A clot too far: An embalmer dissects antivax misinformation about blood clots in Died Suddenly

In my twelve years of funeral service, one thing I have learned to be true; embalmers love a good clot story, and I find myself to be no exception to this. Seven years as an instructor of embalming and restorative art have given me an advantage in that I have more people sharing their clot stories with me. If you gave me ten minutes, it would be easy for me to come up with messages from people who have sent me pictures of large clots they have pulled from the veins of deceased humans during the embalming process. Consider it our version of ASMR in the same way that some people enjoy Dr. Pimple Popper. While I deigned to watch more of the antivaccine “documentary” Died Suddenly than I had to (e.g., all of it), I did, however, enjoy the final sequence in the film in which an embalmer named Richard Hirschman pulled large clots from the veins and arteries of the deceased person being embalmed. So when Dr. Gorski unexpectedly asked me to write a review of the film from an embalmer’s perspective (his more general review of the film from a science-based perspective can be found here), I was happy to do so.

A person might ask: Why is the scene in Died Suddenly featuring the removal of clots from bodies so appealing to embalmers? The answer is simple: The removal of clots of all shapes and sizes is a hallmark of an embalming going well and is exactly what we would expect and hope to see. This is particularly illustrated when Hirschman is shown removing a clot from the jugular vein and there is a burst of embalming solution behind it shown briefly before the camera stops filming. Every embalmer loves to see this because that’s how we know that our embalming solution will have a clear path into the arteries and capillaries. Yes, we embalmers love a good clot story, however it seems that the clot story in Died Suddenly is now being used to repackage many of the same old antivaccination tropes we have heard before.

To the untrained eye, the embalming sequence shown near the end of the movie can indeed appear odd. Because of the secretive nature of funeral service and our reverence for the dead, there aren’t a lot of embalming videos available in general, and even fewer are available to the public. In our culture, a precaution we take when using pictures and videos of people’s loved ones for educational purposes is getting written permission to take photographs of deceased people. It sometimes is the bullet points found on funeral homes’ embalming authorization forms. True, the use of the footage does not have to be specific when an embalmer obtains such permission, and it is unknown if Mr. Hirschman got that permission for this film. Most funeral homes bristle at the idea of bringing this up to grieving families, so it typically is not done unless you are making it part of your embalming case report or working with an embalmer who creates educational content for other embalmers. This is illustrated by Mr. Hirschman’s timidness about asking for permission to film at the funeral home, so instead he chooses to surprise them at the last minute with the camera crew. So please allow me to provide some insight for you into what we are seeing during this sequence that starts around 50 minutes in. I will also warn readers that this discussion features screenshots from Died Suddenly that might be disturbing to some.

Not an embalming table. (Screenshot from Died Suddenly.)

What is going on in this prep room?

After being told none of the footage has been altered, we are immediately treated to a scene of a dimly lit (and possibly foggy) embalming room (also called a prep room) where Mr. Hirschman is portrayed as headed to a final showdown with a deceased person waiting for him on a table. This scene appears to contain footage of two different people on tables. The sequence that includes Mr. Hirschman—I am not even convinced this is him and not an actor—does appear to have a table used for embalming with a body on it. The second shot clearly shows the body wrapped differently and not a table used for embalming (see screenshot above). Embalming tables have trenches around the sides to catch and direct any liquids on the tables (as seen in the shot including “Mr. Hirschman”), this one does not. So much for unaltered footage.

Anatomy of the iliac-femoral artery/vein confluence, where the external iliac artery/vein turn into the femoral artery/vein. The dotted line represents the inguinal ligament.

Also, as an aside, for someone who is so concerned with public health, “Mr. Hirschman” needs to examine his own here, as he is decidedly not dressed in the OSHA recommended personal protective equipment prescribed for embalmers when they are preparing a body.

The first shot is of him pulling clots out of the iliac artery, claiming “this is not normal”. This claim is patently false. First, unless an embalmer is injecting an autopsied case, they are not using the iliac artery, but the external iliac artery or the femoral artery because these are superficial to the surface of the skin, which allows for easy access. This is an important distinction, because it is in this area is that the external iliac turns into the femoral artery as it crosses the inguinal ligament heading towards the leg. This area is a common site of significant atherosclerosis (the hardening of arteries), which slows blood and can capture clots. In fact, if Mr. Hirschman had picked up his embalming book during mortuary school, he would have recognized that we specifically teach that this is a danger area for clots and arterial blockages. When these are encountered, the embalmer might be required to access the femoral (or iliac) artery to inject the leg with embalming solution. It is extremely common to have to raise (the term we use for accessing the vascular system through an incision) more than one artery to complete an embalming, particularly to get better distribution and diffusion of solution to the legs. It is true that many embalmings begin with injection and drainage from the common carotid artery and the jugular vein in the neck, but it is not unusual for an embalmer to start with the femoral/iliac artery as the primary injection site. Since we see both in this sequence and because of potential editing, it is hard to know in what order he did the injection.

