When it came to it, Mum took the day off and went with me to the interview, bringing with her Dad’s good luck wishes. I think she was probably more excited than I was. She waited in the café down the road from the hospital while I sat through the second interview, which involved a lot of questions about my personality and, as I said before, why I wanted the job, and how I would deal with situations that I have never been in, to most of which I replied that I would refer to a more experienced member of staff. The twenty minutes seemed to last for ever. At the end I was told I would be contacted that afternoon. I rejoined Mum, who didn’t say much apart from asking me how I felt and did I need a proper drink to settle myself, but when the phone call came through offering me the job and I accepted, she hugged me to the point where I nearly became unconscious. I rang Dad to tell him the news, and he replied, ‘Well done, love.’
I then rang my brother, whose reply was typical. ‘What do you want to do that for?’
Luke was pleased as he knew how much I wanted the job, and suggested we celebrate that evening. Last, but by no means least, was Gramp. He was not a hundred per cent sure as to what I was talking about, so we visited him later that day and explained all. And, while I’m sure he still did not fully understand, he was very proud that I was going to be working at the main hospital.
THREE
I arrived ten minutes early on my second morning at the mortuary (now that I knew vaguely where it was) and was greeted warmly by Clive who had already been in for forty minutes and had the kettle on. He liked to get in early as he always preferred to be one step ahead of the game. Graham arrived five minutes later and went straight into the body store to register the bodies that had been brought in overnight. I followed him through, as I was intrigued as to what this involved and eager to learn more of the routines of the MTO life.
The body store leads directly from the entrance vestibule. It is a large room containing a huge fridge which can house twenty-eight bodies and is fronted by seven tall doors. Opposite these are some cupboards, with a bench top, as well as a sink and waste bins. Every time the porters bring a body into the mortuary, they fill in a sheet that lives on the bench top; it details who the deceased is, where they have come from and which fridge they have been put into, plus a few other facts for continuity. Graham consulted this, and then went to one of the seven fridge doors; when he opened it, I saw that behind it were four metal trays, one above the other, each supporting a full body bag.
He manoeuvred a hydraulic trolley on wheels in front of this, and then proceeded to raise it by pumping a lever energetically at the far end. When it was level with the third tray up, he dragged this out and I saw that it rolled along metal runners. On the outside of the white body bag was a clear plastic pocket containing the person’s details on a small beige-coloured cardboard label.
Graham removed the tag, opened the bag and checked it against similar tags that were tied around the dead person’s wrist and big toe. He did this in a matter-of-fact manner, as if he had done it a thousand times before. Graham is a man of average height, with a pure white head of hair and the cheeks you get from spending a long time out of doors. Very friendly, he is full of stories about everything which he tells in a deep, cosy voice bathed in a broad Gloucestershire accent; I felt very comfortable in his company from the word go. He has no airs or graces and talks a lot about how things have changed.
When Graham opened the large white body bag containing Mr Evans, I was shocked to see what lay before me. Mr Evans was an elderly gentleman, and I expected to see a body that looked as though it was at rest. What I did see was a frail old man with head tilted back, eyes staring wide and mouth gaping open. Graham noticed straight away that I was taken aback. He explained to me about the muscles in the jaw relaxing at death and making the mouth drop open, but not about the eyes and the arched neck. At that point, Clive came into the body store and said that Mr Evans was going for autopsy, so could we take him through to the post-mortem room and put him on the middle table?
The three tables in the PM room each had a delegated technician in order of rank. Clive was on the top table, being the senior technician, and Graham on the middle one, so I figured I would be assigned the third table, lowest in the rank. Clive told us that this had become a Coroner’s case – and would therefore require an autopsy – because the death had happened a week or so after Mr Evans had been admitted to hospital after a fall at home; all deaths that might be the result of an accident come under the jurisdiction of the Coroner and therefore require a post-mortem examination. Apparently, though, such cases as these are usually straightforward. Clive informed us airily that this was probably a pulmonary embolus – a blood clot that forms usually in the leg veins and then breaks off to travel to and block the blood supply to the lungs. I looked at him blankly and he walked away chuckling, saying as he went, ‘You’ll get there.’
