Helpfully, the living flooded the bar with toe donations (toe-nations?). One was amputated due to diabetes, one due to an inoperable corn (urgh), and one simply arrived anonymously in a jar of alcohol with a note giving the sage advice: ‘Don’t wear open-toe sandals while mowing the lawn’. Recently, though, the ninth toe was swallowed – seemingly on purpose, for the swallower had to pay a $500 fine. That fine has since been increased to $2500 to ensure their back-up tenth toe doesn’t disappear along with all the others.
Anyway, the point is that instead of just incinerating live patients’ parts – or using them for drinking games – let’s put them to good, forensic use.
* * *
People sometimes come into the mortuary fragmented due to a horrible occurrence like an accident or a suicide, the most frequent being RTIs (road traffic incidents), railway incidents or ‘jumpers’.
One suicide I remember in particular was a man who had thrown himself in front of an oncoming tube train, which in London is euphemistically known as ‘a person under a train’. When this occurs, passengers on the platform tend to be informed via loudspeaker, ‘The service has severe delays due to a person under a train’, as though they’re just hiding under there for a bit, or perhaps having a picnic. Death is still so taboo that Transport for London won’t simply say ‘due to a death’.
On opening the body bag at autopsy we were confronted with the extent of the suicide’s fragmentation: the upper left of his skull was destroyed, both hands were hanging off his wrists, attached by a few tendons and some skin, and his body was split across his middle which had caused his behind to spin around to his front; that is, my eyes travelled from his crushed head, down his mangled torso and straight to his buttocks. His genitals were somewhere at the back, underneath him (I hoped, for his sake). He also had one foot completely severed at the ankle and one lower leg off at the knee, both placed in correct anatomical position in the body bag. I think. It was hard to tell because his legs were the wrong way round. To top it off, we could see through the mangled chest and abdominal cavity that most of his organs were missing. However, there were several plastic evidence bags within the body bag containing, as far as we could ascertain, his organs and other fleshy debris which the British Transport Police (BTP) and the recovery team had scraped up from the surrounding area.
All in all, it was a mess. But we still had to carry out a post-mortem.
First, we had to determine exactly which organs were missing. Some, like the two kidneys, were still intact inside his body cavity. Because they’re positioned at the back (retroperitoneal area) of the body and surrounded by a thick layer of fat they are quite protected compared to other organs. In this case they had clung to his back, like two limpets. The spleen, on the other hand, was gone. It’s such a delicate organ that it can be one of the first to be injured or completely obliterated – many people will have heard the term ‘ruptured spleen’. I imagined his was squished somewhere along the train track, leaving a sad, dark red smear.
I sighed as I sifted through the small bags and found some remnants of his brain, his heart, and other pieces of tissue that I couldn’t differentiate from one another.
‘Prof, I think you’re going to need to look through these bags,’ I said, frustrated by what seemed like an impossible jigsaw. I took my gloves off so I could wipe my brow. ‘Your eye is better than mine at working out what some of these pieces are anyway.’ In truth, I could probably have done it, but it was bringing back some bad memories.
People in pieces. It was nothing new to me.
When I’d worked in the temporary mortuary after the 7/7 bombings we sadly dealt mainly with fragments of human beings, especially towards the end: small plastic bags of unidentified material scraped from the four different detonation sites. Combined with what the recovery teams had assumed were the remains of victims were bones from wild creatures that had died in the tunnels (rats, pigeons, mice), bones and meat from discarded Kentucky Fried Chicken meals or similar, and other objects that were not even animal but vegetable or mineral. Add to that the fact that those responsible also blew themselves up and there was the very real possibility their remains had commingled with those of their victims.
Such a horrible way to go: to not only be blasted into pieces but to be mixed in with everyday detritus, even pieces of your murderer.
What a terrible crime.
We did everything humanly and mechanically possible. We sifted through those bags, we identified tissues and bones that were human, and we passed them on to the anthropologists and other specialists further down the facility if we weren’t sure. We tagged everything separately, we sent them for DNA testing, and the results were compared with members of families that had either confirmed they’d lost someone to the blast or had someone still missing.
