18

In the late 1980s the UK saw a series of disasters which claimed many lives. Few if any of these disasters could exactly be called an accident. They almost all exposed major systems failures. Or maybe this was a period when post-war values of self-reliance were morphing into conflicting interests of self and state. Certainly, attitudes were changing as the population grew and the systems we relied on had to increase in size and complexity.

In March 1987 the car and passenger ferry Herald of Free Enterprise capsized outside the Belgian port of Zeebrugge because the bow door had been left open: 193 passengers and crew died.

In August 1987 Michael Ryan went on a killing spree and shot thirty-one people in Hungerford before killing himself.

In November 1987 a lighted match dropped down through an escalator on the Piccadilly line at King’s Cross, causing a fire that claimed the lives of thirty-one people and injured a hundred more.

In July 1988 the Piper Alpha oil rig in the North Sea blew up, killing 167 men.

On 12 December 1988 three trains collided due to signal failure just outside Clapham Junction. Thirty-five passengers died and more than four hundred were injured, sixty-nine of them very severely.

Later that month a bomb planted on a Pan Am jumbo jet exploded over the Scottish town of Lockerbie, killing all 259 people on board and eleven on the ground.

Less than three weeks later, on 8 January 1989, an engine fault developed in a British Midland Boeing 737 which, compounded with pilot error, brought down the plane on the embankment of the M1, just short of the runway at East Midlands Airport. Of 126 people on board, forty-seven died and seventy-four suffered serious injury.

In April 1989 ninety-six Liverpool football fans were crushed to death and more than seven hundred were injured at Hillsborough stadium in Sheffield. It was only in 2016 that a second inquest ruled the victims were unlawfully killed due to gross negligence: the police, ambulance services and safety standards at the stadium were all criticized.

In August 1989 a collision between a pleasure boat and a dredger in the Thames claimed the lives of fifty-one people, most of them under the age of thirty.

Each event shocked the nation. Each resulted eventually in significant improvements, when emotions were calmer and the often multiple, interconnected causes had been unravelled and analysed. Ancient systems were overhauled, the health-and-safety culture blossomed – some might say exploded – employers began to recognize the importance of training, of corporate and state attitudes to risk and responsibility. These areas had suddenly become more serious and security was no longer just a managerial afterthought but a necessity.

I was involved, at emergency or inquiry stage, with many of these events. Pathology learned a lot from them about how to deal with mass disasters – and so did I. It was the lessons of this watershed era that enabled us to cope efficiently with the terrorist horrors of the 2000s.

For me, the first such case was Hungerford. But this was largely an era of transport disasters, and the first of these I worked on was the Clapham rail crash. A fast passenger train from the south coast, full of commuters, drove through a green light near Clapham Junction and rounded a bend on a Monday morning at 8.10 a.m. – only to find that the slow service from Basingstoke had halted on the same tracks.

An inevitable collision ensued. Because the green signal should have been red, but wasn’t. Because a wire was loose. Because the electrician had left it that way. Because he had taken only one day off in the preceding thirteen weeks. And, although his managers thought his work was satisfactory, later investigations showed that it had, in fact, been poor, very poor or simply unsafe for sixteen years. It transpired that no one had supervised or inspected anything he did because he was ‘trusted’ and because there was no culture of inspection. The fundamental trigger, however, was this: everyone had been rushing to replace the signalling wiring. And why replace the wiring? Because it dated from 1936. And there was a need to ensure greater rail safety. We are now inside a law of nature that sometimes seems to account for the bulk of my work: the law of unforeseen consequences.

At the collision, the fast train buckled to the right and hit a third train on the adjacent rails going the other way. Fortunately, this train was empty, heading back to Haslemere: the driver saw what was happening ahead of him but had no time to stop. A fourth train, coming up behind the fast train, was travelling at speed but, because the electrical current had automatically shut off after the earlier crashes, it was slowing down and coasting around the bend. The driver managed to apply emergency brakes in time to narrowly avoid a further collision.

The thirty-five people who died were all in the front two coaches of the fast train. These coaches were ripped open on one side. Closest to the point of impact they completely disintegrated. The first senior fire officer on the scene – and the collision had inconveniently occurred in a deep and wooded cutting – looked down and immediately ordered eight more fire engines, eight ambulances and a surgical unit, as well as cutting and lifting equipment to extract trapped passengers.

A disaster plan is all about the victims, but at an initial glance so much of it seems not to be relevant. Traffic and parking may appear to be minor issues, but if these are not immediately controlled rescue vehicles cannot get to or away from the site quickly. The site must be made accessible (in this case, trees and railings were removed), hospitals must be put on alert and the removal of the severely injured coordinated. Medical teams must arrive. Casualty centres for the walking wounded must be set up and managed, a casualty collection point must be provided as well as a temporary mortuary. Every passenger must be accounted for and this information must somehow be made available to anxious relatives (there were no mobile phones in 1988). There must be stretcher bearers and people delivering medical supplies to doctors, and the entire operation must be co-ordinated by a forward controller who has established radio links so that rescue workers can communicate.

