Unnatural Causes

by Dr Richard Shepherd

  No one in the room, not even the coroner’s officer, looked as though the prospect of examining Michael’s brain was very attractive. I decided not to even try telling them how fascinating this would be.

  Michael had been a healthy enough lad although, despite his young age, a hard-drinking lifestyle was already having its effect. His heart was slightly enlarged and his liver fatty, both probably signs of significant alcohol consumption. I was sure the brain would prove the most interesting organ and, as expected, when I lifted it out I found that it was full of blood. The door slammed. I didn’t even have to turn round to know who had left the room.

  I asked the photographer for a picture of the brain whole, knowing that I would have to section it soon to study its histology. I’d probably get a colleague who was an expert in brain pathology to take a look at the slides too. I also needed to carry out a really detailed examination of Michael’s neck, far too detailed for this post-mortem. So I prepared a fixative in order to transport it. The remaining police officers drew back at the intense smell of the formalin as I turned the body over and carefully removed the neck structures with the accompanying arteries, placing this in a mortuary bucket to make sure I disturbed the vertebrae as little as possible.

  ‘Glad I drove here, I can put this in the boot,’ I said, as the mortuary assistant carried the bucket away to seal it.

  ‘You never would have taken it on the train!’ exclaimed PC Masters.

  ‘I sometimes have to,’ I admitted. ‘It looks a bit strange but I just hope the other passengers assume I’ve been out catching tadpoles in the country.’ Certainly, no one would ever guess what’s in the bucket. Unless they could smell it.

  ‘Right then,’ said the cheerful mortuary assistant. ‘Cups of tea all round.’

  I went into the locker room to change and wash. The police officers had appropriated the mortuary’s bereavement room since it was empty, and I found them here sitting in a circle drinking their tea. It was a quiet room, decorated in dull shades. Along one wall was a large tank, two fish swimming up and down it noiselessly. I don’t know why there is nearly always a fish tank in bereavement rooms.

  The chief superintendent’s cheeks were deathly pale. He was not so much sitting in his seat as propped up by it and he was evidently disinclined to speak, glancing at the detective inspector instead.

  The detective inspector asked, ‘So, what do you think, Doc?’

  ‘It will take a while to get you my full report because I’ve a lot of work to do on the brain and the neck to confirm my findings. But I can give you an informal, off-the-record debrief if you like.’

  ‘Yes please,’ he said quickly, exchanging glances with the super. What was it about this case that was causing the top brass so much concern?

  ‘Well, I don’t believe that the punch-up – alleged punch-up – had anything to do with Michael Ross’s death. He was killed by the impact of the car accident,’ I said.

  The detective inspector tried to stop himself but he couldn’t. He smiled. Even the super, still pale and barely sipping his tea, managed to pull his mouth into an approximation of a grin.

  ‘Are you sure?’ the inspector asked happily. ‘How can you be sure?’

  ‘You can see just by looking at him that Michael screeched to a halt very suddenly – he’s got a seat belt injury on the right side of his neck to prove it. I believe that the sudden stop caused severe whiplash to the spine. Once his spine was out of alignment – and according to his girlfriend he was turning the wheel frantically at the time, which might have given his spine an additional rotational problem – the arteries, or at least one of them, running up the sides of the vertebrae, were ruptured. A ruptured artery bleeds into a space around the brain: he had a sub-arachnoid haemorrhage and that is what killed him.’

  ‘Whiplash. It was whiplash!’ said the inspector, beaming at the super.

  ‘A brain haemorrhage …’ muttered the super weakly.

  ‘Caused by impact!’ the detective finished for him.

  I said, ‘You can get a sub-arachnoid haemorrhage for genetic reasons and I can’t 100 per cent rule out a congenital problem yet. But it’s also caused by trauma and in this case the haemorrhage was almost certainly a result of the accident.’

  PC Masters was looking more serious than his bosses. He had been watching the fish swim up and down their tank.

