So You’re Dead…. Where Are You?

Everybody knows that one day we are going to die, sorry to break that to you if you didn’t. However we usually never know when, how, why or where that will happen (that Uncertain Certain I wrote about previously). ‘Where’ is a big issue amongst the dying industry of late because it would seem more and more people are dying in hospital. The reason this is an issue is because most people would, when asked, choose to die at home. A lot has been discussed on this topic in the media recently, and I think this has a lot to do with the death positivity movement and the move towards a form of ownership over our own deaths.

If you thought that was a discussion around your spiritual location as opposed to your physical one, sorry that’s not really anything I know or discuss very often. I usually get asked on a regular basis if I believe in any religion, the answer is no. I also get asked if I believe in ghosts, and the answer to that is a shrug of the shoulders and I’d tell you that I don’t really know.

Back to your physical body. Chances are in the current circumstances you will be likely to die in a hospital. Either as an admitted patient on a ward or in an emergency department or A&E. I can only use our hospital as an example but when this happens the patient is ideally moved within four hours of death to the hospital mortuary. The porters transfer the patient who is then moved to a fridge space accordingly. During their time in the mortuary they might move around, only within the confines of the mortuary but they could be taken out of the fridge for a viewing, post-mortem or both during their time with us. Occasionally there might be a need to move people to contingency spaces which are slightly smaller than normal so small people are moved to make spaces in the average sized spaces. If their length of stay is anticipated to be lengthy then we may also move people to our freezer, or for other reasons.

If you die at home, you pretty much have three possibilities. If you require further investigation or a post mortem then you would go to a mortuary either public or in a hospital. If you don’t, then you go straight to the funeral directors, or via a combination of discussions you could remain at home until the funeral. Many are not aware that this is a viable (or believe it to be a preferential) option but it is available if you would like it to be. It is actually becoming more common that people arrange funerals themselves without involving a funeral director which would also involve the deceased being at home for some time unless they are at the mortuary for longer until burial/cremation.

I think the point of this post is to inform that there are options and you do not need to be dictated to about where you die or where you end up once dead. The only aspect there is no choice behind is whether or not you need a coronial post-mortem, if the coroner decides that you do then this must be enforced. It is important that people think and discuss these, if only just to be aware and be able to be informed of a decision needs to be made. I don’t believe in people being dictated to in death just as you would not accept it in life.

If there’s anything I have not covered or you would like more information then please get in touch!

MG x

Things I Learnt In Hartlepool (Part 1 of 5)

As I mentioned before, my training requires me to go to Hartlepool five times this year to study for my Diploma. The last three days I have spent in the North-East having a lovely time, learning lots and meeting some great people. Here’s a quick update of where I’m at as my train speeds it’s way back to London.

Getting a group of people together who work in mortuaries is like giving us all a licence to talk. It’s a bizarre thing to witness, discussing mortuary work in fairly hushed voices in a pub like some secret society. However, we got slightly louder when discussing the course and then more trainees joined us after hearing our conversation and realising we were on it too. So then the hushed conversation became bigger but still hushed nonetheless! It’s not as though we ever discuss anything we shouldn’t, but we’re not sure how people would react listening to us discuss was protective equipment we use or how many post-mortems we’ve completed!

In that vein, it is a strange thing but it cannot be denied that every mortuary seems to do something very different to somewhere else. Our dinner on the second night consisted of eight of us from all over the UK (fairly widespread), comparing everything from our equipment, to team sizes, to tools used, to how our department fits in with the hospital or wherever it may be based. Turns out this is a discussion that can go on for some time, with so many differences it seems strange and a bit baffling.

Hartlepool itself is lovely, even if I’ve only really seen the Marina area. Our first evening there it was really sunny and warm which was nice, the other days it’s been a bit more grey but not raining which seemed good. One thing we were advised to do was to give the Monkey a visit. The full back history of the Hartlepool Monkey can be found here, but the basic story is that it’s thought in the Napoleonic Wars some locals mistakenly thought a shipwrecked monkey was a French sailor and he was hanged. A bit along the marina from our hotel is a bronze monkey hanging out by a lock with a bowl to throw money into. One of our course facilitators told us to do this and it ensures that we will pass, so of course we obliged!

The Hartlepool Monkey Just hanging out by a lock

So what did I actually learn while studying? A fairly in depth exploration of Health and Safety in the mortuary and an introduction to Microbiology which nearly made my head explode. My poor cell anatomy knowledge was really put to shame finding out that a lot of cells are a lot more than cytoplasm and nuclei. Therefore I discovered I have a lot of work to put in before I’m back there in May, got three assignments to be getting on with, a portfolio to build and an exam to study for. Feeling slightly overwhelmed is an understatement but I’ll get there. I threw money to the Monkey after all.

