Part 1: Death Chapter 2- Autopsy
Chapter 2: Autopsy
The library became Sakura’s second home for the past month and a half. Her parents had decided to renovate the entire bottom level of their house, since it had received some damage from the failed invasion. As a result, Sakura couldn’t concentrate with all the ruckus going on.
After her victory in gaining the Slug Sannin as her new master, Sakura decided to break the news to Iruka.
To say that the man was smug was an understatement. “I’m proud of you, Sakura-chan. Keep up the positive attitude, because the real work’s about to begin.”
So far, Tsunade had given her new student more books to read, with the clear threat that she’d be testing her weekly to prove whether or not the Genin did as she was told.
Not wanting to disappoint, Sakura read and read and read. She enjoyed learning the new material and dove into each book with gusto.
As wondrous as ninjutsu, genjutsu and taijutsu seem, the wonders of the human body are breathtaking. Her inner voice commented in awe.
Sakura hummed in agreement. The true miracle of life is how two cells only seen under the microscope can fuse together, and eventually create a full-term, multicellular baby.
Absolutely. I can’t wait to perform the autopsy with Tsunade-sama, her inner voice added dreamily.
With the reminder, the rosette shifted her focus onto the textbook in front of her.
She spent these past few weeks focusing on medical ninjutsu. As such, she had added that to her list of skills to master, along with water and earth-styled ninjutsu.
During her brief conversation with Iruka, the man had informed her that Konoha’s genjutsu mistress would be available by the beginning of the summer.
“As for your instructor in elemental ninjutsu, I’ve personally asked for someone special to train you. I’m certain that you’ll be very pleased with him.”
The Chunin refused to say more, which sparked Sakura’s curiosity.
Maybe it’s Ebisu-san? He is a tokubetsu Jonin. Kakashi-sensei had him train Naruto for the final phase of the Chunin exams.
Unlikely, her inner voice disagreed, he’s a fire type.
Sakura puffed her cheeks out in annoyance. Who could it be?
There’s only one way to find out. You’ll have to be patient. Now get back to reading!
Sakura rolled her eyes. Yes ma’am, she replied sarcastically, and delved back into her book.
Yet again, Sakura found herself at the hospital in Hirotoshi’s office. Tsunade was drilling her with an abundance of questions.
“What is the danger triangle of the face? Why is it called such?”
“The danger triangle of the face consists of the area from the corners of the mouth to the bridge of the nose, including the nose and maxilla. It’s a danger because of the possibility of retrograde infection from the nasal area towards the brain, even though it’s rare.”
“What can it cause?”
“Cavernous sinus thrombosis, meningitis or brain abscess.” Sakura frowned. “I don’t understand why though.”
Tsunade urged her to continue. “Use your logic. Think about the venous drainage system of the face.”
Sakura carefully scanned through her mind’s contents of everything she had stored up on human anatomy.
She began to mutter to herself. “Lips, nose and maxilla. The cavernous sinus receives blood from the superior and inferior ophthalmic veins and from superficial cortical veins. The existence of communications between the facial vein and cavernous sinus and the direction of blood flow is important in the spread of infection from the face.” Her eyes lit up in understanding.
The blonde woman nodded in approval. “What are the risks of having a cavernous sinus thrombosis?”
“There can be constriction of the oculomotor nerve, the trochlear nerve, the abducens nerve, and the trigeminal nerve, specifically the ophthalmic and maxillary branches. It can also result in in compression of the optic chiasm, which will result in vision problems, and the pituitary gland.” Sakura answered confidently.
“Very good.” Tsunade replied. She locked eyes with her eager student. “Explain to me how pleasure through anal intercourse is achieved.”
Taken aback, Sakura was speechless. “Ts…Tsunade-sama! What kind of question is that?” Her cheeks burned from embarrassment.
The Slug Sannin cocked an eyebrow. “If you plan on becoming a medical ninja, there’s no reason for you to be shy with sexual orientations. You’ll be dealing with patients from different backgrounds and tastes.”
Sakura desperately wanted to cover her face to hide her shame.
Tsunade gave her a pointed look. “Do I have to repeat myself?”
The rosette shook her head feverishly and took a deep breath to maintain her composure. “There…there’s an abundance of nerve endings in the anal region and rectum which can be pleasurable, depending on the psychological state of the person and whether or not they’ve used lubrication and feel relaxed. The inner third of the anal canal is less sensitive to touch than the outer 2/3 but is more sensitive to pressure. The anus and rectum have the capacity to expand, therefore, to accommodate whatever instrument is introduced inside.” Sakura coughed in discomfort. “A male can experience pleasure due to direct stimulation of the prostate through the anal wall.”