  ‘Doc … how do you know the haemorrhage wasn’t caused by a trauma in the fight; I mean, alleged fight?’

  ‘If the fight had caused the haemorrhage then there would have been a lot more soft tissue injury. There’s just one bruise on the face, which might have been a blow from a fist. I think it’s too minor to have done much but I’ll be checking carefully when I examine the neck. Virtually all the other facial injuries look like windscreen glass to me.’

  The inspector said, ‘But Michael Ross’s family’s asking how he was able to climb out of the car, walk about, smoke, talk, argue, fight. If he had a brain haemorrhage. Until the other bloke, the one with no shirt, hit him.’

  ‘A delayed death is fairly classic for this type of haemorrhage. It can take a few minutes, or even hours sometimes, for blood to spread from the damaged artery up the canal to the skull. He managed to do all those things during the lucidity period that sometimes precedes death from a sub-arachnoid haemorrhage.’

  They all looked at one another.

  ‘So … you’re sure it’s nothing to do with the fight?’

  ‘I don’t think so. But these haemorrhages are found after both pub brawls and road traffic accidents, so I’ll have to do a lot more tests before I can be sure I’m right. I believe the tests will show that Michael was a dying man from the moment of the accident and the fight made no difference.’

  That’s what I thought. The timing, however, was unfortunate, since he seemed to die at the moment the man hit him. I was going to have to work hard to prove my theory, and be prepared to change it, since there was sure to be a second post-mortem.

  The policemen sat back in their chairs and looked at each other.

  ‘If you had manslaughter charges lined up against the man with no shirt, I’d drop them now because they probably won’t stand up. I suppose you might get him for assault,’ I offered.

  They said nothing.

  I asked, ‘Michael Ross had the looks and liver of a rock star: is he famous?’

  They shook their heads.

  ‘So … why do we have a chief superintendent and chief inspector here on a Sunday morning?’

  The super looked at me. So did the inspector. Who paused, then said, ‘Off the record, Doc, we’re here because I thought we were in a spot of bother.’

  I waited. The officers looked uncomfortable. Finally, the super spoke.

  ‘The man with no shirt. The one who hit Michael. He was an off-duty police officer.’

  So that was it.

  ‘We didn’t tell you before because we didn’t want to influence you.’

  I said stiffly, ‘You wouldn’t have influenced me. Pathology tells its own story.’ No, that sounded all wrong. Far too pompous, far too much like someone who was occasionally unnerved by the number of versions of the truth he was beginning to encounter. I added, ‘Even if I wanted to ignore inconvenient truths, there’s usually a second post-mortem, so I couldn’t do that.’

  But the super was not listening. His face still deathly white and his voice low, he said, ‘You don’t know how worried I’ve been about this one. It would look so bad for the force and, between ourselves, a few things have been said about that officer in the past; he loses his rag and … of course, we didn’t want to believe he’d killed a man but his record isn’t … well anyway, what you’ve told us is a big relief, Doc.’

  ‘The thing is,’ said the police constable, who clearly knew the man with no shirt, ‘I can see how it happened. The driver, Michael Ross, he was an idiot to smoke near the car when there was fuel all over the road, and when Mitch told him that, he tried to argue. So Mitch had to
make him stop. I can see that.’

  ‘Persuading an RTA victim to behave safely is one thing, losing your rag with him is another,’ said the inspector.

  Now they knew the officer’s action had not contributed to the death, they seemed able to discuss the matter. Even the super joined in a little.

  ‘Are you going to be all right?’ I asked him as I left.

  He nodded but I thought his face still looked pale and drawn. I wondered then if attending a post-mortem could actually be a traumatizing experience. I had to ensure somehow that it wasn’t. I had done my best today. How could I do more?

  I heard the officers’ voices still debating as I walked down the corridor. I drove home with my bucket and its strange cargo in the boot.

