health-guide-2017

RN&R grapples with the great equalizer

a special supplement to the reno news & review

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Pilates for the People Club Pilates founder Allison Beardsley proves that everyone can do this

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llison Beardsley founded Club Pilates in 2007 with the idea that Pilates shouldn’t just be for Oprah and Madonna. Back then, Pilates was done through private trainers, which meant only certain income brackets could afford it.

Enter Club Pilates, a group-setting studio aimed at making Pilates more accessible.

“Most traditional Pilates people really don’t like me because I changed the industry,” Beardsley says. “Now school teachers and nurses can do it. It’s more of a household thing.”

Since its beginnings in San Diego, the brand now has 230 locations across the country and many more in the works (Inc. Magazine just named it the fourth fastest-growing company in the U.S.). Beardsley sold the brand in 2015 but continues to serve as its creative visionary from her home in Carson City.

How did you discover Pilates?

I was an injured athlete. A week before I signed a scholarship with a Division II university, I tore my ACL. I ended up working in San Diego at this gym. I happened to take my first Pilates class, and I was the worst! But afterwards, I felt so good. I volunteered to teach a Pilates class and brought my unique perspective. I’m a basketball player, so taking that mentality into Pilates made it mainstream — it wasn’t just this thing that ballerinas do.

So everyone can do Pilates? Really?

90s coming in — literally 90 years old, awesome, killing it in Pilates! It’s adaptable to any body — whether you just had knee surgery or you’re Michael Phelps. Two people in the same class could be having totally different experiences because we adjust the equipment individually for them.

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Allison Beardsley

What is going to a Club Pilates class like?

From the moment you walk in, you are directed. The teacher sets all the equipment for you [Reformer, TRX, etc.], and you are told when to push out, when to pull in, what breath to do. All of our Pilates instructors have 500 hours of hands-on comprehensive training, which is really different from traditional fitness.

What kinds of fitness goals can you achieve with Pilates?

You’ll see tremendous weight loss, toning, core strength, flexibility and, this is a key word in Pilates, proprioception. It means you know where your body is in space. With time and practice, your proprioception changes — and you start gracefully trotting around like a unicorn!

What makes Club Pilates different?

Club Pilates was birthed on the idea of making business a spiritual practice — serving people and helping people. It’s a very loving environment, so people become friends, of course and go out for cocktails!

It was created for bedridden soldiers, so yes!

It’s beneficial for high school age kids to older people. In San Diego we had people in their

Everyone’s first class is free! Go online or call to schedule your demo!

Club Pilates Founder Allison Beardsley’s favorite things about Pilates: “You can lose 10 pounds instantly.” Just standing with the proper Pilates posture can make you appear slimmer.

“Laying down while you work out is awesome!”

Plus, there’s zero pressure on your joints and spine.

“It’s inclusive. Not snotty.”

The Club Pilates culture is welcoming and laid back.

ClubPilates.com | 775-525-0549 | Reno - NW Reno – Sparks 2 | RN&R HealtH Guide 2017 | a special supplement to the reno news & review

Health Guide 2017 RN&R grapples with the great equalizer

S

o, are you ready to talk about death?

I’m not sure what people mean when they say death is a taboo subject. (Taboo subjects, to my mind, might be something like the merits of everyday cannibalism or your profound appreciation for Limp Bizkit.)

I don’t think death is taboo, not these days, anyway. I just think most of us enjoy discussing it about as frequently as we do the statuses of our bank accounts or the last time we got a root canal.

Still, plenty of topics surrounding death are worth talking about—from making sure your affairs are in order before you die, to determining what you can do to make sure you’re able to die the way you’d want. That’s why we dedicated this year’s Health Guide to end-of-life issues. (You’ll also find a related story on aid-in-dying in Nevada on page 11 of this week’s regular issue.)

On page 7, you’ll find a story I put together about estate planning. Wait! Are you thinking you’ll just skip past that one—you know, because you’re not some wealthy jetsetter? Think again. Read the article, and I think you’ll agree that estate plans are pretty much for everyone.

How long did you have to wait last time you went to the doctor? And how does that compare to the amount of time you got spend with your doctor?

