I made a note:
Contused and abraded irregular ligature mark across the front of the neck extending from the right angle of the jaw to 2cm lateral to the left angle of the jaw. Level with Adam’s apple. Deepest bruising either side of Adam’s apple …
I checked very carefully all around the neck wound for other relevant marks. I’d seen cases of strangulation where the line of the ligature was surrounded by scratches or bruises, indicating either that the victim was trying to pull the ligature off or, where the ligature mark overlay groups of bruises, that the assailant had attempted manual strangulation before grabbing the ligature. But there was nothing like that here.
‘She said she used his tie,’ the detective sergeant told me.
The inspector shook his head. He had said it before and he said it again: ‘She’s only a little slip of a thing.’
‘Tiny little girl,’ agreed the detective sergeant. ‘I suppose if your life’s in danger you somehow find the strength.’
I documented in detail the scarring of the wrists, the scratch marks on the back of the left arm and the defibrillation marks, measuring them and defining their location.
‘We’ll have the tattoos and the wrists, please,’ I told the photographer.
He took close-ups of the graphically illustrated tattoos: the cartoon character Top Cat and, on the right upper arm: LOVE. Below it, in larger letters, was HATE.
Since a relative had already identified Anthony, we didn’t need the tattoos for that purpose but routinely photographed them anyway. In those days before DNA evidence was used, many a body was identified by tattoos, particularly if early decomposition defied other means.
Although the ligature mark was so significant, I now checked for other indications to confirm Anthony had been asphyxiated. The first tell-tale sign was the redness of the skin on his face, caused by the obstruction of the thin and easily compressed veins in the neck. The arteries serving the brain are much wider and more resilient to pressure and so the blood can still enter the head through them – but, because the veins are obstructed during asphyxiation, it cannot return to the heart. However, the main indicator – whether asphyxiation is the result of choking, suffocation, strangling, or some other cause – is found in and around the eyes. Many, or even most, people develop multiple tiny pinpoints of blood on the conjunctivae, the inner lining of the eyelids, when asphyxiated. These are called petechial haemorrhages: similar pinpoint haemorrhages can also develop, rarely, when someone coughs or sneezes violently. They are less common in suffocation but almost everyone dying of strangulation will show them. As did Anthony. I held his eyes wide open with forceps so that the photographer could see them. Snap–flash!
I measured Anthony’s height (5’11”) and then turned him over so that his back could be photographed. There was a gasp from PC Northern. I felt ashamed for a moment that I’d forgotten him and my intention to steer him through this, but then, I hadn’t made a single cut yet. When I looked up, I saw he was staring at Anthony in horror.
‘Oh my God, she beat him black and blue!’
I shook my head.
‘No, no, that colouration is just one of the normal processes of death.’
He stared at me uncertainly.
‘It’s called hypostasis. Some people call it lividity. I know it looks like bruising and it can be really alarming the first time you see it. But it’s absolutely normal.’
I explained in some detail the science of hypostasis, how it is gravity’s pull over the red blood cells after death which creates such shocking purple areas. I also pointed out how forensically valuable it can be. Since the laws of gravity dictate that the staining always shows at the lowest point, it reveals the position the body has lain in after death. But, if the body has been moved to a different position, then an overlapping pattern, like a shadow, will tell the story. Hypostasis can be misleading though. Somebody dying face down, nose pressed into a blanket, will have a livid face with blanching around the nose and mouth: normal hypostasis. It is too easy to assume from this that suffocation has taken place, and I have known many a pathologist fall into this trap.
Now that Anthony lay on his front, I could minutely examine his neck below the hairline. There was no sign of any ligature mark here. Nothing. I called the photographer over to record this and then turned Anthony over again. Here was the mark, right across his throat, and only his throat.
