Question from 8thday

I was wondering - do you know what the percentage is of people using churches vs. funeral homes for their funerals? And has that percentage changed over the years? It seems like the vast majority of services I attend are now done (non-religiously) right in the funeral home. But that might be a product of who I am and where I live.

I really wish I had an answer for you, but it's hard for me to figure out. I mean, I suppose that the families that choose to have services tend toward their own church, but I have seen an increase in the number of chapel services, and I have had families ask for the chapel specifically because they wanted something non-religious. Part of the reason I don't feel like I can accurately answer you though, is that the last job I had was in a fairly large city, and larger cities tend to be less religious, therefore making the church services less popular. Before that I was in a smaller farming community, and they are traditional as anything, so they are more likely to use churches (and also more likely to choose burial instead of cremation, which also means they are more likely to have services of any kind). Does that clear anything up?

Question from roommates

My roommate turns to me, knowing that I read your blog religiously, and asked me what happens the organs they remove during the autopsy? Do they just put them back in and stitch the person up, or dispose of them? Or you stitch up the autopsy incisions? I told her I didn't know, but would pose the questions to you.


The organs, and the brain (which is also removed during a complete autopsy), are, after their examination, usually put into a plastic bio hazard bag, placed back into the thoracic cavity, the severed ribs placed on top of that, and the autopsy incision sewed back up.  When the case arrives to the mortuary and embalming has been approved by the family, the embalmer opens the cavity, takes out the ribs and the bag, opens the bag and pours high index (strong) embalming fluid in it (called cavity fluid), and closes the bag again so it can "marinate" (man, we use a TON of food references in the prep room that I never really paid attention to). After the rest of the body is embalmed the viscera is taken out of the bag and put into another bag just like it, put back into the cavity, ribs placed on top, and the incision is stitched up again.  That's it!

Aspiration

So, my friend, Miss Anne and I were chatting it up today, and she had some questions, so, with her permission I'm posting some of our convo:

*Mrs.A* says:

how's the deads

any good ones?

Doll says:

yep

*Mrs.A* says:

omg.

you've been holding out!

BITCH!

Doll says:

I had a tough reconstruction yesterday

LOL

I know!

*Mrs.A* says:

what happened?

Doll says:

13 year old

car accident

her mom died too

but I havent done her face yet

*Mrs.A* says:

omg

sadness

Doll says:

yes

*Mrs.A* says:

a 13 yr old ???

Doll says:

yes, and her sister is still in critical at a hospital here

eek!

*Mrs.A* says:

wtf.

is it bad?

Doll says:

yes

*Mrs.A* says:

like un recognizable?

Doll says:

no, but the girl took a lot of work

but i got to train my coworker a bit on it

so that was great

*Mrs.A* says:

wow. girl i dont know how you do it

do you ever get "scared" of the people?

Doll says:

lol

no

*Mrs.A* says:

i think the eyes being open would freak me out

Doll says:

[the other embalmer] was working on the girl and emailed me a "before" photo of a huge gash on her hand

that was kinda gross

but not scary

*Mrs.A* says:

[cute pet name for my other embalmer]???

Doll says:

lol, thats what i call her, its a pet name

Doll says:

(I explain how I came up with the nickname for her)

*Mrs.A* says:

(i love the nickname)

omg

best

so

tell me this

if people have gashes, or jacked up faces... (holes, etc)

and you try to embalm

doesn't the fluid come out?

Doll says:

yes!

but you just let it

so that the rest of everything gets fluid

*Mrs.A* says:

the vag/buttplug are almost too much to think about!

Doll says:

i knoW!

but its WAY better than the old way of doing it

*Mrs.A* says:

?

cotton?

Doll says:

sewing it shut

*Mrs.A* says:

omg

Doll says:

*VOMIT*

*Mrs.A* says:

eeek.

so

i can plan on a buttplug at death.

Doll says:

most likely you wont need one

*Mrs.A* says:

?

Doll says:

most people dont

*Mrs.A* says:

ohhh

only if you have a flappy butt

LOL.

Doll says:

when i aspirate their guts most stuff gets sucked out

LOL

*Mrs.A* says:

how do you aspirate?

