appearance. I was the designated stenographer, assigned to note the weight and condition of each organ and any abnormalities detected. I perused the initial notations of the pathologist so that I could be equally descriptive—I didn’t want to appear inexperienced. Standard initial commentary was already present: “A fifty-four-year-old white female, eyes brown in color, natural hair, streaked in gray. Well nourished, with all natural teeth present. Surgical scar on abdomen suggests past hysterectomy, with no other scars or anomalies noted.”
First, a
The initial sight of exposed human organs always takes everyone aback. My first glimpse reassured me that there is a God, because all of those organs must work together in perfect synchronization to sustain life, and that’s something so complex that only God could make it possible.
After the initial reaction to the sight comes the shock of odor. Blood reeks after death, as do stomach contents and the contents of the colon. Then you note the vivid colors of human organs: the mottled, black- specked appearance of a lung; the reddish-purple hue of a heart; the grayish-blue tint and the glistening wet appearance of a kidney; the three-lobed liver the color of any calf liver in a supermarket meat case.
The pathologist then used a large knife to open the pericardial sac, the structure that surrounds the heart. With a qualified, deft slice, he released the heart from its moorings. The dripping heart was placed in a stainless- steel basket attached to a ceiling-mounted scale. The heart’s weight is critical; if a heart is heavier than normal, that’s an obvious red flag and probably the cause of death. An enlarged, and heavier, heart sometimes pinches off the nearby arteries, dramatically decreasing the blood flow.
After being weighed, the heart was placed on a cutting board, where the pathologist sectioned it to meticulously search for any abnormality, such as scars from past or recent coronary disease.
The remaining organs were removed and examined in the same fashion, with a few exceptions. The stomach was removed and the contents poured into a stainless-steel container for inspection. The first time I witnessed this procedure I was close to nausea. Stomach acids that had ceased working nonetheless carried the familiar odor of vomit. Certain foods do not digest quickly. Salad greens, broccoli, and baked potato skins are clearly recognizable among stomach contents, as are drug capsule remains. I was once instructed to use a screened ladle, much like a net used in fishbowls, to dip into the stomach of a patient who had potentially ingested many chloral hydrate capsules to commit suicide. It was amazing to know the death was on purpose, which I knew as soon as I scooped out more than forty capsules, some dissolved but some very recognizable.
Probably the most unpleasant part of an autopsy is the procedure called
After witnessing many autopsies, all the sights and smells became commonplace. When I became a seasoned veteran, I have to admit that I enjoyed watching young nursing students entering the autopsy theater for the first time. Standing four across at the head of the autopsy table, the fresh-faced kids all wore looks of frightened anticipation. Once the scalpel made the first cut, and the body opened up in all its glory, the students’ countenances changed from nervous grins and smirks to mouth-dropping stares and curled upper lips.
Death unmasks us all.
CHAPTER FOUR
Morbidly obese decedents pose some special challenges. Let me be clear in the beginning—I mean no disrespect to any folks who carry excess weight. But given that the death care of the morbidly obese occurs more frequently today than ever, so much so that casket companies now offer a specific line of caskets reserved for that increasing niche of decedents, talking about how we delicately handle these situations can shed some light on the state of death care.
For example, several years ago, I was called to the residence of a deceased thirty-five-year-old female who weighed 660 pounds. Luckily, the local fire department was already on the scene—the firefighters had dealt with the woman’s medical problems before and knew the inherent problems of transporting her. She was found face- up in bed (“bed” was two twin-sized mattresses on two-inch sheets of plywood that had been glued together and were supported at each corner by concrete blocks). After reviewing the situation, I took the mortuary cot out of the hearse and left it in her front yard. There would be no way she could fit on something that was only twenty-two inches wide. The life-squad personnel and I pondered our dilemma for a few moments. Then I came up with the plan of the century.
I drove to a nearby hardware store to purchase a large canvas tarpaulin to spread out on the floor next to the woman’s bed. Seven men assisted me in grasping the bed linens beneath her and gently pulling her onto the tarp. With four of us on each side, we gripped the tarp and slowly moved her to the front door and into the hearse.
That was the first time I ever placed a body directly on the floor of a hearse, and there was little room to spare. I asked the life-squad personnel to follow me back to the funeral home so they could help me transfer her into the building. At the funeral home, I had to make some adjustments: because the decedent was forty-three inches wide, she couldn’t possibly fit onto a standard embalming table. I placed two tables side by side and latched them together at the legs with nylon rope. The eight of us took baby steps with the tarp and its cargo into the funeral home, down a short hallway, and into the preparation room. Then, after a brief rest, we counted to three and hoisted the decedent onto the joined embalming tables.
Later, since I could not hold the mass of fatty tissue away from her neck to locate the carotid artery or jugular vein, I opted to find and raise the right femoral artery and vein, located in the upper thigh near the groin. After making the femoral incision, I had to ask an assistant to hold open the incision with his hands and some strategically placed duct tape. I was nearly up to my elbow in fatty tissue before I finally could delve deep enough in the femoral space to locate the selected vessels. Arterially embalming a decedent of average weight usually consumes from three to five gallons of formaldehyde-based chemical. In this case, I injected fourteen gallons through the decedent’s arterial system before I finally started recognizing some positive results.
When I received her burial clothing the next day, I pondered the sheer size of the black dress she was to be buried in. My wife styled her hair, I applied cosmetics, and we awaited the arrival of my seven assistants to move the woman into her substantial casket. I had ordered a custom-made forty-five-inch-wide, eighteen-gauge steel version, which had been delivered that day.
The next hurdle was coming up with a proper device on which to place the casket. A standard bier, a wooden pedestal-like device on wheels, would not be strong enough to support her weight. I called around to inquire about the price of having a special bier constructed on short notice—but to no avail. During one fruitless call, however, a gentleman referred me to a welding shop known to have rolling carts on which they mounted equipment. The owner invited me to come over and take a look at a steel cart that sported heavy-duty steel wheels. He agreed to deliver the cart to me, and after a good scrubbing and applying black bunting around the top edge, it was perfectly serviceable.
Throughout the entire process, I made one serious blunder. I had placed the casket on the floor of the preparation room and removed the lid, so that we could get around both sides as we lifted it. Removing the lid was an excellent idea; laying the casket on the floor was not. We hoisted the decedent into her casket and positioned her as well as possible so that she would look comfortable in her repose. But that’s when my blunder sank in. We would need to lift her again—this time with the added weight of the casket in which she was lying! I apologized to my hoisting partners and admitted that I should have placed the empty casket into position on the welding cart and then situated the decedent. I also vowed never to make such a mistake again.
Since a forty-three-inch-wide casket will not fit into a hearse, a standard burial vault, or standard grave, I had to devise a mode of transportation to the cemetery and then arrange for oversize accommodations there. The
