Silent Siren, page 21
In many ways, death is the great equalizer. Whether one is a homeless drug addict on the streets of New York City or the President of the United States, the final seconds of our lives have a way of putting us all on an even plane. If we pass from this life the way most do, our eyes will roll back in our heads, our breath will come first in short gasps and then not at all as our hearts stutter and fail, our bladders and bowels will empty, and we will acquire a complexion of either pasty white or deep purple, depending on the pathology associated with our condition. In death, we will be more alike than different—still, cold, and with the unmistakably unfocused gaze that conveys the absence of a soul. Within hours to days, we will all smell the same as well, at first sulfurous, then, if we are unembalmed, nose-searingly foul.
Early in my father’s introduction to the funeral business, I showed him the vast cooler at the mortuary service headquarters, capable of housing nearly one hundred deceased human beings, each wrapped in an identical plastic shroud with clear tape securing the edges, each labeled with a name and a case number, each reposing on his or her own sheet of plywood on a shelf. Dad had remarked at the time, “That’s how all of us will end up—on a shelf in Jerry’s office.”
The Grim Reaper comes calling for the famous and accomplished just as it does for us “ordinary Joes.” The remains filling out the contours of the non-descript body bag sitting on a table in a darkened mortuary are no longer John Wayne, legendary film star, but Marion Robert Morrison, a seventy-two-year-old white male who died of cancer. Tagged, numbered, wrapped, and reposing on a stainless steel table, he is no different than the vagrant run down by a car, whom no one will claim, and no one will miss.
Death is, as well, the ultimate abdication of responsibility. World events, the comings and goings of neighbors, earthquakes, plane crashes and the stock market mean nothing to the disincarnate. Without complaint, they remain impotent and indifferent to a world that briefly acknowledges their passing and then, as it must, moves on.
I met Richard “Dick” Catalano of Catalano and Sons in the winter of 2005. We had been called to a residence on Baker Hill Road for two very different purposes. I responded as a volunteer firefighter and paramedic to a report of a man unconscious, possibly not breathing. Dick arrived an hour or so later to transport the man’s body to the funeral home.
I had been to that residence a decade prior when the same man suffered a heart attack. He had called 911 for chest pain that came on, “While I was making love.” We had followed oxygen tubing into the house and found him seated on a couch, with his hand over his chest. We had airlifted him to the hospital, where he underwent a procedure to unclog his arteries.
Now, ten years later, I am the first to arrive on scene, followed quickly by a police officer. The man’s wife shouts down from an upstairs window, “Hurry up! He’s not breathing.” I grab my aid kit from the back of my SUV and Rob and I charge up the stairs.
We find him in the bathroom, face up, fully clothed but with his blue jeans unzipped. He is deeply blue. I don’t know how long he has been down. I reach down to feel for a pulse. None. Urine mellows in the toilet behind his head. At least he got a chance to finish his business before he hit the deck.
The officer and I drag the man from the bathroom into his living room so we can begin CPR. I know the cop won’t perform rescue breathing so I clap my CPR mask with the one-way valve on the man’s face as the officer starts chest compressions.
The medic unit shows up after a few minutes. Another paramedic and I work the resuscitation for quite some time. I get an IV into the subclavian vein under his right collarbone and we give it our best shot, injecting epinephrine, lidocaine, even the rarely used magnesium sulfate in an effort to bring this man’s heart back to life.
We are unable to get a pulse back after thirty minutes of advanced cardiac life support and the code is called. The other medic goes downstairs to “drop the bomb” on the wife. It doesn’t come as a complete surprise. He has had heart problems for years, stemming back to the first time I saw him as a patient.
I stay behind after the medic unit leaves to help the coroner with lifting the man down the stairs. The fire department Critical Incident Stress Management coordinator arrives on scene to give comfort to the wife and discuss funeral arrangements.
It is a surreal scene, sitting at the kitchen table in the big house, realizing my brother went to school with the dead man’s daughter. The new widow sips from her coffee cup and inquires about my life and career. We make pleasant conversation and wait for the funeral home to arrive.
Dick Catalano arrives on scene sometime later in his first call van. Dressed in jeans, I surmise he hasn’t had time to dress for the call and had been caught out doing an errand. He and I and the coroner’s deputy wrap the dead man in plastic, zip him into a well-worn burgundy body bag, and trundle him down the steep staircase.
As we load the body into the funeral home’s van, I say, “If you need any help on removals from time to time, let me know. Here’s my phone number.”
In April of the next year, he calls me back and asks me to work for him part-time. In the three years since then, I have done multiple residential and institutional removals at all hours of the day and night. I conduct funerals, process death certificates, do transports to the crematory, and have begun to learn the process of embalming.
Different Missions
When I mention to people that I am involved in both emergency medical services and the funeral industry, it strikes all of them as odd, even contradictory. “Wait,” they’ll say. “Isn’t that a conflict of interest?” or “Aren’t you supposed to save lives?”
