10

Gradually, crime scenes and post-mortems became my working life. I was allocated easy cases to start with. They were all different but they were all straightforward. Routine, in fact. Except that there is really nothing routine about any crime scene, it’s just how we all try to make it seem. A motionless body, sometimes hideously mutilated, lies at the centre of a web of bustling, serious professionals who are all engaging fully with it while somehow remaining detached from its horror.

And at the edges of this web, at a safe distance, is the grief and shock of the bereaved. Pathologists know that even the most routine cases carry a payload of trauma for someone. At that stage, I was still determined to stay uninvolved in this trauma if I could. I did know, however, that sooner or later there would have to be an interface with the living.

At home, there were growing children and a busy wife. I was a hands-on father, unusual perhaps then, but I had been brought up by a hands-on father myself and the result was that making time for my children was a bigger priority for me than for many others of my generation.

However, I did have to learn how to leave the mortuary behind me at home. I had to forget the sights and smells of the place, forget the homicide victim I had just been examining and whip off the mask of clinical detachment just as I walked in through the front door to the quotidian world of daylight and children. Of course, that wasn’t easy. My mask was securely fixed. And so probably I didn’t always remove it successfully. Certainly, my wife did have a problem with that. Jen understood why I had to be detached. But she told me scientific detachment was an approach I adopted far too often. At home. In our marriage. Which was now under strain.

A few years earlier, Jen, who had loved being a nurse and a health visitor, had shyly told me that she had always secretly wanted to be a doctor. She hadn’t progressed well at school because her father held extremely conservative, indeed colonial, views on the ‘right’ sort of jobs for women and the education they required. She was also mildly dyslexic, which had further affected her early educational attainment.

I had no doubts about her abilities or her intelligence, and when she told me her ambition I promised to support her through the long years of hard slog ahead. Now, I was very proud of how she had worked her way through the Open University into a place at my alma mater, University College London. She was already on her way to qualifying as a doctor.

But, of course, this put us under great pressure: of time, of money. I earned a fair salary but nannies were expensive and, although Jen would be earning one day, she wasn’t yet. Quite often my work clashed with her training and then one of us had to give way. Our lives were hectic and complicated and our relationship sagged beneath our loads. A forensic examination of our marriage would reveal clusters of quick discussions, one of us always rushing in as the other rushed out, communication often limited to little more than times, dates, parents’ meetings, school sports days, logistics. Clinical interaction of that sort.

A beautiful summer’s Sunday morning. The children, still small, streaking into the garden like arrows as soon as I opened the back door. Me, a fresh-faced pathologist, always at the ready to rush to a crime scene and getting a whoosh of adrenalin if the phone rang when I was on call. Jen, almost a doctor, always studying.

I was just about to make breakfast.

Outside, the children cried, ‘Oh no!’

The phone was ringing. At this time of the morning. It could only mean one thing.

I considered the possibilities. Probably, because it was Sunday, someone had simply died after a Saturday-night fight. Upstairs, I knew Jen must be sighing. I imagined her sitting with her elbows on the desk, her head sinking into her hands.

I did feel bad. She had been up since the crack of dawn with her books and I had promised to look after the children today. If the phone didn’t ring. But it had, and now Jen was about to take the shrapnel from a drunken brawl.

A voice told me that the victim was a young Caucasian male. So, there had almost certainly been a pub-brawl last night. Except for one thing. The caller had identified himself as a detective chief inspector. A detective chief inspector who said, as the call ended, that he would be waiting for me at the mortuary with a detective chief superintendent. Top brass. At the weekend. There must be something unusual about this case.

‘Which mortuary?’ asked Jen, getting up from her books. ‘Westminster?’

‘Swindon.’

She did a double take.

‘Swindon? In Wiltshire?’

I nodded.

She sighed. ‘See you this evening, then.’

When I arrived in Swindon, the two senior detectives were waiting, along with a police officer and the coroner’s officer. The mortuary staff handed me a cup of tea and the chief superintendent began.

‘Young man. Over the drink-drive limit, took a corner on a country lane badly. His girlfriend was in the front seat and basically … well, have you got her statement, John?’

The detective inspector nodded and opened a file. He shuffled through some pages of typing.

