Down Among the Dead Men (21 page)

‘Not always, Michelle,’ he said, shaking his head. He looked across at Maddie. ‘You could do with listening to this as well, Maddie.’ She moved in closer. Ed and Clive
had been talking about the fact that we needed more anatomy training now we had mastered the day-to-day events in the mortuary and this, I felt, was the beginning. I think Maddie, though, thought
it was a dig about our boozy weekends every now and again.

‘The amount he apparently drank, I’m surprised it isn’t cirrhotic,’ Maddie said.

Ed shrugged. ‘Livers vary. Some can take a hell of a lot of punishment, others can’t.’

‘So what did he die of?’ Maddie and I sounded like a Dolby stereo as we spoke at the same time.

He shrugged again. ‘I don’t know yet.’

For the next thirty minutes he dissected out the organs as Maddie and I peered over his shoulder and Clive whistled in the background, and then, when I had weighed them, Ed looked at them in
more detail. He told us what he found as he went along. ‘Sooty lungs with some emphysema – there are bad nicotine stains on his fingers, so I think we can exclude a life spent down the
mines, it was more the fact he smoked like a trooper . . . the heart’s not big and there is only a moderate amount of furring up of the arteries due to atheroma – alcohol sometimes
seems to wash it away, curiously enough . . . Now, that’s interesting . . .’ Something took his eye.

‘What is?’ I asked.

He pointed at the pancreas. ‘See those dots? Petechial haemorrhages. He’s got them on the pericardium.’ This, I knew, was the sac that the heart sat in, like a protective
pouch. Clive had taught me that almost from day one. ‘Also, look at his stomach. See those red areas?’ I nodded. ‘Wischnewski spots, they are.’

I admitted, ‘I never heard of those, Ed.’

‘What was the temperature last night?’ Ed asked, turning to Clive

Clive, who always knew things like that, said at once, ‘Went down to minus five at my place.’ We all knew it would be a couple of degrees warmer than that in the city, as Clive lived
out in the sticks.

‘Thought so. I’d say that this poor sod went to sleep – probably the worse for wear – and woke up dead from hypothermia. We’ll do full tox, but I can’t find
anything else that might explain it at the moment.’

And so he moved on to Mrs Bartram. She was a large lady, although not as obese as many we get through the double red doors. Her clothes, as Maddie had removed them, looked expensive and there
was a hint of lavender about them, and her cashmere blanket was still with her. Maddie’s evisceration had revealed a liver that was similar to Fred Norris’s – big and pale –
with no sign of cirrhosis. Once again, Ed’s dissection of the organs revealed no convincing reason why she might have died; he could see no significant heart disease, nothing in the lungs,
and the brain was fine. There was no evidence of trauma and none of the signs that he had seen in Fred Norris of hypothermia.

‘Full tox, please,’ he asked Maddie when he had finished.

‘Already got it, Dr Burberry,’ she replied. She then asked, ‘So why do you think she died?’

He replied straightforwardly, ‘Well, at the moment, all I can say with a fair degree of certainty is what she
didn’t
die of. I don’t think she died of heart disease or
lung disease or kidney disease, or of anything wrong with her brain, although I’ll have to check all that by taking samples for microscopy. I can’t see that it was hypothermia –
she was found at home, and the house was probably well heated. There’s no sign of trauma, either.’

‘So, she drank herself to death?’ suggested Maddie.

He thought about this. ‘That’s possible, and she does smell of alcohol, but acute ethanol poisoning is quite rare and, if it’s an experienced drinker, needs a fantastically
high alcohol level – I’ve known cases where people have six or seven times the legal limit for driving in their blood, and they’re still walking around, far from pushing up
daisies.’

‘Then why’s she dead?’

‘Well, if I can find nothing else to have done it, I’ll have to assume that it was SUDCA.’

She threw me a look and I shrugged my shoulders back to her. I had seen cases of this before and knew what Ed was talking about, but it wasn’t my place to explain to her so I played dumb.
He continued, ‘Sudden Unexplained Death in Chronic Alcoholism. Some people who drink a lot for a long time just drop down dead.’

