In the Egyptian mummification process, all organs were removed and placed in jars, bar the heart. The heart – considered to be the centre of the person’s self, their whole being, their intelligence, their soul – was left in place to be judged by the gods. In the underworld, it was weighed against a feather to see if the person had lived a virtuous life. If it did not make the scales tip, the person was granted entry to the afterlife. If the heart proved heavier than the feather, the goddess Ammit – part lion, part hippopotamus, with the head and teeth of a crocodile – would eat it.
In the mortuary, on the lower ground floor of St Thomas’ Hospital, on the South Bank of the Thames, a heart is placed on scales and the result shouted across the room to be recorded on a whiteboard in fading pen. Its weight is determined to be healthy or unhealthy – here you are judged only on what is known and seen by naked eye or microscope. It is not for these people to rule on how you lived, but how you died, on the balance of probability.
This is where the dead body tells its story to someone who is listening: be it murder, suicide, heart attack. It is in places like this that Mo, when he was a detective, would hear that story translated from mute flesh to something he could work with, some evidence to help solve a crime. The manner of someone’s death might remain a mystery to most of the death workers I have already met, but here it’s their job to find out.
If you die on a level above, the porter transfers you on an inconspicuous sheet-covered trolley to a fridge below. If you die in certain boroughs near the hospital, the ambulance that collects you from the floor, or the bed, or the road, will transport you here. If the coroner requires one, an autopsy or post-mortem examination (they both mean the same thing, one’s just in Greek, the other in Latin) will be carried out, in this room, to officially determine how you met your end. If your doctor had seen you shortly before your death and was certain they knew how you died, the death certificate can be completed without taking your body apart. Some bodies are here, untouched by scalpel, waiting for the funeral homes to collect them. Some bodies are unidentified, waiting for a name.
More numbers are being listed aloud in the background, the final results of a woman’s lifetime of growing, shrinking, existing. The liver. The kidneys. The brain. The pathologist is slicing samples of organs under a white spotlight and making notes on her clipboard. I’m peering into the empty abdominal cavity of a large man suspected of dying of a stroke. His internal contents lie in an orange biohazard bag between his feet for the pathologist to weigh and inspect next.
When a heart stops beating, blood ceases to flow around the body at the speed of life, but it still moves. Gravity draws it to the bottom reaches – the back, if the person died on it – and there it collects, slowly turning the skin dark like a bruise. When space is created by removing the organs, blood seeps from severed vessels in the arms and legs to fill it. In the recesses beside his spine, where his lungs were, where his kidneys used to be, blood pools thickly. Lara-Rose Iredale helps it along, gently milking his femoral artery for a sample to send to toxicology. Massaging his thigh, she looks like a physiotherapist on the sidelines of a football pitch.
I knew Lara would be the one to show me what they do here. I’ve known her for years, first as a familiar face with faultless eyebrows who always appeared at death-related talks around the UK, someone who could be counted on to hang around a pathology museum if there was something happening, even if it was just free wine. I became curious about her job at a funeral industry awards ceremony I was writing about, where Lara was nominated for APT (anatomical pathology technologist) of the Year. Her friend Lucy was sitting beside me, and mentioned how much Lara keeps quiet. She told me that Lara had worked on the victims of the 2017 London Bridge attack – where a van deliberately ploughed into pedestrians before the three perpetrators ran through the area around Borough Market, stabbing diners, bystanders and police with twelve-inch kitchen knives – but she never talked about it. Others might talk about their work for internet numbers, broadcast it on social media along with pictures of themselves in scrubs brandishing stainless-steel tools. Lara’s Instagram was full of night-out selfies, pictures of her hanging upside down on an aerial hoop, and sometimes a rare glimpse of the huge easy smile that I’ve come to know her by. She has a tarot card tattooed on each thigh – DEATH and JUDGEMENT – and around Halloween she will draw a little bat in liquid eyeliner on her cheekbone. As for the job, it rarely gets mentioned, though she is clearly in love with what she does. ‘Corpse servant’ is how she describes it, there in the short bio beside her perfectly painted face. I wanted to know what, exactly, that entails.
The job of an APT is to do the physical work of taking a body apart to assist the pathologist in their investigation: they eviscerate and reconstruct the patient, then clean the body and all of the equipment used in its deconstruction. They are the people you meet if you go to a mortuary to identify a body, they deal with the family and the funeral homes, and they wrestle with the mountain of paperwork that comes with every death and the movement of bodies from place to place. The UK, as everyone keeps telling me, is a paperwork-heavy place to die. Lara says she has nightmares where the dead sit up on their steel trays and try to leave the mortuary; she wakes in a sweat not with the horror of the living dead, but with the paperwork it would necessitate if the bodies went missing.