‘So … the lad was working all night on Friday and he’s probably been up all day on Saturday and he’s had a few drinks so now he’s tired and drunk and it’s six o’clock. Good light but the road’s a bit damp. He’s picked up the girl and he’s taking her back to his place for a cosy Saturday night. They’re going round a bend and the van’s coming towards them and she says …’

His finger found its way down the page.

‘ “I shouted, ‘Oh my God, Michael, look out!’ and he immediately jerked the car to the left. Michael’s side of the car hit the driver’s side of the van. At the time of the impact I closed my eyes. When I opened them, both vehicles were at a standstill, although there was still glass flying around inside the car. I looked at Michael and his head was back and his eyes were closed. I thought he was unconscious. I shook him and he sat bolt upright as if I had just woken him up.”

‘ “I saw the other driver get out. And then this man appeared. I don’t know where he came from. He was wearing trousers with no shirt and he was really brown, he gave the appearance of being a labourer.” ’

The chief superintendent said, ‘He was actually working in his garden nearby and heard the crash.’

His colleague nodded and read on.

‘ “This man asked if I was all right. Michael got out through the window and walked to the front of the car. He pulled bits off it and kicked it and seemed to be very angry and upset. I was upset too. I was hysterical. Michael was kicking and throwing a paddy.”

‘ “I got out and lit a cigarette and gave one to Michael and then this man with no shirt said, ‘Don’t light your cigarettes, there’s petrol at the back of the car here.’ ”

‘ “Michael told him to mind his own business and the man with no shirt said something to Michael, I didn’t hear what, which aggravated him and then a fight started.” ’

The detective stopped reading and looked at me. They both looked at me as if they expected me to say something.

‘What actually happened in this fight?’ I asked.

‘Michael tried to hit the man with no shirt and missed. The man hit him back, that’s all.’

That can’t have been all. Why were they reluctant to tell me more? I asked, ‘Well, what does the girlfriend say?’

The detective read, ‘ “The man with no shirt clenched his right fist and hit Michael full in the face, either on his nose or his mouth. Another man, with streaked hair, had pulled up in his car by now and he got behind Michael and put his arms right round Michael to hold him and Michael went a funny colour, a purply red, and passed out. The man let him sort of fall to the floor.” ’

The detective stopped reading again. But I knew there was more.

‘Any further description?’ I prompted.

‘ “By this time, it was raining heavily. The man with no shirt started shaking Michael quite violently to try and get some response from him. He was saying, ‘Come on, get up!’ but Michael didn’t move and I could see he was really hurt, he looked really poorly. The reddish purple tinge had faded. They couldn’t revive him. An old man in a Sierra stopped and put his jacket on him to keep him warm until the ambulances came. When my ambulance drove away, Michael’s ambulance was still there.” ’

The chief superintendent took up the story: ‘Never recovered consciousness. Swindon sent him to Oxford for a CT scan, then he came back to Swindon. He died here this morning.’

He handed me some medical notes from Oxford. I looked at them and nodded.

‘So you want to know whether you’ve got a road traffic accident on your hands or a homicide?’

I saw them flinch at the word homicide. I wondered again why we had the top brass here. Was the deceased famous? Especially well connected?

The superintendent said, ‘The girlfriend’s making a right fuss, saying the bloke with no shirt killed Michael and now the family’s making a big fuss too.’

I got up. ‘Well, let’s take a look at him.’

‘Right,’ said PC Masters as we walked into the room where the young man’s body lay waiting for us. ‘This is Michael Ross.’

I did not recognize the name but I half expected to recognize the face. There were cuts and bruises but I could still see that the young man had handsome rock-star looks, with thick dark hair curling around his forehead. However, there was nothing familiar about him.

‘How old is he?’

‘He’s twenty-four.’

I began to scribble and, when I looked up, saw that the photographer had arrived and was waiting for me to tell him what pictures I wanted.

‘Whole body front. Then we’ll do close-ups of the face and the neck and we’ll have those bruises on his knees, please. Oh, and this fight he got into …’

‘The alleged fight,’ said the detective chief superintendent quickly.

‘… please photograph the hands so that we can see his knuckles.’

I scribbled:

Recent superficial abrasions, mostly vertical over the forehead, bridge of the nose and left side of the chin. Recent punctate area of bruising (8 x 2cm) lying diagonally over the right lower neck.

