Steady Hands, Soft Heart: Staying Human in Forensic Pathology

“Wait…that doesn’t bother you?”

I have been asked some version of this question more times than I can count.

Usually, it happens after someone finds out that before medical school, I spent several years working in a medical examiner’s office.

There is normally a brief pause while they process that information. Then comes the follow-up.

“Like…you actually saw autopsies?” Yes.

“And dead people?” That is generally a fairly important component of the medical examiner’s office, yes.

Then their face changes slightly.

“And that didn’t freak you out?”

And that is where the answer gets a little more complicated.

When I tell people that I want to become a forensic pathologist, there is sometimes an assumption that I must have some unusual ability to look at things other people find disturbing and simply…feel nothing.

As if somewhere in my genetic code there is a tiny mutation labeled “completely unbothered by autopsies.”

I can assure you, there is not.

I was not born magically immune to blood, injuries, death, or the emotional weight of seeing the human body in ways most people never will. I did not walk into a medical examiner’s office for the first time, take one look around, and think, "Ah yes. Completely normal. Anyway, what’s for lunch?"

There was an adjustment.

Of course there was.

But over time, something changed.

Things that initially demanded all of my attention because they were unfamiliar eventually became less shocking. I learned what I was looking at. I learned what mattered, what questions to ask, and how to focus on the work in front of me rather than my immediate reaction to it.

Eventually, the question stopped being: "How am I looking at this?"

and became: "What am I looking at?"

That distinction has become incredibly important to me.

There is a strange conversation around graphic content in medicine, especially in fields like surgery, emergency medicine, trauma, and, of course, forensic pathology. We talk about developing a “strong stomach.” We joke about whether someone can handle blood. We assume that people who spend enough time around severe illness, injury, and death eventually become desensitized to all of it.

And in one sense, that is not entirely wrong.

You do adapt.

Honestly, you have to.

A physician cannot do their job well if every difficult thing they encounter completely overwhelms their ability to think. A forensic pathologist has to examine injuries, interpret findings, and determine what those findings can, and cannot, tell us about how someone died.

That requires emotional steadiness.

When I eventually become a forensic pathologist, I want to be able to look carefully. I want to notice details. I want to think about anatomy, disease, injury, toxicology, and circumstances. I want to give the person in front of me the same careful examination whether the case is straightforward or incredibly difficult.

And to do that, I need enough distance to think clearly.

But distance and indifference are not the same thing.

There are things I can see now that would have affected me very differently the first time I encountered them. That does not mean they have stopped mattering.

It means my brain has learned how to move past some of the initial shock so I can pay attention to what matters instead.

I think that is one of the quieter transformations that happens when you spend enough time around medicine: the extraordinary slowly becomes familiar.

Familiarity changes your reaction.

But I do not think familiarity has to change your humanity.

That is the part I care about protecting.

I do not want to spend my career recoiling from the realities of death. That would not make me particularly useful as a forensic pathologist.

But I also never want to become so accustomed to those realities that I forget what they represent.

Because a case that feels routine to me someday may represent the worst day of someone else's life.

An autopsy may eventually be something I have performed hundreds of times, but it will still be this person's autopsy.

And there may be a family somewhere waiting for the answers that come from it.

Suddenly, “Doesn't that bother you?” feels like the wrong question.

Maybe the better question is: "How do you learn to stand in the presence of difficult things without either looking away or forgetting to care?"

I do not think I have the complete answer to that yet.

I am still a medical student. I am still learning what kind of physician I will become, and there are plenty of experiences ahead of me that I have not encountered yet.

But after spending years around forensic medicine before medical school, and now learning medicine from the other side of that dream, I have started to understand one thing: the goal was never to become someone who is not affected by difficult things.

The goal is to become someone who can stand in their presence, think clearly, and still do the work with care.

And there is a very big difference between the two.

The First Time Is Different

I think one of the easiest things to forget once something becomes familiar is just how unfamiliar it used to be.

There was a time when I had never stepped inside a medical examiner’s office.

There was a time when I had never watched an autopsy.

There was a time when everything I knew about forensic medicine came from textbooks, television, and the slightly concerning amount of forensic content I had consumed since childhood.

And, unsurprisingly, none of that is quite the same as standing in the room.

Real forensic medicine is quieter than television makes it seem.

There is no dramatic soundtrack playing in the background...though you might hear some Tate McRae if I have anything to say about it. No perfectly timed revelation before the commercial break. No investigator dramatically removing their sunglasses while someone announces the exact cause of death after approximately twelve seconds of examination.

Tragic, honestly. Television really oversold that part.

