Unnatural Causes

by Dr Richard Shepherd

  The coroner was forced by the Director of Public Prosecutions to adjourn inquests into the deaths until this criminal trial was over – but there never really was a result. Two juries failed to reach a verdict on the culpability of the master of the Bowbelle, and a later attempt to prosecute the dredger’s owners privately also faltered.

  After the Bowbelle verdict, or lack of one, the coroner decided it was not in the public interest to reopen the inquests as by now there had been close examination of the causes of the collision and safety had greatly improved on the Thames. But his decision added to the relatives’ pain: some believed this was biased thinking, particularly after he made some unguarded comments about one of them to the press, which were subsequently published. The relatives not only wanted a full inquest, they wanted a full public inquiry. Both requests had been stonewalled and it is to their great credit that their determination did not falter. They intended to pursue the possibility of an inquest through the Court of Appeal.

  However, their anger was fuelled by their recent discovery – and unfortunately many of them made this discovery through the Sunday newspapers – that hands had been removed from some bodies in order to identify them. Even more upsetting than that, it had now been learned that the hands were sent back to the mortuary but, unforgivably, some were never actually returned to their bodies. And relatives suspected that the only reason they had been denied access to their loved ones before their funerals was not because the bodies were too decomposed for viewing but because they lacked hands.

  Everyone now directed their anger at the pathologist in charge. That pathologist was me. In their position I, too, would have been angry. But it was wretched to become the focus of such fury. It was no use saying to heartbroken, bereaved people that hand removal was routine in these circumstances. It was no use explaining that fingerprinting the decomposing drowned invariably requires laboratory technology which cannot be carried out at the mortuary. And it was too late to ask whether, just because this removal was standard at the time, it really was an acceptable routine.

  In fact, neither the decision to cut off the hands of some victims, nor their actual removal, nor the failure to replace them was anything to do with me. However, my denials were ignored and my protests taken as somehow incriminating. My photo (looking rather seedy, tie always flying behind me in a sinister fashion) kept appearing alongside newspaper articles, accusatory or snide in tone. I received phone calls from journalists at all hours of the day and night. I was frequently doorstepped. One hack appeared, as though by magic, in the office. I found him sitting by my desk with solemn face and an ominously open notebook.

  As for my colleagues, their headshaking over my contribution to the Rachel Nickell case continued into my handling of the Marchioness case. They asked, couldn’t I have stopped the hands from being removed? Especially as, in most cases, other forms of identity were rapidly available. After all, hadn’t the police reported that they were being swamped with dental records from across the globe? So surely I should have intervened in the idiocy of the hand removal.

  My colleagues did agree, however, that they were all speaking without any experience of a mass disaster, and certainly not one due to drowning. And they agreed they were speaking with the advantage of hindsight, admitting they themselves probably would not actually have intervened in what was police standard practice at the time – especially since it had been authorized by the coroner.

  Iain, head of department, maintained a sphynx-like silence on the whole matter, as he did on any important cases which he was upset at missing. I felt entirely alone with the fury of the press and the Marchioness relatives, a difficult position, no matter how much I sympathized with that fury.

  Pam, who might have offered me some support, was no longer our chief organizer. Quite late in life she had fallen in love with a widower and stepped into the role of wife and stepmother. She didn’t even try to mix pathology with home-making. She recognized that the demands of running a family did not allow space for the complexities of the pathologist–homicide interface. We had bidden her a sad farewell, the other assistants then all reshuffled, a new junior appeared for us to introduce to our murky world of London murders and the capable Lorraine was put in charge.

  Oh, and there was a new pathologist.

  One day a tall, blonde, leggy woman had strolled into the office. She wore a short skirt and a friendly smile and had cheekbones which looked as if they had been cut out of stiff white paper with sharp scissors. The other staff barely had time to look up from their desks before Iain, as the most alpha in an office of alpha males, shot out of his seat and claimed her, yes, like a Neanderthal, because in the last century the male sex was a great deal less evolved.