Regular RN&R contributor Jessica Santina took a look at the situation in Nevada, where the physician-to-patient ratio ranks 47th in the nation. From limiting acceptance of patients with Medicare to abandoning primary care clinics for concierge services—a lot is going on with Nevada’s doctors, some of it with potentially negative implications for the quality of end-of-life care in the state. That’s on page 4.

If you’re already feeling like you’ve had your fill of “death talk,” this last story may not be your speed. If, however, you’re intrigued—and perhaps looking for a new career—check out RN&R editor Brad Bynum’s story on page 10 to read about a woman who found job happiness as an undertaker.

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09.28.17 | RN&R HealtH Guide 2017 | 3

Will the doctor have time for you when yours is running short?

by Jessica santina

L

ast time you went to the doctor, you probably waited at least 20 minutes in the waiting room, although you may have shown up just before your appointment time. Once you were shown into a room, you waited another 10 or 15 minutes. And for your troubles, your doctor probably spent all of five minutes with you, wrote you a prescription and left.

Unfortunately, this is the typical American health care experience—especially here in Nevada, where the physicianto-patient ratio ranks 47th in the nation. For those of us with the occasional sore throat and cough, it’s a hassle we can occasionally put up with. But if you’re terminally ill or facing the end of your life, a lack of options when it comes to seeing a physician—and a poor-quality experience when you finally do—can be devastating.

PrescriPtion for trouble The average primary care doctor carries a total patient load of somewhere around 3,000. And according to the Physician’s Foundation’s 2016 Survey of America’s Physicians, the average primary care doctor sees 20.6 patients per day. No wonder half of America’s physicians say they feel burned out, and 48 percent of them plan to cut back on hours, retire or take other steps to limit patients’ access to their practices, including joining concierge practices.

Four years ago, prompted by the loss of my own primary care doctor to a concierge practice through MDVIP (“The Doctor Won’t See You Now,” RN&R, Feature, Nov. 27, 2013), I went on a research mission to find out how pervasive this model of practice was becoming, and what it would mean for the average person looking for a doctor.

In the concierge model, doctors opt for a business in which a limited number of patients pay them fees on a monthly, quarterly or annual basis for health care. The fees enable 4 | RN&R HealtH Guide 2017 | a special supplement to the reno news & review

The eleventh hour them to considerably scale back the number of patients they see. Patients who can afford these fees in addition to regular insurance are rewarded with more personalized care, increased one-on-one time with their doctor and access to such things as home visits.

In 2013, less than 5 percent of physicians were in concierge or cash-only practices. Only two doctors in Nevada were members of MDVIP. “I think the economy a few years ago got in the way of it expanding,” said Daniel Spogen, MD and chair of the Department of Family & Community Medicine at the University of Nevada, Reno School of Medicine. “Now that the economy is better, we’re seeing new life for it. I think it’s growing more rapidly than it was, say, a year or two ago. And it’s pretty much all the same things contributing to its growth.”

The statistics about the state of primary care are perhaps even more worrisome now. A full 80 percent of physicians surveyed consider themselves overextended or at capacity.

Overburdened doctors spend less quality time with patients, tend to overprescribe medications and may take months to actually see patients in person.

If many of the steps physicians are taking to combat these challenges—limiting the number of Medicare patients they’ll see (if any), leaving practices to work for hospitals and switching to concierge models—create difficulty for the young and healthy, imagine the toll they take on the fragile patients who are facing end-of-life issues. These patients and their family members now need more frequent appointments involving considerable one-on-one time with their doctors.

“The big advantage of concierge medicine is the greater focus on patient care, and when you’re discussing end-oflife care, it’s time consuming, and easy to put off,” Spogen said. “This model allows you to focus more, have more one-on-one time.”

Sure, it behooves patients in this phase of their lives to pay into a concierge practice—if they can afford it and find

one accepting patients. Though there are now seven MDVIP doctors within a 50-mile radius of Reno, two are not accepting new patients, and three have limited or selective availability.

Outside of MDVIP, a small number of concierge-style practices have cropped up in the area, including VIP Medical Access in Carson City and Renown Health Premier Care, but, combined, they include only a handful of doctors, all of whom limit their patient loads intentionally. And as more doctors jump ship to transition to this concierge business model, the particularly vulnerable population must scramble to find care.