Removal of a clot from the iliac artery. (Screenshot from Died Suddenly.)

We are then treated to a montage of piles of blood clots. Again, this does not appear to be unusual. The difference here, is that clots have been collected for dramatic effect, when typically, most of these would just be washed down the drain during the embalming process, particularly the gelatinous red portion.

Shot showing some of the blood clot from the montage of clots in Died Suddenly.

Angular forceps. (Photo courtesy of Benjamin Schmidt.)

Next, after narration from an embalmer named Nicky Rupright King, we return to the prep room where Mr. Hirschman is removing a clot from the jugular vein followed by the burst of embalming solution I mentioned earlier. He says, “That’s a monster!”—indeed it is a good-sized clot—and there is the explosion of embalming solution from the buildup of pressure behind it. I personally breathed a sigh of relief for him because I have done exactly this countless times and taken it as sign that the tide of my embalming was going to turn for the better. Further, the instrument he is using to remove the clot is known as an “angular forceps”, and in embalming we use this specifically because of its ability to grasp and remove large clots! If he did indeed start injection with the external iliac before the common carotid, the injection directed superiorly would have pushed any clots in the body up to his point of drainage in the jugular. We don’t see him doing the actual injection in the footage because there is an absence of an arterial tube (the device inserted into an artery for injection of embalming solution) but we can infer its presence based on the embalming solution and the buildup of pressure in the shot of the common carotid/jugular vein. It is also possible that he was injecting the solution into the iliac artery and draining from the jugular, which is a technique called “split injection” (injection from one site and drainage from another). Drainage from the jugular is common because it diverts clots from being lodged in the head and causing swelling in the features.

Removal of clot before the expulsion of embalming solution. (Screenshot from Died Suddenly.)

The clots themselves

So now that you have a better picture of the embalming process and how it works, we ask ourselves, “where can the clots be coming from?” We embalmers have very simple categories we place postmortem clots into:

• Currant jelly clots: Blood clots that contain all the blood elements coagulated in an evenly mixed mass.
• Chicken fat clots: Blood clots that contains all the blood elements with the red and the white cells separated into distinct layers.
• White fibrin clots: Blood clots that lack red blood cells, often found in the right atrium of the heart.
• Sludge: Coagulated blood elements that have stuck together (also known as postmortem coagula).

I know that these are some very scientific sounding names and can be overwhelming to some when reading them, but the descriptions help. Also keep in mind that all these clots can exist at the same time in the same body. The consistency of the clots will vary as well, based on the following factors:

• Moisture content of the body. After a person dies, water moves towards the ground, because you know, gravity. This is called hypostasis, and livor mortis (the red discoloration from the settling of blood) is the outcome. When this happens, the formed elements and blood proteins separate out as gravity continues its work. If a person was dehydrated when they died, theses clots will solidify sooner, and vice versa if they had a higher moisture content. What little case analysis I was able to do while watching this video, this person seems to be of normal moisture content.
• Time. The more time the body sits, there more solid the clots become based on the separation of moisture. As I mentioned, an indicator of the movement of moisture is livor mortis, and it is not unusual for it to appear very soon after death, and I will explain why in a moment. Based on the angles of the video, I could not determine the movement of moisture based on the appearance of livor mortis.
• Agonal period. The agonal period is the process of death right before the actual death. If a person is ill, their body process will slow, including their circulation, meaning that the blood can pool in places while the person is still alive due to low blood pressure and perfusion. This is known as agonal hypostasis and is common in people who have been in long term care such as a nursing home, home care, or hospice. Therefore, as I mentioned, livor mortis can appear soon after death in some cases. Based on the case analysis in the video here, I cannot determine the changes during the person’s agonal period.
• Refrigeration. Cooling a body does a few things in the short term and even more in the long term. In the short term, it can allow for blood to remain in a liquid state and separate from the formed elements. Air movement over the surface of the body also causes dehydration. In the long term, oils and proteins of the body coagulate. Based on what I gleaned from the conversation about the person being embalmed, I believe that if this person was refrigerated, it was for a short time.

