‘What on earth is that?’ I asked Dr Jameson, who was halfway through the external exam.
He took a quick look. ‘Oh, that’s Vibration White Finger,’ he said, nonchalantly.
‘Vibration White Finger?’
I couldn’t wrap my head around it, so he elaborated: ‘It’s a blood flow issue, a type of Raynaud’s disease caused by prolonged use of vibrating equipment.’
My head shot up in alarm and he suddenly burst out laughing. ‘No, not those types of vibrating tools,’ he remarked, with a wink.
I went utterly crimson.
To make it worse, he added, ‘Are you using hydraulic drills in bed?’
I shook my head, trying not to catch his eye.
‘Then you’ll be fine,’ he chuckled, and cracked on with the dissection as though nothing had happened.
I, meanwhile, wanted the mortuary floor to swallow me whole.
* * *
I discovered early on as an APT that the connection between sex and death is not only symbolic but also literal, when I encountered my first auto-erotic asphyxiation case.
‘Whatever you see here, you can’t tell anybody about it,’ Andrew said to me one day, with a solemn expression on his face.
Andrew’s face was far too expressive. Every thought he had slid across his features like a dark cloud across the sky, and it was often disconcerting to have a conversation with him. He was so pleasant when he was in a good mood and his features relaxed into a smile, but it just didn’t happen often. This particular grim expression lent a note of seriousness to the morning’s proceedings.
Opening the body bag with trepidation I was faced with a sight I’d sadly already become familiar with: a man, face bloated, tongue protruding, a noose tied tight around his neck. But this one was slightly different to the hanging cases I’d seen before. There were some socks between the noose and the skin of his neck.
‘What are the socks for?’ I asked Andrew, my eyebrows raised in surprise. (Perhaps his animated facial expressions were contagious?)
‘Auto-erotic asphyxiation,’ he explained. ‘Because he wasn’t actually trying to kill himself he used the socks to take some of the pressure off the noose and avoid visible rope burns.’
Makes sense, I thought, but I didn’t ask Andrew why he knew so much about it …
Once the body bag was removed, it became clear this wasn’t an attempted suicide but a sex-game gone wrong: the deceased was wearing women’s knickers and stockings. I did wonder if perhaps he had been murdered and set up – I mean, what an utterly embarrassing way to go. If you wanted to really dig the knife in after murdering your enemy you might truss them up to make sure they looked like they’d been doing something like this. But the pathologist reassured me it was unlikely. For a start, there are ways to tell when a person has hanged himself, often to do with the angle left by the noose around the neck. Then there’s the circumstantial evidence: drug use, hotel room booked under a pseudonym, porn on the TV, etc.
‘All very typical, very common features,’ said the pathologist.
‘Common?’ I exclaimed. ‘How common is it?’
I discovered it’s a difficult question to answer. Although, as I’ve said, the Coroner in the UK does not perform post-mortems, he is an important part of the procedure as he oversees the inquests. These public, legal inquiries are sometimes opened in the case of unnatural deaths so that the Coroner can establish the cause. He simply has to answer four questions: who was the deceased, and how, when and where did they die? In a suspected case of auto-erotic asphyxiation the question of ‘how’ can cause problems. The family may be upset at a verdict of ‘misadventure’ as it implies something unusual, and the Coroner may not be 100 per cent sure the death was intended so he may not want to label it suicide. Therefore, the verdict is often left as ‘open’. This means that gleaning statistics of these types of death can be difficult. That said, it has been estimated that five hundred to a thousand men die every year in the US from this practice, but far fewer women. UK figures are harder to come by.
In these cases, it is the external exam that gives most of the information, the attire and the neck wound being most important. Then, of course, circumstances of death add pieces to the puzzle. So why have an autopsy at all? If it’s so obvious from the outside, can’t we just say on the certificate ‘death by hanging’ and leave it at that? We can’t for two reasons. Firstly, there may well be an underlying health condition in the patient. Perhaps the person who diced with death and practised auto-erotic asphyxiation had a reason to throw caution to the wind; maybe he had a terminal illness he’d told nobody about, or perhaps didn’t know about himself. HIV for example, or a form of cancer? This may be useful for next of kin or previous partners to know. Secondly, the World Health Organisation also needs to know these statistics so that they’re informed of the major health conditions people are commonly suffering from, and therefore where to invest money for treatment. An autopsy is not just to establish immediate cause of death, it contributes to a body of knowledge used by the whole world.
