Our forms, the 97As, arrived around eight thirty in the morning with a flurry of beeping, buzzing and swooshing as the sheets were spewed from the mouth of the ancient fax machine and on to the floor of the small mortuary office. On the pages were some details of the deceased and the salient features of the case◦– whatever the assigned Coroner’s Officer had been able to find out in the first few hours after the death. Sometimes there were reams and reams of difficult-to-read lines, especially if medical notes were included. There might be information on prior illnesses, previous drug use, where and how the body was found, family members, charts, height and weight, and whether or not the deceased preferred one lump or two in his tea. In other cases there might be just a few words or lines, like this one:
Anorexic dentist
45 yrs
Bedridden 2 wks
Son Of a Bitch
‘Bloody hell, that’s harsh!’ I said to Jason, so loudly that he nearly spilled his cuppa as he lifted it towards his lips.
‘What is it, hun?’ he asked, his eyes flying to me and away from the pages of his newspaper. He always called me ‘hun’ and I didn’t mind. His huge, muscular, tattooed form belied a very gentle and protective nature.
‘The poor bloke’s dead and they’re calling him a son of a bitch!’
I stomped across the office to wave the 97A in front of his perplexed face. He halted my hysterical form-flapping to get a good look at the info, and after a beat of silence and a confused expression, he roared with laughter. His massive shoulders heaved, his face reddened, and he even wiped a tear from his eye. ‘Son of a bitch…’ He repeated it a few times, the words barely audible through his laughter.
When he calmed down, I discovered the reason. Although I’d read the form that way, it actually stated:
Anorexic dentist
45 yrs
Bedridden 2 wks
S.O.B.
And S.O.B. meant ‘shortness of breath’. No wonder Jason was in hysterics. I was going to have to get used to acronyms if I was to make it in this game.
As there was only one 97A that day, and therefore only one post-mortem or PM (another acronym◦– you’ll have to get used to them too), Jason said today would be my first attempt at making the incision into the deceased myself. As a trainee APT (anatomical pathology technologist◦– another one!) this is the first stage in learning the art of evisceration◦– the medical term for removing the organs, which sounds marginally better than ‘disembowelling’.
Though I was only a trainee, I had the hang of the basics by now◦– the paperwork, signing in new bodies, carrying out viewings, small procedures like removing stubborn jewellery or false teeth◦– but it was time to start some proper training. It was time to do my first full incision and open the deceased. I really wanted to, I was so incredibly excited, but at the same time I was terrified. I’d wanted to do this job for so long, but now that I was about to take the plunge I suddenly had no confidence in myself. What if I messed up? What if I was no good at it and my whole life was a lie? I couldn’t even cut paper straight without drawing a line with a ruler first; how was I going to cut skin straight? And I absolutely, positively couldn’t sew any sort of fabric, so how was I going to sew a person together? Considering I’d never really been interested in paper crafts or textiles at school, the idea of trying out these little-used skills on a human being was beginning to freak me out.
To keep myself calm, I decided to focus on the things I did know, the tasks I carried out every single morning after arriving at work around seven thirty, and I realised it was only a few weeks ago I hadn’t known how to do them either. I was learning quickly and I needed to stop stressing out. Everyone has to start somewhere.
So I took charge. Jason followed to observe as I headed into the small, bright post-mortem room and pulled on some latex gloves, taking a deep breath as I did so. I located the body bag of the anorexic dentist in the fridge by his name written on the door (the fridge being otherwise known as a temperature-controlled storage facility but, eager to avoid yet another acronym, we just called it a fridge). I gently slid his tray out and on to the hydraulic trolley, then I hesitated, thinking I’d made a mistake. The tray was so light it didn’t seem like there was anyone actually in the bag. However, on closer inspection I could discern the curve of the top of a head pressing against the white plastic and a sharper point, much lower down, which looked like it could be a bent knee. Satisfied he was definitely in there, I took another deep breath and turned the trolley a full 180 degrees to position the tray over the stainless-steel holder jutting from the post-mortem room walls. Via this set-up the tray the deceased rests on in the fridge also becomes the dissection bed, cradled in the strong steel arms of the holder.
Sometimes the difficult manoeuvre would be done without a hitch; just the gentle glide of the turning trolley then the muted squeak of the trolley’s mechanism as it lowered the tray down on to its holster.
This wasn’t one of those times.
A combination of my earlier anxiety and Jason watching me intently meant I was just too nervous. There was a crash of metal on metal as I missed the turn by a couple of inches and slammed into the jutting arm with the trolley. It was nothing that would damage the deceased or even the equipment, only my ego, which was feeling more and more like it would need its own post-mortem by the end of the day: cause of death◦– extensive bruising.
‘Don’t worry about it, hun, we all do that sometimes,’ Jason reassured me. ‘It’s a really small PM room.’ I had no idea how he could be so infinitely patient with me especially since sometimes, as a newbie, I felt like all Three Stooges rolled into one.
With no real damage done, I eventually got the tray with the body bag in position on the hoist and slowly unzipped it. Jason let me carry out the entire process as though he wasn’t there, which on this occasion was absolutely fine. Normally it would take two APTs to remove the patient from the bag in a well-rehearsed and carefully choreographed manoeuvre that looks like it’s anything but. It involves tipping the deceased to the side, using legs and arms like levers and fulcrums, so that the plastic can be slid beneath the body on one side; the whole thing is then repeated on the other side, and the bag can be gently pulled out and folded away. But this man was so thin I could move him on my own, with one arm, while I worked the bag out with the other, as easy as holding a baby’s legs aloft while sliding a nappy out from under its bottom. I concentrated on carefully removing the man while taking deep breaths to steady my nerves.
And then I got a good look at him.
I’d never seen anything like it: he resembled a knotted white twig with a few extraneous branches and hairy bark. From the front I could see the shape of his pelvic bones clearly through his meagre flesh, and when I gently rolled him away from me to view his back, every single groove of his tailbone◦– or sacrum and coccyx◦– was visible too. Where his bones had been forcing their way through his paper-thin skin during those last bedridden weeks, angry pressure sores had formed. They were deep red and wet in appearance with yellow-green infected parts, oozing pus. At the sight of them, imaginary pain involuntarily shot through me. It was so unexpected it took my breath away for a second and left me feeling winded.
His hair was long and very dark, almost black, matted to his head and upper back in some places, yet wild in others. His nails were overgrown and yellowed and, taken with the hair and the emaciation, it seemed there was more than just anorexia going on here; I was very much reminded of Howard Hughes and other recluses with psychological problems, and wondered if the same fate had befallen the dentist. But I couldn’t just keep standing there musing because Jason reminded me I had a job to do by handing me a clipboard with a paper form on it. I used the form to make notes about the man’s appearance; his sunken cheekbones, matted hair, bedsores and more. I noted down as much as I could, every mole, every wrinkle, every ‘is that a birthmark or a bit of dirt?’, and I realised it was for two reasons. On the one hand, it was my first external exam alone so I didn’t want to miss anything and look incompetent to the pathologist who’d be arriving shortly. On the other, the longer I took over the examination the longer it would be until I had to make that terrifying first cut.