29

Just thinking about the Hyde area of Manchester always gives me a warm glow. It was here that my mother had been brought up, it was here that her family and friends had lived. It was a place of happy visits when I was small and a place of pilgrimage all my life, too, because my mother was buried here.

It pleased me to think of the old ladies who came from Hyde – my grandmother, my aunt – who were so unlike the isolated, undernourished elderly people whose bodies I sometimes saw. They always welcomed me with warm and caring arms, drawing me into their busy lives and polished homes. They were noticeably an intrinsic part of a wider community.

In 1998 I received a call from a defence solicitor asking me to perform a second post-mortem examination on just such a lady from just that area. Mrs Kathleen Grundy had been known to my mother’s family as a friend and schoolmate of my aunt. She had died on 24 June and on 1 July she had been buried in the same cemetery as my mother.

In August, however, she had been exhumed and now I stood over her body in the mortuary of Tameside General Hospital.

She was eighty-one but appeared to have been in exceptionally good health. There were no signs of a struggle. And, unusually for anyone her age and for the next generation too, her arteries showed only minimal atheroma.

But toxicology told a different story. Although I could find no injection site on her body, she had evidently consumed a substantial dose of morphine or diamorphine in the hours leading up to her death. I gave as its cause: overdose of morphine.

In fact, she had died at the hands of her trusted family doctor, and it was through her sudden death that Harold Shipman was finally revealed as a serial killer. He was highly regarded by his patients, discussed and admired in that community I remembered with such fondness. Many described him as the nicest doctor in the area. He was especially loved by the elderly because he was happy to make home visits and, having worked in Hyde for some time, when he set up his own practice in 1992 he was inundated with patients by word-of-mouth recommendation.

Suspicions about him were aroused by Kathleen Grundy’s sudden death just days after her will had apparently been changed to favour him. He had certified her cause of death as: ‘Old Age’.

Further cases were immediately opened and more exhumations followed. I attended five of these post-mortems. The next I saw, a seventy-three-year-old, had very mild coronary disease and mild emphysema. She cannot have had pneumonia, as claimed by Shipman on her death certificate. She did, however, have morphine poisoning. The next body told the same story. They all did.

It seemed frankly incredible that a family doctor could have killed six of his patients. In a letter I wrote afterwards I said:

It is clearly essential that the source of the morphine is identified and the possibility of contamination must also be considered … given the delay between death and post-mortem examinations and the numerous events and actions that have surrounded these bodies, the possibility of contamination needs to be positively excluded … I would suggest that advice is sought from a chemist to see if it is possible for chemicals used in the manufacture of embalming fluid, coffin wood or coffin furniture to be contaminated by substances containing morphine whilst buried … finally, the possibility of other links between the bodies should also be explored (embalmers, undertakers, staff).

Of course, I thought every other possibility should be investigated not just because I was pathologist for Shipman’s defence (yes, even serial killers are entitled to a defence) but because I was, we all were, resistant to the idea that a doctor had systematically killed his patients. A few years later, when Shipman had been imprisoned for the murder of no fewer than fifteen patients, it was hard to stomach the conclusions of Dame Janet Smith’s public inquiry – that he had, over more than twenty years, certainly killed 215 people and there were hundreds more cases for which it was impossible at this stage to ascertain the facts.

His reasons are unclear. Generally, his victims lived alone. Generally, but not always, they were elderly. Generally, but not always, they were women. Anybody hoping that Shipman would eventually reveal the reasons for his actions – and perhaps confirm how many of the 494 deaths which had occurred on his watch he had actually caused – had their hopes dashed a few years later, in 2004, when he was found hanging in his cell.

Hyde changed for me after the exhumations. Instead of being a place I associated with my mother’s family warmth and bustling old ladies, it became a place where old ladies lay dead at the hands of a serial killer they had trusted to take care of them.

When I returned to London from the exhumations, still half disbelieving that small part of Shipman’s crimes we then suspected, I had another unpleasant experience: I crossed swords with Iain West. To my amazement, he had retired from Guy’s. After all those years of swearing he would never stop, he had done just that. The rumour was that Iain was unwell but, of course, it was impossible for him to disappear from the London murder scene and just tend his garden in Sussex. He popped up frequently in the mortuary and in court, and when I returned from Manchester, brooding over the unfolding truth about Shipman, I found that he was to be my adversary in a knifing case.