I marked Michael’s wounds on my blank body outlines then looked closely at his teeth.

‘No sign that he was hit in the mouth,’ I said. The room seemed to rustle a bit but when I looked up everyone was still.

There were a number of other old bruises and scars on the body, which I noted, as well as details of Michael’s tattoos. His back seemed unmarked. We photographed this and I then turned him over again and began the post-mortem. The officers watched with stony faces. There is usually at least one who turns green and this time, surprisingly, it was the super.

‘I’ll have to get used to it all over again; I haven’t been to one of these for years,’ he said apologetically. ‘I’ve just come back from the fraud squad.’

Ever since the young PC had thrown up in the first forensic post-mortem I carried out alone, I had given a lot of thought to post-mortem revulsion, a condition which can affect anyone whose job requires them to be present.

I asked myself why I had never, not once, shared their revulsion. Answer: because I was so fascinated by the workings of the human body in general and my findings in particular. I decided that if I could somehow share this fascination with others in the room, I might be able to help them past their horror. My theory was that, if I could involve them in the proceedings through knowledge and understanding, then they would no longer be helpless, shocked onlookers.

The nervous silence in which I conducted my first post-mortem and the nausea of the PC who witnessed it could not have been sheer coincidence. So I had determined that the next time someone present became really upset, I’d put my plan into action by talking. Politely but lamely muttering, ‘Er … are you all right?’ as the super’s cheeks took on a greenish tinge would not do.

Adopting what I hoped was a reassuring tone, I said, ‘As some of you will know, I have to check the organs inside the body – not just for injuries from the car crash, not just for damage from the subsequent brawl, but to ascertain that there wasn’t some other, less obvious, contributing factor to this death – like a natural disease. So, I’ll be taking a good look at all his organs.’

The super nodded. Rather slowly. The room was silent, as though a blanket had been thrown over it.

‘Got any music?’ I asked the mortuary staff. ‘Something classical would be nice.’

They switched on Radio 1. I glanced at the super. Maybe the sound of inane voices would steady his nerves. I did ask them to turn it down a bit, though.

Cutting dead skin is like cutting the skin on a chicken joint: easy if you use a sharp knife. The cut is hampered, if at all, not by its strength but by the skin’s natural elasticity, and as a healthy young man Michael Ross’s skin did have that elasticity. As I sliced through the fat which lies beneath – in all of us to some extent, even someone as slim as Michael – I glanced up. The super was not doing too well. Radio 1 wasn’t helping. It was time to start talking again to test my theory that information, any information, is soothing.

‘I’m nearly into the chest cavity now. From this stage, without impinging on Michael’s dignity at all, you could try to forget that we are dissecting a human. You’ve cut meat often enough and this is no different in colour or consistency. You’ll soon see that the liver is like any liver you buy in Sainsbury’s. The kidneys too. And this muscle I’m cutting now, well I always think it’s a bit like a good steak.’

‘Chips, anyone?’ said the detective inspector jovially.

No one replied but the superintendent tried to nod again. As if we were making polite conversation. However, he could not pursue this convention by meeting my eye because his own eyes were now fixed on Michael Ross.

I continued my work. PC Masters was keen to ignore the boss’s discomfort but the coroner’s officer seemed to take a certain amount of pleasure in it.

‘It’s all right, he can’t feel a thing,’ he told the super cheerfully. ‘Bloody good anaesthetic, death.’

I glanced at the super. Hmm. Start talking.

‘Of course, I’ll have to look closely at Michael’s brain and his neck. According to the medical notes, that’s where I should expect to find damage caused by the road traffic accident and by the fight. I mean, alleged fight. But I can only be guided by the notes, not bound by them. I still have to examine every organ carefully in case the doctors missed something.’

No one in the room, not even the coroner’s officer, looked as though the prospect of examining Michael’s brain was very attractive. I decided not to even try telling them how fascinating this would be.

Michael had been a healthy enough lad although, despite his young age, a hard-drinking lifestyle was already having its effect. His heart was slightly enlarged and his liver fatty, both probably signs of significant alcohol consumption. I was sure the brain would prove the most interesting organ and, as expected, when I lifted it out I found that it was full of blood. The door slammed. I didn’t even have to turn round to know who had left the room.