She began her training here in 2014, shadowing an existing APT, and qualified three years later, learning on the job, leaning over the dead. Trainee placements are rare and hard to come by, and for Lara it took years of waiting and hoping. Now, on top of the regular day-to-day admin work and autopsies, she mentors and teaches the new trainees, walking them through the human anatomy and how it fits together, how it looks when it goes wrong, and what it might mean. Trainee APTs are not the only ones looking over her shoulder – trainee doctors are too. As Terry explained at the Mayo Clinic, the role of the medical cadaver is to give the student a map of a body in working order. Here, they can see what an abnormality looks like, and Lara can show them the reality of a diagnosis: what telling someone they have cancer actually means, what cirrhosis of the liver looks like, what obesity means for your cramped organs, and the shocking visual fact that ribcages stay the same size no matter how big you get. Today she’s showing me.
I’ve been here a while. Earlier that morning, I watched as Lara manoeuvred the hydraulic lift to extract three bodies from the fridge and position them by the sinks that stand in a row in the centre of the room. Even though the mechanical lift moves the trays up and down, there is still physical work in pulling the trays out of the cold with enough strength to get them to slide out. She says the first thing to go in this job is your back: you’re not only pulling, you’re leaning and pulling, and you’re pulling not entirely predictable shapes that are unevenly weighted. The mortuary staff have their own health-and-safety training: nobody else in the hospital has to move like these women move. And it is all women here – at least all of the APTs – and they are each, bar Tina the locum who has been in this role for thirty years, covered in tattoos from the neck down, with buzz cuts and piercings and multicoloured hair. They’re all young. They all have tickets to the same Rammstein gig.
After the bodies were all in their places, the three APTs began their visual assessments of their designated corpse, which is a constant part of an autopsy: each step of the way they will stop and look for signs of things gone wrong. As the pathologist circled the man, pausing to make notes on a clipboard, Lara searched him for scars, looking for clues of prior surgery or injury that might have something to do with his death. Even nicotine stains on fingers give clues as to how someone might have died. She rolled him in a routine check to make sure there wasn’t a knife in his back (‘So far we haven’t found one, but you never know’) and stuck a needle into both of his eyes to take a sample of his intraocular fluid – this, along with the blood and urine, will be sent for testing. Then she sliced him in a Y-shape, starting about two inches below the collar bone, continuing down past the navel, but avoiding the actual navel because, she says, it only causes problems later when she has to stitch him up. She peeled back the skin and, pinching it between her fingers, sliced the abdominal muscle carefully so as not to damage any vital organs beneath it. Using a scissor-like tool – rib shears, like I had seen at the Mayo Clinic – she clamped through the cartilage that separates the breastbone from the rib cage, and lifted it off like a shield to reveal pink, glistening lungs.
I don’t know it yet, but from this day onwards I will stop eating ribs – unlike Lara’s manager, who I saw happily eating a barbecue rack in the staff room just across the hall. It was not just the visual that got me, but also the sound. If you’ve ever watched a Rocky movie you’ve heard the rib shears cracking the rib plate, cutting through the cartilage: it is the snapping noise that follows a blow to the chest. A week from now I’ll see Creed II and the sound that accompanies a slow-motion punch to Donnie Creed’s ribs is almost exactly this sound that I heard in the post-mortem room. I’ll spend the next twenty minutes of the movie wondering if they took a mic to the morgue.
Next, she tied a string at the duodenum – the beginning of the small intestine – sliced through it on the lower side of the knot, then lifted the bowel out of his abdomen, pulling out all twenty feet of intestines hand over hand like a sailor with a rope. She dropped all of it into the orange biohazard bag. ‘Through there is the heart,’ she said, pointing with a gloved finger before she leaned over his chest to begin freeing up the structures of the neck.
It takes about an hour to do a standard autopsy – longer for someone who has been in intensive care for a long time, full of tubes and lines whose placements need to be checked too. It’s quicker to autopsy a thin person rather than a fat person, simply because their organs are easier to find. But there are some parts that are difficult whatever the body, processes that need both skill and practice. Lara tied off the base of the oesophagus and then used a blunt tool to sever the connecting tissue around the organ, and then further up, separating the neck skin from the muscle. She put the tool aside then slid her hand up under the skin, her every knuckle visible as she worked to find a pocket at the back of the tongue. ‘There’s no tool that would make this easier,’ she assured me, her arm halfway up the guy’s neck like a puppeteer, her gaze somewhere off in the corner of the room as she navigated by feel alone in that slimy dark. ‘Got it.’ She pulled out the tongue using the pocket as a hook, and the tongue and oesophagus, with vocal cords, came out in one piece. It looked like a long fillet of pork. She pointed to a horseshoe-shaped cartilage construction that sits in the throat. Part of an autopsy is to check if this structure is broken: if it is, that would suggest a strangulation. My gloved hand went to my own throat to see if I could feel it bend.