Maddie, who had had a skinfull the weekend before and had come in on Monday morning looking like she’d spent the night in a tomb, looked slightly alarmed. ‘Why?’

‘No one knows. It might be ketoacidosis, it might hypoglycaemia, it might be asphyxia due to an epileptic fit.’

‘So how can you prove that’s what it was?’

He smiled. ‘I can’t. If there’s nothing else that might have killed her, then I have to make that assumption.’

She frowned. ‘That’s not very good.’

He laughed. ‘No, it’s not, Maddie. Sometimes, death is just as unsatisfactory as life.’

In the pub, after Ed had got our second and last drinks, he said, ‘The thing about alcohol is that everyone assumes it kills you just by causing cirrhosis, but it’s
a lot more subtle than that. Cirrhosis is
bad,
believe me – it alone can cause gastrointestinal haemorrhage, liver failure, kidney failure, or brain toxicity – but that just
touches the surface. Today we’ve had a case where it killed someone because they spent the night out in the open – alcohol causes dilatation of the peripheral capillaries and increases
heat loss – and someone who almost certainly had a huge binge and then died as they started to sober up. It can cause acute pancreatitis, heart disease, cancer and dementia.’ He paused.
‘You know, one of the first cases I did when I came here was a young chap who went out on the lash, took a shortcut across the park and saw the last bus just turning the corner up ahead. In
order to run to catch it, he jumped over a low wall. It was only about two foot high – on his side. On the other side, there was an eight-foot drop to the pavement. He broke both ankles and
smashed his skull. He had five times the driving limit for alcohol in his blood.’

‘Scary stuff I said.

He shrugged. ‘You’re going to die of something,’ he pointed out. ‘Even teetotallers drop down dead unexpectedly – in fact, they’re more likely to do so than
people who drink in moderation. So really, it’s not all bad. You need something to ease the rigours of the day, but everything in moderation, Michelle.’

‘Thank God,’ I said, thinking of the glass of Merlot I was planning to pour down my throat that evening while Luke cooked my supper.

THIRTY-SEVEN

Mrs Georgina Dellaway was a seventy-eight-year-old woman who had three daughters and, between those, eleven grandchildren and three great-grandchildren. When I first saw her,
she looked like a nice kindly old lady with a smile on her face even though she’d been shut in the fridges over the weekend. She had been a school dinner lady for most of her working life,
becoming a lollipop lady when she retired.

She was the last person you would expect to blow something up, but blow something up she did.

To be fair to Mrs Dellaway, it wasn’t entirely her fault because poor Maddie had a hand in it too.

Mrs Dellaway died on the ward in the hospital and everything seemed straightforward, so no one had any idea what was going to happen. She had apparently come in short of breath
and the doctors had diagnosed a chest infection. They had started antibiotics but she also had heart disease and this had got worse. After two days, the doctors had called in the daughters and told
them that the situation was hopeless. They had all agreed that the best thing was to let their mum go peacefully; active treatment had been stopped and she had been allowed to die in her sleep
three days later, then coming into our care.

They knew the cause of death and a death certificate had been written by the doctors, stating that Mrs Dellaway had died of bronchopneumonia with ischaemic heart disease as a contributory
factor. The family decided that they would like her to be cremated and, in accordance with the law, cremation papers had to be filled out and signed; as far as the hospital staff are concerned,
this means that one of the doctors who looked after the deceased certifies that they are happy the death was natural, and an independent but experienced doctor then makes inquiries to ensure this
is, in fact, the case. Sometimes this whole process can be protracted – the next of kin may even complain to the Trust chief executive – but in the case of Mrs Dellaway there was no
problem at all. Everything sailed through. Accordingly, just two days after her death Mrs Dellaway was picked up by the undertakers, and, as far as we were concerned, we had done our job and done
it very well. She had left our care and we moved on to others.

We found out fairly quickly that Mrs Dellaway had exploded in the crematorium. Clive, Maddie and I were sitting in the office at about three o’clock the next day, just having got the
dissection room clean after three PMs and Peter Gillard spraying blood about like air freshener, when the phone rang. Clive answered and was very soon holding the phone away from his ear because
whoever it was was giving him a right royal bollocking. He looked across at us as this was going on and the expression on his face told me immediately that serious shit was happening. Eventually,
he managed to squeeze a few words in. ‘Look, I’m really sorry, Dave . . .’ Dave Mansard, the manager at the local crematorium, hadn’t finished, though. As Clive held the
phone away from his ear again, we could hear for ourselves that Dave was not the happiest of bunnies.