I asked the photographer for a picture of the brain whole, knowing that I would have to section it soon to study its histology. I’d probably get a colleague who was an expert in brain pathology to take a look at the slides too. I also needed to carry out a really detailed examination of Michael’s neck, far too detailed for this post-mortem. So I prepared a fixative in order to transport it. The remaining police officers drew back at the intense smell of the formalin as I turned the body over and carefully removed the neck structures with the accompanying arteries, placing this in a mortuary bucket to make sure I disturbed the vertebrae as little as possible.

‘Glad I drove here, I can put this in the boot,’ I said, as the mortuary assistant carried the bucket away to seal it.

‘You never would have taken it on the train!’ exclaimed PC Masters.

‘I sometimes have to,’ I admitted. ‘It looks a bit strange but I just hope the other passengers assume I’ve been out catching tadpoles in the country.’ Certainly, no one would ever guess what’s in the bucket. Unless they could smell it.

‘Right then,’ said the cheerful mortuary assistant. ‘Cups of tea all round.’

I went into the locker room to change and wash. The police officers had appropriated the mortuary’s bereavement room since it was empty, and I found them here sitting in a circle drinking their tea. It was a quiet room, decorated in dull shades. Along one wall was a large tank, two fish swimming up and down it noiselessly. I don’t know why there is nearly always a fish tank in bereavement rooms.

The chief superintendent’s cheeks were deathly pale. He was not so much sitting in his seat as propped up by it and he was evidently disinclined to speak, glancing at the detective inspector instead.

The detective inspector asked, ‘So, what do you think, Doc?’

‘It will take a while to get you my full report because I’ve a lot of work to do on the brain and the neck to confirm my findings. But I can give you an informal, off-the-record debrief if you like.’

‘Yes please,’ he said quickly, exchanging glances with the super. What was it about this case that was causing the top brass so much concern?

‘Well, I don’t believe that the punch-up – alleged punch-up – had anything to do with Michael Ross’s death. He was killed by the impact of the car accident,’ I said.

The detective inspector tried to stop himself but he couldn’t. He smiled. Even the super, still pale and barely sipping his tea, managed to pull his mouth into an approximation of a grin.

‘Are you sure?’ the inspector asked happily. ‘How can you be sure?’

‘You can see just by looking at him that Michael screeched to a halt very suddenly – he’s got a seat belt injury on the right side of his neck to prove it. I believe that the sudden stop caused severe whiplash to the spine. Once his spine was out of alignment – and according to his girlfriend he was turning the wheel frantically at the time, which might have given his spine an additional rotational problem – the arteries, or at least one of them, running up the sides of the vertebrae, were ruptured. A ruptured artery bleeds into a space around the brain: he had a sub-arachnoid haemorrhage and that is what killed him.’

‘Whiplash. It was whiplash!’ said the inspector, beaming at the super.

‘A brain haemorrhage …’ muttered the super weakly.

‘Caused by impact!’ the detective finished for him.

I said, ‘You can get a sub-arachnoid haemorrhage for genetic reasons and I can’t 100 per cent rule out a congenital problem yet. But it’s also caused by trauma and in this case the haemorrhage was almost certainly a result of the accident.’

PC Masters was looking more serious than his bosses. He had been watching the fish swim up and down their tank.

‘Doc … how do you know the haemorrhage wasn’t caused by a trauma in the fight; I mean, alleged fight?’

‘If the fight had caused the haemorrhage then there would have been a lot more soft tissue injury. There’s just one bruise on the face, which might have been a blow from a fist. I think it’s too minor to have done much but I’ll be checking carefully when I examine the neck. Virtually all the other facial injuries look like windscreen glass to me.’

The inspector said, ‘But Michael Ross’s family’s asking how he was able to climb out of the car, walk about, smoke, talk, argue, fight. If he had a brain haemorrhage. Until the other bloke, the one with no shirt, hit him.’

‘A delayed death is fairly classic for this type of haemorrhage. It can take a few minutes, or even hours sometimes, for blood to spread from the damaged artery up the canal to the skull. He managed to do all those things during the lucidity period that sometimes precedes death from a sub-arachnoid haemorrhage.’

