24

My fortieth birthday coincided so closely with my father’s death that it was inevitable I would start to contemplate my own demise. I did not fear death, but did not much like its predecessor, senescence, the preprogrammed process of ageing. By now I had seen so many bodies that I was all too familiar with the progress of senescence and had a good idea what some of my own vital organs must look like.

At forty, I knew that, on my lungs’ smooth surfaces, tiny black dots were already forming into lines, making tree-like patterns. In their own way the patterns might be rather beautiful, but this was filth: the sooty pollution of London, which alone had probably ensured that I already had a degree of emphysema – even without the twenty or more cigarettes I smoked each day. I wasn’t the only smoker, of course. My colleagues smoked, and we worked in a perpetual blue haze. At home, Jen smoked. On the Isle of Man, her parents smoked. Everywhere, our friends smoked. In 1992 we all smoked, we smoked in pubs and restaurants, we smoked on trains, at our desks and on the bus. We knew it was bad for us, we knew that cigarettes contained over 4,000 constituents, many of which are toxic, from hydrogen cyanide to cadmium to benzopyrene, but we put up with all that for just one ingredient: nicotine. So far, we’d been young enough to think we were invincible. Now I knew that I must stop smoking, and I might be rewarded with an extra ten years of life. Although the structure of my lungs must have been irreparably damaged, and inevitably that damage would increase over time.

Pumping blood through damaged lungs is hard work for the heart, and I hoped that the right side of my heart was not already enlarged by struggling with this extra burden. As for its left side, I knew that, if I couldn’t learn to control my reaction to stress, then my blood pressure would rise and my left ventricle would thicken trying to cope. The heart is an organ one can hold neatly in the palm of one’s hand. So small but so steady, a little fist, clenching and unclenching seventy times a minute, day and night, year after year, 30 billion times over a lifespan. A faithful friend. Until it stops. It was down to me to repay its fidelity by managing my diet, exercise, smoking and stress levels. Just as I knew I should give my liver a rest sometimes from alcohol if I wanted it to carry out its magical repair work on itself.

Good resolutions, all of them. And quickly forgotten. An occasional whisky and soda seemed a good way of relaxing and it was much easier to light another cigarette than waste time contemplating how much I wanted one but couldn’t have one. Stress-relievers, both. And I see in retrospect that there was no question of my giving up that year or the next, because 1993 heralded a period of very significant cases.

In April I performed a routine post-mortem on a young black man from south London who had been stabbed. There were a lot of such knifings then and this death looked like many others. They often turned out to be gang or drugs related. Racial attacks at that time were not immediately suspected. The only information I was given was that the young man had been in a fight. There was nothing to indicate to a pathologist that this was an unusual case, nor that the patient’s name would become so well known, nor that I would have to give evidence about his death so many times.

Stephen Lawrence was a bright, ambitious eighteen-year-old who in no way fitted wider public perceptions of black youth in 1993. Rightly or wrongly, his recognition as a keen student who had a professional future was vital to changing attitudes and prejudices. While simply waiting with a friend for a bus he was stabbed twice by a group of white youths, who, we later learned, were hurling racist comments. There was a superficial incision on his chin, one deep stab wound that had penetrated his lung and another deep wound on the shoulder. Bleeding profusely, he somehow managed to get up and run over a hundred metres with his friend before finally collapsing.

In the months that followed I was shown by the police a total of sixteen knives, of which seven were possible murder weapons. One of these looked particularly likely. In July I was asked to make a further statement and said that, in my opinion, Stephen had been standing when he was stabbed around the right collar bone but had probably begun to fall by the time the second stab wound was inflicted on his left shoulder. Despite some very careful thought, I wasn’t able to say with full confidence whether his assailant was right- or left-handed. Choosing one over the other might have made me look clever but the evidence was really too flimsy to risk exonerating the perpetrator.

That was the extent of my involvement with the police’s investigation into Stephen’s death at that time. I was unaware of the indifference and racism that were hampering it. The Lawrence family, however, were not. They understood there were witnesses, evidence and indeed suspects. But no charges were made.

Four months later, I was called to observe a coronial post-mortem in north London on behalf of the police. The post-mortem was actually performed by another pathologist: it was my job to watch, take any relevant samples and possibly participate if invited to do so but, on the other pathologist’s insistence, I just watched. It was fairly clear to me that the woman we were examining had died of the adverse cerebral consequences of asphyxiation but there might be other causes of death revealed by the experts who were invited to give their specialist opinions on some of the organs – specifically the brain and the heart.

The deceased had obviously been involved in a fierce struggle and then manhandled into a body belt – that abdominal belt with the handcuffs attached. She was covered in cuts and bruises and had been bound at the thighs and ankles as well as the waist. Had she, in fact, sustained a head injury also? The brain pathologist would answer that question for me.

