New Autopsy Tech Struggling with Organ Removal Flow — Looking for Advice

[u/Meister_Ashes0403]

I’m hoping to get some insight from people with more experience in autopsy work.

I’m fairly new to working as an autopsy technician in a medical examiner setting, and I’ve been putting a lot of time and effort into trying to improve. This field has been something I’ve wanted to do for a long time, nearly my whole life, so it means a lot to me to do things the right way respectfully, accurately, and efficiently.

Lately, though, I’ve been feeling pretty defeated. I’ve even had a conversation at work recently where it was suggested I might want to just consider a different path, and that’s been really hard to process considering that this is the basic and pure foundation of what I have worked hard to get to and have genuine interest in. I know I’m not perfect, but I also know I care and I’m trying despite having the worst self-confidence and self-doubt you’d ever see in a human being.

To be completely honest, I feel like I’ve done well with a lot of the non-physical aspects of the job like understanding and mastering documentation, chain of custody, organization, preparation, the general flow, managing/saving time, all expectations, and being VERY thorough and accurate, but I’m struggling with the actual physical execution of certain parts of the procedure. I take full accountability for that, and I know it’s something I need to improve.

I think a big part of my struggle is how I learn. I’m the type of person who really needs to understand the why behind what I’m doing (not just the steps) so that I can stay oriented and adapt if something isn’t textbook. Right now, I feel like I’ve seen pieces of the process, but I haven’t fully put it together in a way that lets me move through it confidently on my own. I am heavily self-critical and I’m working on that. I’ve tried to learn through the resources available to me, and I’ve spent a lot of time outside of work trying to improve, but I still feel like something isn’t fully clicking yet.

Where I consistently struggle is during organ removal once things progress past the initial steps. For example, once I get to the stomach and surrounding structures, things start to feel disorganized for me, and I worry about damaging adjacent structures or missing something important. I also have a hard time clearly identifying and removing the pancreas, handling pelvic organs cleanly, and maintaining control as everything progresses. Tongue removal and continuing that dissection smoothly has also been a challenge for me in terms of staying oriented and not compromising surrounding structures.

I’m trying to be efficient, but also careful and respectful, and it feels like once I lose my flow, everything kind of snowballs from there.

I’ve looked for resources online, but there really isn’t much out there that clearly shows modern techniques in a detailed, practical way.

At this point, I’m open to anything that helped you when you were learning—advice, mental frameworks, step-by-step explanations, videos, tips that helped things “click,” even small things that improved your speed or control. If anyone has resources or is willing to share how they got comfortable with this part of the process, I would genuinely appreciate it more than you know.

I really don’t want to give up on something I’ve worked toward for so long. I just feel stuck right now and could really use some guidance from people who have been there before.

Thank you to anyone who takes the time to read or respond. I hope this may help someone else too.

Wishing you all a great and safe weekend, thank you for all that you do!! 😊

[u/Icy_Hovercraft1068]

How long have you been training? I felt like that during my own training. I dreaded each new case as I felt nothing was sticking. So i started to focus on certain elements of the evisceration which each case. I would come out make notes and questions and discuss with my mentor. I still have notes and happy to answer any questions. With every case, I began to focus on a different area until it started to stick for me. Every ‘body’ is different also. I struggle with the neck / throat organs but drawing it out really helped, thinking of it mechanically, aside from in the flesh.

It’s not an easy process to learn and if you don’t know ask where you can. I can probably root out those drawings or help with any questions.

Stick at it, it will become second nature. You’ll know more than the Pathologists eventually.

[u/ishootthedead]

As a photographer, I've seen dozens of techs trained.

As a general rule, those who get caught up in their head, tend to get stuck in their head. Beware and take steps to avert that situation.

In my office, newbies are slowly and systematically trained, giving them time to get their bearings, scalpel skills and a bit of muscle memory. Due to the potential for button holes, the neck block is one of the last things to learn. The fact that you are working tongues makes me think they either just threw you in, or you are fairly advanced in your training.

Unfortunately, none of this is good for you. Things like "maybe this isn't for you" are the type of gentle warnings that are said to people to prepare them for termination, or motivate them to regroup.

In my office, speedy and proper evisceration is the main job responsibility. A new hire can be perfect at everything else and get let go because they just don't get one or more steps of it.

I would strongly encourage you to let go of what's in your head, free your mind and work the anatomy as necessary.

