The Removalist

by Matthew Franklin Sias

  As the hours turned into days, and the days turned into weeks, his body remained still, but changed nonetheless, his skin turning from white to green, darkening until it was black. He began to stink. His fingers and toes shriveled as his belly bloated with gas. His skin formed blisters and separated from the tissue underneath. The stench increased to the point where it seemed hard to believe that nobody noticed. Tenants in the building walked back and forth from their apartments, separated only by wood and plaster, apparently blissfully ignorant of the rotting corpse mere feet away. Maybe an unusual odor wafted out from time to time and was dismissed as poor housekeeping or food left out for too long.

  Each morning the sun rose, casting its rays through Scott’s dirty window and onto his rapidly changing corpse. Each evening as the sun slipped beyond the horizon, the light faded but the process in Scott’s body continued undaunted, accompanied by a softly playing radio and dimly lit by a tiny lamp. Autolysis and bacterial decay worked in harmony to reduce what was once living into the raw material of something new. And nobody noticed.

  Nobody noticed that he hadn’t left his apartment in a month. Nobody cared enough to investigate the reason he hadn’t shown up to his doctor’s appointment. No supervisor missed him at work. He had no job. If he had friends, nobody stopped by to see him. For a month.

  I thought of my own life, how many obligations I have, places I need to be, and people who rely on me. This man had no one. Nobody missed him.

  The following day I phoned his physician, who hadn’t seen him in some time, so I agreed to sign the death certificate. His belongings were picked up, and my report was completed. The case was closed.

  Now it was up to the apartment manager to arrange for his apartment to be thoroughly cleaned, the mattress disposed of, and the carpets to be shampooed. What little possessions he had were moved out and donated to a charity. Scott’s body was quickly cremated at a local funeral home and reduced to eight pounds of ash. Effectively, all traces of him had disappeared.

  I put a new air freshener in my van, replaced the body bags, and readied it for the next case.

  Autopsy

  Barbara hums as she guides the scalpel behind the ears of the vagrant unfortunate enough to end up on our stainless steel table this fine sunny day. Bloodlessly, the skin separates to reveal a hint of the galea aponeurotica, a band of connective tissue that cocoons the skull. Then, using short, deft movements of the scalpel’s blade, she begins dissecting forward, towards the forehead, cleaving the scalp from its underpinnings.

  “Always look on the bright side of life!” she sings—a line from the last song of Monty Python’s “The Life of Brian” in which a prisoner croons from his wooden cross. She sings as though serenading the dead man’s remains, imploring him to have a better day than the one that brought him to us.

  The scalp is now folded down over the man’s face, completely obscuring his features, a few straggly scalp hairs brushing his stubbly chin, beard-like; it is time for the bone saw. With one hand steadying the top of the skull, Barbara presses firmly in an imaginary line circumnavigating the top of the skull. The high-pitched whine of the reciprocating saw drowns out her humming, but I can still see that she is. Her eyes shine above her surgical mask.

  Dark blood oozes out from the trench created by the saw blade. Much as sawdust falls to the sides of a chainsaw blade, bone dust forms and fills the room with its acrid odor.

  The cut complete, Barbara lays down the saw and picks up a skull key, a metal device with a broad screwdriver-type tip that will be used to leverage the skull cap off the tough underlying dura mater.

  “I’ve always got a song in my head,” says Barbara. “Do you?”

  I do, often an aggravatingly annoying one, such as “The Hamster Dance.” I wake up with them, go to bed with them, and to my chagrin, I am unable to get rid of them. Sometimes these songs become audible as I accidentally burst into song, much to the puzzlement of those around me.

  With a “thwuck” sound, the skull cap comes off and Barbara lays it upside down on the steel table. The dura mater, tough and beige, lies protectively over the delicate, gelatinous brain.

  As Barbara removes the dura and thrusts her small hands into the cranium to sever the brain from its stem, her husband, Graham, a forensic pathologist, dissects the abdominal organs. The couple are an anomaly in the world of death and decay, two perpetually positive folks who welcome a rainstorm as joyfully as most people would welcome a warm, sunny day. Their voices are gentle and they remain respectful of the dead, regardless of the sordid details that may have led them to their demise.