“When one physician goes to a concierge practice, they don’t take many patients with them, and as a general rule, they have to be redistributed in a community where we’re struggling to bring in more providers,” explained Catherine O’Mara, executive director of the Nevada State Medical Association (NSMA), adding that it’s still unlikely that many patients in the end stages of life find themselves doctorless.

It may get worse. The number of doctors ages 46 and older— approaching retirement—has almost doubled since 2013.

“In a community like Reno, when one isn’t practicing, it’s a big strain on the rest of the community,” O’Mara said.

“We feel the loss of even one practitioner significantly. So the larger issue, really, is why don’t we have enough doctors in Nevada? We need to work on our ability to attract and retain physicians in the state so people who choose to go concierge don’t have such an impact on the community.”

O’Mara said she knows of no concierge practices in the state that focus exclusively on palliative care, which focuses on providing relief from the symptoms and stresses caused by serious illness. Grace, a Los Angeles-based start-up formed last year, is a concierge hospice organization that focuses exclusively on end-of-life issues and planning, including the financial and administrative aspects. And others are popping up slowly around the country. She indicated, however, that most concierge practices will continue

Dr. Daniel Spogen, chair of the Department of Family & Community Medicine at the University of Nevada, Reno School of Medicine (pictured here in 2014), says the current health care system “isn’t user-friendly” and “has to change.”

seeing patients in the end stages of life as part of their continuum of care.

PHOTO/ERIC MARKS

A host of Ailments With the numerous problems plaguing the health care system, the elderly population has a few extra ones facing it, said O’Mara and Spogen.

“Medicare is considered a benchmark, but not all practitioners in Nevada take Medicare,” said O’Mara. “So if you turn 65 and go from private insurance to Medicare, you may find all of a sudden that your doctor can’t treat you anymore.”

According to the Physician’s Foundation survey, a full 27 percent of physicians either limit their numbers of Medicare patients or simply don’t take them at all.

“There are a lot of talented physicians who do their best to treat with Medicare, but it doesn’t pay the full cost of service.

It’s better than Medicaid, certainly, but it doesn’t usually cover the full cost of care,” O’Mara said. “So if you’re taking a certain percentage of patients whose Medicare coverage doesn’t cover the full cost of care, you have to be strategic about choosing your patient load and limiting how many Medicare patients you see in order to cover your overhead.”

She added that because of the costs and regulatory issues involved in running a practice, the NSMA is seeing more physicians move to larger practices or hospital-based settings than to concierge practices.

Spogen indicated another byproduct of the current state of primary care is a lack of communication about one of life’s most important subjects: dying.

“People just don’t understand what their outcomes are likely to be,” he said. “Here’s an example: If you’re in, say, the 80-plus age group and you end up in the ICU in a local hospital, the odds are that you’re never going home. Do people understand that? Do they understand that they’ll be poked and prodded, and that they may be exposed to more

harm without a successful outcome? We need to do a better job of planning for the future than we do now.”

A physician shortage means that there’s very little, if any, time to have these important discussions. Compound that with our natural reticence to discuss death, and it’s easy to see why many fail to get the care they deserve at the end of life.

“It’s important to have that conversation with your doctor,” Spogen said. “So, if you’re 70, you should be saying, ‘What things should I be planning for?’ You need to think about what things are acceptable to you late in life and what aren’t.

I just think those things aren’t being talked about. And those conversations need to be had when a person is lucid, not when they’re in the ICU.” He said that if patients do nothing else, they should ask their doctors for a Physician Orders for Life-Sustaining Treatment Paradigm, or POLST form. This direct order, signed by a physician, is a form completed based on conversations between patients and health care professionals about goals of care, quality of life, diagnosis, prognosis and treatment options.

“Every patient should have one of those,” Spogen said. “It takes two to tango, so to speak. You and your doctor need to both be willing to talk about it.”

But that means getting time with your doctor—a luxury few of us get.

“As far as I’m concerned, it has to change,” Spogen said.

“The system isn’t user-friendly. It’s become about seeing as many people as you can and who cares about outcome, and that’s not why we go into practice.” Ω

09.28.17 | RN&R HealtH Guide 2017 | 5

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hoW Much is Peace of MiNd Worth to you?