Instead, there is a person in front of you.

And I think that was one of the first things I began to understand when I entered the medical examiner’s office.

This was not a case written for me to solve.

It was not a photograph in a textbook.

It was not an anatomy model where every structure was conveniently colored, labeled, and behaving exactly as expected.

This was someone.

That reality changes the room.

When people ask about my earliest experiences in forensic medicine, they sometimes expect the answer to center around whether something looked “gross” or whether I felt sick. I understand why. Before you have been around this kind of work, the graphic component feels like the biggest part of it.

But when I think back on learning to exist in that environment, I do not think the most important adjustment was simply learning how to tolerate what I could see.

It was learning how to see it.

At first, your brain notices everything because everything is new: the room, the equipment, the terminology, the process, and the reality of death when it is no longer theoretical.

But slowly, the unfamiliar starts becoming understandable.

You learn the routine.

You learn the anatomy.

You learn why certain steps happen in a certain order.

You start recognizing findings instead of simply noticing them.

You understand why samples are collected, why photographs are taken, why documentation has to be meticulous, and why something that looks insignificant to an untrained eye might matter enormously to an investigation.

The visual component does not necessarily disappear. Your attention just becomes more purposeful.

Instead of: "Oh my God, that's an injury."

your brain begins asking: "What kind of injury is this? Where is it located? What structures are involved? Does it fit with the circumstances we've been given? What else do we need to examine?"

Curiosity begins occupying some of the space that shock used to take up.

Not curiosity in a sensational way.

Clinical curiosity.

The kind that says, there is information here, and I need to understand what it means.

That shift is one of the reasons I fell in love with forensic pathology in the first place.

The human body tells stories in an incredibly literal way.

Disease leaves evidence.

Injury leaves evidence.

Medical interventions leave evidence.

Sometimes even the absence of an expected finding can tell you something.

And the job is not simply to look at those things. It is to interpret them carefully enough to understand what they mean.

Over time, I noticed that shift happening to me. Things became less visually startling because I understood them better, and understanding them gave me something more useful to focus on.

There is also something strangely grounding about having a job to do.

You have a responsibility. You have a process. You learn where you fit into that process, and suddenly your brain has considerably less room to stand in the corner screaming internally because it is busy remembering what needs to happen next.

Very convenient.

Thank you, task-oriented coping mechanisms. Five stars.

But becoming more comfortable also taught me something I had not expected: you do not always know what is going to affect you.

Something can be objectively more graphic and barely stay with you.

Another case might not appear particularly unusual at all, yet something about it follows you out of the room.

Maybe you understand why.

Maybe you do not.

Sometimes it is the circumstances. Sometimes it is a person's age. Sometimes it is one painfully ordinary detail that reminds you there was an entire life before this examination began.

And suddenly, the thing affecting you most is not the thing everyone assumes should.

That taught me fairly quickly that having a “strong stomach” and having an emotional response are two completely different conversations.

I could become comfortable with the physical realities of forensic medicine and still recognize the weight of what I was participating in.

In some ways, becoming more comfortable with the physical part gave me more room to notice the human part.

Once your brain is no longer spending all of its energy processing "I've never seen this before", you have more space to understand what is actually in front of you.

So when I think about my earliest experiences in forensic medicine, I do not think of them as the time I learned how to stop being bothered by death.

I think I learned something much more useful.

I learned that discomfort can change shape.

Unfamiliarity becomes familiarity.

Knowledge grows.

Competence grows.

The initial shock becomes quieter.

But that does not mean everything else has to become quiet with it.

Because the first time is different.

Eventually, though, there is not a first time anymore.

There is a second.

And a tenth.

And perhaps, someday, a hundredth.

The question then becomes what happens to us as those numbers grow.

Do we simply become numb?

Or can we become steadier without becoming harder?

I think there is a difference.

And learning where that difference lives may be one of the most important parts of becoming comfortable around the uncomfortable.

Getting Used to It Is Not the Same as Not Caring

There is something slightly unsettling about realizing that something which once felt extraordinary has started to feel normal.

Especially when the thing becoming normal is something most people will never see.

At some point during my time in forensic medicine, I became aware that my reactions had changed.

Things that once would have immediately grabbed my attention simply…did not anymore.

Not because I had stopped noticing them.

Not because I had stopped understanding what they meant.

I just did not have the same visceral reaction.

And if I am being completely transparent, there can be a strange little moment of guilt attached to that realization.

"Shouldn't this bother me more?"

"Is it weird that I can look at this and be okay?"

"Am I becoming desensitized?"