  Graham, a vegetarian, and Barbara, a vegan, are also tender souls when it comes to vermin in their own house. Instead of setting traps that snap the necks of mice or leave them to starve to death on a sticky trap, Graham traps them and drives them far from his home to release them into the wild. It is though his constant exposure to death has made the idea of killing even the smallest animal utterly repugnant to him.

  Barbara cradles the newly released brain in her gloved hands, as gently as if it were a new baby. The seat of the soul, of fifty years of memories, joy and pain, the command center of this now destroyed human, looks terribly vulnerable and fragile, jiggling like gelatin as Barbara places it on a gray plastic board for photography.

  I know little of the man whose nude and flayed-open remains repose on the cold autopsy table, only that he was found facedown in a friend’s house after complaining of not feeling well. An alcoholic without a permanent residence, he was well known to the local police for sleeping off his stupors in the alleyways and parking lots of Mount Vernon. The clothes we had stripped off him prior to autopsy had been ragged, soiled, and stained with urine. After removing two shirts, we discovered tiny bugs that had made a home between the layers of clothing, lice perhaps, though Graham wasn’t sure.

  His skin is scabbed from itching, his toenails long and yellow. He had long ago given up on hygiene in favor of pursuing the next drink. We had rinsed and scrubbed the dirty skin and turned him this way and that to make note of his scars and multiple tattoos, the marks of a storied life that had ended way too soon.

  I take digital photographs of the brain as it would appear looking downwards from the top of the head and then gently turn it over to photograph the underside. Visible are the cerebellum, the center of balance, as well as the pons and medulla, brain centers that control breathing, blood pressure, and such basic functions as yawning and blinking.

  Graham has removed all the organs from the chest and belly and placed them in a shallow bucket. From here he will remove each, weigh and dissect them. The heart is much too large at 450 grams, floppy and soft from the effects of chronic alcoholism and high blood pressure. The liver, unnaturally yellow and spongy, its surface irregular, is proof of the alcoholic cirrhosis and Hepatitis C noted in the medical records on the desk beside the table.

  However, it is the lungs that most interest the pathologist. As he slices through the delicate pulmonary tissue, he notes foam in the small airways, or bronchioles, that terminate in tiny air sacs, known as alveoli—evidence of pneumonia, not an uncommon occurrence in an individual as weakened as this man.

  He takes tiny samples from each organ and places them in cases for further study under a microscope. The rest of the sliced organs he places in a plastic bag that lines a standard five-gallon bucket. Before concluding his examination, he slices the brain into sections, using a broad, non-serrated knife, making it appear not unlike he is preparing sushi. He notes no strokes or tumors, but the brain is smaller than it should be, owing to the tissue-shrinking effects of chronic alcohol intake.

  Since it will be my responsibility to sign this man’s death certificate, I need to be sure of the cause and manner of his death, as well as the time interval over which the effects occurred. There exist only five manners of death—natural, accidental, homicide, suicide, or undetermined, but potentially thousands of causes of death, some occurring in seconds, others taking ma
ny years to wreak their deadly effects.

  The pathologist thinks aloud in his soft, monotone voice. “There are several conditions that could have caused this man’s death. He’s got cardiomyopathy, moderate stenosis of the coronary arteries, and a fatty liver, as well as the pneumonia, but I think given the circumstances of his death and his complaint of not feeling well over the course of a few hours, I’ll say his cause of death is pneumonia, and we can list the heart and the liver as contributory. Does that sound right to you?”

  I am flattered that he has considered my opinion in his determination, because I am all too aware that his medical knowledge and experience dwarfs mine several hundred-fold. However, I think it is a mark of a great physician when he can be humble and able to take into account viewpoints other than his own.

  “Yes, that sounds about right,” I say.

