‘I don’t understand it, Josh,’ I said, after that first perinatal autopsy during which I’d done nothing but watch and ask a million questions. ‘How can the parents see their baby this afternoon if the head is sliced open and the brain is meant to stay over there for a week?’ I pointed to a labelled Tupperware pot in which the delicate pale mass was submerged in fluid on a dedicated ‘brain shelf’ among countless others.
‘We don’t need the brain to be in the head,’ Josh explained patiently as he removed a small piece of cotton wool from a large roll, formed it into a ball roughly the size of the pink cerebral tissue that had been removed, and placed it delicately into the empty skull.
It was starting to make sense but I still had a query: ‘But if we stitch that up now we’ll have to unstitch it to put the brain back in next week, won’t we? Then stitch it again? It’ll look messy.’
Ever patient, Josh simply reached for some cyanoacrylate, or ‘superglue’ – something I was about to learn is the mortician’s best-kept secret, and which really earns its name – and said, ‘We can’t stitch this. Look, it’s too friable.’ He was right. It was like the skin of a recently burned victim; it would tear too easily. Instead, I watched, fascinated, as he neatly folded the edges of the doctor’s incision so they were perfectly straight, delicately lay a trail of glue along the skin of one incision, then pressed the other edge against it, holding for a few seconds. The line that joined the two pieces of scalp together was as thin as a hair and barely noticeable. I looked at him, impressed.
There wasn’t much time for admiration, though, because the glue dried quickly and he gently turned the baby over on to his back to reveal the empty thoracic cavity.
‘Right – your turn.’
OK, the first problem here was that lying on the small dissection board I had a tiny pile of miniature organs and tissues which all looked the same anaemic pink. They needed to go back into the baby and an adult viscera bag was obviously not the way to do it. That’s when I spied the clingfilm. I reached for it and Josh nodded his approval at my correct assumption. I removed a piece of the awkward clingy plastic, scraped the organs and tissues gently on to it with a small blade, then wrapped it up into a neat package which fitted into the cavity perfectly. Then, taking the superglue, I attempted the same technique as Josh. He had made it look effortless. It was actually as fiddly as hell but I got there in the end, the miniature torso now intact with a little line down the middle no wider than a piece of embroidery thread. I felt a flush of pride when I saw him smile at my efforts, but as usual there was no time for revelling in small achievements. We were already moving on to the next task.
‘Right, we’d better get him dressed and set up for viewing.’
* * *
At first, I hadn’t understood what Josh meant when he said we had to ‘dress’ the first Lilliputian cadaver I’d ever encountered. Surely clothes were not made for babies so small that they wouldn’t survive outside the womb. Did we buy dolls’ clothes, perhaps? I came to learn that volunteers actually knitted miniature garments in pink and blue, usually hats and cardigans, specifically for these tiny viewings. The hats in particular were welcome because they helped to humanise the odd-looking little corpses and hide the incisions at the back, no matter how neatly they had been reconstructed.
As the only female on the team here, I seemed to become the go-to girl for perinatal viewings arranged by the Bereavement Service’s head officer. I found that I liked the job of carrying them out: I cared that the child was dressed correctly and that any toys or photographs the parents had requested to be placed in the small crib were there as they should be. I got used to the unfamiliar perinatal world and I felt like I could communicate with these devastated parents at such a difficult time much more appropriately than the Terror Trio could. Plus, it gave me more tasks to do in the afternoon to keep me away from the rest of the team. Often, Josh would come and help, and that was fine – he was sensitive to the parents’ needs in the same way I was. What with the baby viewings and studying for my Diploma I began to feel like I had my own specific purposes at this mortuary and they didn’t really involve spending a lot of time with the others.
Which suited me just fine.
* * *
Why is it that baby viewings require such a delicate touch? It may seem like a stupidly obvious question since they’re babies and ‘their death is a shock’ so it’s incredibly sad, but that can apply to many decedents. Lots of people lose a loved one suddenly, someone they may have been close to for years such as a sibling, a parent, a best friend. They too deserve the same amount of care and attention. Yet there is a good reason why there is more sensitivity towards baby viewings. Perhaps it the sadness is about a life which never had the chance to start; the hopes for a child and their innocence.
