Category Archives: Essays

Live Stream Autopsy in the Time of Fake News

There’s nothing more real than an image of an autopsy. You’d think. Not in the time of fake news.

We started live streaming autopsies in 2017 to hundreds of thousands of viewers (our first drew in over a million). Family consent beforehand and maintaining patient confidentiality during the case are, of course, requirements. We have an open Q & A during the case where I talk with viewers and answer questions. The videos are left up after the case and more Q & A rolls in, for later discussion. It’s been a phenomenon for us.

To sort it through, I pay attention to where our viewers lead us. Sure, we get our share of horror fans and, shall I say, worse? Our videos, I’m told, have found their way into a “serial killer” site. I’m not sure what that means. I’m hoping it’s for people CSI-curious about criminals…not a club for serial killers. And, through Google’s truth-outing, I’ve recently seen that we’re now up on a site called Cute Dead Guys — it is what it sounds like. I only know because of brief descriptors out there. I have not (and will not) be seeking the password access that tens of thousands have. To get personal, many of you who know me will have discovered the shocking truth that I don’t like horror movies or watch CSI. When I’m not doing autopsies, it’s Toy Story and Moana (“See the light where the sky meets the sea, It calls me, And no one knows how far it goes…”). Ahh, Disney. But I believe passionately in compassionate education about death, dying, health and the body. So I do what I do. It’s a balance.

On a more tame scale, our viewers have a fascination with death. Our social media serves an important normalizing function there. Our comment section on Facebook is filled with statements like “I watch all your videos. I love them. My boyfriend thinks I’m a weirdo.” And then a stranger replies: “I love them, too.” And so friends are made and it becomes ok to be interested and to learn. We work for that comfort on our site. It’s a place for people to feel comfortable with themselves and the topic. I explore and understand the body after death to help the family with closure. The autopsy is an intimate medical procedure. We design the Facebook page to highlight respect for the process and for our families. But we see the struggle with taboo in our culture that makes it so hard for people to be ok with wanting to know.

Next seems to be the largest group of our viewers: one that simply has a huge need for knowledge. Seeing the inside of the body is educational. Many comments reflect this: “I didn’t know fat was yellow.” “The skull is so thick.” “That’s where the pituitary is — no wonder they talk about some tumors being ‘inoperable’.” Many people aren’t exposed or educated about what’s on the inside. We show that. It fills a need.

And then, we have our share of professionals — nurses, paramedics, funeral directors and a variety of students. “Better than a textbook” is a theme. Stay tuned for “augmented reality.”

So that’s an encapsulation of who views us. It’s a simplification — we get moms who watch with their 3-year-old; one who watches to relax before going to sleep, and others. We think carefully about what happens to the material once we put it out there and consider how we should make it available. But we believe in education and keep our “graphic warning” front and center for our videos. The idea is not to shock, but to educate for those interested.

Now onto our place in the time of fake news. I wonder if one of our draws is simply that we are real — if that brings in a good number of our 23K Facebook followers. We are real but not a “reality show.” With the near-impossibility finding the truth on-line these days, I’m wondering if we become a place for that. In addition, we foster trust by talking without taboo. Our discussions cover death, dying, the body, nudity, health care, social media issues and the truth itself. Our Facebook page is modeled after the meaning of autopsy, “to see for one’s self.”

Let me add another phenomenon from our page. We have many people asking if the person in the video is dead. How can that be? We are removing a brain. This person in the video cannot be alive. The answer is complicated. In part, it’s the shock and surprise of seeing the procedure on-line. We’re not used to seeing autopsies. We’re used to surgeries — health care for the living — so it’s an adjustment. Another reason has to do with a deeper psychological readiness to understand “dead.” Like children developmentally, not all adults are there. It can take some processing. I get why people ask. And lastly, as one insightful Facebook fan commented — thinking of the person as alive is just easier. It can be psychologically stressful to be faced with full-on “dead.”