Eventually, Clive put the phone down and his face told of someone who was seriously out of sorts. With barely contained anger he asked of Maddie and me, ‘Who checked out Mrs
Dellaway?’

It took a few moments for the two of us to get our brains in gear. ‘It was me, I think,’ said Maddie nervously.

‘Did you follow the protocol?’ he asked. His voice was dangerously calm.

‘Of course,’ replied Maddie at once, and full of confidence.

‘Then would you mind explaining,’ asked Clive, ‘why she just exploded and did God knows how much damage to the crematorium?’

The point is that when our patients come into the mortuary, they are liable to have had all sorts of things done to them, and all sorts of things put into them, and some of
these have consequences even after they have passed away. On the whole, fillings, artificial hips and knees, and most of the ironmongery that surgeons put in are fine and the fire of the
crematorium doesn’t touch them; they’re left among the ashes to be retrieved by the crematorium staff. Pacemakers, though, are different. Pacemakers, when heated to the temperature of
the fires at the crematorium, explode, and it’s not a muffled little affair, either. They go BANG and will easily damage the walls of the furnace. Not only that, but can you imagine the
distress of the deceased’s nearest and dearest when, just as they are filing out of the chapel saying their thank-yous to the vicar, there is a loud explosion, the ground rocks and things
fall off the walls of the vestry? Not surprisingly they are perturbed and, when they discover that Uncle Alf hasn’t so much been cremated as splattered all over the shop, they are upset.

So it’s important that pacemakers are taken out before they go to the fires. The cremation papers specifically ask if there is a pacemaker (and, if so, has it been removed) but it is
usually down to us to do the actual business of making the incision and winkling the thing out. In the case of Mrs Dellaway Maddie had forgotten to do this, and so she had gone out with a bang
rather than a whimper.

Actually pacemakers cause us a lot of trouble in the mortuary in other ways. In the old days, all pacemakers were just harmless little things about the size of a box of matches; they’re
usually put in just under the skin in front of the left shoulder, with a lead going from there into the heart, and they’re accordingly easy to take out. All these ones do is send a regular,
small electric shock to the heart to make sure it keeps beating. Nowadays, more and more of them are sophisticated and actually sense what the heart is doing; if it stops, they will deliver a large
electric shock to restart it. From our point of view this presents a serious problem: in order to get the pacemaker out, we have to cut the leads to the heart, and the bloody thing interprets this
as the heart stopping, so we get the shock. Some mortuary staff have been severely injured. The cardiac technicians have to come over and wave a special wand over them to switch them off, and if
this is not picked up on and the leads are cut, you may need an ambulance on stand-by.

Telling which are the ordinary ones and which are the lethal ones is becoming harder and harder, so every time we take out a pacemaker, we tend to utter a silent prayer to St Dismas, the patron
saint of mortuary technicians.

THIRTY-EIGHT

Christmas in the Williams household has always been a big deal. When Michael and I were children, it was a strict rule that no matter what time we woke up in the morning, be it
five or eight thirty, we were not allowed downstairs until our parents woke and took the lead. Right up until our early teens, before we both discovered alcohol and Christmas Eve on the town with
our friends, Michael and I would always abandon one of our bedrooms and share the same room on the night before, and wait and watch for Father Christmas. This process usually involved one of us
dragging the mattress across the landing to whoever was occupying the bigger room, and it was the only night of the year we would be granted Mum’s approval for this act.

Dad would always go first down the stairs when my parents woke on Christmas morning. He would open the door to the lounge and, guaranteed every year, would turn to us both and say, ‘Sorry,
kids, he’s not been,’ his face looking disappointed. And, again, up until our early teens Michael and I fell for it every time. As our faces dropped while we sat on the bottom of the
stairs, Dad would open the lounge door slowly to reveal the whole room overflowing with presents. An armchair each piled high, with plenty surrounding the floor around them.