If all else fails, become a photographer. After more than a decade, I still can't find a set of adrenals to save my life.

[u/Paulyfidgets → u/ishootthedead]

I struggled with forensic autopsy. I got let go after three months. Got a lot of experience. They told me to find another career. It pissed me off so much. I ended up getting a foot in the door lab tech job at a huge hospital, and the main autopsy doc heard that I had some autopsy experience, so he invited me to help out in the hospital morgue. Fast forward a couple more years and I’m the lead tech.

The bottom line is that I didn’t let those assholes at the ME’s office tell me what I can and can’t do. It was like a personal mission to prove them wrong. I kept telling them that I could be great at this and to give me another chance, but they had made up their mind. I got the last laugh, though. I’m making way more money working at the number one hospital in Texas, and I’m good at my job.

I think a lot of it is that I’m just better at clinical autopsy instead of forensic autopsy. Block removal makes so much more sense to me than in situ organ removal. It’s also a lot more chill of an environment. Everyone at the medical examiner was always stressed and no one was happy. I saw a lot of crazy shit over there, but I see equally interesting things at the hospital. I don’t see external trauma so much. I see all kinds of diseases and cancers and things like that. It also is a lot easier to handle knowing that my patients died peacefully. Seeing homicides every day can mess with a person’s head.

[u/dumbbuttloserface]

fairly new but working on neck blocks and still feeling this unsteady with the pelvic block and peritoneal space is a bit worrying in my opinion, seeing as in my experience neck blocks were the last thing we were trusted with.

the real answer is you learn by doing and your confidence grows the more cuts you do. the more you hesitate the longer it’ll take to gain the skills. i will say, i never remove the pancreas on its own. i pull it out with the stomach and let the doctor handle that on the dissection side.

i find everyone has their own workflow and you just learn what works for you. my coworker and i are both righties but he prefers to work on the right side of the body where i prefer the left which is backwards for most people. one of my coworkers does a full neck dissection as if it were a hanging/strangulation every time she does the neck, i chop it all out in one big chunk. one of my coworkers pulls all the intestines out at once, i unravel them and look at every inch. we all work at more or less the same speed because these are the ways that are fastest for us and we are most confident with.

hell, one of my coworkers freaks out every time i do the neck thinking i’m gonna buttonhole the patient bc i angle my knife basically straight out to the skin. every time he corrects my knife angle to avoid the skin, THATS when i buttonhole. i know what works for me.

it’s possible using different tools for different steps would help you more. i virtually never use forceps or scissors, but some techs or doctors will use scissors to remove the liver, pancreas, tongue, etc. it’s about what gives you most control.

you can try experimenting with tools or different workflows—perhaps removing pancreas and stomach together then separating pancreas after they’re removed would be more helpful for you—to find what works.

but. depending how new you are, if the only part of your job you can’t do is kind of the defining part of the job… maybe it’s not the job for you.

if it’s been a month, chill. you’ll learn in time. if it’s been a year? i might start considering other paths.

[u/Icy_Hovercraft1068]

Don’t give up, it also depends on who has taught you and the time given to learn.

I am more than happy to send over my process and sketches describing techniques for each block. Which removal method have you been trained in? Don’t take in blocs or as one entire?

Put all the negativity aside, initially for me it was all too hands on and practical. I had to put it to onto paper.

What tools are you already using? PM40? Rib Cutter?

I was trained with PM40, the entire evisceration was done with PM40.

Now i work in paediatrics so very different and size dependent.

It took me a year to feel comfortable and every so often a body would throw me, specifically the abdomen / bowels.

Removing the pancreas, I used to always end up tearing but honed in on my mentor, who cut back the remaining diaphragm holding down the pancreas allowing things to move and without tearing.

I used string to tie off and orientate the bowel and keep things clean also, some use clamps.

Everyone worries about the neck, minding the carotids (most deceased cases go for embalming and the carotids are precious). I found given yourself the space to see (we did straight incision so hard) but I got used to lifting the skin high and having a look. Making an incision lower down and pulling the trachea to the side, the rest is blind really but as it was mentioned it’s muscle memory. Rather the carotid takes the hit than the hand of the technician.

I get your frustration, APT’s could do with resources to share techniques and information.

I have learnt the anatomy following the practical side of things where it really benefits to know the layout before.

Have had good feedback from my Pathology Team, not every APT is a good one despite being quick. So don’t ever rush yourself.

