Unnatural Causes

by Dr Richard Shepherd

  That was why we bought a cottage on the Isle of Man. We had fallen in love with it one holiday. It was not far from Austin and Maggie’s house and it would need a lot of work but we had agreed that, eventually, we would like to live there all the time. Although eventually seemed far, far away.

  In 1999 I finally did stop smoking. New millennium, new century, did I really want to welcome it in through a haze of lung-congesting cigarette smoke? No, I did not. Did I really want to limit my chances of seeing more than a few years of the century by consuming industrial quantities of expensive carcinogens on a daily basis? No, I did not. And, although I had tried many times before to give up, it was the impending arrival of the year 2000 which meant that this time I was successful. After four or five months of grumpiness, nicotine gum and jaws like a hamster from chewing it, I reached a sweet point. I suddenly knew I could live without cigarettes and that I would go into the new century without ever smoking again. And I haven’t.

  We saw in the New Year on the Isle of Man.

  ‘I do want to live here,’ said Jen. ‘That’s what I really want for the next century.’

  ‘I think I’ll have my pilot’s licence soon. We could live here and just fly everywhere we need to go,’ I said. Places are always nicer when you fly to them. But I was in no rush. I wasn’t fifty yet and the Isle of Man was a retirement sort of place. Wasn’t it?

  Chris was planning to start vet’s training in the next year or two. Anna was studying for A-levels and still agonizing between becoming a vet and a doctor.

  ‘Dad, I think it would be a very good idea if I came to a post-mortem,’ she said one day.

  Reflex reaction: no.

  Anna, so young, so inexperienced, with her smooth cheeks and bright eyes, should not be confronted by life’s ugly realities in the mortuary, that was obvious.

  ‘Chris went! And he wasn’t even sixteen!’

  ‘Chris was simply shown through the post-mortem room by an idiot coroner’s officer. And he wasn’t very happy about it.’

  ‘This would be different, because I’d be prepared. You’d talk me through it, wouldn’t you?’

  No.

  ‘And when I apply to medical school, think how it would look on my personal statement. I bet no one else applying will have watched a post-mortem.’

  No.

  So she came with me to a mortuary one day. Not to see a victim of suicide or homicide but a few sudden, natural deaths. As we leaned over the body, I glanced up at Anna, her brows knitted with concentration, as I pointed out that brain haemorrhage, that entirely occluded coronary artery, that cirrhotic liver, which looked so like a mottled mackerel.

  ‘If you go into medicine, you don’t have to become a pathologist,’ I reminded her on the way home. ‘Talk to your mother about dermatology.’

  She said, ‘I have. I just wonder if I’m not more of a pathologist, really.’

  It was strange to think of the next generation of Shepherds being grown-up and out there working. Because that meant the last generation must be getting old.

  I knew this for sure one summer day in 2001 when I found myself attending the funeral of Iain West. He had died, aged only fifty-seven, of lung cancer, caused, I can say without doubt, by his smoking – a habit that, of course, I had shared until recently.

  We had known he was dying for a few months, but when I heard the news, I could hardly believe it. I had seen him not long ago at Westminster coroner’s court. He had come to give evidence: nothing could keep the old trooper away. Perhaps he knew it would be the last time he’d take the oath and hold a court in thrall. Downstairs, in the offices, I thought how much he had aged and how diminished he looked. He climbed the stairs to the oak-panelled courtroom very slowly – but no one dared to offer assistance. Then when he rose to give evidence and took the oath, there was a metamorphosis. The old Iain West was still there. Still in command. Still a presence.

  Now that he was gone I felt keenly that, as well as being my mentor and teacher, my opponent and rival, he had also been my friend. Those long conferences in his office and in the pub, the sudden kindnesses, the knowing but unacknowledged intimacy of colleagues who have worked closely together for many years – it was no less a friendship for being office-based. And now my friend simply was not there any more and I had not made enough effort to see him and enjoy his company during his last illness and enforced semi-retirement.

  As if this was not melancholy enough, there was double devastation because, on that same day, Jen’s father, the estimable Austin, died on the Isle of Man, leaving the family heartbroken.

  Not one memento mori, but two. You might think that, since we constantly stare death in the face, pathologists don’t need to be reminded of our own mortality. We do. We, too, need prompting by the death of those close to us to get on with the things we want to do in life. For Jen and me, living on the lovely Isle of Man was one of those things. Now we wondered if we shouldn’t do it sooner rather than later. We also thought Jen’s mother, the widowed Maggie, might need us. It was time seriously to recognize that, if we wanted to live on the island, this was not something we could put off for ever.

  That year, 2001, also saw the release of the final reports on the Marchioness disaster. Lord Justice Clarke held both a formal inquiry into the disaster itself and a non-statutory inquiry (which is more flexible and generally regarded as less ‘clunking’ in its approach) into the handling of the Marchioness dead and their relatives. After the formal inquiry, there were still more recommendations for the improvement of safety and lifeguarding systems on the Thames. And, at the non-statutory inquiry, Lord Justice Clarke confirmed that the Marchioness relatives were the victims of a human and systems failure. His report recognized the muddles in management and identification procedures: he noted confusions between key figures who were on holiday and their deputies, between the many ranks of police officers, between police, coroner and fingerprint officers, between coroner’s officers, between the mortuary staff and the undertakers.