  ‘Pooh, Daddy, you’re really smelly,’ said my daughter. Anna’s never been one to mince words. Jen fell gratefully on her books and I made supper and then, when I was no longer on call, allowed the children to persuade me that we should take the dog to the park.

  I loaded all three into the car.

  ‘Anna, seat belt,’ I said.

  ‘No.’

  ‘Seat belt.’

  ‘Don’t like my seat belt.’

  ‘It’s not the law to wear a belt,’ piped up Chris. ‘Because we’re in the back seat.’ Which in those days was true.

  ‘It’s the law,’ I said firmly, ‘in this car. Seat belts! Now! Or we don’t move.’

  Michael Ross was not saved by his seat belt but I had already seen many, many fatalities that could have been prevented by wearing one. Travelling without a seat belt is a risk I would never take.

  ‘I’m not going to put my seat belt on!’ Anna declared. ‘Anyway, it’s not fair, because Dilly doesn’t have to wear a seat belt.’

  Dilly wagged her tail.

  I said, ‘Right. Then we don’t move.’ And to show how ready and willing I was to sit in the car until she was safely buckled in, I got out my cigarettes, lit one, and proceeded to puff on it until my daughter had fully complied with my health-and-safety rules. Then we drove to the park. I know, I know. But at least I opened the windows.

  From this you will see that my attitude to risk-taking – my own and my children’s – has always been as idiosyncratic as everyone else’s. At least working with death has helped me recognize it can arrive most unexpectedly and therefore I do appreciate the good things life has to offer. So that evening I enjoyed the park, I enjoyed the general laughter while bathing the children and I enjoyed reading them stories and then kissing them goodnight as they snuggled into bed.

  Later, Jen took a break and we sat together in the garden. As usual on a Sunday, we were synchronizing diaries, working out how we were going to manage our various commitments. We couldn’t afford after-hours childcare, so each week our time had to be planned and managed.

  When we had finished, we sat back. With our cigarettes. The evening was so still that the smoke rose upwards in a straight line. It was good to relax as the sun went down. And it was inconceivable to us that it might be possible to relax without cigarettes. We were fully aware of the effect of this: I often found myself looking at lungs which bore the strangely beautiful but deadly patina of smoke inhalation. But we regarded cigarettes as an essential part of our full and busy lives.

  The next day I did some research into sub-arachnoid haemorrhages. I found that victims often show aggression in that period when they appear to be recovering, the period between accident and death during which Michael Ross had started fighting. And alcohol, which frequently plays a role in these haemorrhages, can certainly make matters worse by increasing blood pressure and making rupture of any damaged area more likely.

  It seemed Michael was a textbook case but I still had a lot of work to do. I not only had to X-ray the whiplash injury to the spine but I had to take a series of cross-sections of the spine’s arteries to find the resulting rupture and show how it had caused the haemorrhage.

  The chief superintendent phoned me.

  ‘Michael Ross’s family wants another post-mortem. They think we’re closing ranks and they say that if we don’t charge the off-duty police officer with manslaughter, they’ll file a civil case against him.’

  ‘Did you explain that I found –’

  ‘They weren’t interested in hearing anything from me. They’ve got their own pathologist.’

  ‘That’s not unusual.’

  He named the pathologist the family was consulting.

  I was pleased. ‘Oh, I know him and he’s very good.’

  The super sounded less pleased. ‘Wants to do his post-mortem the day after tomorrow.’

  ‘I’ll be there.’

  When there is a second post-mortem – and there often is, for example lawyers defending clients on a murder charge frequently call for one – it is normal but not required for the first pathologist to be present. I thought it would be both useful and interesting to watch a post-mortem performed by this esteemed colleague.

  Before the second post-mortem, I examined the brain further, reassuring myself that there was no congenital aneurysm that had caused the haemorrhage. And I continued with my slow and careful dissection of the vertebral arteries, photographing every step of the way, until I found the rupture which had caused the haemorrhage. I sent specimens and photos to the Ross family’s forensic pathologist and to another neuropathological expert who was also coming to the second post-mortem.

