"Behind the Scenes" is a series that takes you inside work areas at Mayo Clinic you might otherwise not see. The articles highlight teams — often unseen — that perform work critical to Mayo Clinic. In this installment, learn how colleagues in the Office of Decedent Affairs and on the Autopsy team are guided by compassion as they support the families of deceased loved ones and perform autopsies to seek answers and advance research.

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Life in any hospital revolves around making patients feel better. But life also intertwines with its inevitable counterpart. When a patient dies at Mayo Clinic in Rochester, two distinct teams silently weave a tapestry of compassion and dignity.

The needs of the patient come first — in life and death.

Compassion in a sacred time

Compassion drives Johnna O'Neill, a specialist with the Office of Decedent Affairs. She and her nine colleagues are often the first to provide grieving loved ones with support and a sense of order in difficult times.

"We can't make them feel better, but we can give them clarity and confidence about what's going to happen next," O'Neill says.

When families face the tangled threads of grief, loss and sorrow, O'Neill helps weave their next steps. That includes educating families about the choice of an autopsy, finding funeral resources, arranging transportation for the body, helping facilitate donations for organ, tissue and eye procurement, and organizing belongings and keepsakes.

"It's very meaningful work to me. It's a sacred time, and I so appreciate being involved in it," she says.

That includes the most tragic cases, such as when a child has passed away, a highly emotional affair for all involved. Those moments are some of O'Neill's most challenging ones on the job, and she says it can be hard to decompress. That's partly because each Decedent Affairs specialist is typically on the clock for 12 hours, overlapping with the next colleague by 30 minutes for a handover.

Still, O'Neill says her team — which has office space on the Saint Marys campus, at the morgue in the Stabile Building, and at the Methodist Campus — is a tight-knit group of professionals with a laser focus on providing grieving families with comfort and information.

"It's the best team I've ever been on. We're genuine with each other, and we all have a sense of who we are," she says.

Culture of care

Created in 2016 as part of a project to improve deathcare processes and become more efficient, Mayo's Office of Decedent Affairs in Rochester brought a new approach to handling the administrative side of the morgue and supporting families in the hospital. That work used to fall on autopsy and nursing staff. But Mayo Clinic realized that deathcare needed a dedicated team.

O'Neill and her colleagues are crucial components of Mayo's culture of care and experts in navigating the complexities associated with death.

"When you talk about Mayo Clinic's approach to care and its emphasis on the needs of the patient, the Office of Decedent Affairs is the logical continuation of that philosophy," says Kristina Peters, the office's supervisor. "The care doesn't end the moment a patient dies. We are part of the team approach. We provide the final, compassionate care for that patient and their family."  

Answers, knowledge through autopsies

Intertwined in the information Decedent Affairs specialists share with families is the choice of an autopsy for their loved one. Mayo Clinic offers autopsies for any patient at no charge, as long as the death doesn't fall under the jurisdiction of a medical examiner or coroner.

Families' motivations to pursue an autopsy can be manifold. Some want to learn more about how the disease process took their loved one's life, including learning about potential hereditary concerns for children and grandchildren. Other patients may have consented to donating their bodies for research.

The current autopsy consent rate at Mayo Clinic is between 22% and 24%, which is a sharp increase since the implementation of the Office of Decedent Affairs and among the highest in the U.S., according to Peters.

Once an autopsy has been determined as the next step for a deceased patient, the body becomes part of a carefully interwoven process designed to treat the patient with dignity and respect while using science and technology to gain knowledge and unravel the potential mysteries of why a life has ended.

Morning huddle

A typical day for the Autopsy team begins with a morning huddle. Autopsy technologists, residents, pathologists' assistants and the pathologist gather to discuss the day's cases, which could be as few as one or as many as eight or nine autopsies.

Team members discuss the different goals for each autopsy and assemble the threads of their work for the day.

"If a case is approved for research and education, we look at what the appropriate studies are in our queue, based on the history of the patient," says Reade Quinton, M.D., who co-directs Autopsy Service with Ross Reichard, M.D. "For example, if we know a neuropathology study needs a certain amount of tissue, and we have a case consented for that, we'll discuss that in advance."

egardless of the extent of an autopsy, the team's goal is to complete it in less than 24 hours.

"If someone passes at six o'clock in the morning, they could have an autopsy and be at the funeral home by mid-afternoon," Peters says.