Only rarely do we have anyone call out our work fake. I have seen it only twice in closely reviewing thousands of comments. One person commented on Facebook that the fat looked fake — this was easily explained because there is no bleeding in an autopsy (since the heart stops circulating blood). So the fat sits there as a bright yellow plasticky-looking layer. The second comment, from YouTube was more direct: “Clearly fake. Pasta. Props on the special effects”[sic].

The draw to our page, value to our viewers for the education, the struggle some have with “understanding dead” and occasional call-outs of Fake! point to one thing: a person’s psychological readiness for the truth determines what they look for and can accept. I suspect this is true in the media in general. We should have compassion for people who need fake news. They must have some deep limitation as to what they can handle from the daily, painful reality that bombards and overwhelms us in the media. (This, of course, does not mean we should tolerate efforts to undermine the truth.) On the flip side, those fighting to access the truth — or place to say a five-minute autopsy video is of interest — show courage. Fake news is a broad cultural expression of psychological stress in the face of reality.

Autopsy Center is here to develop a place for those ready (or who can be ready) for the truth. One of the things we are doing at the Center is developing our high school program, Live from the Morgue. Schools from across the country can join us simultaneously during one of our video-educational sessions. We’re developing our school-to-school shared experiences specifically with an eye to breaking barriers at an early age.

Join us when you’re ready and if you’re interested. We’re here to share the truth. To our pasta-commenter from YouTube. No, not fake, not pasta, not special effects. Real. The human body. Props on how beautiful life has made us.

Check out our videos on Facebook or YouTube or download our Autopsy app.

Essay: The Only Acceptable Option

IV image

Joe and his wife, Carla, talked about it when she got the news – she didn’t want chemo. She didn’t want chemicals to destroy her body. She made that clear to Joe. Her father went through something awful when he got cancer and she just didn’t believe in those poisons. And they had done their research — how much does chemotherapy actually work for cancer of the stomach?

There was only one acceptable option – treatment had to be “natural.” They considered a trip to Mexico for some “alternative” treatments but money was a concern. So they sought out doctors nearby who believed the same as they did — that cancer should be treated without western poisons. After a few weeks, they found their medical sanctuary and the treatments began.

Carla seemed to be doing well on weekly intravenous hydrogen peroxide, Joe explained as we sat in my office. I swallowed and could feel the blood rushing from my face. What kind of doctor treats cancer patients with injections of hydrogen peroxide? My heart sank. This is why I help families — vulnerable in so many way and at such critical times.

Joe’s faith in the “treatment” and his disbelief in the outcome were profound. It was stomach cancer but Carla had been eating — maybe a little trouble swallowing but not much in the way of other symptoms. The tumor must not have been growing, he had concluded. The treatment was working. His older brother, Mark, was with us, nodding and supporting him, listening and asking questions.

What went wrong? Joe wanted an autopsy to find out.

It showed widely metastatic cancer. Outsized lymph nodes formed a slowly tightening noose around the esophagus; a destructive bio-lava of tumor pushed from the stomach into the pancreas; and metastatic growths nested insidiously throughout the liver. Remarkably, the gastric tumor had grown out and away from the stomach, not into the stomach itself. No wonder there wasn’t much in the way of swallowing or digestive symptoms. But this apparent health belied the tumor’s silent and dangerous growth nearby.

When we met again to discuss the results of the autopsy, Joe was shocked. She had seemed to be doing so well. He was surprised that her tumor was so advanced. With diagrams and details, I went through the case step by step.

He was stunned, but understood. And then he understood what this meant — that the treatment had not worked. And then he understood the inevitable — that he had participated in the choice of treatment.

“Did we do the right thing? Should we have gone with chemotherapy?” he asked, wrestling with guilt as so many families do.

I sorted through the question, looking for a way in to help. It wasn’t my judgment to pass. Gastric cancers do not respond well to chemotherapy. Choices at the end of life are important and personal. But he had said “we” and Carla had really made the choice herself with Joe supporting her — it really hadn’t been his decision. She had been adamant. Maybe I could point that out?

