Inside the hospital mortuary, lessons in life and death
CNA Insider gains unprecedented access to the TTSH mortuary and finds out what it is like working with dead bodies and what happens on the last leg of a patient’s journey.
SINGAPORE: Mortuary supervisor Moshien Mohamed has received all kinds of bodies in his 14 years in the job: Infectious bodies, accident fatalities, the rare murder victim, tens of thousands of bodies in all.
He always looks at their faces.
To others, the dead tell no tales, but the 62-year-old might see a story in their final expression. A look of calm tells him of a nice ending; an air of worry could be because of family or money.
Sometimes their eyes are open and he sees shock. An accident can do that to someone.
But the living do not ask him about that. When they find out that he works in the Tan Tock Seng Hospital (TTSH) mortuary, they want to know if he has any “funny story” that cannot be explained.
“People have a wrong conception of a mortuary,” he said. “They have the fear that (there are) all kinds of stories which they watch in the movies … A movie is (meant) to create excitement.
“Here, (there’s) no excitement. Here, every day is normal, quiet – no sound at all.”
The doors of the mortuary in Level B1 open to reveal a brightly lit corridor. In one of the rooms on the right, there are bodies stored in fridges – where the only sound is the hum of the refrigeration units.
The smell of cleaning agents fill the air. The labels indicate that amputated body parts, from the operating theatre or otherwise, are stored here too.
What there is in abundance, however – as CNA Insider discovered after gaining unprecedented access to the hospital’s mortuary – is dignity, respect and love on the last leg of a patient’s journey.
It starts the moment he or she dies and lasts until the body is transported from the hospital. And it is a journey that has taught lessons in life to Mr Moshien.
WATCH: Lessons in life and death, from inside the hospital mortuary (7:58)
FROM SECURITY GUARD TO UNCLE FESTER
Life itself has taken the father of three on different trajectories. His first job was as a security guard at Singapore Telecommunications. Retrenched after 18 years, he joined TTSH in 1995, also as a security officer.
Within three months, he was promoted to assistant car park supervisor. Then in 2004, he wanted a new challenge and was told there was an opening for an assistant supervisor in the mortuary. He asked for the transfer without hesitation.
But his decision caused consternation in his family. “They were scared that … the dead would follow me (home),” he recalled. “I said no lah, don’t worry lah.”
He told them it was a “noble job”, although it took a lot of persuasion to convince his wife that he would benefit from learning new things.
“Excited” as he was to find out what happens in a mortuary, and even though he did not consider himself superstitious, he admitted that he was also a little fearful at first – that he would “hear some noise”, for example.
“But as time went by, the fear went away,” he said. And in all the years since, “nothing has happened”.
Neither has he heard any of his staff say the mortuary is haunted. But for the many who have joined and left quickly, they did not need to hear things that go bump in the night to find another job.
“Sometimes they might work for one week. After that … they fall sick,” he said. “They fell sick not because they were working here … but they made use of this to say, ‘Oh, I work in a mortuary. I’ll fall sick.’”
There are others who say they cannot get a good night’s sleep, which makes Mr Moshien “start to laugh”. “Some of them are too scared,” he said wryly. “I tell them, ‘Don’t worry, if at night you’re lonely, read books.’”
Ask him if he is scared of the dead at all and he says the living are scarier. As he would tell others, “(A dead body) can’t do anything to me, right?”
Amid the high staff turnover, he has been a constant. “Everybody (in hospital) recognises me, mortuary man,” he said.
Or, as some of the TTSH staff told CNA Insider half in jest, he is their Uncle Fester from The Addams Family, pop culture’s kooky household with macabre humour for the ages.
FROM ANGER TO EMPATHY
The jovial supervisor is part of a team of nine, including mortuary attendants, mortuary registration officers and medical social workers, who work round the clock to receive about 3,600 bodies annually from various parts of the hospital.
There was a time, however, when Mr Moshien was less jovial and more short-tempered. “Before I joined the mortuary, if anybody told (me off) in a (heated) tone, I’d very easily get agitated and get angry,” he admitted.
So his first six months were rough. Faced with grieving families who may have been impatient to claim the body of their loved one, he often lost his cool when scolded for perceived delays or items thought to be misplaced.
Eventually, he started to reflect and realise he was wrong. “I’m an ambassador for TTSH … Why should I behave like this? The image of TTSH won’t go down because of me,” he resolved in his mind.
While it should take no more than 30 minutes for his attendants to return with a body once the mortuary gets the call from the ward, sometimes there may be a few deaths around the same time.
“But we can’t just tell them (the families) that we’ve got many cases. Because they aren’t interested. They only want their (loved) one,” he acknowledged.
That means his job entails a lot of apologising – and commiserating – to relieve the emotional tension of family members.
It was a hard adjustment for him to make, but his bosses kept advising him on the importance of empathy. And it took one incident to touch a chord in him emotionally.
While he had seen families offering prayers in the mortuary or telling the deceased not to worry because they would take them home, one day he encountered a different sight: A convict escorted by prison officers to see his mother.
“He really regretted what he had done … He said: ‘Mother, I’m sorry. I hurt you a lot during your life,’” recounted Mr Moshien.
