As a new arrival in London, I was entitled to move into NHS accommodation – the place near the prison, asylum and graveyard which would make the perfect horror movie. The building was practically derelict and very unkempt and I couldn’t believe that the people who were helping to save lives in the hospital, such as the nurses, were living there. It was like a Soviet Gulag camp: smashed windows, mouse droppings in the shared kitchen cupboards, barbed-wire fences. Because I also had to walk through a pretty rough housing estate to get to my accommodation I was terrified of having to return after dark. I might be having a coffee with a friend one day and notice the sun starting to set so I’d jump up and run off like Cinderella, trotting down the High Street on foot to get to the Gulag before sundown.
Early nights were probably for the best anyway. At the Metropolitan the system was different from what I’d been used to. We APTs had to be in for seven a.m. and the post-mortems started at about seven thirty as the pathologist, Dr Singh, headed to one mortuary after another, carrying out as many cases as he could. I was happy to get out of the Gulag as early as possible every morning anyway, but on my first day I got a bit lost wandering round the hospital complex. When I did arrive it was slightly later than planned.
‘What the…?’ I exclaimed, on entering that first day. I’d been shown into a small utility room containing a washer, a dryer and several shelves which held what I assumed were clean scrubs, but they weren’t folded or in any particular size order. There was a pile of them on the floor so I assumed they were the dirty ones.
The manager, Danny, said, ‘We’ve got the cases out and ready so just get some scrubs that fit and crack on.’
Easier said than done, I thought, as I eyed up the mismatched pile (some were green, some were blue), but I managed to dig out some coordinating ‘smalls’ and some size 5 wellington boots. It was clear there was no laundry collection service here and the APTs were ‘responsible’ for their own washing and drying. As the only female on the team I was certain this was to become my job from now on.
On entering the autopsy room I again exclaimed ‘What the…?’ There were six post-mortem tables in this new place and every single one of them was occupied. That seemed like a lot of cases, certainly more than I was used to at the Municipal Mortuary, but there were to be three technicians working so it wasn’t too bad. I was just perplexed that everything was in full swing so early in the morning: all the patients were already open, in that they’d each had their sternum removed and their internal organs were glistening under the multitude of lights on the huge PM room ceiling. It was Chris, the assistant manager, who’d dashed through all the cases, whizzing through the process of making the incisions and removing the sterna only, his bald head also glistening under the lights as he moved deftly.
‘Right, here’s what we’re gonna do,’ he said to me authoritatively as Ryan entered the PM room with the pathologist right behind him. ‘You’ve been doing the Y-incision in the last place, haven’t you? Well, we do the I-incision here and it has to be quite low down so the family can’t see it. For today I’m doing all the incisions because I need Ryan to show you something else we do different.’
I nodded my head. Basically, the pathologist was already there and ready to start, so Chris didn’t have time to fanny about with me right now making slow, unfamiliar incisions, i.e. straight lines.
‘Ryan, go over there with Carla and show her the method,’ Chris shouted as he pointed with a bloody PM40 to a male patient on the first table with not only his sternum but also his bowels removed.
I was getting nervous. What ‘method’? Why all the military orders? I hadn’t even had a cup of coffee yet.
Ryan, obviously used to Chris’s curt manner, took me over to the first patient in a relaxed way and said, ‘Basically, we take the organs out in blocks here so I think Chris wants you to practise doing that on all these cases. I’ll show you it so that the doc can crack on with mine, then you can do the other five.’
‘So you mean you use the en bloc method of Ghon, rather than the en masse method of Letulle, usually incorrectly referred to as the Rokitansky Method?’ I said, like a total smart-arse. ‘And you think you need to teach me that?’ I even pulled my visor down and looked over the top of it at him like an annoyed school teacher.
He obviously knew the mechanics of their system but perhaps not the history behind it. He looked at me, surprised that I did. ‘OK – go ahead.’
‘Do you want the neck and tongue?’
‘Nah. I’ll go and start on the next one.’
It’s true that we commonly took out all of the organs en masse at the Municipal Mortuary but I had worked at other mortuaries, sometimes filling in for people off sick, sometimes training, and, of course, there was the mass fatality incident in London. I was used to varying my methods.
The fact that the pathologist didn’t want the neck and tongue removed made this very simple for me. I bent down over the deceased with my trusty PM40 at the ready and sliced across the oesophagus and trachea at the level of the clavicles. Then I carried out my usual scooping check behind the lungs: slap, the left one was unattached; slap, the right one was unattached. All I then had to do was sever the oesophagus, trachea and aorta beneath the lungs and above the diaphragm and there it was: the cardiorespiratory block or ‘pluck’. This contained only those organs necessary for respiration – the lungs and, of course, the heart – which were within what is known as the mediastinum: the central compartment of the thoracic cavity. It allowed the pathologist immediately to focus on the dissection of the heart – the most important organ in terms of cause of death – without waiting for the rest of the viscera to be removed. Statistics vary, but in general coronary heart disease (CHD) leading to heart attacks and heart failure is the main cause of death both in the UK and worldwide. Yet experts say that most cases of premature death from heart disease are completely preventable. Smoking, being overweight, having high blood pressure and/or high cholesterol, heavy drinking and physical inactivity are all key risk factors.
