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An elderly man lying by his garden gate in a pool of blood. On the road an elderly woman, dead. Face down. I knew from news reports that this must be Ryan’s mother. She lay outside her burning house. Further on, a man on a path, dog lead in hand. The juxtaposition on that almost-dark August evening between the quotidian streets and the extraordinary random acts of killing that had taken place there was, frankly, surreal. Nothing at all like this had happened in the UK before.
We went upstairs. That rubbery smell of school. And when they opened the classroom door, there were desks. Some of the desks were scattered but most still stood in neat rows. Pinned around the walls were pictures and scientific diagrams. All perfectly normal. Apart from a body, propped up in a sitting position at the front of the class near the blackboard.
Michael Ryan was a mass murderer. He killed sixteen people and there were almost as many wounded. My career so far had focused on the victims of accidents, crime or just bad luck. I seldom saw perpetrators, and had certainly never seen someone who had caused so much death and injury. Could I, should I, treat Ryan with the same respect I showed his victims?
There could be a man lying dead of gunshot wounds and the pathologist would not only examine the scene and the wounds but also, said Simpson, at once demand to see any firearms found in the vicinity. He must then ask himself four questions: Could the wound have been inflicted with that weapon? At what range was it fired? From what direction? Could the wound have been self-inflicted?
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.
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.
Embarrassment is just the kind of worldly concern which I believe the dying relinquish, often perhaps with relief.
It is hard to imagine what our world would be like without the ultimately cleansing process of decomposition, smelly and ugly though it may seem to the living.
There are three ways a body can decompose: by putrefaction, mummification or adipocere, of which putrefaction is by far the most common.
When the next opportunity to meet some bereaved relatives arose, I dreaded it but reminded myself that coping with their emotion was better than contemplating the cruel isolation of the uncared-for. Which didn’t entirely eliminate my dread. At the thought of these relatives I felt something like nausea and even considered saying I was too ill to attend. But I knew there was no escape. I would have to engage with the pain of their loss. Which, I now admitted to myself, meant recognizing the resonance of my own, long suppressed pain.
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.
while few people actually want to die, when it happens, death itself is probably actually pleasurable.
’Tis not enough, your counsel still be true, Blunt truths more mischief than wise falsehoods do.
Death may bring a pleasurable release, but whatever immediately precedes it can, of course, be terrible.
Death is a process. I’ve used that phrase so many times now. During this process, each organ of the body shuts down at a different rate according to its own internal cellular metabolism. And then this in turn triggers further processes which eventually lead to the decomposition and natural disposal of the body. Dust to dust.
For a few hours there might be random heartbeats. Digestion may continue. White blood cells can move independently for up to twelve hours. Muscles may twitch. But that’s not life. There may be exhalation. But that’s not breathing.
When the individual will never again communicate or deliberately interact with the environment, when he is irreversibly unconscious and unaware of the world and his own existence: that’s death.
Of course, that may define someone in a deep sleep or under a general anaesthetic – conditions that are reversible. It may also define someone in a coma or persistent vegetative state. But these patients do have heartbeats and show at least some brainstem activity: that’s not death.
When there is no heartbeat, no breath, and the ECG shows a flat lin...
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It had never really occurred to me before then that for most people I am the dark figure of death cloaked in Halloween colours who has ‘cut up’ their loved one. And it was the first time I encountered the false assumption that we pathologists turn beautiful corpses into mangled meat. Although I’ve met it often since.
Seeing a loved one’s body is a way of saying goodbye, recognizing death’s finality and celebrating a life.
Grief is not an emotion I experience as I incise a body. It is something I experience when I see others suffering their own loss, either within the controlled forum of the coroner’s court or, more informally, at the mortuary or office.
Analytical readers will by now be associating my reluctance at the start of my career to meet relatives with the death of my own mother so early in life. And at my subsequent willingness to engage with others’ grief they will say, ‘Aha! He couldn’t allow himself to experience the enormity of grief for his own loss! So, he experiences it again and again in manageable proportions through the grief of others. And, at the end of the meeting, he walks away from it!’ I accept that there is probably something in that theory.
People always think that by opening the bodies of the dead I will find their secrets locked inside, like someone who cracks safes.
I personally believe every relative who wishes to do so has an absolute right to see the body of their deceased. It is cruel to deny – for whatever reason – a family this chance to say goodbye personally. But the reality is that bodies may be injured, decomposed and smelly. We can do a lot with reconstruction, but we can’t perform miracles. So it may take many hours of talking and discussing, of initially showing photographs of the body, before we can move into the room where the body lies. And then maybe more time again before the relatives will actually look at the body. Spending this time
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Everyone responds rapidly and wholeheartedly to an emergency. Everyone does their best at the time. So, although everyone, no matter how well meaning, should be held to account, it is hard to receive criticism afterwards for actions that may have been taken under extreme pressure in a crisis.