And while Carla seemed to have driven the choice of “treatment,” it wasn’t clear to me how deep Joe’s mistrust of chemotherapy was. Many chemotherapies do work. Hodgkin’s lymphoma, for example, can be cured. I thought it could be worth exploring. What if Joe had such a choice to make again? What if that choice was for himself? Feeling protective of him, I thought I could explore it gently and carefully. Autopsies are about the truth and can be turning points for families.

But his brother spoke first, injecting the only acceptable option he could see — that there could be no second guessing.

“Of course you did. Of course you did,” he said, shooting a glance at me and touching his brother’s arm.

It was an older brother’s protection. The dynamic here was powerful.

“Yes,” Joe nodded, losing himself into his brother’s verbal embrace.

I thought Joe could have handled more, and wondered where the conversation might have gone. I grimaced internally as I saw the opportunity dissolve. It was now too risky to start a discussion that could be misconstrued as “blame.” “Do no harm” — my physician oath ingrained — meant that I could not risk infusing guilt on top of grief.

So I said nothing. It was the only acceptable option.

The Independent Autopsy or Private Autopsy – and Your Rights

FullSizeRender
Most people understand that autopsies can be performed by the hospital or by the coroner (or medical examiner). In the first instance, the usual story is that the patient has died in the hospital. Then the hospital (or health care provider) may ask the family to authorize an autopsy. The purpose of the autopsy is to find out more information about the patient’s medical condition or cause of death. In the second instance, there is a “suspicious circumstance” (e.g., homicide, suicide, etc.) prompting an investigation by the state. The coroner or medical examiner gets involved. He or she may take the body to the state’s facility to perform an autopsy. The purpose of the autopsy is to understand the circumstances of the death or “solve the crime.”

This historically-formed process builds in a culture of control and oversight that can subtly exclude the family. Because the autopsy process is initiated by the institution (hospital or coroner/medical examiner), communicated to the family as an institutional “need to know,” and performed by the institution itself, the institution becomes — in the family’s mind — the gatekeeper for the autopsy. The family’s role is more passive. In the case of a coroner or medical examiner case, it’s to wait till the state’s work is done; in the case of a hospital case, it’s to consent to the procedure.

Attached to that passivity, the family may feel a lack of control over the disposition of their loved one.

With coroners and medical examiners, the family’s lack of control is real. The family does not have control over the process. State law typically grants coroners and medical examiners legal priority over the family when it comes to an autopsy. It’s part of living in society.

With hospitals, that lack of control can still be perceived. But it’s not real. It’s more about the hospital’s presence in the process. And about the family not knowing their rights and options.

When it comes to autopsies, the concept of choice is generally absent from our culture and, often, from the institutions that have first contact with families after a loss. It’s the coroner’s job to take the case based on legal guidelines. Choice of service does not come in to the picture. But, when interacting with a hospital, families don’t know and don’t hear that they have a choice. States such as Connecticut and Texas have laws that require families receive information about their right to choose their own service provider. Illinois and other states do not.

It’s really not different from other parts of health care. Most people know that, in general, they have the right to choose their health care provider — or even shop around; that they have the right to a second opinion; and even the right to switch providers or hospitals. The same is true of autopsy service.

This is where the private autopsy or independent autopsy comes in. These are autopsies performed by a service separate from the hospital and through a contract made directly with the family.

The term “independent autopsy” emphasizes that the autopsy is performed in a way that is completely separate from the care provider. For better or worse, many families can feel mistrustful of the hospital when the death occurs in the hospital. In this litigious age, it’s a “fox guarding the hen house” concern. The family may wish to have the autopsy performed by a service that is completely separate and unaffiliated with the care provider — an independent autopsy.

The term “private autopsy” emphasizes that the autopsy is performed through a service with its own (e.g, private) relationship with the family. The term “private” also highlights that autopsy results are given confidentially to the family and not to the hospital or care provider. An autopsy report from a private autopsy is not automatically submitted to the hospital to become part of the hospital medical record. The only time the report is released is at the family’s consent or as required by law. Medical confidentiality laws apply.