We disagreed fundamentally: not by meeting face to face but by writing strongly worded, contradictory reports. His rebuttal was, as usual, extremely robust. Although it did occur to me at the time, and not just in retrospect, that his prose was a little less robust than it used to be.

The case centred on the perpetrator’s account of how the knife entered the heart of the victim. Such accounts are often highly creative and by now I think I had heard every excuse in the book for the presence of a blade in another person’s body. The most common is the claim that ‘he ran onto the knife’. This is not always easy to prove or disprove and I need as many witness accounts as possible to help me reconstruct the attack. On this occasion, there were none. A woman and her husband had argued, the outcome was his death, and we only had her word to go on. The senior investigating officer actually phoned me for advice before interviewing her, a rare enough event, but he knew the entire case did rest on her exact description of what happened.

I said, ‘Don’t give me generalities, pin her down. Don’t let her tell you: “He just came at me!” That means nothing, so get her to re-enact it, describe it, say who was where and how she was holding the knife, which hand did she have the knife in and in which direction each of them moved. Then I might be able to prove or disprove her story.’

He did exactly what I asked. This case, however, remained a conundrum.

The divorcing couple were arguing very acrimoniously over which of them their two young sons should live with. They were well off and their house was large and well cared for. The father wanted the two boys desperately and a Family Court hearing was imminent. They were all still living in the same house, although the mother had arranged to take a rental property for herself and the children which they would move into shortly.

On the day of his death, the father had taken time off work to go out with the children. The mother was waving them goodbye when he suddenly stopped the car in the driveway and went into the house, gesturing for the mother to follow him. Thinking he had forgotten something, she did so. The father shut the door behind them and announced that he wanted the children to live with him.

According to the wife’s statement, here is the argument which followed:

I said: ‘But you go to work, how are you going to do this?’

And he said: ‘I’m going to resign. And I’m going to take care of my children.’

I said: ‘Oh no you’re not.’

The wife then described her husband’s fury. Its tell-tale sign was the way he twisted his jaw: she remembered this from one previous occasion when he had hit her. But, as she made clear, despite the middle-class lifestyle she was a tough cookie from a tough area and had learned early in life that cowering only encourages bullies. So on that previous occasion she had hit him back and now she was ready to do the same.

She was unable to explain how the couple had moved from the hallway to the kitchen.

But the next thing was when I was at the back of the kitchen and I thought he was punching me in the stomach. He started punching me in the stomach and I thought he was hitting me but when I looked, I looked down and I saw a green handle and he wasn’t punching me, it was stabbing me.

I said: ‘What are you doing, you’re trying to kill me!’

And he, then he got it, got the knife from my stomach and he started shoving it into my neck. He was trying to cut my throat. He was trying to get my artery cut in my throat so I would die …

And I said to him: ‘For God’s sake, you’re trying to kill me, think about the boys … don’t, don’t kill me, think about the boys … you can have the boys … have the boys, just please don’t kill me.’

It didn’t occur to me that he might get another knife or anything but then he started kicking me. He got my head and banged my head on the floor. I got a bruise here and he broke a tooth. He’s banging me and banging me and he got a kitchen chair and he hit me with the chair and I just thought, my God, he’s not going to stop until I’m dead. I’m half dead already with all these wounds. I was soaked in blood. I felt like I’d, I’d, been in the shower I was so covered in blood.

He wasn’t saying anything, he was just shoving it into my neck and I had to get that knife off of him … he was holding me here and shoving it into my neck and I, with my right hand, I got hold of the handle or the blade or whatever it was and I just held on to it … there was blood everywhere, all over the floor and the wall.

And I had, had, already had the knife in my hand, my right hand, so I swiped. I either went forward or I swiped with the knife … I must have either slipped or I went down on the floor and I was cowering over the knife …

The interviewer stopped her there and asked her to act out exactly what happened, more than once. He was able to establish that she had waved the knife in the air as she sat on the ground, but she was unable to describe the contact between the victim and the knife. Indeed, she had no reason to believe she had killed her husband because he ran out of the room. She rushed to the garage, locked the door and called the police. And throughout this, the two little boys were strapped into their car seats in front of the house.

Was she telling the truth? Or had she killed him and then injured herself to substantiate her story that he had attacked her?