In the UK in the late 1990s, something called the organ retention scandal or Alder Hey scandal occurred. It began when a bereaved mother learned that her child’s heart had been kept for testing at a Bristol hospital without her knowledge (meaning she had unwittingly buried her child incomplete). There was then an investigation in which it transpired the same type of organ retention occurred at Alder Hey Hospital in Liverpool, not far from where I’d been working. Further investigations uncovered another two hundred or so hospitals and teaching facilities which routinely retained organs, despite parents not being aware of it, simply because it wasn’t specifically stipulated in the Human Tissue Act of 1961 that their permission needed to be sought. The public was outraged, and the media didn’t help the sensitive situation, writing articles under headlines such as ‘Ghoulish Malpractice!’ and ‘Return of the Body Snatchers!’ In truth, nothing illegal had occurred, except in the case of one dodgy pathologist who went by the gothic horror name Dr Dick van Velzen. He was based at Alder Hey, which meant a lot of the focus ended up on that hospital – which is why the scandal is often referred to as ‘Alder Hey’ for short. An organisation of bereaved parents demanded a change to the law and the Human Tissue Authority was eventually formed in the UK in 2005. Their job was to ensure that ‘informed consent’ for any organ retention was obtained from next of kin, and to govern the use of human tissue for post-mortems, public display, some transplants and more. This is why we had to treat baby viewings carefully, despite the fact that most parents were happy to discuss their babies’ autopsies and routinely agreed to tissue retention. It seems that, for some people, the stigma of the 1990s scandal hasn’t left when it comes to deceased babies, but it also seems that neither has the anxiety or dread of being buried ‘incomplete’ in some way, mirroring those fears of cadaver dissection from the past.
This has left us with a skewed vision of perinatal autopsies and medical specimens such as those on the shelves of my museum, despite the fact we don’t treat them like the pickled punks of old. Why are most people more sensitive about them than they are with adult specimens? Perhaps babies floating in preservative fluid or laid out on an autopsy table, completely whole, are more recognisably human with their tiny eyelashes, fingers and toes? Or is it the idea of an innocent wasted life that makes some people more sensitive to deceased babies in general? Some feel that exhibiting these specimens in museums is traumatic to those who have suffered a miscarriage or stillbirth. But then what of the female pathologists, police personnel, social workers and others who have experienced these traumas in their personal lives as well as in their careers? Do they stop working? Does everything come to a standstill?
I was about to discover that no, it does not. Life goes on.
* * *
In one way my life was definitely moving on. I saw a job advertised for a Senior APT in another London mortuary, St Martin’s Hospital, which I could apply for now that I was a Diploma-holding technician. I was as highly qualified as an APT could be, on paper. My interview again involved a panel of four people but it was something I’d become used to and I gave it my all. I was confident and capable, and, more importantly, I was beginning to shake off the negativity of the past year. Af
ter more than five years I was experienced in embalming as well as all aspects of mortuary work and nearly every post-mortem possible: Coronial, hospital, forensic, perinatal. The only thing I’d never experienced enough of were autopsies of individuals designated High Risk; that is, decedents with a known infectious disease, intravenous drug users, and people who have been exposed to dangerous chemicals or radiation. Such ‘High Risk’ autopsies could only be performed by a Senior APT.
I needed that experience, and I needed to get out of the hospital I was working in. I was a good APT but I wanted to be great, and St Martin’s was one of the best places to learn. My enthusiasm and hunger for the challenge must have been very obvious during the interview and my CV must have backed up my claims of competence because I hadn’t even left the hospital grounds when one of the interviewers called my mobile phone.
I’d done it – I was offered the job. I literally skipped out of the hospital gate.
