minister’s porch smoking cigarettes, waiting for me to arrive. Everybody smoked back then, so usually we all lit up and discussed our plan for removing the body. But the assembled group appeared to be sizing me up. I quickly discovered why. It seems that my friend had expired while perched on the commode, and he had subsequently slumped against the door of the tiny bathroom, his full weight pressing it closed.
We all ventured inside to allow me to survey the situation and offer my expert evaluation of possible procedures. The EMTs and police officers decided that, since I was the skinniest one present and familiar with the decedent, I should be the one to climb inside a small window, squeeze my way into the tiny bathroom, move the man away from the interior door, and thus allow for proper removal.
I took off my fairly new, double-knit suit coat and, with some assistance, delivered myself into the bathroom through a window never designed for a six-foot-three man. In those days, I was agile enough to stick my left leg into the room first, and then swing my right leg and stand upright without even banging my head on the upper window frame.
I was certainly saddened to see my friend deceased—but also to encounter him in such a state. He still held a
Still, a house call (when death occurs at a private residence) tests the strength and sometimes the ingenuity of those doing the removal. A ranch-style home or any residence in which the deceased is located on the ground level is a huge plus. In at least half the cases I encounter, however, my hopes are dashed when I learn the person is on the second or third floor.
New home construction considers not the lowly funeral director. Wide doorways and high-ceilinged atria in the living areas often give way to narrow upstairs hallways and doorways barely wide enough for a mortuary cot, let alone an ambulance gurney. People should keep this in mind—they’re likely to need ambulances long before they need funeral directors.
Long ago, when I was a young and foolish teenager, I assisted my older brother, then also a budding funeral director, on several occasions to run ambulance calls and make removals. One morning we were called to the home of a wealthy family. The homeowner’s drunken black sheep of a brother had died on the mansion’s third floor. So we left our cot near the front door (it weighs nearly one hundred pounds and is difficult to maneuver to higher floors) and clambered up the steps to survey the situation. We had brought with us a collapsible device called a litter, which is basically three steel poles supporting a thick canvas sheet, and commonly used to traverse stairs.
On entering the room, we discovered the 350-pound decedent supine on the hardwood floor, clad only in jockey shorts and a T-shirt—which was thoroughly soaked in vomit. His stomach contents puddled around the entire body. I had never witnessed such a thing, and I was on the verge of involuntarily giving up the ham sandwich I had consumed only a half hour earlier.
We placed the litter on the floor next to the deceased, and my older, wiser brother began to rattle off the game plan: I was to simultaneously take hold of the thin T-shirt and the waistband of the jockey shorts and then turn his body toward myself as my brother pushed the litter beneath him. A good-sounding plan—except that I was barely able to budge him. Plan B entailed both of us lifting the man onto the litter by brute force. Again, I was to grasp the T-shirt and my brother, the waistband.
But this plan went awry as the thin, vomit-soaked shirt slipped from my grasp, and the deceased hit the hardwood floor with a resounding thud. Family members downstairs no doubt heard the commotion, but we hoped they thought we had knocked over a chair. Immaturity ruled as both my brother and I nearly collapsed in fits of muffled laughter, to the point that both of our young faces were red with shame.
On our second try, we were finally able to position the deceased on the litter, cover him, and make our lumbering way down the steps to the waiting cot. Our faces still red, we prayed that the family would assume that our strenuous trek down the stairs with a 350-pound man in tow was the source of our breathlessness.
These days family members are often present even when a death occurs outside the home, such as at a nursing facility or even a hospital. In the past, when I arrived at a nursing home at three o’clock in the morning, no one but the nurse on duty was available to help move the deceased out of the bed and onto the cot. Today the family is often waiting—I suppose because nursing home caregivers attend death education classes that stress that family members should be at a terminal patient’s bedside for end-of-life support. At hospitals this can be more complicated, because most hospitals still require that hospital personnel transport the deceased to the facility’s morgue, where the body is left in cold storage until the funeral director arrives.
With the hospice movement having become so popular, however, more and more terminally ill people are choosing to die in their own homes or in those of family members, as opposed to in the antiseptic settings of hospital rooms. Hospice nurses and other caregivers are usually present when such a death occurs, or they are quickly summoned if needed. A death in hospice care at a private residence is not considered “death without medical attendance.” For example, when someone is found deceased at home and not under hospice care, the coroner or medical examiner almost always will examine the case. Some counties require a pronouncement of death by a physician. On many occasions I have had to transport a deceased loved one from his or her place of residence to a hospital, so that one of the doctors on duty could come out to the transport vehicle and pronounce the patient dead. Nine times out of ten, the doctor looks briefly at the deceased and then at his or her wristwatch and says, “Let’s call it 2:45 a.m.” That is declared the official time of death, even though the patient more than likely expired an hour or so earlier.
Very rarely do doctors come out to a funeral home vehicle completely equipped to make a death pronouncement—no flashlight to shine into the eyes and no stethoscope to detect a heartbeat.
It is important, though, to make sure that the patient is actually dead! I have heard of cases of nursing home patients being transported to funeral homes only to “come to life” during the trip. A colleague once told me that he had an elderly man on his preparation room table and was in the process of removing the man’s clothing when the “dead” man suddenly began to moan and move. After a few seconds of freaking out, my colleague called for an ambulance. The old man was very much alive; he was transferred to a hospital to stay overnight and the next day he returned to the nursing home.
Sometimes I have been just about to roll up the cot to the wrong bed in a nursing home, only to hear the person still breathing. Obviously, I needed to attend the bedside of his or her late roommate. At some older nursing homes, patients are bedded in wards, and there are three or four non-ambulatory people in one large room, which is separated into sections by a floor-to-ceiling privacy curtain. Arriving in the dark in the middle of the night, a kindly nurse in charge once commented to me, “Take your pick,” as we surveyed a row of four elderly patients, all of whom appeared to be dead.
Before the invention of the stethoscope, there were some interesting tests for death. The fire test involved holding an open flame to the skin of the potentially deceased. If the skin blistered, then the patient was not dead —skin cannot blister after death. For the mirror test, a small handheld mirror was positioned under the nose or mouth. If the mirror fogged, then there was obviously breath. The water test was administered by placing a glass of water on the chest to detect any motion in the water from the rise and fall of breathing.
Even such fail-safe tests were not trustworthy; that is why the term
An autopsy may be required for medical or legal reasons—suspected homicide, accident, suicide, or other probable unnatural death. Many teaching hospitals, such as those with a degreed nursing program, or hospitals owned and operated by a university, are required by hospital associations to conduct a certain number of autopsies for teaching purposes.
As an orderly during my college days, I witnessed hundreds of autopsies. As a result, I fervently hope that such a procedure is never performed on anyone in my family. Before proceeding, the pathologist would hand me a notepad and pencil, both already stained with blood from his earlier notations on height, weight, and general
