I was so immersed that I had forgotten the tutor, the other students, the smell of formalin. When the tutor spoke, I looked up, blinking in surprise. Around us, there was movement. At another table, a girl had fainted and was surrounded by a circle of concern. Further down the vast room the swing doors were slamming behind someone’s rapid exit. A few more students were heading now towards those doors. One was a friend who was never to return, either to Anatomy classes or medical studies. But among those of us left, there was a new closeness. By dissecting a dead body, we were becoming professionals together. We were joining a very small group, a sect, a tribe. We were initiated. And for me, this maiden flight with the scalpel confirmed my great hope: I belonged here.
As well as Anatomy classes, I was delighted to find that routine post-mortems of patients who had died at University College Hospital were performed daily at lunchtimes and that medical students were invited to view them. And I often did, when a pint of beer and a pie in the Medical Union didn’t demand my attention. These teaching examinations were very different from our careful, slow analysis of layer after layer, muscle after muscle, nerve after nerve of the human body. This was a place where I could watch experts at work. They began by slicing down the midline, as I had in Anatomy – but fearlessly. Then I saw them, with great skill, peeling back layers of the body to uncover the organs and the cause of death. That massive cancer, that diseased pancreas, that cerebral haemorrhage, that occluded artery. I wanted to see them all.
University was full of opportunities: to do interesting things, meet people, study, have fun. What a relief it was when I left home to enter this world. Because home had changed. It had become a tense and sometimes comfortless place.
My father, while loving and caring, could also be irascible after my mother’s death. Very irascible. I well understand where this came from: his adored partner had died and previously shared burdens all fell on his shoulders. He had been left with a young son at home in need of his love and another son who, feeling his mother’s loss acutely, had proved a challenging teenager. On top of it all, my father longed for female company.
Despite his great grief, some time after our mother’s death he did start to meet women. Robert and I didn’t object: our father was unhappy and one of his early girlfriends, Lillian, was a widow who made him – actually, made all of us – feel much better. She was warm and motherly. She laughed a lot. Our own house was rather quiet, a place of shadows, memories and some empty spaces, while Lillian’s was noisy and fun, with good food on the table and friendly guests sitting all around it. And Lillian had parties. Parties! We joined in one Christmas, giggling and fooling with the rest of the guests as an orange was passed down the line from chin to chin.
Unfortunately, Lillian became history. Someone – and the chief suspect was Lillian herself – started a rumour that she and our father were going to marry. He spun on his heel and ran. By then he had turned our mother into something of a saint and perhaps marrying someone else so soon would have felt like less than beatification.
One summer, when we all went on a walking holiday in Devon, our father disappeared, announcing he was looking up an old friend. We noticed that he dressed very smartly for this old friend.
The next day he brought the friend to meet us. Her name was Joyce. She had apparently once worked in the same office as our father, but then had left London for reasons unspecified and retreated to her home in the south-west.
Joyce tried hard to be pleasant. She was middle-aged and nondescript and so sugary sweet to us that she made my toes curl, but I forgave her because I felt rather sorry for her. There was something cowed about Joyce. And indeed, it turned out that she lived with her ill father and her bullying, overbearing mother. Nearby she had a married niece who seemed friendly. Apart from the niece, the inconsequential father and the horrible mother, Joyce was alone in the world.
Her relationship with our father proved to be more than a brief holiday reunion. She began to appear at our home for weekends. She tried to be maternal but she just didn’t know how to take charge of teenage boys. On the other hand, she cooked meals, and these were nothing like the meals my father made. Once she even attempted paella, a dish of some daring in the 1960s. She also tidied up and generally brought more of a woman’s touch to our male household.
‘We don’t need a woman’s touch,’ said Robert. He did not like her saccharine ways and he did not like her inept attempts to fill the gaps. Mother-shaped gaps, gaps where hugs or laughter should be, gaps in the conversation.
