Our culture has a sideways fascination with death even if most people don’t want to talk about it: all those Law & Order spinoffs, murder mysteries, true crime podcasts (My Favorite Murder has 35 million downloads per month, as of 2020). Campbell engages the topic by curating stories of and interviews with workers in the “death industry.” Going beyond the gravedigger and the embalmer, she approaches her subjects with kindness and humor, highlighting an industry that will always be in demand. She also makes clear that by looking at death as an inevitable truth of life, we are better able to define and value life itself. Campbell shows that death workers are an essential part of everyday life, tied to many areas of civil society (e.g., the death penalty), reproductive health (e.g., bereavement midwives), and futurism (e.g., cryogenic freezing).
Campbell details the work of anatomical pathology technologist (APT) Lara-Rose Iredale, whose job is to assist pathologists in determining cause of death. Inside the mortuary of St Thomas’ Hospital in London, Iredale and Campbell meet for the second time, the first being the funeral industry awards ceremony at which Iredale was selected APT of the Year. She describes her job as “corpse servant” and has a tattoo of a tarot card on each thigh, one of “DEATH” and the other “JUDGEMENT.” In addition to assisting at autopsies, APTs deal with families when bodies are identified, liaise with funeral homes, and complete the paperwork that every death requires. Iredale also works with trainee doctors, a group Campbell writes about in a chapter covering the director of anatomical services at the Mayo Clinic. As an ATP, Iredale shows trainees “the reality of a diagnosis: what telling someone they have cancer actually means, what cirrhosis of the liver looks like, what obesity means for your cramped organs, and the shocking visual fact that ribcages stay the same size no matter how big you get.”
Campbell follows Iredale through an autopsy, from the cracking of the ribcage to the opening of the abdominal cavity, enduring as she “scoops the loose pieces of shit from around the rectum, inside the cavity […] One nugget falls off the edge and sits precariously close to my boot for the next three hours.” Far more traumatizing is her experience watching a deceased baby undergo an autopsy in a pediatric pathology department. After the investigation into cause of death is complete, the baby must be bathed, as all pathology subjects are, in a blue plastic tub. As the small body sinks into the water, Campbell feels an urge to save him even though she knows he is already dead. Though Iredale congratulates Campbell on “not having to step outside at any point” during her day of observation, she later has nightmares of babies lying in rows outside her bedroom window and spends the next three weeks in bed.
In the next chapter, Campbell’s thoughts return to infant mortality when she interviews a bereavement midwife, Clare Beesley, who delivers only dead or soon-to-be-dead babies. Beesley explains that the wing she works in has an entrance separate from the maternity ward, which is filled with the screaming associated with live births. According to Campbell, one in four pregnancies in the United Kingdom results in death either during gestation or shortly after birth. In the United States, the CDC calculates five deaths per 1,000 live births as of 2019, the most recent year data was available, but that figure seems to omit those babies who live briefly outside the mother’s body, not to mention the miscarriage rate, which is not tracked. The populations of each country are quite different, however, as is their respective access to healthcare.
Beesley defines her job as “look[ing] after a family when they are dealing with the most devastating moment in their lives.” To help process her own grief, she creates memory boxes for the bereaved, often including photos to prove that the loss did happen, this greeting and parting all in one breath. Grieving cannot happen “without the finality of seeing, [if] you’re still trapped in disbelief.” Beesley explains that, in the past, it was common practice to remove the dead baby from the mother without any contact or comfort, in the belief that seeing it would upset her. While this attitude is still common, with some family members requesting that the mother not have contact with the deceased infant, Beesley has years of experience and empathy for both sides: “They don’t want to see somebody they love in […] pain […] and they think by taking what’s happened away, it takes the pain away. But it doesn’t.” Campbell references a 2016 study by the University of Michigan Medical School on the level of PTSD and depression in bereaved mothers. The study was unable to conclude if holding one’s baby had any effect on the likelihood of depression or the higher rates of PTSD, since many reported that they were not given the opportunity to hold their child.
