Illustration by Landis Blair (LandisBlair.com)

The Dead Beneath

2.5 million people die in the United States every year. Where do they all go?

by Caitlin Doughty

THOUGH YOU MAY NEVER have attended a funeral, two of the world’s humans die every second. Eight in the time it took you to read that sentence. Now we’re at fourteen. If this is too abstract, consider this number: 2.5 million. The 2.5 million people who die in the United States every year. The dead space this process out nicely so that the living hardly even notice they’re undergoing the transformation. We’d probably pay more attention if no one died all year, and then on December 31 the entire population of Chicago suddenly dropped dead. Or Houston. Or Las Vegas and Detroit put together. Instead, unless a celebrity or public figure dies, we tend to overlook the necro demographic as they slip away into history.

Someone must take care of these corpses, who have become useless at caring for themselves. Someone must pick them up from homes and hospitals and transport them to the places we hide the bodies — mortuaries and coroners’ offices. In Dante’s Inferno the job fell to Charon, a shaggy-jowled, white-haired demon who piloted sinners by boat across the River Styx into hell.

At San Francisco’s Westwind Cremation, that job belonged to Chris.

Chris was in his late fifties, tan with a shock of white hair and sad basset-hound eyes. He was always impeccably clean and wore khakis and a button-down shirt — California formal wear. I took to him immediately. He reminded me of Leslie Nielsen, star of the Naked Gun movies, which were my favorite as a child.

Chris’s voice was slow and monotonous. He was a bachelor — never married, never had children. He rented a small apartment he would return to in the evening to eat a bowl of ramen and watch Charlie Rose. Chris was pessimistic and borderline curmudgeonly, but in a way that brought me happiness, like watching a Walter Matthau movie.

You are reading an excerpt from Smoke Gets in Your Eyes by Caitlin Doughty. Skip to the bottom for links to buy it online now or ask for it at your local bookstore.

As the body-transport driver, Chris technically worked for Mike, even though he was older than his boss and had been in the funeral industry longer. Chris and Mike’s conversations were akin to old-time comedy routines. Chris would walk into Mike’s office and monologue in painstaking detail his planned driving route to pick up the recently deceased Mr. Kim in Berkeley, taking into account possible traffic, construction, and the evils of the modern world. Mike would grunt and half nod, elaborately ignoring him, focused on the computer screen, filing death certificates without really listening.

Picking up a person who has died at home is known as a house call. Doctors may not make them anymore, but morticians are happy to come, day or night. Protocol in the funeral industry says that one person may go alone to pick up bodies from hospitals, nursing homes, and the coroner’s office, but a team of two people must pick up a person who died at home. When a house call came in, I was to be Chris’s number two.

I appreciated the two-person rule tremendously. The gurney was the most uncooperative, unyielding machine e’er created by man. It tried, in sinister fashion, to embarrass you in front of your boss by being clunky and useless at every turn. The gurney was the only thing in this world less cooperative than the dead bodies that were strapped to them. The thought of having to operate a gurney alone in someone’s private home was horrifying.

THE FIRST HOUSE CALL I went on, a week into working at Westwind, was in South San Francisco. The deceased was Mrs. Adams, an African American woman in her late forties who had died of breast cancer.

To pick up Mrs. Adams, Chris and I hopped into the van, his version of Charon’s boat. This particular van, which Chris had owned for more than twenty years, was a white, windowless box of a vehicle, the kind they featured in televised public service announcements to remind children not to ride with strangers. Westwind owned its own removal van — much newer, dark-blue, designed and outfitted with special features for picking up the dead. But Chris liked routine. He liked his van.

As we drove over the massive Bay Bridge connecting Oakland to San Francisco, I made the mistake of commenting on how beautiful the city looked that day.

Chris was horrified. “Yeah,” he said, “but you live there, so you know once you get up close it’s just a noisy and dirty hell pit. It would be better if we just fire bombed the whole city. That is — if we even make it across.”

