My long-suffering mother was not happy with this use of her cutlery.
* * *
I still go to the hair salon, of course, and when I inevitably get asked about my job I’ll happily talk about it. These days people are often very interested, and many of the other customers and stylists in the salon usually get involved in the chatter too. Everyone, it seems, has seen CSI or Silent Witness, or read books by Patricia Cornwell or Kathy Reichs and has a glamourised idea of what the job is like. Forensic science fascinates, and as long as I don’t go into too much of the minutiae of my routine (nobody wants to hear about that time I walked around with faeces on my elbow all day) I can quite happily carry on a conversation for hours about work, usually being asked the same questions I’ve been asked a million times before. In any case, they’re so much better than the usual salon queries about where I’m thinking of going on holiday. Corpses = interesting. Costa del Sol = not so much.
The exception is when I go to get my nails done (and I do this now because I was unable to when I worked in mortuaries due to the constant use of my hands for intricate work, so forgive me this one small vanity. If you’d spent eight years walking around in wellington boots and PPE looking like a fishwife, you’d do everything you could to feel glamorous now, too.) There’s one man in particular at the salon I often ask to do my nails because, in a bizarre synchronicity, he has just one long thumbnail, exactly like my great-granddad, which he uses to scrape errant nail varnish from my cuticles when he makes a mistake. I never met my great-granddad but the similarity gives me comfort.
None of the nail technicians in my local salon speak much English so I can’t really do anything except watch them. And I like to watch them because, as they go about their intricate work, they remind me of me, and of many APTs like me, as we prepared for an autopsy. They carry out their task diligently, with all their tools and all their liquids and powders ready to go – a place for everything and everything in its place. They are prepared even to the point of tearing off single pieces of absorbent paper towel so they don’t need to scrabble about for it later and mess up the whole roll.
That was how I began every single day as an APT, coming into work at least half an hour before I was meant to, no matter where I was employed, and always long before the pathologist arrived. Generally, as an APT my day would start at eight but I’d arrive at seven thirty to put the coffee maker on before colleagues appeared. Because the pathologists aren’t around for the whole autopsy they’d usually pop their head in to identify the deceased first and sign some paperwork before going to their office and allowing us to carry on with the preparation. This initial identification is obviously extremely important – a decedent will be checked and checked and checked again via ankle ID and wrist ID. Carrying out a post-mortem on the wrong person would be unthinkable. Once identified, the doctor would then leave, aiming to be back down in about an hour’s time, and this would be my time to shine: I’d begin the autopsy, a term which comes from the Greek ‘to see oneself’ or ‘examination of the self’.
For me, everything had to be laid out meticulously, ready for the procedure, or I felt like I wasn’t doing my job properly. I liked being the type of APT who would be holding a particular utensil or object aloft ready for the doctor before they even asked for it, like a nurse in an operating theatre. That way I felt in control of what I was doing, and that’s all the better for the patient. In addition to this, post-mortems are messy and you will get covered in blood and other fluids so the last thing you want to do, when the procedure is in full swing, is open cupboard doors and drawers and start searching for things like swabs or spare scalpel blades. Much better to do what the nail technicians do and pre-empt every possible action.
First I’d ensure there was plenty of what we call ‘blue roll’ to hand, an absorbent paper towel we used to mop up spills and clean out cavities. I’d lay out all my tools, with fresh blades on the scalpels, and the PM40 – which is like a very large scalpel with a blade so big it needs to be screwed on – but once attached I’d leave the new blades shrouded in their foil or paper wrappers, having once been told that even the gentle action of oxygen molecules blowing against the thin blades’ surfaces can dull them. I didn’t know if it was true but I wasn’t taking any chances with my equipment.
Other tools laid out would include a very long knife about an inch thick with a square end, a bit like a Samurai sword, called a brain knife. A sharp, disposable blade like this is necessary to slice the delicate brain into sections. There were the rib shears I’ve mentioned, used for cutting through the ribs at the costal cartilage, which is much softer than the bone. The older a person gets, the more calcified their cartilage becomes, and it’s tougher to cut through without creating ragged edges and bone splinters which can actually penetrate your gloves and even your flesh. This is what caused such an awful noise when my friends watched me on TV. There was a ladle or two and something called a skull key which is a T-shaped piece of metal used to aid removal of the top of the skull later on. There was an array of scissors including bowel scissors, a variety of forceps (some with teeth and some not – a bit like my patients) and the cute-sounding ‘bone nibblers’ used for delicately removing pieces of bone. I’d also thread large, curved C- and S-shaped needles with thick white twine ready for sewing the skin together, and tape them to the side of the cupboard so they’d be ready to pull off and use. There’s nothing worse than fiddling with pristine rolls of twine when you have several pairs of gloves on, slippery with blood. But I tried not to automatically do what I might if I was sewing fabric with cotton: that is, moisten the end of the string with my mouth to sharpen it to a point! Soon the tool trolley would have a DIY vibe about it too, because I’d add a chisel or two with a huge mallet, an electric bone saw as well as a manual one in case the power cut out, and several large buckets and bowls.
