The electric fire glowed warmly, although probably with more light than heat. And the armchairs may have been worn but they were strategically covered by antimacassars. Yes, it was cheering to listen on the loud living-room carpet to tales of that lively woman. But she seemed to have nothing in common with the mother who often languished in bed. Upstairs. Or in hospital.
Her hospitalizations were long and frequent, at least that is how it seemed to me as a boy. I was often packed off to seaside holidays with my grandma in Lytham St Annes, or to my aunt in Stockport, and didn’t discover until long afterwards that this wasn’t so much for me to have fun on the beach or to see my cousin but to allow my mother time for surgery and convalescence.
At home with me, she certainly tried hard to be normal. She got up each morning and packed me lovingly off to school (even very young children walked to school alone in those days). It was only when, one day, I forgot my violin and returned unexpectedly to find her back in bed, that I realized she collapsed between the sheets each morning as soon as I left. She was as shocked to witness my discovery as I was to make it. I fear I was so taken aback that I even chided the poor woman. I wanted her to get better and be that mother everyone said she once had been. But even I could see that she was disappearing before my very eyes.
One day in December I came home from school and found her gone. She was in a hospital I now know to be the Royal Brompton. More tests and more bed rest. She was forty-seven.
I was taken to see her on Christmas Day. My memory of that visit has almost broken beneath the weight of subsequent memories of the many hospitals of my working life. I can dig down through the years, sifting geological strata, until I reach Christmas 1961, but what I find there breaks into fragments when I try to stare at it. It can only be captured in swift, sideways glances.
I was aware that nine-year-olds were generally not welcome on the wards. I was told to be on my best behaviour. Full of this knowledge, I was led down high, echoing corridors. Busy nurses in smart, starched uniforms scurried past us. On each side were vast rooms. A smell of disinfectant. Through faraway windows, the yellowing light of a dull London day. Turning suddenly behind my father into a large ward. Floorboards. A long line of beds, all white, all ready for the next patient. In my memory, all of them empty. Except for one. In it was my mother and, looking back, it seems to me she was the only patient on the ward for Christmas.
I wish I could remember how my mother greeted me, how she looked at me. I expect she hugged me and held my hand. I think she did. I expect I climbed on the bed and showed her the toys I’d received. Maybe I opened some presents with her. I think I did. I hope I did.
A few weeks later, on a cold January morning, I got up early as usual and left the room I shared with my brother, Robert, to cross into my parents’ room and slide into bed with my father. I did that every morning. But today, something was wrong. The bed was cold. The sheets were still tidy. It had not been slept in.
I crept to the top of the stairs. Lights. Lights on in the house early in the morning. And voices. They weren’t speaking normally, as if it were daytime. They were night-time hushed voices, their register strange, singing notes of alarm I didn’t recognize. I stole back to bed and lay there. Waiting. Worrying. Something had happened and sooner or later someone would explain it to me.
Eventually, our father came in.
Horrifically, shockingly, he was crying. We stared at him, Robert blinking because he had just woken up.
Our father said, ‘Your mother was a wonderful woman.’
At nine, that was too subtle for me. Robert had to explain the significance of the past tense, that our mother was in the past tense now. Because she was dead.
Eventually, I learned that my father and sister had gone to visit her as usual at the Royal Brompton the previous evening. She still wasn’t well, but didn’t seem any worse. They wished her goodnight as usual and were just leaving when the nurse took them aside and said, ‘You do realize how ill the patient is? I’m afraid Mrs Shepherd probably won’t last the night.’
This was shocking news because the possibility of her death had simply not occurred to anyone. If it had occurred to my father, or had been suggested to him by medical staff, he had convinced himself it wouldn’t happen. She was in hospital to get better. Family visited her. That’s how things were. No one anticipated an end to it.
In fact, she was a terminal cardiac case. She had heart failure and had now developed bronco-pneumonia, a disease which is often called Old Folks’ Friend because it releases the weak from their suffering. She was certainly unable to withstand pneumonia, even though there were now antibiotics to treat that infection. If only penicillin had been discovered in time to prevent rheumatic fever from damaging her heart as a child.
Years later, when I was a medical student, my father solemnly produced her post-mortem report from some special drawer and asked me to explain it. I told him how her body’s response to childhood rheumatic fever had made chemicals in the blood that killed the bacteria. But those chemicals had attacked not just the infection but also the body’s own tissues – in this case, quite typically, the mitral valve of her heart. This valve, which controls the flow of blood through the left side of the heart, had become so scarred that it was stiff and jammed partly shut. Every time my mother went into hospital for open-heart surgery, the surgeons literally poked their fingers through the valve to free the valve cusps. Result: they flapped more normally again and blood flow between the left atrium and the left ventricle was restored. Or anyway, improved. For a while.
This was why she had so often disappeared to the hospital prostrate and returned reinvigorated. But each time the improvement was smaller.
