Unnatural Causes

by Dr Richard Shepherd

It was a few years before I was to hear another such silence, the silence that follows horror.

Until she arrived he had remained in the small area around his house and I personally formed the theory that her death released him to rampage much more widely through the town. I thought this had set him free to revel in the experience of an extraordinary and unaccustomed power, the power his weapons gave him over the unarmed.

that the pilot’s preoccupation with staying alive, which so powerfully suppresses all other thoughts, feelings and fears, may be one of the reasons I fly.

It all happened again soon afterwards when I came home from school and found the house full of relatives and flowers. I worked out later that the funeral had taken place; it had not crossed anyone’s mind that I should go. When I walked in they looked at me tragically. What were they expecting me to do, to say? I felt nothing. Perhaps deep down I simply did not grasp the concept of death. My mother had so often disappeared before and had always come back.

He firmly believed it was possible to do anything you set your mind to. So, he rewired the house and painted the kitchen and serviced the car and learned to cook (with, admittedly, variable results). In addition, he somehow arranged his life to accommodate our needs and this involved his discovery of a new ability to give and receive great affection. I look back on all this and feel huge admiration for him.

Even the most amateur psychologist must deduce that my need to explore death’s presentation was the reason for my extraordinary interest in that copy of Simpson’s Forensic Medicine.

More than an interest, it was a fascination. It went further than prurience and much further than the other boys’ eagerness to be horrified.

the life of a GP, confronting a line of sniffing people every morning.

I read as much as I could about him and fell in love with the way he rushed to crime scenes, often in those days by steam train, and then used his medical skills to help detectives reconstruct homicides, solve the unsolvable, exonerate the innocent, argue the case in court and bring to justice the perpetrator.

It was a little while before I came to understand that his curious greyness was a feature of the formalin injected to preserve him and not of death itself.

At another table, a girl had fainted and was surrounded by a circle of concern.

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My father, while loving and caring, could also be irascible after my mother’s death. Very irascible. I well understand where this came from: his adored partner had died and previously shared burdens all fell on his shoulders. He had been left with a young son at home in need of his love and another son who, feeling his mother’s loss acutely, had proved a challenging teenager. On top of it

all, my father longed for female company.

This great secret shame had enabled Joyce’s mother to keep her firmly under the maternal thumb.

She had never been given a chance to mother her own child.

The meeting introduced me – or, perhaps no introduction was necessary – to the awful collision between the silent, unfeeling dead and immensity of feeling they generate in the living.

But we were both taken aback by the weeping, the sheer dissatisfaction with which our little prince responded to our efforts to please him. And all the time we were awash with a love for him which was so deep and passionate it shook me to the core. And his apparent lack of appreciation of our efforts perhaps shocked us both.

Truth is based upon knowledge. So, of course, it can be compromised by incomplete knowledge. As a doctor I sought truth through facts. As a pathologist I was now learning that truth could be directly affected by choices I made, by

how many facts I chose to study. It was the first step in what was to become a lifelong examination of the nature of truth.

I reminded myself that I became a forensic pathologist to be a seeker of the truth. That meant I must stand up for the truth whatever pressure I was placed under to massage it.

I had not worked on enough cases to know how malleable a concept truth is for some people, nor how open to interpretation, instinct and inclination are all truths, even those that appear to be

scientific fact. Although there had already been some intimations of truth’s elasticity. In court, for instance. But overall I was still deluding myself that it was always possible to find a moral pathway that everyone would recognize as clear and correct.

Embarrassment is just the kind of worldly concern which I believe the dying relinquish, often perhaps with relief.

There was an orchestra of cigarette lighters clicking outside the door.

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But why is this? Why must I now always be right when it is the human condition to be wrong sometimes? Answer: because the adversarial nature of our criminal justice system has no room for ‘perhaps’ or ‘maybe’ or ‘possibly’.

For myself, I had no regrets. It would have been unbearable if she had been tried for murder on the basis of evidence produced under pressure but against my conscience.

Female stranglers are extremely rare, almost non-existent. Looking back now, tens of thousands of post-mortems later, I believe there is no other female strangler in my files.

They are less common in suffocation but almost everyone dying of strangulation will show them.

Sometimes hypothermia is simply the final step in a tragic pattern of depression and apathy towards eating, heating and personal care.

Hypothermia can be difficult to diagnose in a body after death because dying of cold and the cold of the dead can have very similar appearances.

And the crucial diagnostic finding is the presence of numerous small dark ulcers in the stomach lining.

Families who ask to see the pathologist want just one thing. The truth.

One of the normal phases of grieving is guilt. There was nothing you could have done won’t magically wipe away guilt, but

it may allow it to pass more quickly. I hope so.

That interview changed the way I received relatives and, to some extent, took away my horror at dealing with them. I stopped trying to save the bereaved from their misery and now tried to deliver only the truth as kindly as possible – while accepting that the truth is not always simple and singular. It can be a fractured, fragmented beast.

occurs in the most violent of circumstances, death is finally an experience of supreme release and relaxation.

I’ve come to the conclusion that, while few people actually want to die, when it happens, death itself is probably actually pleasurable.

I have very often heard that phrase: ‘She looked so peaceful!’ In fact, the facial expression of the deceased does not, in my view, necessarily mean that death was peaceful. The calm composure of the dead is simply the result of, I believe, the total relaxation of the facial muscles after death. Given the comfort that look of peace can bring the living, this is one truth I distribute economically, although, if asked, I will

Humans only switch off completely, in one moment, like lights, if they’re vaporized in a nuclear explosion. In all other circumstances, death is a process.’ Death is a process. I’ve used that phrase so many times now.

In fact, these cells can be removed and then grown in a laboratory for some days after a body has been certified dead.

When there is no heartbeat, no breath, and the ECG shows a flat line, that’s real death.

Occasionally people have told me that they knew the exact moment, sitting at a bedside, when a relative died. But they are almost certainly wrong. They are referring to the time that breathing and heartbeat stopped. They witnessed a somatic death. Cellular death takes longer.

the false assumption that we pathologists turn beautiful corpses into mangled meat. Although I’ve met it often since.

The result of this mythology is that, sadly, many relatives who are asked to agree to a post-mortem of their relative will not do so.

Bearing in mind that a relative could be – and quite often is – the murderer.

And perhaps the hardest thing is to see the insertion of that knife not as an intrusion but an act of respect and, yes, maybe of love.

I am ascertaining the exact cause of death and in doing so it is very distressing to be regarded as a mysterious, cloaked butcher. I sincerely hope that those to whom I have spoken directly, or who have heard my evidence in court about the death of their relative, appreciate that I did my job with care. And, I believe, love for humanity. Very gently, I tried to help Alannah’s sobbing family to understand that her body had not been brutally mutilated at post-mortem but respectfully investigated – for their sake, her sake and society’s sake.

Seeing a loved one’s body is a way of saying goodbye, recognizing death’s finality and celebrating a life.

Information, its very solidity and certainty, can provide not just clarity but support, relief and a sound basis from which relatives might, eventually, move on.

she with groaning wardrobes of glamorous dresses,

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