While I cannot definitively do any type of case analysis based on what is in the video, I do believe that it is fair to say that many of the 118 bodies Mr. Hirschman has claimed to have tracked and presented for evidence have been affected by one of the clot creating factors listed above.

So, now that we have an idea of how to categorize clots, let’s take a look at what types of clots we can see. First, remember that clots look weird even to us (hence part of why embalmers love clot stories). To the uncalibrated eye, it can be difficult to define them exactly. The other thing is that we must remember that all the different categories of clots can exist in the same body simultaneously. In the sequence where Mr. Hirschman is removing the clot from the iliac it would appear consistent with a currant jelly clot or maybe a chicken fat clot where the white portion is covered with other parts of the blood. The clot clusters in the blood clot montage, are clearly a mixture of chicken fat clots and sludge. Also, in the film Hirschman discusses a doctor’s concern over “microclots” and describes the drainage as dirty or sandy. The image we are shown of this is exactly what you would expect to see during an embalming. Later, he swirls the “dirty” blood in a vial. In fact, I would be concerned if I didn’t see this during an embalming, because it indicates the removal of postmortem coagula from the smaller arteries and capillaries.

“Dirty” blood on the table. (Screenshot from Died Suddenly.)

“Dirty” blood in the vial. (Screenshot from Died Suddenly.)

The “monster clot” from the jugular vein could be a chicken fat clot where the red portion has sloughed off due to the pressure build up and the extraction of it from the vein. We can see evidence of it surrounding the incision. It could also be a white fibrin clot as a properly placed angular forceps enters the right atrium of the heart via the jugular vein, as this is the center for drainage in a deceased human.

Effects of the embalming process

We also need to consider the effect of the embalming process on the clots themselves. A repeated discussion of the clots describes them as “rubbery,” and this is reiterated again when a crew member feels one of the clots Mr. Hirschman dangles for all to see. This comes as zero surprise to any embalmer because that is exactly what embalmed tissue feels like. One of the functions of formaldehyde is to coagulate protein, and this is what produces the rubbery feel. In fact, embalming chemical companies add modifying chemicals to their products in order to reduce this texture.

“Oooh, rubbery!” (Screenshot from Died Suddenly.)

The whopping one sample that has been analyzed by Mike Adams using inductively coupled plasma–mass spectrometer (ICP-MS) came back with these results:

• The clot lacks the metals such as calcium and magnesium normally found in blood.
• The clot had a high concentration of chloride.

Again, had Adams or anyone taken the time to open an embalming textbook, they would have had their answers. Embalming fluids used for arterial injection frequently contain the metal chelator EDTA and other anticoagulants whose specific purpose is to strip metals from the blood. Calcium is responsible for the blood clotting reaction even after death, so we have preservative fluids with anticoagulants built in or added to the embalming solution separately to promote drainage and reduce clotting. If Mr. Hirschman was expecting to find clots, it is likely he would have chosen fluids that would aid him in their removal, because his goal after all is to have a well-embalmed body. As for the chloride, again simple explanation; many prep room cleaners, including bleach, contain chlorides. If the clots came into contact with a surface (the embalming table for example) they would be contaminated by the cleaning agent. We also need to consider the physics of embalming as well, embalming machines vary in their pressure and rate of flow combinations, and embalmers like to manipulate these settings as they go.

If Mr. Hirschman was expecting clots, he would have been changing these settings to prevent swelling but loosen the clots at the same time. The general rule for this is low pressure, low rate of flow. There is another thing we should not overlook here; as a seasoned embalmer, I have no doubt that Mr. Hirschman is really good at extracting clots. Developing this technique over time to keep clots intact as you remove them is in an embalmer’s best interest to clear arteries and veins, as necessary.

The claims about the clots

Before I conclude, I would like to examine the claims about the clots through the qualifications of an embalmer and as I see it, there are three; there is a rise in clots, the clots are unusual, and the clots are caused by the COVID vaccine. So let us look at them one by one:

There is a rise in clots.

It is impossible to tell, at least from the information presented in Died Suddenly. As far as I know, there is not a database of all reported clots that creates statistics for us to reference. Plus, as you can imagine, it would be really hard for us to accurately gauge the number of clots in all the dead people in the entire world, especially considering that most of the people do not get embalmed and are not examined by a coroner or medical examiner. If there is one, I would love to see it. As early as summer 2020, we were told that a side effect of COVID-19 was clots, so if there is a rise in clots, there’s a reasonable explanation.