  Often it is difficult to determine exactly what was directly responsible for someone’s death at the exact time that it occurred. Since nobody was around to peer directly into the body as it was dying, all we have is a body with several things that do not appear quite right, any of which could potentially cause death. Except in cases of trauma, such as multiple gunshot wounds to the chest, or decapitation, an educated guess is made as to the cause of death, given multiple organ abnormalities, combined with the results of toxicology tests, the results of which may take weeks or even months to come in from the State Toxicology Lab. Such results can often change the cause of death, if, say, the decedent’s alcohol level came back sky-high, or there were lethal levels of narcotics in the system.

  By this time, Barbara has begun re-assembling the body as neatly as possible. “Do you know, Matt, will this be an embalming?” she asks.

  “We don’t have a funeral home designated yet, but I really doubt it.”

  Barbara nods. Regardless of the disposition of the body—cremation or burial, Barbara reconstructs the body with the utmost of care. She places the skull cap back on the empty skull and folds the scalp back into its original position. With tight sutures of heavy twine, she sutures the skin back into place so that the scalpel margins are almost imperceptible. The large plastic bag of organs is secured with a zip tie and placed in the canoe-like abdominopelvic cavity. Barbara replaces the breast plate and then begins tightly sewing together the skin flaps created by the y-incision.

  After rinsing the blood off the man’s skin, she shampoos and combs out his long, tangled, and sparsely distributed hair. She closes his eyes and he appears much more peaceful than when he came in, possibly more peaceful than he had appeared in years.

  In autopsy, my colleagues and I are charged with a responsibility that is both awesome and humbling, writing the final chapter of someone’s life. As we peel back the layers of skin to reveal the often-damaged organs within, we are figuratively peeling back layers of someone’s life, less to reveal how they had died, but more to reveal how they had lived. I continue to be struck by how many meet their end through their own self-abuse or neglect, the years of imbibing, the unhealthy diets, a drug to get you up in the morning, and one to put you to bed, a never-ending cycle.

  Before I started in the death-care industry, I had no conception of how many lives ended prematurely because of addictions, whether to food, alcohol, drugs, or cigarettes. When we open them up at autopsy, their innards look as rough as their graying skin and generally haggard appearance. Black-speckled lungs, arteries so hardened they make a “chink” sound when they are struck with a pair of forceps, massive, floppy, myopathic hearts rendered useless by high blood pressure or alcohol, and livers so shrunken and yellow they are only recognizable by their position within the abdominal cavity. If people could only see inside themselves to realize the damage they were doing, maybe they would stop. Then again, maybe they wouldn’t. But it’s all preventable. The sad fact that healthy bodies are destroyed every day by insidious, long-term poisoning from foreign substances is still something I find vexing.

  As death investigators, we don’t see the healthy ones, those who had lived to enjoy a long and happy retirement, those who passed peacefully in their beds at ninety years of life. We see those whose choices have led them to where they are, the one without hope who hangs himself from a rafter in a garage at twenty-five years old, the fifty-year-old woman who makes the fateful decision to drive after five martinis and wraps her car around a tree, the young methamphetamine addict who collapses into unconsciousness and chokes on his own vomit.

  And when I meet their grieving families, I often get a glimpse into the conditions into which these dead folks may have been born. The apple doesn’t fall far from the tree, so to speak. The wheezing mother of an alcoholic arriving at the office to pick up his personal belongings, appearing much older than the age her driver’s license photo states, her world-weary face heavily lined, her fingertips brown with nicotine stains, coping with her own addictions, the meth’ed out thirty-year-old son fidgeting at the scene of his sixty-year-old father’s demise from heroin after so many years of cheating death.

  At least we are able to give families some answers as to the final days, hours, and minutes or their loved one’s lives. “Closure” really never happens. The pain of loss fades somewhat with time, but never fully goes away. Months later, I have received phone calls from family members, wanting once again, to be very sure of the details of their loved one’s death. Did he suffer? Was there a clue someone missed that could have prevented this? My answers are the same: No, he didn’t suffer. It was very quick. No, there was nothing you could have done to prevent your daughter from fatally overdosing. To say anything different would invite the growing, gnawing sense of regret that makes us want to go back in time and change things, though of course we never can.