They all looked at one another.

‘So … you’re sure it’s nothing to do with the fight?’

‘I don’t think so. But these haemorrhages are found after both pub brawls and road traffic accidents, so I’ll have to do a lot more tests before I can be sure I’m right. I believe the tests will show that Michael was a dying man from the moment of the accident and the fight made no difference.’

That’s what I thought. The timing, however, was unfortunate, since he seemed to die at the moment the man hit him. I was going to have to work hard to prove my theory, and be prepared to change it, since there was sure to be a second post-mortem.

The policemen sat back in their chairs and looked at each other.

‘If you had manslaughter charges lined up against the man with no shirt, I’d drop them now because they probably won’t stand up. I suppose you might get him for assault,’ I offered.

They said nothing.

I asked, ‘Michael Ross had the looks and liver of a rock star: is he famous?’

They shook their heads.

‘So … why do we have a chief superintendent and chief inspector here on a Sunday morning?’

The super looked at me. So did the inspector. Who paused, then said, ‘Off the record, Doc, we’re here because I thought we were in a spot of bother.’

I waited. The officers looked uncomfortable. Finally, the super spoke.

‘The man with no shirt. The one who hit Michael. He was an off-duty police officer.’

So that was it.

‘We didn’t tell you before because we didn’t want to influence you.’

I said stiffly, ‘You wouldn’t have influenced me. Pathology tells its own story.’ No, that sounded all wrong. Far too pompous, far too much like someone who was occasionally unnerved by the number of versions of the truth he was beginning to encounter. I added, ‘Even if I wanted to ignore inconvenient truths, there’s usually a second post-mortem, so I couldn’t do that.’

But the super was not listening. His face still deathly white and his voice low, he said, ‘You don’t know how worried I’ve been about this one. It would look so bad for the force and, between ourselves, a few things have been said about that officer in the past; he loses his rag and … of course, we didn’t want to believe he’d killed a man but his record isn’t … well anyway, what you’ve told us is a big relief, Doc.’

‘The thing is,’ said the police constable, who clearly knew the man with no shirt, ‘I can see how it happened. The driver, Michael Ross, he was an idiot to smoke near the car when there was fuel all over the road, and when Mitch told him that, he tried to argue. So Mitch had to make him stop. I can see that.’

‘Persuading an RTA victim to behave safely is one thing, losing your rag with him is another,’ said the inspector.

Now they knew the officer’s action had not contributed to the death, they seemed able to discuss the matter. Even the super joined in a little.

‘Are you going to be all right?’ I asked him as I left.

He nodded but I thought his face still looked pale and drawn. I wondered then if attending a post-mortem could actually be a traumatizing experience. I had to ensure somehow that it wasn’t. I had done my best today. How could I do more?

I heard the officers’ voices still debating as I walked down the corridor. I drove home with my bucket and its strange cargo in the boot.

‘Pooh, Daddy, you’re really smelly,’ said my daughter. Anna’s never been one to mince words. Jen fell gratefully on her books and I made supper and then, when I was no longer on call, allowed the children to persuade me that we should take the dog to the park.

I loaded all three into the car.

‘Anna, seat belt,’ I said.

‘No.’

‘Seat belt.’

‘Don’t like my seat belt.’

‘It’s not the law to wear a belt,’ piped up Chris. ‘Because we’re in the back seat.’ Which in those days was true.

‘It’s the law,’ I said firmly, ‘in this car. Seat belts! Now! Or we don’t move.’

Michael Ross was not saved by his seat belt but I had already seen many, many fatalities that could have been prevented by wearing one. Travelling without a seat belt is a risk I would never take.

‘I’m not going to put my seat belt on!’ Anna declared. ‘Anyway, it’s not fair, because Dilly doesn’t have to wear a seat belt.’

Dilly wagged her tail.

I said, ‘Right. Then we don’t move.’ And to show how ready and willing I was to sit in the car until she was safely buckled in, I got out my cigarettes, lit one, and proceeded to puff on it until my daughter had fully complied with my health-and-safety rules. Then we drove to the park. I know, I know. But at least I opened the windows.

