Todd Miller slowly positions the head of the body between plastic blocks as Curtis Foley makes a 2-inch incision on the neck near the collar bone. Miller then digs beneath the skin, grasps the carotid artery and jugular vein and pulls them toward the surface, tying them together to ensure easy access for later. Foley makes a tiny cut for a tube to enter each vessel.
Meanwhile, Miller closes the corpse’s eyes. He uses plastic eye caps lined with a texture similar to Velcro to affix the eyeball to the lid. This prevents the eyes from sinking into the skull and keeps the eyelids from dehydrating.
Miller washes the body several times with heavy-duty disinfectant soap and water and massages the body to loosen the muscles, reversing the effects of rigor mortis.
He runs his hands along the arteries, preparing them to be emptied of blood.
In the world of morticians, this process is called “setting the features.” Once embalming fluid is added, the body will stiffen into position — the position it’ll stay in until it’s buried.
This body, like most of those that are embalmed, is destined for a plush casket, a fancy outfit and plenty of makeup and refinement, all before being placed in the ground and topped off with an elegant headstone.
It’s here, lying on a shiny metal table under the care of morticians like Foley and Miller, that most of us will eventually wind up. Roughly 2.5 million Americans die each year, and about 2 million of them will be embalmed, according to the National Funeral Directors Association. Though overwhelmingly popular in U.S. funerals, embalming is performed on only a fraction of the world’s newly dead.
Although conventional embalming and burying the dead remains the most popular choice in this country, recent years have shown a shift toward different methods to dispose of America’s dead. Today, the bodies of about one-third of Americans are cremated after death, perhaps the most significant change in consumer preference.
Though no concrete numbers exist, industry experts estimate that 10,000 bodies are donated to science each year. Movements toward green burials and home funerals and burials are emerging, creating a simpler and significantly cheaper transition from life. In some cases, these emerging practices reject America’s idea of a conventional funeral.
For those dealing with loss, navigating the world of death care can be a daunting and expensive task. Critics say many people avoid planning for death until it happens, leading to uninformed consumers and a system susceptible to abuse.
It’s a problem many have faced. For one U. Kansas professor, the experience of arranging funerals for her father and two grandparents during her time of grief left her feeling so unprepared and frustrated that she devoted much of her research and writing to the topic. She now teaches a course on death and dying to help students prepare for and understand death.
In the embalming room at Rumsey-Yost Funeral Home in Lawrence, Kan., Miller and Foley are covered head to toe in protective gear. They each wear thick, blue rubber gloves, non-absorbent gowns and plastic protective masks.
Bodies often leak. Vomit and bile are prone to purging through the mouth. Without muscles tightly holding everything in place, feces can spill onto the table.
The embalming room, behind a heavy metal door in the basement, looks more like an operating room for the living than a place to care for the dead. Each of the two adjustable tables is lined with a guttering system, positioned near cabinets and shelves that store sterile-looking utensils, creams and chemicals.
Foley, with four years under his belt as a licensed funeral director and embalmer, has this process down to a fine art. Miller is still a student, and he’s working to get his state license. But first, he must complete a mandatory apprenticeship. He’s not allowed to embalm a body himself, but he assists wherever possible. In three years working at Rumsey-Yost, Miller has watched and participated in this process at least 100 times.
With the corpse washed, the muscles loosened and the hair freshly rinsed with Head and Shoulders shampoo, the two begin the embalming process.
Foley attaches plastic tubes to the incisions on the carotid and jugular. The tubes lead to the embalming machine, which holds several gallons of embalming fluid. The mixture is made of formaldehyde and contains perfumes and dyes. Without blood in the body, the skin will be pale white.
The machine will pump for about 90 minutes, acting almost like a heart for the deceased’s circulatory system. One tube pushes the potion into the body, where it streams through every artery, vessel, vein and capillary. The other tube drains the blood, which is dumped into the sewer system like dirty bath water.
After the blood is replaced by preservative, the artery and vein are tied off, and Foley stitches the incisions closed. The wounds will later be masked by makeup and cream, leaving no evidence of the operation they’ve performed.
Miller then grabs a trocar, a metal tool used to poke a hole near the navel. The trocar is attached to a suction tube, which draws the remaining fluid out of the cavities. It punctures each organ, releasing its contents such as gas, bile and bodily fluids.