This case also turned into a significant one. Joy Gardner was a forty-year-old Jamaican who lived with her five-year-old son. That she had outstayed her visa and was in the UK illegally is not in dispute. Her mother and a large number of relatives were here, offering support while she studied, and she did not want to return to Jamaica.

Early one morning and without warning, immigration officers arrived at her home to deport her. They were supported by police officers, perhaps because resistance was expected. And Joy Gardner did resist. She must have thought she was fighting them for her way of life. She perhaps did not guess that she was fighting for her life.

Unskilled, untrained and determined to carry out orders, the officers struggled to get her into a restraining belt while she fought them and bit them, watched by her young son. In response to her biting, they wound almost four metres of one-inch-wide adhesive surgical tape – Elastoplast – around her mouth and face. They mistakenly believed that by leaving her nose clear they were allowing her to breathe. This is a myth. Covering the mouth can kill. It is not just a question of being able to breathe – it’s a question of being able to breathe enough. Especially if a struggle has caused stress and exertion and massively increased the body’s need for oxygen. In these circumstances, an individual simply cannot take in the oxygen needed, which may be many times more than usual.

Gagging can cause vomiting and, with the mouth blocked, vomit obviously cannot escape. So it gets into the airways. And a gag can press against the tongue, pushing it to the back of the mouth and blocking the back of the nose. Secretions also accumulate in the mouth and throat, and this further inhibits the ability to get air into the lungs. Gagging a distressed woman who had been struggling hard for many minutes was all it took to bring about cardiac arrest.

Joy Gardner was not strangled. There was no traumatic head injury. She had not inhaled her own vomit. She was asphyxiated by the gag. However, an ambulance crew managed to resuscitate her. That is, they restarted her heart and then rushed her to hospital where she was placed on life support. Sadly, her brain had been so badly damaged by the prolonged lack of oxygen that she died four days later.

There was a breadth of involvement in this case – hospital, police, family – and consequently her body underwent so many post-mortems and so much tissue analysis that meetings about Joy Gardner sometimes felt like pathology conventions. Among the most important were the brain specialists, since it had been alleged by the first pathologist, whose post-mortem I had watched, that she had died from a head injury. Finally, overall, there was broad, general agreement that she had died from asphyxia caused by the gag.

I wrote a detailed report examining all the possible causes of death, which, as usual, went through various drafts and revisions. In the meantime, there was a growing outcry from human-rights organizations and others. It seemed to many, especially members of the black community, that police officers who regarded deportation as a job to be done at any cost and that they had killed Joy Gardner by thoughtlessly over-restraining her.

You might remember that the first death in custody I encountered caused by restraint had left me feeling some discomfort at the coroner’s verdict. That patient had both pneumonia and sickle-cell trait and so was deemed to have died of natural causes aggravated by lack of care. From that day, I had been concerned about the methods sometimes used by enforcers of the law: it was obvious that some simply didn’t know how to restrain people safely.

And restraint – indeed, death from restraint – was definitely on the increase. Joy Gardner was restrained so that she could be deported. Other deaths were caused when the police tried to apprehend suspects, particularly if those suspects had sickle-cell trait. But most deaths we were seeing caused by restraint now were due to another factor: the spiralling use of just one drug. That drug was, of course, cocaine.

Cocaine blocks the brain’s uptake of neural transmitters and the blockage can give continual, pleasurable stimulation: it gives confidence, euphoria and energy. Cocaine users can talk for hours, have heightened responses to physical stimuli, so sex is more enjoyable, and they have little need for food or drink. It can, however, lead to a greatly stimulated heart rate, agitation and psychosis. So, if restraint is required for a cocaine user, it is usually because he appears to be suffering from uncontrolled psychosis.

My first cocaine death came at about this time, and it was an early marker in Britain’s rising cocaine use. A very large and muscular drug dealer (who was also himself an addict) was arrested, having just bought a large quantity of cocaine, and at once began to punch the two police officers detaining him. An officer stuck an arm around his neck but that was just one manoeuvre in what was pretty much a fight. The fight ended with the dealer’s death. But how had he actually died?

A highly regarded neuropathologist confirmed that the dealer did not sustain a head injury in the fight, so that was not a cause of death. He may have been asphyxiated by the arm around his neck, but he showed only one of the three classic signs of this: insufficient to give asphyxiation as a cause of death. He had consumed a lot of cocaine, but his blood sample put him below the fatal level, so he probably did not die of an overdose.

Finally, I gave a combination of causes: the stress on his heart generated by his fight with the police, coupled with the fundamental stress caused by his cocaine use. Although a young man, he suffered from an inflammation of the heart muscle. Now this is recognized in cocaine users and sometimes called ‘cocaine myocarditis’.