I didn’t object to her but found myself retreating to friends’ houses for much of the time when she came to stay. The fact was, she made our father – well, if not actually happy, then at least less volatile. Because hidden somewhere inside that kind and loving man was a volcano. It could erupt at any time. Suddenly. Unpredictably.
When he lost his temper he screamed, he shouted, he threw things, he terrified me. It didn’t happen very often but I always knew the volcano was there, waiting to burst out of him in a red-faced fury, and it was so frightening that once I even wet myself.
We sometimes went to stay near Manchester in the homely, polished house of my maternal grandmother. One morning there, when I was about thirteen, I as usual climbed into bed with my father for a chat and a cup of tea. I was comfortable lolling against his pillows, my body between crisp, linen sheets and a warm mug in my hands, when he suddenly said, ‘I’m thinking of marrying Joyce.’
I wanted to shout, ‘No!’
I said, ‘All right.’
Maybe if he married her he would be happy. And I really did want that. Maybe he would be less prone to mad furies. And I wanted that too.
None of us was invited to the wedding. Our father just drove down to Devon one day and they came back married. For Joyce, it was the escape from her unkind mother that she had dreamed of. Into another kind of jail, maybe, because the running of the house was now placed entirely in her hands. In fact, my father seemed to switch out of domesticity as rapidly as he had once switched into it. Perhaps theirs had been less of a courtship than a job interview. And the job was: housekeeper.
I do believe that Joyce tried to be a good wife. Our home certainly became a feather-duster sort of a place. But for me now there was no escape: Joyce was always there. I couldn’t even invite my friends home because she just didn’t know how to receive people. But she was kind enough, and, thankfully, she soon abandoned her inept attempts to be a mother to me, perhaps because I made no effort to treat her like one.
My father, Joyce, Robert and I were just four people who happened to live in the same house. Even my father distanced himself from her. I cannot call the marriage a happy one. There would be rows and periods of icy fury. Once, to Robert’s and my secret delight, he dumped her with her mother in Devon. But she came back. Then there would be arguments during the day followed by what I realize in retrospect were nocturnal rapprochements. With residual, tooth-grindingly over-loving mornings which didn’t, of course, last long. It was frankly baffling.
Robert went to university to study Law, a subject of which our father greatly approved. I missed my brother but at least his absence meant there were fewer arguments and slightly fewer eruptions.
A year later, Robert reappeared, having failed his exams. He announced that he didn’t want to study Law anyway. He wanted to study Psychology and Sociology.
Result: exploding father.
‘Sociology?’ he spluttered. ‘What kind of a subject is that?’
But Robert did study Sociology and then went on to a successful career teaching it at several universities in France. Where he remained for the rest of his working life.
Helen, whenever she visited, would point out all the things that were missing from our home. I chose not to take any notice of my sister but, as I grew older, I could see that she was right. Our mother was being gradually redacted. Over the years, everything associated with her just disappeared until no ornament, picture, photo, piece of darning, sew
ing basket, book, duster or crockery remained. Poor Joyce might try to replace all these items with something of her own but nothing she bought or did or made could ever fill the void my mother left in that house.
By the time I departed for London, then, it sometimes felt as though Joyce had erased my mother and, to some extent, taken my father away too. All that changed when I was a few years into my medical training. He retired from the council and took a job as an accountant in central London. Now our meetings weren’t confined to my occasional visits home, with Joyce watching on. We could meet for lunch in town, and we did, often. I had time alone with him again.
We always went to the same restaurant in Greek Street. It was so tiny it sometimes felt like someone’s parlour. The food was cheap and delicious and I suspect the kitchens were less than hygienic but it didn’t matter: we had warm, close, father–son lunches here. It was like the old days – I mean, before Joyce. He was relaxed and affectionate and so was I, partly because there was no risk of the volcano erupting in a public place.
