The Chick and the Dead

by Carla Valentine

  However, I received a panicked call from our producer one morning a week before filming. ‘Carla,’ she said, ‘they’ve sent the donor but they’ve chopped off both her arms. It looks so unsightly – she looks like a turkey!’

  ‘What on earth did they do that—?’ I asked, but never got to finish as she interrupted me with, ‘But they did also mail us one of her arms. I don’t know why they chopped them both off and then mailed one separately. Can you do anything?’

  ‘Are you asking me to come over and sew her arm back on?’ I asked. ‘Because that’s no problem.’

  ‘Would you? Oh my God, you’re a lifesaver! I didn’t want to ask the question – I thought it sounded weird.’

  ‘It’s really not the weirdest question I’ve been asked,’ I assured her – and it wasn’t. I regularly receive queries like ‘How can I pickle my dead kitten?’ and ‘Is it possible to taxidermy my wife if she dies?’ If she dies? To that one I’d replied, ‘Well, it’s better than doing it when she’s alive.’

  And so, a couple of days later, I found myself in a high-tech surgical and post-mortem suite, about to reattach the arm of this poor donor woman who’d had it removed in an incredibly unsightly fashion.

  ‘Are you sure you can do this?’ asked the producer. ‘The edges are all ragged. What did they even use to do it?’ She was in a pretty big flap.

  ‘Don’t worry,’ I said calmly, thinking of all the fragmented cases I’d reconstructed in the past, particularly Railway Man. ‘This isn’t my first rodeo.’

  Once the arm was stitched on, of course it looked heinous, but then I wrapped the join with flesh-coloured sticky bandage. If you squinted your eyes a bit or took a step back you could barely tell it wasn’t her own skin. The relief in the air was palpable. Crisis averted.

  * * *

  The Victorians, with their elaborate Cult of Mourning, are famous for their use of fragmented human remains in jewellery – mainly hair, but sometimes even teeth and bone. They also used these same body parts as a way to express their love for someone very much alive, whether a child or a partner. The practice became rare after the First World War but it does continue in the modern era. When Lucas Unger proposed to girlfriend Carlee Leifkes in 2015, he did so with a ring made from his wisdom tooth. Prior to that in 2011, Guernsey-based couple Melita and Mike Perrett were married after he proposed with a ring containing a diamond and fragments of bone from his amputated leg. So the Victorian tradition continues, and I think it’s lovely that some of the original antique objects, so often mistakenly assumed to be commemorating death, are actually celebrating love.

  We fall in love so that in effect we don’t die: we theoretically live on in the children we’re supposed to procreate. Without the threat of looming death, love may not be a priority or instinct.

  I would never procreate; I knew that immediately after my miscarriage. None of it had seemed right and I felt broken: I was ‘hole’ rather than ‘whole’, keenly aware that where there had been something, there was now nothing. Back then, in that mortuary, at that time, I just couldn’t shake the negativity, no matter how much I tried. Then one of my friends from my school days, Gina, came to my rescue with the offer of a week in the South of France – an opportunity to get away from Grey Britain and the imposing walls of my workplace which were closing in on me every day. I only needed the air fare; accommodation was free. I jumped at the chance.

  And it was just what I needed. We had long chats on the beach at night beneath the brightest stars I’d ever seen, the sharp edges of my exploding pain blunted by the delicious yet cheap and locally produced red wine. I spent the days languidly in the sun, perhaps drinking more wine than I should – this time ice-cold white in two-litre bottles which we’d pick up by cycling five minutes to the local vineyard. Gina went on some excursions – she could speak fluent French and wanted to explore. I, however, just lay there on our veranda, burning in the hot French sun, partly wondering if I could incinerate away the feeling of being tainted since excessive bathing hadn’t been working. I was pretty drunk. It was a bad plan.