The process begins with efficiently transporting the body from the patient's room to the morgue. Once there, bodies are stored in a cooler unit, which can hold up to 20 bodies. Cooler checks are performed twice a day to ensure proper documentation and storage of belongings.

Access to the cooler, belonging cabinets, lab and morgue area is also strictly monitored. Funeral home staff can get to the morgue through a dedicated elevator from the outside but cannot access the lab area. If a transporter is not from the local area and unfamiliar to Rochester's autopsy team, an Office of Decedent Affairs staff member will provide an escort.

The process of moving bodies in and out of the morgue is swift, continuously tracked and has never faltered, including during the COVID-19 pandemic.

Subspecialty conferences

The autopsy team also plans daily subspecialty conferences — educational and diagnostic events for small groups from all Mayo shields to study and document the condition of tissue samples in detail. The sessions resemble an intricate tapestry of medical knowledge, where consultants, residents and fellows, pathologists' assistants and autopsy techs gather around specially equipped tables to examine brain, heart, lung or other tissue from patients who have consented to research and education as a way to give back to Mayo.

"It's quite remarkable," Peters says. "The images the techs take get a lot of compliments during presentations because the team does such a good job with photography and appropriately showing what a consultant wants to convey. Their images are also used in publications and book chapters."

Unless tissue samples are purposely saved forever, they are medically cremated after 10 years. Formalin-fixed paraffin blocks and slides are saved forever. That makes tissue samples a powerful tool in Research. A sample could be involved in as many as 4,000 to 5,000 studies at Mayo Clinic.

"It's a huge, huge gift," Peters says.

Once an organ has been cut and studied, it may not always be stored immediately. Sometimes, the organ will be prepared for a special opportunity offered to transplant patients.

Viewing room

The viewing room has become a meaningful part of the transplant patient's healing journey. After they receive their new organ, patients can come to a small room, divided by a large, sliding glass window behind which their native organ is displayed.

"So they could see their heart, for example, look at it and talk with the cardio pathologist who read their case," Peters says. "They can also wear gloves and touch their native heart if they want."

Patients also receive a 3D-printed slice of their organ to take home.

Dr. Quinton credits the Transplant team and its close relationship with the Autopsy team to make this special educational offer possible for patients.

"It's an amazing opportunity," he says.

Peters echoes that sentiment.

"When you think about it, this is a piece of your body leaving, and another piece that wasn't originally yours is coming in. For some, there is a grieving process involved," she says.

When the transplant viewings started as a project five years ago, the room was only used about a dozen times a year. Now, transplant viewings with patients are done two to three times a week.

Careers marked by curiosity, compassion

One person who has witnessed the Autopsy Team's evolution into a lean, value-driven group first-hand is Timothy Kalleberg. The autopsy technologist has been a member of the team for 21 years. Kalleberg originally wanted to become a funeral home director. When a program at the University of Minnesota opened new opportunities, including a weekend position to perform autopsies, that's when he found his calling.

"It's really about your curiosity. Mayo is probably the best place ever to be in this position," Kalleberg says. "We have such interesting cases that come through. Many patients have pretty severe pathology you wouldn't get to see in every institution."

He also appreciates Mayo's role as the Southern Minnesota Regional Medical Examiner's Office, which accounts for about 60% of Mayo's autopsies, and includes homicides and other suspicious deaths.

"I think that's a driving factor for many people. It's a stepping stone for their career," he says.

Kalleberg has seen many autopsy cases in his two decades on the team. Dealing with death daily isn't easy, he says, and he has honed his ability to weave threads of positivity and resilience amid the challenges of dealing with death.

"The needs of the patient come first. That message is loud and clear here, as well. An autopsy is the last thing that can be done for them, and hopefully, we can find answers for the family. It's about the task and being of service," he says.

That's also what drives O'Neill when she meets with loved ones.

"It is my favorite job I've ever had. It's such a privilege to work with these families. Some of them just want to talk or get a hug," she says.

Team pride

Dr. Quinton and Peters say they couldn't be prouder of their teams.

"I cannot say how much I love working with all the groups. They're fabulous," Dr. Quinton says, adding that he was struck by everyone's level of passion from the minute he joined the team.

"In many places, you have very talented people, but they don't feel like they have a voice sometimes. I was stunned to find the opposite when I first came here four years ago. Their level of engagement is incredible," Dr. Quinton says.

Peters agrees, adding that the needs of the patient are at the center of her team's work, with each autopsy representing a final, compassionate gesture woven into the patient's medical journey.