Doll says:

you use a trocar

ill take a photo in  a bit and email it to you

*Mrs.A* says:

(vacuum?)

Doll says:

sorta

*Mrs.A* says:

where do you poke?

Doll says:

near the belly button

lol

its so funny how people have NO CLUE

*Mrs.A* says:

i know

WHY do you think i'm OBSESSED?

/curious

Doll says:

because youre NUTS

lol

*Mrs.A* says:

but i also am kinda scared of the deads

i dont wanna see anyones eyes

Doll says:

you just shut them, you know

or put a towel over their face like you do with their private parts

*Mrs.A* says:

ever have one "gone"

Doll says:

what do you mean?

*Mrs.A* says:

like popped out

or poked out

or missing

Doll says:

ive seen a glass eye a time or two

and one guy had part of his face gone including one eye because of face cancer

*Mrs.A* says:

wow.

how do you fix that?

Doll says:

just like fixing an auto accident

*Mrs.A* says:

lol

Doll says:

lol?

*Mrs.A* says:

like just throw in a muffler, some oil, a wrench and call it good

lol.

 (that's what came to mind)

then i was like ....ohh... like facial reconstruction.

 (sorry)

Doll says:

LOL

*Mrs.A* says:

i need to jobshadow for a week

*Mrs.A* says:

seriously.

Doll says:

thats funny!!

you do!!

*Mrs.A* says:

omg they wouldn't let me watch anything there tho would they?

Doll says:

they sooooo would!

my boss LOVES hot chicks

so you could totally

*Mrs.A* says:

lol right.

So, a trocar looks like this:

(source)
The three small, pointy objects you see are the tips of the trocars and are sharp.  The tip is screwed on before the trocar is used, and comes off to aid in cleaning, as well as to replace when it becomes dull.  The two trocars at the top of the photo are used for regular aspiration of the deceased.  The end with the handle gets attached to a hose and the hose is attached to a bibb (is that the right word?) that sucks air in when the faucet is turned on (see photo below).  Aynway, we use the trocar to puncture the viscera (see other picture) and suck out the remaining body fluids, then pour in some strong embalming fluid to harden and sanitize the trunk of the body.

and is inserted (usually) here:

(source)

I got an email question:

Good Day Dollface:
First off, I enjoy your blog for giving us readers an insight into both your professional and personal life. I live in Canada and I have a question.
I would like to simply be cremated in a cardboard box without embalming. Is this possible? How can I ensure my wishes?
If you could address this question on your blog, I would really appreciate it.

Now, I don't know the rules there in the land above, but I do know them here, and I would imagine they are a lot the same, and to be sure I called up a funeral home in Vancouver to ask a question or two, and I was right.

If one wants to be cremated, and there is no viewing of the body, there is no reason to embalm the remains.  Instead, the remains are refrigerated, so as to slow down their decomposition, and then cremated when the proper documents are filed and the cremation is approved.  Into a cardboard box the remains will go, and into a retort (mortuary term!) and viola! the cremation begins.  Now, in order to ensure that your wishes to be cremated (directly, without viewing) are followed, you need to pre-arrange your cremation with a local funeral home, and then let your family know that you have done so, so that they don't call the wrong place when you die, and make unnecessary (and unwanted) arrangements. It would also be a good idea to prepay for the services, as most mortuaries will offer a guaranteed price when you pre-pay.

Is that sufficient? Would you like me to email you some mortuaries' contact info in your area?

Friday Question-fest

Question from Jenn:
Also, most of us like to think of death as a nice, quiet passing; but there are those that pass quite violently (car accidents, buildings collapse, airplane crashes) how does that differ? Have you ever encountered anything so horrific that you couldn't stand it?

It's strange I suppose, but the horrifying part of dying is usually okay with me.  There have been auto accidents that have been very scary looking when the body reaches me, with the re-building of the skull alone taking a whole day, and the actual face taking a lot longer.  A few suicides have also been quite the projects, shotguns are very damaging.   The worst looking cases (and most likely that I cannot help them) are usually drowning victims that don't get removed from the water quickly.  We call them floaters, and the water makes them decompose very quickly, and they smell awful and look even worse.  But really, I haven't ever had a case that I couldn't work on because it was too gross, I actually like the gross ones, they give me something to do. 