  As Barbara slicks the last few wet strands of hair against the dead man’s scalp, she once again begins to sing. “Always look on the bright side of death, hm hm. Hm hm hm hm hm hm. Just before you draw your terminal breath…”

  Lamentation on a Cheeseburger

  As I inhale the last few bites of my second McDonald’s double quarter-pounder with cheese, I contemplate the almost certain sad state of my coronary arteries. I imagine the pathologist pointing with his scalpel at a cross-section of my left anterior descending artery, plugged at 90%, allowing only a trickle of blood to pass through to my oxygen-starved heart. “Well, I think we have a cause of death,” he says, rather matter-of-factly. Of course, then there is the extra-large portion of fat-saturated, over-salted fries still left on my greasy tray. Would I like to supersize that? Why, of course! Once again, my need for sustenance—any sustenance, has won out over my better judgment, bolstered by years of witnessing the ravages of heart disease, both as a paramedic treating chest pain patients, and as a deputy coroner, observing the end results of bad dietary choices.

  Despite witnessing, on a daily basis, the devastating effects of unnatural “food” on the body, the ravages of chronic alcoholism, and the disintegration of the lung tissue by heavy smoking, those of us in the death business are not, on the whole, any healthier than those who aren’t. Maybe it’s difficult to believe that what has happened to so many others couldn’t happen to us, or perhaps it’s a more informed ignorance—“yeah, this stuff will kill me someday, but I’m not about to quit.” Everybody needs a fix. An embalmer I once worked with, as he exhaled nasally a goodly portion of acrid cigarette smoke stated, “I’m working on about three different types of cancer right now.” To say nothing of the lung and throat cancer almost certainly stewing away in his respiratory tract, he breathed in formaldehyde fumes from embalming, without a mask, in an unventilated room, increasing his risk for leukemia. As he stubbed out his cigarette, he said, “Well, I’m off to the Mexican restaurant for a drink.” And off he went.

  I recall the time I drove an ambulance into the covered parking area at a hospital emergency entrance in Tacoma and left the engine idling as my partner went inside for some supplies. An RN in scrubs stood just outside the automatic doors, puffing on a cigarett
e and fanning the air in an exaggerated manner in annoyance at our diesel fumes. God forbid that our fossil-fuel emissions should detract from the delicious taste of her carcinogen-laden cigs. I had glanced through the windshield with bemusement at this rather shriveled woman in blue scrubs, shrugged, and shut off the engine.

  The death rate still stands at 100%. Always has, always will. The Grim Reaper will get us all in the end. Whether you drink wheat grass smoothies and run ten miles a day or live on junk food and contemplate your expanding belly, everyone who reads this, yours truly included, will be dead in eighty years or so. I’ve seen many a former resident of planet Earth who has eschewed any form of risky behavior and still ended up just as dead as the guy who jumped out of perfectly good airplanes and whizzed around on a motorcycle. The stress of working in a business that involves daily interactions with distraught families, persons both living and dead in various states of trauma and disrepair, and irregular hours can often give rise to the pursuit of any meal, no matter how unhealthy, nicotine to briefly energize, or alcohol to numb us to what we see every day.

  Though the unhealthy habits that many of us in the death business have taken on may surprise the un-indoctrinated, we really aren’t that different than the average Joe on the street. Morticians, death investigators, and pathologists don’t appear any different than anyone else. With a few exceptions, the pale, ghoulish, hollow-eyed, and dour stereotype of a mortuary worker doesn’t hold water. To the contrary, most are happy, full of humor, and often very involved in their families, churches, and communities.

  While my dietary habits may leave much to be desired and alcohol is a frequent companion, I haven’t given up entirely on my health. At forty years old, married to a younger woman, and with a brand-new baby daughter, I’ve decided that I’d like to spend a little more time above ground before I take The Big Snooze. I take fish oil, I floss, and I do calisthenics, much to the amusement of my little dog, who looks at me in puzzlement as I leap into the air with all the gracefulness of a rhinoceros attempting ballet. All these activities I have come to consider as very adult. As I notice the fine lines under my eyes in the mirror and experience the hesitancy and dribbling from an enlarged prostate, I am reminded of the passage of time, the unstoppable momentum of aging, and the inevitability of death.