The Chick and the Dead Read online

  And I did.

  I’d seen technicians make this incision many times before and I executed it almost perfectly. Starting on the right side behind the ear I slid the blade down the side of his neck, altering the angle slightly as it travelled over the clavicle and down in a ‘V’ to the breastbone, the skin parting with the ease of butter beneath the sharp steel. I repeated this from the left side, a slightly more awkward angle when using the right hand, and when I reached the point of the ‘V’ I took the blade in a straight line down his abdomen, just circumnavigating his belly button slightly. I stopped abruptly at the pubis leaving a fairly neat ‘Y’ shape, which is why we call it the ‘Y-incision’. There were a couple of slight deviations in the skin, but I defy anyone to cut open a human being for the first time with a blade that could take off your own finger and not falter just a little bit. Anyway, slightly wonky lines aren’t visible after they’ve been stitched back together during the final reconstruction.

  I was quite proud of myself. I stood there breathing a sigh of relief, admiring my handiwork for an inordinate amount of time, until Jason spoke.

  ‘Come on, Edward Scissorhands, we’ve still got the rest of the PM to do.’

  * * *

  The next stage, at this point of my training, was to relinquish the blade and observe Jason for the rest of the process. Autopsy technicians tend to learn evisceration in stages, a bit like driving. For your first driving lesson you don’t get in the car, gun the engine then start parallel parking and doing five-point turns, and it’s the same with autopsies. It all happens step by step.

  Once the incision has been made in the chest, and the breastbone – the sternum – has been removed, there are a few different methods for systematically removing the organs for examination. The most common is often called the Rokitansky Method, though in fact it was Maurice Letulle who created what is also known as the en masse procedure in which, as the name suggests, organs are removed in one large mass. This was to be the way I would carry out an evisceration for much of my career so I watched carefully as Jason proceeded.

  First, some exploration, as he used his non-cutting hand to feel behind each lung for possible pleural adhesions – parts of the lung that may be stuck to the chest wall. They can be caused by previous trauma or diseases such as tuberculosis or pleurisy. The best-case scenario was that the lungs, pink, moist and healthy, would not be attached to the inside of the cavity by adhesions and after a brief manipulation – a scooping motion – would just fall back to their original position with a gentle, wet slap. With the condition of the lungs confirmed, he tackled the bowels next, their slick, curled lengths removed in one long string to be examined later, as they were not the most important part of the organ hierarchy when it came to establishing cause of death. The bowel removal created much-needed space in the crammed body cavity so Jason returned to the lungs, using the PM40 to detach them, again with another scooping motion and two long incisions, one on each side of the spine, to release each organ. Using a similar technique, he loosened each kidney and its surrounding fat from beneath the level of the stomach and liver, and sliced through the diaphragm, which separates the organs of the thorax and abdomen. He then used the blade to make a nifty slice across the top of the lungs which effectively severed the lower part of the windpipe and the food pipe – the trachea and oesophagus – from the upper part containing the pharynx and tongue, i.e. the throat. Then, with one hand he pulled the heart and lungs down and away from the spine, while gently easing the flesh away with the blade in his other hand if it was a bit too stubborn. He continued the motion down into the abdominal cavity. Soon, he was holding aloft a mass of dripping viscera which contained most of the organs from the body cavity: the thoracic components (heart and lungs) and the abdominal organs (stomach, spleen, pancreas, kidneys and liver). He lowered the mass into a huge stainless-steel bowl and placed it on the matching steel bench countertop with a metallic thump, ready for the examining doctor.

  Jason then moved on to the bladder, which was still in situ deep in the pelvis. Because the deceased clearly hadn’t eaten or drunk much it was small and empty: it looked like a deflated yellow balloon as he removed it and handed it to me to place on the dissection board. I wasn’t sure what ‘bladder-holding’ etiquette was, so I pinched it between thumb and forefinger and held it at arm’s length as I transported it to the steel bench, just like a disapproving mother with a teenage boy’s dirty sock.

  The next stage was for Jason to move on to the head. At this point in the evisceration the pathologist, Dr Colin Jameson, arrived in his maroon Volvo – we saw him slide the vehicle into the tiny car park through the frosted windows of the PM room; a bloody, moving smudge. We always mused about his choice of car, the Volvo, said to be the safest in the world. (In fact, the Volvo V40 is still the safest car you can buy.) Was it a deliberate choice? Had carrying out autopsies on so many victims of road traffic incidents – RTIs – made him paranoid, we wondered? I left Jason continuing his work on the head while I took off some of my PPE (gotta love those acronyms: this time ‘personal protective equipment’) and went to meet Dr Jameson in case he wanted a coffee before getting started. It was such a small building it took me only a minute to get out of my PM room clothes and into the office just as the bell rang.

