Dead bodies and Ash Cash

Have you checked in recently at The Daily Rhino?

If you haven’t, you should. It is written, well written, by a junior hospital doctor, and it is fun. He writes for the Medical Student Magazine, as did I. The Daily Rhino gives you some excellent insights into what it is like to be a young doctor. Beer, sex and hard work. Well, something like that.

The Daily Rhino has been picked up today by the BBC. By the PM programme no less.

Our main story this week came to us via listener Pauline Levey. She emailed to suggest we take a look at 'ash cash'. This is a fee that's required in order for doctors to release a body for cremation. It's currently set at a level of £71 each for two doctors, paid in cash on top of the doctors' NHS salaries. Pauline - whose mother was cremated a year ago - says the charge is unfair and cruel. Here she explains why. (BBC)

As the Americans would say, sorry for your loss, Pauline, but you are naive. You do not seem to mind that the undertaker charged you a couple of grand for the funeral, but I suppose that is different. I do not know if the words are yours, or the BBC's, but who ever wrote them is a poisonous fuckwit. Doctors do not hold on to bodies and blackmail families to pay them a fee before they will "release" them. It's the law of the land. The law insists that checks are made to ensure that people are dead before they are burnt.  Do you have a problem with that?

The Daily Rhino has not helped, for he has been writing about Ash Cash.

Ash cash. The sixty two pounds a doctor pockets every time a patient they have certified pops their clogs and is burnt to a crisp is nothing short of infamous. Known as the house officer’s privilege, it is the fund for Thursday night drinks all over the country. A colleague working on care of the elderly has effectively gone up a banding due to the vast amounts of ash cash he rakes in. No comment on his quality as a doctor, of course. Ahem. Yet when we are filling in the form, we all answer ‘no’ to the question ‘Do you have any pecuniary interest in the patient’s death?’ Despite some noble souls donating their cheques to charity, the rest of us catch ourselves secretly hoping that families opt for cremation. If a terminal patient is known to several doctors, we also hope they survive just until we’re on call and then we’ll be the one called to confirm, see the body after death and head down to patient affairs before anyone else beats us to that cheque. Well, perhaps that’s just me.The Daily Rhino

When you are a young doctor, death means nothing. It is something that happens to people on a different planet; to people older even than your grandmother. When I was a young houseman, I had to fill in death certificates. Then, if the patient was for cremation, and they usually were, I had to fill in the first part of the cremation form. This meant stating that I was certain as to the cause of death but most importantly that I was sure the patient was dead. To reach that state of certainty, I visited the hospital morgue, inspected the body, and then, drawing on my wealth of medical experience (I signed my first cremation form 48 hours after I first qualified) filled in the form. I had not got a clue what to put, but the secretary made lots of helpful suggestions, and I survived. Not a pleasant business. Best not to think about it. Best to laugh it off. And one did get paid a fee for doing it, which we called “Ash Cash” because that was traditional, and funny (ha! ha!) and eased the pressure. We used to crack jokes about death, and cancer, and foetal abnormality, and children with deformities too – ever seen the acronymn “F.L.K” in a child’s notes? It means “funny looking kid.” Ha! Ha!

I still go to the morgue. It is usually at the undertakers. Unlike the hospital morgues, commercial undertakers are not as scrupulous about refrigeration as I would like, but you don’t want to know that, do you? The undertaker’s typist opens the fridge, and slides the body out. Nowadays, the body is not from a different planet. It is not a body at all. It is a patient. Someone I have known for maybe twenty years. Someone whom I have looked after. Someone who is younger than my grandmother, younger indeed than my mother. And I look, and identify, and check they are dead, and feel sad, and a little guilty (could I have done better?), and above all else I satisfy myself that they are truly dead, and I wash my hands, and I fill in the form, and the typist jokes about this, that and the other, and she gives me a cheque, which I do not look at (I think it is for about £40) but which I will hand to the practice manager when I remember, and I drive back to the health centre to deal with the living, and I think that one day not long from now someone will slide me out of a fridge and look at my cold, dry eyed cadava, and I am quiet for the rest of the day, and when I get home the children notice and ask why I am quiet, and maybe I shout at them. I wish I was young again so that it could all be fun and “ash cash”, but that is not possible. My skin is no longer Rhino-thick for now I understand what I am doing, and how important it is that I do it properly. The last job you do for your patient. Important, then, to get it right.

What fee should I be paid for this work? I have not got a clue. The last funeral I organised for a close member of my family cost over £2000. £80 of that went to the doctors who made sure that their patient was dead. Is that too much? Beats coffins with fingernail scratches on the inside of the top lid.

I don’t care what the fee is. There is no amount of money you could pay me that would make me feel comfortable about this job. Young doctors deal with it, as did I, by cracking macabre jokes. I cannot do that any more.