Since I hadn’t made a cut yet, PC Northern might have been hoping that by some miracle I wouldn’t need to. He had been sufficiently interested in hypostasis to relax, or almost. Then I picked up my trusty PM40, large and heavy. Through my earliest years of performing post-mortems on sudden natural deaths, there had only been its little cousin, the scalpel. As I moved into forensics, the PM40, a knife specifically designed for post-mortems, with bigger, removable blades, had begun to dominate and by now it had long been every pathologist’s best friend.
Its handle slipped easily into my palm, its weight felt reassuringly familiar. Suddenly all chat ceased and the tension in the room was almost palpable. I heard PC Northern take a deep breath as if he expected it to be his last for some time. But for me, picking up the PM40 felt good, as though I were a conductor picking up his baton. The orchestra is about to play.
I made my usual first cut, straight down the middle of the chest.
I said, ‘We can all see that Anthony was strangled, and we have a statement to that effect, but I have to check that there wasn’t some other cause of death. A natural cause, perhaps. A heart problem, for example, or maybe he had a condition that might have made him especially vulnerable. I’ll have to examine all his organs to establish that. But first, of course, I’ll have to examine the injuries inside the neck, beneath the ligature mark.’
No response from PC Northern.
I carried on working, talking all the time.
‘The internal damage caused by strangling may not be very dramatic. Anthony was just twenty-two. At his age, the cartilage in the larynx and around the thyroid is still pliable. In older people, it becomes increasingly calcified and more brittle so it’s more likely to be broken during strangulation.’
PC Northern inclined his head in something like a nod. Or was he trying not to retch?
‘Strangling has interested pathologists for generations because nobody fully understands the mechanism that causes death,’ I continued. ‘It was once assumed that victims were asphyxiated. Even today most lay people probably think that constricting the neck simply cuts off the air supply. But we know that asphyxiation alone can’t always be the cause because some victims die very quickly from pressure on the neck. In fact, a few die almost instantly, giving no signs of classic asphyxia. And even those who do show those signs have generally died too quickly for lack of oxygen to be the sole cause.’
To my delight, PC Northern’s interest in this exceeded, for a few moments, his revulsion at it.
‘So how do they die?’ he asked weakly.
‘Well, we know that compression of the jugular vein – here in the neck – will increase venous pressure in the head to an unbearable extent – that’s what turns some victims blue. Pressure on the carotid arteries, here, means the victim will rapidly lose consciousness as blood supply to the brain is cut off. But strangling can also put pressure on the nerves of the neck, which then can affect the parasympathetic nervous system. This controls the bodily processes we don’t really think about, like digestion. One of the main nerves in this system is the vagal nerve and you can die instantly from neck pressure, which, via a complicated mechanism, instructs the vagal nerve to simply stop the heart beating. It’s a reflex reaction.’
‘Is that how Anthony died, then?’ asked the police officer, peering at the inside of Anthony’s neck.
‘His head and neck are congested and there are petechial haemorrhages in his eyes. That suggests asphyxia, or certainly not an instant death.’ I leaned over the body. ‘A very famous pathologist called Professor Keith Simpson records the example
of a soldier at a dance who, lightly and affectionately, tweaked his partner’s neck – and then saw her fall down dead. He’d tweaked her parasympathetic nervous system. Ever since then, defendants in strangling cases have tried to argue that they had no intention to kill, they simply took hold of the victim’s throat, and the victim’s vagal reflex caused them to expire for almost no apparent reason.’
‘But Theresa Lazenby used a tie,’ one of the detectives pointed out, a little reluctantly I thought. How had she won over these hardnosed men so effectively?
‘Looking at the injury, I’d say she used the tie and held it there for quite a while,’ I confirmed. ‘So if that’s her defence, she’s on rocky ground.’
‘Her defence is that he was trying to kill her,’ said the detective.
‘Poor kid,’ agreed his colleague.
PC Northern, although not participating in this conversation, was still in the room and I’d like to think it was thanks to my reassuring patter that he’d managed to stay so long. He plunged outside only when the mortuary assistant arrived to cut the skull so that I could remove the brain. During this noisy procedure, in which a special saw is used, even the two experienced detectives looked away. Although the SOCO, for whom this was an everyday event, chatted with me over the roar of the saw, it was impossible not to acknowledge, at some deep, instinctive level, the smell of heated bone.