Maybe he was beginning to see me as a doctor and an adult; anyway, he was expansive. He told me that Joyce’s ‘niece’ was, in fact, her daughter, fathered by a Canadian airman in the war. Joyce’s mother had brought the girl up and Joyce was relegated to the role of an occasional aunt – a story certainly not unusual in the 1940s. This great secret shame had enabled Joyce’s mother to keep her firmly under the maternal thumb. So, when my father appeared, the middle-aged Joyce saw him as her escape route.
It was easy now to understand why she had been unable to show the slightest motherly feeling towards two teenage boys. She had never been given a chance to mother her own child.
My father even described the misery of his wedding to her and how, driving down to Devon for it, he had seriously considered crashing the car. Not badly enough to kill himself, just enough to evade the marriage. But, typically of him, he had decided he had better go through with it in case Joyce – or more likely her mother – sued him for breach of promise.
I smiled at the way my father tried to be correct in everything he did, and remembered the dictionary he had given me when I was sixteen. In the front he had laboriously written, in a perfect copperplate hand, set inside a box carefully drawn in ink, some lines from Alexander Pope. What were those lines? I had learned them by heart as a teenager but now I could capture only a fragment.
In all you speak, let Truth and Candour shine …
I determined to go back to my flat and relearn all the lines. I remembered that the poem offered a code for proper living and correct behaviour. My father believed in that code and wanted me to believe in it too.
At one of those lunches he told me how, after my mother’s death, he had many times come close to committing suicide. Only the feeling that he could not leave Robert and me stopped him. To cope, he was prescribed Valium. Gradually he weaned himself off it by substituting alcohol to help him sleep and relax. I never saw him drunk: he just had at the most a pint or two of Devon cider each evening, but that seemed to make his loss and his late, unhappy marriage more bearable.
And as well as talking openly about his own life, including his regrets and mistakes, he told me how proud he was of the three of us: Helen the teacher, Robert the university lecturer and me the doctor. And how proud our mother would have been. I was deeply moved to receive this blessing, which really felt as though it came from both parents. Even now, although my mother and father are long dead, I can allow myself to feel touched by those words, delivered in a shabby little restaurant in Soho. How lucky I was to have those adult, honest conversations with that dear man.
After a year, they ended. My father was offered a lectureship in the Department of Management at Loughborough University. This was quite an achievement for someone who had left school at fourteen. He and Joyce now had to sell the family home and move to another part of the country. I did wonder what effect this would have on them but in fact it improved their relationship considerably: no tragic first wife had left indelible fingerprints in their Loughborough house.
Most students returned to their family home for the holidays but this was a habit I kicked early. Summer holidays were spent working and travelling. In 1974, driving up the coast of Italy towards Venice in a Ford Anglia with my mates, blissfully unaware of the political upheavals we had just left behind us in Greece, Tubular Bells on the cassette player … well, it didn’t matter that home wasn’t there for me now that my father and Joyce had moved away. One taproot of my life had shifted just as other roots were forming. I had a new girlfriend and she seemed more like the future.
6
I was almost thirty before I performed my first post-mortem. There had been the usual house jobs in different departments around the hospital, from surgery to gynaecology, from dermatology to psychiatry. Only when these were completed as 1980 ended did I begin to focus on my goal. It was more than ten years since I’d started medical school and I hadn’t even reached the first rung of the ladder to becoming a forensic pathologist, which was to qualify as a histo- (or hospital) pathologist.
In general, pathology is a science that enables us to understand disease by studying it in micro-detail: we name it, find how it is caused, learn how it progresses. Everyone has some sort of contact with a path lab without really being aware of it: all urine and blood samples are sent there, for instance. Of course, staring at so many samples in such minute detail is not glamorous work and, unsurprisingly, the pathology department is always somewhere at the back of the hospital, far away from patients.
Qualifying as a hospital pathologist involves spending a huge amount of time looking at microscope slides, studying both normal and diseased tissue. I have lost count of the hours I spent peering at, for instance, cancerous cells.