This was to be the only PM for the day, so Clive asked me if I would be satisfied just to go and watch Graham take the organs out of the body – eviscerate it – and then help him clean up afterwards. More than happy, I was shown into a small changing room where I dressed in blue scrubs that were three sizes too big and picked from a large selection of white clogs the pair that was closest to my size. I entered the PM room from the opposite, ‘dirty’, door in the changing room. Graham was already there and he showed me a small alcove off the main room which housed disposable hats, masks, gloves and goggles.
Not having a clue what glove size I am, I chose the smallest and then struggled with the disposable hat – I probably ended up looking like the Pope until Graham pointed me in the direction of the mirror. I found myself looking at someone out of perhaps a science fiction film or a medical soap opera; I felt really weird wearing all this protective gear and, once again, was worrying that I was out of my depth.
Graham had stripped Mr Evans and placed a wooden block under the middle of his back so the torso was raised and the spine slightly curved to expose the neck. Graham checked the identification on Mr Evans against what was written on the postmortem request. Having satisfied himself that this was the right person, he told me that identification of the body is our most important responsibility; every so often the wrong body gets eviscerated, and what follows is a tidal wave of trouble. The next of kin, not surprisingly, tend to become upset when they discover what has happened. From the way he spoke, I guessed that he might have committed this sin in the past, but I did not want to pry further because it was obviously painful; however, it lodged at once in my head as something to avoid and something to be worried about.
Graham had a tray of instruments on the table with him, resting on Mr Evans’ legs. From this tray he took a knife; it was about the size of a table knife, but with a disposable blade that looked as though it would cut through steel. Graham placed the tip of this at the top of the torso, in the midline just below the Adam’s apple, and ran it down with a single, easy sweep to end just above the pubic hair. Sticking his fingers in a small, deeper incision that he had made in this slit just under the ribcage, he then cut down through a couple of layers of fat and muscle to expose the guts; he extended this down towards the feet so that all the abdominal organs were exposed. This done, he then began to gently retract the skin from the ribs, slicing it off with practised strokes of a knife laid flat to the ribs, so that within a couple of minutes Mr Evans’ skin was completely free of the front of his body, hanging away from it. It looked as if you would almost be able to zip him right back up.
He rinsed off his knife, which was apparently called a PM40, and replaced it in his tray. After that, he washed off any blood that was on the table, and was telling me about how some corpses ‘bleed’ more than others depending on how long they have been dead as he picked up what looked like a pair of small stainless steel garden shears. He opened them up and put the blades around the lowest of Mr Evans’ ribs on the right-hand side. He began to cut upwards, severing each rib with a crunch and then moving on up to the next until he reache
d the top; he did this on both sides, and thereby removed the front of the ribcage, pulling away a big triangle like a prehistoric crab. This exposed the heart, lungs and most of the liver. He placed the ‘crab’ to one side and moved down the table so that he was over Mr Evans’ bowels, which were fully exposed and waiting to be unravelled.
Next, Graham took a pair of scissors and cut through a piece of gut near the stomach. He tugged at the guts and began to unwind them, cutting as he did so through the fatty membrane that was holding them in place. Within a very few minutes, the bowels were lying in a stainless steel bowl at Mr Evans’ feet. While Graham was doing what he had done a hundred times before, I started to notice the smell. I stood thinking of what it reminded me of. Graham told me how he used to work in a slaughterhouse, and then it hit me. The smell was almost the same as in the butcher’s. By the time I had gathered my thoughts, Graham had loosened the remaining organs from the back of the opened torso – although I missed how he had done it – and he now had his PM40 up inside Mr Evans’ throat, busily working away under the skin, pushing the blade into the floor of the mouth. After a few moments he had cut through this and around the back of the tongue so that he was able to free the mouth and neck organs. What he did then was like some sort of gory magic trick; he pulled the tongue down through the throat, everything still intact, and then he continued to pull everything away from the spine – lungs, heart, liver, stomach, spleen, kidneys . . . It amazed me then – and still amazes me now – how all the organs are attached to each other.
