And then, like a miracle, sitting in Clive’s inbox the next morning was the PM request for Mr P. One problem down, but another one to be resolved. We needed to get Mr P on the table. The hydraulics on the trolley refused to work under the strain of the weight, so Mr P was at a level beneath the dissection table and we couldn’t slide him directly on to it. We needed manpower so Graham rang the porters’ lodge and asked them to send two burly porters down to the mortuary. Within ten minutes, they arrived. They were astounded by what they saw and smelled, but they got to work straight away. It took all five of us to do it, but we managed to raise the trolley by sheer force, and quickly pulled Mr P onto the table.
All of which effort only meant another problem: he was on the table, but now we had to get him undressed. Graham was not going to be able to carefully unbutton his clothes, fold them nicely and place them in a bag. They were going to have to be cut up the middle and pulled away (complete with skin and slime) as Clive and I rocked Mr P from side to side on the table; that operation alone left us feeling completely exhausted.
Once undressed, he did not present a pretty picture; both sides of his body were hanging down off the table, he was going a very dark, slimy green, and various blisters had started to appear over his body as his skin began to break down. Graham was doing the evisceration on this body and, although understandably not cheerful, was professional and resigned about it. What with Mr P being so slimy, he explained that he needed to be extra careful of slipping with the knife and taking off one of his own fingers with it. He said that the hardest job with cutting open an obese person is the layer upon layer of fat you have to get through. Once that is done, taking out the organs is a doddle as they aren’t usually so much bigger than those of an average person. He was huffing and puffing, trying to get the fat to stay back while at the same time trying to reach the organs, which even he – and he is not short – could only do on tiptoes. All the tools he was using had sheen to them now from the layers of greasy fat that clung to them. Clive made various comment about how he possibly needed to tie some rope around Graham’s ankles in case he fell in.
And never believe an obese person who tells you they are big-boned; inside Mr P was a small man trying not to suffocate. As it happened, Dr Burberry discovered that Mr P had a deep vein thrombosis in his leg, which can break off and lead to pulmonary embolism in the lungs. He said that he probably got it because he hardly ever moved.
After this, Graham reconstructed the body, which on an obese body usually proves very difficult as the skin will tear when the needle goes through because of the sheer weight you are trying to stitch back together; even if that doesn’t happen, you have to hope and pray that the two sides of the incision down the body are lined up. Graham explained that when he started out, quite often he ended up with one nipple two inches higher than the other! But he now had a nifty way of dealing with the reconstruction of a larger body. He would draw three lines across the body, horizontally, then stitch these back together first, so everything was lined up again. Job done.
That still wasn’t the end of it, though. Clive said that the problem now was that Mr P was a health hazard. His body cavity had been opened and contaminated with gut contents; we had no body bag big enough to put him in and we could not refrigerate him as he was too wide. Clive was worried about the health of those of us working in the mortuary. Although with any body there is a danger of disease and therefore a daily risk to the staff, with an average-sized body, they can be handled safely by being sealed in a body bag and put back into refrigeration. Mr P was lying uncovered, oozing body fluid which was dripping and trickling onto the floor. Clive rang Neville at once to confirm that we could release the body back to the funeral directors as Ed had given them a cause of death and our job was done. Initially the funeral directors were not keen on coming and collecting Mr P; they don’t want decomposing bodies around the place any more than we do.
What the hell were we going to do with him? He could not stay on the table over the weekend forming a puddle on the floor. Clive muttered about the possibility of the mortuary being closed down and all this hitting the local press. He thought about contacting the Infection Control Department, but wasn’t sure how to go about it. He took this problem to Ed who, thank goodness, got to work it. Within the hour everything was settled; although there had at one point been talk of hiring – at a cost of several thousand pounds – a refrigerated lorry just for Mr P, the funeral directors were persuaded to co-operate and come and collect him that day.
Barry Patterson at last left the building just before it was time to lock up for the evening, in a coffin that looked like a wardrobe, and carried by eight undertakers. Another week gone and definitely time for the pub again. I rang Maddie at once.
I had first met Maddie a couple of days into working in the mortuary. She had started at about the same time as me, taking on a job upstairs in the histology lab as a Medical Laboratory Assistant, or MLA; these are the people who do the less specialized tasks in the pathology laboratory. It was part of her job to bring down to the mortuary the products of conception – foetal tissue – for ‘sensitive’ disposal. We clicked instantly and soon became close friends.
Maddie had come to Gloucestershire from Wales with no ties and, since Luke is not the controlling type, we were able to go for a drink after work whenever we felt like it in order to catch up; in this way our friendship grew. That night, I was overwhelmed by what I had seen over the past week or so with Mr Patterson and bent Maddie’s ear about it for the first part of the evening. We had gone to the closest pub to the hospital, but as the evening moved on, it started to become full of underage squealing teenagers so we headed to a place we had discovered in town called The Firestone, an old bar with a modern relaxed feel. They had got it right with this bar when they redesigned it – neutral colours with dark furniture; not huge leather sofas that you just wanted to curl up and sleep on, but sensible drinking furniture, and nothing too soft or too high. We managed to get what was becoming our regular table by the window so we could watch the sights walking by and comment on the usual collection of fashion disasters. Maddie and I were smartly dressed in work clothes so we felt entitled to criticize. We stayed until throwing out time, and then took a taxi back to mine to annoy the neighbours with some loud music and more drinking.