No one wants a solemn funeral service interrupted by the gurgling sounds of settling gas in Grandma’s tummy.
The tool then injects more embalming fluid through the puncture site, preserving the body’s innards. The puncture wound is sealed, and the body is given time to rest.
Embalming bodies this way didn’t become popular until well into the 20th century.
Before that, the funeral and burial took place at home or church. Embalming started during the Civil War as a means of preserving and shipping the bodies of fallen Union soldiers back to their Northern homes.
Although embalming made sense to allow for time to transport bodies before the development of refrigeration and high-speed travel, now environmentalists and industry watchdogs are questioning the practicality, the high costs and the environmental effects of the tradition.
When a lengthy journey of a decomposing corpse ceased to be a problem, undertakers touted embalming as a safeguard for public health. Not many diseases can survive in a body steeped in formaldehyde.
But scientists have since discovered that, except in the rarest cases, a dead body poses little risk to the health of the living. The Centers for Disease Control and Prevention now maintains that embalming serves no benefit to public health.
But now it’s thought that embalming is detrimental to public health. In 2009, research from the National Cancer Institute linked embalming fluid’s active ingredient, formaldehyde, which is classified as a known carcinogen by the International Agency for Research on Cancer, to myeloid leukemia. The study proved what many had suspected for years: Funeral directors who embalm over an extended period of time have an increased risk of contracting cancer.
Embalming also poses a problem for environmentalists, who can only guess what long-term effects toxic formaldehyde has on the Earth.
Funeral directors now pay close attention to the health debate, if only because evidence suggests their work environment may be accelerating their own need for a funeral.
After release of the National Cancer Institute’s findings, the National Funeral Directors Association updated its list of Formaldehyde Best Management Practices, which suggests increasing ventilation, limiting exposure to formaldehyde and using a less concentrated mixture of embalming fluid.
Still, no federal regulations or industry-wide changes have been implemented since the research was published.
“If there was a serious risk with embalming, the government wouldn’t allow it,” said Pam Scott, executive director of the Kansas Funeral Directors Association.
The Environmental Protection Agency has yet to take a stance on embalming, but it does note that formaldehyde can cause cancer “within the respiratory or GI tract after inhalation or oral exposure.”
It’s estimated that Americans annually bury more than 827,000 gallons of embalming fluid — enough to overflow an Olympic size swimming pool — across America’s 22,500 cemeteries, along with nearly 93,000 tons of steel, copper and bronze and 30 million board feet of hardwoods from caskets.
LIVING THE GREEN LIFE — AND DEATH
The government’s inaction on the matter has caused environmental activists to create their own organization to promote more environmentally friendly ways of disposing of the dead, said Joe Sehee, executive director of the nonprofit Green Burial Council.
The council has enlisted the help of 300 funeral homes across the nation to begin offering green burials that do not use embalming or other traditional but wasteful materials, such as metal caskets and granite and marble headstones.
“It’s really the energy that goes into all this that is most worrisome,” Sehee said.
The council has created criteria for evaluating whether a cemetery is green and how green it is.
Lawrence is home to Kansas’ only green cemetery. It’s actually a smaller, wooded section of the city-operated Oak Hill Cemetery in East Lawrence near 15th and Elmwood streets. At Oak Hill, regular burials and green burials cost the same. Each plot costs $700 in addition to a $640 to $1,100 fee for digging and covering the grave. Embalmed bodies and caskets that use metal or glues can’t be buried in the green section.
“We think green burial is a traditional burial,” Sehee said. “Ashes to ashes, dust to dust is a concept that’s been with us a lot longer.”
Despite the amount of national press coverage, green burials in Lawrence haven’t been that popular. Only three individuals have chosen to have a green burial here since it became an option in January 2009. In 2009, 225 bodies were buried in Lawrence’s three cemeteries.
Environmentalists also want to change the types of embalming fluids used.
Some formaldehyde-free embalming fluids have been introduced into the market, but they’re not widely used. Even crematoria, the ovens used to burn the human body into a gravel-like consistency of bones and ashes known as cremains, are being eyed for more energy-efficient upgrades.
Some critics decry the release of greenhouse gases and mercury from dental work that pours out of the ovens, which burn at temperatures close to 2,000 degrees Fahrenheit. Some have suggested that morticians start removing metal dental work from the deceased before cremation.