Although every case was slightly different, there were common procedures. I’d be able to guess what specimens would be taken from someone suspected of an intravenous drug overdose, and they’d be different from those taken from someone who died in a nursing home and had a bedsore, for example. In the former, it would be necessary to send samples of body tissue to toxicology to establish exactly what levels of which substances were present in the tissues, and whether or not they led to the cause of death. In the latter, just like in the case of the anorexic dentist, a microbiology swab would be taken as a record of the sores and what organism they were specifically infected with. In his case, it took a couple of weeks for the pathologist to receive results from the lab, and that is fairly standard – unlike on TV, when results appear within the hour. The doctor was right: the cause of death had been septicaemia leading to septic shock due to microbes entering the blood from the decubitus ulcers.
Pathologists, too, are all different, and part of the skill of being an APT is getting to know each one well enough to pre-empt the equipment they’ll require. Some would be more fastidious than others, requiring many more specimens to support the conclusion they’d eventually reach. And more specimens meant more containers and labels, which would need to be pre-printed, ready to go on pot after pot of urine, blood, vitreous humor from the eye, bile, pus, tiny pieces of organs or bone and more. These small sections, taken for histology – the microscopic study of cells – were usually about a centimetre by a half and fitted neatly into plastic cases called histology cassettes. If I had a feeling the pathologist needed to take ‘histo’ then I’d have these cassettes out ready too, also printed with a unique case number, already with their lids open and standing to attention along the edge of the dissection board like little soldiers. Contrary to popular belief, it’s not very common for a pathologist to remove and keep whole organs. Modern techniques with microscopes mean that the smallest pieces of tissue are all that are required. The exception may be if there was extensive and unique damage to tissue and in that case the doctor would receive consent to keep the specimens for whichever length of time and whatever purpose was necessary.
* * *
The mantra one of my colleagues taught me was ‘the Five Ps’ – Prior Preparation Prevents Poor Performance. It applies to everything in life, from cooking your beau a romantic meal to disembowelling humans. It also applies to embarking upon your chosen career. Most people don’t accidentally end up in their ideal vocations, and I couldn’t just fall into a job like anatomical pathology. I had to work at it and start preparing from an early age.
After the fairly restrictive years at my religious school, culminating in GCSEs, I went to college. I opted to study some Biology and Psychology but I also worked part-time as I wanted the freedom, money and time to mature a little. After working in my gap year, I did a Foundation Degree in Biological and Chemical Sciences, which was the equivalent of doing A-Levels in Biology, Chemistry, Physics and Maths in one year. This led me directly into a degree in Forensic and Biomolecular Sciences during which I’d not only learn more about the human body in detail but also the techniques used by forensic scientists. Modules I studied included toxicology, microbiology, cellular biology and forensic anthropology – the examination of skeletal and decomposed remains.
I thoroughly enjoyed being at university and working towards a goal but, having also had real work experience, I felt I wanted something more than simply sit-down lectures. I knew that reading books on forensics and autopsies was one thing and seeing images in class from an experienced pathologist or anthropologist was another, but I needed to know exactly how I would react in the presence of the most difficult cadavers; I needed the whole multi-sensory experience. If I could handle the worst, then I could handle anything. Looking at pictures of decomposing corpses is very different to smelling them and feeling the Rice Krispie pop of maggots beneath your feet.
Then fate struck when I met the eminent forensic pathologist Dr Colin Jameson, who was giving an evening lecture on Mass Grave Excavation in Srebrenica.* I commandeered his time to chat after the lecture – I was shy but what did I have to lose? In fact, he was very accommodating and I discovered he worked in several mortuaries, one of which was very near where I studied. He suggested I drop in one day to facilitate my university degree and that’s how I ended up on the steps of the Municipal Mortuary asking if I could volunteer one afternoon a week. I thought I’d have no chance but, perhaps because it was very uncommon for people to want to work in mortuaries then or perhaps because Dr Jameson had vouched for me as a student, the new manager there, Andrew, said yes. I was allocated some steel-toe-capped wellington boots of my very own and I entered the world of the mortuary, not really knowing what to expect. As much as I’d tried to research and prepare I was only really familiar with sensationalist ‘morgues’ from the media. Would there be organs in glass jars on shelves? Would there be stone slabs and weird electrical equipment, like something from a B-movie? Not at all – it was all very bright and clean.
Although the recent renovation of the mortuary meant everything was fairly modern, there was one throwback to the ‘creepy mortician’ stereotype of old: the current senior technician and lone staff member, an ageing Teddy boy. He was called Alfie and he was a real character, a relic from the days when everyone who worked in the death-business was male. He had stringy grey hair greased up into a Teddy-boy quiff and thick 1950s-style glasses which he wore non-ironically. He was originally from London and sounded just like Michael Caine, although the accent may have been slightly exaggerated.
