Does This Mean You'll See Me Naked? (4 page)

INSIDE THE AUTOPSY

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 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
Y
incision is made with a scalpel on the chest of the decedent. A large knife pares away the muscle and fatty tissue to expose the ribs. The ribs are cut away with a cast saw to expose the thoracic and abdominal organs for the pathologist's inspection.

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
running chitlins
: several feet of intestines curled up in the abdomen are pulled out a foot or so at a time by an assistant (me) and then handed to the pathologist, who slices open the structures and inspects the interiors for tumors, restrictions, or any other abnormalities. Part of my duty was also to squeeze the exterior of the intestine to force fecal material out of the way so the pathologist could obtain a clearer view. That particular procedure took a little getting used to, but after a few times, I thought nothing of it.

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.

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 burial vault company offered its flatbed truck, which was also equipped with a hydraulic crane, for use as a hearse. Following the funeral, the truck backed up to the chapel door, and two canvas-strap slings were slid underneath the casket. With little strain, the hydraulic lift gently swooped the casket onto the truck for its short journey to the cemetery.

I'm sure the sight of a white flatbed truck with a very large blue casket on the back leading a funeral procession down the street is not very common. When we arrived at the cemetery, I noticed that an inordinate number of gawkers had staked their claims near the grave site to catch a glimpse of what they had heard was a woman with a very large casket.

The bottom part of the vault was twice the normal size. The vault company also made concrete septic tanks, so with such a large grave opening, it had used an actual septic tank. For the first time, I witnessed a graveside ceremony standing next to a minister and a vault truck, with the honored decedent resting on the truck's bed rather than on a lowering device above the open grave. With a twist of a lever, the casket was raised and gently cranked down to its final resting place.

CASKET TECH

Expensive caskets, such as those of sixteen-gauge steel, stainless steel, solid copper, and solid bronze, are sometimes urn shaped rather than rectangular. The urn shape is not only more attractive and more expensive but also serves a practical purpose for funeral directors. The extra inch or so of width inside allows us to position a heavier person in a more comfortable repose. With arms crossed across the abdomen, the elbows rest against the interior sides of the casket. Without that extra room, the deceased appears, and is, stuffed uncomfortably into the casket.

For decedents who weigh 350 pounds and up, oversize caskets must be used. A standard casket's interior dimensions are twenty-three inches wide and seventy-eight inches long. Oversize caskets are available in widths of twenty-seven, thirty, and thirty-four inches. For the morbidly obese, custom-made caskets must be specially manufactured and are usually available in two or three days.

Many midrange and high-end caskets are equipped with a plastic tray underneath the dead body—a fail-safe liner. Embalming and other fluids frequently ooze from the deceased even if an expert and thorough embalming job has been done. Incisions that have not dried properly or have not been stitched tightly enough have also been known to leak, as does the site of the trocar, where embalmers insert a thin, tube-like instrument just above the belly button to aspirate the thoracic and abdominal cavities. Obese decedents present an additional problem in this regard because of the immense pressure on the abdomen from their weight and the weight of their arms and hands resting on the belly.

Many years ago I was approached at a visitation by the deceased's spouse, whose husband was morbidly obese. She asked me to explain the moisture and the odd sound emanating from his casket. Luckily, he was dressed in a black sports shirt, which made the moisture less apparent to the public; however, as I held my ear to his belly, I could distinguish a bass sound similar to the opening notes of the 1960s gag song “Tie Me Kangaroo Down Sport.” I asked those gathered to leave the room for a moment while I investigated further.

I pulled up his shirt and undershirt and discovered that the trocar hole, originally closed with a threaded plastic button, was belching liquid, probably propelled by a belly full of gas. His immense girth and the pressure of arms and hands had forced the liquids outward and onto his clothing. I replaced the trocar button, laid plastic sheeting against his bare belly, and sprayed Lysol around the casket. It sufficed until the visitation was over, and we were able to treat the problem later more thoroughly. I had not been the embalmer in this case; whoever was had obviously not treated the thoracic and abdominal organs.

Those who leave a larger body behind make a larger impression on us all.