The Mortuary Show

Handling Obesity in Funeral Service ⚰️

Josh handles remains over 700lbs. A tough thing for everyone involved: the deceased, family, and us in funeral service. Michael gets in to how he takes care of embalming obese cases, Josh’s best tips for transferring large bodies, edema, fight outbreaks. Lots to discuss today!!

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Show Notes:

(07:45) – Obesity & removals.

(15:32) – How to appropriately ask for estimated weight.

(21:06) – Edema in the prep room.

(32:08) – A fight breaks out at the FH.

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Takeaways

Handling cases of deceased individuals who weigh over 700 pounds presents unique challenges in the funeral service industry.
Gathering as much information as possible before the removal, including the layout of the house and the approximate weight of the deceased, is crucial for planning and ensuring a safe transfer.
Delicate and respectful communication with the family is essential when discussing weight-related considerations.
Having extra staff on hand for larger cases is necessary to ensure the safety of both the staff and the deceased.
Funeral homes and businesses may need to upcharge for larger cases due to the additional staff and resources required. Handling large and obese cases in the funeral industry requires specialized equipment and techniques, such as pulleys and Reeves cots.
Positioning is crucial in the embalming process for larger bodies to ensure proper preservation and a lifelike appearance.
Dealing with physical altercations between family members is a challenging aspect of working in the funeral industry, and maintaining professionalism and composure is essential.
Communication and teamwork are key in successfully handling difficult situations and ensuring the safety and well-being of everyone involved.