Pictures of the scene confirmed her claim that there was blood on the kitchen walls and that it was thick on the floor. Chairs were upset. It certainly looked as if there had been a fight here.

The husband had various injuries:

– A superficial incision of his upper chest.

– A wound that penetrated three centimetres into his left, lower leg.

– Two slightly deeper, small injuries on the palm of his right hand.

– A stab wound to the heart that had penetrated the anterior wall of the right ventricle and left a smaller injury at the apex.

He had been rushed to hospital and extensive heart surgery had been attempted, so there was a lot of suturing. The surgery was eventually unsuccessful and, of course, it was this wound to the heart that had proved fatal.

However, at a superficial glance, his injuries did not look as bad as his wife’s. I did not meet her or examine her myself; instead I reviewed the many photos taken of her wounds. I was looking for self-inflicted injuries, the sign of a murderer who plans to plead self-defence.

Pathologists frequently have to decide between homicide and suicide, accidental and deliberate injuries. And knife wounds are the realm of the faker: they look so horrible that at first glance the inexperienced must immediately believe that no one could possibly do that to themselves. I have learned over the years, however, that there is almost nothing people will not do to avoid a murder charge. Self-inflicted injuries are generally recognizable: they are created with the minimum force to create maximum effect, and obviously they are always in parts of the body which are readily accessible to its owner’s hand. Injuries which cannot possibly be self-inflicted are also identifiable, and, because of this, I am sometimes pleased to help relieve the innocent of assault charges.

The wife in this case had:

– Bruising to her left upper arm, left shoulder, left side of neck, right hip, left hip, right thigh, right hand.

– A gaping incised wound, but not a deep wound, on the front left side of the neck.

– Superficial scratches in the same area.

– A puncture wound by the neck wound.

– An incision over the collar bone.

– Incisions on the back of the left elbow.

– A horizontal incision under the right breast.

– Short stab wounds on both sides of the abdomen.

– A puncture wound in the right thigh.

– A gaping incision on the right hand.

– Short, superficial cuts on the right thumb.

– A knife graze on the left hand.

– A broken tooth.

The Crown Prosecution Service had many meetings about this case. When the late husband’s family picked up the possibility that the wife might not be charged, they furiously talked of a civil prosecution. They hired Iain to write a report comparing the description of the fight the wife had given the police with her actual wounds.

And here was his report, waiting on my desk when I returned from Manchester. It was so thunderous that it was practically rumbling.

The blunt injuries to the arm could have resulted from a series of blows to the arm. The pattern does not appear to be typical of gripping …

While it is possible for individuals to produce bruises on their own body by striking themselves with objects or by pinching etc., in this instance the injuries on the arm could be the result of an assault by the husband.

The overall pattern of her injuries, however, is not at all typical of the type of wounds which would have been sustained if there had been a vigorous assault by the deceased who had been attempting to stab her. Skin is one of the toughest tissues in the body and once the tip of a knife has pierced skin, assuming even a moderate degree of force behind the thrust, there would be nothing to stop the instrument from penetrating deeply into the body: in many instances the blade penetrates to full length. All of the wounds seen on this lady’s body appear to be very superficial and there does not appear to be any substantial degree of penetration.

Self-inflicted, incised wounds in the neck are not uncommon. There is no evidence to suggest that the knife had been thrust into the neck in a stabbing motion. Given the manner in which the wounds were alleged to have been caused on her abdomen, I am firmly of the opinion that they are not consistent with deliberate forceful knife thrusts but are consistent with self-injury or stab injuries inflicted under considerable control.

This lady may have been the victim of an assault involving blows such as punches or even blows from a chair, although I can see little evidence to sustain an allegation of heavy kicks to the thighs or of the head being forcibly struck against the floor. The overall pattern of the wounds is, however, consistent with self-injury.

I agreed that the wife had been subjected to a blunt trauma attack. I disagreed that the knife wounds were self-inflicted.

I gave several reasons for this.

First, when she was stabbed in the abdomen she had described this as feeling like punches, not like being cut or stabbed at all. This is a very common misperception of an individual who is stabbed: time and time again I have heard victims say that they could just feel a punch rather than the knife itself penetrating. This is a fact, but it is not the kind of fact that the wife is likely to have known.

Second, although she could have injured her own neck and abdomen, it would be very difficult and most unusual for someone to injure the back of one elbow and the back of the opposite hand.