And perhaps the most uncomfortable version: "Does this mean I'm becoming numb?"

For someone who wants to work in forensic pathology, that question matters to me.

Because there is a version of “getting used to it” that I actually want.

I want to become comfortable enough around death that I can think clearly in its presence.

I want to examine injuries without my own reaction distracting me from what I need to see. I want to recognize pathology rather than recoil from it. I want to walk into an autopsy suite, put on my PPE, and focus on the responsibility in front of me.

That is not something I think I should be ashamed of.

It is part of becoming capable of doing the job.

Medicine requires an ability to function in situations that are objectively difficult, and forensic pathology is no different.

If I am so overwhelmed by what I see that I cannot think clearly, I am not helping anyone.

There are findings to document. Questions to answer. Details that may matter medically, legally, or to a family trying to understand what happened.

The decedent deserves someone who can stand in that room and do the work carefully.

So yes.

I want steady hands.

I want a clear mind.

I want enough distance to remain objective.

What I do not want is for that distance to become indifference.

Those are not the same thing.

I think we sometimes talk about desensitization as though there are only two options: either you are deeply affected by everything you see, or you become cold and detached.

Human beings are a little more complicated than that.

Thankfully.

Otherwise, medical education would probably need an entirely separate prerequisite called Emotional Damage 101.

Actually, now that I think about it, perhaps that is already included in tuition.

Anyway.

There is a middle ground.

You can look at something difficult without being shocked by it and still understand that it matters.

You can perform a task routinely without treating the person involved as routine.

You can speak clinically about an injury without forgetting that someone experienced it.

You can become comfortable around death without becoming casual about the life that preceded it.

And maybe most importantly: you do not have to prove that you care by suffering every time you encounter suffering.

I think people in medicine need permission to hear that.

Caring is not measured by how devastated you are at the end of every day.

Empathy is not a competition to see who can absorb the most pain.

Being able to go home, eat dinner, laugh at something ridiculous, read a book, call someone you love, or simply continue with your evening does not mean that the people you encountered during the day meant nothing to you.

Sometimes being able to put the day down is part of what allows you to pick the work back up tomorrow.

That does not make you heartless.

It makes the work sustainable.

But the opposite extreme does not feel right to me either.

I do not want cynicism to become synonymous with experience. I do not want being “seasoned” to mean becoming dismissive of the people whose worst moments happen to intersect with my workday.

There is a difference between developing emotional boundaries and building an emotional wall.

Boundaries allow you to keep doing the work. Walls can make you forget why you are doing it.

I want the boundaries.

I do not want the wall.

Of course, that sounds beautifully simple written out in a blog post.

In real life?

I imagine it will be considerably messier.

Unfortunately, I do not think medicine comes with a little internal notification that says: Congratulations! Your professional distance has now exceeded the recommended empathy threshold. Please recalibrate.

That would be convenient.

Instead, I think staying aware requires intention.

It means paying attention to how I talk about people when they are not in the room. It means noticing when frustration starts becoming cynicism. It means remembering that efficiency should never require disrespect.

It also means allowing myself to acknowledge when something affects me without treating that emotion as evidence that I am less capable.

And just as importantly, it means allowing myself to acknowledge when something does not affect me without wondering whether something is wrong with me.

Because not every case needs to become an emotional reckoning.

Not every difficult thing needs to follow you home.

Sometimes you do the work carefully, fulfill your responsibility, and move forward.

I think accepting that is just as important as acknowledging the moments that stay with us.

Maybe the question is not whether I feel enough.

Maybe it is whether I continue to care enough to do the work well.

Did I pay attention?

Did I treat the person with dignity?

Did I stay curious?

Did I resist assumptions?

Did I give this person the same care I would want someone to give a person I loved?

Those questions tell me far more about my humanity than whether my stomach turned.

Maybe that is what becoming accustomed to difficult medical content is supposed to look like.

Not the gradual disappearance of feeling.

The gradual development of capacity.

More room to think.

More room to notice.

More room to do what needs to be done.

And, hopefully, enough room left over to care.

Because I do not think the opposite of being overwhelmed is being numb.

I think there is something in between.

Something quieter.

Something steadier.

Something I hope I spend the rest of my training learning how to protect.

Humor, Heavy Days & the Things That Follow You Home

There is something people do not always expect about working around heavy things: Sometimes, you laugh.

Not at the person.

Not because what happened is funny.

Sometimes you laugh because you are standing beside people who understand exactly how strange, difficult, exhausting, or emotionally intense the work can be, and for thirty seconds someone says something ridiculous enough to make the room feel lighter.

I think humor in medicine can make people uncomfortable when they encounter it from the outside.