From this you will see that my attitude to risk-taking – my own and my children’s – has always been as idiosyncratic as everyone else’s. At least working with death has helped me recognize it can arrive most unexpectedly and therefore I do appreciate the good things life has to offer. So that evening I enjoyed the park, I enjoyed the general laughter while bathing the children and I enjoyed reading them stories and then kissing them goodnight as they snuggled into bed.

Later, Jen took a break and we sat together in the garden. As usual on a Sunday, we were synchronizing diaries, working out how we were going to manage our various commitments. We couldn’t afford after-hours childcare, so each week our time had to be planned and managed.

When we had finished, we sat back. With our cigarettes. The evening was so still that the smoke rose upwards in a straight line. It was good to relax as the sun went down. And it was inconceivable to us that it might be possible to relax without cigarettes. We were fully aware of the effect of this: I often found myself looking at lungs which bore the strangely beautiful but deadly patina of smoke inhalation. But we regarded cigarettes as an essential part of our full and busy lives.

The next day I did some research into sub-arachnoid haemorrhages. I found that victims often show aggression in that period when they appear to be recovering, the period between accident and death during which Michael Ross had started fighting. And alcohol, which frequently plays a role in these haemorrhages, can certainly make matters worse by increasing blood pressure and making rupture of any damaged area more likely.

It seemed Michael was a textbook case but I still had a lot of work to do. I not only had to X-ray the whiplash injury to the spine but I had to take a series of cross-sections of the spine’s arteries to find the resulting rupture and show how it had caused the haemorrhage.

The chief superintendent phoned me.

‘Michael Ross’s family wants another post-mortem. They think we’re closing ranks and they say that if we don’t charge the off-duty police officer with manslaughter, they’ll file a civil case against him.’

‘Did you explain that I found –’

‘They weren’t interested in hearing anything from me. They’ve got their own pathologist.’

‘That’s not unusual.’

He named the pathologist the family was consulting.

I was pleased. ‘Oh, I know him and he’s very good.’

The super sounded less pleased. ‘Wants to do his post-mortem the day after tomorrow.’

‘I’ll be there.’

When there is a second post-mortem – and there often is, for example lawyers defending clients on a murder charge frequently call for one – it is normal but not required for the first pathologist to be present. I thought it would be both useful and interesting to watch a post-mortem performed by this esteemed colleague.

Before the second post-mortem, I examined the brain further, reassuring myself that there was no congenital aneurysm that had caused the haemorrhage. And I continued with my slow and careful dissection of the vertebral arteries, photographing every step of the way, until I found the rupture which had caused the haemorrhage. I sent specimens and photos to the Ross family’s forensic pathologist and to another neuropathological expert who was also coming to the second post-mortem.

Afterwards, the expert and the family’s pathologist conferred and then wrote a detailed report that confirmed all my results. The pathologist agreed that whiplash, caused not just by Michael’s sudden braking but his frantic turning of the steering wheel, had dislocated his spine. This dislocation ruptured an artery carrying blood to the brain, resulting in a haemorrhage.

He said, ‘The walking about, smoking, talking, arguing and fighting may have accelerated the rate of haemorrhage but I doubt very much whether the fatal outcome could have been avoided. After a few minutes, the amount of haemorrhage became such that Mr Ross lost consciousness and from then on the fatal outcome was inevitable.’

My post-mortem had pleased the police and the cause of death was certainly beyond dispute when the second post-mortem concurred. But supposing the forensic evidence had not been so clear-cut and the police had put pressure on me to exonerate their officer? A slight adjustment in wording at the end of a report (‘There is a possibility that …’ to ‘It is unlikely that …’) can be enough for the Crown Prosecution Service to bring charges or to drop them. How hard would it have been to resist such pressure if it came from the Met, fostered by the hopes and fears of individuals I worked with on a regular and friendly basis?

I reminded myself that I became a forensic pathologist to be a seeker of the truth. That meant I must stand up for the truth whatever pressure I was placed under to massage it. I see now that this is just the sort of noble thought a keen young man of limited experience might have. I had not worked on enough cases to know how malleable a concept truth is for some people, nor how open to interpretation, instinct and inclination are all truths, even those that appear to be scientific fact. Although there had already been some intimations of truth’s elasticity. In court, for instance. But overall I was still deluding myself that it was always possible to find a moral pathway that everyone would recognize as clear and correct.