Charges against the two police officers were later dropped. But this was another case that left me with a sense of discomfort I could not ignore. There were simply too many deaths when police officers restrained people. They surely believed that they were simply doing their duty, and they certainly had no intention of killing anyone. But people were dying. I knew I would have to do something, but it wasn’t clear to me yet what I could do.

While we waited to see if anyone would be arrested for Joy Gardner’s death, headlines everywhere announced an arrest for Rachel Nickell’s murder. It came as no surprise to me. I had been aware of the police’s suspicions about a man called Colin Stagg. I knew that, in the absence of forensic evidence, they had set up a honey trap on the advice of a psychological profiler. They recorded intimate sexual conversations between Stagg and an undercover policewoman, hoping Stagg would reveal himself as Nickell’s murderer. He did not, but the Crown Prosecution Service thought that what he did say was incriminating enough. I answered a number of questions about the murder from the team targeting Colin Stagg and my reconstruction of events that day on Wimbledon Common was used as evidence for the prosecution. I was expected to appear as a witness at the trial the following year.

With Britain’s most notorious murderer now believed to be safely on remand and awaiting trial, I was surprised to be called, in the autumn, to the body of another young woman. She had been the victim of an even more deranged attack than that on Rachel Nickell.

Jack the Ripper, who killed at least five women in East London in 1888, is still the stuff of film, fable and countless guided walks daily around Whitechapel. I suspect that the public is so fascinated by his gruesome crimes because they happened long ago. Samantha Bisset’s name, and that of her killer, are barely known, I believe because she was the victim of such a truly shocking Ripper-type murder that the press, for once, was reluctant to inflict on readers the horrific information unfiltered by time’s lens. I feel the same reluctance and do not here give details of this homicide.

Not only was Samantha killed and sexually assaulted, but also her four-year-old daughter. Whose body was then tucked into bed with her toys so that the first police officers on the scene harboured hopes, soon dashed, that she had safely slept through the murder of her mother.

I was called in by the coroner, my interest in knife crime now widely acknowledged, to carry out the second post-mortem on the bodies of Samantha Bisset and her daughter. This second post-mortem was not for the defence, since no one had been charged with the murder, but for the coroner so that the bodies could be released.

It had fallen to a colleague to visit Samantha Bisset’s flat, where these crimes had taken place. Therefore I saw the scene only through the photographer’s lens. I could imagine the terrible silence, how the usual camaraderie, the exchange of pleasantries, inquiries about families or holidays, the workaday stuff we use to remind ourselves of normal life when we are confronted by a homicide, how even that must have been impossible for all investigators in the home where these acts of cruelty and mutilation had occurred.

As I carried out the post-mortem, it became clear to me that the killer had been, like Jack the Ripper, something of a trophy-hunter.

I said to the police officers attending, ‘If I didn’t already know you’ve got Colin Stagg, I could really think this was carried out by the same bloke as Nickell’s murder.’

The senior officer shrugged.

‘No way; we’ve got Stagg and he’s as good as confessed.’

‘It’s not that similar,’ pointed out his colleague. ‘No one mutilated Rachel Nickell.’

‘Maybe he would have done if he hadn’t run out of time. Maybe he wanted to enjoy himself killing her but he was in a public place and he just couldn’t do that without getting caught. Killing a woman slowly in her own home probably would have been the next step for him, too.’

‘Yeah, well, he’s inside and he’s staying there for the rest of his life,’ said the officer. And soon the same could be said of the man who killed Samantha Bisset. Robert Napper was a twenty-eight-year-old warehouseman with a history of violence and mental illness. He had often been brought to police attention but somehow, perhaps due to poor record-keeping in those days before the widespread use of computers, he had always slipped under the radar. Now his fingerprints in Samantha Bisset’s flat connected him to this crime.

On his arrest, the police were confident that they had taken two ruthless murderers, Stagg and Napper, off the streets. So it was a very great shock when, in September 1994, Colin Stagg was acquitted.

The case was thrown out by a judge who said that the police operation was nothing more than entrapment and that, because Stagg had been lured into talking to the undercover policewoman, anything he said was inadmissible evidence. I was as astonished as everyone else: the police had worked with many professionals on the case and it had not occurred to me to challenge their absolute certainty that Colin Stagg had killed Rachel Nickell.

Colin Stagg was released – but into a different sort of jail. He only had to walk outside his front door to be subjected to immense cruelty. The police, press and, most of all, the public, were still convinced that Stagg had murdered Rachel Nickell and somehow got off on a legal technicality. This belief was so widespread that it didn’t even occur to me to draw attention once again to the similarity between Nickell’s killer and Bisset’s. I had learned only too well that expert opinion is marginalized by the system and, despite my brief foray into crime reconstruction, I was now firmly back in my box.