MG x

Platform 9 3/4

Or actually Platform 8, but I can dream that I’m finally aboard the Hogwarts Express and not a Grand Central train about to depart for Sunderland swinging by Hartlepool on the way.

It’s actually happening. I’m off on my first of five trips up North to begin learning and training for my qualification. I’m going to learn the ins and outs of being an APT with a whole bunch of other cool people doing the same thing. Plus I bagged a window seat which makes this trip even better. The train is warm and stuffy, but the sun is shining and my sunglasses are in reach at least which is good because I think once we’ve pulled out of the station the sun will be directly in my eyes. After note, I wasn’t wrong about that.

All-Weather Gemma (my alter-ego) is always prepared

I had a good start to this week, I had a busy day on Monday in the post-mortem room and felt good about my skills leading up to today. Then yesterday I had a great day, performed two eviscerations and then assisted the pathologist and felt like I was so happy with where I am at right now. The brain count is up to 78, surpassing my 75 milestone that I was aiming for and already made a start towards 100. The skills I want to try and improve in the post-mortem room going forward are to perfect the three block technique because I tend to not be able to get the organs out correctly when I attempt this.

On a personal level, I’ve had a noticeable improvement since the first two weeks of the year where I had a panic attack followed by a bout of gastroenteritis. I’ve been having some counselling sessions and focusing on small achievable goals with the ‘Counsellor Man’ as I’ve been referring to him as. We discussed how nervous I was about this trip today, turns out in my classic way I’m more nervous about this journey, the hotel and the people I meet along the way than I am about the actual studying. I don’t want to sound arrogant, I’m a natural Ravenclaw and study is my strongpoint.

I am looking forward to beginning and understanding a bit more about what this course entails. I’ve got a few bits and bobs to keep me busy while I’m on the train, a few emails and things to read plus a catch up of a couple of tv shows. I just finished Umbrella Academy this morning annoyingly but I might have to rewatch it at some point.

For now, I’ll post again when I’m on my way back and I’ll be working on my next ‘So You’re Dead…’ post too. I also just misplaced my favourite pen and I’m stuck in a window seat surrounded by passengers. This could be a long journey after all.

MG x

So You’re Dead… Now What?

I thought this week I would discuss a bit about the different stages of death, or what happens after we die. Most people will have heard of rigor mortis and know that this is a stiffening of the body, but you might not know that there are other stages and aspects to death that the body goes through. Here’s my whistle stop tour of some of them and what happens in each one!

Now what happens?

Obviously, death occurs when the body stops functioning as it should. This can be classed as either a brain stem death, or a cardiac arrest, or respiratory arrest. In order to be alive you need those three to be working together so you can breathe and pump blood around. Hence why life support machines provide these functions for you if necessary. People clearly can and do die in a number of ways but ultimately they all cease to have a functioning brain, heart and lungs in whichever order.

Immediately after death four things occur in the body which signify the changes occurring. These are known as the familiar rigor mortis, alongside pallor mortis, algor mortis and livor mortis. After these processes the processes of decomposition follow which I’m sure you all know too. In case you need reminding Wikipedia states that this is “accompanied by a strong, unpleasant odour”. While decomposition is interesting and something I find fascinating, it’s the subtler four initial stages that are also really quite interesting.

I’ll just say here that this is a super simplified version and there are many other things that can happen to the body depending on the situation or condition it is in. Also, there is not an easy timeline for these changes which again depends on the condition or situation of the body, which further supports the need for research and human taphonomic facilities (body farms). These can be proven to occur at set times but they overlap and coincide with each other. For want of a better term, when these things occur is complicated with many factors to consider and for now I will leave it at that.

It’s complicated and difficult to predict but can be generalised fairly easily

Dead people have some traits you would easily recognise and be familiar with. I think if you were to describe one you would most likely use these words, ‘pale, cold and stiff’ and you would largely be correct. Firstly, the paleness is from the process of pallor mortis where the colour from the skin fades within two hours of death. I think dead people often look waxy too, although also sometimes people simply don’t have this at all and look pretty much asleep! This of course depends on the pigment in your skin and darker skin tones have less paleness occur.

The coldness is mostly from our fridges at work but a bit like a forgotten cup of tea, with nothing sustaining the body’s heat it sinks to the same as it’s surroundings, so without a fridge this would be the ambient room temperature thanks to algor mortis.