Duration:: 35m
Broadcast on:: 06 Aug 2024
Audio Format:: mp3

(upbeat music) - Josh, I know you had a PR that you set this week, a personal record in your line of funeral service. Why don't you open it up for us and tell us, what'd you get after today? - I did. So since the last time that we spoke, I had a new PR, personal record. In our line of work, it's something that people in our line of work deal with on a daily basis. People who pass away, their weight can be an issue physically. And I, a few months back, hit a PR and this person passed away at home and it was actually a night that I wasn't even on call and we received the message through our answering service and the city police reached out to us, gave us a description and usually when we get house calls, one of the things I like to do with any call really is try to get an approximate weight on a person. Just for my own knowledge, just to see how many people it may take to go on this removal because the weight could be an issue. You don't wanna get hurt yourself. You don't want your partner to be hurt and the police told us that this person approximately looked to be about five or 600 pounds and they passed away at home. So before we go to a call, we try to get as much information. - Yeah, that's a tough one. - You know, the layout of the house, where they located in the house, are there steps? Are they on the second floor? Is there anybody else in the house? And luckily this home was a ranch style home. It was all on one floor. And getting the information that we got being that this person may be five, six hundred pounds, we took about, I think there were six or seven of us total. Myself, my partner, younger, a livery service, a removal service that helps us out sometimes when we get backed up. So we in total had seven people grown men and this person was much more than five, six hundred pounds. And it's always more. It's always more, it's always more. No matter the situation, we talk to doctors, nurses, police officers, paramedics. And we always try to get an estimate. And they usually don't do a good job. It's always more. So you always have to prepare for the worst. And this person, they passed away. They had a laundry list of health issues. They were in their early sixties and through the whole process, they were cremated. There were no viewing or services or anything. The final way in when we got to the crematory was seven hundred and thirty five pounds. And you know, it just. That is something. It breaks your heart too because you know that this person had to have been dealing with some things and you know, a person of that size, it's just it cannot be easy. You know, physically, mentally, emotionally, you never know what someone's going through. And it was just something that, you know, not only myself, but my coworkers, you know, it was a first for them. They, they have never, you know, had to deal with a person their size and in our line of work, you know, we deal with, with people of all shapes, sizes, backgrounds, everything. But this kind of just, you know, in the past over the eight years, I've dealt with a lot of, you know, heavier, heavier people. And you have to treat them just like you treat anyone. - Sure. - Dignity, respect, fulfill the family's wishes, take care of them. And you know, there are some challenges when it comes to taking care of someone of that size. And it was a, it was a home call that I'll never forget. And it was just a very special, you know, circumstance. And, you know, you go, you go to a house and in order to get the disease into your care and respectful and it's easygoing manner as possible. You know, you have to move furniture. You have to kind of rearrange things inside the house and you have to do it, you know, with respect. And you have to do it very carefully and communicate with the family and the people that are there. And just, you know, you know, you can't just go into someone's home and just start moving stuff and throwing stuff around. It just, it takes time. It's a process and you got to do it very carefully. But it was, and it took every single one of us, all seven of us and every ounce of strength that we had and we had to, you know, use all of our experience and use techniques to maneuver this person. And it was, it was tough. But we luckily, you know, we worked together, we communicated and in situations like that, you need like one person to kind of call the shots and say, hey, we're going to do this, you do this. Yep, I'll do that. You know, have a countdown, three, two, one, because somebody pulled it back in the situation. Seriously, yes. And, you know, someone that just has to take control and, you know, one mistake, somebody could get seriously hurt and it was just, yeah, it was just a, something I'll never forget. And to this day, like I said, going almost eight years strong and that's definitely a, that's a PR. Yeah, that's, that's no joke. And something that a lot of us probably have had to deal with a couple of times in their career. And it's one of the hardest situations and you have to be delicate with the families. But at the same time, that's a question that you do have to ask. How do you typically go about it? So if you're taking a first call or you're talking to a family, how do you approach asking that question about weight? Because I know that's a sensitive thing. And like you said, the more information we can get, the better. And you, but you don't want to, you know, ask them too many questions. You know, we feel that they're going through a loss to you. You don't want to have to ask, oh, are they upstairs? Oh, do they, how much do they weigh? All of these things, it's really challenging. So what is your strategy usually when you talk to the families when you first get a first call? It doesn't matter if it's, you know, a situation like you just had or a normal one. What does your process look like that helps you? You use the word delicate, Mike. I think it's a very appropriate word for situations like that. And when you take that first call, you know, you take the first call, it could be from a nurse. It could be from a