  One evening we headed out to the fairground and I was dizzy with the noise and the music and the lights. It was a surreal experience, as though I was dreaming. After so many quiet days the noise seemed tempestuous in my head, but somehow challenging. I wanted to feel something other than what I’d been feeling for too long, so I begged Gina to come with me on ride after ride. Sometimes spinning horizontally, sometimes vertically, sometimes swinging like a pendulum. Then, finally, I told her I wanted to go on the rollercoaster. Maybe an adrenalin rush would get the endorphins going and fix my brain? The rickety apparatus didn’t necessarily instil any confidence in us but, truth be told, it didn’t scare me either.

  It swerved and ascended and descended and went upside down, and I did something I’d never, ever done on a rollercoaster before: I let go.

  Ten

  Reconstruction: ‘All the King’s Men’

  You may see a cup of tea fall off of a table and break into pieces on the floor. But you will never see the cup gather itself back together and jump back on the table … The increase of disorder, or entropy, is what distinguishes the past from the future.

  —Stephen Hawking, A Brief History of Time

  Of course, I didn’t die on that rollercoaster – I was belted in. But that night taught me something about my frame of mind at the time and I knew it had to stop. I had to move on.

  * * *

  I don’t know what had caused my Railway Man to jump in front of an oncoming train, but I had an inkling of what his mindset must have been like. One thing was certain: once he had done it, there was no going back. Time would not rewind. The spectators at the station would not see him consolidate in an arcing red and pink implosion and then land on the train platform, safe and complete. I wondered what had gone through his mind as he leaped. Did he regret it and become filled with terror? Was he grateful for the imminent sensation of peace and relief he had so craved? Or was there time for neither of those things before he was struck by the train’s relentless steel?

  I had plenty of time to wonder about it because I had decided to spend hours reconstructing this suicide victim entirely, to do the best I could to piece him back together. The Coroner’s Officer hadn’t expected his family to be able to view him. Unlike the brief autopsy, the reconstruction process took me four hours, but every minute was worth it to hear the voice on the end of the phone say ‘Sorry, what?’ in response to the statement I had just made.

  ‘I said, his family can view this afternoon, or tomorrow if they like.’

  ‘I don’t understand.’ The Coroner’s Officer was clearly baffled. ‘I thought he was in pieces. The BTP and the recovery team said there was no way he’d be viewable.’

  ‘He was in pieces,’ I explained, ‘but part of our job is to do the best we can to make sure the deceased is in a respectable and dignified state. In this case, actually viewable.’

  ‘Okaaay,’ she said, and I could hear the scepticism in her voice. ‘You’re going to have to talk me through this one.’

  * * *

  Using the phrase ‘all the King’s men’ from ‘Humpty Dumpty’ is not meant to be facetious. Much like the superficially nonsensical Alice in Wonderland is said to contain mathematical references such as the concepts of ‘limit’ and ‘inverse relationships’, ‘Humpty Dumpty’ is often used to represent the Second Law of Thermodynamics. Earlier, when I was describing the ecosystem of a decaying cadaver, I mentioned the First Law of Thermodynamics, which states that energy cannot be created or destroyed, it can only change form. The Second Law states that ‘the total entropy of an isolated system always increases over time’, entropy in this context meaning disorder or chaos. In the rhyme, after the unfortunate egg falls and is shattered into pieces, ‘all the King’s horses and all the King’s men couldn’t put Humpty together again’. The inability to restore poor Mr Dumpty to the way he was before his fall is a representation of this principle.
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br />   This law describes perfectly the reconstruction of the deceased after a post-mortem examination too. APTs are not embalmers and don’t use cosmetics and high-tech superficial methods to reconstruct a patient; they have to begin from the very inside, as though the deceased were a completely cracked egg, and do their best to make them whole again.