As you probably know the stiffness is the rigor mortis where the muscles have chemical changes that cause them to tighten. They are not impossible to move and you can often ‘break’ the rigor mortis simple by moving the arm or leg slowly but firmly. Once broken it won’t return and it does eventually leave the body to become floppy again. Rigor mortis can set in within four hours and stay for around two days or so but maybe longer.

The other stage mentioned above is the livor mortis which is subtle in some ways but also the most visible in most cases. In this process the blood in the body, no longer being pumped around by the heart, comes under the influence of gravity and sinks to the lowest point. Generally, with people lying on their backs this means to their posterior so the back of the head, chest, abdomen and legs. If the person was face down then this would sink to their anterior or front and if, for a strange example, the person was standing up somehow it would sink to their feet, ankles and legs. It is visible by a purple hue to the skin, sometimes very dark and sometimes just a hint.

It’s these stages that we see from our hospital patients who reside in or mortuary. My manager has instilled in me the knowledge to know the simple things, like if a patient isn’t laying with their head slightly raised and facing directly upwards the discolouration can show in their face and be not very nice for families coming to view. Also, until this stage where the blood has settled, removing any lines from drips or intravenous medicine from their skin can cause them to bleed uncontrollably thanks to the lack of clotting. We also use aspects of rigor mortis, for example closing a patients mouth before this has set in will ensure it is closed for family viewings and the patient looks peaceful. It’s these small things that I’ve learnt so far like this that I try not to take for granted because they are small but so important to our work.

If you have any questions about these things please get in touch, I might know or I can always try and find out!

MG x

The Certain Uncertainty of Death

Something I’ve noticed recently is how quickly time is moving for me. It feels like I blink and a month has gone, the days go fast and the seasons change quicker than I realise. I’m barely used to winter and it already feels like spring is on its way. Thinking about this made me realise some things I’d like to share. Some random thoughts about why we fear death so much and how we can recognise this in ourselves and other people.

One aspect of the modern world I find amazing is how long we all expect to live. People who die at 70 are considered to die young, whereas a several decades ago that would have been an achievement. Medicine progresses to cure more and more, so it feels like we’d only be happy to die of old age at 110 in our sleep. Sadly, very few of us will actually experience that and the truth of the matter is that we could die at any age. It’s the uncertain certainty, death will happen but rarely can we be sure of how and when until time is running out.

In this sense, the modern world prepares us to die at a ripe old age. We are advised to invest in pensions pots and plan for our retirements even though the pension age gets higher and higher. The world expects to live for a longer and longer time each year. This can only add to the sense of being robbed of this liberty when somebody dies young. I’ve noticed a large number of people dying in their 40s for example, for a range of reasons or illnesses. This is only about ten years older than I am now but the prospect of only having ten years remaining seems grossly unfair. Yet it could happen.

Once the fear of this creeps in, it’s hard to shift that thought and appreciate life in the way we think we should. The contradiction of living each day like it’s your last but saving money because you’ll grow old is around us everywhere. You can see in the same magazine two different articles about why we need to eat a healthier diet and then later on why we should just eat the damn cupcake. In a practical sense, we somehow have to accept that life is finite and varied in length, but in reality this is not a thought that comes easy. I remember learning once something like that a thousand years ago living past 35 could be deemed old age. These things change and develop through time and I wonder if their thoughts would have been any different or the same just on a much shorter timescale. Religion has had and does have a lot to say on accepting your time and the will of higher beings, but I think in a modern world where people rely less and less on religion we will of course question these things instead.

I do hope that this is thought provoking and not depressing as it could be interpreted. What I am trying to emphasise is that fearing something unknown will ultimately not lead to any good. Learning to accept the unknown and know it exists is key, and by understanding that you can see through the fear to some extent. I’m not saying that I am not afraid of death, or that I am not sad when those around me die. It doesn’t make grief or bereavement necessarily any easier, but it does make living with the inevitability of death a lot easier.

MG x

I’ll Sleep When I’m Dead

If you speak to me, or see me recently you have probably heard me say I’m tired, or thought I look rough. Truth is, I feel it! Between mystery pain and insomnia, my brain is in overdrive and it’s a really busy time of year in the death industry. I’m really proud of my team and of being a part of it this week. We’ve pulled together through some tough situations, just got on with it when we’ve been pushed to our limits and all our strength is gone. When I say strength, although you might think mental I actually mean both mental and physical. There’s been moments when my arms just don’t want to do what I need them to.

