Whenever you visit a hospital, your destination is always clearly marked. Signposts are suspended above your head along all of the corridors. Arrows are painted on to floors. Colourful you are here! maps are drilled into walls. Everything is described, pointed out. You can’t possibly get lost, at least in theory, because the purpose of every department is made clear to you and on each door hangs an explanation.
The door I was looking for, however, did not possess an explanation. It sat by a reception desk in a small corner of the hospital. It did not have a sign or a purpose drilled into the wall, and should you happen to have noticed it as you walked by, you might have imagined that it led to a stationery cupboard or a small cloakroom. It was the door to the mortuary.
For my time at medical school, I had chosen to commute each day, and during that morning’s long drive of one hour and forty-five minutes I had played the radio on an especially high volume. It was a distraction, filling my car and my head with the lyrics to songs. I didn’t know it then, but a few hours later, I would return home without the radio on at all. Music would eventually become a barometer, used as a diversion or as a comfort. Its absence denoted an especially difficult day, when I needed the quietness in order to process my own thoughts, and there would be many times when I would drive the entire journey home in absolute silence.
Once I had found the unmarked door, I walked through and was immediately faced with a labyrinth of corridors. In offices on either side, secretaries typed behind towers of patient notes. People passed by me with mugs of coffee and quiet conversation. Everything felt so ordinary. I walked down more corridors, through more unmarked doors, each progressively harder to negotiate, like a real-life but sobering computer game. Swipe cards. Keypads. Codes I had written on pieces of paper were carefully pressed into silver buttons. I became stuck between two doors and had to be rescued by a man in scrubs, but eventually, I arrived at my destination – the mortuary, where I was met by my registrar.
‘You made it,’ she said.
I think she was as surprised as I was.
The changing room in the mortuary felt reassuring, with its quaint and nostalgic air of a childhood trip to the swimming baths. There were wooden benches and a tiled floor. Rows of lockers, most unlocked and gaping open, were filled with photos and stickers, personalised mugs and spare cardigans. Post-it notes of lives lived outside the hospital. Just like at the swimming pool, there was even a little walk-through area, but instead of being filled with a chlorine solution, pressure hoses and scrubbing brushes hung on its walls. I was given protective clothing, which I expected, but added to that were goggles and wellington boots, and giant rubber gloves which reached right up to my elbows. I stared down at my new outfit and wondered what might lie ahead that made it a necessity.
My registrar turned to me. ‘We’re now going through those doors.’ She pointed. ‘Beyond those doors are three tables and on those tables are three bodies, all at different stages of a post-mortem. The body we’re working on today is on the far right.’
I stared over at the doors and I felt the familiar tread of anxiety creep from my stomach and into my throat.
‘It’s perfectly normal to respond to it. It’s perfectly normal to feel anxious or upset, or to want to leave,’ she said. ‘You can leave at any time. Just walk back through those doors and you’ll be in the changing room again. No one will mind. No one will think any less of you.’
And with those words, I knew I would be okay. Because with those words, the registrar handed me something very rarely given to us in medicine. She gave me permission to react. Permission to experience emotion and distress, and to acknowledge my own feelings. On so many occasions we are expected to remain impassive, to be mechanised and empty, programmed and preset to be unresponsive to all the unhappiness and misery we encounter. This disapproval of emotional reaction exists in everyday life too. Certain corners of society maintain a particular distaste for anyone displaying emotion, anyone who admits they are overwhelmed or unable to cope. Newspapers and magazines devote a special place on their front pages to any celebrity who cries in public, especially if that celebrity is a man. We are expected to somehow absorb our feelings and our responses to life, to banish them far from the surface of who we seem to be, because their disappearance makes it so much easier for everyone else. In medicine, it’s seen as almost mandatory.
‘You’ll be fine,’ said the registrar.
I was fine.
Of course, what I saw beyond those doors was undoubtedly shocking. My first reaction was that I must be on a film set or backstage at a television show, because the scene in front of me was so far removed from anything I had ever witnessed, and my brain was unable to process it. My eyes needed distance at first, and I prowled at the edges of the room. I wiped my very clean goggles. I adjusted my perfectly placed gloves. I did anything but look at the thing I was there to look at. It’s amazing, though, how quickly we are able to adjust and within a few minutes I was at the side of my registrar (who, because she was very wise and very kind, had allowed me to prowl and adjust, and wipe my very clean goggles, without comment).