  As for me, the inquiry closed a chapter of my life. The pathologists were at last exonerated of any blame for the errors that had been made. Eleven years after the disaster I was finally free of the fury the identification problems, particularly the missing hands, had generated. The angry phone calls and press disdain that had reappeared periodically in my life for so long, stopped overnight.

  The non-statutory inquiry report’s wider interest was its many recommendations for the treatment of relatives and the identification of victims in a disaster. It happened that for a few years now I had myself been giving quite a bit of thought to this problem. During the 1990s I had been asking myself how well we – forensic pathologists and crisis teams in general – would cope in London with a mass disaster. Because disasters were changing.

  By 2001 our transport systems and cities were much safer than in the past. The greatest threat now was terrorism. IRA bombings of the 1970s and 80s and into the 90s were still in our consciousness. And other cities had suffered. In 1993 a bomb exploded at the World Trade Center in New York, killing six people and injuring over a hundred. In 1995 cultists gassed the Tokyo subway with Sarin.

  The coroner for West London, Alison Thompson, shared my concern about planning – or rather the lack of it – for both natural and unnatural disasters. Her jurisdiction covered the Fulham mortuary where St George’s pathologists worked but, more significantly, Heathrow airport. In the event of a mass disaster in London there was an existing understanding that bodies would be brought to a special hangar at the airport. We decided to go and have a look at it. And found something that was more like a large garage. It was full of runway snowploughs and ancillary equipment.

  It would have been hard to find a site less suitable. Apart from the fact that it was dirty and oily and full of heavy plant, access was difficult and there was only one small hand basin. We proposed to the police, the other emergency services, local authorities and the supporting charities that we should all review London’s plans fo
r a large-scale emergency. It turned out that we weren’t alone in worrying about how the capital would cope in such an event and everyone was keen to participate.

  We knew how to define an emergency. Dr David Paul, the retired coroner for North London, had once done so very simply, saying, ‘My idea of an emergency is having at least one more body than my mortuary can manage.’

  Our group met regularly at Heathrow Police Station and the first thing we did was try to anticipate what sort of emergencies might occur. We frequently sat around tables drinking coffee and discussing how to deal with a flu pandemic. Or a big plane crash in the city. Or a terrorist attack. But we knew that, no matter how bizarre and outrageous our thoughts, the reality would always be different and that we needed to think and plan from the specific to the general.

  And we were proved correct. Chris was just about to leave home. His bags were packed and he was soon to catch a train north to study veterinary science when he phoned me.

  ‘Anna and I are watching it on TV …’

  ‘Watching what?’

  ‘Dad, are you on call for international emergencies?’

  That day was 11 September 2001.

  I switched on the TV and stared at footage of American Airlines Flight 11 hitting the North Tower of the World Trade Center. This at first looked like the kind of terrible accident our group had talked about. But when United Airlines Flight 175 hit the South Tower shortly afterwards, I realized that, although we had discussed both acts of terrorism and city plane crashes, it had never occurred to us that the two would be combined in such a deadly way.

  Then, incredibly, impossibly, as the world watched, the Twin Towers actually fell. First the South. And then the North. And now it seemed to me that these terrorists had taken disaster to a level that was far, far beyond anything we could have dreamed of.

  I was as appalled and mesmerized as the rest of the world by this spectacular coup. The possibility of my own involvement did not occur to me. I assumed my colleagues in America would get on with the massive job of saving the wounded and finding and identifying the dead: what was there for the British to contribute? But Alison Thompson was soon on the phone.

  As the coroner for West London, Alison would be receiving any repatriated British bodies at Heathrow and it would be her job to establish a cause of death. Any British citizen who dies abroad is entitled to an inquest in the UK by law: this has been the case since 1982, when the father of a young British nurse who died in sleazy circumstances in Saudi Arabia refused to accept the official cause given for her death, and the consequent change in the law has resonated through the decades.

  Alison was also well aware that, when a civilian plane had been downed by a terrorist bomb over Lockerbie in Scotland more than ten years earlier, a number of mistakes had been made in the management, not least the identification, of just a few of the bodies. But ‘a few’ mistakes in this critical situation has the effect of destabilizing and distressing a huge number of families.

  Alison’s concerns about the management of the British fatalities resulted in the rapid formation of a group at Scotland Yard consisting not only of the police and emergency services members of our existing mass disaster committee, but also many more high-ranking officials.

  The questions we asked were: What support can we offer the New York operation? How should we repatriate our dead? Should we carry out our own post-mortems on the British fatalities back here in the UK? Would the families find acceptable that further interference with the bodies of their loved ones? Or should we leave all post-mortems and identifications to the Office of the Chief Medical Examiner (OCME) of New York? If we repatriated the bodies, they could be distributed around the country to their own local coroners, in which case should each local coroner hold an inquest and reach his or her own verdict? We could imagine inquests going on for months or even years and there would probably, certainly, be a huge range of different and maybe conflicting verdicts, ranging from accidental death to homicide to unlawful killing.