  * * *

  Just after hosing the dissection bench and surfaces down, I threw a bucket of warm water and disinfectant over the stainless-steel bench and let it soak for a while. Then I moved to my case, Railway Man. When washing the deceased we’d use the hose too, but the aim was to keep it gentle, to try to avoid blood and tiny particles of tissue being splashed all over the floor and equipment, and creating an aerosol of minuscule blood drops which could be inhaled. The post-mortem tray is usually on a slight incline, with the deceased’s head at the top, meaning that the water flows down the body and tray, then out through a plughole leading to a sink at the deceased’s feet. It might seem strange, this washing of the dead, as though they’re a car or dishes in a restaurant, but in reality, with a gentle touch, it’s not too disconcerting. In one hand I’d hold the trigger of the hose like a pistol, and in the other I’d hold a sponge soaked in a mild, foaming sanitiser. I’d clean the blood off constantly throughout the procedure, not only because it’s mortuary best practice and more dignified for the patient, but also because it stops the blood coagulating on the skin which makes it far more difficult to remove later. The soap and blood mixing together would form a familiar pink lather that slid down the arms and legs of the decedent and swirled around the plughole. It was familiar because I saw it every day, and now, when I wash my red hair, the pink suds that fill the bath and embark on a similar spiralling journey look exactly the same. I feel like I’m straight back in the post-mortem room.

  The part that was disconcerting was hosing the face. Even the gentlest of spray over the mouth and open eyes would cause me to expect a flinch; to expect the eyes to close reflexively against the onslaught, and the head to turn away. But, thankfully, that never happened. The water would just splash across the half-exposed eyeballs and drip into the open mouth of the deceased. I didn’t like it when small globules of debris or fatty yellow adipose tissue became caught in the teeth and against the gums. I couldn’t just spray harder into the mouth – that didn’t seem right. Instead, I used to brush their teeth with a proper toothbrush.

  I’m not sure how many of my colleagues ever noticed that.

  Once the patient had had a first clean down, I’d begin the reconstruction. First, the head. Since the hair was wet it was easier to comb in the same way I did earlier while making the incision: half of the hair up and over the face, half down the back of the neck. Unlike perinatal cases, whose brains are huge in relation to the body, the brains of the adult deceased do not go back into the head. This would be impossible because the brain is such a soft organ – I described it as a ‘mousse’ earlier – and the face has so many natural orifices it would be unsanitary. Instead, I dried the base of the skull with blue roll then took a huge wad of fresh white cotton wool and moulded it into the approximate size and shape of the brain. I placed this into the empty skull cavity, for two reasons: first, it gave shape to the head by allowing me to place the calvarium on top and keep it stable; second, the absorbent nature meant it would soak up any fluid which might leak from the foramen magnum, or any fluids I’d missed with the blue roll.

  With the skull reconstructed, I’d smooth the temporal muscles back into place then pull the scalp over so that one side of the incision joined the other side at the back of the head, with just a small gap between. Then I’d sew, using my pre-prepared needle and PM twine, in the exact same way I’d made the earlier cut with the scalpel – from right to left. I’d push my S-shaped needle up and under the upper flap of scalp, exactly in the middle where the yellow adipose tissue and even the bulbs of the hair roots could be seen. Then I’d push it down and under the lower flap in the same place. Up and under, down and under, and on and on, until I had created a neat seam which resembled the stitches on a baseball. We actually call it baseball stitch.

  After that, I’d dry out the body cavity with more blue roll or a clean sponge and place more fresh, white cotton wool into the pelvis. This replaces the bladder and pelvic organs and again absorbs any fluids before they can escape through the body’s natural orifices. I’d add more cotton wool to the neck for the same reason, as well as to give the neck some shape back, sometimes even forming a little Adam’s apple for the men. This meant that every single organ from the deceased was placed into biodegradable clear bags – the viscera bags. They’re made for this specific purpose – we don’t use bin bags or clinical waste bags. The bag, neatly tied, can be placed into the empty body cavity, and then the sternum, which was previously removed to access the heart and lungs, is placed on top. This, again, gives the patient a natural shape. I’d bring the two main flaps of skin together and stitch the incision in exactly the same way as I’d made that too, from top to bottom, using the same baseball stitch.