It’s not easy to hear or discuss such details. I could, of course, go into much more detail, but I won’t, for reasons I gave earlier in the book. Nonetheless, it’s important people appreciate the lengths the professionals went to in order to reunite those fragmented remains with their source and ensure no one was laid to rest with a remnant that didn’t belong to them. It’s crucial to know the realities of these crimes, particularly terror attacks, which play, in part, on that age-old fear of being fragmented in death, or of perhaps leaving no remains and therefore nowhere for next of kin to mourn.
I put on a fresh set of gloves now that I’d had a moment to stretch my hands and breathe, and turned my attention back to Railway Man. It was fairly evident the cause of death, according to the pathologist, was ‘extensive and severe blunt force trauma’, and the manner of death was Suicide (as opposed to Accident, Natural Causes, Homicide or Unascertained). In the UK, the manner of death has usually been identified at this point by a legal officer, such as the Coroner.
Professor St Clare had thankfully told me there was no need to ‘open’ the head since we could see inside anyway and his brain was already ‘removed’. That was beneficial for my reconstitution of the deceased later. It didn’t take Prof long to fill out the form and take it with him as he removed his PPE and headed up to his office to write his report. I was left alone not only with Railway Man, but a dissection bench, cutting board, sink, walls and equipment all covered in blood and pieces of tissue. My priority was to ensure the blood didn’t dry on the various surfaces and stick to them so first I gathered together every single piece of excess flesh and placed them in a steel bowl with the rest of my patient’s organs. I even used forceps to pick up the smallest remnants I could find. They would all be dealt with during the reconstruction. In autopsy rooms we use hoses attached to the dissecting benches to clean down. They usually have spray nozzles with trigger handles to control the flow of the water. I picked up the hose and began to spray all the surfaces down thinking, with typical dark humour, that it was a metaphor for my life right then: me being left alone to clean up a mess somebody else had made.
* * *
I knew at some point I had to take some responsibility for the mess that had been my relationship and the effect it had had on me. The thoughts going round my head about it somehow being my fault, and how I should have been more vigilant, and how on earth I could have been the last to know about the situation, were ruining my days – but what was worse was that I was letting them. I decided that, rather than try to desensitise myself and prolong the process of ‘grief’, or whatever it was I was feeling, I’d just come off the meds, do some cold turkey, and get through it on my own. I kept thinking of that Winston Churchill quote: ‘If you’re going through Hell, keep going.’ I figured things couldn’t get worse, so that was that. ‘Adios, Prozac. Time to move on.’
* * *
I opened the fridge one morning to see for myself a mistake I had assumed had been made on my baby funeral paperwork. I was supposed to organise a funeral for a child aged two and a half years. That couldn’t be right: surely they meant two and a half months? On unzipping the small white body bag I was shocked to see the most be
autiful baby boy. His blond hair was curled against the marble of his forehead like one of Botticelli’s angels, and the eyelashes of his closed eyes were so long they caressed his plump cheeks like tiny, dark kisses. I wanted to kiss those cheeks. I was overcome with sorrow for this cherubic child who had been abandoned in death for unknown reasons and left in my care – the care of a stranger – for ‘disposal’. A sob escaped me, and it echoed around that cold fridge room, ricocheting off each white door so that by the time it reached my ears again it was unrecognisable.
‘I don’t cry,’ I thought. ‘I have a job to do.’ But even as I heard the words in my head I was scooping the cold, dead toddler out of the fridge and my tears were falling, creating cerulean circles on his pale blue baby-gro.
I think I was crying for a hundred reasons. I was pressing his frigid body to me in a warm embrace and weeping because I wondered where his parents or other family were and why they weren’t dealing with his funeral. I was crying for that ‘fish-baby’ I’d witnessed that perinatal pathologist throw on to the weighing scales like she was at a deli counter; crying for every single perinatal post-mortem I’d done in the last few years; and crying for the one baby I hadn’t even been able to keep safe – my own.