When I had finished the post-mortem, the police officers went back to the station to brief their colleagues and to sign off duty.
‘And I’ll tell you what we need after that. A pint. Or three. Fancy joining us at the Duck and Ball, Doc?’
I would have enjoyed seeing PC Northern come back to life with a pint but, of course, for Jen’s sake, I had to decline. So I headed south. But all the way I had a sense that something wasn’t right. I felt uncomfortable. It was like putting your shoes on the wrong feet or your shirt inside out. The Anthony Pearson case was nagging me. Something to do with the girlfriend who had confessed to killing him. Something the police officers had said about her. But whatever it was floated away like thistledown whenever I came close to grasping it. No doubt all would become clearer tomorrow when I wrote up the post-mortem report. And there was no time to think about it now, I could see my own front door. Portal of delusion.
I deluded myself that it was possible to detach my emotions totally from the evidence I daily encountered of man’s inhumanity to man. To feel nothing beyond scientific curiosity when confronted by death’s manifestation of the madness, the folly, the sadness, the hopelessness, the utter vulnerability of mankind. To be blokeish, the way my colleagues seemed to be. Invincible at work, untouched by the mortuary’s vanity fair laying bare all it means to be human, untroubled by any complexity in the concepts of right and wrong. And then, in another one of those Clark Kent moments, to walk through my own front door and turn back into the warm, loving, emotionally supportive, wholly engaged husband and father I thought I was underneath my work persona. So. Deep breath. Stop thinking about what Theresa Lazenby had done to Anthony Pearson and how. Just stop. Key. Door handle. Step. Smile. Be jovial. Ask questions. Cook. Smile. Read stories. Smile. Over supper, talk to Jen about her day, about the work she must do tonight. Don’t think about Anthony Pearson, that thin trickle of blood from the side of his mouth, the red, ragged line of the ligature. That’s OK then.
The next day at the hospital I took the post-mortem notes out of my briefcase. A smell – broken branches, winter woodland – briefly wafted out with them. The smell of the mortuary.
I handwrote my report for Pam to type. It concluded that Anthony Pearson had no natural illness and gave as cause of death ‘Ligature strangulation’. I noted that
the position and distribution of the bruising of the neck suggests that the assailant was behind the deceased while pressure was applied, and that the ligature was not crossed behind the neck.
I still could not decide what was bothering me about the case but once the report was submitted I quickly forgot about it. I assumed that the Crown Prosecution Service would be contacting me eventually to give evidence at the trial of Theresa Lazenby, and then I would get the file out and start thinking about it again. For the time being, I was too busy.
15
I was now proud to be master of my moods, slipping from homicide to home without dropping a stitch. I was also proud to be the smooth comforter and conveyor of information to those present at but repulsed by post-mortems. In fact, I had come to regard myself as a five-star, fully competent controller of emotions. Until I met relatives of the deceased.
Relatives, with their burden of shock, horror, grief. Relatives, looking at me for answers to the often unanswerable (‘Did he suffer, Doctor?’). Relatives, wanting to know the truth but greatly fearing the truth. Relatives’ emotions filled rooms like a huge and unstable spongy mass, absorbing all the available oxygen, while the relatives themselves sat awkwardly on hard chairs, passing tissues around, mouths open, eyes wet, heads shaking. Waiting for me to speak. Relatives, with their capacity to erupt into anger or hysteria or tears, frankly scared me.
This was something I had to learn to deal with, and the first lesson came, strangely, when a case taught me there was something much worse than relatives. And that was no relatives.
It was winter and I was called to the house of an old lady whose body lay naked and huddled under the table. The police were treating this as a crime scene and it certainly looked as though someone had been searching for valuables: cupboards and drawers were open, their contents spilling everywhere. Some of the lighter furniture had been shoved on its side.