police officer, a paramedic. And a lot of times it's from the family. It's from the person that's there with the deceased. And, you know, if I'm taking a first call from a first responder or a nurse or someone, you kind of have a little bit more flexibility and how you kind of ask things. But if you're talking to a family member, just one of the ways that I'll ask. And like you said, I try to do it in a delicate manner, a respectful manner. I just say, do you happen to have an approximate weight on so-and-so? And the reason I ask that is so that we know how many members of our team that we can send. You know, we just want to make sure. - How much team it is. - Yep, exactly. So, you know, if it's someone who's smaller and- - Not only- - Go ahead, Mike. - Not only for the safety of your team, but the safety of their loved one and the dignified transfer of them. Because if you are understaffed in those situations, it could sometimes be not pretty. - Right, right. So we just always ask, do you happen to have an approximate weight or to the best of your knowledge, you know, how much did you think so-and-so may have weighed so we know how to staff and approach the situation. And we usually always go on a home call or at least minimum two people, but in circumstances where someone, you know, weight may be a factor. You know, we send as many people as needed. And that way, you know, you could send somebody to kind of bring the family in a side room and talk to them while the other staff members, you know, tend to the deceased and take care of them. - Yeah, that's a smart way to do it. Do you have a typical philosophy? Like I know a lot of firms and especially transfer services are, you know, if it's over 250 or 300 pounds, we're bringing one person per hundred pounds over that limit just to cover all basis. Do you have a similar role to that? And, you know, I know that a lot of funeral homes and businesses are, they have to obviously upcharge. On those transfers because there's a lot of extra staff we have to pay people in those circumstance. And it's so hard because, you know, it wasn't their choice, you know, to be in this situation that they were in, but at the same time, you know, we're bringing in extra extra staff and extra people. And it's more than just your common case. So would you have a philosophy on either of those things? - As far as like a protocol, we don't really have for every 50 or 150 pounds send, you know, an additional person. We just, we always go to the house calls and teams or if, you know, if someone passes away at a facility or hospital, again, I've gotten into that routine to try to get an approximate weight. And if there's ever, if you're ever in doubt or question it, just, you know, send a few people, just cover yourself. And then to have that conversation, because like you said, a lot of firms, when it comes to taking care of some of the folks that we do to where, you know, there's weight could be an issue. You know, crematories, they charge more. And a lot of the families that we take care of, they understand, you know, they understand if, you know, for example, the person that we took care of that was over 700 pounds, that can get very expensive when it comes to cremating, just because the equipment that the crematory has, you know, they have their limits as well. And there's costs to all of that. And again, it's just something that you have to approach with respect and dignity and a lot of the families that we deal with, they understand, they know. And a lot of times they say to us, I'm so sorry you had to deal with that. I know it could have been challenging, but we, you know, everyone seems to understand. It's just, it's something that's not gonna go away either. Mike, you know, it's just, you know, that's just part of it that there's people out there, you know, they need taking care of too. And that's what we're here for. And, you know, we can't discriminate against that. And we're gonna deal with it on a daily basis. It's not something that's gonna change soon. And you just, you gotta approach everybody the same. And be smart and take precaution. - Absolutely. - It's safety is a huge, huge thing in this line of work. - Yeah, yeah, safety is everything because, you know, someone that gets injured on the job and it absolutely happens, that's their livelihood. A lot of us are very much involved on the manual labor side of things. And if you go down, that's your job. Like if you're out for a couple of months, like that, you know, that's your livelihood. So there needs to be something for that and you need to be able to articulate to the family saying, you know, we need extra precaution in this situation or whatever the case might be. And that's nice that I do agree that most families are going to understand those situations. And to piggyback of something you said during the beginning of the story, you know, when I were to ask someone, you know, if you could get us an approximate weight for your loved one, I'm adding 25% almost guaranteed unless it's, you know, a little old lady, you know, you're got to tack on 25%. I think to what they're giving to you so you can be well prepared. And usually you're going to be more accurate adding on that 25% than someone is just guessing because no one wants to say, you know, my loved one weighs, you know, 700 pounds. Like no, no, no one's going to say that. And it's out of respect for their loved ones too. I don't think they're trying to do anything or pull a fast one or anything like that. But I think for our usage, that's a rule that, you know, you want to live by for someone, you know, that's over the average size of maybe an individual. - And I think that's a safe rule, very safe. It's just, you know, it causes for, it could be very challenging, you know, and had this family decided that they wanted to have some type of viewing or visitation than, you know, the whole preparation and embalming and cascading. - Oh yeah. - That's a whole other, you know, can't it work? - It's a whole different ballgame. - There's a lot of challenges, but I think we have a lot of different ways to make things