Third, it was the husband’s injuries that were most important and, of his four stab or incised injuries, three were in non-lethal areas of the body. The unusual stab wound to the leg did suggest that his wife was on the floor when it was inflicted, or anyway she was low down. The fatal wound to the heart may have been inflicted deliberately, but in the context of a struggle for control of the knife I felt that it was not possible to exclude beyond reasonable doubt the possibility that the wound was inflicted accidentally. And no one could maintain, from the blunt trauma injuries on the wife, that there had not been a very serious struggle.

So, although the case was full of doubts and discrepancies, as an expert witness I couldn’t state beyond reasonable doubt that the fatal stab wound to the husband was deliberate or that the wounds to the wife were self-inflicted. Even on the lower level of guilt, the balance of probabilities, I felt that it was the husband and not the wife who had inflicted her wounds.

The Crown Prosecution Service decided that it would not be in the interests of the public – or the public purse – to pursue this case. The coroner, aware that a very angry family was sitting in his court, ensured the police were present for the inquest. Iain did not give his statement in person, although, of course, there was reference to it. My evidence was punctuated by angry cries and much scoffing. The coroner more than once had to call for calm.

My opinion was vindicated when the coroner gave the verdict of justifiable homicide. It was delivered to a court which, for a moment, listened in complete silence. And then broke into uproar.

I slipped away as the shouting worsened. So far as I am aware, the threatened civil action against the wife did not materialize. When I got home, Chris was out and Anna was bending over her physics books in a bubble of concentration. She reminded me of Jen. As I carried in the thick files from the knifing case, I wondered if I had ever pored over my books with such concentration or if, like Chris, I had been more erratic.

‘What have you been doing today?’ she asked.

I told her about the coroner’s court, the angry relatives. It was the first time she had ever inquired directly about my job.

To my amazement, she said, ‘Can I see the photos?’

The one thing she did know about my work was that the pictures were taboo.

‘The photos of …?’

‘The husband’s body.’

She was fifteen and studying for her GCSEs. I shook my head. ‘You’re a bit young to look at pictures from the mortuary.’

‘No, really, I want to see them. I’ve seen loads of diagrams in biology.’

‘But your biology book diagrams don’t have stab wounds.’

‘I really think I can take it, Dad.’

Maybe she was right. Maybe it was time to stop shielding my children from the unusual nature of my work. Maybe all those fixed specimens in my study that were en route to lectures or court (it was scarcely possible to hide them all), the medical talk at mealtimes, maybe it all meant death was more routine for her than I’d realized.

I said, ‘I’ll show you the wounds on the wife and we’ll see how you get on. Since she’s very much alive. And you can tell me if you think she stabbed herself to make it look as if her husband attacked her.’

Anna’s eyes lit up.

‘I thought she didn’t, the coroner thought she didn’t, but Iain West wrote a scathing report saying she did.’

Anna nodded enthusiastically.

‘And this is not, I repeat not, to be discussed with anyone outside this family,’ I added sternly. She gave me a withering look.

‘Duh. I know all that.’

We spent an odd but strangely bonding half hour discussing wounds. Their ugliness seemed not to bother Anna at all. Finally, at her pleading, I showed her the pictures of the husband, of the stab wound to the heart that had killed him. Cleaned up in the mortuary, it looked unspectacular.

‘He’s just like an asleep person,’ she said. ‘Dead bodies aren’t scary really.’

‘They aren’t scary at all, but I’m not showing you the pictures of his insides, all the same.’

She shrugged.

‘OK,’ she said, ‘but it wouldn’t bother me.’

It did occur to me, for the first time, that Anna might be discovering her inner pathologist.

‘I thought you and Chris both wanted to be vets,’ I said.

‘He does. I do. But I might want to be a doctor.’

‘Well, I wouldn’t think of becoming a pathologist, certainly not a forensic pathologist.’

She blinked at me in surprise. Even I was surprised to hear myself.

‘But Mum says you love your job!’ she protested.

‘I do. But …’ But what? Suddenly the courtroom humiliations, the angry relatives, the many faces of grief, the healthy old ladies whose deaths no one had thought suspicious and who had now been disturbed in their graves: it all seemed like something I wanted my daughter to avoid.

‘Dad?’ She sounded alarmed. ‘What’s up?’

I said, ‘Anna, I’ve just realized something. It’s time I took up flying again.’