“What do you mean if we make it across?” I asked, still adjusting to the concept of fire bombing.

“Think about the way this bridge is built, Cat” — he called me Cat — “crammed up here on eighty-foot Douglas fir pilings just stuck in the mud. It’s like toothpicks in Jell-O, structurally. We’re just swaying up here. The legs could just snap in half like twigs any second, and we’re all dead.”

I laughed at a slightly higher pitch than usual, glancing out the window at the long drop to the Bay below.

We pulled up outside the Adamses’ home twenty minutes later with none of the pomp and pageantry of the funeral carriages of old. In lieu of plumed horses in a cortège, it was Chris and me in his twenty-year-old unmarked white van.

Before we went in, I made Chris go over everything again. I wasn’t about to embarrass myself in front of this woman’s husband.

“Don’t worry about it, Cat. A monkey could do this job. I’ll talk you through it.”

As we got closer to the house, it became clear that we would not be dealing with just the woman’s husband. At least fifteen people were milling around outside, eyeing us suspiciously as we walked up the front path to the door. When we walked through the front door we found ourselves in a high-ceilinged living room, where at least forty people were gathered around a woman’s body. Like the scratch of a needle on a skipping record, their voices all went silent at once as the group turned to look at us.

Oh great, I thought, the only two white people here have arrived to take their beloved matriarch away in our roving child-molester van.

Chris, however, didn’t miss a beat. “Hello, folks, we’re here from Westwind Cremation & Burial. Is this Mrs. Adams here?” he asked, gesturing to the dead body in the center of the room.

It was a pretty safe bet to assume that this was, in fact, Mrs. Adams, but the group seemed to appreciate the question. A man stepped out and introduced himself as Mr. Adams.

Quick to prove myself useful, I asked in a solemn tone, “Were you her husband?”

“Young lady, I am her husband. Not were her husband,” he replied, fixing me with a withering gaze, compounded by the forty other withering gazes from around the room.

This is it, I thought. I’m done. I have shamed myself and my family and all is lost.

However, Chris was, again, unfazed. “Well, I’m Chris, and this is Caitlin,” he said. “Are we ready to take her, here?” At this point the family usually leaves the room, leaving the funeral-home employees to do whatever they do with the corpse to make it disappear. But this family wanted to watch us. This meant my first time removing a dead body from a home was going to be in front of forty crying people who hated me.

This was the moment I learned the magic of Chris. He began talking me through the process in the same voice he’d told Mike about the day’s elaborate traffic route. He explained how we were going to remove Mrs. Adams as if he were telling the crowd.

“Now we’re going to pull the gurney right alongside the bed, and Caitlin is going to use that handle there to lower her side down. I’m going to take the sheet next to her head and Caitlin is going to take the sheet by her feet and slide it right underneath her. Caitlin is going to pick up her feet onto the gurney in one, two, three. Now she’s going to wrap the second sheet over her and snap her in tightly.”

This continued until Mrs. Adams was swathed and buckled securely to the gurney. The people in the room paid rapt attention to the process, following Chris’s voice step by step. I was grateful that he didn’t expose me as a fraud. I didn’t even really feel like a fraud. The way Chris explained things made me believe I actually knew what I was doing. Surely there had never been a time I hadn’t been an expert body shrouder.

As we wheeled Mrs. Adams out the front door, her son came up to us. He was my age, and his mother was dead. He wanted to lay a flower on the gurney. I didn’t know what to say, so I blurted out, “She must have been a really amazing woman. Trust me, I can just tell about these things.”

This was, of course, a lie. This was my very first house call and I still didn’t know how to properly wrap the body in a sheet, forget measuring the vibe of the room to determine just how “amazing” a dead person was when they were living.

“Um, yeah, thank you,” he said.

Driving away from the house, Mrs. Adams rattling gently in the back, Chris assured me that I hadn’t actually screwed everything up forever. “Look, Cat, we see people at their worst moments. Maybe if someone’s buying a new car, or a new house, they want to be there. But what are they buying from us? Nothing, we’re charging money to take away someone they love. That’s the last thing in the world they want.” This made me feel better.