This is a huge task, and it must be carried out at speed. Speed is only possible after planning and practice. As it happened, 12 December 1988 was the first day the new A&E department at the nearest hospital, St George’s in Tooting, was open. The staff who took the initial ‘red alert – disaster call’ had to be persuaded that the rail disaster was real and not a hoax from colleagues at another hospital.

The total numbers involved in the Clapham rescue were vast: they came from all over London for the London Fire Brigade, the London Ambulance Service, the Metropolitan Police, the British Transport Police, the British Association for Immediate Care (specially trained doctors, mostly GPs, who are on call to leave their day jobs and rush to disasters), British Rail, the London Borough of Wandsworth (fortunately one of the very few local authorities in the country at that time to have its own emergency plan, which was put into immediate action, providing 134 invaluable staff) and, of course, the Salvation Army, who arrived with a mobile canteen to offer physical relief in the form of drinks and food but also psychological relief to rescuers, staff and relatives.

The first role of the emergency services is certainly to take care of the living, to extract the trapped and to get casualties to safety as quickly as possible. Only after that come the dead.

The London Fire Brigade, as first on the scene, having been assured the rail power was off, allowed the traumatized walking wounded to leave the train. They were escorted to casualty centres in the adjacent Emanuel School and the Roundhouse pub and there was a collection point for them in Spencer Park.

Sixty-seven ambulances were used to ferry the wounded to hospital. The thirty-three who died at the scene were removed along with any body parts. Initially they were put in a temporary mortuary but their stay was brief, as it should be. The coroner organized a fleet of undertakers to pick up the bodies and body parts from here. They were to be taken to the mortuary for full identification and autopsy. In any mass disaster, one of the key questions, as well as dealing with the wounded, is: where do we put the dead?

By 1.04 p.m. the last live casualty had been stretchered away from the train. By 3.40 the last body was removed from the wreckage. Unfortunately, no pathologist was sent to the scene so there were no detailed pictures taken of the bodies in situ, which might have helped with identification. And it would certainly have assisted greatly in our analysis of the injuries.

The mortuary chosen to receive the dead was that recently rebuilt and state-of-the-art facility, Westminster.

Four of us from Guy’s went, including Iain, who was of course in charge, as well as Pam, to keep us (and the Metropolitan Police) in order. Initially we had no idea how many dead to expect, so we created a flow diagram showing how the bodies would progress through the mortuary. This started with the numbering, labelling and photographing of each body or body part on arrival. Each then went straight into a specific fridge labelled with that unique number.

The four of us, helped by mortuary staff, were working simultaneously, and as soon as one of us was free, the next body, escorted by a police officer, was taken from its fridge and again photographed. This is a crucial part of the ‘chain of evidence’. We had to be able to prove that the body that came into the mortuary as Body 23 was the body we examined as 23 and that Body 23 was, eventually, when positively identified to the satisfaction of the coroner, the one released to the undertakers for burial.

Initially we did not carry out full post-mortems but focused on information that might identify the bodies. We described general appearance, any jewellery, clothing or tattoos plus major obvious injuries like missing limbs. The police filled in ID forms. The bodies were fingerprinted and cleaned. They would be removed from their fridges a second time for full post-mortem and for the retention of blood samples.

Identification was, and is, the first priority for the pathologists in any mass disaster – there were many worried relatives, desperate for reliable information. The number of a call centre had been given out through the media for friends and relatives to phone, but it had no queuing system so callers found it to be constantly engaged. One can only wonder at the anger and frustration that caused. But the lesson was learned and call centres were organized and designed differently after that. There were thirty-five deaths but over the ensuing day the call centre took 8,000 calls, and there were many more to hospitals and even mortuaries.

If injuries were slight the police gave information over the phone. Bad news was delivered personally by officers. It would have been all too easy, without proper care, to tell a woman her husband was dead when he wasn’t, or vice versa. For instance, there were four people on the train with exactly the same name. Incredibly, two of them were in one carriage – but only one of them was dead.

Fingerprints and dental records were at that time the only really dependable means of identification: it was no good relying on the loose personal effects like handbags or wallets that arrived with the bodies as these almost invariably turned out to belong to someone other than the individual in that body bag. In addition, the police and fire service were so keen to remove all human tissue that a body bag containing three body parts very often contained the body parts of three different people and not one, as the rescuers must have assumed. There were about sixty separate body parts – heads, legs, jaws, internal organs – and they all had to be matched up. The coroner’s staff and the police entered the details onto a database and from this, gradually, complete human beings began to emerge in cyberspace … the male, aged about forty-four, six feet tall, slightly overweight, balding, birthmark on right shoulder, travelling in the train’s front carriage, eventually turned into a person with a name. We were pleased to reach the point of positive identification. But, of course, at that same point hope ended for friends and family.