And IT asked:
Do funeral homes charge like a corkage fee if somebody already has casket that they bought from Walmart or Costco?

LoL.  It's actually illegal to charge a casket handling fee, but funeral homes get around it by either offering package pricing when a family buys a casket from them and then itemizing their service fees if the casket is purchased elsewhere, or by raising their service fees and lowering casket prices so that they get the money anyway.  Costco has been selling caskets for a while now, and I have only encountered a family using them twice, so I'm not really sure how well they're doing with the whole thing, and just as a side note: the caskets offered now by Walmart are made by the same company as the Costco ones.

And a last one from RIC Girl:
I have a question about facial reconstruction. Can you explain how you disguise bad cuts, broken bones or areas of the face that are shattered? How about the smells involved with the whole embalming process? Is it something you get used to?

As for facial abrasions, it depends a lot on the type of wound.  No matter what the hole is stitched up, I usually use dental floss (white, mint).  It's very strong, and thick enough not to rip through and tear the skin when pulled tightly enough to close a gaping facial wound, but not heavy like the string I ues to stitch up the embalming incision(s), and it smells nice.  Anyway, if part of the skin is missing i bring the two (or more) sides together as much as possible when I stitch it up without pulling too hard so that the skin looks too tight.  That way there is floss going across the hole, giving the stuff I use to fill the hole up with something to hold on to.  once its all stitched I dry the tissue really well with a chemical, and I can then start rebuilding.  The product I like to use the most for that sort of thing is called "Easy Way" (I know, totally lame name) and is made by a chemical company called Dodge (I think they're out of Massachusetts (wow, I don't think I would have EVER been able to spell that state n my own)).  The Easy Way is a powder and a liquid that I mix together when I'm ready to use it, and I can make it any consistency I need.  I usually make it a little more pliable than modeling wax, and stick it where I need it.  If I'm using it to fill a hole I just sculpt it to fit the surrounding tissue, and smooth it over using a paint brush and a chemical called "Dry Wash II" something a lot like nail polish remover, that allows the brush to glide over the Easy Way and not stick to it.  When the Easy Way looks the way I want it to I cover it with some of the powder in the mixture and let it sit for a bit.  I can add layer after layer to build up features (like a nose or lip, or something like the brow bone or cheekbone if it wasn't able to be rebuilt from the underside) after the underneath layers dry and become hard if I need to.  When Easy Way first came out it was hard to work with, but I kept at it, and now I like it much more than the wax clays we used for eons before the Easy Way came along.  I've been trying to teach Jane to use it as well, but she's old and set in her ways (and she usually hires me to do reconstructions anyway).  Once the features are the way I want them I use make-up over them, and then apply any hair that might need to be there (eyebrows/eyelashes are common things that need to be replaced in accident victims).

As for the smells, yeah, they're gross, and I'll admit, I have gagged a time or two, but they really don't bother me too often.  Don't get me wrong, I dont adore the smell of decomposing flesh, or the smell of viscera on an autopsied case (imagine what rotting feces would smell like), but it's just part of the job.  Same thing for the smells of the chemicals, I just kinda have to bear them, so I do.

Children and Babies

So, I've been really thinking about the questions regarding children, and I have a few different answers.  People usually want to know how I work on children and babies, like how I don't just cry and cry when I work on them, but they never really ask about the process and how it differs from that of adults, and I'd like to cover all of that here.

Children and babies have higher fat content in their bodies than normal adults, which makes it harder for the bodies of children to embalm as well as an adult since embalming relies on fixing proteins (muscle).  Fat people are a lot the same, the tissue just doesn't "fix" (get firm) as well as in bodies of someone with less fat.  In order to compensate for the higher fat content we usually use stronger formaldehyde content, but that can lead to tissue becoming dehydrated more quickly than in a "normal" case.  with children I try to use the stronger fluid mixed with humectant chemicals, which, if I try to explain, is like injecting them with lotion so as to moisturize the tissue from the inside.

With babies, especially with fetal deaths that were premature, sometimes it isn't possible to embalm them using the arterial system, as it is not developed enough to do much good, and their skin is so underdeveloped that it tears easily and is hard to stitch up any injection site.  In cases like that we normally "pack" them, which means we wrap the baby in cotton and saturate the cotton with embalming fluid, and let the body sit for a day or two.