What a lot of people don’t realise is, mortuary work is very physical especially when it’s busy. You might find yourself cleaning, moving patients around or just running about trying to keep on top of phones ringing, doorbells going off and people being released to funeral directors. When I quite Archaeology I didn’t think a physical job would be part of my life again, because it felt like most jobs now are office based. Sometimes I now get time to sit at a desk and those times I relish, whereas previously the prospect of a desk job really did not appeal to me whatsoever.

In the hospital world, there is what is known as ‘Winter Pressures’. The wards feel it with meetings about beds and spaces, the emergency areas feel it with huge increases in footfall through their doors and the mortuaries feel it with constant new patients and community members arriving. It’s slightly different every year, in that the issues caused by this are different but largely space related. The other difference is that the time of year when it is at it’s worst is never predictable. It can coincide with dips in weather and temperature but it can also appear to be utterly random.

A lot goes on, some I’m aware of and some I’m sure I’m not, behind the scenes to ensure we are best prepared for these times and can cope in one way or another. It may mean just using our extra storage. It might mean transferring people to our surplus storage in an external company. The worst I’ve seen in my time at the mortuary is a concern that places are getting very full, and that even extra storage is not enough. However, there are plans, upon plans, upon plans to ensure that there is always a way to cope. This doesn’t make it any less stressful for those involved but it should calm any concerns from the public who might believe there is a problem.

February Death Cafe is coming up soon!

I do wonder if I’ll ever get used to this time of year, and not find it completely tiring. The lack of sunlight doesn’t help me and drains energy. I’m hoping for sunnier, calmer days ahead. Looking ahead, it’s not long now before I head up North to start my training officially! However, before then we have our February Death Cafe coming up on the 19th at our usual lovely venue at the usual time. Hope you can make it!

MG x

Back at the Old Operating Theatre

On Thursday night I had the pleasure of returning to one of my favourite places in London for a fabulous evening of wine and Victorian surgery. Rachel had asked me if, instead of exchanging Christmas presents last year, we bought tickets to an event she had found online through a friend. It was a great idea and I jumped at the chance to introduce her to a place I love.

The Herb Garrett is in the attic space around the Operating Theatre and is a lovely collection of objects and fascinating things.m

That’s how I ended up back at the Old Operating Theatre at the Herb Garrett site on St. Thomas’ Street. Another friend came with us who, due to an unfortunate injury, was able to try out the newly installed lift at the museum. Previously, the museum has only been accessible via a very small and unnervingly narrow spiral staircase that scares me somewhat. It’s handy to know, and I’m pleased to broadcast that in future, if you need disabled access to this museum it is available upon request with a valid reason.

The Operating Theatre with original operating table on the left and reproduction on the right

Another thing I’m pleased to say is that the museum have invested in some further cushions for the wooden steps! Previous visits had made me recommend to friends to take at least a rolled up jumper to sit on because after and hour sat on the wooden floor made for a very numb bum and achey hip joints. However, handy seat pads are now provided which is excellent!

Rachel did not appreciate the smell of the soap bars being passed around

I won’t spoil the content of the Victorian Surgery Demonstration talk for those who will be attending in future, it’s often on during normal museum opening hours and also some are available after hours. It is a fabulous talk and the speaker is very knowledgeable in the subject matter. Objects are passed around and you can really get a feel for what surgery would have been like in the past, particularly pre the introduction of anaesthetic.

In depth demonstrations upon a willing volunteer

Sadly I tore myself away at the end, partly because I needed to empty my bladder so badly but also because I always feel a huge spend up coming on when in their wonderful gift shop. I cannot recommend a visit to this delightful museum enough and think it is one of the best hidden sites in London. One thing I had been curious about was how this theatre had survived, the lady told me that the whole area had been boarded up and not accessed for a long time and almost been forgotten about. It makes me wonder how many roof spaces of old buildings are hiding little treasures like this!

MG x

My Heart’s Still Beating

It’s been a slow start to the year but I do feel fully back in the swing of things and much better with my mental state! Still having the odd blip but that can only be expected.

This week we’ve been really quite busy, which comes with the unfortunate task of often having to not be able to give families what they always want. By that I mean, I think a lot of families believe they can either show up at any time or see their relative whenever they want. While this is something that in a perfect world would be possible, with our staffing, workload and space limitations we are very limited on the times we can offer. Viewings can be very time consuming if we have to take a lot of time to prepare the person, depending on what condition they are in, and we cannot give the amount of time demanded from us towards them. Sadly I’ve had to speak to family members on the phone and tell them they cannot come and see their relative either right at that minute, or recommend that they wait until their family member has gone to the funeral directors.