The majority of my paramedical work is done two hours to the north of where I work for the funeral home, so it’s not like I’d be dropping my business card at the scene of every failed resuscitation. Also, I see both of my vocations as intertwined in the shared mission of service to the community. As a paramedic, I see myself primarily as a skilled intervener in a time of crisis. Sometimes we save a life. Sometimes we are there simply to hold someone’s hand and comfort him when death is imminent. Often our mission is to relieve pain as much as it is to extend life. In our arsenal, we carry drugs to blunt pain, to relieve anxiety, and to dim memories of traumatic events. The role of a modern paramedic extends beyond drama, blood, and guts, and into the ability to relate to a fellow human being and to relieve discomfort.
My role is surprisingly similar in the funeral industry. I’ve always been more interested in the immediacy of meeting with a family shortly after a death occurs than I have selling caskets or urns. Very little can be done for the person who has died; I can preserve him temporarily, make him look peaceful, dress him in his finest suit, but he won’t care. It is the living that care, those left behind to mourn a loss. It’s my hope that the compassion of a paramedic comes through in the sensitivity of a removal technician who can calmly and compassionately explain the process of “what happens next” to those who are grieving. The roles of a paramedic and mortician both take a special kind of person with a certain demeanor. Neither is rocket science. Both require the skills of a medical practitioner combined with the acumen of a social worker.
My Other Car is a Hearse
I drive a 1990 Cadillac Victoria funeral coach, also known as a hearse. It is nineteen feet long, white, has a full vinyl top with Landau bars, and gets terrible gas mileage. The s-shaped bars on the back, reminiscent of hinges used to lower tops on 19th century horse-drawn carriages, are iconic symbols of the funeral trade. Cat prints dot the long white hood; Snickers the cat likes to sleep there.
I’ve gotten used to the stares I get when I pilot this lumbering, ornate station wagon down the road. Sometimes I forget that I’m driving a hearse and am temporarily mystified by how much attention I draw.
Do I have a flat tire? Is my blinker on? Oh yes, I’m driving a hearse.
The novelty has worn off. My biggest issue with it now is finding a parking space wide enough and long enough. The hearse’s mirrors are small, designed for the sedan from which the coach is converted, so multiple blind spots exist. A few months back, my dad was driving the hearse on Interstate 5 to pick up a casket and was nearly annihilated by a semi-truck. He refuses to drive the coach anywhere but locally now.
Since the cremation rate in the northwest hovers around 70%, the hearse is only used about three times a month, for the traditional families—those that choose burial over cremation. Some families, however, choose a traditional funeral and viewing in a scaled-down casket, with cremation to follow, and the hearse is used for these services as well.
Until the early 1970s, hearses often did double duty as ambulances. Funeral directors, in acts of good will, donated their time and services to the victims of accidents and medical emergencies. On some hearse/ambulance combinations, the Landau panels were removable and access to the roof was possible through a zippered compartment, allowing the driver to place a flashing red light on top. The back was sparely equipped, with a gurney, oxygen, and a flip-down seat for a first-aid trained technician to ride in the back with the “victim” (the days before they were referred to as patients).
So, strong parallels exist between the fields of EMS and mortuary science. Essentially, the neophyte field of EMS grew, in part, out of the altruistic efforts of funeral directors who had access to a vehicle that could comfortably transport human beings horizontally, the first requirement of any ambulance service.
Embalming Mrs. Ramirez
Concepcion Ramirez reposes nude on our gleaming porcelain embalming table, her feet tilted down for drainage, her gray hair falling in tangled hanks over a white plastic block that elevates her head, preventing the oozing and facial discoloration that often occurs postmortem. A transparent anti-dehydration cream covers her face and ears, painted there hours prior, immediately following her removal from the Ramirez family compound this morning. Her brown eyes are barely visible through semi-closed lids. Her toothless mouth gapes, dentures resting on her ample chest. A gold wedding ring gleams from her left hand, placed above her right, atop her abdomen. An air conditioner hums in the corner next to a tall metal shelf that contains embalming chemicals in bright oranges and reds. The air is dry and smells of antiseptic.
Behind Concepcion’s head, a wheeled cabinet similar to those used in auto repair shops contains the tools of the trade— metal catheters for placement in arteries, devices to hold the eyelids shut, plastic implements designed to compel the mouth to close in a natural and pleasant way, devices to close an opened skull, cosmetics, biohazard masks and gowns. A small tray of instruments containing forceps, scissors, clamps, hooks, scalpels, and curved needles sits near a stainless steel sink under bright white lights.
Embalming appeals to the frustrated doctor in me. It requires knowledge of anatomy and, specifically, of the circulatory system. My anatomy and physiology background from college and my paramedic training both dovetail nicely into the application of preserving a body for viewing.
Our prep room resembles a surgical suite. Tucked in the back of the mortuary, behind a locked door with a Biohazard
Sticker and the words “Dangerous—Formaldehyde, Authorized Personnel Only,” it is the repository for our three cloth-covered gurneys and most often, their cargo, recently deceased Bainbridge Island residents.