So that's the technical aspect.

As to the emotional side of things, that's a lot harder to answer.  It wasn't until recently, in dealing with the homicide of a young child, that I had any emotional issues with the death of children.  I don't mean to sound like I am cold, or unfeeling, but I am fairly good at understanding that people, even children and babies, die.  I don't feel like it's fair, and I don't think that I feel like it has to be fair, and I know that me doing a good job, whether it be meeting with the family of a dead child, or embalming them, that it will help a grieving family, and that helps me tremendously.  Usually when a child dies it is because of an accident, or maybe a long-standing illness, and while families have questions about why their child had to be the one to die, I don't tend toward those thoughts.  But then, with the homicide case a little while ago, I was shaken.  I cried when the case got to the funeral home.  I sobbed, I was uncontrollable.  I didn't understand.  I still don't.  I cried when I met with the family.  I cried at the service.  I cried as I attemped to make the little body look like it hadn't suffered.  I cried to my mom, and my friends, and was just not myself.  I still don't sleep well, waking to thoughts and images of the little body.

So, that's what took me so long to post.

Questions of the day, Jenn edition

So here are Jenn's questions, and my answers. Keep in mind that different morticians do things differently, so my answers might not be true to what your local funeral professional does.

1. Do the bodies ever move or twitch or make noise (groans, etc.)? Yes and no. When someone dies there is no twitching or moving of the limbs and what have you. They might move a little because their muscles have completely relaxed (eyelids open, mouth opens, arms relax, etc.), but there are no other motions made by them. They can, however, make noise, usually because of air trapped in their lungs that releases, especially when we move them from their place of death onto a gurney. The air will kind of just come out, sounding like a heavy sigh. The first time that happened to me I took the guy's pulse to make sure he was dead. He was.

2. Do you really put a plug in the rectum to stop "leakage"? Yes, sometimes. The plug is actually called an A/V plug (anal/vaginal), and looks like this:

It screws into the cavity (after embalming), and first I fill it with absorbent powder (the one in the photo is a bit different than the ones I like to use, the ones I like have a larger area to put powder into). It isn't the best part of the job, but it's better than sewing the anus or vagina shut (very hard to do effectively) and WAY better than having stuff leak out of their body.

3. Do you really sew the eyes closed and/or wire the jaw closed? Kinda. With the eyes I use things called eye caps, which look like contact lenses made out of plastic, with tiny raised spots on them to "hold" the eyelid down, shown here:

The ones I use are clear, and they are placed on the eyeball before embalming.  This keeps the eyes closed during embalming, and after the embalming the tissue is hard enough that the eyelids don't open easily.  Just as an added precaution though I use a dot of glue on the eyelid to make sure that there isn't any chance the lid could open during a viewing (due to the dehydration and shrinking of the eyelid tissue, not because people try to pry eyes open all the time).

As for the mouth, the other embalmers I work with wire the jaw shut using things called injector needles, wires with a little barb on the end that embeds into the gum tissue, one on the top and one on the bottom, and intertwine those two together, closing the mouth.  I don't like the barbs though, they seem mean, even if they are easy, so I sew the jaw shut (my husband thinks it's crazy that I don't have any issues sewing a mouth shut but won't use a needle injector (the instrument used to force the barbs into the gums)).  I might have to work on a diagram to explain how I sew it, I guarantee it isn't the way you are thinking it is done.  Maybe I'll work on that this weekend, or see if I have a book with an illustration of it.

4. Do the muscles relax when you pass and you poo and pee? Yes, but most of the time that is taken care of during embalming.  Not only do a lot of the people that die have on some sort of adult diaper, but they are also on diets that consist of water and IV nutrients, so they don't have much to excrete (gross) anyway. And one of the things I do during (after) embalming is called aspirating, in which i take a trocar (a long "needle" of sorts, about two feet long) and puncture the stomach and suck out anything trapped in the organs (poo, pee, blood, bile, etc)  and drain it, and put in extra strong formaldehyde to embalm those organs well.

So, let me know what else you have...