Unnatural Causes

by Dr Richard Shepherd

  The following morning I performed some routine post-mortems: drunks, drug addicts and heart attacks, all at Westminster mortuary. While my colleagues asked me for details of Hungerford, the police there were moving the last bodies to the mortuary at the Royal Berkshire Hospital in Reading. When I arrived at about 2 p.m. I was greeted by the staff and then got to know them in our business’s time-honoured fashion, over a cup of tea. A brew was and is regarded as a mortuary essential, both a right and a duty before performing a post-mortem.

  And then the door swung open and Pam Derby bustled in. The room was filled with movement. Pam was our diminutive but crucially important secretary.

  ‘Right!’ she said.

  Always a commanding presence, she was now looking at her most formidably efficient. Two unhappy mortuary assistants struggled behind her with the computer.

  ‘Where can I plug in?’

  This wasn’t a question, it was a demand. Office computers were in their infancy in 1987 and they were very large infants. In fact, ours must have hatched from a dinosaur egg as Pam had to bring it down from Guy’s in a van.

  She saw that I was in my green apron and white wellies, just starting to get the external examinations and X-rays organized. I was ready to go.

  ‘No, no, no, you can’t start until the computer’s warmed up and it takes at least ten minutes or you’ll get too far ahead of me. Make me a cup of tea,’ she instructed. Iain West was clearly deluding himself that he ran the department.

  While the computer and the kettle whirred, Pam sat down at the keyboard.

  ‘Not much point in all this nonsense; they’ve been shot, anyone can see that,’ she said briskly. Pam was familiar with the emotional, unplanned chaos of real homicides. That’s why she and the other staff, for relaxation, often read neatly plotted whodunits, where the murderer leaves clear clues and at the end the pieces of the jigsaw click into place. It’s all so different from the many versions of the truth, the conflicting facts and interpretations of them which are the messy face of real investigations.

  She was right, there were no mysteries ahead today. But each case was a sibling, a parent, a child, a lover. Each was special to family and friends and each presented a unique puzzle for me to solve. The six tables stretched to the end of the room with a body on alternate surfaces: the empty tables in between were to be used for bagging and documenting the hundreds of exhibits we were going to take.

  The first body was Michael Ryan. Probably most bereaved relatives did not wish him to share a mortuary with his victims, let alone a post-mortem room. In fact, everyone just wanted him to go. The press was still hinting with smug glee that he had been ‘taken out’ by the SAS – despite the police press release which confirmed, after my visit the night before, that he had committed suicide. Now we also needed to say that the post-mortem confirmed his suicide.

  A post-mortem, also called an autopsy, is carried out in two situations. It may be performed after a natural death, usually in hospital, despite the cause of death being known, to confirm the patient’s medical diagnosis and, possibly, examine the effects of treatment. The deceased’s immediate family will be asked to agree to a post-mortem and will have an absolute right to decline. Fortunately, many agree. Their decision can help other patients by giving medical staff a superb opportunity to learn and improve. Agreeing to such a request for a post-mortem is, I think, a very generous act.

  The second situation occurs when the cause of death is unknown or where there is a possibility it is unnatural. In this case, the death is referred to the coroner. All suspicious, unnatural, criminal or unexplained deaths have not just a post-mortem but a forensic post-mortem. This is a complete and extremely detailed investigation of the outside and the inside of the body. Afterwards these details are recorded by the pathologist in the post-mortem report.

  The report must confirm the formal identification of the deceased and this alone is often a very long and complex process, and one which occasionally can never be completed. The report also explains why the post-mortem was requested by the police or the coroner. It lists those present while it was carried out. It gives details of any subsequent laboratory tests.

  The bulk of the report is a description of exactly what the pathologist has found. We usually offer some interpretation of these findings and at the end we give a cause of death. If we don’t know why the person died we say so – although usually after discussing the possibilities.