By doing this, he had released all Mr Evans’ organs from his body, and was now holding what he told me was referred to as the ‘pluck’. Grasped firmly in Graham’s hand were Mr Evans’ neck structures, his tongue resting on Graham’s hand while suspended below was every other major organ except the gut and the brain. He placed all this in a second stainless steel bowl, and placed both of the bowls on the dissection bench ready for the pathologist. Graham got cleaned up and we both took off our protective equipment, changed into clean scrubs and went back to the office for coffee. Clive had already rung the pathologist, Dr Ed Burberry, who had told him he would be down at ten thirty to start, so we still had an hour before he was due to arrive. Graham and I took our drinks and went and sat under the canopy outside the double doors to the mortuary to have a smoke.
From here, at the back of the pathology building, you can see loads of staff walking about, but they don’t really see you. It’s as though this place is completely ignored – a blind spot or something that they would rather not think existed – or maybe people are just not aware of it. We went for a little stroll around the car park. ‘So you can get your bearings,’ Graham said. We didn’t get very far, as Graham knew so many members of staff that he spoke to everyone we met; he had worked at the hospital for years and years, first as a driver before joining the mortuary. He introduced me to everyone, but I knew I would never remember them all, and I thought it would take a few weeks till I got my bearings.
After our break, we returned to the post-mortem room and Graham stitched up the lower half of Mr Evans’ torso, leaving the top half open so he could put the organs back when Dr Burberry had finished with them. He removed the wooden block from under Mr Evans and rested his head on it. Taking a scalpel, Graham then cut behind Mr Evans’ right ear and ran the blade around the back of his head to end behind the left ear. He informed me that it was important to make this incision on the head as low as possible. The reason for this is that if a family want to view the deceased after a post-mortem, the lower the incision on the head, the less likely it will be seen as it will be nestling on the pillow. Apparently, the technicians have lots of little such ploys to hide things from people. I thought it was good that Graham had thoughts for the family of Mr Evans, although it somehow made it all feel very real.
Graham then began to retract Mr Evans’ scalp from his skull. This is not an easy thing to do, because the skull and the scalp do not come apart readily; in fact, Graham got even redder in the face than usual as he folded the scalp back to cover Mr Evans’ face. After he had loosened the scalp from behind the ears, he then took a wide wedge of the skull off with an electric rotating saw to expose the brain; this he then removed by sliding his fingers between the brain and the forehead bone, then gently pulling it so that he could put a scalpel under the brain. I asked what he was doing and he explained that he was cutting through a fibrous membrane that held the cerebellum in place, and then severing the cranial nerves and the spinal cord. Having done this, he withdrew the scalpel and pulled out the brain with frightening ease and nonchalance.
Dr Burberry arrived shortly after this. Graham had been telling me that Dr Burberry is the lead pathologist for the department, so he takes the rap for the whole of the department when things go wrong, and has the responsibility for the mortuary. Graham was proud of the fact that he felt he had a normal relationship with Dr Burberry; as he put it, ‘One that two human beings should have. We can talk openly, but we both know where the levels of respect lie.’ I was intrigued to see what Dr Burberry was going to be like; Clive had spoken highly of him too.
Dr Ed Burberry gave off the aura of a very important person. Of average height and stature, he was in his mid-forties and very well spoken. I could see instantly why he was in charge. He wasn’t what I was expecting at all, because he looked relatively normal and not at all the snooty professorial type. He greeted us both with, ‘Good morning,’ and once again, I felt out of my depth, as if maybe I should be cleaning the toilets or something. How was I ever going to be able to hold a conversation with somebody so highly qualified? I suddenly found myself staring at Graham and wondering how this was going to progress. Never had I imagined being in a situation like this. Me, a normal female (except that, OK, I was one with an interest that a lot of people might find odd), Graham, an ex-slaughterman with no desire to better himself, just wanting to do his job and go home; and Dr Burberry, a highly educated consultant, who was about to perform a detailed dissection of Mr Evans’ internal organs, and who would then be able to determine what killed him.