Tsunade nodded. “Yes. Many men who practice anal intercourse claim that prostate stimulation produces a deeper, longer-lasting orgasm. How does a female experience pleasure in this case?”
The rosette barely managed to restrain her groan. “Theoretically, there could be indirect stimulation of the clitoris because of the shared sensory nerves, particularly the pudendal nerve, which gives off the inferior anal nerves and divides into the perineal nerve and the dorsal nerve of the clitoris.”
She was greeted by another nod. “Correct.” An amused grin graced the Sannin’s face. “Since you’ve survived that, I believe that you’re ready to handle an autopsy.”
Thank the heavens! Sakura’s inner voice exclaimed. I’d thought we’d die from embarrassment!
Outwardly, Sakura offered a shaky smile. “I’m ready, Tsunade-sama.”
“Excellent. Head over to the women’s changing rooms and get into your scrubs. I’ll be waiting for you in the morgue.”
“Hai!”
With a quick bow, Sakura left the room to do as she was told. Once she was dressed appropriately, the rosette eagerly entered the morgue where both of her medical superiors awaited her.
Tsunade addressed her. “Haruno, you’ll be recording the procedures as Hirotoshi-san works.”
Said person nodded at her. “Welcome to the morgue, Sakura-san.”
The Slug Sannin continued. “You’ll also be identifying the cause of death, based on the evidence provided by the autopsy. Understood?”
Sakura inwardly gulped. “Yes ma’am!”
The Genin proceeded to wash her hands, and accepted the sterilized towel the nurse handed her, before sliding her arms through the sleeves of the surgical robe.
She thanked the nurse for tying it firm around her and approached her superiors.
Even after all these weeks and proving to Tsunade time and time again that she was a dedicated student, Sakura still didn’t feel confident enough to stand by her side.
Instead, she chose to stand beside Hirotoshi.
The medical ninja was a middle-aged man with greying hair, yet his eyes remained sharp with youth as he picked apart every detail from each of his cases. Sakura admired his professionalism and work ethics.
“What defines sudden death?” Tsunade asked.
There she goes again, Sakura’s inner voice commented.
The rosette ignored her. “Sudden death occurs naturally, unexpectedly and in a short time from the onset of premonitory symptoms or collapse, in a person in apparent good health and who is usually doing their typical activities in the moment of the fatal event. Most experts agree that the time limit is within twenty-four hours.”
“Did you take on a student or a walking encyclopedia?” Hirotoshi teased.
Tsunade smirked. “You haven’t seen nothing yet.”
The middle-aged man chuckled.
The Slug Sannin stared at Sakura expectedly. “Begin, Haruno. Describe the corpse.”
Nodding, Sakura spoke into the recorder that hung above them. “This is Haruno Sakura, Genin of Konohogakure and current medical student. I’m accompanied by Senju Tsunade, current Hokage of Konohagakure and head of Konoha’s hospital, and Amano Hirotoshi, head of the medical program. We’re beginning the second time. The corpse is that of a male, around fifty years of age, two hundred and sixty-seven pounds, approximately one hundred and sixty-six centimeters in height.” She added as she glanced at the weight automatically added in the surgical table. “There’s a marked generalized stiffness, with medium intensity lightness in the posterior plane, of obese contexture, presence of hairs in thorax, abdomen, armpits, and genitals.
“Starting with the head.” Sakura added as Hirotoshi began to manipulate the corpse. “Well implanted hair, with the presence of facial hair. Well implanted atrial canopy. No obvious lesions. Generalized facial cyanosis. Upon opening the eyelids, blue irises are observed, there are no obvious lesions, hyperemic conjunctiva, no previous history of injury or pathologies. Centered nasal septum, open nostrils without visible lesions. Closed buccal region with presence of foamy white substance.”
The male medic nin began to palp the thick neck.
“No visible external lesions are observed. Trachea is centered. No palpable masses.”
The two experienced medical nin rolled the corpse over to it side.
Sakura’s keen eyes observed closely. “In the posterior region there is no presence of visible external lesions. Presence of well-marked demarcations, which disappear at the digit pressure. In the gluteal and anal region there are no obvious external lesions. Presence of fecal material in the anal region, with no presence of blood or insertion of foreign objects. Well defined anal borders.”
The corpse was rolled over to its back once more.
“In the upper limbs there are no visible external injuries to the hands, which are in rigid semiflexion. The fingers are cyanotic.”