The mortuary had been renovated because the local council had been restructured; it had been moved from the Public Health Department, which put it in the same category as Pest Control and Refuse Services (i.e. rats and bin bags), to the much more apt Cemeteries and Crematoria Services, run by the new head, Arnold. On seeing the mortuary and its staff, a decision was made by Arnold and his team that absolutely everything must go, starting immediately with Alfie’s co-worker, Keith, and then, soon after I arrived, Alfie himself. When I’d been there a while and heard tales of Alfie and Keith’s exploits I could understand why …
Because mortuaries used to come under the banner of Public Health, one worker used to use his ambiguous identification card to receive free meals at restaurants under the pretence that he was a health inspector there to grade them. Apparently, he also brought his dog to work every day and it was given free rein to wander between the office and dirty post-mortem areas at will … and then go back to his house. He kept porn in his locker at work; another worker, Samurai swords. They ate and smoked in the post-mortem room and wore their own clothes with nothing but an apron over the top – no scrubs, no disposable gowns, nothing. The whole set-up was a health, safety and ethical nightmare.
When I was asked to pop in and chat about volunteering it was mainly discussed with Andrew, a young, serious man who slightly resembled Beaker from Sesame Street with his glasses, strawberry blond hair and white shirts which reminded me of lab coats. He was evidently determined to bring anatomical pathology into a new era and I can’t say I blamed him. Mortuary work in particular had been undergoing an image overhaul over the course of the late nineties and early noughties, a natural progression as part of the Modernising Scientific Careers initiative. It was being championed by a younger, more progressive generation who wanted the work as pathology assistants to involve more qualifications and stringent checks – checks there’s no way some of the older generation would ever have passed.
I came in every Thursday (my one day off from university), and while Andrew stayed in the office to send emails and deal with paperwork and get the mortuary’s new management systems up to scratch, I went into the post-mortem room with Alfie. I watched him remove the deceased from the fridge for examination and I met the different pathologists as they arrived to carry out the autopsies, telling me their findings, which I made notes on. My little autopsy notebook was filled with exciting new fragments:
22nd Feb: myocardial infarction most common cause of death in the Western world; 29th Feb: pulmonary embolism in CALF MUSCLE! Watched Dr. J open the leg!!
I viewed all the organ dissections by the pathologists and watched as Alfie put them in a viscera bag and set them back into the body, and I observed Alfie alone as he reconstructed the decedents and placed them back into their temporary refrigerated tombs. Then I helped to clean up all the mess. I did all this in silence. I didn’t really want to engage with him as, in so many ways, what he did represented the old way of carrying out mortuary work while I was more interested in the way younger APTs were attempting to change the old approach to anatomical pathology. I do remember him telling me that he had been friends with the infamous London gangsters the Krays in their heyday, and how they had thrown a dead body off a bridge over the Thames.
I just nodded politely.
Also, he told me he wanted to write and publish a book called Death Can Be Fun. He never did, and at the rate he was smoking when I met him, I seriously doubt he’s still alive.
* * *
This continued for a year – my studying and helping out in the mortuary every week. Soon enough, Alfie was gone, replaced by the younger APT, Jason, who was working as a locum APT then. (This meant he travelled around the UK to work short stints in mortuaries which were understaffed. It could be for a week or two, or even months in the case of maternity leave, for example.) Jason was a lot of fun. He was huge because he was a bodybuilder, enthusiastic about training me in mortuary ways as well as chatting about the gym. I’d always had the romantic idea that being a mortuary technician would be like being in the FBI and assumed I’d need to be physically fit. I modelled myself on Clarice Starling from The Silence of The Lambs and Dana Scully from The X-Files and became a bit of a gym fanatic. I was in there most of the time when I wasn’t in the mortuary or at university and it was a good move because I hadn’t realised until I volunteered that being an APT involves a lot of time on your feet. Good strong leg and back mus
cles are required just for that alone, never mind the fact I had no idea at this point what sort of strength was needed to carry out an evisceration. Jason allowed me to wash the deceased myself, rather than just watch, and explained all the qualities of the different disinfectants, which I could relate to because of my microbiology studies. He also handed me bowls full of organs – the bigger the better – to help me get used to the weight, so that I constantly looked like a dinner lady at an industrial canteen heaving massive bowls of pasta around and complaining about my back.
Finally, the day came for the Municipal Mortuary to advertise for a trainee, someone like me who wanted to be a fully trained APT but had to start on the bottom rung of the ladder, with years of on-the-job training ahead and a qualification at the end of it. I had to apply for the job and go for an interview like everybody else. I met the management team from the Cemeteries and Crematoria Services, including the new head, Arnold, and was asked questions by a panel of four people – something I’d never experienced before in my life. I was terrified, even though they were all lovely. Thankfully, all that preparation paid off and I got the job. I left university with a Postgraduate Diploma and became a full-time trainee anatomical pathology technician. But just because I left university I knew I hadn’t left behind my education. In fact, I was going to learn more, everything that was relevant to the path I wanted to take.
And thus began a new chapter of my life in death.
Three
Examination: ‘Judging a Book by its Cover’
As if you were on fire from within, the moon lives in the lining of your skin.
—Pablo Neruda
I ran into the office one morning to find Andrew in his usual seat, typing away. I could barely contain my glee.
‘It’s finally happened!’ I squealed.
He looked up from his computer and frowned at me over his spectacles.
The Chick and the Dead Page 5