* * *
What a contrasting experience St Martin’s was! It was hectic in a whole different way to the last place. There I had only been occupied when I chose to keep myself occupied. Here I had no choice: I was constantly buzzing around the mortuary like a Calliphora vomitoria (that’s the scientific terminology for a blue-arsed fly). It was the busiest, most productive mortuary I’d ever been in. And talk about extremes: I’d gone from a team of four boys to a team of five girls which was actually about to become six as there was a new trainee starting, so seven including me. So much testosterone in an enclosed environment had been a problem in the last place; how would I fare with a massive cocktail of oestrogen?
Time would tell.
At least the overall manager of the facility who popped in now and again, Juan, was male and able to add a bit of masculinity to the proceedings. I had met him before at the 7/7 facility and I liked him. He was ambitious and inspiring, gentle and encouraging, but tough when he needed to be. I was happy to be working with him.
The first day I started there I tried to act as comfortable as possible even though I was crazy nervous – a year of working with four men who resembled The Young Ones does that to a girl. But, newly single and ready to mingle, it was nice to be part of a gaggle of girls and in a totally different environment. It was a change I sorely needed.
As we sat down that first morning to introduce ourselves over coffee I spotted a copy of Maxim magazine in the office next to the computer. ‘Maxim? Isn’t that a bloke’s magazine? It can’t be Juan’s, can it?’ I said, with a wink.
The girls laughed, and Sharon, the other Senior APT and my closest colleague, replied, ‘Nah, we bought it because it’s got a big feature on the funeral directors we work closely with: Anderson Morgan Funeral Service in South London.’
‘Ah,’ I said, as I flicked through the magazine with interest, and sure enough there were about six pages dedicated to Anderson Morgan. It was a very well-known family-run establishment which had been the focus of a TV show and had carried out some high-profile funerals.
I stopped, mid-flick, to focus on a page featuring someone from the firm who I thought was fairly good-looking: brown hair, strong arms crossed over the typical green plastic apron indicating mortuary work specifically. On closer inspection I read that this was Thomas, the embalmer of the company. Wanting to carry on the conversation I exclaimed ‘Wow, who’s the hottie?’, at the same time as holding up the magazine for the rest of the girls to see – several of them, including the mortuary manager Tina, all sitting on chairs around the small office.
‘That “hottie” is Tina’s husband,’ said Sharon, with a smile.
‘Haha, come off it,’ I scoffed, with a raised eyebrow. I really thought they were having me on, messing with the new girl.
‘No, seriously,’ Tina said, without a trace of a smile. ‘That’s my husband.’
I’d just called my new manager’s husband a ‘hottie’.
Great start to my first day.
* * *
When I say St Martin’s was busy, that really is an understatement. It was the mortuary of one of the largest hospitals in London, but it also accepted Coronial cases from the local jurisdiction, meaning some deceased came down from the wards and some from the outside. Also, because it was an established ‘centre of excellence’ when it came to High Risk work – one of the main things I’d be doing as a Senior APT – it also accepted deceased individuals from places as far away as Brighton and Ipswich. I was never not busy. Our hours were officially eight a.m. to four p.m. (unless we were on call) but I’d religiously be in at seven thirty to make a pot of coffee because, believe me, we were all going to need it. There were many nights when I left nowhere near four but closer to six or seven.
My usual routine was to carry out one or two High Risk cases in the morning – tuberculosis, HIV and hepatitis when I first started, as they were the most common daily occurrence. I enjoyed the challenge immensely. High Risk patients require their own room and equipment; they can’t be mixed in with other cases in the main post-mortem room which trainee and Certificate holders are working in. The St Martin’s main autopsy suite was as large as the one at the Metropolitan; larger, in fact, as it had a perinatal bench and X-ray machine at the back (rather than in a separate room) as well as a gallery for medical students to view post-mortems as part of their training. But I loved having what felt like my own personal autopsy suite – the High Risk room – to set up for cases exactly as I wanted, while awaiting the arrival of the hilarious, talented and enigmatic Professor Aloysius St Clare to carry out the examination. He wore a hat like Indiana Jones and sometimes, of all his garments, he’d take it off last in the High Risk changing room as he swapped his street clothes for scrubs. One day I walked in to find him in nothing but his boxer shorts and Indiana Jones hat, though he wasn’t at all embarrassed. Hands on hips, he simply said, ‘Carla, I think we’ll need a lot of labels for this one. Lots of samples to take,’ and I just looked all around the locker room at everything but his bare chest and pants and said shyly, ‘Yes, Prof,’ before dashing out of the room as quick as I could to print off labels, thankful for the excuse.
