Nine Days in a Warm Flat: Decomposition and a Family Request to View
A 60-year-old man was found in his flat nine days after last being seen, during a warm spell with indoor temperatures around 28–30 °C. On arrival at the mortuary the abdomen is distended and green, there is a network of purple-brown marbling over both thighs, the skin of the hands slips away under light pressure, and dark fluid has purged from the mouth. There is no injury. The GP has issued the certificate and the family wants a viewing before cremation in three days' time.
1. Assess what stage of decomposition this represents and what that means for what you can honestly promise the family.
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Assessment: advanced decomposition, past the stage where embalming produces a normal-looking body.
Reasoning:
- The green abdominal discolouration reflects bacterial proliferation in the caecum and spread through the abdomen; marbling is haemolysis with bacteria tracking along the superficial vessels; skin slip is the epidermis separating from the dermis; purging is gas-driven fluid from the respiratory and gastric tract. Taken together with nine days at near 30 °C, this is well beyond early putrefaction.
- Embalming will arrest and slow further change, reduce odour and make the body safe and presentable for a short viewing. It will not restore normal skin colour, will not remove the marbling completely, and will not make the body suitable for a long or unrestricted viewing.
- So the honest conversation happens before the work and before the family commits: what can be achieved (a brief viewing, face and hands, soft lighting, closed lower casket, prompt timing), what cannot (a natural skin tone in the marbled areas, an absence of odour over several days), and what alternatives exist (viewing sooner rather than later, a closed casket with a photograph, or a viewing of the hands only).
- Quoting and consenting on the basis of a good result you know you cannot deliver is the failure mode here.
2. Set out your fluid choice and injection strategy, with numbers.
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Decision: high-index solution, multiple injection sites, and deliberate cavity treatment.
Reasoning and figures:
- Preservative demand is very high: there is a large bacterial population, a lot of gas and a lot of decomposed protein to fix. Use roughly 3% formaldehyde rather than 1.5–2%.
- With 30-index stock and two US gallons (256 fl oz): 0.03 × 256 = 7.68 fl oz formaldehyde; ÷ 0.30 = 25.6 fl oz of fluid (about 760 mL), made up to 256 fl oz. That is a visibly stronger tank than usual and the label should say so.
- Sites: right common carotid for the head and right arm plus right femoral for the trunk and legs, with drainage from the right internal jugular and the right femoral vein. In a body this decomposed, single-site injection reliably leaves the lower trunk and legs under-treated; the marbling tells you where the bacteria already are.
- Use co-injection and restricted drainage - enough to remove the putrefactive fluid, not so much that the pressure collapses and the solution never reaches the periphery. Slow rate, moderate pressure.
- Finish with thorough cavity treatment (aspirate and inject a strong cavity fluid to each of the four quadrants), and use surface/hypodermic injection on the marbled thighs and any areas the arterial route does not reach.
3. The family still wants an open casket. How would you present the body, and what would you do about the hands?
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Decision: control what the eye sees rather than trying to paint over what you cannot fix.
Reasoning:
- Colour: green and marbled areas will not take ordinary translucent foundation convincingly. Use an opaque, high-pigment cream foundation to block the underlying colour, then a lighter shade to bring the face forward, and keep the lighting warm and indirect. Heavy repeated application over decomposed skin tears it further.
- Texture: the slipped skin of the hands will not tolerate massage, cleansing with friction or tight positioning. Support rather than manipulate. Where tissue is lost, a tissue builder or wax can fill a defect, but on skin this fragile the priority is coverage and gentleness, not reconstruction.
- Hands: position them naturally and cover the forearms with a long-sleeved garment or a shawl. A hand that is slipping is far less conspicuous than a hand that has been overworked.
- Timing and containment: view as soon as possible after preparation, keep refrigeration running until the viewing, keep the viewing short, and consider a casket that allows the face to be seen while the lower body is closed. Deodorising the room and managing airflow does more for the family's memory of the visit than any cosmetic.
- Say all of this to the family in plain terms beforehand so that nobody is surprised at the door.