Though the release of carbon dioxide from crematoria isn’t easy on the environment, experts say less overall energy is expended in cremation than in traditional burial. Nonetheless, the Green Burial Council is working to promote more energy-efficient crematoria and is looking at ways to install filters on existing crematoria.
THE MEMORY PICTURE
The ancient Egyptians believed the dead were capable of taking their bodies and possessions with them into the afterlife, making preservation of the earthly body a necessity. Thousands of years later, that idea is all but extinct in mainstream society. But funeral directors have still found a way to sell the value of embalming.
They maintain that viewing the restored, preserved body helps mourners cope with the loss.
“I wonder why it’s not popular in other places like it is here,” said Patty Dardis, a veteran funeral director at Rumey-Yost.
Dardis said she found that when she lost loved ones, viewing the body provided closure for her, just as it does for other survivors.
“Seeing is believing,” she said.
That’s not to say that embalming is required to view the body.
Most states do not require embalming except in special circumstances. In some states, including Kansas, embalming is required for interstate shipping of the body. Some funeral homes may require embalming for open-casket funerals or public viewings. But most will still allow the family a private viewing of the body even if it’s not embalmed.
Popularized in industry trade publications, the concept of the “memory picture” is how morticians continue to sell the art of temporary preservation. The embalmer is not only looking to preserve the body, but is also trying to create a positive last image for loved ones.
Through restorative art, as it’s called within the industry, nearly all physical imperfections of the live human body can be erased.
No longer does Grandma look frail from months of illness. The woman who was mutilated in an automobile accident suddenly looks as if she avoided any injury at all. Even a decapitated cadaver can be altered to look whole again.
This restoration, funeral directors argue, provides a positive psychological effect for grievers that can’t be realized in immediate burial, direct cremation or green burial.
This “memory picture” concept benefits the funeral industry financially. Not only do undertakers charge a fee — in Lawrence it ranges between $550 and $675 just for the embalming — but they make even more money on the accompanying casket and service.
“Number one, once they pretty up the body, they can probably sell you a more expensive casket. So you’ve got to follow the dollar here,” said Lisa Carlson, an outspoken critic of the funeral industry and author of the books “Caring for the Dead: Your Final Act of Love” and “I Died Laughing: Funeral Education with a Light Touch.”
FUNERAL FLAK
Carlson, the former executive director of the Funeral Consumers Alliance, a nonprofit that educates families of the deceased about their rights, is a leader in the recent movement toward caring for the dead at home. In all but a handful of states, it’s legal to care for the dead, hold a home funeral and even perform a burial within the privacy of your own home. In Kansas, home burial is legal, but it is subject to county regulations.
Carlson argues that the funeral industry has long taken advantage of customers, who are vulnerable because of their grief. Morticians can essentially charge whatever they like for their services, creating “a system that invites abuse,” she said.
But consumers are partially to blame. Americans shy away from planning for death, which cripples their decision-making when death and grief arrive.
“People don’t want to talk about it, and they don’t want to think about it,” said Tracey LaPierre, assistant professor of sociology and assistant research scientist in the U. Kansas Gerontology Center.
The loss of her father and two grandfathers back in Canada while she was a graduate student here in the U.S. sparked LaPierre’s initial interest in the funeral industry. Her interest quickly turned into a passionate research topic. She’s now one of the few KU professors knowledgeable in thanatology, the study of the social and psychological implications of death. She teaches the course “Sociology of Death and Dying.”
Her father’s death in a car accident was the first death of a close family member she experienced. The tragedy left her with a list of decisions she was unprepared to make.
Would he have preferred cremation or burial?
Did he want a religious ceremony?
What songs would he want played at the funeral?
In her class, LaPierre preaches the importance of making one’s wishes known through wills, advanced directives and dialogue with family, which can help avoid these lingering questions. Open discussion and understanding of death is perhaps one of the best ways to prepare for and cope with loss. Yet, she, like many people, still hasn’t made her own final wishes known on paper.
“I’m just as susceptible as everyone else,” she said. “You always think there will be more time tomorrow.”
The whole experience of her father’s death is a blur, but she remembers one thing.
“Honestly, price wasn’t an issue,” she said. “We didn’t even care.”