Next she sliced through the diaphragm, and lifted the heart and lungs off the spine in one connected block. Then the stomach – with oesophagus and tongue still attached – liver, gallbladder, spleen and pancreas in another block. These organs joined the others, squelchily, in the bag at their owner’s feet. Then, finally, the kidneys, adrenals, bladder and prostate, all connected, all in the bag too.
The smell of a fresh abdominal cavity opened to the world for the first time is hard to forget in the days after you encounter it: it smells of refrigerated meat, human shit and the blended penny tang of blood. Add that to the smell of unwashed skin, groin and open dry mouths that house rotting, unbrushed teeth and you have a whole human body at our base level. Seeing it all come out like this, it’s hard to believe all of this stuff makes a person live, and that it can exist without going fatally wrong for so many years. I stare in at the empty space, while the woman on the table beside us has her organs weighed and recorded on the whiteboard. Our guy will be next.
‘I look at all of this and wonder how it doesn’t just fall out of me,’ says Lara, pausing the thigh massage for a moment and gesturing at the bag of organs. She scoops the loose pieces of shit from around the rectum, inside the cavity, and places them on the table next to his leg to deal with later. One nugget falls off the edge and sits precariously close to my boot for the next three hours, until it is washed away with a jet hose, just like everything else. At one point Lara is talking and gesticulating and a sliver of visceral fat flies off her glove and lands on the floor too. This is clearly not a glamorous job, though she discovered it on television: she wanted to be Dana Scully in The X-Files, specifically Scully in the episode ‘Bad Blood’ where she plays a forensic pathologist, autopsying victims of a drugged pizza murder. ‘It’s one of the funny ones,’ says Lara, who grew up watching late-night TV in the nineties just like I did, and abandoned the idea of becoming a forensic pathologist when she learned you had to become a doctor first. Then, even in full-time training, it takes five and a half years to qualify. She wanted to go straight to the mortuary and skip the living entirely.
The man has a history of epilepsy, so Lara figured he was ‘a probable neuro case’ and said if there was anything to find, it would likely be in his head. ‘In the UK you either die in your head or in your heart,’ she says, combing a neat horizontal parting in his hair in a line from ear to ear to clear a path for a scalpel blade. She slices the skin, then folds the face down towards his chin, but it seems harder to do than she was expecting, the skin less easy to separate from the bone than usual. Then she uses a circular bone saw and finds that the skull is thicker too. The pathologist comes over and points at the man’s folded face, at his dark strawberry birthmark. She says that a birthmark like this happens when the foetus is being formed, when there is little to separate the face and the brain: whatever happens without will be seen within, and in this case everything is slightly fused, the imprint of the birthmark runs through the layers of flesh and bone like a stick of rock. When Lara removes the top of the skull and peels back the thick membrane that protects the brain (it’s called dura mater, meaning ‘tough mother’), there is a dark mark where the birthmark touched. She takes a photo for the pathologist’s records and pulls the brain out of the skull. She asks me if I would like to hold it.
I cup my hands together and feel the weight of it. This is the thing that made him who he was, and inside it was the clot that probably killed him. It is flesh-coloured and white, shot through with wormy lines of red and black – this is not the pink of cartoon brains, or the grey matter of high-school biology books, or even the brains in jars in the pathology museum, which are bleached, set, stiff. In my hands the lobes flatten and relax, taking up more space than the dome of the skull would allow. Later, Lara will pack his skull cavity with cotton wool because the brain would never reform the neat shape it once held inside it, a tight case to keep the brain compact and safe. The weight in my hands is cold and heavy, dense but fragile – it moves like jelly. I wouldn’t want to press it even lightly for fear of damaging it, yet I’ve sat through boxing matches and watched blunt impacts to the head knock fighters to the floor unconscious. I think of the wives who insisted their American footballer husbands were never the same after the years of charging head first into other players, how they became violent and confused and nobody saw it but the women. Hold a brain in your hand and you realise how much danger we put them in to score points while others watch and eat hot dogs. I imagine what a bullet would do. I remember Neal Smither, the crime scene cleaner, washing the brain off the side of his grandparents’ house, how it hardens to cement and becomes impossible to clean.
I slide the brain off my gloves into Lara’s blue plastic bowl. She threads twine under the basilar artery, which protrudes enough to act as a shallow loop, and dips the organ upside down into a bucket, tying the ends of the twine around the handles to suspend it in formalin. Over the next two weeks, it will firm up enough for the pathologist to slice it open – to ‘breadloaf’ it, like Terry – in search of the cause of death. ‘RTB’ (return to body) is already written on the side of the red-and-white bucket, and Lara places it on a shelf where it disappears in a crowd of more brain buckets. Everything you came here with leaves with you – organs are put back in the orange biohazard bag after the pathologist has weighed them and searched them for tumours and other malfunctions. And after the abdominal cavity fluids are ladled out like soup from a pot, the bag is placed in the empty space the organs once filled, with cotton wool tucked into the gaps around it. The front of the rib cage is slotted back into place, and the skin sewn up. Weeks from now, when the pathologist is finished with the brain, an APT will undo enough stitches to be able to slide it into the orange bag with the rest of him, and his body will be ready for collection by the funeral home.