When you work with the dead you cannot weep for every single case you encounter – you’d be utterly useless. It’s a defence mechanism that works perfectly well until something just snaps and tells you, ‘OK, it’s time: now have a cry, then get back to it.’
This was one of those times, and I just came apart.
I cried for every deceased patient I’d ever worked on and every one of their family members or friends. I think I also cried for myself: for the long work days, coming in up to an hour early in the morning just so I could try to catch up on paperwork before the fax and the phone began ringing and the others turned up and the pandemonium started again. I cried because of the weekends when I felt lonely in a city I had yet to figure out. I cried because I felt unsupported by the girls I worked with. I cried because I’d come off the medication and was feeling the intensity of my emotions for the first time in a long time. I cried because – who knows? I just needed it.
I kept going until I had run out of tears, then I wiped my face with the sleeve of my white coat and placed the angelic baby back into the fridge with the teddy bear in his arms. I also covered his face and zipped up the body bag to make sure there would be no fridge burn on those perfect cheeks. It wasn’t much; just one small gesture to encompass a world of grief. And then, like I always did – like we all always do – I moved on.
* * *
At this point I wasn’t to know that things would get so much better; that I’d spend the next years of my career surrounded by fragmented human remains at the Pathology Museum, yet still feel completely whole. It hadn’t even been in my ‘career plan’. But something or someone had a plan for me and it exposed me to yet more death contemplation and research. There was so much more to learn from fragmented bodies that had withstood preservation for one to two hundred years, because the reasons for their procurement were so different from remains I’d dealt with at autopsy or helped remove for histological analysis. The preservation or ‘potting’ procedures used at Bart’s were old and varied wildly, meaning I would be able to focus more on the history of dissection and display rather than current guidelines in my ‘red book’ or from the Human Tissue Authority.
I also didn’t know I’d end up working sometimes as a prosector in the dissection room at our other campus. A prosection is different from a dissection (the act of cutting something open to study its internal parts), which is what medical students frequently carry out as part of their studies to learn about something they’ve never seen before. A prosection is the dissection of a cadaver, or part thereof, but it’s carried out by an experienced anatomist in order to demonstrate a specific anatomical structure to students. Most dissection rooms will own a series of prosections which the students can observe as they dissect their own donated cadavers – a kind of 3D atlas of body parts. A prosection can be of the cardiorespiratory system, the head and neck, or perhaps a limb. These incredible real-life ‘sculptures’ created from embalmed donor cadavers illustrate layers of muscle, tendon, fascia, vessels and more. Stored correctly in a preservative such as formalin, these pieces can inform students for years to come. One doesn’t need to be ‘whole’ to help train the doctors and surgeons of the future; fragmented remains are just as useful. Even more interesting was that after years of having to carry out autopsies on fully embalmed cases, the flesh of which becomes as grey and hard as overcooked tuna, I was able to see the newer forms of ‘soft-fix’ embalming used for donated teaching cadavers. One example is called the Thiel Method, named after its creator, Austrian anatomist Walter Thiel. He had a ‘Eureka!’ moment in the butcher’s one day when he noticed the preservation of wet-cured ham left the flesh more realistic than the preserved flesh at the Graz Institute. Years later he’d refined his technique, which used a colourless, nearly odourless solution of salts, antiseptic boric acid, ethylene glycol and antifreeze with a very low level of formaldehyde to create incredibly realistic soft cadavers. These newer methods made the dissection a much more authentic experience for the medical students and made me feel like I was right back at home in the post-mortem room.
I was in the Bart’s dissection room for the first time one summer, when most of the students had gone home. Some city-based students remained on as paid prosectors through the holiday and the talented anatomy teacher, Carol, had asked if I’d like to join them. She wanted me to help create some prosections for the new term since I had a background in autopsies, and of course I jumped at the chance – I wanted experience with human remains of all types in order to be the most informed I could possibly be. When I was presented with my donor, which was only a head and torso, I began by dissecting out the muscles of the neck, expecting to reveal the sternocleidomastoid – that muscle we APTs cut through when we make our Y-incision.