work. - Yeah, yeah, absolutely. So what was it like, what was the situation that this person was in at the house and how did you and the team actually perform this removal? Because it's all gonna depend on what the situation is and obviously most of our gurnies are not gonna be able to handle that type of situation, especially if we're talking stairs. So what did you do with this circumstance and what was the layout like for you? - So luckily there was only one small step of it into the house. It was a ranch style house. This person was in their bedroom. The house in itself was not a very big house, but there was a lot of clutter. And I don't know about you, but a lot. There are more homes that we go into for death calls that are cluttered and borderline hoarder situations that we go into. It's very common. And I don't think people realize that - Which is dangerous in itself for us. - It's very dangerous. So you kind of have to go in with a plan and just kind of one thing I always like to do when I first get there, talk to the family, express my condolences, get a little bit of a background and then I'll ask to see where the deceased is, kind of get a layout in my head, kind of get a plan of the best route to get in and out of the house. You kind of just go in with like a plan and you got to act on it quickly and you have to do it professionally. So we kind of all gathered inside where the decedent was. And again, you have to move some furniture. You have to communicate and the gurney, the cot that we use, the standard size, I think it holds up to around 400 or 500. And then luckily, the removal service, delivery service that we contacted, they have an oversized cot and that holds up to 1,000. But even though that 1,000 pound limit is 1,000 pounds, it's still a tight squeeze. It's challenging. And we, some of the techniques that we used, bed sheets, kind of rolling up bed sheets to put underneath the deceased to use it's kind of like a pulley. Yeah, as a pulley and to kind of get your grips, we used a few of those, a Reeves cot, which is what we take into homes and it's flexible and it has straps, it has buckles on it. And then a person of that size, you never really want to, but once they're off of their bed and on the floor, there's really no picking them back up, regardless of how many people you may have. So, what we had to do was ask the family to go in a side room and what we had to do is luckily there wasn't a long distance from his bedroom to the front door, but you kind of just have to work as a team and drag and kind of pull him across the floor. And then there were a lot of one, two, three counts. There were a lot of, like you said, quarterbacking, you do this, you do this because one mistake could injure not only one, it can injure a ton of people and then you're in a pretty bad situation. So we were able to kind of move furniture around and of course, once you're finished, you always want to put it back to how you found it, but it actually went pretty smoothly. And I think that was mainly because of the communication and some of the equipment we had with us, we definitely prepped. You've got to expect the worst, hope for the best and it worked out. And then that's just the first half of it. - Any issues with the doors? - The doors, no, we, luckily we were all good there. We had a prop open, the front screen door and once you get them, onto a cot or onto a Reeves, the next step is getting them into your removal vehicle. And that took a few of us and you have to move some seats around and it's just, it's a process. From the time you bring that to seeding into your care until the very end, whether they're buried or cremated, it's a task. And over that couple day period, we needed all the help that we could get. - Yeah, well, that's good that you had a lot of hands that we're able to help in this situation. And seems like you handled it with a lot of grace there, which is very impressive. And a situation that is good to hear if you've never been in it before, now you can take some tips and tricks from Josh here and what you guys did in that situation. 'Cause it's gonna happen and it's gonna continue, unfortunately, probably to happen more and more. And it's just you got to be prepared. You have to have the right equipment, teamwork, all that stuff. I'd like to talk about, since we sort of approach the subject, about if this, if an individual of this size or in the same realm is in the prep room and we're talking and bombing here, what are some different things that you've done with this? And I could give you some of my procedures for dealing with, you know, large obese, you know, because that is a very difficult, difficult process and I know everyone probably has their own little tips and tricks, but I think it's good for us to learn from each other. - Oh yeah, and I'm still learning. I learn every day, I think every day on this job, you learn something different. And, you know, when it comes to embalming, I've taken care of multiple, you know, larger cases, and positioning is always a factor. You wanna make sure that the body's positioned, the embalming process itself, raising arteries can be tougher on obese cases. - No doubt. - There's a lot of tricks and behind the scenes work that we have to do in order to, you know, preserve the body correctly, have a pleasant lifelike appearance to them. It just, it takes a lot of work and somebody of that size, it's a challenge because once they're set up, that's, you know, you're not gonna have much time to maneuver them and doing it by yourself, it's tough. So, like any other embalming, you wanna assess it, you know, visually, you know, take notes, you know, if the person has edema or if they're emaciated or if they have trauma, you gotta first visualize and do a visual, you know, just take a look at things and kinda go from there and it's very challenging and embalming is another thing in our line of work that you really only get one chance to do it and do it in a good way, 'cause if you find yourself having to redo things or recheck things, it could become a mess, but it's, you know, positioning blocks for