* * *
One of my new roles as Senior APT in this mortuary was to bury dead babies.
This was something I hadn’t been expecting.
Every hospital has a Bereavement Centre, just like they’d had at the Metropolitan, but what I hadn’t known was how closely this one and the mortuary department worked. For example, if the Bereavement Centre was completely overwhelmed and had lots of paperwork and we were quiet (not like that happened often), one of us would be expected to go upstairs and help them out. It was beneficial to us because we saw every single aspect of a patient’s death and learned about all the relevant death administration.
Many hospitals have a fund they use to pay for very basic funerals for the deceased of their jurisdiction who are unclaimed. Or it may be that family members simply can’t afford to do it themselves and meet government criteria for financial aid. The adult funerals were handled upstairs. What I had to do, sadly, was exactly the same thing for deceased babies but down in the mortuary, in the basement. I did not think there would be many situations in which parents wouldn’t want to organise and directly oversee the funerals of their progeny – anything over twenty-four weeks’ gestation came under my care, and anything under twenty-four weeks was under the care of Sharon – but it was a common occurrence and had me dealing with ten to fifteen perinatal funerals a month. I hadn’t expected it because many funeral homes waive certain fees for baby and child burials, making them less expensive than the average ceremony – but still there were situations where I had to step in.
Organising these funerals usually involved lots of paperwork – everything in mortuary work does; it’s the side that’s never discussed – as well as a lot of contact with Anderson Morgan, who had the borough contract to carry out these ceremonies. I’d receive funeral request forms from the bereavement office via the maternity wards, then go and check the fridge to
assess the size of the baby. As they’d be transported to Anderson Morgan via one of the temporary cardboard coffins, I’d then need to choose one for each tiny body, and that was always odd. Very small baby, eighteen or nineteen weeks? Definitely around a size 4 ‘shoebox’. New-born, full term? More like a size 13. The bigger the baby, the bigger the cardboard box, and the harder it was for me to understand why the parents had seemingly abandoned their deceased child. I was, however, given all their details and I sent them letters via post and email instructing them of the time and place of the ceremony in case they wanted to come.
These tiny cadavers, which I came to call ‘my babies’, were collected monthly by a member of Anderson Morgan and I’d make sure I personally oversaw the process – the last part of my involvement with these apparently unwanted angels. I’d check every cardboard box and every ID band, tick each name off the list, then hand the whole batch over to the undertaker to be placed on an adult stretcher and covered with an elasticated topper. Then I’d mentally say my goodbyes.
* * *
When funeral directors came to collect the adult deceased, the procedure was similar: we’d answer the door, make chit-chat while we ensured the undertakers had the correct paperwork to state they could claim the deceased, and help them transfer the relevant patient over to their stretcher to be covered again by the topper. Various signatures were exchanged, a name – written in whiteboard marker – was rubbed off the fridge door, and the undertakers went on their merry way. It was sometimes difficult to remain friendly with all of them, especially the ones who seemed desperate to chat, when you were actually in the middle of an autopsy and you’d had to remove all your PPE to come out and deal with the situation – something I hadn’t had to do at the Metropolitan. It’s not malicious, it’s just that your head is on your latest case and nothing distracts from it.
That’s why I was surprised when Tina, who’d easily forgiven me for my initial faux pas about her ‘hot’ husband, came up to me one day with a playful glimmer in her eye.
The Chick and the Dead Page 15