  We agreed we should assess what OCME in New York was doing first. We could then determine a formal UK response and offer appropriate help.

  We reported directly to the prime minister, Tony Blair, at the Cabinet Office’s central emergency co-ordinating group, COBRA. They decided we needed some first-hand opinions and so it was finally determined that on 20 September – the day on which I became forty-nine years old – I would fly out to New York to see how the Americans at the Office of the Chief Medical Examiner were handling things. I phoned my colleague at OCME, Yvonne Milewski, and arranged to meet her on my arrival. She sounded tired and emotionally drained. But welcoming all the same.

  I landed in a New York that was strangely quiet, even for the middle of the night. The city was still hushed with horror. Nine days after the towers had collapsed, the event’s dust and smell still hung in the air. And although roads were blocked and tunnels were closed, when the traffic stood still not one horn honked. I told the taxi driver where I was staying and he said there were at least four hotels of that name. So we drove through quiet streets trying them all. Eventually we knew we’d found the right one because the lobby was full of British police officers, some of whom I recognized. They gave me a warm welcome and asked me if I fancied a drink, but I had to decline. I’d arranged to meet Yvonne at the OCME mortuary and was taking a cab straight there.

  I arrived at 2.30 in the morning to an unforgettable sight. The building itself was an ugly 1960s concrete pill box, but the building was not the focus of attention. The surrounding streets and parking lots had been partitioned off and were fully guarded because here was the twenty-four-hour receiving area. Once through security I was into a makeshift, floodlit resting plaza, full of tented cafes and workers taking a break over coffee and doughnuts. Beyond were huge, refrigerated trailers, at least thirty of them, lined up neatly in adjacent tented parking lots, flowers guarding the entrances, American flags standing sadly sentinel.

  I sniffed. That aroma. It was obvious the trailers were full of human body parts.

  Even at this time of night, an occasional hearse reversed into the docking bay with a body bag on board. The search crews at Ground Zero were working around the clock and the pathologists were working too: Yvonne had volunteered for the night shift. And the day shift. She just grabbed sleep when she could.

  You needed huge resilience to cope in this bizarre and disturbing environment. Many people found that they didn’t actually have that resilience and the mental trauma to the rescue workers and to the mortuary staff was huge. Some coped. Some were sent home, looking like people with shellshock.

  The shift pattern meant that there was never a delay in the start of the formal examination and identification process. Some of the body bags were known to contain a member of the police or fire service who had risked – and lost – his or her life in the carnage. For these Members of Service, a colour party formed which formally saluted their bravery as they were carried in to OCME.

  Inside the many body bags were whole, or almost whole, bodies. Smaller body parts sometimes came in smaller boxes. The basic rule of all disaster recovery sites is that if a rescue worker finds, say, a finger, even if it seems quite clear which body that finger belongs to, it must be catalogued separately and given a unique number. The nature of this disaster, the huge forces from the impacts and from the collapses, meant that the bodies were frequently so fragmented that you simply couldn’t put people together by sight, guided by their location or clothes. It was clear, very early on, that many or maybe most of the identifications would have to rely on DNA. Later, sometimes much later, based on this amazing technique, limbs, portions, parts, pieces and fragments of tissue would come together to reform something like a body, or what remained of it. As in all mass disasters, identification of the victims was to be a huge administrative as well as scientific operation. It was just that in this disaster the task was in every way bigger, worse and harder than anything experienced before.

  As they
arrived, bodies were taken into the primary receiving room where preliminary examinations were performed. And then they were taken directly to one of the examination suites. Each suite had a full team of police, pathologists, photographers, radiologists and assistants. Post-mortems were carried out in the usual way, on whole bodies or parts of bodies. Extensive details were recorded and these findings were linked with the fragments of clothing, personal artefacts – jewellery, credit cards, etc. – and any other features and details of where exactly the body had been found. Then, carefully numbered, the body or body part was taken to its unique place on a uniquely numbered shelf inside a uniquely numbered trailer.

  The bodies were treated with great respect and the trailers were kept clean and well ordered, the Stars and Stripes a reminder of the state and the containers of flowers a reminder of the people. The trailers solved the key problem of any such disaster: not so much processing the dead as storing them until the identification can be made. After that, they can be released to the families. It was clear to me that the Americans were doing a fantastic job of looking after things, methodically and respectfully.

  I tried to remain as unobtrusive as possible, since everyone on site was working hard. The same was true when I returned the next day to meet the chief medical examiner himself, Charles Hirsch. He was a small, slight and distinctly stressed man in his mid-sixties who was running this massive operation with stitches across his head and some fractured ribs. He had been among the early rescue workers who arrived at the World Trade Center just before the first of the towers fell. How had he escaped with comparatively minor injuries when the colleagues who had been standing next to him were felled by rubble and were now in intensive care?