And then, of course, there’s the odd surprise. When we opened up the case that morning we found a butt plug that had entered the man’s rectum so far we hadn’t noticed it during the external examination. I removed it as it seemed more dignified to bury the man without it in there, and I was used to pulling things out by now after thrusting so much cotton wool into patients like I’d seen Sarah do years earlier. But I really didn’t want to be the one to hand it over to the family with the man’s personal effects. How would they feel? Ultimately, our aim is to allow the deceased to leave the premises in the best shape possible and as close to their natural state as possible, interfering as little as we can with the perfection of the outside and inside of the deceased. A butt plug doesn’t come into the equation of ‘natural state’, but after I placed it in a sealed plastic bag I did stand in the mortuary, holding it by the corner, for an inordinately long amount of time, while I tried to work out what on earth to do with it.
The stunning thing about the human body is that every tissue looks different yet every single one has a purpose and a place, even the strange flap of yellow omentum providing a safety blanket for the organs. It’s a marvel of design and engineering, even if it can be artificially manipulated by ropes around the neck and foreign objects inside orifices.
* * *
This, then, is the landscape of the human body at the first frontier. Sometimes after that initial incision – the moment the curtains of the flesh are pulled back to reveal the ribs – there will be evident pathology to help identify cause of death: perhaps lots of yellow fluid called ascites in the abdomen, or perhaps some angry red criss-cross rib fractures. Other times, as Elisabeth Bronfen said, ‘Cutting into the body, entering the labyrinth of Otherness, may in fact only lead back to an encounter with oneself…’ Either way, you’re now inside and there’s no turning back. The only option is to go in deeper.
Six
Thoracic Block: ‘Home Isn’t Where the Heart Is’
I am my heart’s undertaker. Daily I go and retrieve its tattered remains, place them delicately into its little coffin, and bury it in the depths of my memory, only to have to do it all again tomorrow.
—Emilie Autumn, The Asylum for Wayward Victorian Girls
I watch horror movies quite frequently and often the lazy plot twist will be ‘This house was built on an Indian burial ground!’ or ‘This orphanage used to be an asylum!’ and of course that explains why the child became possessed or the closet contains an opening to hell, blah blah.
These storylines don’t scare me.
When I first moved to London I lived just past the graveyard, round the corner from the prison and opposite the mental hospital. Throw in an Indian burial ground and my life would have been the ideal Halloween TV special. But, I digress. Just what made me leave my relatively safe and small hometown and try my luck in a horror movie cliché? Partly it was a desire to train more, ‘to go in deeper’, to be
promoted somewhere as a now-qualified APT and not just be paid and treated as a ‘mortuary assistant-slash-trainee’. But more than that, it was due to one life-changing event.
* * *
The morning of Thursday, 7 July 2005 is so fresh in my mind it may as well be yesterday. June and I were in the PM room around eight a.m. with one case each as Andrew took his usual seat in the office chair at his PC – he was finishing up paperwork before heading off on leave. June and I weren’t listening to the radio; we’d started proceedings by arguing about whether we’d play my Arcade Fire CD – again, as I’d recently become obsessed with the band – or whether June would finally win out and instead get to listen to the Hannibal Lecter theme composed originally by Bach. She won this time; it was only fair.
While we were carrying out our external examinations to prepare for the pathologist to arrive a little later, we were interrupted by his premature, flustered entrance. Dr Sam Williams, tall and lanky with an air of typical English ‘properness’, was always a bit awkward, but on this occasion his flurry of activity caused both me and June to cease our banter and lower our clipboards. He dropped his papers and briefcase, stopped the CD and flipped the hi-fi to the radio.
‘Haven’t you two heard what’s going on?’
‘No – what?’ June asked, bewildered.
‘We’ve been in here since about seven thirty,’ I added. ‘We haven’t got a clue.’
When you’re in the isolated PM room focusing on autopsies, the rest of the world may as well not exist.