  Vesna Djurovic was a forensic pathologist, half Serb, half Croatian, from what was then Yugoslavia. She was the, in those days, unusual combination of breathtakingly glamorous and highly skilled. She had been practising in Belgrade and was now looking for a job in London. She not only found a job at Guy’s but also something she had perhaps not expected: a husband. Iain was already married and the resulting manoeuvres were complex and difficult, but, in so far as our dark landscape of homicide could shine with a celebrity couple, Vesna and Iain were soon it.

  Jen and I could never be such a couple. With Vesna and Iain in forensic pathology together there became more social events involving partners but we were too busy to join in most of them. Jen had just finished her house officer year. Her shifts were thirty-six hours, which meant long days and alternate nights in the hospital. However, this pattern was just beginning to ease now because she had started to train as a GP, at the same time finding what was to become her particular interest: dermatology.

  I knew that, at this stage of her career, she needed a lot of support. I’d needed it too, and she’d been there for me. Now I was trying to do the same for her. Becoming a doctor was such an achievement when she hadn’t even started studying until she was over thirty. Probably I didn’t express my pride often enough. I hope I expressed it sometimes. I mean, at least once, for heaven’s sake.

  Now our paths seldom crossed, and when they did we often argued. There didn’t seem to be a mechanism to help us find our way back to a safer, happier place. I knew some couples reconciled in a loving, kind way, but I had never seen it happen – certainly that kindness had been lacking in my father’s relationship with my stepmother – and I wouldn’t, or perhaps couldn’t, play the game. How exasperated my good wife grew with her busy, distracted husband.

  ‘Why won’t you let me love you?’ Jen would cry. ‘Why are you so quiet all the time?’

  We went for counselling. I agreed to it, but all the same I felt as if Jen was hauling me up before the beak.

  ‘His mother died when he was nine,’ she said significantly. And the counsellor nodded, also significantly it seemed to me. Were they old friends, these two women, or was all womankind in some kind of conspiracy?

  ‘What would you like Dick to do for you, Jen?’ the counsellor said.

  ‘Just put his arms around me and tell me he loves me! That’s not much to ask, is it?’

  ‘And Dick? What would you like Jen to do for you?’

  I thought. But not for long.

  ‘Make me supper,’ I said.

  The counsellor leaned back in her chair, eyebrows raised.

  Jen’s lack of culinary skills had always been a bit of a joke.

  ‘Preparing and giving me a meal. That would be an act of love. But I’m always too busy looking after everyone to receive and Jen’s always too busy with her training to give.’

  ‘So, Dick, you feel you look after everyone?’

  ‘I’m not complaining. My father did it too, he brought me up. I’m pleased to care for the kids and cook and be there for them, that feels normal. It’s just …’

  My father had done all those things. But there had been his anger too. The way it occasionally just exploded out of him, whatever the collateral damage to those around. Now I beg
an to wonder if that had in fact been the welling up of some great unhappiness. My father had been unhappy. Maybe I, too, was unhappy. It occurred to me for the first time that my marriage might be improved if, like him, I sometimes lost control and allowed my feelings to erupt. But, if I had any such feelings, they were firmly buried in some inaccessible place. And if I couldn’t even cry, how could I erupt?

  ‘Yes?’ said the counsellor. I had forgotten that I was sitting in this room now in Clapham with ambulance sirens blaring outside and my wife and a counsellor watching me, waiting for me to speak.

  She prompted, ‘You do the cooking and a lot of childcare but it’s just … what?’

  ‘I’d like Jen to show me she loves me by doing things sometimes.’