And honestly, I understand why.

When you are talking about illness, trauma, or death, laughter can sound wildly out of place.

But I also think there is a difference between making light in a heavy environment and making light of the reason the environment is heavy.

That distinction matters to me.

The person should never be the punchline.

Their body should not be the punchline.

Their death should not be the punchline.

Their family should not be the punchline.

But the absurdity of your own day?

The fact that your stomach apparently still expects lunch after spending the morning in an autopsy suite?

The very specific brand of nonsense exchanged between coworkers who have collectively decided they need thirty seconds of normal human interaction?

Sometimes you laugh.

And I do not think that makes you disrespectful.

I think sometimes it makes you human.

There are only so many hours you can spend being intensely serious before your brain eventually says, "Okay, babe. We are going to need a coping mechanism."

Preferably a healthy one.

Humor can be one of them.

So can talking to people who understand the work. Taking a minute after a difficult case. Going home and doing something completely unrelated to medicine. Reading. Cooking. Calling someone you love. Sitting in silence. Going for a walk. Watching something so unserious that your brain gets to clock out for a while.

Sometimes caring for yourself after heavy work looks surprisingly ordinary.

And sometimes, despite all of that, something follows you home.

I learned fairly early in forensic medicine that the cases that stay with you are not necessarily the ones someone else would predict.

You can leave the room, finish your responsibilities, go home, and realize some small piece of the day came with you.

I do not think that means you failed to maintain professional distance.

I think it means you are a person doing work that occasionally asks you to stand very close to some of the hardest parts of being human.

And I never want to confuse being good at that work with being completely unaffected by it.

There may be days in my future career when I finish an autopsy, complete the report, and go home without thinking much more about the case.

I hope there are.

There may also be cases I remember years later.

I expect there will be.

Neither response makes me more or less compassionate.

The important part, I think, is learning to notice when something has stayed with me, and knowing what I need to do with it.

Maybe that means talking to a colleague who understands.

Maybe it means giving myself a little more space than usual.

Maybe it means acknowledging, simply, THAT one was hard.

And if something becomes heavier than I know how to carry on my own, I hope I am always willing to ask for help.

Medicine sometimes celebrates the person who can seemingly handle anything.

But I am not sure “nothing gets to me” is the badge of honor we think it is.

I would rather become someone who knows what she can carry, recognizes when something is becoming too heavy, and has enough self-awareness to put it down somewhere safe.

Because resilience is not pretending nothing affects you.

And professionalism is not pretending you are not human.

Sometimes you do the work and go home.

Sometimes you laugh with the people beside you.

Sometimes you need a minute.

Sometimes a case stays.

The goal is not to make sure nothing ever follows you out of the room.

It is learning how to make sure you do not have to carry everything alone.

I Do Not Want to Become Numb to Death Working in Forensic Pathology

When I picture myself years from now as a forensic pathologist, I know there are things I hope will feel completely different than they do now.

I hope my hands are steadier.

I hope my knowledge is deeper.

I hope I can walk into an autopsy suite and trust the years of training behind me.

I hope I can recognize findings that would confuse me today, know which questions to ask, understand when something does not fit, and have the confidence to say "I don't know yet" when the answer requires more investigation.

I hope so much of what feels new now eventually becomes familiar.

But there are some things I hope familiarity never takes from me.

I never want to forget that before someone became a case on my schedule, they were a person in someone else's life.

They had routines.

They had people.

They had favorite foods and inside jokes and annoying habits.

They had plans for days they never got to live.

They existed far beyond the circumstances that brought them to the medical examiner's office.

And even if I never know most of those things about them, I want to remember that they were there.

Because forensic pathology occupies such a strange space in medicine.

Our patients cannot tell us what hurts.

They cannot clarify their history.

They cannot tell us when something does not make sense.

They cannot advocate for themselves.

In many cases, part of the forensic pathologist's responsibility is to speak through what the body, the history, the investigation, and the evidence can tell us.

That responsibility is one of the reasons I am drawn to this field.

There is medicine in it.

There is anatomy and pathology and toxicology and investigation.

There is the constant question of why.

But underneath all of that, there is also trust.

Someone is being placed in your care at a moment when they can no longer participate in that care themselves.

I do not ever want the frequency of that responsibility to make it feel insignificant.

Someday, an autopsy may simply be part of my normal workday.

I may know the routine so well that my hands move through parts of it without conscious thought.

I may discuss findings over coffee.

I may finish a difficult case and immediately move on to the next because there are three more waiting.

I may become completely comfortable in an environment that once felt foreign to me.