This was pioneering open-heart surgery for its era, at the forefront of medical science, but it was no way to win a battle against a recalcitrant heart valve which the patient’s own body was determined to destroy. Indeed, by the time I got to medical school ten years later, such treatment had already been superseded. Now she could have been fitted with a new, synthetic heart valve and survived, leading an active life for many more years.
I knew none of this at the time of my mother’s death. I didn’t know what I was supposed to feel, either. Everyone looked at me with tears in their eyes expecting something. But what? I went next door to my friend John’s house. It was a Saturday and the whole family was there. His mother was warm and tearful and John and I sat watching television cartoons together. Even when they were funny, I thought I shouldn’t laugh.
It all happened again soon afterwards when I came home from school and found the house full of relatives and flowers. I worked out later that the funeral had taken place; it had not crossed anyone’s mind that I should go. When I walked in they looked at me tragically. What were they expecting me to do, to say? I felt nothing. Perhaps deep down I simply did not grasp the concept of death. My mother had so often disappeared before and had always come back. Possibly, despite appearances, I trusted her to return again.
When I look back on the early years of my life, on my mother, I remember little and feel nothing of her. Was this because of her frequent absences in hospital and strange lack of presence even when at home? How is it that I remember so much from that time about my grandmothers, my brother, sister, father, aunt … but there is a void where she should be? And I suppose there always will be.
After her death, the most surprising thing happened. My father changed. I think he analysed what we had lost and tried to supply it by becoming both mother and father. He stopped being dour and withdrawn and instead turned into an immensely loving man. My big sister helped a lot, although she was nineteen when my mother died and had already left home for teacher-training college. My father thought she might come back to look after the lads but, wisely, she did not – although she remained the most loving and supportive of elder sisters, even after her own marriage a few years later.
My father managed the house, shopping, cooking and working full-time in an era when th
ere were few single fathers and consumerism was so undeveloped that shops were invariably closed when working people could visit them. He firmly believed it was possible to do anything you set your mind to. So, he rewired the house and painted the kitchen and serviced the car and learned to cook (with, admittedly, variable results). In addition, he somehow arranged his life to accommodate our needs and this involved his discovery of a new ability to give and receive great affection. I look back on all this and feel huge admiration for him.
There is a small black-and-white picture of my father with a large, leggy child, who must be me, enveloped in his lap. Both of us are asleep. This picture is most unusual for its time. Post-war men, on the whole, had been brought up by Victorian fathers and simply did not know how to show their sons such a degree of love and kindness.
He ensured I had a good childhood. I enjoyed school, passed my eleven-plus, loved swimming, went to the local youth club, sang in a choir and had a lot of friends. One of these friends was the son of a GP. When we were about thirteen, to spook us all, he ‘borrowed’ one of his father’s medical books from the shelves at home and brought it to school. It was Simpson’s Forensic Medicine (Third Edition) by Professor Keith Simpson, a small, tatty, red book which promised nothing on the outside. But inside, it was full of pictures of dead people. In fact, mostly murdered people. They were strangled, electrocuted, hanged, knifed, shot, asphyxiated … no hideous fate could escape Professor Simpson. He had seen everything. There was a photo of the fern-like pattern on the skin that a lightning strike can leave, a picture of the inside of the skull of a boy who had been hit on the head with a brick and an astonishing gallery of bullet entry and exit wounds as well as photos of bodies in various stages of decomposition.
I was, of course, by now all too familiar with the concept of death. I had personally experienced many of its repercussions. But I knew nothing about death’s physical presentation. My mother had died in hospital far away and certainly no one had thought it appropriate for me to see her body. Even the most amateur psychologist must deduce that my need to explore death’s presentation was the reason for my extraordinary interest in that copy of Simpson’s Forensic Medicine. More than an interest, it was a fascination. It went further than prurience and much further than the other boys’ eagerness to be horrified.
I borrowed the book and studied it for hours. I read and then reread the text and stared at the accompanying pictures. They were certainly graphic, especially since in those days no attempt was made to spare relatives, so victims’ faces were not obscured.
Perhaps I wanted to view that horrifying thing, the worst that could happen, that thing called death, through the detached, clinical, analytical eyes of the great Simpson. Perhaps Simpson helped me to manage the unmanageable. Or perhaps I was simply excited by this mixture of medical knowledge and detective work.
I’d considered studying medicine. Pathology was interesting but forensic pathology was medicine and then some. I understood that, unlike other pathologists, the forensic pathologist does have patients. Unlike other doctors, though, all his patients are dead. And there certainly could be no comparison with the life of a GP, confronting a line of sniffing people every morning.
I learned that the forensic pathologist was called to any suspicious death at any time of the day or night, and that might mean to the actual scene of an actual murder. His job (it was always a he in those days) was to carry out a thorough medical analysis of the body to help police solve the crime. There could be a man lying dead of gunshot wounds and the pathologist would not only examine the scene and the wounds but also, said Simpson, at once demand to see any firearms found in the vicinity.
He must then ask himself four questions:
Could the wound have been inflicted with that weapon?
At what range was it fired?
From what direction?
Could the wound have been self-inflicted?