  The facility had recently undergone a renovation so, small as it was, it was fairly modern inside. Our single post-mortem room had two stations for autopsies but I would later discover that many had three, four or even six, and that didn’t include perinatal (baby) autopsy benches. The fridges, as in most modern mortuaries, were double-sided which meant that they formed a dividing wall in the building. Behind their pristine white doors the heads of the deceased pointed into the PM room – the so-called ‘dirty’ or ‘red’ side – which is where I’d extracted this morning’s patient; and the other side was the ‘transition’ or ‘orange’ side where the decedents were originally received from out in the community.* Although opening the door on that side would usually mean you were greeted by several sets of pale feet, they didn’t have the proverbial toe-tags on them as you see in the media – we don’t label our dead like we label our luggage. Plus the area was only for staff, never family or friends of the dead. There was also a staff office, a smaller doctors’ office, a waiting room and a connecting viewing room which had the typical curtain to pull back in order to present the deceased to the next of kin.

  Most mortuaries in the UK have a similar layout, particularly if they were erected in the same period. There was a spate of local authority mortuaries built in the 1950s and 1960s and they look totally unassuming from the outside, with their sharp angles, bricks and concrete. But they weren’t the first mortuaries, not by a long shot. According to a paper by Pam Fisher entitled ‘Houses for the Dead: The Provision of Mortuaries in London, 1843–1889’ (which I consider a gripping read), the need for places to store the recently deceased was first noted in the mid-1800s. At that point London’s population was booming and many families occupied only a single room, so when a family member passed away, the decaying body was simply kept in that same room with everybody until the burial; there was nowhere else to put them. The deceased might remain there for a week or more, particularly if poorer families had to scrape the money together for a funeral, and anecdotally these corpses were said to be making the population sick. According to press from the time, learned men concluded that London’s dead were killing the living, and eventually facilities were created which were to be ‘houses for the immediate reception, and respectful and appropriate care of the dead’. The facilities were known as Waiting Mortuaries or Dead Houses.

  When I opened the door of our own Dead House in answer to the bell, I was surprised to see someone else on the step in place of the pathologist, who was still standing at his Volvo, searching for something in the boot. It was a young police officer who appeared far more surprised to see me. He stared at me wide-eyed and in silence, looking a bit pale.

  ‘Yeees?’ I asked, sl
owly and deliberately, eyebrows raised, trying to encourage him to speak. It was nothing new to me: I’d been told before that first-time visitors to the mortuary expect to come face to face with a lazy-eyed male hunchback when the door creaks open, not a petite blonde Marilyn Munster. It probably caught him off guard for a second, although it didn’t explain why he looked so pale. I suddenly became worried that perhaps I had a blob of fat or smear of blood on my face, so my hands involuntarily flew up to my cheek and started rubbing.

  He eventually found his tongue. ‘Is this the morgue?’

  I took a deep breath. ‘No, it’s the mortuary,’ I corrected him, unable to hide my annoyance.

  Tiny pet peeve here: mortuary literally means ‘house of the dead’ (hence Dead House) and has been in use for that purpose since around 1865. Morgue, on the other hand, comes from the French verb morguer which means ‘to look at solemnly’. It hails from Paris in the late 1800s, when the deceased were on display at the Paris Morgue in Notre Dame for the locals to come and stare at or, I suppose, look at solemnly. Initially, this was so that the many decedents pulled from the River Seine or those who’d died elsewhere in the city could be identified by their family and friends, either physically or via their apparel. But this public activity became so popular that it could attract up to forty thousand visitors a day until it closed in 1907; to put that into perspective, it helps to know that the London Eye accommodated only fifteen thousand visitors a day in its heyday. (Not a lot to do in Paris back then, I take it?) While it’s true that the terms ‘mortuary’ and ‘morgue’ are interchangeable, most UK technicians will never use the latter, though it’s more common in the US.

  After I’d put him right, the young policeman informed me he was escorting the funeral directors who were bringing in a deceased man from his home. I finally understood his pallor and assumed the scene had been pretty grim.

  ‘There’s a Volvo in the way at the moment, though,’ he explained. ‘Thought we’d just let you know.’

  Five minutes later, when Dr Jameson had moved his car, he stood with me, Jason, the pale policeman and the funeral directors as we checked in the fridge’s newest ‘resident’. He’d been found in quite a common way: neighbours had begun to complain about a smell and flies had congregated in the area so the police had broken down his door. This didn’t bode well as it meant he was very likely a recluse who had lain undiscovered for a long time, which in turn meant severe decomposition. The undertakers were complaining profusely, and one of them was particularly vocal.

  ‘As if it’s not bad enough that he’s massive and green,’ he grumbled, ‘he was one of those – what do you call ’em? – hoarders.’ He pronounced it ‘orders’. ‘Couldn’t fuckin’ get to him cos of all the piles-a-shite everywhere. Nearly broke me back, the son of a bitch!’

  Hearing this, Jason turned to me and roared with laughter. I was hoping he’d forgotten my earlier mistake now that the pathologist was here. No such luck.

  ‘Eh, Doc, you won’t believe what Carla said this morning,’ he chuckled, at exactly the same moment the man’s body bag burst open and a spectacular wave of dark brown fluid hit the clean linoleum floor.

  I put my head in my hands. This day was going to be longer than I thought.

  One

  Information: ‘Media Most Foul’

  We live in a society in which spurious realities are manufactured by the media. I ask in my writing, ‘What is real?’