  Afterwards, the expert and the family’s pathologist conferred and then wrote a detailed report that confirmed all my results. The pathologist agreed that whiplash, caused not just by Michael’s sudden braking but his frantic turning of the steering wheel, had dislocated his spine. This dislocation ruptured an artery carrying blood to the brain, resulting in a haemorrhage.

  He said, ‘The walking about, smoking, talking, arguing and fighting may have accelerated the rate of haemorrhage but I doubt very much whether the fatal outcome could have been avoided. After a few minutes, the amount of haemorrhage became such that Mr Ross lost consciousness and from then on the fatal outcome was inevitable.’

  My post-mortem had pleased the police and the cause of death was certainly beyond dispute when the second post-mortem concurred. But supposing the forensic evidence had not been so clear-cut and the police had put pressure on me to exonerate their officer? A slight adjustment in wording at the end of a report (‘There is a possibility that …’ to ‘It is unlikely that …’) can be enough for the Crown Prosecution Service to bring charges or to drop them. How hard would it have been to resist such pressure if it came from the Met, fostered by the hopes and fears of individuals I worked with on a regular and friendly basis?

  I reminded myself that I became a forensic pathologist to be a seeker of the truth. That meant I must stand up for the truth whatever pressure I was placed under to massage it. I see now that this is just the sort of noble thought a keen young man of limited experience might have. I had not worked on enough cases to know how malleable a concept truth is for some people, nor how open to interpretation, instinct and inclination are all truths, even those that appear to be scientific fact. Although there had already been some intimations of truth’s elasticity. In court, for instance. But overall I was still deluding myself that it was always possible to find a moral pathway that everyone would recognize as clear and correct.

  11

  Someone had to go and speak to a CID training course, and I was pleased it was my turn. There are a lot of police courses and officers have no choice about attending – but some make it obvious they would rather be playing golf or even out on the job than sitting in a lecture hall.

  I was sure of getting their attention today, however, because my subject was the human body after death. The police are seldom present when someone dies. They inevitably arrive after the event, sometimes a long time afterwards. This lecture was designed to help them recognize what they might find.

  I began by explaining that death is a process. And when that process, dying, is complete, it set
s off another series of processes which eventually return us to the earth and complete the life cycle.

  The screen lit up above me and the police officers stretched out their legs. A few sipped their coffee and relaxed with the air of men settling down with their wives to watch a David Attenborough wildlife documentary.

  I didn’t want to give them too much science, so I simply said that oxygen is vital for almost all cells. It facilitates the cells’ multitude of life-sustaining chemical reactions: this is metabolism. On death, when there is no oxygen, muscle cells rapidly become flaccid. They may, for some hours, still respond. To touch. Or the discharge of a dying motor neurone cell. Or other forms of stimulation. As a result, disconcertingly, limbs may even twitch in a lifeless body.

  The eyelids may close or, more often, half-close, because muscles in the eyelid are too flaccid to complete the movement. The response to light is lost; however, there is a myth in some cultures, predominately Asian but also in the West, that the eyes retain the final image they see, so exposing the face of their killer. This was considered as a scientific possibility in Europe in the 1870s. It was called Optography and experiments were performed on individuals before and after execution, but without success. Despite the lack of any scientific proof, the concept took root in the public imagination, thanks in part to authors such as Rudyard Kipling and Jules Verne, who used it in short stories. The idea even featured in an episode of Doctor Who in the 1970s. Once cemented in the public psyche, it has been very difficult to remove. Another old wives’ tale is that hair continues to grow after death. In fact, the cells in hair follicles die with the rest of the skin. The skin, if the deceased is Caucasian, becomes pale on death because blood is not circulating and blood pressure is lost.

  The rings of muscle that control the passage of food and liquid through the digestive system lose their tone, which means that, depending on both the angle of the body and the individual’s internal organs, urine may leak out. Faeces also, but this is less common because of the structure of the rectum.