  The counselling didn’t last long. Somehow it fizzled out, or maybe we were too busy. Our children were still primary-school age, they were happy and healthy and we worked hard to create a loving home. There was often noise, sometimes music, sometimes laughter. Jen and I were both fully involved in jobs we loved. We were comfortably off. I had joined the parents’ choir at the kids’ school and by now I had become a loud, shameless and, I fear, usually tuneless singer. Jen, Chris, Anna and I all sang our way up the motorway to holidays full of sand, rock pools, mountains and moors on the Isle of Man, where we were received by generous and cherishing hosts. Our lives were surely good enough.

  24

  My fortieth birthday coincided so closely with my father’s death that it was inevitable I would start to contemplate my own demise. I did not fear death, but did not much like its predecessor, senescence, the preprogrammed process of ageing. By now I had seen so many bodies that I was all too familiar with the progress of senescence and had a good idea what some of my own vital organs must look like.

  At forty, I knew that, on my lungs’ smooth surfaces, tiny black dots were already forming into lines, making tree-like patterns. In their own way the patterns might be rather beautiful, but this was filth: the sooty pollution of London, which alone had probably ensured that I already had a degree of emphysema – even without the twenty or more cigarettes I smoked each day. I wasn’t the only smoker, of course. My colleagues smoked, and we worked in a perpetual blue haze. At home, Jen smoked. On the Isle of Man, her parents smoked. Everywhere, our friends smoked. In 1992 we all smoked, we smoked in pubs and restaurants, we smoked on trains, at our desks and on the bus. We knew it was bad for us, we knew that cigarettes contained over 4,000 constituents, many of which are toxic, from hydrogen cyanide to cadmium to benzopyrene, but we put up with all that for just one ingredient: nicotine. So far, we’d been young enough to think we were invincible. Now I knew that I must stop smoking, and I might be rewarded with an extra ten years of life. Although the structure of my lungs must have been irreparably damaged, and inevitably that damage would increase over time.

  Pumping blood through damaged lungs is hard work for the heart, and I hoped that the right side of my heart was not already enlarged by struggling with this extra burden. As for its left side, I knew that, if I couldn’t learn to control my reaction to stress, then my blood pressure would rise and my left ventricle would thicken trying to cope. The heart is an organ one can hold neatly in the palm of one’s hand. So small but so steady, a little fist, clenching and unclenching seventy times a minute, day and night, year after year, 30 billion times over a lifespan. A faithful friend. Until it stops. It was down to me to repay its fidelity by managing my diet, exercise, smoking and stress levels. Just as I knew I should give my liver a rest sometimes from alcohol if I wanted it to carry out its magical repair work on itself.

  Good resolutions, all of them. And quickly forgotten. An occasional whisky and soda seemed a good way of relaxing and it was much easier to light another cigarette than waste time contemplating how much I wanted one but couldn’t have one. Stress-relievers, both. And I see in retrospect that there was no question of my giving up that year or the next, because 1993 heralded a period of very significant cases.

  In April I performed a routine post-mortem on a young black man from south London who had been stabbed. There were a lot of such knifings then and this death looked like many others. They often turned out to be gang or drugs related. Racial attacks at that time were not immediately suspected. The only information I was given was that the young man had been in a fight. There was nothing to indicate to a pathologist that this was an unusual case, nor that the patient’s name would become so well known, nor that I would have to give evidence about his death so many times.

  Stephen Lawrence was a bright, ambitious eighteen-year-old who in no way fitted wider public perceptions of black youth in 1993. Rightly or wrongly, his recognition as a keen student who had a professional future was vital to changing attitudes and prejudices. While simply waiting with a friend for a bus he was stabbed twice by a group of white youths, who, we later learned, were hurling racist comments. There was a superficial incision on his chin, one deep stab wound that had penetrated his lung and another deep wound on the shoulder. Bleeding profusely, he somehow managed to get up and run over a hundred metres with his friend before finally collapsing.