At Autopsy Center of Chicago, we provide private or independent autopsies. Know that we are a service to look to for an autopsy when your loved one dies either inside or outside the hospital. As long as the state has completed its evaluation, you can request an autopsy from any provider you like. Independently. Privately. Either way, it’s your right.

[button label=”Frequently Asked Questions” url=”/why-choose-acc/frequently-asked-questions/” target=”_blank” color=”#f05134″]

The Autopsy: An Emotional Choice

Autopsy emotions

For the family, requesting an autopsy is always an emotional choice. I don’t mean that the family is always upset when they request an autopsy. I mean that the request is always based on some emotional need for closure. This is in some ways different from what motivates physicians and hospitals to request autopsies (although there are emotions behind that, too); and completely different from the legal criteria that drive coroner and medical examiner autopsies — no emotions there.

Meet David (name altered), spokesman for his two brothers — all adult children living scattered around the country. Their father has long since died, and none have been in touch with their mother except for an occasional obligatory call barely wetting a parched, ten year stretch without visits.

The mother is older but managing: volunteer work, bridge games with friends on Saturdays, church, and a comfortable flat.

An unanswered call to the mother by a friend after a missed bridge game prompts a call to the police a day later; and then a break-in to the mother’s apartment by paramedics. The EKG pads placed on her body are an obligatory electronic documentation of the chest’s silence, obvious from a distance when the paramedics find her.

David doesn’t care about the story. He is clear: his mother is dead and he and his brothers just want to know if there was anything inherited for them and their families to know about. The autopsy they are requesting is “strictly” for purposes of looking for genetic conditions. They want to plan for their health.

Matter-of-fact business and just-have-me-sign-the-form practically set the tone of his distant engagement. This family wants the data from the autopsy and nothing more – nothing from me.

I take note. This is unusual. It’s rare to meet a family that seems cold to condolences and insensitive to the invasiveness of the experience: a stranger’s hands deeps inside their loved one. It’s a process I respect — performing the autopsy, a final gift of intimacy, is an honor. It’s a request that comes with difficulty for many families.

The mother’s autopsy proceeds “routinely” from a medical point of view — severe blockages in the coronary arteries give plenty of reason for the heart to have stopped.

I prepare myself for the follow-up call to the family. I imagine the discussion will center on whether there was evidence for inherited high cholesterol or if the blockages were more related to life style (dietary) factors.

I start in with my descriptions and explanations — which vessels, what blockages, the health of the rest of the body. But when I pause to see if David has any questions, he is crying.

“Do you think she suffered? When do you think she died?”

I am surprised but understand immediately that I should not be. The feelings that drove her children’s physical and emotional distance have given way to the unbreakable bond underneath: that of mother and son. Ten years of distance could not make that go away. Nor could one hundred.

Imagining her dead in her flat, David is desperate for more than what the paramedic’s note-sheet can offer; not knowing what happened during that overnight gap is unbearable to him. He does not want to imagine his mother too sick – or injured from a fall – to call for help. He wants to know if I can tell him that the death was sudden and painless or something else. I wonder if guilt from their years-long separation makes it even harder for him to imagine her alone, aware and helpless in her last hours.

We continue to talk together. David, step by step, tries to understand what all the details mean for what we can know about that overnight stretch. Step by step, he is walking across the autopsy’s long and dangling bridge of facts and relationship back to his mother.

The autopsy is always an emotional choice.

Loss Twice: Death in the Hospital

Hospital death relationships

The hospital is a paradox. Even for a long stay, many relationships can be fleeting: Who is the phlebotomist today? What resident will be seeing me? Patients (and their families) may wonder these and other like questions. If the hospital experience has lasted months — with surgeries, ICU stays, complications, and medical twists and turns — the family will also have made more solid connections along the way. Like all relationships, these will have ranged in quality and meaning to the family. There may have been supportive — or fighting — interactions with ICU nurses; questions and challenges to residents and specialists; and one or a few bright spots along the way: that emotionally available student, nurse, social worker, or physician who swings by, welcome at any time. The family will have worked with and worked its way into this world. While no one person or interaction may determine the family’s experience, the sum total experience becomes a living system for the family.

