitudinally and examined.

Most of the organs mentioned above are sampled for microscopic examination. Sections of the organs are cut with a bread knife or scalpel and placed in labeled plastic cassettes. Each section is the size of a postage stamp or smaller and optimally about three millimeters in thickness. The cassettes are placed in a small jar of formalin for fixation. They are then "processed" in a machine that overnight removes all the water from the specimens and replaces it with paraffin wax. Permanent microscopic sections (five microns, or one two-hundredth of a millimeter thick) can be cut from these paraffin sections, mounted on glass slides, stained, coverslipped, and examined microscopically. The permanent slides are usually kept indefinitely, but must be kept for twenty years minimum.

Additional small slices of the major organs are kept in a "save jar," typically a one-quart or one-pint jar filled with formalin. Labs keep the save jar for a variable length of time, but at least until the case is "signed out" (i.e., the final written report is prepared). Some labs keep the save jar for years. All tissues that are disposed of are done so by incineration.

A note on dissection technique: All of the above procedures are done with only four simple instruments -- a scalpel, the bread knife, scissors, and forceps (which most medical people call "pick-ups." Only scriptwriters say "forceps"). The more handy the prosector, the more he relies on the bread knife, sometimes making amazingly delicate cuts with this long, unwieldy-looking blade. The best prosectors are able to make every cut with one long slicing action. To saw back and forth with the blade leaves irregularities on the cut surface which are often distracting on specimen photographs. So the idea is to use an extremely sharp, long blade that can get through a 2000-gram liver in one graceful slice. Some old-time purist pathologists actually maintain their own bread knives themselves and let no one else use them. Such an individual typically carries it around in his briefcase in a leather sheath. This would make an excellent fiction device, which, to my knowledge, has not been used. Imagine a milquetoast pathologist defending himself from a late-night attacker in the lab, with one desperate but skillful slash of the bread knife almost cutting the assailant in half!

Note on the appearance of the autopsy suite: Toward the end of the autopsy procedure, the room is not a pretty sight. Prosectors vary markedly in how neat they keep the dissection area while doing the procedure. It is legendary that old-time pathologists were so neat that they'd perform the entire procedure in a tux (no apron) right before an evening at the opera (pathologists are noted for their love of classical music and fine art). Modern prosectors are not this neat. Usually, the autopsy table around the patient is covered with blood, and it is very difficult not to get some blood on the floor. We try to keep blood on the floor to a minimum, because this is a slippery substance that can lead to falls. The hanging meat scales used to weigh the organs are usually covered with or dripping with blood. The chalk that is used to write organ weights on the chalkboard is also smeared with blood, as may be the chalkboard itself. This is an especially unappetizing juxtaposition.

Another example using the Virchow method:

After the intestines are mobilized, they may be opened using special scissors.

Inspecting the brain often reveals surprises. A good pathologist takes some time to do this.

The pathologist examines the heart, and generally the first step following its removal is sectioning the coronary arteries that supply the heart with blood. There is often disease here, even in people who believed their hearts were normal.

After any organ is removed, the pathologist will save a section in preservative solution. Of course, if something looks abnormal, the pathologist will probably save more. The rest of the organ goes into a biohazard bag, which is supported by a large plastic container.

The pathologist weighs the major solid organs (heart, lungs, brain, kidneys, liver, spleen, sometimes others) on a grocer's scale.

The smaller organs (thyroid, adrenals) get weighed on a chemist's triple-beam balance.

The next step in the abdominal dissection will be exploring the bile ducts and then freeing up the liver. The pathologist uses a scalpel or other similar tool.

After weighing the heart, the pathologist completes the dissection. There are a variety of ways of doing this, and the choice will depend on the case. If the pathologist suspects a heart attack, a long knife may be the best choice.

In the example: The liver is removed. The pathologist finds something important. It appears that the man had a fatty liver. It is too light, too orange, and a bit too big. Perhaps this man had been drinking heavily for a while.

The pathologist decides to remove the neck organs, large airways, and lungs in one piece. This requires careful dissection. The pathologist always examines the neck very carefully.

The liver in this example weighs much more than the normal 1400 gm.

The lungs are almost never normal at autopsy. In the example, the lungs are pink, because the dead man was a non-smoker. The pathologist will inspect and feel them for areas of pneumonia and other abnormalities.

The liver is cut at intervals of about a centimeter, using a long knife. This enables the pathologist to examine its inner structure.

The pathologist weighs both lungs together, then each one separately. Afterwards, the lungs may get inflated with fixative.

The rest of the team continues with the removal of the other organs. They may decide to take the urinary system as one piece, and the digestive system down to the small intestine as another single piece. This will require careful dissection.

One pathologist holds the esophagus, stomach, pancreas, duodenum, and spleen. He opens these, and may save a portion of the gastric contents to check for poison.

Another pathologist holds the kidneys, ureters, and bladder. Sometimes these organs will be left attached to the abdominal aorta. The pathologist opens all these organs and examine them carefully.

Dissecting the lungs can be done in any of several ways. All methods reveal the surfaces of the large airways, and the great arteries of the lungs.

Most pathologists use the long knife again while studying the lungs. The air spaces of the lungs will be evaluated based on their texture and appearance.

Before the autopsy is over, the brain is usually suspended in fixative for a week so that the later dissection will be clean, neat, and accurate.

If no disease of the brain is suspected, the pathologist may cut the brain fresh.

The kidneys are weighed before they are dissected.