And for Professor Keith Simpson, that was all in a day’s work. Thirsty to know more, I read as much as I could about him and fell in love with the way he rushed to crime scenes, often in those days by steam train, and then used his medical skills to help detectives reconstruct homicides, solve the unsolvable, exonerate the innocent, argue the case in court and bring to justice the perpetrator.
My future became clear to me after that. My lofty ambition was to become the next Professor Keith Simpson.
5
I was in an immense, clinical, white-tiled basement in Bloomsbury. Overhead, lights glared. Before me, under a sheet, its shape eerily discernible, lay the first dead body I would ever see.
All the medical students at University College London took Anatomy. There were about seventy freshers, and we knew what Anatomy meant. Dissection. I’d dissected a dogfish at school. Also a rat. Now we were going to dissect a human body.
When I walked down the stairs and smelled the formalin I recognized it at once from the school biology labs. We progressed through the room, passing perhaps forty porcelain tables where dissections were still in progress for the students from the years ahead of us. We threaded our way carefully, knowing that there were bodies under those sheets. Then, when I brushed past one, the sheet fell away at the corner to reveal a huge, hairy gorilla foot. Ha ha, just part of the Comparative Anatomy course. I laughed nervously. We all laughed nervously. Everyone was nervous.
For a lot of people, what we were about to do was scary or disgusting. My own anxiety was different. I was still determined to become a forensic pathologist like Professor Keith Simpson but I had actually only seen dead humans in photos. So how would I react to my first dead body? I knew that if I vomited, fainted, blanched or even faltered (and there were people in the room on the verge of doing all that), then the career I’d set my heart on would be over before it had begun.
Four to a table, wearing our new, crisp, white coats, we gathered around the bodies. These bodies would stay with us throughout our Anatomy course for eighteen months until we knew more about them physically than they could ever have known themselves – but less about them personally than any stranger who had shared a bus ride and seen their face in motion or heard their voice.
While we waited for the tutor, we all tried, in our different ways, to displace our emotions. But the unmistakable curves of those human forms, lifeless beneath the sheets, changed the dynamic in our group. There was a lot of bravado. Some made jokes, others felt obliged to laugh heartily. And eyes met, people held each other’s gazes. A few invitations to date were blurted out. The room throbbed with intense personal relationships under this new and unaccustomed pressure.
Then the tutor started to speak and we stood to attention by our bodies. His words were received in deep, deep silence. The harsh light bounced off the tiles, off our lab coats, off the shiny scalpels and off our now tense, drained faces.
The sheets were removed and there they were. The dead. Grey, still, silent, unseeing. Some people fixed their eyes on the tutor. Others stared at the naked form before them, or at its blank face.
On our table lay an elderly man. His eyes and mouth were closed, his cheeks pronounced, the flesh beneath his chin firm, his hands by his sides, his belly rotund, his knee joints arthritic, his feet wide. Vulnerable and invulnerable. Human and yet not.
We were told when our bodies had died. A whole year ago in my group’s case. This man had nobly bequeathed his mortal remains to medical science and apparently we callow students were considered medical science. He had been embalmed very soon after death and had then been immersed in formalin until he was placed on this table. It was a little while before I came to understand that his curious greyness was a feature of the formalin injected to preserve him and not of death itself.
We were not told the names of our bodies or anything personal about them, perhaps to dehumanize them a little. As I now knew Simpson’s Forensic Medicine almost by heart I might secretly have been hoping for at least a small gunshot wound, but it was explained to us that all the deaths had been f
rom natural causes and that we weren’t anyway looking for a cause of death – although we might come across one. This was simply a fundamental introduction to the human body and how it worked. We would be seeing for ourselves how muscle connects to bone, we would be uncovering nerve fibres, examining the plumbing around the kidneys and the vessels around the heart.
We opened our manuals: Aitken, Causey, Joseph and Young’s A Manual of Human Anatomy, Volume 1, Section 1: Thorax and Upper Limbs. The tutor explained that we would start by cutting straight down the middle of the chest. There was silence as he asked who, in each group, would take up the scalpel. Who was ready to make the first incision into human flesh?
Me, that’s who. This was a big test for me. I had to know if I could do it.
I stared at the dead man’s face, a blank testament to its owner’s long absence. What had he seen? What had he known? He had been a part of the same world as us but in the year since his death that world had changed and moved on and he had not. I looked at his chest. The skin on it was nothing like my skin. It was firm but rubbery.
I picked up the scalpel. I had handled a scalpel before at school but this one felt weighty. How much force would I have to put behind it to cut through human flesh? The eyes of the group were fixed on me. No one spoke.
A hand placed the scalpel on the body’s chest. I watched the hand and realized it was mine. The group craned forward. I pressed down. Nothing happened. I pressed harder and felt the skin give. I had made an incision. I pulled the blade slowly, firmly down. The flesh parted cleanly as I cut, in as straight a line as I could, from the jugular notch to the tip of the xiphoid process. We were going to open this flap like opening a book and inside it read the human body! I wanted to dig deeper, right now, and see what was in there.
Unnatural Causes Page 3