‘There’s been an explosion in London,’ he informed us, looking pale. ‘It might even be two. They think more than one can’t be just an accident.’
We didn’t really know what to assume but we knew we had to keep working on the patients at hand who deserved our full attention. Still, we left the radio on in the background to find out exactly what was going on. We all had friends and family in London, we were all worried about the situation, and we wanted to know what was happening. We never normally carried out post-mortems in silence: there was usually constant banter about the cases or what we’d been up to the night before. This time, though, there was no talking from us, only the drone of the small radio in the corner of the room echoing off the bare walls and floor tiles.
As time unfolded, like the skin on the torsos of our deceased patients, the truth was revealed, just like their ribs and organs. There had been a terror attack in Britain’s capital which had effectively brought it to a standstill. Due to the fact that four bombs had detonated in separate areas of the city, communication lines were down and no one knew for hours if their friends or relatives were safe. It was a cataclysm the like of which our generation in Britain had never experienced.
By the end of that afternoon I had been recruited to go to London and work in the temporary mortuary which was in the process of being set up as part of ‘Operation Theseus’. All four bombing sites were to be investigated and their remains to be brought to one central mortuary facility large enough to accommodate the evidence and the victims, as well as the huge number of staff who would need to be involved in this gargantuan investigation: APTs, pathologists, anthropologists, radiographers, DVI (disaster victim identification) teams, SO13 (the Anti-Terrorist Branch as it was at the time), Interpol and more. It was a purpose-built complex of marquees and temporary buildings set up at a barracks in central London in accordance with previously devised emergency preparedness plans. Construction began by the end of that fateful Thursday and it was expected to be fully functional as early as the following day.
I was recruited because I’d put my name forward to be part of a team for emergency alerts in case such an incident should happen in the UK. There is a similar US organisation to the one I’d joined and it’s called D-MORT, the ‘Disaster Mortuary Operations Response Team’. Great acronym! It practically explains what it is without you even needing to know all the words; it sounds like it could require its members to wear X-Men-style uniforms. And what was ours called in the UK? The ‘Forensic Response Team’, or FRT. Throw in the word ‘anatomical’ and I would have been working for FART. I wished it was called something as descriptive and snappy as D-MORT but still, a rose by any other name etc. I’ve since come to realise that clever puns or abbreviations aren’t respected by those who don’t understand the power they can have when attempting to engage people with a topic. Suffice to say, by the time I was using the word ‘technologist’ in the wrong context and working for FART, I was already becoming a bit disillusioned and hoping to progress far enough up the professional chain to be a part of the decision-making process in future.
Regardless, being involved in this mass fatality investigation was something akin to being called into a religious order for me. I had studied mass disasters and graves as part of forensic anthropology courses, been to conferences on Disaster Response and was a member of Amnesty International, attending meetings and keeping up to date with global conflicts. I’d read books on mass excavations in the former Yugoslavia and Rwanda and knew there was a possibility of carrying out such work as an APT. Now, suddenly, it was my turn to do something important. I was so grateful. I didn’t want to just helplessly watch events unfold on TV. I felt honoured to be given this opportunity to use my training and do something for those who needed it most.
Andrew had left by the end of the working week bound for warmer climes, which left only myself and acting manager, June, in the mortuary. I was incredibly thankful to her for letting me go. I arrived in London on the morning of Saturday, 9 July, having flown into City Airport from Liverpool at seven a.m. as it was a lot quicker than taking the train. I was at the Honourable Artillery Company barracks by eight, and half of the APTs, mostly the London and southern-based ones, were already there. I’d brought my own kit with me: the all-important face visors I was so used to working with, my white nurse’s clogs with my name written on which I’d wear daily in our mortuary, and my own set of scrubs – just in case. I also had clothes and toiletries; the usual for a few days away. Although we were all being accommodated in the same hotel, there was no time to take those bags to my room. I was instructed to put them in the corner along with everyone else’s and then I went straight into the recently erected changing cubicle to throw on some provided scrubs and start work.