Hirotoshi moved his hands to the thorax.
“Thorax has no visible external lesions. Symmetrical. Presence of hairs in thorax and armpits. No obvious masses.” Her gaze lowered to the abdomen. “There are no obvious external injuries. Presence of hair. Globose by adipose panicle. Presence of bruises or cyanosis in lower abdomen.”
No blush adorned the girl’s cheeks. “Genitals according to age and sex. There are no obvious external injuries. Presence of genital hair. There is no edema, nor any tears. No secretions of seminal fluid are observed.”
Tsunade and Hirotoshi lifted a leg each.
“In the lower extremities there are no obvious external lesions. They are symmetrical. Cyanosis in pulp of the toes. Presence of edema with marked fovea. Faded scars on both knees.”
Both legs were lowered shortly afterwards.
Hirotoshi smiled. “You’re a natural at this, Sakura-san. If you keep up that attitude, you’ll be performing autopsies on your own.”
Sakura beamed at him.
Tsunade handed the male medical ninja a scalpel. “The real autopsy is about to begin. Continue, Haruno.”
Sakura nodded, and carefully observed their actions. “An incision is made with a scalpel at the level of mastoid skin and the scalp is separated. Under the skin there is ecchymosis located in the right occipital area. The cranial vault is divided into two parts for the removal of one of them. The detachment of the dura is continued to visualize the brain.”
“Nothing quite like taking out a brain in the morning. I could go for some miso soup.” Hirotoshi commented.
Tsunade snorted rather un-lady like. “A nice cup of sake would do any time of day.”
The male medical ninja pretended to be disapproving. “My-my, Tsunade-sama. What kind of example are you giving to your student?”
The woman rolled her eyes in fake exasperation. “It’ll do the girl and her skin wonders.”
Sakura blinked in confusion at their behavior.
Tsunade dropped the brain unceremoniously into the weight. “Have you gone mute, Haruno? The recorder can’t voice what’s going on.”
Startled, the Genin focused once more on the autopsy. “Congestion and apparent flattening of convolutions and fissures are observed. The brain weighs 1400 grams, which suggests the presence of edema, since the normal weight is 1300 grams. The Willis polygon is removed for examination, observing atheroma plaques, which suggest an occlusion of 50–75%. Coronal cuts of the brain are made to assess the closure of the fissures and if there is evidence of any pathology.” She glanced at the empty skull. “No fractures or lesions are observed at the base of the skull.”
Hirotoshi proceeded to apply the scalpel to the thorax and abdomen.
“A dissection is performed in the neck that continues in the chest and abdomen. In the neck, no soft tissue lesions are observed. No lesions in the thyroid gland, nor hemorrhagic infiltrate at the level of thyroid cartilage. When performing the face lift, the complete denture is observed. No lesions or alterations are observed at the oral mucosa level. In the thorax, there are no soft tissue injuries of the rib cage, no fractures or alterations in the bone tissue.”
“Here comes the fun part,” Hirotoshi said as his hands dove into the corpse’s chest cavity.
“The thoracic cavity organs are removed. Foaming trachea lesions are observed, which may be associated with pulmonary edema. The heart weighs 700 grams. There’s evidence of cardiomegaly. It’s dissected to assess the coronary arteries and if there is any occlusion; In this case, occlusion of both coronary arteries is observed, both greater than 50%. In the interventricular septum muscle, whitish areas of fibrosis are observed, which are considered the product of old myocardial infarctions. Hypertrophic interventricular septum, larger than 2cm. Left lung weighs 800 grams, and the right lung weighs 1000 grams.
“The autopsy is continued with dissection of the abdominal cavity and removal of internal organs. No adipose tissue abnormalities or level lesions are observed in the intestines.”
The next fifteen minutes were spent examining and weighing each abdominal organ, none of which showed signs of damage.
Tsunade turned to Sakura expectedly. “With all of the evidence gathered from the autopsy, what was the cause of death in this man? Start with basic cause, then intermediate, and finally the direct cause.”
Sakura pondered deeply for a minute and exchanged mental notes with her inner voice.
She answered. “Due to the presence of occlusion in both coronary arteries, the basic cause of death was coronary and systemic atherosclerotic disease. The intermediate causes were cardiomyopathy and history of myocardial infarction, due to the hypertrophy of the interventricular septum, and the presence of fibrosis inside of it. There are actually two direct causes of death: acute lung edema and cerebral edema.”
Silence greeted her answer.