  In the months that followed I was shown by the police a total of sixteen knives, of which seven were possible murder weapons. One of these looked particularly likely. In July I was asked to make a further statement and said that, in my opinion, Stephen had been standing when he was stabbed around the right collar bone but had probably begun to fall by the time the second stab wound was inflicted on his left shoulder. Despite some very careful thought, I wasn’t able to say with full confidence whether his assailant was right- or left-handed. Choosing one over the other might have made me look clever but the evidence was really too flimsy to risk exonerating the perpetrator.

  That was the extent of my involvement with the police’s investigation into Stephen’s death at that time. I was unaware of the indifference and racism that were hampering it. The Lawrence family, however, were not. They understood there were witnesses, evidence and indeed suspects. But no charges were made.

  Four months later, I was called to observe a coronial post-mortem in north London on behalf of the police. The post-mortem was actually performed by another pathologist: it was my job to watch, take any relevant samples and possibly participate if invited to do so but, on the other pathologist’s insistence, I just watched. It was fairly clear to me that the woman we were examining had died of the adverse cerebral consequences of asphyxiation but there might be other causes of death revealed by the experts who were invited to give their specialist opinions on some of the organs – specifically the brain and the heart.

  The deceased had obviously been involved in a fierce struggle and then manhandled into a body belt – that abdominal belt with the handcuffs attached. She was covered in cuts and bruises and had been bound at the thighs and ankles as well as the waist. Had she, in fact, sustained a head injury also? The brain pathologist would answer that question for me.

  This case also turned into a significant one. Joy Gardner was a forty-year-old Jamaican who lived with her five-year-old son. That she had outstayed her visa and was in the UK illegally is not in dispute. Her mother and a large number of relatives were here, offering support while she studied, and she did not want to return to Jamaica.

  Early one morning and without warning, immigration officers arrived at her home to deport her. They were supported by police officers, perhaps because resistance was expected. And Joy Gardner did resist. She must have thought she was fighting them for her way of life. She perhaps did not guess that she was fighting for her life.

  Unskilled, untrained and determined to carry out orders, the officers struggled to get her into a restraining belt while she fought them and bit them, watched by her young son. In response to her biting, they wound almost four metres of one-inch-wide adhesive surgical tape – Elastoplast – around her mouth and face. They mistakenly believed that by leaving her nose clear they were allowing her to breathe. This is a myth. Covering the mo
uth can kill. It is not just a question of being able to breathe – it’s a question of being able to breathe enough. Especially if a struggle has caused stress and exertion and massively increased the body’s need for oxygen. In these circumstances, an individual simply cannot take in the oxygen needed, which may be many times more than usual.

  Gagging can cause vomiting and, with the mouth blocked, vomit obviously cannot escape. So it gets into the airways. And a gag can press against the tongue, pushing it to the back of the mouth and blocking the back of the nose. Secretions also accumulate in the mouth and throat, and this further inhibits the ability to get air into the lungs. Gagging a distressed woman who had been struggling hard for many minutes was all it took to bring about cardiac arrest.

  Joy Gardner was not strangled. There was no traumatic head injury. She had not inhaled her own vomit. She was asphyxiated by the gag. However, an ambulance crew managed to resuscitate her. That is, they restarted her heart and then rushed her to hospital where she was placed on life support. Sadly, her brain had been so badly damaged by the prolonged lack of oxygen that she died four days later.

  There was a breadth of involvement in this case – hospital, police, family – and consequently her body underwent so many post-mortems and so much tissue analysis that meetings about Joy Gardner sometimes felt like pathology conventions. Among the most important were the brain specialists, since it had been alleged by the first pathologist, whose post-mortem I had watched, that she had died from a head injury. Finally, overall, there was broad, general agreement that she had died from asphyxia caused by the gag.

  I wrote a detailed report examining all the possible causes of death, which, as usual, went through various drafts and revisions. In the meantime, there was a growing outcry from human-rights organizations and others. It seemed to many, especially members of the black community, that police officers who regarded deportation as a job to be done at any cost and that they had killed Joy Gardner by thoughtlessly over-restraining her.