  Despite all our years of training on the macro- and microscopic appearances of the organs in thousands of diseases, just looking carefully at the body before us is often the most vital part of the post-mortem. During this detailed external examination, we measure and record the size, location and shape of every scratch and bruise as well as any bullet holes and stab wounds. This may seem simple compared with our medical analysis of the body’s interior but it has often proved the most important part of reconstructing a homicide. It is all too easy to regard external examination as a mere formality, and therefore to rush it. Then, long after a body has been cremated, we might regret those skimpy notes.

  Michael Ryan was a mass murderer. He killed sixteen people and there were almost as many wounded. My career so far had focused on the victims of accidents, crime or just bad luck. I seldom saw perpetrators, and had certainly never seen someone who had caused so much death and injury. Could I, should I, treat Ryan with the same respect I showed his victims?

  I knew I had to. Feelings have no place in the post-mortem room. I suspect that one of the greatest skills I have learned is not to feel a moral repulsion which others might think is not only justified but required. So whatever I felt about this young man and his actions, I excluded that from my mind and my heart. I knew that his examination required as much, or maybe even more, care and attention than others. Only after a thorough and conclusive physical investigation could I furnish the coroner with the information he needed to confidently give the correct verdict at the inquest. I knew that proof was crucial for this verdict, to quell any future challenges or the inevitable conspiracy theories.

  It was hard to imagine that the slender young man who lay naked on the post-mortem table had just finished a killing spree. Everyone in the room – police officers, mortuary staff, even Pam – stared at him with incomprehension. He looked as vulnerable as any victim of crime, as any of his own victims.

  Then I got on with my job: fully to examine him, particularly the entry and exit wounds in his head. Next to open his body up for internal examination, taking samples for toxicology. And finally to trace the bullet’s trajectory through his brain.

  As I started work, the place was plunged into absolute and total silence. No calling. No rattling. No banging. No kettles or cups of tea. Just silence. Even the temperature seemed to drop significantly. As soon as I had finished, he was wheeled away. No one wanted to be near him, this strange young man who had lived quietly with his mother harbouring an obsession with firearms and thinking God knows what thoughts.

  Now I started on Ryan’s victims, and I could see it would be a long, hard, stressful day. Fridges clanged open and shut as we completed one post-mortem and started another. Apart from this, and my voice dictating to Pam, the room remained silent. I was helped by a trainee pathologist, Jeanette MacFarlane. Pam typed at my dictation and a rolling rota of photographers and police officers followed me from table to table, the most senior taking notes, others taking my exhibits.

  Behind me the mortuary staff worked, cleaning bodies then sewing them up and preparing them for their families to see.

  The deaths were straightforward, all from gunshot wounds. Not one victim had seen Ryan bristling with weapons and simply dropped dead from a heart attack. But it was my job to look for any natural disease that might have caused or hastened death. Once again, I had to carefully document each wound, describe it, analyse it, follow the trajectory of the bullet or bullets. I walked around each body, directing the photographer, measuring wounds, noting abnormalities, chanting my lit
urgy to Pam. Gradually a picture of Ryan’s day of madness emerged.

  Generally, victims who were killed with only one shot had been killed from a distance. If he got close to a victim, Michael Ryan apparently had the urge to fire more often.

  When his mother, a dinner lady, heard from a friend what was going on, she came home to remonstrate with him. The friend drove her to Southside and she walked up the road towards their home, past injured and dead people, approaching her son fearlessly.

  She said, ‘Stop it, Michael!’

  He faced her and shot her once in the leg with the semi-automatic rifle. This brought her face-down on the ground. In my opinion, it was his intention only to maim her with that shot. He then walked up to her, stood over her and shot her twice in the back to kill her.

  These last two shots showed the typical soot and burning around the wound when a weapon has been fired from close range, maybe from within six inches. Perhaps he simply could not look at her face as he murdered her. Until she arrived he had remained in the small area around his house and I personally formed the theory that her death released him to rampage much more widely through the town. I thought this had set him free to revel in the experience of an extraordinary and unaccustomed power, the power his weapons gave him over the unarmed.