Months prior to this I sat at a picnic table in winter as Anil Seth, a neuroscientist, explained consciousness to me. He told me that reality is the brain’s best guess at what is happening outside of its own dark room, where it sits windowless and blind, being fed information by other tools – eyes, ears, fingers. All of your senses are spies for your brain. It pieces together what it can from the scant information it is supplied, blurs it with memory and experience and calls it life. Now, all of this magic, all of this brain’s best guesses in the dark, are inaccessible. They are pure organic matter in a bucket, firming up so that someone can slice its billions of forged connections that create reality and wisdom, an entire universe of someone, and find the reason why it all stopped.
On the other side of the room, a tiny organ is being held aloft, pinched between tweezers. A pathologist and two policewomen are judging the weight of a baby’s heart.
The day before I came to watch Lara work, she emailed me the standard document that she has to send to everybody coming to view an autopsy. It was a warning, along with the suggestion to have a good breakfast and wear thick socks for the wellies. She said she knew that I had seen death before, but even so, I needed to know that this was a specialist paediatric pathology department as well as a straightforward hospital mortuary. Babies and children were sent here from all over, and their post-mortems were carried out in the same room as the adults. It was possible, though she didn’t know the schedule yet, that I would see dead children. I said this was fine, I’d seen dead bodies before. I’d seen, at this point, hundreds of them, whole and in pieces.
I was, in hindsight, somewhat cocky.
After she stitched up the man, methodically and neatly, Lara shampooed his hair (Alberto Balsam in sweet strawberry, which from my experience is every mortuary’s shampoo of choice – a surreal smell to mix with the abdominal cavity and the formalin of the brain buckets), sprayed him with antibacterial solution and hosed him down. She sponged him, lifting his arms and legs, trying to clean as much of him as possible. She explained that not all mortuaries did this, but here they considered it the right – the nice – thing to do. ‘You’ve just had your insides on your outsides,’ she says, matter-of-factly, adding that because decomposition is a bacterial process, they figure anything to help stall it is a good thing for the funeral homes and families (not everyone thinks of the chain of death workers like Lara does – embalmers, like Kevin and Sophie, frequently have to hide the effects of careless autopsies or storage). There was antibacterial spray bouncing off his body, a jet of water ricocheting loudly off steel, and I was getting in the way so I backed away from the table. I backed away so far that I found myself beside a baby. He was two weeks old.
I had been watching this baby for the past two hours out of the corner of my eye, trying to keep focused on what Lara was doing as she looked for a pocket inside the neck, as she tied off organs and photographed the brain. The room was large, but not huge; Lara and I were maybe ten feet away. The whole time, I could see it. I could see that a baby’s skull does not need to be sawn open like an adult’s – nothing is fused, so the pathologist trimmed the thin connecting fibres with scissors and peeled open the five planes of the skull like petals on a flower. Using only his thumb, he levered them up from the fontanelle, that forbidden soft spot on the baby’s head that I, age four, remember promising not to touch as I was handed my new sister to hold. I heard one of the police officers say the mother has a history of psychosis, and realised they were looking for evidence that she had killed him. I watched the pathologist fan out the ribcage like a palm frond, separating each rib, sliding his finger along the curve, checking every tiny bone for fractures. I watched as this baby was comprehensively taken apart, his back resting on a block so that his open chest was pushed forward and his open skull thrown backwards while they discussed the findings above him. I could not read the police officers’ faces as they perched politely on stools, occasionally making notes, frequently leaving the room.
Now I’m next to him, and a young, green-haired APT is having a hard time putting him back together. She has stitched up his body, but she’s having trouble with his face. During the postmortem investigation, he was cut under the neck in such a way that it changed the way the face now rests on the skull: the bottom lip hangs loose from the chin and the weight of the droop causes one eye to keep opening. The APT has to make him look normal again, pressured by the knowledge that the parents will notice any change, that bereaved parents, in their final visit, try to mentally record every detail they can before the baby is taken away. She keeps closing the eye, pushing at the small pink lip, sighing, trying to get the expression right – the blank serenity of a sleeping baby – and it keeps falling off the bone. Lara pauses her cleaning to come over, and with her calm, patient direction combined with a tube of Fixodent, the younger APT manages it. It shouldn’t matter, but the baby is unusually beautiful. I am utterly transfixed by his glued-together face.