Who Needs aN estate PlaN? You do—whether your estate is large or small. Either way, you should designate someone to manage your assets and make health care and personal care decisions for you if you ever become unable to do so for yourself. If you fail to plan ahead, a judge will simply appoint someone to handle your assets, personal care, medical decisions, and to care for your children.

Why do you Need aN estate PlaN? You need a Trust or Will to Plan for the management and protection of your most important asset- your family. Many people mistakenly think that estate planning only involves the writing of a will. Estate planning, however, can also involve financial, tax, medical and business planning. A will is part of the planning process, but you will need other documents as well to fully address your estate planning needs. This is why you need to consult a qualified, experienced attorney like Tory D Allen, Esq. to assist you with proper planning of your estate. through estate PlaNNiNg, you caN coNtrol: How and by whom your assets will be managed during your lifetime if you ever become unable to manage them yourself. You determine how and to whom your assets will be distributed after your death. You decide how and by whom your personal care will be managed and the health care decisions made during your lifetime if you become unable to care for yourself.

Most importantly you decide who will be entrusted to care for your minor children after your death.

6 | RN&R HealtH Guide 2017 | a special supplement to the reno news & review

What is the differeNce betWeeN a trust aNd a Will?

Wills are probated through the Probate Court which can cost a significant amount in fees, expenses and delay. A Trust is exempt from Probate. It does not go to court for a judge to decide and is therefore private, unlike a Will that becomes public record.

However, a Trust is not usually a substitute for a Will. Most people will need both, that is why you need to contact the Law Office of Tory D Allen to plan your estate. do you Need to be rich to have a trust?

No, a Trust is for anyone who owns property and wants to pass on their assets to their loved ones and not pay unnecessary costs to courts and lawyers. Everyone has something of value they can pass on to their loved ones. is aN estate PlaN exPeNsive?

The cost of a proper estate plan is significantly less than the financial and emotional costs paid by families of those who failed to plan or who “saved” with a “cheap” estate plan.

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Real estates W Yes, you do need an estate plan

by Jeri Chadwell-Singley jer i c@ n ew s r ev i ew . com

Learn more about the Family Estate Planning series here: http://bit.ly/2yg4IPz.

hat is your estate? Put simply, it’s everything you own—from personal possessions and real estate to things like mutual funds, rights and licenses, stocks, bonds, retirement accounts and life insurance death benefits.

It’s also everything you owe. According to Virginia and Kenneth Morris, authors of Standard & Poor’s Guide to Saving for Retirement, “Just as everything you own is a part of your estate, what you owe reduces its value.” They explain that before you could determine the value of your estate, you’d need to subtract from it things like “income taxes, mortgages or other debt, funeral expenses, and the costs of settling your estate.”

So, who needs an estate plan? The notion that it’s a concern for the wealthy is prevalent. It’s an idea people arrive at because they’re aware that the federal estate tax applies only to estates worth $5.45 million or more. Many locals may also know that Nevada doesn’t collect an estate tax. However, according to information on the State Bar of Nevada website, “If you’ve had your 18th birthday, you need your own estate plan.” And here’s the kicker: the reason it’s so important is that laying out what will happen with your assets—however great or little—after you’re dead, is only a part of the equation. An estate plan will also set up the legal framework to determine things like “who makes medical decisions on your behalf if you are not able to do so yourself” and “who raises your children if you become incapacitated or die.”

It’s pretty easy to learn the basic components of an estate plan through online sources. From Forbes to Fidelity Investments, most lists include the same basics: a last will and testament, durable power of attorney, health care power of attorney, living will and possibly a trust.

Having a basic understanding of these different documents can help you decide which ones you might need. But from there, you’ll have another important decision to make. Will you draw up the documents on your own using an online resource, or will you turn to an expert for help?

Where there’s a Will A will, as you probably know, is a document you create to direct the distribution or management of your assets upon your death.

It can also be used to leave details regarding things like funeral arrangements and who you want to care for your minor children.

Arguably, the most important thing to know about a will is what happens if you die without one. The legal term for this is dying “intestate,” and what happens to your assets in this case depends largely on you’ve left behind.