  Over the next few days I continued with my strange work, slowly moving from body to body. Death for these victims was an unexpected, violent end to peaceful and perhaps otherwise uneventful lives. Everyone in the mortuary was greatly moved by this, but we could not allow ourselves to give in to our sense of horror, or even to feel upset. Shock has no place in the work of a pathologist. We must seek the truth with clinical detachment. In order to serve society we sometimes have to suspend some aspects of our own humanity. I believe that same suspended humanity powerfully reasserted itself as I flew over Hungerford almost thirty years later.

  In fact, it has taken me all this time to admit that I was very deeply affected by the massacre. I did not then acknowledge to myself shock or sadness, not in any way. My colleagues, alpha males or aspiring to be, were my role models, and they would never have shown or expressed such a thing, nor allowed themselves to think it. No, in order to do this work, I had to remember the professional integrity of the forensic pathologist Professor Keith Simpson that had inspired me in my teens to pursue my training. Was shock or horror something he ever wrote about? No it was not.

  When Iain came back from holiday he did not ask me about Hungerford, he did not offer me advice or refer to the events there in any way at all. It is certain that he was livid with me for taking on such a huge case in his absence, although it was my job to cover his holiday period. Could I have located him to recall him from holiday? Perhaps, and, for this, he would certainly have come. We both knew that such a huge case should have been his: he had dealt with many IRA bombings and bullets; indeed, ballistics was his speciality.

  The face of his fury was froideur, but gradually reports leaked out from colleagues that Iain believed one of the stupidest parts of Ryan’s rampage was to do it while he, Iain, was on holiday. And among ourselves we added that, as if that wasn’t stupid enough, Iain privately thought Ryan was an idiot to shoot himself, depriving the renowned Dr West of a spectacular court appearance.

  For a long time, Hungerford lay between us, but there was no doubt my position at Guy’s, and probably throughout the UK, shifted as a result of my work there. I was no longer the gawking, younger brother and doting follower of Iain. I was a noted forensic pathologist in my own right.

  3

  My strange, emotional flashback to the events of 1987 in Hungerford was all too easy to ignore once I had made the radio calls, turned the plane onto final approach and landed safely. It’s a Cessna 172 that I share with a syndicate of twenty or so other people in Liverpool. It is my pleasure (and my madness, because door-to-door the train is nearly always quicker), to fly to meetings and post-mortems in other parts of the UK and Ireland as often as I can.

  I bounced along the landing strip at the grassy little airfield in broad sunshine, found my stand and shut down the engine. I left the Cessna and saw my colleague waiting for me. I felt fine. As we drove off I began to wonder if I had imagined that something had happened up there. Perhaps I had been short of oxygen in the cockpit? Well hardly, at 3,000 feet. Anyway, I was now sure my reaction could not have been as violent as I remembered. Not a panic attack at all, really.

  As I flew back later, the more variable weather conditions demanded my undivided concentration and I hardly thought about Hungerford. Except to avoid it. It did occur to me then, for the first time, that the pilot’s preoccupation with staying alive, which so powerfully suppresses all other thoughts, feelings and fears, may be one of the reasons I fly.

  Home at last, the clouds cleared to reveal a soft summer’s evening. I made myself a whisky and soda and sat outside on the patio to enjoy the last rays of the setting sun.

  But suddenly, unexpectedly, the pearly summer dusk, and that hushed stillness which accompanied it, reminded me of … Hungerford. Again. My heart beat faster. I felt strangely lightheaded – and I hadn’t taken one sip of my drink. Once more I was moving slowly through a small town’s streets as bodies lay unmoving in pools of blood by lawnmowers, in cars, across the pavement. A sense of dread began to grip my chest and squeeze it hard.

  I breathed deeply. To calm down. I reminded myself that I now knew what was happening. I had established my own mind was playing tricks. Obviously. So, with great effort, I must be able to control it. Obviously.