I’m not sure when it happened, or why, or even how, but at some point during those first few minutes of being in the mortuary, I let go of the shock and the fear. They disappeared somewhere, evaporated into the miracle of what I was witnessing – the miracle of anatomy and physiology, the miracle of the human body, and with each stage of the post-mortem, more small miracles were revealed and more diagrams came to life. When we reached the heart, and the left ventricle was pointed out to me, the sense of excitement was quite extraordinary. There was the left ventricle! The thing I had stared at in a textbook for the past few weeks was right before my eyes! It felt as though I had stumbled upon a celebrity.
The very greatest miracle of all was left until last. As the brain was lifted out and passed to me, I realised that I held in my hands the very essence of who this person was. Their thoughts, hopes, dreams, worries. Their personality. Their sense of self. A lifetime of memories. All of those things rested on my fingers and for a moment, the privilege of what I was doing took my breath away.
When the brain is dissected, you will find, lying deep within the cerebellum (the ‘little brain’) an area concerned with transporting motor and sensory information. It looks like a series of delicate branches or the fronds of a fern, stretching its tiny fingers out deep within our minds. It helps us to negotiate the landscape, to make sense of what’s around us. To survive. It’s called the arbor vitae, or the tree of life, and it remains one of the most beautiful things I have ever seen.
After that day, I became a regular at the mortuary. I was on first-name terms with the attendants. I didn’t need to check the pieces of paper in my pocket in order to press numbers and letters into a silver keyboard, and I no longer became trapped within corridors. I even had a need for my wellington boots and my elbow-length gloves.
Of course, I still went to the dissection room, which no longer held any fear for me at all, and I would enjoy staring down a microscope at the many towns and villages that lie deep within our bodies. But the mortuary seemed more real, more relevant. Whenever I left, I would move back along the corridors, past the secretaries typing letters and the people carrying mugs of coffee, further and further towards an everyday life, and I would emerge through the little unmarked door at the reception desk. On each occasion, I would walk back to my car, passing crowds of people living their ordinary lives, and I would think ‘you have no idea what I have just seen’.
On the way home, I would study everyone around me – a cyclist at a set of traffic lights or people making their way across a pedestrian crossing – and I would imagine all the anatomy that lay beneath their flesh. All those small miracles. I became slightly concerned about myself as I began to wonder if I would ever again view human beings in the same light. I decided I would visit the mortuary one more time. I had other subjects to learn about and it had served its purpose. It had helped me to face the thing that had terrified me the most, and the rest of medical school would be plain sailing.
I was deeply naïve.
On my last visit to a post-mortem, I arrived in the changing room to find my registrar standing in front of the double doors, blocking my way into the tiled room with the three stainless steel tables.
‘I was going to text you,’ she said.
I thought there’d been a change of plan. Perhaps she had to be somewhere else. Perhaps there were no dead people that day.
‘Is it cancelled?’ I said.
‘No.’ She shook her head. ‘It’s not cancelled. I just wanted to give you the choice.’
I frowned.
‘It’s a suicide,’ she said. ‘Do you still want to be here?’
I looked beyond her, towards the double doors, and I wondered what lay behind them.
‘I still want to be here,’ I said.
It was a man.
The two other tables were empty, and he was alone. He’d failed to turn up at a prearranged appointment and his daughter had gone to her childhood home to find that her father had hanged himself in the garden shed. He was fifty-three. There had been no warning. No prologue to the story. No indication he had decided to take his own life, because you will never spot the suicide who does not want to be seen. The daughter somehow managed to cut him down, and she performed CPR with such desperation, such anguish, that she broke every bone in her father’s ribcage. I stared at his face and at the ligature mark around his neck.
We began.
Afterwards, my registrar disappeared briefly to collect something and, for the first time, I was left alone. While we’d been working, someone else had been brought in. It was also a man and he waited for us on one of the other tables. I walked over and looked at the whiteboard on the wall above his head, where the attendants wrote any information they had been given. This man was also fifty-three, and he’d been killed that morning in a car accident. I walked back to my table. Again, I looked across at the other man.
If you had asked me prior to that moment about my views on suicide, I would have told you how much compassion I had towards someone who had been so desperate they had felt compelled to take their own life. I would have told you how much understanding we should all try to find and how we should never judge someone unless we have walked alongside them on their journey. Yet, standing in that mortuary between those two tables, I was filled with so much rage, so much fury, I almost had to leave for fear of being unable to control my temper.
I thought about the daughter, I thought about how she had tried so desperately to revive her father, and about how, no matter what else might happen to her in life, she would never be able to lose her memories of that day. I wondered how the man could have done it, knowing his daughter would be the one to find him, knowing how it would affect her. I thought about how these men were both the same age and had died on the same day, but how one had been given a choice about the matter and the other hadn’t.
Many years later, and many patients later, I finally reached the truth.
It took someone else to help me understand – someone I got to know on the psychiatric wards.
He was a junior doctor.
He was also a patient.