Everyone Dies Alone
Alex expresses curiosity about how bodies are found. When it comes to the details of exactly when your neighbors notice a weird smell, or how long you don’t answer the phone before family and friends grow concerned, I can’t comment—except perhaps to encourage everyone to check in on their loved ones. I’m not privy to the events leading up to that moment when someone realizes they need to call the authorities.
On the mortician’s end, we have to wait for a body to be formally released before we can take custody. This requires medical professionals or the police. The bulk of our clientele come to us through hospitals, nursing homes, or other care facilities with a doctor present. More than half of the house calls we perform are for those who died under hospice care. The moment may be unexpected, but the event itself was imminent.
When an unforeseen death occurs, the police and other emergency services are involved. If you come home to find a family member dead on the kitchen floor, call the police first and foremost. The local coroner or medical examiner will decide if the death warrants further investigation. If so, the deceased will be sent for an autopsy. If they deem the causes natural enough, they’ll release the body to a funeral home for pickup.* These tend to be the “interesting” calls. I could—and likely will—go into more depth about our interactions with the police and fire department.
There is a different direction in which I can take that question, however: the conditions in which people die. Specifically, the conditions in which people die while in long-term care facilities.
Eldercare is a serious issue for…everyone, really. Unless you’re holding out for vampirism, cryogenic suspension, or digital consciousness upload, senescence waits for us all. Some of us may be lucky enough—or privileged enough—to remain independent until the end, but for those without savings, without lifelong access to healthcare, without a family support network, options may be grimmer.
I’ve discussed suicide before, and the particular sadness of seeing young people laid out on my table. Those deaths stand out for their relative rarity. Most of the decedents we pick up are elderly, people who have died of natural causes after what most would consider “a good run.” A good run, however, does not always finish well.
One of my most vivid memories from my early days as a psychopomp (aka removal technician) was my very first nursing home call. The entire floor reeked of urine. The residents’ doors were nearly all open, letting everyone watch me wheel my cot down the hall to the nurses’ station. The nurse on duty signed my paperwork, and waved me vaguely down the corridor; no one was available to help me. I could have taken anyone out of that facility, living or dead.
It didn’t take me long in the field to notice the difference between that kind of nursing home—crowded and filthy, with exhausted, overworked staff—and the much nicer kind. Clean and cheerful, where the staff come out to say goodbye to their residents before we cover them up. That difference, all too often, is money.
As a removal tech, I’ve watched residents wander the halls in confusion, haranguing the beleaguered staff. I’ve listened to people call for help unceasingly for the entire time it takes me to complete a removal. I’ve entered bare, grimy rooms and lifted emaciated bodies dressed only in diapers off sheetless mattresses. Some facilities house two or three residents to a room. If we’re lucky, the living roommates are taken elsewhere while we perform the removal. Sometimes a curtain is drawn between beds, and we try to be as quick and quiet as possible. When I started embalming, I got an even closer look at the unwashed hair, necrotizing toes, and truly horrifying bedsores that so many of these people died with. And that was before the pandemic struck: COVID hot-spot nursing homes were a nightmare out of a disaster movie. All these things fill me less with sadness and more with deep, abiding anger.
Occasionally that anger surfaces when I’m dealing with seemingly uncaring staff, but I know that only in rare cases is neglect the fault of any one person. My brief exposure to the foster care system left me with a similar undirectable rage. State and federal programs like these—understaffed, underfunded, ignored—grind down the best-intentioned nurses and social workers.
I’ve spoken of the loneliness of depression, how it can leave you feeling isolated even when surrounded by friends and family, how it can convince you that the people you love the most don’t love you in return. The decision to place a relative into a care facility isn’t an easy one. Many families have no other option, but will still wrestle with guilt over the necessity. My anger is never for those facing only bad and worse choices. I’m furious at an entire system that decides that humans can…depreciate in value. That without money, the best we can hope for is a bare minimum of support until we’re disposed of as quickly as possible.
Everyone may die alone when it comes to our individual experience of that final moment, but far too many people spend their final days, weeks, years, suffering alone—or simply suffering a loneliness that breaks my heart. By the time I arrive at a bedside, the most I can do is offer some sympathy to the living, and perhaps a little dignity to the dead. But the more dead people I carry out of empty rooms, the more fiercely I want a sea change, a revolution, for the living.
* Around here, certain counties are notorious for deciding not to spend money on an autopsy.
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Amanda Downum is the author of The Necromancer Chronicles, Dreams of Shreds & Tatters, and the World Fantasy Award-nominated collection Still So Strange. Not content with armchair necromancy, she is also a licensed mortician. She lives in Austin, TX with an invisible cat. You can summon her at a crossroads at midnight on the night of a new moon, or find her on Twitter as @stillsostrange.