Why don’t we take the heart more seriously, as a culture? This precious organ is literally the epicentre of our physiological existence and is also symbolically so important. The Ancient Egyptians believed that the heart and not the brain was the source of wisdom in humans (as well as the soul, the personality, the emotions and memories) and it was therefore one of the only organs left in situ during the mummification process. In the fourth century BC the heart was identified by the Greek philosopher Aristotle as the most important organ in the body, ‘a three-chambered repository that was the seat of vitality, reason and intelligence’. However, in the second century AD our Mel Gibson of Medicine, Galen, considered the heart to be most closely related to the soul (as we do today), and some of my favourite historical quotes on the heart’s function come from him. ‘The heart is hard flesh, not easily injured,’ he said. ‘In hardness, tension, general strength, and resistance to injury, the fibres of the heart far surpass all others, for no other instrument performs such continuous, hard work as the heart.’ I like to think of this ‘hard work’ as being emotional as well as physical. I’m certain everyone reading this will have had their heart take an absolute battering at some point in their romantic lives, but of course the pain does go away – eventually – and the heart recovers.
In the twelfth century, the popularity of medieval courtly love caused another switch in opinion and cemented the connections between the anatomical heart, the heart shape that we now see on all our Valentine cards (which is called a ‘cardioid’ in geometry) and the idea of romantic love. The heart was used to symbolise this courtly love on banners and shields; then, despite the Church attempting to monopolise the symbol for their images of the Immaculate Heart of Mary and the Sacred Heart of Jesus, the heart penetrated further into the public domain when, around 1480, it was chosen to represent one of the suits of cards.*
I held at least one human heart in my hand nearly every single day of my life as an APT, and this
day was no different. Washed clean beneath running tap water, its thick dark blood clots removed and swirling down the plughole so it was ready for the pathologist to dissect, this organ was still a miracle to me, no matter how familiar the process. The fact that it did look like the cardioid shape on a Valentine card; the fact that it fitted in my hand yet contained the electrical impulses necessary to keep humans twice my size alive; the fact that it could stop beating and start again in certain circumstances – all of those things ran through my mind each time I held one, and I felt I could hear my own heart beat louder in recognition of its power. In the cartoon from the 1980s, He-Man used to hold his sword aloft and shout ‘By the power of Greyskull!’ and light would flow from the sword and change him. I wanted to do the same thing: I felt like, if I held a heart high above my head, beams of light like those from the Sacred Heart would radiate from it and I could shout, ‘I have the powwwweeer!’
I obviously didn’t do that.
I’m not the only one who understands the heart’s majesty. Nowadays, at the museum, I teach people to preserve organs in glass jars using the same method I would with the rest of the collection. I always give a choice of kidneys or hearts and it’s inevitably the hearts people want to preserve or ‘pot’. They poke them tentatively with gloved fingers, pore over them (usually working in twos), and exchange them when they’re finished. ‘Here, have my heart, darling,’ and so on.
The heart is a fragile yet potent item. In some ways, it’s just as Galen said, resilient because ‘no other instrument performs such continuous, hard work’. But in other ways, the heart can be as fragile as a dried flower and just as easily crushed.
I must have stood there thinking for far too long because Chris suddenly shouted to me, ‘Get a move on, girl – we need to race and see who can open the bodies the quickest. The loser buys everyone lunch.’
* * *
Since there were six post-mortem tables in this new place – much larger than my last – we’d autopsy up to five or six adults a day on a rota system, and there was no way I was getting out of autopsying bariatric bodies here: at the Metropolitan I had no special treatment due to my size. Each week, a specific APT was assigned to office work only, a specific one to perinatal (baby) PMs only, and the other two or three APTs would handle the rest. As there were a few of us, all very experienced, the cases could all be finished by ten a.m. I was not used to that. At the Municipal Mortuary I was used to two autopsies and their paperwork taking us right up to lunchtime around one p.m. I was used to undertakers arriving throughout the afternoon to bring in cases from the outside or to collect decedents for funeral homes. As I had been ‘a trainee’ there, it had been my job to answer the ringing doorbell and become proficient at dealing with the paperwork. I did it so often I developed a Pavlovian response to any type of ‘ding-dong’ noise.* Now that there was always someone designated as the office worker here, I didn’t have to answer so frequently, and we had an intercom rather than a doorbell.