  More breathing. Close my eyes. I had to crush this, crush it like ice inside curled fingers.

  Gradually my body relaxed. My clenched fist loosened. My breathing deepened. I raised the glass unsteadily to my lips. Yes. Everything was back under control.

  By the time I had drained the glass, I could safely answer the two questions I had asked myself in the plane that morning. No, of course I didn’t need to see a psychologist, and certainly not a psychiatrist: the very idea seemed absurd. And there was no good reason for me to stop practising as a forensic pathologist either. Whatever was happening to me today would soon pass and all would be well. For sure.

  A few months later, in the autumn of 2015, co-ordinated terrorist attacks on Paris bars, restaurants, a sports stadium and a music venue claimed 130 lives and injured hundreds of others. I was out on a call when I heard the radio news. Behind the reporter were the wails of sirens which accompany every emergency and the gabble of shocked voices. Horror’s soundscape. I had to stop the car.

  Sitting in a lay-by near my house, I closed my eyes. But they could still see, and my ears could hear. Ambulance blue lights. Police barriers. Rows of post-mortem tables under the bright mortuary glare, and on them human body parts. Shouting. Police radios. The cries of the wounded. Before me, bodies. In my nostrils, the smell of death. A foot, a hand, a child. A young woman who had been dancing in a nightclub, her intestines unwinding. Men in suits and ties but without legs. Office workers, tea ladies, students, pensioners. Destroyed, every one of them.

  I don’t know which of the disasters I have seen I was looking at now: the Bali bombs, the 7/7 London bombing, the Clapham rail disaster, the sinking of the Marchioness, 9/11 in New York, the Whitehaven massacre … or maybe it was all of them.

  I waited at the roadside for the tidal wave that was engulfing me to subside. When it was over, I was left with a sense of misery and dread. The smell of human decay seemed to linger in the car for some minutes. I took deep breaths. It passed.

  I drove off, shocked but under control.

  Maybe I did need to discuss this with a professional after all. A priest, perhaps? Some person, anyway, whose job it is to receive our weaknesses and offer us strength.

  Involuntarily I shook my head. Of course not. The events in Paris were terrible but I had not been called to help and they were nothing to do with me. I had a thorough understanding of death and no fear of it. The news from Paris had unexpectedly opened up
a seam of memories, but the crevasse had closed again now. Aware of the long night of work that lay ahead of them, I just felt sorry for my French colleagues.

  So I continued my journey. Off to the mortuary and business as usual. Surely I would be just fine.

  4

  From an early age I have had a relationship with death that is both intimate and distant. I come from a comfortable home near London. My father was a local authority accountant who had moved with my mother from the north of England to seek his fortune in the south. There was no fortune but we were well enough off: people who like categories would have called us lower middle-class. My sister is ten years older than me and my brother five. I was the loved baby of the family and we were unusual in only one respect. Our mother had a heart complaint that meant she was gradually fading away.

  She had contracted rheumatic fever as a child and one of the complications of that childhood infection was that her mitral heart valve was progressively damaged. I know that now. Then, all I knew was that she was frequently breathless even after only a little exercise and, unlike other people’s mothers, often had to sit down.

  My big sister, Helen, assured me that my mother had once been a vibrant, laughing woman who mercilessly dragged my reluctant and rather dour father onto the dance floor at every opportunity. Who had set off as a young woman with him on a bicycle-built-for-two on a tour of Europe just when war was about to break out. Who was always the life and soul of the party.

  I liked to sit in the living room listening to my sister’s stories about our mother. Walls, in those days, were rather bare, but carpets overcompensated for this in swirliness. In the corner was a tiny black-and-white television, one in which the white dot at the centre of the screen persisted when you switched off the picture, enduring mesmerizingly for several minutes in the dark. There was a radiogram (a huge combination of record player and wireless), its front covered in gauze, from which issued mainly light classical music of the type considered improving by the aspiring middle classes.