Dick reaches to a metal shelf, grabs a bottle labeled “Hydrocel,” and pours the contents into the top of what resembles a large blender—a Portiboy brand embalming machine. He adds water from a spigot overhead and then caps the machine with a lid before the fumes make my eyes water. Formaldehyde is a gas carried in a liquid medium. As it rises through the tissues, it arrests decomposition and restores a lifelike appearance to the remains.
As Dick readies his equipment, procuring stainless steel clamps and rubber tubing, I go about setting Mrs. Ramirez’s features. I place perforated discs resembling half ping-pong balls under her eyelids to close them. From a cabinet above a stainless steel sink, I cut a length of twine and thread it through a curved needle. With this I will suture her mouth shut. I pierce her lower gums and then bring the needle underneath her upper lip and into her nasal cavity. I pass the needle through the septum from the right nostril into the left and back down behind her lower lip. I hold her jaw closed with one hand, while I tie the twine in a bow with the other, just tight enough so that her mouth will close in a relaxed but pleasant manner. Too tight and she will spend her viewing scowling at mourners. Too loose and she will look, well, dead.
Dick and I each grab a limb and begin moving her arms and legs back and forth, loosening the joints, relieving rigor mortis. Next, Dick slices a horizontal incision above the right collarbone, and locates the connective tissue bundle that contains the carotid artery and jugular vein. A small incision is made into the carotid artery and an arterial cannula is placed inside, the other end connected to tubing that extends from the embalming machine. The artery is tied off above the incision site to prevent the face from swelling. The jugular vein is isolated as well; it will be used for drainage. A small slit is made in it as well and Dick slips a thin pair of forceps inside to break up clots that may block drainage.
Dick flips a button on the embalming machine and it comes to life with a whir, beginning to pump the amber solution into the carotid artery and through the entire circulatory system. Very soon, an embalming fluid/blood mixture can be seen flowing steadily from the jugular vein wound. That is how we know the circulation is intact and the process is working.
Embalming is an active process. It requires not only that the machine does its work, but that the practitioner bend and massage the limbs to ensure that the fluid reaches the feature of the face, the tips of the fingers, and the tips of the toes. This is especially important in those who have suffered from poor circulation—or peripheral vascular disease. Concepcion’s body begins to take on a more lifelike hue as the formaldehyde is distributed through her capillaries. In addition, the flaccidity of death is replaced by firmness as the proteins in her cell are gelled. Since formaldehyde is a gas, it will rise naturally through her tissues and continue to infiltrate the cells hours after the embalming process is completed.
A small amount of bloody froth oozes out of the corner of Concepcion’s mouth and we know the arterial embalming is complete. Dick switches off the embalming machine and removes the hardware from her blood vessels, dropping the metal implements into a vat of disinfectant above the sink.
The only way to ensure that the Clostridium Perfringens bacteria normally present in the intestines will not take over the abdominal and chest cavities, causing them to swell, is to directly inject fluid into those spaces with the use of a wicked-looking device known as a trocar. I hook the spear-like apparatus to suction and plunge its tip at an upward angle into Concepcion’s abdomen, just above her belly button. As I strike her aorta, dark blood flashes into the transparent tubing and gurgles down a drain at the foot of the embalming table. I move the trocar around in both the abdomen and the chest, puncturing all internal organs. The tubing flashes brown, tan, yellow, and then back to maroon again as the trocar strikes bowel, gall bladder, lungs, and arteries. It’s like post-mortem liposuction. Her belly flattens. After fluid is suctioned from the body cavities, I exchange the long tubing for a shorter piece that is then attached to a bottle of very caustic embalming fluid known as cavity fluid. Via the ancient method of gravity embalming, I run the cavity fluid through the trocar, effectively searing or rubberizing all viscera. I withdraw the trocar slowly, detach it from the tubing, and place it in the disinfectant bath. Using a device resembling a screwdriver and a plastic device known as a trocar button, I plug the hole made by the trocar and thus prevent leakage.
Dick stuffs a wad of formaldehyde-soaked cotton in her chest incision and then pulls a paper sheet up to her chest. Tomorrow, we will dress her in her flowered and pleated dress and wrap rosary beads around her fingers. The stylist will arrive and fix her hair the way she wore it in life. Her casket, an 18-gauge steel affair with a sealing gasket, silver in color, will arrive later today.
The typical embalming will keep the body in good shape for about two weeks, usually all the time that is needed in the interval between death, viewing, and burial. It is possible to keep a body preserved for much longer, but it is a more labor-intensive and expensive process, and, ultimately, not very useful. The decedent in these cases is very stiff, not very life-like, and prone to dehydration because of the high concentration of formaldehyde.
The process is somewhat different in a body that has undergone an autopsy, in that the circulation is completely disrupted. In these cases, the carotid arteries are located within the open chest cavity and injected upwards. The femoral and brachial arteries are individually injected and the process is completed with what is known as hypodermic embalming, using an adult or child trocar to make multiple injections in the skin flaps. The viscera is soaked in a viscera bag, to which is added a bottle of cavity fluid and then placed back in the abdominal cavity at the conclusion of embalming. A good embalmer is able to make an autopsied body viewable with no evidence of the autopsy obvious to the viewer.