In retrospect, it probably wasn’t a good idea to dish out thousands of dollars for a fancy casket. But at the moment, the pressure to act quickly and demonstrate her love for her father trumped reason and practicality, she said.
The experience of planning a funeral, coupled with her in-depth study, has left her a much more enlightened consumer. She suggests planning ahead and never being afraid to shop around or to leave a funeral home that doesn’t treat you well.
The Funeral Consumers Alliance maintains that an abundance of funeral homes and undertakers in many states has caused an oversaturated market and higher costs for consumers. In Kansas, the Alliance estimates a need for only 99 funeral homes, but 326 funeral homes are currently in operation.
“They’re fighting over dead bodies in many areas,” Carlson said.
Lawrence is home to three funeral homes, two of which are equipped to perform cremations. About 500 people die each year in Douglas County.
Even critics aren’t predicting the death of the death care industry. Neither Carlson nor Sehee foresee the extinction of the traditional American funeral anytime soon.
“Home schooling never put the schools out of business. Home births never put the OB/GYNs out of business. Home funerals aren’t going to put the funeral directors out of business,” Carlson said. “But they may have to start selling homeowners insurance on the side or refinish antiques or something.”
THE GRAVEYARD SHIFT
The job of undertaker is a lot like a doctor — always on call.
But in this business, no one is ever saved.
At Rumsey-Yost, Todd Miller and other students trade off nights sleeping in a small room on the third floor. When a nursing home, hospital or family calls, they throw on a suit and tie and quickly retrieve the dead.
Miller moves the corpse onto a stretcher and covers it in a maroon velvet body bag. Overnight, the body will stay in the coolness of the basement until Foley or another embalmer arrives in the morning.
Only a few feet away are the two options — the crematory and the entrance to the embalming room. Not a long journey.
Local funeral homes see this 24/7 service as part of their duty in serving bereaved families.
“We’re always here,” funeral director Patty Dardis said. “It doesn’t matter if we were just sitting down to Christmas dinner.”
Dardis says funeral directors must find a way to separate grief and sorrow at work from the happiness of home life, just as doctors can’t bring every patient’s illness home with them.
To the embalmers, this level of separation is also vital to their success.
After letting the body firm up, Foley and Miller now set out to beautify the corpse — the last step.
Once the cadaver is completely sealed, the two dress the body, usually in clothes picked out by the family. Underwear, socks and a bra are all draped on the deceased. No detail is left out. The shirt, jacket or dress is cut down the back to make manipulating the stiff arms easier. The same goes for the pants. The shoes can also be cut if there’s any trouble getting them on.
The face and hands are then stained a more lifelike color. They fix the hair just as the person wore it in life and apply makeup. A lift lowers the body from the table into the casket, the head cradled by a plush pillow, tilted slightly to the right for easy viewing. The elbows rest on blocks hidden under the casket lining to keep the arms from falling. The hands are set on the abdomen, one over the other. The goal is to make the body look as though it’s enjoying peaceful sleep.
Miller says he treats every body as respectfully as if it were his own grandmother, but it’s not as if he is actually caring for a living person.
In the embalming room, Mr. Smith is no longer Mr. Smith. He’s an object to be preserved and dressed up.
Though they don’t know the person in the coffin, Miller and Foley take great care in this process. This is their gift to the family, the most important result of their labor.
Regardless of what critics say about embalming, cremation and the financial and environmental costs of the funeral industry, this is what a majority of grieving families choose.
Embalmed, buried, cremated or donated to medical science, the physical body remains the centerpiece of American death rituals. It allows them to grieve the loss of a loved one and perhaps to catch a glimpse of what inevitably waits in the future.
The truth is, this entire process isn’t for the dead.
In the end, the dead won’t see the embalming room in the basement. They won’t feel the blood being sucked out of their bodies or smell the formaldehyde as it’s pushed through their veins. They won’t feel the pain of sharp tools jabbing into their abdomens or the searing heat of the cremation oven.
They won’t enjoy the comfort of the lush, silky mattress that lines their polished coffin. They won’t see their precisely styled hair or marvel at the granite headstone over their grave.
By the time the mourners gather, the dead are no longer present, at least not in this world. But they have left behind remains for others to mourn and remember as the body is shown, the casket is closed and the grave covered with dirt.
No, this process is all for the living.