I found all this very tedious because I knew that, when I actually reached my goal and became a forensic pathologist, I’d be referring such slides to specialists and seldom looking at them myself. But I had to study this now. There are many pathologists who will carry out post-mortems, if death is believed to have occurred naturally, to establish the exact cause and this would be the next part of my training – because how could I examine suspicious, unexplained deaths and view them forensically if I couldn’t recognize natural causes?
So, there was nothing of the criminal in my first post-mortem. The patient had died at St George’s, Tooting, and the case had been chosen specially for me because it was considered straightforward.
I knew I would be surrounded by senior colleagues and helpful mortuary staff but nevertheless the butterflies in my stomach as I went to work reminded me of my first day at school. Handfuls of rain banged against the bus windows and then ran down them, blurring the world outside, and I longed for the day when I could afford a good pair of shoes which would keep my feet dry and a good coat to keep me warm. I sat huddled upstairs at the front of the bus as it rattled and swayed to Tooting Broadway. I tried to distract myself by rereading, yet again, the medical notes of the deceased. I’d been given them the day before, discussed them with the more senior trainees and almost knew them by heart already.
I had watched quite a few post-mortems at the mortuary and had half anticipated, half dreaded the time when it would be my turn to take up the scalpel here. Like the first Anatomy class, it was a test – no fainting, blanching or vomiting allowed. Not because this would mean the end of my career, but because I knew my colleagues would never let me forget it. The same was true of mistakes. The others would correct me – and then tease me about it endlessly. And I really did want to do well. No cutting my fingers instead of the patient, no making holes in critical organs, no slicing the bowel by mistake. I wanted clean cuts, decisive exposure of the relevant organs, correct note-taking, accurate diagnosis. Plus, a bit of luck. Oh, and a lot of courage.
Most people recoil at the smell of the mortuary. I’d say now that mortuaries don’t smell at all, but it may be that I’m just used to it. Certainly, in those days it seemed to me that the n
ose was assaulted by the whiff of formalin, a smell as acrid as broken branches: perhaps holly in winter or an elder bush snapped in summer. But far more penetrating.
The first sound heard on entering a mortuary is the rise and fall of almost unfailingly friendly voices. And, believe it or not, often those voices may be laughing, as in any office or workplace in the land. In fact, if undertakers are coming and going, I think the word is banter, although I have never heard jokes at the expense of the dead. In my experience, they are always treated with the greatest respect.
The dead’s entrance is unseen by the public. It is usually next to a neat, bright office where arrivals are carefully, no, meticulously booked in and then taken down well-lit corridors to the banks of fridges, ten or fifteen of them, in a solid line.
The fridges are a few metres high. Inside, each has shelving for about six bodies. The dead slide on their trays from their metal trolleys onto their shelf. Clang. The door is shut. Whoomp. The trolley is parked, ready for its next use. Clatter. That is the sound of the mortuary. Clang, whoomp, clatter.
I already knew these sounds and smells well. In fact, mortuaries were just beginning to feel like home. But I can’t pretend that today this familiarity brought any comfort.
‘Cup of tea, Dick?’ offered a kind assistant. I couldn’t even answer him, let alone drink it.
The other mortuary staff were determined to treat my rite of passage as a joke.
‘Er, Dick, make sure you get the right body, would you?’
Etc., etc. I tried to laugh but risus sardonicus – the grim, fixed smile of strychnine poisoning – seemed to have set in.
I emerged from the changing room in my scrubs and found mortuary wellies. They were a deathly white, which, that day, perfectly matched my face. I wore a pair of bright yellow Marigold gloves and an apron. The kit has changed a lot over the years but then the apron was something akin to the aprons worn in abattoirs and butchers’ shops. The gloves were no doubt cheap and good for washing dishes, but they protected you only from germs, not cuts.
Unnatural Causes Page 4