I actually hope I do.

Because comfort allows me to focus.

Experience allows me to recognize.

Objectivity allows me to interpret.

And steadiness allows me to do the job well.

But none of those things require me to stop caring.

I do not want to become numb to death. I want to become capable in its presence.

I think there is a difference between those two things that I will probably spend my entire career learning how to navigate.

Capability says: I can stand here. Compassion says: I remember why it matters.

And I want both.

I want to be the forensic pathologist who can examine devastating injuries without looking away and still remember that those injuries happened to someone.

I want to speak clinically without becoming careless with my language.

I want to maintain objectivity without confusing objectivity with coldness.

I want to give the hundredth case the same dignity I would have given the first.

And when a case does affect me, I do not want my first instinct to be embarrassment that I was not “strong enough” to leave it behind.

I hope I can simply recognize that sometimes the work is heavy because what happened was heavy.

Maybe that is part of why this field has held my attention for so long.

Forensic pathology asks for both things.

It asks you to be analytical enough to separate evidence from assumption.

Steady enough to work around death.

Curious enough to keep asking questions.

And human enough to remember why the answers matter.

There is a version of myself years from now that I think about sometimes.

She has finished medical school.

She survived boards, residency, fellowship, and whatever other minor existential crises medicine decided to sprinkle along the way for character development.

She walks into an autopsy suite and knows exactly what she is doing.

Hopefully she is wearing pink scrubs under the PPE.

Obviously.

And maybe things that once felt overwhelming barely register anymore.

But I hope she still pauses sometimes.

Not because she cannot handle the work.

Because she understands the privilege of being trusted with it.

I hope she remembers the student who wondered whether becoming comfortable around death meant losing some part of herself.

And I hope, by then, she knows the answer.

You do not have to become harder to become stronger.

You can have steady hands and a soft heart.

You can learn to carry heavy things without pretending they weigh nothing.

And you can become comfortable around death without ever forgetting the life that came before it.

If that is the kind of forensic pathologist I become someday, I think I will have become exactly the kind of doctor I hoped to be.

Steady Hands, Soft Heart

And with that, I think we have officially spent enough time contemplating my future relationship with death for one week.

Very normal hobbies over here at Forensic Fashionista.

But in all seriousness, I think this is a conversation I will carry with me for a long time.

Medicine asks us to become comfortable in situations that were never meant to feel completely comfortable.

We learn to talk about devastating diagnoses.

We learn to look at injuries.

We learn to sit beside people on some of the hardest days of their lives.

And, in my little corner of medicine, I am learning how to stand in the presence of death and ask what it can teach me.

Somewhere along the way, the things that once felt overwhelming may start to feel familiar.

I do not think we need to be afraid of that.

I think we just need to be intentional about what we allow familiarity to take from us.

If you work in medicine, or you are becoming someone who will, I hope you remember that you do not have to absorb every difficult thing you encounter to prove that you care.

You are allowed to have boundaries.

You are allowed to laugh.

You are allowed to go home and have a normal evening after an abnormal day.

And you are allowed to admit when something was heavier than you expected.

None of those things make you less compassionate.

Sometimes they are exactly what allow you to keep showing up with compassion tomorrow.

And if you are not in medicine but you have ever wondered how someone can spend their career around illness, injury, death, or any of the heavier parts of being human without becoming numb to them, I think I am beginning to understand the answer.

Maybe you do not try to feel everything.

Maybe you do not try to feel nothing.

Maybe you learn how to stand somewhere in between.

Steady enough to do what needs to be done.

Soft enough to remember why it matters.

As for me, I still have a lot to learn before anyone hands me the responsibility of being the forensic pathologist in the room.

There are exams to survive, boards to take, residency to complete, and approximately seven million more pathology slides standing between me and that autopsy suite.

Minor details.

But someday, I hope I get there.

Pink scrubs underneath the PPE.

Steady hands.

Soft heart.

And a very clear understanding that becoming comfortable around death never has to mean becoming careless with the life that came before it.

Thank you, as always, for spending a little piece of your week here with me, especially for one of our heavier conversations.

Take care of yourself this week.

Put down what you do not need to carry.

Ask for help with the things that feel too heavy to hold alone.

And never mistake your capacity to care for an inability to handle hard things.

Sometimes the softest parts of us are exactly what make us capable of doing difficult work well.

I will be over here continuing to learn how to do exactly that.

One lecture, one pathology slide, one existential crisis, and one pair of pink scrubs at a time.

Until next week, babes.

XOXO,

Kenzie

The Forensic Fashionista

love a good Pathoma study day :,)