Campbell strikes a more lighthearted note in her chapter about a death-mask sculptor in London, Nick Reynolds, whose father was the mastermind of the Great Train Robbery. Death masks, she writes, “have been the realm of kings and pharaohs, used in the making of effigies so that dead royalty could travel their land and people could pay their final respects to an imperishable leader,” but they were also once “an artist’s reference tool before the invention of photography,” created “of unknown dead in the hopes of one day identifying them.” Campbell references Camus here as the owner of a copy of the most famous death mask in modern history, that of Resusci Anne, who became the face of the CPR training doll. Reynolds, the only person commercially working in the United Kingdom who casts faces of the dead, explains the history of the practice, including its connections to animism, the belief that through concentration one can summon the spirit of a person into an object.
Reynolds’s clients are mostly widows who have commissioned their dead husband’s masks. Most aren’t rich, despite the roughly $3,000 price tag. The masks capture a moment in time shortly after death, the culmination of a lifetime lived. As Reynolds puts it, the bereaved have “managed to save a part of them that isn’t going to become worm food or ashes.” Often, he is called to make a mask weeks after the deceased has died, either because an autopsy was required or a drawn-out court case has left them in a mortuary freezer. Reynolds nips, tucks, smooths, and sculpts the remains into an image of what they might have looked like just after they died. The work of creating a mask involves pouring blue alginate, the same liquid used by dentists to make impressions, on the face and letting it set for 20 minutes, then filling the mold with plaster and chiseling any changes after it hardens. Finally, the mold is filled with polyurethane resin mixed with metal powder, creating multiple layers that form one incorruptible bronze face.
The book’s most heart-wrenching chapter follows an executioner in Virginia, Jerry Givens. Campbell takes great care to humanize Givens, a prison worker who oversaw 62 executions and investigated botched executions in states across the country. Givens explains his reasoning for choosing to do this kind of work: “I prepared a guy for his next phase of life […] [M]y thing is to get you ready. How do you prepare yourself to be killed? I studied him, I talked to him, I prayed with him. Because this is his last everything.” In Givens’s view, death isn’t the end because a higher power supersedes the power of the state.
Campbell points out that the official manner of death listed on an executed inmate’s death certificate is homicide. As David R. Dow, founder of Texas’s oldest innocence project, wrote, “[T]he machinery of death cannot run without human hands to turn the dials.” In 62 cases, those hands were Givens’s. Rather than accept the verdict of homicide, Givens rationalized his role by equating the deaths with suicides, believing that the inmates had made choices that eventually resulted in their own execution. But he eventually lost faith in judicial accuracy when an inmate on death row was released based on DNA evidence nine days away from meeting Givens at his death chamber. Campbell notes that the death penalty in Virginia was abolished in March 2021, less than a year after Givens, who contracted COVID-19 while singing in his church choir, died.
The 12 stories of death industry professionals outlined in this book are varied and richly wrought, and that enough is reason to read them. “The death machine works,” Campbell writes, “because each cog focuses on their one patch […] It is a series of people, connected in their industry, disconnected in their roles.” She closes the book with a quote from William Gladstone, the former prime minister of England, that was framed on the wall of a worker’s office at Kenyon International Emergency Services, a company that conducts administrative cleanup after airplane crashes and terrorist bombings: “Show me the manner in which a nation cares for its dead and I will measure with mathematical exactness, the tender mercy of its people, their respect for the law of the land and their loyalty to high ideals.” Reading this book because the hidden world of death workers is fascinating is reason enough, but one may find in reading it, as I have, that attending to death deepens one’s understanding of its mystery and, by extension, the mystery of life. By considering our common destination, we deepen our understanding of our common humanity.
Jeannine Burgdorf is a writer and storyteller on stage in Chicago. Her essays, reviews, and short stories have appeared in The Signal House Edition, New Reader Magazine, and Quail Bell, among others.