When a death occurs in the loved one, the family will experience the death of the system, too. Gone is their loved one. And, with his or her last breath, gone is the family’s ticket past admitting, up the elevator and into the complex hospital world. There is not one loss but two. This presents a unique challenge for these families.

Especially when the death is unexpected or, in the family’s mind, attached to issues of care, the hospital relationships may feel less welcoming and more of a battleground in their fight to participate in their loved one’s care. What happens when these relationships end? If the family has become angry, who is there to hear the family’s anger? Even the broken relationships are important.

Families at times find a way to continue to participate within the health care system. Some families return to the provider for a discussion – an option I am quick to recommend. Others will take the discussion into the legal system.

But some families will request an autopsy. When a family calls to request an autopsy, that conversation is a chance for the family to tell their story, get heard, and process their experience. I may not be talking with the family in the ICU, but I can hear their words bouncing off IV pole, the heart monitor and the isolation mask; and know that I am being asked to step in to a doctor-patient relationship attached to a history.

Although my role with the family may seem to focus on the technical — autopsies are precise procedures — it is also a powerful emotional one. My conversations with the family become a “processing cushion” for the family to make the second loss (the loss of the hospital system) a bit more gradual and bit less of a sharp shock. This eases the way forward to what is not at all a paradox: that it’s time to grieve over the loss of the loved one.

Meeting the Man on the Table

In May I autopsied a man I had gotten to know. He came to the autopsy table more rapidly than usual after he died, because the autopsy was for cancer research. Joseph (yes, not his real name) was a “tumor donor.” Tumor chemistry is unforgiving and ephemeral — the mysteries fly away unchasable unless the tissue is dropped into a test-tube and frozen right away. We move quickly with these cases.

And yet, in the struggle of end-of-life family logistics, it took weeks till I met Joseph. I worried constantly that our difficulty organizing the family meeting would mean that death would intervene before we could make arrangements. We had to be patient, knowing the arms on the end-of-life clock were were swinging and shaking forward erratically and unpredictably.

My first contact with Joseph was by phone. Raspy, gruff conviction and the choppy conversation of a man with difficulty hearing greeted me.

“Yes, I want to donate my tumor! What the hell do I need it for?! I’m not taking it with me!”

Joseph was direct, pointed, and at ease with the process of Tumor Donation. Part of his motivation, I learned later, was that Joseph had received a living organ donation some years prior. He was living — had gotten to stay alive — because someone else had given a part of themselves to Joseph. Now dying of cancer, he wanted and was ready to give his own tissue – “give back” or, in more Joseph-language, a “take-it-the-hell-out-of-me” gift. His gruffness made it all the more moving to see this man — filled with incessant, growing tumor — deciding to donate that tissue for research. My experience with Joseph was not the soft and painful poetry of cancer introspection, but the hardness of a good, working man armed with a cause.

When we met, Joseph was garrulous and eager; clear and open to the discussion. I wondered not only what it would be like to know a person before their autopsy, but to like them.

Only twice in my career have I personally known the the body on the table: once early in training some 20 years ago; and once, more recently, in in my private practice. In the first instance, I walked in to a case and peered through a huddle of residents to find this was the body of an attending from my internship. I hadn’t known he had died. Shocked, I asked my pathology attending to be excused and left the room. The second case I performed unknowingly. Again, it was an attending from a past training experience, but this one had been a mentor and friend. With many years distance, death’s stiffening withdrawal of the spirit, and my professional focus — I hadn’t recognized him. When I realized later, again, it was a shock. I wasn’t prepared.