heavier set people, a lot of tricks, a lot of things that we can do. I have not had to do it in a long time, but it can be a challenge in itself, the size, and then to take into account, you know, how they passed away or if they had passed medical history, it can be a real challenge. - Yeah, no doubt. I do like what you said about using the positioning blocks, especially with some of that line, you know, of that size, making sure that we have the flow of water being able to get, you know, into its proper position. So using those to prop up. And then also I'd say because in this circumstance, you're dealing with a larger abdominal region too, I would very much encourage, you know, some sort of positioning blocks or bricks, whatever you like to use underneath the shoulders for sure to prop them up because, you know, when someone is that large and they're laying in a casket, it a lot of times, if you're watching on YouTube, I'm leaning back way back and it makes them look like sunken in. So you want to try to do everything you can to prop them up and make it seem like they're on that elevation because the casket springs and, you know, is only going to do so much. So doing that, making sure that is in a good position, making sure you're using a high concentration too, with, you know, the fatty tissue, you're not able to get those normal signs that we look for when we're embalming to make sure that we have proper preservation. So just making sure going the extra mile to use that fluid that's strong. Another like purge is definitely a scary thing for this situation, there's so much pressure. So just aspirating to no end and making sure you're doing everything in that realm. And like you said too, like raising arteries is not easy in those situations. So just being patient, longer cannulas, I'd be a proponent of in that situation too. A lot of times you're finding smaller arteries too, at least from my experience, you know, a larger person is going to have smaller and that's a challenge all in itself because you're dealing with a greater depth depending on where you're raising, it's just inevitable. So just being patient and, you know, using those straps in that lift as best you can after, hoping for the best and having everything, 'cause once they're sat in that casket, there's not much you're gonna be able to do there. So really being vigilant in that process too. - You don't get many second chances when it comes to a person, you know, that's a larger in size. They're very hard, difficult to maneuver and readjust and back to the embalming, you know, somebody who's a little bit heavier, it puts a lot of pressure on arteries and on the veins, the distribution can be harder. So, you know, a lot of the times in some of the obese cases, hypodermic injection, surface embalming, you know, you know, using gels or powders. - Do whatever you can. - Do whatever you can and there's a lot of tissue, you know, there's a lot of mass there. So you gotta make sure the preservation is consistent and thorough throughout the entire body. And again, hypodermic injections, gels, surface embalming, you know, in a perfect world, you do a one point. - We're talking a lot of blisters, a lot of times too. - Exactly. Blisters, you're talking a lot of blisters, a lot of times too, because you're, you know, we're using extreme amount of force and effort and using all of our mites for the movement. And that's just gonna, it's a scary situation. So really being thorough with your whole procedure and then post embalming too, having a full analysis of what's going on, making sure that, you know, we're not gonna have any issues when we are going through casketing. - Right. - Very, very important too. - Right, and you know, the folds, you know, there's areas on the body, the skin that may not get full distribution, you have to take care of that now, because it's just gonna, you're gonna run into bigger issues later. Back to what you were saying about the positioning blocks, you know, always, you wanna try to get something underneath the shoulders and something that I was always taught, you know, in mortuary school and while I was an intern from my preceptor who his main job was embalming. So he had 35 years experiencing it. You know, the head should always be above the shoulders. The shoulders should always be above the midsection and the midsection should be above the feet. So, you know, kinda in this position, you'll avoid perversion and leaks and like you said, post embalming, you could take care of any issues that you may see. Start to finish until the time that body's in the ground or cremate it, you have to keep an eye on everything. - Yeah, that's a good call, I'm with you there. I know you had yourself a whole different set of issues this week at the funeral home. You had a little bit of a brawl, a little, you know, tissy fit, well, what happened over there? - In the past, you know, funerals, nobody wants to go to a funeral, tensions are high, emotions are, you know, it's a roller coaster up and down and you deal with families who have tension and you know, sometimes there's not a good relationship there and death kinda escalate to that. And a couple weeks back, we had a full on brawl outside of the funeral home. - Oh boy. - It was right before we were taking leave for the cemetery. It was, some of the family was still in the visitation room saying their final goodbyes. Some of the other family had already said their goodbyes and we're out front of the funeral home and words were exchanged. There must have been some tension that we didn't know about. And as funeral directors, you can't get in the family issues. That's not your business, it's not, you know, not the time or the place to stay out, stay, always stay out of it. You know, your job is to take care of the deceased. You know, do what you can to be there for the family and any outside issues, just stay out. But there was an issue and family members approached each other, punches were thrown, one fight led to another fight. And oh yeah, and I think there were three separate alterations. - Any good connections? - I didn't, I couldn't