Nervous, Sakura continued somewhat timidly. “The type of death was natural, since there was nothing suggestive of a provoked wound. The deceased time is estimated to be around 10-13 hours since the corpse is rigid, warm and presents the libor mortis due to changes in position.”
The rosette alternated between glancing at the two-medical ninja, who were still quiet.
All of a sudden, both of them exchanged a look and burst out laughing.
Sakura stared at them in confusion; her nervousness turned into irritation at their blatant disregard of her answer.
When both superiors calmed down, Hirotoshi spoke. “Please don’t take offence, Sakura-san. We’re not laughing at you. On the contrary, we’re extremely pleased by your performance today. In all my years dealing with medical students, you’re by far the brightest of them all.”
“I must say, I’m impressed, Haruno. Considering how little time has actually passed since you’ve started out, you’ve taken to medical ninjutsu like a natural. You’re ready to begin your training.”
Sakura stared at her in confusion. “I thought I was already doing that?”
Tsunade waved her off. “You’ve been studying, but you haven’t been training. I’m prepared to set aside some time to get you started on it.”
Sakura’s eyes widened in awe. “That’s amazing!” Confusion filled her once more. “Tsunade-sama, you’ve stated in your second clause that ‘no medic ninja shall ever stand on the front lines.’ Isn’t training me going against that?”
An amused smirk appeared on the Sannin’s face. “You’re correct, however, there’s a fourth law in existence.”
Sakura stared at her in surprise.
The blonde woman looked back seriously. “‘Only those medic ninja who have mastered the Strength of a Hundred Technique of the ninja art Creation Rebirth are permitted to discard the above-mentioned laws.’”
Holy shit, Sakura’s inner voice remarked. She’s going to train us to be combat-ready.
The rosette could only stare at her in stunned silence.
Tsunade cocked and eyebrow. “Cat caught your tongue, Haruno? You demanded to have me teach you, and now that you’re succeeded in getting me to do so, you’re hesitant. Should I withdraw my offer?”
Immediately, the Genin shook her head feverishly. “No, no! I’m just in awe, Tsunade-sama.” She then bowed. “I’d be honored to have you train me.”
“Careful what you wish for. You have no idea of the hell I’ll be putting you through.”
Boldly, Sakura looked her master in the eye. “With all due respect, come hell or high water, you can’t scare me away.”
Hirotoshi burst into laughter. “She’s a feisty one. Soon another, we’ll be dealing with the second coming of you, Tsunade-sama.”
The woman smirked in amusement.
Sakura inwardly beamed at the thought. “When do we start, Tsunade-sama?”
“Since you’ve done well today, I’ll be giving you the afternoon off. I expect to see you tomorrow morning at 05:00 in training ground three. Don’t be late.”
Sakura bowed. “Hai, shishou!”
Sakura could barely sleep that night. She was too excited and amazed that she’d at last begin her training with one of the legendary Sannin, so she ended up arriving at the training ground an entire hour before she was instructed to.
Let’s see if we can survive the training, her Inner voice commented. I don’t think Tsunade-sama was kidding when she said she’d put us through hell.
Sakura attempted a brave front. Whatever she throws our way, we’ll survive it.
The question is, will we come out with our sanity intact?
The rosette couldn’t answer since the woman in question appeared before her.
She gave the girl an approving look. “You’ve arrived before me. Excellent.”
Sakura stood at attention. “I’m ready to begin, shishou.”
The woman held her hands up. “Slow down there. I know you’re eager to get started, but I want to see if you understand the most basic concept that a shinobi must know. What can you tell me about chakra control?”
At ease, Sakura replied effortlessly. “The key to chakra control is being able to sufficiently control and conserve it. In order to have good chakra control, a shinobi should only mould as much chakra as they need to perform a given ability. Generally, people with less chakra reserve have better control over it.”
Tsunade nodded. “That’s correct. The reason I’m emphasizing on chakra control is especially because of your low reserves. I won’t lie, Haruno. You’ll often feel exhausted completing tasks that other shinobi would be able to do without breaking a sweat.”
Sakura glanced down in disappointment.
“That being said, you also have a point in that people with lower reserves generally have better control over their chakra. Eventually, your reserves will grow through meditation and repetitive usage of them, which is why you’ll be mediating before and after our sessions. For the next hour, that’s what you’ll be doing. Understood?”
The rosette nodded. “Hai, shishou.”
She sat down and crossed her legs. She closed her eyes and took deep breathes to relax herself.
“Use your mediation time as a way to become familiar with your chakra coils and reserves. I expect you to know them like you know the back of your hands.”
The rosette nodded and delved into her deeper conscious.