Let’s say, for example, that you have a spouse but no children, and you have two living parents. Because Nevada is a common property state, any income you earned or property and assets you acquired during your marriage would go to your spouse. In fact, if your entire estate were worth less than $100,000, everything left over after debts were paid would. If, however, you were worth more than that, your spouse would only get half of any property and assets that are considered “separate”—including anything you brought into the marriage with you and any inheritances or gifts you received. The remaining half would be divided equally between your parents.

(Las Vegas attorney Thomas R. Grover maintains a website that includes more information about Nevada intestacy laws and how they work: bit.ly/2wzy8XI.) Another important thing to consider with wills is when they may need to be supplemented. For example, while a will can be used to designate who you want to care for your children if you die, Northern Nevada estate planning law firm Anderson, Dorn & Rader notes on its website that “permanent guardianship in a will is approved by a court, which may take weeks or even months.” To ensure that kids don’t have to spend any time in child protective services or foster care, the firm recommends parents take advantage of a Nevada law that allows them to appoint short-term guardians for a maximum of six months. And, according to the firm, “In order to protect the children, there must be a separate legal document appointing short-term guardians.”

tried and trusted Perhaps you’ve heard a bit about living trusts and have found yourself wondering if this could be an option for you. The Reno law firm Cross Law maintains a website with information about trusts that starts, helpfully, with a fairly clear definition: “Most people like to think of a trust as a legal entity, similar to a corporation. And many lawyers will even explain trusts using this analogy. Although thinking of a trust this way can make it easier to conceptualize, it’s not technically correct. …

A trust is a relationship between three parties: the settlor, the trustee, and the beneficiary. Under this relationship, the settlor transfers property to the trustee, who then promises to hold such property on behalf of the beneficiary.” It also notes that “there is usually a written agreement to formalize this relationship, but it is not required.”

A living trust allows you access to your assets while you’re still alive, and—like a will—it clarifies who gets what after you’re

“Real estates” continued on page 9

09.28.17 | RN&R HealtH Guide 2017 | 7

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“Real estates” continued from page 7 dead. It’s worth noting that living trusts are generally more expensive to draw up than wills, and they may have associated administrative expenses going forward, especially if the trustee is a bank or trust company. But they come with advantages, too.

One is that a living trust will allow you to put restrictions on inheritances to control how and when they’re spent by beneficiaries. The second—and most commonly touted benefit—is that they can keep your estate out of probate.

Probate is the court process that’s undertaken to verify a will’s validity and execute it. In a report available online explaining the process, Reno probate attorney Bryce L. Rader wrote, “If the deceased person’s assets exceed $20,000, or if there is real estate involved, probate is normally required.” Trusts don’t have to go through this process—which many people also avoid for privacy reasons. (Like most court files, probate files are public records, and any member of the public can walk into the court clerk’s office and request to see them.)

If at this point you’re thinking that wills and living trusts seem like an either-or decision, you may want to think again. A 2015 article in CNN Money notes that not only are wills important for things like naming guardians for kids, they can also be used to make sure assets you intended to put into a trust before dying— but didn’t—make their way there after you’re gone.

Power to the PeoPle Wills and living trusts make up only a part of estate planning— the part that comes into play after you’re dead. But, however awful it is to consider, your estate may need managing before

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you’re gone. With the right documents in place, you can determine who will make financial and health care decisions for you if you’re incapacitated.

When you choose a person to manage your finances or health care decisions, it’s called a durable power of attorney. Since you’re still alive and kicking, you’d want to draft what’s known as “springing” powers of attorney—meaning they wouldn’t go into effect unless you were incapacitated. The people you designate in these documents become your “attorneys in fact.” With a financial power of attorney document, you can designate a person who can access your money, pay your bills and even buy and sell assets in your name. If you designate a medical attorney in fact, he or she will be able to make health care decisions for you—up to and including whether or not to pull the plug.

You may not be comfortable handing over the reins on your health care decisions to someone else. If that’s the case, you probably want to check out Living Will Lockbox. It’s a program run through the Nevada Secretary of State’s office that will allow you to file an advance directive—a document specifying the types of care you do or don’t want to receive. You can print a registration form online. Send it to the secretary of state’s office with a copy of your advanced directive, and it’ll be kept online, where health care professionals can access it any time.