‘Cold in here!’ I said to the police officer. The weather had warmed up over the last day or so but the large old house was still chilly.
‘Damp,’ he agreed. ‘That makes it colder.’
‘Didn’t she have the heating on?’ I asked.
He shook his head. ‘No central heating.’
A detective overheard this.
‘Probably intended to light a fire but the intruder must have got in before she had a chance.’
We looked around at the high-ceilinged room. The hearth had been swept and there had been no attempt to start a fire. There was an ancient two-bar electric heater in one corner. It was not plugged in.
I stared again at the fallen shelves, their contents – books, medication, knick-knacks, cards – all over the floor, the small chair on its side, newspapers that had clearly once been piled now smeared unevenly across the rug. I looked at the hunched, defensive body of the woman. She was pitiably thin. The scene was pitiable.
‘What do we know about her health?’ I asked.
‘Nothing yet, Doc.’
‘Has anyone spoken to the neighbours?’
‘Yeah, they don’t know much about her, kept herself to herself. Next door said they thought she was going a bit doolally.’
The police officer nodded. ‘The cleaner said she was definitely losing the plot.’
Doolally. Losing the plot. Forgetful. Doesn’t know what day it is. So many euphemisms.
In the kitchen, stale bread. An unopened tin of sardines. A tin opener. A jar of marmalade. A bread knife. Curious marks around the lid of the marmalade indicating perhaps that someone had tried to slice it with the bread knife, open it with the tin opener. Letters, most of them circulars or official looking, in the fridge.
No more euphemisms. I said, ‘Dementia.’
‘Expect she thought the intruder was a long-lost son or something,’ said the detective. ‘She probably answered the door and threw her arms around him. There’s no sign of a break-in, no sign of a scuffle in the hallway.’
‘Who found her?’ I asked.
‘Cleaner.’
‘Yeah, she couldn’t get in this morning and called us. Said the old girl was one sandwich short of a picnic and didn’t realize she was in here: thought she might have wandered.’
‘How often does the cleaner come?’
‘Once a week but she’s just be
en on holiday for two.’
A scenes of crime officer put his head round the kitchen door.
‘OK by us now if you want to move the body, Doc.’
‘Got anything much?’ the detective asked him.
‘Nah, lots of her fingerprints, can’t find any prints from the intruder. Must have worn gloves.’
I turned to the detective.
‘In my opinion, there was no intruder.’
He blinked at me.
I said, ‘Only the cold.’
By now there were four officers in the room. They said nothing.
‘I believe she died of hypothermia. I think she may have lost the mental capacity, or maybe even the physical ability, to switch on the heater, let alone light the fire.’
The detective started to shake his head vigorously.
‘Now, come on,’ he said. ‘It’s not that chilly!’
It is a myth that, in order to die of hypothermia, you have to be outside the house on a mountainside in freezing temperatures. We know that the old and vulnerable (and actually the young and vulnerable) can die indoors in air temperatures that are as high as 10°C – and that even higher temperatures can be lethal if there is a chilling wind outside or a strong draught inside.
If the body’s core temperature falls below approximately 32°C then heart rate and blood pressure fall and there is a dulling of consciousness. If the body’s temperature falls below about 26°C then death must almost certainly follow, although there is a famous case of someone who reportedly recovered – albeit mutilated by frostbite – from a body temperature of 18°C. (In forensic medicine it is amazing how often you find just one exceptional exception. Followed always by a defence barrister trying to make it sound commonplace.)
Hypothermia is, surprisingly, a not at all unusual cause of death. Its victims may have fallen in the sea or other cold water, or they are drunks who have dropped off to sleep in the park or they are young children who have been neglected. The great majority of victims, however, are elderly. Perhaps they think they cannot afford heating – and perhaps they really cannot – or perhaps physical or mental disability prevents them from switching it on. Sometimes hypothermia is simply the final step in a tragic pattern of depression and apathy towards eating, heating and personal care.
Unnatural Causes Page 13