Mary: Autopsies Save Lives

Early in the pandemic, when little was known about the SARS-CoV-2 virus, neuropathologist Mary Fowkes, MD, PhD, volunteered to perform autopsies on COVID-19 victims. Wearing a full-body protective suit and often working alone, she painstakingly examined the virus’s impact on the brain. What she and her team found shocked her—significant blood clots in the brain and vital organs. The discovery led to the increased use of blood thinners in COVID-19 patients. In this episode, Dr. Fowkes tells her COVID-19 story and explains why autopsies are so important.

Dr. Fowkes died on Nov. 15, 2020 of an acute heart attack. An autopsy did not reveal the presence of COVID-19.

Links

• Mount Sinai Analysis of COVID-19 Autopsies Reveals Many Details About This Disease 
• Pathology Clinical Services
• Neuropathology Fellowship at The Mount Sinai Hospital
• Dr. Fowkes' obituary in the New York Times and The Lancet

Episode Transcript

DR. MARY FOWKES (00:02):
I love to hike.
I love to be outdoors.
I love animals.
I love to fish.
I absolutely love to fish.
I'll get up at anytime in themorning—I'd get up in the middle
of the night to go fishing.
It's kind of like the autopsystuff.
I don't know.
I just find it really exciting.

(00:23):
I'm Dr.
Mary Fowkes.
I'm Director of theNeuropathology Division, as well
as the Autopsy Service here atthe Icahn School of Medicine.
I have always been good atdissecting things from even when
I was little.
I've always been the one thatfilleted the fish and was the
go-to person—if there was amedical, an animal that was
hurt, I was the go-to person tobring the animal to.

(00:45):
Oh, and my grandmother had astuffed skunk in her attic.
And I just thought that was thecoolest thing.
So that probably started me onthe path.
Pathology is like being adetective.
You can investigate what's goingon with the patient.

(01:09):
And we have the gold standard ofdiagnosis.
We have the best answer fortrying to help the patient.
And I like that.
I like being able to helppatients.
So now we're in the basement ofthe hospital.
Most morgues or autopsy suitesare in the basement, just by
convention.

PRODUCER (01:29):
Why is that?

DR. MARY FOWKES (01:29):
They get us out of the way.
So this patient had a priorstroke affecting the right
frontal lobe and right temporallobe.
So we're going to cut it and seeif we can identify evidence of
the stroke.
Sometimes people have a hardtime dealing with things that

(01:50):
are not what they expect.
So just leave the room, sitdown, collect yourself.
Nothing to be ashamed of.
But I don't want people passingout.
People have this perception thatit's gory and bloody.
And it's how it's portrayed onTV, in some horror movie, you

(02:12):
know, blood shooting everywhere.
And it's not like that.
And in most instances, if youtalk to families and you explain
to them that an autopsy is donevery carefully with
surgical-like incisions, and wecan sometimes provide important
information for familiesrelating to inheritable

(02:33):
diseases, patients usually wantto have an autopsy.
Okay so I'm going to cut this.
If you approach thingssystematically, look at the
vessels, you look at the cranialnerves, and try not to focus on

(02:55):
lesions that you immediately seewhen you cut the brain.
So your eye is drawn to thingsthat are interesting, but you
have to systematically look ateverything so that you don't
miss things.
I've always thought thatautopsies were important, but
then when COVID hit, it just hitme so hard how important they

(03:20):
can be.
I was one of four pathologistshere at Mount Sinai that were
willing to volunteer to do theCOVID autopsies, despite the
risk.
I didn't tell my kids.
My daughter didn't know untilone of my colleagues posted a
picture of me in a full PAPR.

(03:41):
I told my kids I wasn't doingautopsies.
I wasn't doing the generalautopsy, I was just doing the
brains.
So I felt like I kind of wasn'ttotally lying.
The first time that I did aCOVID autopsy.
I learned very quickly that youhave to go slow and calm when

(04:04):
you're working with a PAPR.
It's like a space suit.
You're not gonna breathe what'sin the room.
You're gonna only breathe what'sgone through the machine.
But I had one incident where itstarted going off in the middle
of doing the brain removals.
"Beep beep beep beep." And thenif it continues to not be

(04:25):
working properly, where the airis not coming into the hood
properly or into the suitproperly, it has a continuous
beep,"Bzzz." That's when Ireally started getting nervous.
Then I realized, yes, I canstill breathe.
Does that mean that it's notprotecting me from the air
that's in the room?

(04:47):
So I finished the work that Iwas doing.
I waited the 15 minutes.
I took off the hood and then Iwent home and see if you come
down with symptoms.
We did a total of 102 COVIDcases and we've done at least
four more now that arepost-COVID.
We found that the lungs wereseverely affected and we found

(05:10):
blood clots throughout the body,but most importantly within the
brain.
So patients with strokes.
That was shocking.
And we made sure that theclinical team here at Mount
Sinai was aware that concernabout blood clots needed to be
followed in these COVIDpatients.

(05:31):
I'm really not that talented.
I'm not that smart.
I have my faults.
But I work really, really hardand I pull it off.
So I am seeing some changeshere.
There's a stroke in the rightside of the brain.

(05:51):
It's an area of graydiscoloration, softening, and
it's knocking out portions ofthe white matter.
It's about maybe two centimetersfront to back in measurement.
So it's pretty big stroke.
I think that autopsies arephenomenal.
I don't understand why moreclinicians don't push for them.

(06:14):
We've had people say,"We didn'twant to put the patient through
an autopsy." Well, the patient'sdead.
The autopsy's gonna help theliving.
It's the last gift that apatient can give to their
family.
And it makes the family feelbetter most of the time.

(06:35):
It provides this little glimmerof good out of something that is
really hard.
So, if I had a billboard inTimes Square, I would put,
"Autopsies save lives." Becausethey do.

DR. CARLOS CORDON-CARDO (06:56):
One, two, three.
I'm Carlos Cordon-Cardo.
I'm the Professor and Chair ofthe Department of Pathology at
the Icahn School of Medicine atMount Sinai.
We are saddened and shocked bythe passing of our esteemed and
beloved colleague Mary Fowkes,who passed peacefully at her

(07:17):
home of an acute heart attack.
The autopsy didn't reveal anyCOVID disease.
She was truly heroic in herefforts during COVID-19, where
the findings from autopsychanged clinical care at Mount
Sinai with national andinternational repercussions
during the first surge of 2020.

(07:39):
She was cherished by theresidents, fellows, staff, and
all faculty members.
A friend to all, she was alwayshelping others and always with a
smile.
We will miss her teaching, herbrilliance and great sense of
humor.
We will miss her gentlecharacter.

(08:00):
We will miss an outstandingcolleague and mentor.
We will miss a friend.