WESTWIND’S TWO CREMATION MACHINES could handle six bodies (three in each retort) on a typical 8:30–5:00 day — thirty souls a week during busy periods. Each removal took at least forty-five minutes, far longer if the deceased was across the bridge in San Francisco. By all rights Chris and I should have been out fetching bodies constantly. Chris was out constantly, but often just to avoid Mike by volunteering to run petty errands like picking up death certificates and going to the post office. I mostly stayed at Westwind and focused on cremation, since the majority of body pickups didn’t require a number two. Most deaths no longer happen at home.

Dying in the sanitary environment of a hospital is a relatively new concept. In the late nineteenth century, dying at a hospital was reserved for indigents, the people who had nothing and no one. Given the choice, a person wanted to die at home in their bed, surrounded by friends and family. As late as the beginning of the twentieth century, more than 85 percent of Americans still died at home.

The 1930s brought what is known as the “medicalization” of death. The rise of the hospital removed from view all the gruesome sights, smells, and sounds of death. Whereas before a religious leader might preside over a dying person and guide the family in grief, now it was doctors who attended to a patient’s final moments. Medicine addressed life-and-death issues, not appeals to heaven. The dying process became hygienic and heavily regulated in the hospital. Medical professionals deemed unfit for public consumption what death historian Philippe Ariès called the “nauseating spectacle” of mortality. It became taboo to “come into a room that smells of urine, sweat, and gangrene, and where the sheets are soiled.” The hospital was a place where the dying could undergo the indignities of death without offending the sensibilities of the living.

In my high school, my classmates and I had been told in no uncertain terms that we would not get into college and thus would never get a job and thus would end up unsuccessful and alone if we didn’t serve a certain amount of summer volunteer hours. So the summer between my sophomore and junior years, I signed up to volunteer at Queen’s Medical Center, a hospital in downtown Honolulu. They confirmed I was not a drug user and had decent grades, and gave me a hideous bright-yellow polo shirt and a name tag and told me to report to the volunteer office.

The volunteer department allowed you to select two areas of the hospital to rotate between from week to week. I had no interest in popular choices like the gift shop or the maternity ward. “Get Well Soon” balloons and crying babies seemed like a cloying, sappy way to spend the summer. My first choice was working the front desk at the intensive care unit, imagining a glamorous-nurse-wiping-fevered-brows scenario out of World War II.

The ICU was not the thrill ride I had expected. Turns out, they never called the high school student in from the reception desk to assist the doctors in lifesaving procedures. Instead, the job entailed hours of watching incredibly worried families wander in and out of the waiting room to use the restroom and retrieve cups of coffee.

I had more success with my second choice, the distribution department. Working for the distribution department meant passing out mail and memos to different wings of the hospital or wheeling old women out to the front curb after they were discharged. But it also meant transferring dead bodies from wherever they had expired to the morgue in the basement. I coveted that task. The people who worked full-time in the department may not have understood my enthusiasm, but when there was a “code black” called for a corpse transfer, they would generously wait for me to arrive.

In retrospect, it seems odd that the hospital administration would say, “Sure thing, fifteen-year-old volunteer, you’re on corpse-transfer duty.” I can’t imagine this was something they normally assigned to young volunteers. In fact, I recall a fair amount of initial reluctance on their part — overcome by my successful begging.

Kaipo, my direct supervisor, a young local Hawaiian man, would look at the board and declare in his thick pidgin accent, “Eh, Caitlin, you like come get Mr. Yamasake from Pauahi Wing?” Oh yes, I most certainly did want to get Mr. Yamasake.

Kaipo and I arrived in Mr. Yamasake’s room to find him curled up in the fetal position on his immaculate white hospital bed. He looked like a museum mummy, with taut skin like brown leather. He was less than ninety pounds, desiccated by disease and old age. Either one of us could have lifted him onto the stretcher with one hand.