EIGHT
Clive felt that first thing the next Monday morning I should start to eviscerate. I had been handling the organs while doing the weights for the pathologists, so I knew what sort of textures and smells to expect. This was going to be very different though, and I was nervous.
I stood there that Monday morning, in my scrubs, almost shaking. In front of me lay a little old lady, totally unclothed, waiting for me to start the process that would reveal to her family why she actually died. This was the first time that I had worked with Clive in the post-mortem room. Being the senior technician, Clive was responsible for training the new technicians in their evisceration technique, but he had little time for everyday post-mortems due to being tied up in the office with paperwork; that was what Graham and I were employed to do. He went through some basic anatomy which went over my head; all I could think about was how the hell I was ever going to do this. I had seen Graham do it plenty of times, but he was a dab hand; this was about to be very real for me. I was going to open up someone’s mother, grandmother, sister, aunt. And then, was I going to be able to get out the organs intact, or was I going to slice and dice them all into an unrecognizable mess so the pathologist would not be able to work with them?
None of this seemed to matter to Clive, as he encouraged me to place the PM40 onto the body. As I did this, Clive said I had to push down harder on the knife; I needed to cut the skin, not scratch it. As I put pressure on the blade, I could feel it bump across the bone in the middle of the ribs which, I was to learn, is called the sternum. As I reached the bottom of this, Clive suddenly informed me that I now had to take the pressure off the knife. Without even thinking, I pulle
d the knife up and away from the body. I was a bit shocked by the quick instruction from Clive and felt I had made a horrible mistake. He went on to say that I had to be careful at the lower end of the sternum as the stomach and intestines lie just under, and it is quite easy to put the blade through them, thereby causing a spillage of contents which not only would be messy and unpleasant, but also might be required for testing by the pathologist. Clive went on to explain in great detail about the mess and smell this causes, and I got the feeling he was more bothered about that aspect than losing the stomach contents for the pathologist.
I eventually managed to expose the ribs and the intestines, and then folded back the skin to either side of the body, as he told me to do. This was to take a while and Clive got a bit agitated; he eventually lost patience with me. He had shown me at what point you need to cut the intestine, to be able to unravel it, but I only managed a few inches before, in a hurried manner and while trying hard not to show his impatience, he took the knife and finished the rest of the evisceration himself. At least, though, as he eviscerated, he talked me through everything he was doing, and got me to do the ‘easy’ bits, like loosen the lungs from the back of the thoracic cavity, which meant basically just lifting them up. The speed and slickness with which he released the tongue from the bottom of the mouth were unbelievable. Clive never made a mark on the neck and, once he had packed the inside of the throat with cotton wool, you would never have known any different.
Clive went on to tell me about a family that he once had to show the stitching to on a deceased’s head, as they did not believe that he had had a post-mortem. ‘The secret is to cut low around the back of the head, Michelle; that way, when they are laid out on the pillow, the stitching is concealed underneath the head, and with the knots behind the ears, see?’ I was not about to tell him that Graham had already told me this, and just nodded. ‘Then, Bob’s your uncle; nobody but us need know the difference.’ He finished this sentence off with a wink.
He then said, ‘I think you should have a go at reconstruction.’ With that, Clive handed me a large shiny silver needle that was curved at the end. This was threaded with what looked liked carpet twine and, as it turned out, it was. ‘Start from the pelvis up, over and under, over and under,’ he said, leaving me a little foxed. To Clive it was second nature; to me it was piercing someone’s skin and sewing them up with carpet twine.
I had no idea at that time that I would soon get into such a flow, but I actually found it quite easy to reconstruct and my initial fear of piercing a body with a huge needle soon faded. Clive reminded me to stop three-quarters of the way up, as we still had to replace the organs in the body after they had been examined by the pathologist.
Clive next told me that I needed to stay in the post-mortem room because, having worked with the body, I was now contaminated, and that Dr Burberry would be arriving shortly. He then left and so I sat in the PM room alone with the little old lady, listening to the radio and awaiting the pathologist. Within ten minutes, the door from the consultants’ changing room opened, and Dr Ed Burberry entered the PM room. ‘Good morning, Michelle,’ he said with a smile. ‘How are you?’ He must have seen that I was as nervous as hell. I was convinced he was going to ask me a medical question that I had no idea about, and that I would probably forget everything that Clive had told me I had to tell him about the patient in front of me.
I nodded at him and squeaked rather inanely, ‘Yes, thank you, Dr Burberry.’
I should not have worried about striking up a conversation with Ed. It turned out we got on like a house on fire. We spoke freely about each other’s interests and I began to relax in his company. He let me in on a few secrets about Clive and Graham, as he had worked alongside them for so long; he knew how they liked to work and what routines they had. He gave me tips on how to stay ahead of the pathologist during an evisceration and what they expected from their technician while in the PM room.