  —Philip K. Dick

  I have never been close up to a fake corpse before. I’ve seen thousands of genuine cadavers in different shapes and sizes, their bouquet of smells and spectrum of colours all competing for my attention. But, in a bizarre inverse to the experience of most of the population, it’s the fake corpses I’m unfamiliar with.

  The prosthetic dead body now in front of me is quite pleasant despite being very realistic: she’s a slender female with ivory skin and a tiny waist which I find myself envying, in the same way a young girl may envy the curves of a Barbie doll. Her long, tousled, chestnut hair is splayed around her head on the post-mortem table like a dirty halo. Her chest has been opened via the usual Y-incision, causing her loose skin to cascade over her breasts like two bloodstained pink and yellow petals, and the pearly white of her intact breastbone is just visible in the gap. She is a fake cadaver at the phase of the autopsy in which she is not quite open but merely on the cusp – just at the point where I’d relinquished my PM40 to Jason during my first case. As a result, she is still easy for me to identify as a young female and therefore identify with: the tangles of her hair immediately make me think of the struggle I have when blow-drying mine, and her fingers, curling gently up from the surface of the metal, have such a realistic human quality I’m glad they’re not painted with nail polish as it would only add to the illusion. She looks so real I feel there should be an odour of blood, day-old perfume and sweat about her. There isn’t, of course.

  ‘What do you think?’ the assistant director, John, asks me.

  ‘She’s wonderful,’ I reply with awe. ‘If only all my cases were this pleasant!’

  I’m in a small, freezing-cold film studio in East London. I’ve been brought in because the picture being made here focuses specifically on an autopsy and the director wants to make sure everything – every instrument, every technique, every sentence – is absolutely perfect.

  I have to hand it to them: as far as fake mortuaries go – and I’ve seen a fair few now – they’ve done incredibly well. There’s only the odd anomaly. For example, in place of rib shears, the specific medical tool which would be used to remove that as-yet-unopened rib cage, there is a pair of heavy-duty bolt cutters from a hardware store. I suppose they do look fairly similar so they’ll pass for correct. Instead of post-mortem twine, which should be more like the thick white string used to tie up parcels, there is thin green cotton – cotton which would slice through the delicate skin of a real cadaver and be useless at sewing up any incisions. Also, on a magnetic tool rack above the sink there seems to be a cake slice. I can think of no justification for that …

  Perhaps these are things that only someone qualified to work in this environment – a pathologist or a pathology technician – would notice in a film. But, boy would they notice. ‘What’s a friggin’ cake slice doing next to the knives and scissors?’ I can already hear that audience cry, incredulous. Granted, there are some pathological conditions with confectionery-themed nicknames, such as ‘maple-syrup urine disease’, ‘nutmeg liver’ and ‘icing-sugar spleen’ – an observation that once led me to a pop-up anatomical cake shop called Eat Your Heart Out – but I don’t think there’s such a thing as ‘Victoria sponge pancreas’, even if it does sound delicious. Mind you, there are times when the skin of the deceased flakes off like the pastry of a croissant, and there can sometimes be a dark brown, gritty purge fluid we call ‘coffee grounds’ which escapes from the mouth and nose. Perhaps these, along with ‘foamy discharge’ and the aforementioned ‘nutmeg liver’, mean the dead can resemble a Starbucks menu more than a cake stand?

  I do my best to explain to John that these errors will be noticeable to certain parts of the audience but he informs me it’s too late now to make any changes to the props or the set because the team have already started filming scenes in the fake mortuary. I discover that in showbiz parlance this is ‘the shots have already been established’. But there are still some things I can advise on: for example, the exact technique for crunching through the ribs (you really need to put your weight behind the shears and give it some welly) or the type of container that would be used to collect specimens for examination.

  * * *

  Back in the post-mortem room, after our distraction, I’m just in time to help Jason collect specimens from the anorexic dentist.

  ‘Carla, can you swab the decubitus ulcers, please?’ Dr Jameson asks.

  I look at him, puzzled.

  ‘The bedsores,’ he explains.

  I feel like an idiot.

  J
ason gently tilts the deceased on his side while I take a swab – the correct container for this type of specimen collection – from the stainless-steel cupboard and begin labelling it, hiding my flush of embarrassment behind the cupboard door. The swab’s casing is a long, thin plastic tube with a rounded bottom and a blue lid. The rounded end is filled with a nutrient jelly that allows microbiological cultures to be grown and then examined in the lab. When I pull off the lid, the swab comes with it, its end already moist and prepared with the jelly from the bottom of the tube. It looks like an elongated wet cotton bud. I use this to gently swipe at some of the greenish-yellow pus in the purulent bedsores, then place the swab and its contents safely back in the tube.

  Dr Jameson writes on his clipboard as he explains, ‘I thought perhaps heart failure may have been his cause of death, but now I’m suspecting septicaemia.’

  Septicaemia is often called blood-poisoning or sepsis and is caused by an infection entering the bloodstream. It looks as though this man’s bedsores have become infected and, left untreated for so long, the microorganisms have poisoned his blood. Jason has already taken some blood samples and now they’re also off to the lab for the microbiologists to help in the post-mortem process. We’ve done our part perfectly, for now.