It’s one of the hardest parts of my job in all honesty, you want to be able to give people what they want but you end up some days being overwhelmed by the demands and unable to not be annoyed at some expectations. I can only recommend for anyone who thinks they would visit their family member in hospital that you call as early as possible to ensure you have better chances of getting an appointment (a bit like the GP surgery!). However, something I always do recommend is that it is better in many people’s minds to visit loved ones at the funeral directors where a lot more can be done and a lot more time dedicated. I often feel like our viewings can be very clinical and not always the best for families even though we try our best with what we have. I’m sure this could be different in other hospitals but some may agree with me. I would be interested to find out!

I had the opportunity yesterday to go into the post-mortem room with the other trainee and work together which was fantastic. We really work well and help each other with the bits we both struggle with. I’m so glad that we can share the stuff we know and I hope we can get some other occasions where we can do this going forward. I’ve really noticed recently that my confidence has grown again and come back to where it was before. I feel like the weaker points I was struggling with are becoming easier too. Really bodes well for starting my official training in a month’s time!

Finally, today I had to go for an ultrasound scan on my abdomen due to some right upper quadrant pain I’d been having which was suspected gall bladder issues. I’m pleased to say my gallbladder is fine, but now just concerned about what the pain actually could be. One funny thing however, when the man performing the scan showed me the screen I think I said ‘WOW’ a little too loudly. He went on the describe my gallbladder and what it does, and then my kidney and I had to interrupt him to explain what I do and why it was so cool to see my own. He smiled and sat back and said ‘Well you see all that movement, that your blood pumping around and you don’t get that’ which really made me laugh. Good to know my heart is in fine working order too hopefully!

Tomorrow night I’m off to an event in the city which I’m excited about. Then I have a long weekend to recover. I’ll let you all know about the event and some upcoming stuff in my next post. Hope you’re all having a good week!

MG x

The Importance of Talking About Death

You might have already seen that my very exciting news last week was that I was approached by a BBC Radio producer to appear on a Radio 1xtra show about death on Sunday night. I was incredibly apprehensive but knew it was too good of an opportunity to refuse so anxiously I went along. Originally, crossed wires meant I was on air a lot longer than I thought I would be, I was not the only guest as I thought and that it was broadcast live! At first I thought it was recorded to be broadcast later and that the documentary parts of the show were the main bulk of it. As terrifying as it was, the team there made me feel really relaxed and even though I sound nervous at the start and at one point my mic wasn’t switched on and I was talking, I really enjoyed the whole experience! If you would like to listen, it is available online here. We discuss how Death Cafe’s work, how they help people and what is involved.

The host Reece Parkinson, the other guest Angel and myself in the studio after the show.

This week I have managed to finally sort out my workspace at home and I’m really pleased with the result. I needed an area where I could work on my course and also any other computer work I needed to do, but somewhere quiet and where I could concentrate. Luckily one of the reasons we bought our house was a really neat little feature of a mezzanine loft extension area which I’ve now decked out with a place to relax and folding desk with chair for my work. There’s even a little heater for when it’s cold and space for all my folders and books. I’m so chuffed and happy it’s completed before I start my course at the end of February.

My little safe space to retreat to!

Wednesday evening there were two important death related shows that I can thoroughly recommend. On BBC Radio 4 at 8pm, We Need To Talk About Death about the role of the Coroner in unexpected deaths that a Death Cafe attendee pointed me in the direction of. This is a topic that was recently raised at our Death Cafe and something I think requires a greater clarity for people. Then at 9pm on BBC 2 a Horizon programme called We Need To Talk About Death with Dr. Kevin Fong which mainly explored the relationship between palliative care and traditional medicinal care for patients nearing the end of their life. I can thoroughly recommend both, the first because I learnt a bit more about how families may feel for our community cases that we receive, and the latter because I never knew how palliative care worked or how it is used so effectively. I also found the hospice scenes absolutely fascinating. Have a listen/watch and let me know what you think. They can be found on BBC Sounds and IPlayer respectively.

An interesting radio show highlighting the emotional reaction and the Coronial reaction to sudden deaths.

A brilliant documentary about the importance of planning and thinking about the kinds of care we receive towards the end of our lives.

Finally, this week I have been starting to make plans for Dying Matters Week 2019! This year it runs between the 13th-19th May and I’ve been planning some ideas for myself and discussing some potential activities at work at the hospital. I’m hoping to make the most of the week and get everyone I know talking and thinking about death, I’ll use any excuse really. If you would like to get involved in any way please let me know.

MG x

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