It is the pathologist's decision as to whether to open the small intestine and/or colon. If they appear normal on the outside, there is seldom significant pathology on the inside.

One pathologist prepares the big needle and thread used to sew up the body.

When the internal organs have been examined, the pathologist may return all but the tiny portions that have been saved to the body cavity. Or the organs may be cremated without being returned.

The appropriate laws, and the wishes of the family, are obeyed.

The breastbone and ribs are usually replaced in the body.

The skull and trunk incisions are sewed shut ("baseball stitch").

The body is washed and is then ready to go to the funeral director.

These notes do not show all the steps of an autopsy, but will give you the general idea.

During the autopsy, there may be photographers, evidence technicians, police, hospital personnel, and others.

In the example, the pathologists submit the tissue they saved to the histology lab, to be made into microscopic slides.

When these are ready, they will examine the sections, look at the results of any lab work, and draw their final conclusions.

The only finding in this sample autopsy was fatty liver. There are several ways in which heavy drinking, without any other disease, can kill a person. The pathologists will rule each of these in or out, and will probably be able to give a single answer to the police or family.

CLOSING UP AND RELEASING THE BODY

After all the above procedures are performed, the body is now an empty shell, with no larynx, chest organs, abdominal organs, pelvic organs, or brain. The front of the rib cage is also missing. The scalp is pulled down over the face, and the whole top of the head is gone. Obviously, this is not optimal for lying in state in public view. The diener remedies this problem. First, the calvarium is placed back on the skull (the brain is not replaced), the scalp pulled back over the calvarium, and the wound sewn up with thick twine using the type of stitch used to cover baseballs. The wound is now a line that goes from behind the ears over the back of the skull, so that when the head rests on a pillow in the casket, the wound is not visible.

The empty trunk looks like the hull of a ship under construction, the prominent ribs resembling the corresponding structural members of the ship. In many institutions, the sliced organs are just poured back into the open body cavity. In other places, the organs are not replaced but just incinerated at the facility. In either case, the chest plate is placed back in the chest, and the body wall is sewn back up with baseball stitches, so that the final wound again resembles a "Y."

The diener rinses the body off with a hose and sponge, covers it with a sheet, and calls the funeral home for pick- up. As one might imagine, if the organs had not been put back in the body, the whole trunk appears collapsed, especially the chest (since the chest plate was not firmly reattached to the ribs). The mortician must then remedy this by placing filler in the body cavity to re-expand the body to roughly normal contours.

Ultimately, what is buried/cremated is either 1) the body without a brain and without any chest, abdominal, or pelvic organs, or 2) the body without a brain but with a hodgepodge of other organ parts in the body cavity.

FINISHING UP

After the funeral home has been called, the diener cleans up the autopsy suite with a mop and bucket, and the prosector finishes up the notes and/or dictation concerning the findings of the "gross exam" (the part of the examination done with the naked eye and not the microscope; this use of the term "gross" is not a value judgement but a direct German translation of "big" as opposed to "microscopic").

For some odd reason, many prosectors report increased appetite after an autopsy, so the first thing they want to do afterwards is grab a bite to eat.

The whole procedure in experienced hands, assuming a fairly straightforward case and no interruptions, has taken about two hours.

Complicated cases requiring detailed explorations and special dissections (e.g., exploring the bile ducts, removing the eyes or spinal cord) may take up to four hours.

AFTER THE AUTOPSY

Days to weeks later, the processed microscopic slides are examined by the attending pathologist, who renders the final diagnoses and dictates the report.

A final report is ready in a month or so. The glass slides and a few bits of tissue are kept forever, so that other pathologists can review the work.

Only the pathologist can formally issue the report, even if he or she was not the prosector (i.e., the prosector was a resident, PA, or med student).

The report is of variable length but almost always runs at least three pages. It may be illustrated with diagrams that the prosector draws from scratch or fills in on standard forms with anatomical drawings.

The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), which certifies hospitals, requires the final report to be issued within sixty days of the actual autopsy.

The College of American Pathologists, which certifies medical laboratories, requires that this be done in thirty days.

Nevertheless, pathologists are notorious for tardiness in getting the final report out, sometimes resulting in delays of years.

Perhaps the non-compensated nature of autopsy practice has something to do with this. Pathologists are otherwise very sensitive to turnaround times.

THE BRAIN-CUTTING

The examiner returns to the brain left suspended in a big jar of formalin for a few weeks. After the brain is "fixed," it has the consistency and firmness of a ripe avocado.

Before fixation, the consistency is not unlike that of three-day- old refrigerated, uncovered Jello.

Infant brains can be much softer than that before fixation, even as soft as a flan dessert warmed to room temperature, or worse, custard pie filling. Such a brain may be difficult or impossible to hold together and can fall apart as one attempts to remove it from the cranium.

Assuming good fixation of an adult brain, it is removed from the formalin and rinsed in a running tap water bath for several hours to try to cut down on the discomforting, eye-irritating, possibly carcinogenic formalin vapors.

The cerebrum is severed from the rest of the brain (brainstem and cerebellum) by the prosector with a scalpel.

The cerebellum is severed from the brainstem, and each is sliced and laid out on a tray for examination.

The cerebrum is sliced perpendicularly to its long axis and laid out to be examined.

Sections for microscopic processing are taken, as from the other organs, and a few slices are held in "save jars."

The remainder of the brain slices is incinerated.

Sources: 1 2 3 4

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sillyoscfan

2 months ago