‘Don’t go straight for the SCM,’ Carol suddenly said, causing me to pause with my scalpel in mid-air. ‘Try to reveal the platysma first.’
‘What on earth is the platysma?’ I’d asked, flummoxed. I had over ten years’ experience with human remains but I’d never before heard the term.
Carol was very understanding. ‘It’s an incredibly superficial muscle that overlaps the SCM,’ she explained. ‘You won’t have seen it in post-mortems. When it’s in action it draws down the lower lip and angle of the mouth in expressions like sadness, surprise or horror.’ She pointed to her jawbone. ‘It also produces a wrinkling of the surface of the skin of the neck and depresses the lower jaw.’
‘So it makes us look like Deirdre Barlow from Coronation Street?’ I asked.
‘Haha, exactly!’
Carol started off the process so I could see the tip of this new piece of the human puzzle I had just learned about, then left me to continue with the scalpel. The platysma was no more than two millimetres thick and slightly orange in colour next to the yellow adipose tissue of the neck so it was difficult to differentiate. But I persevered, and I got there: I exposed the whole platysma and suddenly heard a whisper in my ear. It was Carol: ‘I knew you’d be good at this.’
I beamed. It was such a strange form of job satisfaction, but now I had created something that would teach other students the position and use of the platysma. Thus the knowledge was being passed on.
I had a lot of fun prosecting. The atmosphere was always wonderful and respectful yet happy because these deceased people were consenting donors who’d usually passed away from natural causes. Even the banter between the other prosectors taught me things I’d never heard of as an APT. One of them, Gavin, came over to my trolley and pointed at the exposed lung of my donor after I’d removed the sternum.
‘Look, this one has a lingula.’
Again, I was puzzled by a new anatomical term.
Noticing my face, he continued, ‘It’s a small, tongue-like str
ucture that sometimes projects from the lower portion of the upper lobe of the left lung.’ He flicked it gently with his gloved finger. ‘See? It looks like a little puppy tongue.’
‘Oh, yeah.’ I realised it did on closer inspection. ‘And I suppose “lingula” comes from lingua, like language.’ I thought for a moment, then said, ‘But I thought it meant “lips”.’
He burst out laughing. ‘No, you’re talking about labia!’
‘Who’s talking about labia?’ Carol exclaimed as she walked by at just that moment.
I started laughing. ‘He is! He started it!’ I pointed at Gavin but we were all laughing by then.
Lips/tongue.
Labia/lingula.
Tomayto/tomahto.
Good old Latin. It reminded me of being in university, studying microbiology with my lab partner Paula, and reading our instructions to swab each other’s uvula. ‘Right, lie on the floor, Paula, and get your pants down,’ I’d said, pretending to misread uvula for vulva. She panicked when she saw me coming at her with a swab, and looked very relieved when she realised I was joking. The uvula, the little drip of flesh that hangs down at the back of the throat which is often mistakenly called the tonsil, is an ample and marginally less X-rated place to obtain various bacteria for study. But it was funny to see the look on Paula’s face.
* * *
Significantly, the smallest body part removal can change the status of the deceased – something else I didn’t learn until I was no longer a full-time APT. Once again, I was lucky enough to be able to film an educational documentary about the autopsy process. I carried out the evisceration of a donor cadaver, alongside a well-known pathologist, with three cameras pointing at me over the course of a few days. In our earlier production meetings it was clear that in the time frame we had to make and air this documentary it would be difficult to receive the perfect donor cadaver from somewhere as small as England. Because the facility we’d be filming in already had a supply contract with a US company – they purchased limbs for surgeons to practise on – it made more sense for the team to use that company. But there was one snag: it’s illegal to ship whole bodies for this purpose. The only way it could be done is if one appendage was removed – a hand or a foot, for example. That way, the deceased was classed as a ‘body part’ but from the right angle would of course look completely whole. A technicality, really.
The Chick and the Dead Page 19