“Dang, dis guy’s pretty old, yeah?” Kaipo said, Mr. Yamasake’s age surprising even a veteran of the corpse-transfer beat.

The stretcher Kaipo and I had brought with us was actually a hollowed-out metal cage. We placed Mr. Yamasake inside before covering him with a stainless steel top, like a lid. A white sheet was draped over the whole opera- tion. Kaipo and I left Mr. Yamasake’s room pushing what appeared to be an empty stretcher.

We rolled into the elevator with regular hospital visitors holding their teddy bears and flowers, none the wiser about the secret corpse in their midst. (The next time you see two full-grown adults moving an unoccupied stretcher in a hospital, think of Mr. Yamasake.) The others got off the elevator long before we did. Kaipo, Mr. Yamasake, and I continued down to the basement.

The hospital presented itself as a positive place of healing with the latest technology and attractive Hawaiian art prints on the walls. Everything — the false stretcher, the secret morgue in the basement — was artfully designed to mask death, to distance it from the public. Death represented a failure of the medical system; it would not be permitted to upset the patients or their families.

Kaipo and Chris from Westwind were kindred spirits in a way: two men of quiet dignity who transported the husks of the recently alive. To them it was a prosaic day job, while to the average citizen theirs was a task both mystifying and disgusting.

The first few house calls for Westwind taught me that Chris was unflappable, even when removing bodies in the cramped, near-impossible conditions of San Franciscan homes. We’d walk up perilous, winding staircases, and Chris would just sigh and say, “Better get the portable.” The portable was a portable stretcher, the kind they use to carry casualties off the field of battle. Chris and I would strap the deceased to that sucker and bring them out on their sides, their stomachs, straight up and down, over our heads — anything it took to get them out to the van.

“It’s just like moving furniture,” Chris explained. “Geometry and physics.”

Chris was equally unflappable in the face of decomposed bodies, overweight bodies, and downright bizarre bodies. By bizarre, I mean like the time we arrived at a home in the Haight District and were escorted into a cold, decrepit basement by a gentleman who had the pointed mustache and clawed hands of horror-movie actor Vincent Price. Propped up in the corner was the dead man, curled up in a ball with a single glass eye gazing up at us. “Well, that’s weird, Cat. Him winking at us? Let’s go get the portable.”

The most important thing about body removal was to never give up. Trite, perhaps, but it was Chris’s mantra. He told a story about a four-hundred-pound body located up three flights of stairs in a hoarder house infested with roaches. His number-two man that day had refused to even attempt the removal, saying they would never be able to get the person out with just the two of them. “I just lost all respect for him right then,” Chris said. “I hate people who don’t try.”

In our long trips in his van I learned more about Chris, like his single-minded obsession with the two years in the late 1970s he spent working for a tyrannical construction manager in Hawai’i. Some Google mapping showed that during his time in Hawai’i he had lived within a three-block radius of both my newly married parents and a young Barack Obama. (It was easy to construct mundane fantasy scenarios in my head where they were all at the same corner store together or crossing the street at the same stoplight.)

A FEW WEEKS AFTER our trip to the Adamses’, Chris and I took a house call in the Marina District of San Francisco at a fancy home on a well-trafficked street. We had been chatting about Hawai’i or the weather or Mike’s brusqueness when we pulled up outside. “You know what I think about, Cat?” Chris said as we grabbed our pairs of rubber gloves “How we’re like hit men. Like the guys in Pulp Fiction. They’re sitting there in the car talking about a sandwich, and then they go blow someone’s brains out. We’re just sitting here in the car chitchatting and now we’re goin’ in for a dead body.”

When we knocked, a dark-haired woman in her fifties opened the door. I gave her a big, sincere smile, having learned at that point that a sincere smile was more effective than faked sympathy.

“I called you hours ago!” she shrieked.

