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.
With all this preparation, everything was out and ready to go in order for the post-mortem to run as smoothly as it possibly could.
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.[6] 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.
6
Yes, that was the sort of thing I did in my spare time: attended lectures on mass fatality protocol and capacity building in post-conflict regions rather than head out to the students’ union for Red Bull and vodka.