In the event, though, what happened I would never have believed, and you had to be there to see it. Graham and Dr Burberry chatted like old friends, which I suppose they probably were, as they had worked together for a long time. They spoke about cricket, television, the weather and what they had planned for the evening. In the background, Dr Burberry insisted that we have Radio 2 on as loud as possible. As he examined Mr Evans’ organs, he placed them in a plastic tray and Graham weighed them individually, making a record of each weight. While they were doing this, they talked so normally it was obvious that they were immune to what they were doing. I stood in the background, watching in awe. It all felt comfortable and my thoughts of being out of place were starting to fade.
Dr Burberry had finished his examination within thirty minutes and then left the post-mortem room. Graham returned all the organs to Mr Evans’ body and finished stitching him up. I was asked to wash down the work bench that Dr Burberry had been using and disinfect it, which I did with pleasure. I actually felt useful at last.
FOUR
One of the things I had to learn about quickly was the Coroner’s system. The Coroner is effectively a judge – usually a lawyer, although there are some medically qualified Coroners – who has legal jurisdiction over a corpse if no natural cause of death can be given by a suitably qualified doctor. If the medical cause of death is unknown or if there is reason to believe that it may be due to unnatural causes, then the case has to be reported to the Coroner. He then has absolute control over that body – no one, not even the next of kin, can stop him asking a pathologist to do a postmortem and that way find out the reason for the death.
So much to take in. Clive told me that most of our work was for the Coroner because, following the scandals at Bristol and Alder Hey, very few hospital (for educational or research purposes) post-mortems – which require the consent of the next of kin because the cause of death is al
ready known – were being done. This was because families, given the choice, very rarely want their loved ones literally internally examined.
Whether a cause of death is unnatural is not always as clear-cut as you may think, either. Obviously, cases of suicide, violence by a third party (which would require a forensic autopsy by the Home Office Pathologist and not just a Coroner’s autopsy) or accident are unnatural, but so is industrial disease, and so is neglect, whether self-neglect or neglect by someone else.
This leads me on to Amber Court . . .
I had been in my new job less than a week when I met my first body from Amber Court which had come to us for post-mortem. Amber Court is a large residential home on the other side of Gloucestershire; it has a reputation for being low cost and, in residential care as in most things in life, you get what you pay for. It houses a large number of frail and elderly people, and is staffed by the least talented members of society. As long as they can walk and breathe, the owners of Amber Court are happy to employ them; they are paid to do a very bad job and, in return, those in their care are treated with no respect and little, if any, kindness. I imagine a little fat greedy man, sitting in a back office tucked away somewhere, rubbing his hands together at all the money he is making by providing so-called care.
As this is common knowledge throughout Gloucestershire, almost every death they have in Amber Court gets reported to the Coroner. It is his statutory duty to rule out neglect in cases of unexpected death, and that, inevitably, means that most deaths at Amber Court end up having a post-mortem.
Clive did a quick evisceration of an elderly, frail, almost gossamer-thin lady – Mrs Ethel Humbler – that took him no time at all, but it turned out to be fascinating. Ed was on PM duty again, and what he found made everyone stop the banter and friendly insults that were being fired around and led Clive to turn down the volume on the radio. In Mrs Humbler’s throat, wedged right down in the trachea, was a paper napkin. It was almost spooky when Ed flattened it out, because written in the corner was Mrs Humbler’s own name. It was immediately obvious what had happened; in their uneducated wisdom, her so-called ‘carers’ had left her, despite the fact that she had full-blown dementia, to help herself to her own lunch. In her own confused world, Mrs H had obviously felt compelled to consume everything that was laid out in front of her and, with no one around to stop her, she had stuffed the napkin into her mouth. It had become lodged in her throat leading to what I can only imagine to be a lonely and scary death.
Down Among the Dead Men: A Year in the Life of a Mortuary Technician Page 2