But my encounter with Joseph on the autopsy table was planned. I knew I would be meeting him while he was alive for the purpose of meeting him while he was not. I both braced myself for the experience and worked to stay open to whatever that experience might be.

When he arrived at two in the morning, I was grateful for the head-to-toe white sheet covering him and took a moment to reflect on our few encounters. I had seen him sitting outside my office after the family meeting, chatting with my assistant as he waited for his family to pick up him along Michigan Avenue. I had seen him later in hospice, quiet and confused, sipping water from an offered cup and straw, vigor and fight traded in for infection and the ability to whisper and nod. I did not want to override those memories yet by looking at his face; and decided to perform the incision with the face still covered. The warmth of his abdominal organs melted through my double gloves, and reminded me that there was no hiding from what was different here.

The tumor was out of the body, sorted into various lab containers and the case over in half an hour. With Joseph cleaned up and sewed up, I still wondered if should look at Joseph’s face. My job was done. Would it be too upsetting? Did I owe it to him to see him? Did it matter? Could I skip it?

I removed the sheet over his face.

Sleeping. That’s all. I was not shocked. He looked like he was sleeping. I covered him up.

And then — never for any other case — I stopped and made a prayer of sorts. Standing by Joseph’s side, hands folded together in front of my chest, elbows bent, more feelings than words, and to no one in particular:

Thank you for this gift, for sharing your tumor, Joseph.

With all my supplies back into their boxes, I took one last look around the autopsy suite and clicked the lights off.

Three labs awaited Joseph’s tumor. I wondered what it would be like to meet the next the patient I’d autopsy, and the one after that. This was no longer the usual autopsy practice.

Poem – Mariner

Mariner photo

Journal of the American Medical Association Vol. 313 No. 11 (2015) p. 1171

Entering the body for an autopsy is a precise, medical procedure with scientific purpose. Nonetheless, the soul and spirit of this profound human experience float in the air of the autopsy suite. Journey into the body and into harrowing waters with Dr. Margolis’s poem “Mariner.” Published in the Journal of the American Medical Association this month.

Read the poem here.

What’s Wrong with You – Fiction

What's wrong with you image

What’s Wrong with You

by Ben Margolis

Ars Medica Vol 10, No. 1 (2014), p. 142-146

Author’s note: caution, graphic content

 

“What’s wrong wit’ you?” asked the shopkeeper.

“Ain’t nothin’ wrong with me,” scowled Mr. Jackson as a flap of skin unfolded across his chest. Hinged at the side like an armoire door to Mr. Jackson’s body, the flap opened at the breast bone, curling outward towards his left arm….

Read the full piece:

What’s Wrong with You (pdf)

What’s Wrong with You (on-line)

 

Reflections on an Autopsy Seminar

[one_half]

Life Matters Media photo credit.

[/one_half] “Was that a one-glass slide? Or a two-glass slide?” I called over to an attendee, gently teasing, as I advanced to the next photo in my presentation. He was all but hiding in the corner. This was the one who had brought in a bottle of wine to our cabaret-style theater where we were holding the event, Science to Humanity: The Autopsy. He had come accompanied by some friends, but really a glass of wine (or two, or three, or a bottle) is what he thought he would need to get through experience. I was just checking in on him.

He smiled.

“I’m good!” he called out.

I was glad to know our at-first-fearful gentleman was doing well. Our attendees always do.

People really don’t know what to expect when they come to an autopsy class. For most, that’s just right. What they get is so different from what they ever imagine.

The class is respectful, paced gradually, engaging and set with a warm, open tone. Who would have thought that the room often fills with laughter? It’s the laughter comedic improvisers know comes from the place, “I recognize that from life.”

This makes sense in a class about the autopsy, perhaps not so paradoxically. The autopsy is about closure. And closure is human. This is a class where people connect.

I have been giving this class since 2012 and we are delighted to now be moving to the International Museum of Surgical Science. It is a milestone for us. We are honored to be able to hold the event in such a respected venue, and looking forward to continuing our outreach.