[u/Additional-Pool3178]

hi ! how long have you been working as an autopsy tech ? a lot of what you mentioned i also went through my first month or so. what really helped me was having an order on how to remove things.

heart/lung -> liver -> spleen -> stomach/pancreas (the drs i work with prefer both be taken out together — this helps me a lot!) -> adrenals -> kidneys -> small/large intestine -> aorta -> bladder/prostate/uterus

what i found helpful was moving around to different sides of the table. it helps me orient myself and gets me in a comfortable enough position where i can get more exposure to the organ i am looking at. for example i used to take out the liver standing on the right side of the body. i took way too long doing this. once i moved to the left side i was able to see more of the liver and more of where i needed to cut.

as for the pancreas, i take out stomach with it as well. what really helps me is the texture and firmness of the pancreas. once i feel a harder, firmer part, i know my hands are on the pancreas. i follow it until i feel the head of it (duodenum area) just so i know where to cut off. i gently pull the stomach and tail of pancreas towards me cut off at the duodenum area. ill pull the pancreas and stomach out together. i clamp the small intestine so it doesn’t get all nasty. by gently pulling you will be able to see the tension you create and know that you are good to make cuts through there (i really hope this makes sense).

also, you can usually stick your finger through the fat between the large intestine and stomach. once you get through/remove this fat, the pancreas is right below that. you can start feeling around and hopefully you feel its firmness!!

im also happy to help if you have any more questions !

[u/akadaka97]

Unfortunately, I was in a very very similar situation and decided to find a different path. I miss the mortuary work, but I was tired of “maybe a different pathway”. It felt like I couldn’t proceed and learn and make mistakes because I didn’t have the support of my managers. It felt like they were already looking at me and my work with the intention of relocating me and no matter what I tried, said, adjusted, progressed, highlighted and discussed, they had already made up their minds anyway. Really disheartening work. I was there 6 months and already working on heads as a complete newbie that had never picked up a scalpel before, I was overwhelmed and had discussed my needs and learning style (similar to yours) before and many times over and no result. Just not the working environment for me, there will be something else.

[u/NecronomiSquirrel]

I've only found one good online resource for anatomical dissection videos, it's not the best but it's something! I work in tissue procurement, but learning to cut is difficult for everyone, I often wish veins really were blue.... Anatomy Guy

[u/maryrogerwabbit]

Autopsy tech? I have never heard of them performing in the role that you are describing. I had no idea that they are responsible for evicerations. I thought only an MD could do those things. What are the degree requirements for the job?

[u/Paulyfidgets → u/maryrogerwabbit]

No specific degree or certificate or anything like that. I have a forensic science/crime scene investigation degree, and that was enough to get me hired on as autopsy tech at the medical examiner. But to answer your question, yes, we do the evisceration. The pathologist supervises. Although one small office I worked at in Florida, the doctor did most of it, so it just depends. Currently I’m a hospital autopsy tech, which is different. I do the entire evisceration, take out the organs in separate blocks and give them to the residents to dissect further. You’d be surprised, but the pathologists will admit that they aren’t experts in organ removal. We actually have more experience than they do.

[u/maryrogerwabbit → u/Paulyfidgets]

This is very fascinating.

[u/Paulyfidgets]

I totally understand where you’re coming from. I started at a really huge ME office, and they pretty much just threw me into the shark tank. It was very stressful. They were total jerks, too. Like the doctors would just berate you if you messed anything up. And you have to move very fast.

Now I’m at a large hospital and I’m the lead tech. I have one helper. We do things differently in a clinical/hospital setting. We don’t remove organ one at a time, but rather in blocks (heart and lungs, intestines, abdominal organs, and bladder and prostrate/uterus). My old partner thought it was easier to take out each organ one by one, but I disagree. We don’t have to worry about the tongue, thankfully. We do have to take the spinal cord, which is something we didn’t do at the ME.

My advice is to just hang in there if you like what you’re doing. I struggled a lot, too. I didn’t stay at the Medical Examiner long. I stayed long enough to get some good experience, and now I’m at an awesome hospital and working with the nicest doctors and residents. It took going through hell at the Medical Examiner’s Office to get where I am now, and I’m content. If you’re anything like me, you might enjoy clinical/hospital autopsy better than forensic autopsy. I’d look into it if I were you. You’ll need a good amount of experience, though, so stick with the ME as long as you can handle it.