We continued working until the small hours of the next morning to get the first view finished. Then we went home to rest in order to avoid fatigue errors before returning early to begin the post-mortems. The bodies of a few people who had died in hospital after the crash were now arriving. These added to our workload but, since these individuals had all been identified by relatives while in hospital, the process was much easier.

Most of the dead at the very front of the train had been killed by severe injuries, not just from the initial impact but by forcible ejection from their seats and hard contact with the unforgiving inside of the carriages. Some died of traumatic asphyxia because the tables they were sitting at were forced back into their abdomens, or because other objects fell onto them. There were many lessons learned from Iain West’s overall report of our findings, including the need to anchor seats to the floor and to redesign hard surfaces to lessen their resilience in a collision. There were some calls for seat belts, but this was impractical and has never been implemented on trains. Overall, British Rail, which then controlled the signalling equipment, learned that there were many improvements to be made both to routine safety systems and to crisis systems. If any phoenix rose from the Clapham ashes, it was these improvements.

And for me, there was a personal phoenix too.

The mortuary after the disaster was a busy, focused place and I got on with my job. As I looked at each victim I remembered that they had set off for work one morning and never arrived. Instead they had been crushed and severed, their families bereaved. The ramifications of that would continue for years, if not generations. I thought all this but I could not allow myself to feel it. To feel anything. I knew that the intensity of my emotions was so strong that I could not have worked and so the door on them had to be kept slammed tightly shut.

At one point, I looked up to notice how very white the face was of the police officer who had been at my side for some hours.

I said, ‘Do you need a break? You don’t look very well.’

He said, ‘Doc, I think I’m going to be all right. Because there’s one thing keeping me going.’

I waited for him to tell me that a pint at the pub or the embrace of his girlfriend would be his reward.

He said, ‘My flying lesson.’

I must have misheard. I thought he’d mentioned something about flying …

‘Yes, Doc, soon as I finish my shift, I’ve got a flying lesson.’

I stared at him.

‘You fly a plane?’ I asked, incredulous. ‘That’s something I’ve always wanted to try!’ I did not add, ‘… but have never been able to afford.’

Well, hasn’t everyone wanted to fly? But the idea of finding the money then fitting flying into my everyday life, slotted somewhere between home, giving lectures, departmental meetings, post-mortems and court appearances … well, it seemed barely worth considering.

The officer said, ‘I’ll tell you, the fresh air up there beats the smell of the mortuary any day.’

I looked around me at the collection of crushed limbs we were now investigating. Did I need anyone to tell me that the clouds are a better place to be?

The policeman said, ‘The Met has a flying club, that’s how I do it. If you’re interested, I reckon you could join, seeing how closely you work with us.’

A few weeks later I found myself at Biggin Hill. Precisely, at the threshold of runway 2–1. More precisely, inside a two-seater Cessna 152 beside a police officer who was also a qualified flying instructor.

We’d sat with cups of coffee while he briefed me on this, my first lesson, and then, heart beating wildly, fingers shaking with excitement, a buzz in my stomach that felt like raw terror, I opened the throttle and runway 2–1 unspooled before me.

‘Pull back gently when we reach fifty knots,’ said my instructor. ‘Gently!’

I did so and the nose of the plane lifted. There was a heart-halting moment as the rumble of the wheels on the tarmac faded then stopped and suddenly all I could hear was the whoosh of the wind and the noise of the engine. Yes! We were airborne.

We climbed. Up, up. The deep blue horizon shifted further down. I looked at our speed. Seventy-five knots. We passed a cloud. Just flew past it, the way the bus passed me in the mornings when I was about to miss it. I was flying through thin air. In a tiny metal box. And I wasn’t falling down.

I realized I had been holding my breath. I exhaled. I inhaled. I dared to look below me. The houses of Greater London were behind us and I could see all the way to the south coast, all the way to Brighton. My eyes rested on the sheer stunning beauty of the countryside laid before me like a feast, like a woman in her finery, like a work of art, a picnic of clouds. I felt elated. I was really flying. I was leaving behind the sad and the drab. Mortuaries full of the still bodies of humans devoid of human spirit, the small failures, the niggling worries, the disappointments, the silences at home, the recent spate of that annoying compromise ‘Cause of death: Unascertained’; the idiotic vanities and the frustrating rivalries. All the joyless trivia which can paint life grey had simply disappeared to be replaced by this surge of wild happiness.

I concentrated on the controls of a small plane suspended somewhere over Kent and knew that if flying could make me feel this way, I must never give it up. Ever.