The class began on the 84th floor of the then Sears Tower — my office space at the time. Our first attendees were a young couple, and that was it. The young man had called me in seeming desperation hours before.

“I missed the ticket deadline! Can we come?” he inquired.

“Of course,” I responded, and called the office to reschedule the room reservation I had just cancelled.

And so, with a bit of a hurry, the first class was held with the three of us. Slide after slide, question after question, proceeded; explanations turned into stories; and, as it always does, the class became an experience. The man ultimately disclosed that his mother had had the same procedure I had shown in one of my slides — placement of a gastrostomy tube. The slide showed a medical mishap. I gasped, fearing what he might infer about his mother’s experience, and I quickly reminded him that I see cases only when things “go wrong” — it’s just the nature of my work. When I was done reassuring him — emphasizing the countless times the procedure had helped patients — he sighed and relaxed. And the flow of questions continued. The young couple walked out hand in hand.

While the class is educational and not a counseling experience, I am aware that what happens there can have an impact. I see this in the letters I receive from attendees and in the reviews.

One attendee wrote months after coming to the class:

“I just wanted you to know that your workshop has been helping in our understanding that [our mother] might not have felt any pain [during her death].”

And a recent reviewer commented:

“I wasn’t considering myself “in bereavement” when attending [the class] although I did lose someone very close to me earlier this year….I was incredibly suprised at how some of the presentation struck a chord with me and answered some questions that I didn’t even realize that I had. I left feeling a sense of peace that I didn’t realize I needed. I didn’t know that certain questions could even be answered.”

So I take the class seriously, keep it “light” — as much as possible for this topic — but respectful and am open to the human experience as well as sharing my own. People leave satisfied.

Our gentleman with the bottle of wine told me at the end that the slides were his favorite part.

“They really weren’t bad,” he said. “I wanted to see some more.”

Next event: July 30. Tickets/information/reviews: here

Poem: Invitation

Med Humanities (British Medical Journal) 2013;39:72 doi:10.1136/medhum-2012-010312

Invitation
Ben Margolis

Come.

I will show you grief.

Look here.

You want to see?

The open refrigerator door frames the lovers.

Just this way.

Follow me.

We’re almost there.

You will stand with me by the side.

You will have to look down—it’s private.
[one_half] But can see from the corner of your eye.

A cold visitation deep in the quiet maze of the hospital basement. Just myself witness. Best man to half an alter-vow fading under caresses. Now you along side.

‘Can I cut a piece of hair?’ she asks, no longer knowing what was hers. Crush hold memento.

‘Of course, or we can take care of that for you’. I would start the case as soon as she finished. An intrusion of strong gloved hands and calculating blades waiting.

The hair was her final quiet request, but the visit had started with a scream. Mrs. Paznyk had seen her husband immediately after he had died, but not since, now a day later.

‘Close his eyes! Close his eyes! Close his mouth! Stop it!’ Eyes as wide as his, mouth not quite, body pulled back. She was unprepared for rigor mortis’s play. Swift sculptor of all dead. No embalmer’s rewinding art yet.

‘It’s part of death’.

‘Ok. It’s part of death. It’s part of death. It’s better this way. It’s normal’. Recoiled pain and suffering stuffed into calmed adult readiness. But still bruising, tearing under the surface.

We had agreed on 15 minutes for this last viewing. It made sense to have a start and an end, or she would have remained there, in the cold walk-in, drinking passionate memories and tender commitments from a bottle of Amontillado-laced grief.

I shall leave you here.

If this is what you were looking for.

Unless you would like to meet four year old Javier.

Rolling onto my lap.

‘Read it again!’

Giggle.

‘Ok. I love David. He’s such a bad boy!’

Booga-booga-booga belly!

Nose up to mine.

Smiling.

Hand on book.

‘Read it again!’

You start.

 

Footnotes

Competing interests None.  Provenance and peer review

Not commissioned; internally peer reviewed.

Author note:  All names and events are fictional.

[/one_half]