Dare you DIy? Is doing your own estate planning a good idea? Well, it depends on who you ask. There’s a bevy of online estate planning resources available. Some, like Nolo—a publisher in Berkeley that puts out do-it-yourself legal books and software—suggest that there’s no problem with going it alone but advise having an estate lawyer at least look your documents over.

But information on the Nevada State Bar website warns against this: “While it may appear that you are saving money by not paying legal fees, it is likely to cost you, or your beneficiaries, more money in the long run or your plan may not actually accomplish what you intended or even be completely enforceable.

“For example, what if an inheritance you pass to a loved one disqualifies her from receiving governmental assistance? What if your daughter’s inheritance is taken by a divorcing spouse or used to pay a judgment in a car accident law suit? What if your documents are legally invalid and the court chooses who raises your minor children or they are placed into foster care?”

ShoP arounD There’s a lot to consider, and you may not yet be ready to decide whether you’ll take on the task yourself or hire a professional. If that’s the case, there’s a free series of educational workshops underway now you may want to look into.

Sponsored annually by KNPB, the Community Foundation of Western Nevada, and other local nonprofits, the Family Estate Planning Series consists of one-and-a-half-hoursessions with experts, covering different aspects of estate planning. The workshops are held Wednesdays from 10:30 a.m. to noon and 1:30 to 3 p.m. at the Sierra View Public Library inside the Reno Town Mall, 4001 S. Virginia St. There are five remaining sessions between Oct. 4 and Nov. 1, including “Wills, Probate and Trusts,” “Responsibilities of Fiduciaries, Executors” and “Power of Attorney, Health Care Directives, DNR [do not resuscitate forms].” You can reserve a seat at these by calling 333-5499. Ω

3:12 PM

09.28.17 | RN&R HealtH Guide 2017 | 9

Body moving

by Brad Bynum | b r a d b @ ne wsr e v ie w.c o m

A young undertaker reflects on her career

A

year and a half ago, a friend sent Kaity Blank a link for a job posting. A local funeral and burial company was looking to hire a first call specialist—that’s the funeral home representative who shows up to fetch the body after someone dies. It’s sort of an entrylevel undertaker job.

Undertaker Kaity Blank purchased this skull from the owner of a museum of oddities.

PHOTO/BRAD BYNUM

10 | RN&R HealtH Guide 2017 | a special supplement to the reno news & review

Blank was immediately interested. “I’m way more relaxed with death than most people are,” she said recently. For her, the idea of working in close proximity with death was appealing—in a field of study that’ll never be completed, with a great, unanswerable mystery at the heart of it.

“Nobody knows—you can’t really go to anybody and say, ‘What is death? What happens after death?’” she said. “You have all the different religions. You have nihilists. You have everything, but nobody knows. Nobody has a sure answer.

That’s what I like about it. It’s a mystery.”

Before taking on the undertaker job, Blank worked dispatch for a trucking company and part-time as a clerk at Recycled Records, the second-hand music and movies store.

As her undertaking career has developed, she’s given notice at the dispatch company, but is happy that the record store and the funeral company want her to keep both jobs. The record store provides a nice change of pace: “Instead of working with constant death, you’re working with something that brings life to people.”

Blank grew up in Cedar City, Utah, but has lived in Reno for 15 years. She likes horror movies and has the eclectic taste of a well-informed record store clerk. She owns a real human skull that she bought from the owner of a San Diego museum of oddities. (Holding a human skull, by the way, feels strangely intimate. You don’t usually see or feel inside of people unless you’re very, very close to them. It’s like a radical level of nudity.)

“When I went into the job, I had never really seen a dead body in person,” Blank said.

After the job interview, she got a tour of the facility, and she was giddy with fangirl enthusiasm. “I remember thinking, ‘Oh, shit, I’m going to see some dead bodies!’” she said.

“I was kind of excited about it, but I was trying to remain humble and not get excited, but it was like meeting one of your heroes—Alice Cooper or something.”

But that giddiness vanished once she actually started on the job.

“As I was going in, I was kind of giddy about picking up my first dead body, and I remember when I first walked in, met the family, and seeing the body, it just stopped.

Something in me just stopped. I wasn’t excited anymore. I wasn’t mad. It was just professionalism. It literally turned into a job the second I walked into the house.”