  If I’d had to remove vitreous from the eyes of my case, I’d inject saline into them to maintain the intraocular pressure, which would give them back their spherical shape. If I’d taken out false teeth, they’d go back in now. The face would often look more at peace after an autopsy than before. I’d once again wash the body completely and shampoo the hair to remove any grease or residual body fluids. Sometimes I’d clean the fingernails, and if any sores continued to ooze, for example ulcers or sites of medical intervention, I’d wrap them in an absorbent bandage or cover them in a large plaster. Once dried with a towel and placed into a temporary, single-use shroud the deceased looked clean, complete and at peace.

  But the Second Law of Thermodynamics is in action. It’s not possible for us to put every single organ back into its original position by stitching them in place like pieces of a jigsaw, and it’s not possible for us to refill the veins and arteries with the blood of the deceased – this will have disappeared down the drain and entered the sewage system like every other type of waste produced by the population. Quite simply, we cannot put Humpty Dumpty back together again. No one can.

  What we can try to do is such a good job of it that the deceased looks much better and much more cared for after the process of a post-mortem than before it.

  * * *

  My Railway Man was more complicated than this. I had to use the same baseball stitch to secure every severed and partly severed limb: the two hands (at the wrists), one leg (just below the knee) and one foot (at the ankle). I then had to do the same thing all around his waist as he had been practically split into two. What I was left with really did resemble a crude Frankenstein’s monster – as though I’d taken various body parts out of the limb bin and stitched them to a head and torso in order to make my own ‘Adam’. But after I’d wrapped flesh-toned bandage around each join, these ugly indicators of a violent death were hidden. He looked so much better.

  I explained this to the Coroner’s Officer on the phone.

  ‘How long did that take?’ she asked, incredulous.

  ‘About four hours or so. But it was the head that was a lot more hard work.’

  In fact, it had taken me nearly an extra hour to fill the cavity with as much cotton wool as possible then glue some fragments of skull to it with superglue, in what I guessed were the correct anatomical positions. I’d then wrapped the whole head in a white bandage, taking it further down on the left side to cover most of the damaged tissue.

  ‘He looks a bit like Mr Bump, OK?’ I warned the Coroner’s Officer. ‘But he is perfectly viewable – you can see his face quite clearly.’

  ‘Amazing. I’ll let the family know,’ she said.

  I was pleased for the family and I was pleased for him, but I couldn’t stop thinking of the decision he’d made, from which there was no going back, and how I’d diced with such a decision, and how this case had come just at the right time to teach me a valuable lesson.
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  * * *

  Often APTs will say they do what they do for the families of the dead, and of course this is very often true. However, it’s also a way for them to explain why they do a job which can seem so odd to most people. It normalises it. It can be a way to receive some positive reinforcement for the hard work that goes into assisting at a post-mortem, then reconstructing the deceased; a chance for them to be thanked by someone. We all need that encouragement, whatever job we do.

  What I find odd is how few admit that they also do this job for the dead themselves. When I reconstructed the anorexic dentist, no one came to see him or claim him, yet I carried out my reconstruction duties anyway, even going above and beyond what some mortuaries require. This wasn’t for the family; it was for him. I didn’t expect a ‘thank you, he looks wonderful’ from anyone, although of course sometimes, like in the case of my Railway Man, I did receive that type of praise. In general, we APTs thoroughly enjoy working to the best of our ability, most of us like to do as much as we can for the families, and our main purpose is to provide the dead with some dignity as they pass through our care.

  Why, then, are some APTs so quick to censor their activities by frowning upon honest accounts of autopsies in the media or photographs of the procedure released by artists like Sue Fox and Cathrine Ertmann; or by not allowing people to view any part of the post-mortem process (unless they absolutely must); or by euphemising their job as something they do ‘for the living’? If they can’t even admit what their job actually consists of, if they keep the profession shrouded in secrecy, if they don’t illustrate that they are human beings too and that they can have a sense of humour and still be a good pathology technician, then how are the general public supposed to assume those things? It’s as though the profession is creating its own taboo on the dead.