I finished my first post-mortem session full of knowledge, but the best thing was the feeling that I had done something a step up from cleaning down. I was now, sort of and after a fashion, able to do what Clive and Graham did, and I could now properly help towards the running of the mortuary. And he might be a consultant pathologist, but I was sure I had found a friend in Ed.
When I got home that evening, the first thing I did, after letting Harvey and Oscar out, was phone my parents to tell them I was a fully fledged mortician. I thought about ringing Gramp, but after the conversation we had had when I got the job, I thought it would be better to tell him when we visited him at the weekend.
NINE
On Wednesday the following week, Ed Burberry did the post-mortem of Samuel Chandler who had come into the hospital for an elective operation to remove his gall bladder. Before that he had been reasonably fit; he had had the odd touch of chronic bronchitis in winter, a hernia operation three years earlier, occasional gout and mild hypertension, or raised blood pressure. He had been married for forty-nine years and was a retired local government officer. It had been a ‘keyhole operation’ and had apparently gone well in that Samuel had made a full recovery from the anaesthetic and the surgeon, Mr Wilson, was happy that there had been no technical problems. Two days later, though, he had begun to feel unwell and very soon after that he had become very sick. Mr Wilson went back in and found bile and inflammation all over the abdominal cavity. He had tried to wash this out and then sent Mr Chandler straight to Intensive Therapy, but the poor man died just twelve hours later.
When Graham and I got Mr Chandler out of the body bag, I was shocked at the state of him. He was bloated with fluid that had leaked out of him so that he looked, as Graham remarked, as if he’d been dragged from the river. He was covered in a patchy red rash and there was a liverish tinge to his waxy skin. Something else that I was amazed at was the number of places that intravenous lines had been inserted – one into the crook of each elbow, one into each wrist, one into his left ankle and one (with six tubes spreading out from it) into the right side of his neck. There was a urinary catheter, a tube down his nose and one poking out of his mouth from his throat. Running down the front of his tummy was a long adhesive dressing with two smaller ones just under the ribs on the right. He wasn’t smelling too clever, either.
Graham told me to make a note of all the lines and tubes, but not to start the post-mortem yet because he thought Ed would want to see Mr Chandler as he was. I did as I was told, then we went back into the office for some coffee. Clive had gone to our sister hospital for a meeting, so Graham and I exchanged chat about this and that for half an hour. Ed came in, wished us both good morning, then went into the dissection room. Almost immediately we heard him cry out, ‘Oh, my God! Not another ITU failure?’
When we followed him in, he was reading the notes and looked up to say, ‘Mr Wilson, surgeon to the stars, strikes again, then.’
Graham laughed. ‘Looks like it.’
Ed explained to me, ‘Charlie Wilson is a regular contributor to our workload. He’s a surgeon of the old school, which basically means jack of all trades and master of none. All around him, younger colleagues are coming through and techniques are being developed, and he can’t quite seem to cope with either.’
While he was talking, he was walking around Mr Chandler, checking that I had noted all the tubes correctly, looking for old surgical scars, and recording the swelling of the tissues and the rash.
‘Michelle’s doing this one with you,’ said Graham.
‘Good. You get started while I change. When you take the dressing off the wounds, don’t forget to measure them.’ With that he was off to the changing room, and the bell for the front door sounded, so that Graham left the room too. From watching Clive and Graham, I knew that I could now take out the lines and make the first midline incision, but what I would find when I did worried me greatly.
Inside two minutes, I knew that I had been right to worry. In the few weeks I’d been doing this job, I’d seen a lot of astonishing things �
�� blood filling the abdomen when an aortic aneurysm burst, a liver almost completely replaced by white cancer deposits, an ovarian cyst eighteen inches across – but this topped them. The abdominal cavity is normally a clean place but Mr Chandler’s was filled with curdled, yellow pus. I had to step back and turn away because it not only looked horrible, it stank horribly too and, forgetting his poor stomach, mine began to churn at the sight.
At this point, Ed came back into the PM room and sniffed the air. ‘Eau de peritonitis, I think,’ he said cheerily. ‘Hang on.’ Having put on an apron, a cap, a mask, plastic sleeves and gloves, he came to stand beside me. ‘Forget about removing the intestines first. Just take it all out in one.’ Normally, we tie off and remove the intestines before taking out the rest of the organs, but delving around in that horrible mess would have been vile and probably done more damage than good.
Even so, it wasn’t easy, what with having to reach down so far into the body that I was almost falling in, and with having to avoid splashing. Eventually I got everything out of Mr Chandler and Ed helped me get it all across to the dissection bench. While he set to work, I scooped out the rest of the pus from the abdomen, trying hard not to fill my own mask with vomit, and then set about taking out the brain. Every so often Ed swore loudly (which I tried not to laugh at) as the intestines, made fragile by the inflammation, tore and spilled contents over the dissection table. Usually he could take all the organs out in ten minutes but this time it took him closer to thirty. As I was weighing the organs, he said suddenly, ‘Ah!’ and he beckoned me over, waving the brain knife in my direction.
Down Among the Dead Men: A Year in the Life of a Mortuary Technician Page 4