The clots are unusual.

As I have explained, every clot is unique, and the variations of clots are based on all the factors I listed. There is a way we could gain more information about the conditions when the clots were produced and that is if Mr. Hirschman were to release his embalming case reports for review. A typical embalming case report has demographic information such as gender and age as well as any antemortem and postmortem conditions such as medical devices found, signs of moisture content, livor mortis, etc. It would also tell us what embalming fluids he used and the concentration of formaldehyde his embalming solution was. He already has a catalog of his cases, and each sample bottle was labeled with the number, so if he allowed us to analyze his embalming case reports for each one, we would have more information. However, based on the images I have seen, particularly the image in the film’s thumbnail of the clots on the blue glove, there is nothing unusual about them at all.

The clots are caused by COVID-19 vaccines.

There is no compelling evidence of this, and Mr. Hirschman’s own study does not lead us in this direction. He has confirmed 16 of these bodies are vaccinated, but the vaccination status of the other 102 remains unknown. As we see looking over his shoulder on his computer, he has logged a lot of bodies that have clots in them. This makes sense to me because lots of bodies have clots in them. One of the issues never really addressed here is whether we are to assume all of the clots found in a person are caused by the vaccine, or only some of them. How does Mr. Hirschman determine this? Also, more confusing is how Mr. Hirschman has even confirmed the 16 he claims he has verified. At the beginning of the movie, he is identified as a “trade embalmer”. A trade embalmer is a person who goes from funeral home to funeral home embalming bodies as an independent contractor. They rarely, if ever, have any contact with the families directly, unless of course they also transport the person from the place of death and the family is present. Laws on who can transport a body from the place of death vary from state to state and in Alabama, no specific license for this is required. My guess is that the funeral homes hire a transfer service or have a driver who is paid minimum wage for this purpose if they are not sending one of their own funeral directors as a representative. It would not be considered good etiquette to ask a grieving widow at that time if her husband was vaccinated. So, this means that he is likely getting this information second hand from people at the funeral homes that hire him.

Now the scope of work that Mr. Hirschman and the trade embalmers does vary depending on what services they offer a funeral home, however, based on what we saw in the film we can assume that embalming is his main duty because he was called by a funeral home, went to the funeral home, and then walked like some kind of warrior towards a dead body for a showdown. What should also be noted here is that if a person dies a natural death, the embalmer typically does not know their cause of death at the time of their embalming. Because decomposition begins at the moment of death we try to embalm as soon as possible. It may take several days for a doctor to complete a death certificate, indicating the cause of death. So, as you can imagine, the idea that we would know a person’s vaccine history is almost unheard of. Case in point, it was also unknown to us as the viewers of Mr. Hirschman’s embalming if the person that was being embalmed was indeed vaccinated. This means all the “whoa babying” he was doing over the clots during the embalming, might have been on a person who was not vaccinated. In general, this is all anecdotal evidence causing the embalmers to jump to conclusions and make claims they are not qualified to make. We do not have training in the collection or the testing of blood, and as evidenced by the corruption of the one sample sent to Mike Adam’s laboratory, Mr. Hirschman specifically does not have this training.

To me, Mr. Hirschman demonstrates the qualities of a good embalmer but a terrible scientist. Instead of jumping to conclusions based on his own confirmation bias, he should have opened one of the embalming textbooks available to him because that would explain a lot of what’s going on here. It is an old trope in our industry that when a new embalmer begins at a funeral home, they are told by the embalmers training them, “Forget what you learned in school. I will teach you everything you need to know”. There is a culture of hubris and argument from authority that is entrenched in funeral service, and it is on full display here. The assumption that the embalmers make in this film that they have any qualifications to make the claims they are is laughable. I say this with added confidence because I know for a fact that I had the same education as one of the embalmers featured in this film and then went on to teach embalming at the same school we both went to! In short, if you find yourself taking medical advice from embalmers, you are likely to find yourself on their table soon after.

NOTICE: The thoughts and opinions expressed in this post belong to Ben Schmidt alone and are not necessarily representative of any organizations he is affiliated with.

References

Mayer, R. (2012). Embalming history, theory, and practice, 5th Ed. McGraw Hill: New York.
Strub, C., Frederick, L.G., (1989). The principals and practices of embalming, Professional Training Schools: Dallas.