Unnatural Causes

by Dr Richard Shepherd

I had probably sounded very sure of myself. And I was very sure. But deep down I have, since childhood, recognized that life is a series of unexpected twists and turns. This knowledge enslaves me. Although it is my job to be certain, I was unable that day, and am still unable, to escape a greater certainty: that there are always other possibilities.

A lot of murderers say, ‘I didn’t mean to kill him!’ What they are actually saying is, ‘I didn’t think that what I was doing would kill him.’

even highly trained professionals want to ‘do something’, when they know full well that the correct thing to do is absolutely nothing.

accuracy was more important than speed.

I loved my job. But, unfortunately, I’d run into turbulent waters lately. First, I was roundly attacked by my colleagues for complying with the police request for a reconstruction of Rachel Nickell’s murder. ‘You’re stepping right outside your area of expertise,’ they said. I pointed out that, actually, I had relied entirely on my expertise for the reconstruction. ‘And this is the way forensic pathology’s definitely moving in America,’ I added. They were unimpressed by the way forensic pathology was moving in America. They shook their heads. They said, ‘When they arrest someone, and the prosecution uses your reconstruction, defence counsel will slaughter you in the witness box.’ By now I’d experienced enough public humiliation as an expert witness to know this was probably true.

I had learned only too well that expert opinion is marginalized by the system and, despite my brief foray into crime reconstruction, I was now firmly back in my box.

There are fads in illnesses, as in most things. Their popularity waxes and wanes according to our perceptions.

We pathologists were called upon to offer a medical and scientific analysis within the context of society’s current thinking and I’m sorry to tell you that the purity of scientific truth rarely cuts through contemporary social attitudes.

truth, that elastic commodity I once thought so immutable, becomes a question not of fact but of definition.

There are few jobs where it is routine to stand up in public and defend your professional opinion in the face of very personal attack. There are, of course, expert witnesses who get the reputation of being a liar for hire. I’m not one of them and don’t like to be treated that way by solicitors asking if I might alter my view a little or delete an inconvenient paragraph in my report. When I chose this career, I thought that I would be conveying the truth about the dead to the living – who would be grateful to hear it. But, as we approached the new century, I instead was starting to feel like the faithful dog that proudly lays a stick at the feet of his master only to receive a hearty kick for his efforts.

This case illustrates that there are facts – and there are the conclusions that can be drawn from them.

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.

It was strange to think of the next generation of Shepherds being grown-up and out there working. Because that meant the last generation must be getting old.

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.

That’s pathologists for you. Miserable, death-obsessed, dour-faced butchers.

And, looking into the future, I could see that pathologists eventually could be tendering for contracts, competing for bodies, even undercutting each other on price. Forensic pathology was a service, but no longer the intellectually rigorous world I had entered, with its scope for debate, study and social change.

One piece of bad, off-the-cuff, maths in court under intense cross-examination was a sad ending to a previously highly distinguished career.

His condemnation by the GMC received wide coverage: his subsequent complete exoneration went almost unreported.

In fact, although the pathologist involved certainly made errors of recording and disclosure, the medical evidence was extremely complex and controversial and huge numbers of experts lined up to disagree with each other in court on almost every aspect of both children’s deaths. The truth in the Clark case, as in so many, proved to be not solid but a rather unpredictable liquid. The courts wanted honesty and truth and then chose to be selective and make their own assessments of highly complex medical issues. No one emerged unscathed from the tragedy of the Clark case. For forensic pathologists, it was certainly a horrible reminder of the huge responsibilities of our profession.

The general rule when presented with a high-profile death is to stop. Do everything slowly. Carry out all procedures correctly and in strict sequence. It is worth following these rules because a celebrity death means that your every action will be questioned for a long time afterwards in public and in private. During the event itself, you are under pressure to get things done right now. In half the usual time and with half the usual information. To give simple answers immediately to complex medical questions. I have learned the hard way that no one says thank you in these cases. Ever. The only comments that are made are critical – you either did something you shouldn’t have done or (more commonly) you failed to do something that, in retrospect, you possibly should have done.

On the Isle of Man, Simpson’s Forensic Medicine, Twelfth Edition had been not just finished but published. My pride in it was tempered by the sense of finality the book’s completion gave me. Reading the third edition had started my career. Was the writing of the twelfth edition a sign my career was ending?

How quickly, in comparison to its length, the marriage unravelled. Perhaps every entity has a limited lifetime. Perhaps senescence is built into relationships just as it is built into the human body.

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.

the first casualty of war is truth.

I cannot imagine how the parents of Baby Noah felt on receiving that judgment. I was so crushed by it that I believe I actually gasped for breath. It was impossible that harsh words from a judge about a Home Office pathologist would not cause considerable repercussions. I had reached the age of sixty and had tried hard to work through medicine in the interests of justice all my life. And now it seemed that balance and justice were being withheld from me.

The unfairness of this possibility made me sit up in bed. I was being accused of poor judgement on the basis of poor photos.

Pathology is a combination of facts, experience and judgement. But the tribunal could ignore this

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 summer taught me that I wanted to finish it, that I did not want my life’s work, forensic pathology, to be a ghostly, ghastly secret from the public.

I can’t call this really a champagne moment. I had travelled too long and too painfully for that. But a weight did lift. The world did look clearer, sharper, as if someone had refocused my lens. For a few minutes, I didn’t know what to feel. GMC investigation or no, a deep fissure had opened up in my psyche which would always be there.

‘Doc …?’ I looked up and blinked at him. ‘I really admire you.’ I blinked harder. No police officer had said such a thing to me before. Ever. ‘You’ve done a job all these years that most people don’t even want to think about. And you’re still fascinated – I can tell by watching you. Here’s some idiot who pegged it, probably because he fell over peeing while pissed. That woman was a hopeless alcoholic who was at death’s door anyway. And you still care about them. No matter what, you care enough to be fair.’ Behind us the mortuary clanged as wagons moved the dead around. Nearby, in the softly lit, pastel-painted bereavement room, a relative sobbed loudly. Around us the group of police officers waited, watching the knife in my hand. I looked at the body before me. Overweight, balding, fingers puckered and whitened, some skin slippage, a bit of decomposition, a lot of bad luck. My fellow man. I tried to respond to the detective’s words with a light-hearted, throwaway line. Something about how I still loved solving puzzles after forty years. But I couldn’t. Because I knew he was right. I did care. And I still do.