As with the adults the babies are washed, not by hose, but in a small blue plastic tub in the sink, as natural as my mother bathing my pink siblings in the kitchen. He sits propped up in the corner, the bubbles almost at his shoulders. The APT leaves him there briefly to fetch something off a shelf and I am left watching as he starts to sink, slowly, his face slipping below the suds. I’m supposed to be observing, not touching – especially away from Lara, in a part of the room where I was not invited nor expected to be – and I stand frozen, unsure of what to do. I try to suppress every in-built urge to stop him drowning, telling myself he is dead, realising that he is dead, that nothing I do here would matter or change the outcome of his being dead. He slips below the waterline as I stand stiff and useless, coming undone.
The APT returns, lifts him out of the bubbles and dries him. She lays him on a towel as she collects the things she will need for the next part of the process: a nappy, booties, a romper suit. After dressing him, she slides three plastic hospital armbands over the chub of his hand, holding his tiny fingers as she pushes them further up his limb. She’s as gentle with him as you would be with a living baby, supporting his head as normal where babies this age are unable to, but even more so: the pathologist has severed the vertebrae in his neck.
With babies, they usually do put the brain back into the skull – since it has not yet hardened and fused, the space is more forgiving than an adult’s. But mostly it’s because the weight of a baby’s head is something that comes biologically programmed in a human’s mind: parents, cradling their child in the viewing room, will notice if the weight of the head is too light. But in this baby’s case, a forensic one, the brain needs to be kept for further tests. Lara suspends it in a bucket, just like she did with the adult brain, small and lost-looking, a planet in deep space. Meanwhile, a knitted bonnet is selected from the huge clear Tupperware box of baby bonnets in the corner – lemon yellow, pink, blue, there are hundreds of them – and pushed down over his head to cover the incision that runs across his scalp from ear to ear. I help the APT steady his tiny body, his loose neck.
I thought that the head, now empty, would be relatively weightless – from where I stood hours ago, the bones of the skull were so thin in the fluorescent light as to be almost translucent. But it was not. There was still the soft flesh of his face, the plump rounded cheeks. A baby’s head, without the brain, feels sickeningly light and unfathomably heavy.
I never found out if the mother did kill her baby, if whatever mental-health issue she had had pushed her to shake him. I do know that his only possession in the world was her breastmilk in a half-filled tiny bottle that was tucked beside him in his cardboard coffin, before he was placed back in the designated baby fridge with his name on the door shortly before I left. I peeled off my gloves, waterproof apron, scrubs and wellies, handed back my visor, and Lara congratulated me on not having to step outside at any point. I could stand it. I withstood it. I didn’t tell her that all I could smell was the cold meat and shit of abdominal cavity and all I could think about was the baby.
I reverse our steps that morning, back through the green linoleum corridors, back past a decommissioned gurney with a note on it, up the stairs, through the door and crowd of families waiting, pushing prams, eating packaged sandwiches while they wait in the hospital reception area. I step into the light outside and I feel like I’m under water. Big Ben is visible from the door of the hospital through the thick autumn mist. It stands on the other side of the Thames, wrapped in scaffolding, silenced for the handful of years it will take to restore. This particular bell tolls for no one, currently, but the dead still grow in number every day. Some of them are here.
It seems obvious now, but I had no idea so many of them are babies. I didn’t know the infant mortality rate in the UK is, while falling, still higher than other comparable countries. I didn’t know that an English soap star campaigned for foetuses born dead before a certain age to have birth certificates as well as death certificates – something that proved they existed, if the parents wanted one. I didn’t know that when a baby dies of SIDS (Sudden Infant Death Syndrome), that cause is only ruled because it has been autopsied and every other possibility eliminated. I never really thought about dead babies, or the mothers who lose theirs repeatedly; when I read about miscarriages I thought only about blood and clots, not recognisable organisms with limbs and eyes and fingernails that go to the mortuary and have a designated refrigerator. Lara tells me that she sees some mothers’ names turn up multiple times – another attempt, another death, another storm in the mother’s heart that she will keep quiet because it’s not something people talk about, because we don’t know how to, because most people are, like me, blind to the reality. I didn’t know that small foetuses can be taken apart to find out if there is something, anything, they can do for the mother’s future pregnancies so that they will not end like this one. The hope that maybe the problem is genetic, maybe it is preventable, maybe this occurred for some diagnosable reason. Of course all of this happens. Of course it does.
I take the train home and stare at the empty seat across from me, avoiding looking at the toddler in the pram by the door and the pregnant woman pushing it. To get deliberately pregnant feels like the most hopeful, reckless thing you can do to your heart. Parenthood, from what I can see, must be a mess of love and terror. The thought of it makes me woozy.