The victims were already being brought in and I was amazed that the system was running like clockwork, with teams of people contributing to one well-oiled machine. Each decedent was first X-rayed inside the body bag, with a pathologist overseeing the process, so that pieces of debris that were either dangerous (for example shrapnel) or pivotal to the investigation (for example parts of the bombs) could be recorded in situ then removed carefully. After bag and detritus removal the deceased was then X-rayed again, still under the pathologist’s supervision, with just clothing on, to ensure that nothing important had been missed.
Then the victims were transported to the APTs, with the pathologists joining us, working at four autopsy bays in small teams. The teams consisted of the pathologist, two APTs, a photographer and evidence collector from the police force and a member of SO13 – more members than for a routine autopsy but perhaps similar to a forensic post-mortem. We APTs assisted with the removal of the clothing and jewellery, as photographs were taken and personal effects were collected to be labelled with DVI numbers. Once in a blue moon we struck gold and were able to identify victims using their wallets, but most of the time it was more difficult.
It is perhaps obvious that I can’t go into too much detail, as it was a sensitive operation and family members who lost loved ones are still grieving, while victims are still suffering from their injuries. It would be careless and cruel for me to reveal too much about what went on.
The days at the facility were intense. We’d begin at seven a.m. or thereabouts and end around seven or eight p.m., at which point we’d have to clean down the whole mortuary ready for the next day. I’d brought enough luggage and clothing for a few days, yet two weeks later I was st
ill there. The APTs working together so tightly under such circumstances became incredibly close: we were all staying at the same hotel, eating meals together, spending all day together then going home together to ‘debrief’ – by which I mean a drink in the bar and a discussion of the day’s events as an emotional outlet. It was here that I met Danny and Chris, the managers from the Metropolitan Hospital in London. They were vivacious and raucous and so different to Andrew in terms of how they managed their younger APTs, Josh and Ryan. They were constantly playing practical jokes and talking about their hilarious escapades. They were able to keep my spirits up through the process of autopsying larger human fragments until finally we were examining small fragments and the forensic anthropologists took over. Then, it was time for me to go home.
* * *
Six difficult months after the terror attacks, once I was back in the Municipal Mortuary and the intensity of the days at the barracks had left me, I was in a dilemma: I wasn’t sure if I was happy that things had calmed down or if I was missing the excitement of doing something that felt more worthwhile in a busier place. A position suddenly opened up at the Metropolitan Hospital for a qualified APT with the Certificate. Danny and Chris, remembering me from our time together following 7/7, contacted me to give me the heads-up and see if I wanted to apply.
Had I thought of moving? Had I thought of working in a hospital rather than a Coronial mortuary? Did I want to work towards my Diploma?
Yes to all these questions. Yes, yes, yes. I suppose that answered my dilemma.
I applied, and I got the job.
* * *
Even with my eyes closed, I always knew when I’d stepped off the train, through the doors of Euston Station and into London. Compared to the north, the air had an oppressive quality; perhaps because the temperature was always a degree or two higher than I was used to, or because there were more buildings shielding me from the winds, or more traffic fumes – the famous London smog. London is hardly Las Vegas but it felt overwhelming to me; muggy, hypnotically brighter and louder, the puddles in the road gleaming with rainbows of oily colour which were unseemly somehow, and wave after wave of people stampeding down the pavement so I could never quite walk in a straight line. Reading, I discovered, was a different type of pastime in London. People read on the move: magazines, newspapers, even books! They read as they were walking on pavements, travelling on escalators and – very carelessly – while crossing roads. I never considered reading to be an ambulatory activity until I moved to London. I still live in the capital and have come to love its quirks: the people so desperate to read they walk into lamp posts, the bright red sign that warns ‘Do Not Feed the Pigeons’ which has been vandalised by someone who has written over the word ‘Pigeons’ with ‘Tories’, the constant feeling of being told off by unseen dictators via loudspeaker – ‘Do not cross the yellow line: stand back from the platform edge’ and ‘Do not stand on the left of the escalator: walk on the left and stand on the right’. Jeez, there are so many rules! Back then, it was all quite alien to me. I think, as much as I was excited to move to the ‘Big Smoke’ and climb up a rung on the career ladder, there was still a feeling of unease because I associated the city with those July terror attacks. I hoped it wouldn’t last.
The Chick and the Dead Page 12