“Well, ma’am, you do know that it is rush hour and we were coming from Oakland,” Chris said in his soothing Chris voice.

“I don’t care, Mom deserves the best. Mom would have wanted everything to be dignified. She was a dignified woman, this is not dignified,” she continued, still shrieking.

“I’m sorry, ma’am, we’ll take good care of her,” Chris said.

We continued into a bedroom to find Mom. As we pulled out the sheet to shroud her, the woman hurled her body over her mother, wailing dramatically. “No, Mother, no, no! I need you, Mother, don’t leave me!”

This is what raw human emotion should look like. It had all the signs: death, loss, gut-wrenching wailing. I wanted to be moved, but I wasn’t. “Guilt,” Chris mumbled under his breath.

“What?” I whispered back.

“Guilt. I’ve seen this so many times. She hasn’t visited her for years. Now she’s here acting like she can’t live without her mother. It’s bullshit, Cat,” he said. And I knew he was right.

The woman finally extricated herself from mother’s corpse, and we were able to get Mom wrapped up and out the door. As we rolled the gurney out onto the busy street, people stopped and stared. Dog walkers halted and yoga moms slowed their baby carriages. They gawked at us as if we were detectives or coroners, pulling a body from a violent murder scene, not two mortuary workers handling a woman in her nineties who had died quietly at home in bed.

There hadn’t always been this scandal surrounding scenes of death. When the bubonic plague swept through Europe in the 1300s, bodies of the victims would lie in the street in full view of the public, sometimes for days. Eventually the death carts would collect the dead and take them to the edge of town, where trenches were dug for mass graves. A chronicler in Italy described how bodies were layered in the ground — bodies then some dirt, bodies, then some more dirt — “just as one makes lasagna with layers of pasta and cheese.”

Today, not being forced to see corpses is a privilege of the developed world. On an average day in Varanasi, on the banks of the Ganges in India, anywhere from eighty to a hundred cremation ghats burn. After a very public cremation (sometimes performed by young children from India’s untouchable caste), the bones and ashes are released into the waters of the holy river. Cremations do not come cheap; the cost of expensive wood, colorful body shrouds, and a professional cremationist adds up quickly. Families that cannot afford a cremation but want their dead loved one to go into the Ganges will place the entire body into the river by night, leaving it there to decompose. Visitors to Varanasi see bloated corpses floating by or being eaten by dogs. There are so many of these corpses in the river that the Indian government releases thousands of flesh-eating turtles to chomp away at the “necrotic pollutants.”

The industrialized world has established systems to prevent such unsavory encounters with the dead. At this very moment, corpses motor down highways and interstates in unmarked white vans like the one driven by Chris. Bodies crisscross the globe in the cargo holds of airplanes while vacationing passengers travel above. We have put the dead beneath. Not just underground, but under the tops of fake hospital stretchers, within the bellies of our aircraft, and in the recesses of our consciousness.

It is only when the systems are subverted that we even realize they are there. After Hurricane Katrina, Dr. Michael Osterholm of the Center for Infectious Disease Research and Policy was quoted in the Washington Post as saying, “One of the many lessons to emerge from Hurricane Katrina is that Americans are not accustomed to seeing unattended bodies on the streets of a major city.” Understatement of the century, Doctor.

For the few minutes it took Chris and me to roll “Mom” from her front door to the back of the van, we gave the dog walkers and yoga moms a cheap, manageable thrill. A whiff of depravity, a small taste of their own mortality.

Buy “Smoke Gets in Your Eyes and Other Lessons from the Crematory” today.

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Illustration by Landis Blair (LandisBlair.com)

CAITLIN DOUGHTY is a licensed mortician and the host and creator of the “Ask a Mortician” web series. The New York Times bestseller Smoke Gets in Your Eyes is her first book. She founded the death acceptance collective The Order of the Good Death and cofounded Death Salon. She lives in Los Angeles.

You can find her in all the usual places: Twitter, Facebook, and Instagram.