Sakura’s vision was impaired with a thick cloak of darkness. Her mind felt like it was light years away from her body as she stood motionlessly within the dark abyss. Despite having no sense of sight, the rosette could still hear what seemed to be a pulsing noise.
Blindly, Sakura turned her head towards the source of the sound, her own heart beating in time to the pulse.
Hesitantly, she took cautious steps as she awkwardly walked through the dark layers of wherever she was.
The pulsing noise became stronger, and it vibrated deep within her ribcage. Whatever it was, it felt like it was a part of her.
Abruptly, the darkness receded somewhat as thin streams of blue plasma flowed past Sakura’s feet. Ahead of her was the source of the plasma in the form of what resembled a waterfall. It was there that the pulsing noise grew stronger.
“Hello, stranger.” A voice called to her left.
Sakura spun in that direction and came face-to-face with her Inner self. It was like looking into a mirror in negative film.
Her Inner smiled. “You seem shocked.”
Sakura shook her head. “It’s just been a while. The last time I’ve consciously entered here was during our fight with Ino.”
Her Inner snorted. “And look what good it did her. This is our domain, and we won’t let anyone hurt us in here.”
Sakura nodded. “You got that right.”
Almost comically, her Inner self waved her arms around. “There’s not much to see here. As you can tell, our reserve’s not very big.” She gestured at the mini waterfall in the background.
The rosette’s eyes narrowed. “It won’t stay that way for long. I’ll never have a huge reserve like Naruto or Sasuke-kun, but someday, ours won’t be a laughing matter.”
“Absolutely,” her Inner agreed. “We’ve got a decent amount of spiritual energy, though we could always store up on more. We just need to increase our physical energy.”
Sakura punched her right first into her left palm. “Let’s get to it.”
Preciously an hour later, Sakura opened her eyes into the expectant gaze of her master.
Said person cocked an eyebrow. “Feel relaxed yet?”
The rosette nodded and stood up. “It’s something I wouldn’t mind doing every day.”
“Good, because that’s exactly what you’ll be doing whether you like it or not. Even if I can’t train you every day, I expect you to continue meditating.”
“Of course, Tsunade-sama.”
“Excellent. Now, as a medical ninja, you’ll often be the most sought-after target in your platoon. Any shinobi with a brain will want to kill their enemy’s medical ninja to increase the chances of the platoon’s defeat. Your first task with me will be to develop and hone your evasive skill. You can’t afford to get injured, never mind dying.”
“How will we will be doing that, Tsunade-sama?”
A cheeky grin graced the woman’s face. “I’m glad you asked. I prefer a hands-on approach, so try to keep up.”
Sakura stared at her in confusion, and gasped when her master disappeared.
Instinctively, she looked up when she sensed a huge concentration of chakra descending towards her.
Tsunade was crashing down with her heel held up. “Dodge this, Haruno!”
The girl barely had time to get out of the way when Tsunade’s heel made contact with the ground and shattered it instantly.
Sakura concentrated chakra to the soles of her feet to prevent her from falling over. She shakily stuck to the large boulder that was unearthed by the woman in front of her.
Suddenly, the Slug Sannin appeared in front of her and jammed her elbow into Sakura’s stomach.
Pain instantly coursed through Sakura’s nervous system, and she could barely breathe from its intensity.
The hit launched her back several feet, and she only stopped when her back collided painfully against a tree’s trunk.
For several minutes, Sakura couldn’t move as she desperately tried to breathe.
Move, Sakura! Her Inner voice pleaded. That woman’s mad. She could easily kill us!
On cue, a voice called out to her. “Have you given up, Haruno? I told you that I’d be putting you through hell. If this were a real fight, you’d have been dead several moves earlier. Get up!”
Sakura gritted her teeth to push away her need to scream.
Gingerly, she attempted to slide up the bark, but immediately crashed back down.
“Are you deaf, girl? I said, GET UP HARUNO!”
Do as she says! We’re too young to die!
The rosette spat out blood and gritted her teeth as she tried again to stand up. She was successful, although her legs shook greatly and threatened to collapse at any moment.
“I didn’t peg you as being a quitter. I guess I was wrong.”
Sakura ignored the jab and narrowed her eyes at the woman. “I won’t quit.” She gritted harshly.
In her mind’s eye, her two teammates stood on either side of her and placed their hands on each of her shoulders, seemingly giving her the strength to continue.
With new determination, Sakura straightened her posture.
Seeing the change, Tsunade launched herself at the Genin.
The girl stood her ground and braced herself for the impact.