see. So I was actually in the back with the family getting ready to close the casket and we had somebody run into the background today. There's a fight, there's a fight. You know, so and so is so disrespectful. I can't believe this. It's not the time or the place. So I had a staff member stay with the family. I had to go outside, see what was going on and therefore I could get out there. There were four or five police cars out front and the funeral home this happened at is not far from a police station in the city of Pittsburgh. So it was traffic was stopped, there was arguments. There was, you know, clothing and jewelry on the porch of the funeral home on the sidewalk. It was chaos. And at that point, we had to ask everybody to leave. We had to lock the doors and kind of shut things down. You know, because then it becomes a safety issue. You know, not only for yourself and your staff, but other people, guests and you know, that's a huge liability thing. And when it comes to that, you know, we can deal with verbal confrontation. We can call people down and, you know, ask people to step outside, take a minute, take a breather. Oh, and it starts to get physical and there's a huge crowd and there's multiple different ball games. Pull different ball games. So at that point, you got to think quick and you just got to ask everyone to leave the building, lock doors, shut things down. We still have a job to do. So we had to take care of what we had to take care of. And I was actually driving the hearse this day and my coworkers were kind of leading things. So we got the casket ready to go and we were getting ready to pull out and get our procession going. And I made an announcement to everybody that was outside. There were still people outside arguing. I made an announcement and I pretty much said, listen, if you're going to the cemetery, we're leaving now. And by the time I got back into the hearse, people were jumping in their cars. We took off and some cars stayed behind. Our procession got broken up and it was just a, it was a long day. - Yeah. - A very long day. Things eventually, you know, worked out after the fact when things cooled down the family, obviously apologized to us. In situations like that, there's not much to say, you know, we did our job, you know, we got the deceased to their place arrest. The family was happy with our work and sometimes there's just some things you can't control. They're out of your control. But it was the first physical altercation that I had to deal with. And it was just, it's been a wild couple of weeks here in the funeral business. - It really sounds like it. It seems like you handle that too. The only way you can. You can't get involved, you can't get in the middle of it. I like what you guys did honestly. It was like, we're shutting this down, locking the doors and you're like, we're leaving right now. If you're coming to the cemetery and you have, you know, the respect to do that, stop what you're doing, we're going. You have to put your foot down in those circumstances because if you are a little too soft or tender with that situation, it's not gonna lead to the actions that you need. It's like, hey, we have a job to do here. We're taking care of this family. And that's our priority. Not whatever else you have going on. So we're not gonna hang around and sit in the parking lot until this is all resolved. No, absolutely not. We're proceeding with this for the sake of that person that is no longer with us. And if you phrase it like that and you're a little bit firm in those situations, I think that is your best route to go. It's not easy 'cause you want to, you know, make sure that everyone's able to go. But if people are acting inappropriately, that's not the time of the place and that's not our job to be, you know, allowing that in our place of work. Yeah, at that point, you just kind of have to put, you know, the nice guy face that kind of you have to throw that to the side and say, listen, we have a job to do. And we still have to do it regardless of what your issues are. And the police officers who were outside actually said, you guys should probably get a move and kind of break this thing up. And it kind of forced people to go to their cars. And yeah, we lost a few cars. We had the first couple. We had the immediate family. And then just anyone else, they eventually made their way. But it was an experience for sure. We meet you there. Exactly, we'll meet you there. Oh, I can only imagine. Yeah, yeah, it's like, at that point, we just want the immediate family to get there safe. And it's like, if people are trying to catch up and all that stuff, that's creating more dangerous situations that already was a bit challenging, it sounds like you've had a heck of a couple of weeks here. Oh, yeah, it's been fun. But that's the name of the game, that's part of it. I'm sure I'm not the only funeral director who has dealt with those similar situations. It's just, it's part of the... Oh, yeah. Oh, yeah. Well, one of the things I love about the job is just you come to work every day, you don't know what you're gonna get. Yeah, that's right. That's right. And that's always a little bit of a... Yeah, backtracking, bed sheets, bed sheets are huge when it comes to making removals. They'll help you out in more ways than one. So make sure you always have some strong sturdy bed sheets handy and a little can go a long way. Absolutely. It's the removal person's best friend, but... Absolutely. Josh, thanks so much for doing this again. We're gonna have to do it another time. You got great stories, so... Actually, we're gonna come a bit more until we run out of them. I got a couple more. I'd love to share and, again, I always appreciate. I always appreciate the invite and I look forward to talking to you again and in the meantime, just take it easy and try not to work so hard. Yeah, and same to you. Hopefully we get a couple of weeks of a little bit of a piece and a little bit of an easiness in your line. Well, we'll see how it goes. I'll keep you updated. Thanks, Mike. Fingers crossed. (laughs) (upbeat music) (upbeat music) [MUSIC PLAYING]