Something vast and unknowable seemed to gape at me. The immensity of death, which I always managed to evade in the course of my work, startled me by engulfing me now.
On the loss of his Father.
The heart is an organ one can hold neatly in the palm of one’s hand. So small but so steady, a little fist, clenching and unclenching seventy times a minute, day and night, year after year, 30 billion times over a lifespan. A faithful friend. Until it stops.
It never occurred to me when I examined the body of Stephen Lawrence that precisely those knife wounds would, over the next twenty years, be the precipitating factor in that change.
Unascertained … means that the child’s death may have been natural but without explanation – perhaps what the jury knows as a cot death. Or it might be that the child died unnaturally but I can’t find out why, or it might be the child died of a natural disease that I am not clever enough to diagnose and recognize …
‘One sudden infant death in a family is a tragedy, two is suspicious and three is murder unless proved otherwise.’
the purity of scientific truth rarely cuts through contemporary social attitudes.
And so, truth, that elastic commodity I once thought so immutable, becomes a question not of fact but of definition.
speak diffidently even when sure I am right, to readily admit the possibility that I may be wrong, to examine my errors and admit to them, to teach or correct others with generous regard for their feelings, never to agree for politeness’ sake with concepts I know are wrong and to accept correction when it is appropriate.
The police’s investigation into Stephen Lawrence’s death was described as ‘palpably flawed’ and I believe it was here that the public first encountered the expression ‘institutional racism’. The inquiry and its revelations marked a significant change in the public’s attitude to the police: they were no longer necessarily the trustworthy friends of the innocent.
You might think that, since we constantly stare death in the face, pathologists don’t need to be reminded of our own mortality. We do. We, too, need prompting by the death of those close to us to get on with the things we want to do in life.
Sir Roy Meadow, the man who produced the extraordinary statistic that there was a 1 in 73 million chance of two children from the same family dying naturally, was publicly discredited. A number of the other mothers he had given evidence against and who were serving sentences now launched successful appeals. His maths was challenged by statisticians and he was struck off by the General Medical Council. He later, much later, won his appeal against being struck off, but by then he was over seventy. One piece of bad, off-the-cuff, maths in court under intense cross-examination was a sad ending to
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Her initial period of consciousness and initial survival after the accident is characteristic of a tear to a vital vein. Her specific injury is so rare that in my entire career I don’t believe I’ve seen another. Diana’s was a very small injury – but in the wrong place.
Her death is a classic example of the way we say, after almost every death: if only. If only she had hit the seat at a slightly different angle. If only she had been thrown forward 10mph more slowly. If only she had been put in an ambulance immediately. But the biggest if only, in Diana’s case, was within her own control. If only she had been wearing a seat belt. Had she been restrained, she would probably have appeared in public two days later with a black eye, perhaps a bit breathless from the fractured ribs and with a broken arm in a sling.
Most people would agree that a civilized society should endeavour always to find, no matter what it costs, the true cause of death. The cost of the trials, the inquest and public inquiry into the death of Stephen Lawrence should serve to remind anyone in any doubt that it is far, far better and far, far cheaper to do all things properly at the start.
I am no stranger to joy. I know that joy can be truly experienced only by those who have known adversity. And adversity is an inevitability.
I couldn’t make the decision to pick up a book, or to open it. I couldn’t make any decision at all. Would I like a cup of tea? I had no idea. I barely knew whether to get up in the morning, let alone bother to get dressed. The future? It didn’t exist. Everything I thought I had known or cared about suddenly had no meaning. Much of the day I simply concentrated on trying not to blink, since I had noticed the images that hovered over me, waiting to kidnap my mind, were quick to pounce when I closed my eyes.
On his experiences suffering from PTSD
My PTSD is not caused by any particular one of the 23,000 bodies on which I have performed post-mortems. And it is not caused by all of them. It is not caused by any particular disaster I have been involved in clearing up. And it is not caused by all of them. It is caused, in its entirety, by a lifetime of bearing first-hand witness to, on behalf of everyone – courts, relatives, public, society – man’s inhumanity to man. The result of this diagnosis? The summer of 2016 off work. Two cures: talking and pharmaceutical. And this book.
I did not want my life’s work, forensic pathology, to be a ghostly, ghastly secret from the public. Because talking about the things a civilized society requires civilized people to do makes all of us healthier.