The situation was inevitably going to feel different for a while. One thing I found particular to London (or perhaps just my new mortuary) was the use of the word ‘cunt’. Up north, that word is like ‘Voldemort’ – something that shouldn’t be said out loud. If you used it in an argument the whole room would go quiet. At the Metropolitan it was used like punctuation, and peppered nearly every sentence: ‘Make me a cuppa tea, you cunt’ or ‘Go and measure the bodies, you cunt’. Here a cunt, there a cunt, everywhere a cunt, cunt.
In that place I couldn’t move for cunts.
* * *
I don’t know what it’s like to have children, but I think my experience working at the Metropolitan gave me an idea of how it could be. I’d known it would be a male team, but in contrast to the mixed-gender situation at the temporary mortuary for 7/7, this place had a different dynamic. There was a lot of testosterone in one small place. Of the more junior ATPs, the more evolved Josh brought some welcome sensitivity and common sense into the environment, but Ryan was more outwardly confident. Although I thought of them as the Terror Trio (I excluded Josh), all four men were either related or very close family friends who’d known each other for years. As a result, they had a bond with each other that left me feeling as though I was on the outside, looking in.
I don’t think I’d ever been in such a close-knit situation with so many men in my life, and, given that I had undergone such a dramatic upheaval, the problems that would eventually occur were inevitable. I was too vulnerable. Normally fairly tough, among these men I was like a fragile flower; it just wasn’t the right situation for me to be in. For that reason, when I look back on the time I spent with the ‘boisterous’ boys at the Metropolitan, I try to see the best in it despite all their escapades. However, they were constantly scrapping and joking and their mock insults extended to practically everyone, whether inside the team or out.
There was an undertaker who would come to the department every now and again and he had a deformed hand. Two of my colleagues would carry on a conversation with him, acting as normally as possible, yet all the while trying slyly to squeeze the word ‘hand’ in, like some sort of dare, to see who could do it the most.
‘Let me give you a hand with that,’ said one, exaggerating the word.
‘Nah, I’m sure he can handle it,’ said the other, with a wink.
‘Well, if you change your mind we’ll be all hands on deck,’ replied the first.
I knew the undertaker could tell they were making fun of him and chose to ignore their remarks and rise above it, but it can’t have been easy to be on the receiving end of a prank like this. I was unhappy, not necessarily with the job but with the accommodation difficulties, the upheaval and the general atmosphere. It was a cocktail of negativity. Perhaps I was living above an Indian burial ground after all? A month or two after my arrival I managed to find myself a cheap room in a shared house just by the tube station and ten minutes’ walk from the mortuary. Saying goodbye to the Gulag was a much-needed boost, but I was still living with strangers – forced to by London prices. After previously having my own little Rose Cottage it felt like a huge step down.
A certain level of strength is something we are all born with, and then, as we grow, we learn to be stronger. I’ll freely admit I did not feel strong at that time. Alone and lonely, working hard from seven a.m. to keep the negative thoughts at bay and attending the gym every night to avoid going back to a house of people I didn’t know, I was becoming fatigued. Even my long-distance boyfriend was noticing my lack of enthusiasm and energy for nightly phone calls. Carrying out four to five adult autopsies and dealing with riotous men daily was physically draining but it didn’t distract me from exercise. I’d remove my scrubs at the end of the long day, throw them into the washing machine with the others and change into my shorts and vest for yet more physical exertion at the gym. But for some reason, that didn’t stop one of them from commenting that I was gaining weight. ‘You go to the gym a lot but by the size of you, you must be going home and stuffing your face!’ he said to me one day. Bear in mind he was no oil painting himself and in no position to point fingers, his comments made me paranoid, made me question myself. Was I gaining weight? I couldn’t understand how it was possible – I was barely ever sitting down and I barely had time to eat. So I started going to the gym twice a day, still attending my usual leisure centre in the evenings but fitting in forty-five minutes at the hospital gym at lunch, too.
The weight gain, thankfully, was temporary – a simple side effect of my new contraceptive pill. The barbed comments from my colleagues, however, were not. They were either directed at me, at each other, or to visitors coming in. It was exhausting trying to keep an eye on them or work out how or what they would do next. Some afternoons, their morning antics must have fatigued them because one might pull the office blinds down and actually take a nap. Relief would wash over me; in the silence, I’d feel like a parent who could finally relax. I’d make a cup of tea and study for my Diploma, dealing with any
visitors as they arrived, ‘shushing’ them and closing the door of the office quietly behind me as I did so, in order to make sure the sleeper did not wake up.
When they finally did, towards the end of our day, about three p.m., I’d wander into the PM room, despite all our cases being completed and the room having been cleaned. I’d go on tidiness detail: bleach the scalpel handles, use forceps to pull old hair from the drains, organise drawers and trays, wash all our scrubs in the washing machine, fold the ones that had been washed and dried then put them all in size-order, colour-coordinated piles. Anything to just be doing something. If there really was nothing to do I’d wander away from them to the place where we carried out viewings and let the silence wash over me like an elixir.
The Chick and the Dead Page 13