I ask Clint to come over because I need to be reminded that bodies are warm. I tell him about the baby, and about the others – a line of small white cardboard boxes with paperwork resting on top, ready for post-mortems in the afternoon. I tell him about the foetus that was so small that he was resting on a kitchen sponge with his legs dangling over the edge. He was purple, translucent, wet-looking – a half-formed alien face. In the supermarket, buying dinner I won’t eat, I burst into tears at the sight of a tube of Fixodent. That night I dream about dead babies wrapped in their blankets, lying in rows on the gravel outside my bedroom window. In the morning Clint tells me I mumbled into my pillow, ‘I need to remember they’re not real.’ Something in my subconscious was in self-preservation mode, rationally dismissing my nightmares, but I woke to remember some nightmares are real. I had seen them.
I stay in bed for about three weeks, crawling out only when work forces me to. I try to process why I am reacting like this to something so clearly part of life, of so many lives that aren’t mine. I don’t have any children, and until I saw that baby in the blue tub I didn’t feel any desire to. I had never felt any maternal urge until I saw a dead baby, sinking. Waves of thought and possibility crashed in my head and heart as I stood there that day, watching him slip under. I felt seasick.
I needed to figure out why the baby in the bathtub affected me on an emotional level that watching him being autopsied did not. I told friends about it – in vaguer terms, so as not to transfer the image like a virus – and they said, ‘Of course you’re upset, you saw a dead baby.’ But I wasn’t upset when he was being taken apart by the pathologist – an objectively more horrific scene. I’ve seen a headless man, I’ve seen heads without bodies, hands without arms. I had just held a brain. The emotional reaction I had when I was dressing the dead man for his coffin made total sense to me, and the honour of being there felt like a conclusion to a lot of my thinking. It was confirmation that this was the right thing to do by someone you love, and also a good way of teaching yourself that the dead body is not a thing to be feared. Why is a baby in a bubble bath the thing that knocked me down? I felt like I was being absurd. I stopped trying to explain it, I was only making other people feel ill.
In 1980, Julia Kristeva, the Bulgarian-French philosopher, published Powers of Horror: An Essay on Abjection, about how a threatened breakdown in order causes a loss of distinction between subject and object, between the self and the other. Something is not where it should be, and the terms of our corporeal reality shift; we become horrified. She writes that ‘the corpse, seen without God and outside of science, is the utmost of abjection. It is death infecting life.’ When the baby was in pieces, to me he was pure biology, pure science, the pathologist was doing his job and everything was in order within the context of that room. But when he was in the tub he was just a baby – it was a life scene, infected by death. The tectonic plates of my reality moved as I stood there. Kristeva had a similar experience visiting the museum that was once Auschwitz. We are all taught what happened there, we are given the sky-high numbers of death and injustice, but the enormity is hard to grasp until you are given something small and familiar, like a pile of children’s shoes.
Life is not supposed to surface in the mortuary. Everyone has their boundaries: some APTs won’t read the suicide note in the coroner’s report, but all of the APTs hate it when the bodies are warm, when the patients have been transported from a hospital bed upstairs to the mortuary below and have not spent enough time in the refrigerator to cool their organs. It’s physically uncomfortable for them to work on the cold bodies – they each keep a bowl of warm water in the sink, to periodically de-ice their hands – but they prefer it, emotionally. ‘Wouldn’t it be nicer and easier if they were less cold inside?’ I had asked, as Lara stood there, soaking her frozen fingers. She looked visibly repulsed at the thought. ‘Nope. Dead bodies cold. Live bodies warm.’ Aaron had told me the same thing in the mortuary with Adam. There is comfort in their discomfort – it is what solidifies the distinction between the living and the dead.
To me, the most affecting horror is not the blood-soaked madman with the chainsaw, but the quiet domestic scene gone wrong, the minor note on the piano keys: it’s the suicide in the family home, the bodies under the patio, the baby drowning in the bath. He was no longer the biological specimen I could observe objectively in a medical context, mentally shielded and separated by waterproof apron and visor. He became a familiar scene not just gone wrong, but gone deeply, bottomlessly sad.
It’s early evening and we’re sitting at a table outside in December, beside glowing red heaters and drunk office workers in Santa hats, the temporary Christmas town by the river glittering and lit up around us. We’re drinking hot cider, Lara is hiding under a black hood and periodically swigging from a bottle of cough syrup to stave off a winter cold. We’ve been here for a while. We’ve talked about our similar Catholic upbringings, how for Catholics death is the event – the thing that all life is working towards – and how the weirdness of such a death-focused religion that keeps severed hands as holy relics can produce people like us. We’ve talked about how we don’t believe in God, how there is probably nothing beyond this, how the human brain struggles to contemplate not existing. And we’ve talked about the baby. For the last month, I’ve been emailing her about the baby. I’ve got more questions about her job, but mostly I just want to talk to someone who was there and saw what I saw. I want to know how she stands it, how she can go back there every day without falling off her feet, and why she would want to. She assures me that this reaction is not unusual – you never know how anyone is going to take it before they get there, whether they have experience with the dead or not. ‘It’s very circuitous thinking,’ she says. ‘You wouldn’t get into the job if you couldn’t handle it, but at the same time, you don’t know if you can handle it until you do it.’ The actual act of carrying out this job is a mental obstacle for most people, in the beginning. Even her.