She’s on call most evenings. Once she gets the call, her goal is to get to the destination within an hour. She’ll have to get dressed appropriately—modest and professional, a black button-up shirt with a black skirt or slacks—go to the funeral home and pick up the van—equipped with two cots—and get to the destination—often a hospital, private residence or a hospice center. If it’s at a hospital, she has to verify the identity, and at a hospital, the body is already in a body bag.

At a private home, she’ll need to wrap the body in a sheet and then plastic. Either way, she goes back to the funeral home and puts the body in a refrigeration unit, awaiting a death certificate and funeral proceedings.

The smell “The smell can be very unpleasant … sickly, pungent, soured,” Blank said. “My cats love me after I’ve picked up people. They just can’t stop smelling me. … Dogs are afraid of it. They shy away from you. They don’t want anything to do with you when you come home smelling like death— because I live with two dogs and three cats—and those cats, it’s like I just bathed in tuna.”

The size and weight of the deceased can make the job more challenging—as can collecting bodies from cramped homes

that can be difficult to navigate. Changes in weather can also complicate things.

“Summer is really hard for pickups because they start decaying faster,” she said. On one particularly hot day, she was moving a body, and her hand slipped because the person’s skin had started melting. “It was like goo. It was like slime.

It was so hot that he had started melting, so my hand slipped off.” She was wearing gloves, of course. “I’m very desensitized at this point, but that made me a little ill.”

And because she does coroner calls, she’s seen some possible homicides and suicides.

“A woman overdosed, and I don’t know exactly on what, but whatever she overdosed on, she bled from her ears, eyes, nose and mouth. And her head was laying back, and it was running all over her face. And the smell wasn’t even like a decaying body—that’s a completely different thing. But the texture of the blood almost didn’t even seem like blood. It looked like brain matter coming out of her face. It was absolutely, horribly disgusting.”

Despite these extreme cases, Blank said, “I really love my job.” And she’s sticking with it. She’s in the process of obtaining her funeral arranger license and is working toward mortuary school. She’s learning the embalming process. One of the first steps is closing the person’s mouth.

“Ninety-nine percent of the time, you die with your mouth open,” she said. (If your instinctual reaction, upon reading that, was to close your mouth, you’re not alone.)

After cleaning up the body, the next step is to seal up the facial orifices. “Superglue is an embalmer’s best friend,” Blank said. The blood is drained and then formaldehyde is pumped in.

“You actually perform a massage on the dead person,” Blank said. “You get their arms, and you have to break the rigor mortis. You pick up the arms and start bending them

and working them out—the legs, the whole thing. You get the body and do aerobics with it, and that formaldehyde starts loosening up everything and the formaldehyde starts flowing in. Sometimes when there’s a blockage in the artery you have to cut open the veins in the inner thigh. You have to go through everything. Once you start seeing the fingernails and toenails turn pink, you know your process is complete. For a body that’s not complicated and it’s still flowing, it takes about 30 to 45 minutes.”

NighT of The liviNg For Blank, one of the most rewarding parts of her job is interacting with the living.

“I try not to ever say ‘the body,’” she said. “You have to be really careful about the verbiage. You don’t ever want to make the person an object.”

Sometimes there are inquisitive family members, sometimes not. The most common question: Where is the deceased going?

“I have to choose my words carefully, because you don’t want to say, ‘I wrap them up and put them in a cooler.’”

In talking to families of the recently deceased, Blank said they’re only very rarely hysterically upset. More often, the people have a surreal, displaced sense of calm.

“In a year and a half of picking people up, I can count on one hand how many people have been in hysterics,” she said. “Usually people are at their most kind and vulnerable, sweet selves. I love that part. You have to understand that these people are in shock. They don’t really know how to feel because, you know, who does? … When they come to the funeral home later, it’s a totally different person.

They’ve had time to process it. They’ve had time to calculate the finances. Sometimes they’re more abrasive.

Sometimes they’re just as sweet.” Ω

Who’s going to take care of the details if something happens to you?

Get it in writing.

Your funeral or cremation arrangements are important items that must be handled when the time comes. Getting this information down in writing now can take the burden off your family members by not making them guess your wishes. For more information ask us, we’re here to help.

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