It struck me that when a person is alive, whether a friend or parents, we shouldn’t hurt their feelings, so that’s why we must have empathy … I realised anger doesn’t make anything out of my life.
THE LAST OFFICE
It is not only the living he has to be gentle with, but also the dead.
“We want to respect them. Okay, respect means (we) transfer the body from the bed (to the mortuary trolley) … very carefully and slowly. And when (we) push the trolley, it has to be very slowly,” he said.
This process of care after death – the last office performed for a patient – begins with the nurses.
And like the mortuary team does, they treat a body as if it were alive by, for example, apologising as they work in pairs to clean it from head to toe, so that the deceased look presentable for their families.
Senior staff nurse Shahirah Moshien, who works in the intensive care unit and is Mr Moshien’s daughter, explained: “It reminds me of myself – (if) people (were to) clean me in my private areas … So we always say so sorry.”
In the ICU, where patients generally require more life support, such as breathing tubes and arterial lines, the cleaning takes longer than in the general wards.
Once a body is ready, it is wrapped in a shroud – or a body bag in infectious cases – with the legs and arms tied together to prevent movement during rigor mortis, the stiffening of the joints and muscles after death.
The last office is significant not only for a patient and the family, but also the nurses themselves, as a symbol of their final goodbye.
“Definitely, we’ve developed some kind of connection with our patients. So the last office is definitely some sort of closure between the nurse and the patient,” said Ms Shahirah. “At least we know it’s the end of the (patient’s) journey.”
The 28-year-old remembers one patient in particular, a “bubbly old lady” from four years ago. It was Chinese New Year’s Eve, and the woman had asked her family to go home for their reunion dinner.
“She told me not to leave her alone, and I said I wouldn’t,” recalled Ms Shahirah. “I went out to just take medicine for her, and (when) I came back, I saw … her blood pressure crashing down.
I had to call her family and go, ‘I’m so sorry, your mum passed on’, when they were having their reunion dinner.
The patient was in hospital for only three days, but Ms Shahirah “will always remember her” for being “so jovial” despite being unwell.
“I really cried when I did the last office,” she added, her tears falling again at the memory. “I felt that it (the last office) was a way for me to thank her for being so nice.”
As Mr Moshien has also seen, closure is important. For example, if there are family members overseas, some families wait for them to return before they claim the body of their loved one.
In such cases, it can be stored in the mortuary’s fridges, which can accommodate up to 30 bodies and come in different dimensions to cater for various body sizes.
At 4°C, the bodies are kept from decomposing or freezing, with the infectious ones stored separately from the rest.
These fridges are also where unclaimed bodies can lie for up to a month. TTSH sees about nine cases a year, and its medical social workers go all out to locate the next of kin to do the last rites.
The social workers are also activated to support grieving family members and those who need financial help for the funeral arrangements.
If no one comes forward, he arranges for their last rites by engaging an undertaker for the cremation – with the ashes scattered at sea by the National Environment Agency – or burial in the case of Muslims.
“At least there’s somebody to handle the cremation or the burial … for the closure, dignity and respect,” added Mr Moshien, who also makes these arrangements for body parts not claimed by the deceased’s family.
The only times the TTSH mortuary does not issue the death certificate are for coroner cases, in which the cause of death must be established at the Health Sciences Authority’s mortuary on the Singapore General Hospital campus.
A police hearse will transport these bodies, which have a yellow tag instead of the usual blue tag.
Among the many death certificates Mr Moshien has issued, some have been for his friends’ parents. And he is moved by their emotions at times, especially when the death was unexpected.
He has also assisted the families of TTSH colleagues, for example a security officer who died of cancer.
“In the morning in the ward, we were laughing and … suddenly two hours (later), we got information that he died,” he recalled. “From there, I realised that life is very fragile. Anything can happen any time.”
In the beginning, as his job changed his outlook on life, he often used to go home and tell his family, “Tomorrow, start afresh. Don’t think about what happened yesterday.”
It was his idea for his daughter to study nursing. And since she joined TTSH, they have often talked about patients who have died.
Invariably, if any were involved in an accident, he would have a reminder for his youngest child, who got married not too long ago.
“He always tells me, because I drive, ‘Drive carefully … Wait for the rain to stop, then you drive off,’” said Ms Shahirah.
She also attested to his change from being hot-tempered to managing his emotions well, “so now he’s very cool and … everyone loves him”.
Her friends have even asked her if he could take them round the mortuary, but she herself has not gone inside.
“We aren’t mortuary staff, so … we aren’t supposed to enter. As much as I’m curious about it, I respect what he says about it,” she said.
What her father would like people to think about, however, is death itself. “Because one day, they’re bound to fall sick. They’re bound to die,” said Mr Moshien, who is “100 per cent ready” to meet his Maker.
“Every morning, I wake up (and) say, ‘I’m blessed and grateful … to be alive, to be peaceful and to enjoy this (life).’ So life’s a celebration.”
What everybody has, he added, is the power of choice. “Your life is a lump of clay in your hands … God’s a creator, but you’re a co-creator. That’s what I’ve learnt. So you’re the author of your own life story.”