‘You physically have to move and manipulate people in a way that if you do that to the living, it would hurt them,’ she says. She’s not just talking about rib shears and bone saws: she’s talking about cracking the rigor mortis out of the person’s legs, lifting them high above her head just like Sophie did in the embalming room, forcibly snapping them so they would bend. ‘I know they’re dead, they can’t feel this, but it just feels wrong to do it,’ she says. ‘It’s the same with the babies.’
She recalls a baby she had to put back together very early on. She says you can get a better angle on the head stitching if you approach it from the back, but that means turning the baby on its face. She says there’s a nicer way of doing it, which is to create a kind of miniature massage table by laying the baby over a sponge, but even so, the first couple of times she did it, it still felt wrong. ‘You wouldn’t want the parent of this child to see you do this. And when you’re washing them, you don’t deliberately put a kid’s head under water, but…’
Lara is talking faster now, trying to pin down the inherent contradictions of this job that requires both empathy and ruthlessness. In the post-mortem room, before the baby, I had watched her standing over the body of a sixty-something drug addict. Even with the cracking of the rigor he remained curled in the foetal position, his bright green belly keeping to the bend of the curve of his spine, his arm covering it in protection. He was so thin that there were sores where his bones dug into the mattress he’d died on, in a room filled with crack pipes and heroin paraphernalia. He had rings on his fingers, frayed woven bands on his wrists, a single earring and long straggly grey hair. When they opened him up, as well as the APT could do from the side, his lungs were black as tar, adhered to the ribcage. His neck rested on the stand, his empty skull tipped backwards, his mouth open to reveal brown teeth. Lara had paused beside him and said that a case like this makes her wonder what it was like to be him, what it was like to inhabit this body. How did he breathe? What did that feel like? His feet and hands were black with dirt. He was the culmination of years of neglect and malnutrition. When was the last time he shampooed his hair? That day, it was washed and combed for him. Despite the relative brutality of a post-mortem, he was treated with more care by these women than he gave himself.
‘… with the baby,’ she continues, ‘you put him in the tub, you wash him and go grab a towel while leaving him still in the sink full of water, or with his head immersed, and you think that feels weird. It’s not that it doesn’t matter as such, but it’s necessary. You have to clean this child, and because you can do things you wouldn’t do with a living one, you do it because it is easy. The way that you get your job done is completely alien to anything else. It’s against anything that you’ve been taught about what you should do with other people.’
There was a time when Lara did consider working with the living, until someone close to her died. She was studying forensic psychology at university, believing she wanted to work with young offenders, when her friend was murdered – had the shit kicked out of him on a night out by a group of boys and died from a slow bleed on the brain. After that, she no longer believed she had the emotional capacity to help similarly aged offenders, to patiently undo whatever it is that makes someone act out in violence. But why would someone like Lara, who always wanted a job where she would be able to help people, now have a job where she feels like she’s hurting them?
She brings up another case, one she says gets to the heart of why she loves what she does. It was a woman in her forties, another drug user, recently relapsed. The family said she had been clean for a long time. ‘But people lie, families lie, you never really know.’ Everybody figured she had overdosed and the post-mortem was just a formality. But when Lara opened her up, there was not a single organ untouched by cancer. ‘No one knew,’ she says. ‘Absolutely no one knew. Maybe she was in pain, which might explain why she had been using drugs again.’ Lara followed the path of the tumour, and found its root in the vicinity of the uterus. ‘Gynae cancers can have a strong genetic component, and this woman had children. So we needed to do a lot of testing, and suggested that her family go through genetic counselling.’ I think of Terry in his freezer in the Mayo Clinic preparing the lab for practice runs on intricate spinal tumours. Neither he nor Lara can explain why they are not squeamish, or why they can do this every day – Lara doesn’t even mind working on the decomposed bodies; she is fascinated by how much people can change, how much life is still going on after death – but both of them have their searchlight on the good it does the living. ‘Somebody getting screened for cancer,’ she said. ‘That was because of me.’ She looks, for the first time, proud.
After talking to her for hours, and seeing her at work, it is clear to me what makes Lara able to do this job, and why it would follow on from an abandoned desire to do social work: she is still giving a voice to the voiceless, and her eyes are still drawn to the helpless. Like me becoming overwhelmed by the baby and staying up late to read about infant mortality, what got to Lara at the beginning of her training in the mortuary was the number of dead mothers that came through it – she had no idea just how many dead mothers there are. There is little public discussion about what happens, physically, to a woman after a baby is born – she goes from being a protected vessel to a kind of milk accessory, one so changed physiologically that her post-mortem is a speciality in itself. What shocked Lara was how social factors, like race and economic status, would play such a huge role in whether she lives or dies; Maggie Rae, president of the Faculty of Public Health, was quoted in the British Medical Journal saying that these complex social factors underlying this increased risk need action beyond the health sector, and long before pregnancy, in order to make any difference. In the days after we speak, Lara sends me piles of information she has kept over the years on maternal deaths. It’s not because she wants to be a mother herself, she has no interest in having babies – she tells me she is fuelled purely by feminist rage.
It also upsets her that the role of the APT goes largely unnoticed. It’s one that is rarely glimpsed on television – you might see someone in scrubs in the background behind the pretty dead girl on the table, but TV abbreviates the role to the pathologist. Lara didn’t know APTs existed until a chance late-night google led her to a blog post written by one. This is pretty much fine and expected – a lot of death is hidden from the public, and TV abbreviates a lot of things for time and money – but it’s the fact that the role is also forgotten within the hospital that stings. At an internal event thrown in the wake of the London Bridge attack, to acknowledge and thank the employees for their work in the crisis, Lara recalls a speech given to thank all of the unseen staff. ‘Obviously you’ve got the doctors and the nurses, the frontline staff who deal with this, but then you’ve got the communications team who had to field tons of phone calls, you have the porters who have to run around the hospital, you have housekeeping, you have catering, you have all these people in these other roles that are important but you never see,’ she says, listing everyone who was thanked by job title. But only those who cared for the living were praised from the podium.
‘We were not named,’ she says, pausing, her perfect eyebrows hovering somewhere near her hairline. She is, still, clearly hurt. ‘No one wants praise, no one does this for the glory of it, but you do kind of want some acknowledgement that what you do matters. It matters to the families.’
In the days that followed the speech, Lara says that internal emails announced that all London Bridge patients had left the building (much like Terry at the Mayo Clinic, she calls all of the dead ‘patients’ even if there was never a time when they were in the building alive, being seen by doctors – they are being cared for by her), along with more thank-yous to everyone for the work they had done. She had stared at the screen dumbstruck, knowing that eight of them were still in her care, waiting to be collected. She resented being forgotten, and she resented the dead being forgotten too.
‘Back in Ancient Egypt, working with the dead was a very, very special profession, whereas now you’re reviled. You don’t want to say “I love my job” because that makes it sound like you’re saying “I’m really happy that your loved one died!”’ The smile that is usually so warm is repurposed here as sarcastic and ghoulish. ‘But you feel protective over the dead. Kind of like, I will take care of you because no one else will. How do you celebrate work that has essentially come from someone else’s pain?’
The emotional burden of this job is not in the taking apart of human anatomy, but the knowledge of what has occurred – the extent of it, the reality of it, the sheer human loss of it. They see the number of babies that lie in their fridges, and because they are the ones that see the totality of it, the APTs here are in support of a formal request to the government to widen coronial jurisdiction to include stillbirths, to find out why so many are dying (the coroner currently only has jurisdiction over deaths if that person breathed outside of their mother). The APTs are among the first to learn the identities of people in mass accidents, and they are among the last to look into the eyes of the people you see in the ‘missing’ posters. Lara describes walking to work from London Bridge Tube station, in the days after the attack, seeing the faces on the front pages of newspapers and knowing they were in her mortuary. ‘I didn’t feel like I should be the first one to know this,’ she says. ‘Not necessarily how they died, but that they are dead. Everyone knows that these people are missing, or that these people are probably dead, but you’ve got a family who may have a little bit of hope.’ She talks about the unidentified suicides that lie in the fridges for days over Christmas, while family members go unnotified because nobody knows their name. ‘It feels intrusive, that we know things before the families do.’
The reality of death cannot be denied in the cold, stark light of a hospital mortuary, but attempts are made to mitigate it. There is a viewing room where a pane of glass separates the family from the body, if that is required – usually because of far-gone decomposition, but also in ongoing police cases – though some insist on bypassing the glass to kiss the very dead, while others write them letters they’ll never read and stand vigil outside the hospital just to be near. But without the glass between her and the bodies, Lara cannot avoid the truth, and knows – just like in the tarot cards tattooed on her skin – that endings are intrinsically woven into beginnings. This job has solidified what she wants her death to be, but also how she wants to live her life. Her job is to notice things: scars, tumours, the recurring mother’s name on another miscarried baby. She notices how many deaths are lonely ones, and mostly she just doesn’t want to die forgotten. ‘I don’t want to be one of the people who lie dead in a flat for months. I want to be missed,’ she says. ‘I want someone to notice.’