Down Among The Dead Men Part 9

'Oh, yes, he could, Mich.e.l.le. Quite adept at using it, too. Unfortunately one of his friends came to call while he was using it and surprised him. That was how he got the cut. His friend took him to Casualty where it was sutured closed and he was kept in for a day or two. He returned home, refused all social services, and was intent on carrying on as he had always done.'

'So what happened?'

'The police reckon that he was reaching up into the fridge to get some milk for tea. The act must have stretched the st.i.tches too much and opened the wound up. The saw had cut through the radial artery so once it was open again, he would have bled to death pretty rapidly with no one to help him.'

I winced.

'Everyone has to have a hobby,' observed Ed, shaking his head, 'but even so . . .'

THIRTY-FIVE.

There was only one occasion on which everyone in the Department of Cellular Pathology the histology staff, the cytology staff and the mortuary met together and socialized and that was the Christmas party. Apparently, this sometimes took the form of a disco or cabaret but, according to Clive (who had strong views on the subject), the only time it was worth going to was when there was a decent nosh-up in a nice restaurant. This year it was to be in Number Sixteen, a restaurant that he approved of, often taking his wife, Sally, there. It was to be held on a Wednesday night in early December because it had been booked late; husbands, wives, boyfriends and girlfriends were not invited, the exception being the consultants, who were paying for it all. Graham had been invited and had accepted, which surprised quite a few in the department As was usual when going out with Clive, we changed at work and went straight on to the nearest pub for a few liveners, where we met up with Graham. He looked well, although he was limping badly and walking with a stick. He had a grin you could fall into for Clive and me, but I thought he was a bit off with Maddie, and I couldn't help but notice that he kept ignoring her when she spoke. During the first part of the evening, Clive explained the way these events usually went.

'You see, you have to understand, girls, that we might all be eating the same grub in the same room on the same night, but we're not really eating it together.' Graham chuckled and nodded at this. Clive went on, 'The histology technicians mostly sit together, the cytology technicians likewise, the secretaries huddle in their own group, the consultants that choose to turn up usually talk amongst themselves, and then there's us. n.o.body wants to talk to us.'

'Except Ed Burberry,' pointed out Graham. 'He always makes an effort.'

Clive nodded. 'Except Ed.'

I'd been there for nearly nine months now and was beginning to understand the way things went, especially because, knowing her as I did, Maddie had given me the low-down on some of the characters upstairs in the lab, and how they looked down on us because of what our job entailed; they seemed to think that anyone who works with the dead must be weird, forgetting the fact that we care greatly about what we do and that we provide a good service for the next of kin.

Clive said, 'Part of the fun is to be as nice as you can to them. Go and sit at their tables and chat with them; doesn't half make them uncomfortable. We know that we do a b.l.o.o.d.y good job, but they don't know what we really really do, so it's fun.' I must have looked a little worried about all these undercurrents, but Clive rea.s.sured me. 'Don't worry, Mich.e.l.le. The grub's free and the wine's pretty pukka. Anyway, by the time we get there, hopefully you won't care much anyway.' do, so it's fun.' I must have looked a little worried about all these undercurrents, but Clive rea.s.sured me. 'Don't worry, Mich.e.l.le. The grub's free and the wine's pretty pukka. Anyway, by the time we get there, hopefully you won't care much anyway.'

The restaurant was cosy and warm, with low lighting and comfortable chairs. The department would fill the place, so we didn't have to worry about disturbing other diners. As Clive had predicted, by the time the four of us turned up, we were just about mellow enough not to be too bothered by some of the glances that were thrown in our direction. We sat at one end of one of the tables and immediately dived into the wine. The place soon filled up as Clive had predicted, with each work group sitting together. Ed and his wife, Anne, were late and sat with us.

The service was good and the food delicious. Graham kept hobbling out for a smoke and I joined him on a couple of occasions, but we all spent most of the time listening to Clive. Any form of communication offered by Graham throughout the evening was aimed at Clive and me, completely ignoring Maddie, but she didn't let this get to her. During the evening, Clive got mellower and mellower, and began to talk about some of the people he'd worked with over the years. Ed, who hadn't been there as long but knew a lot of them, joined in as and when.

'Mitch Jones was before your time, wasn't he?' he asked Ed. Ed nodded. 'He used to be one of the consultants here in the old days; that was when things were a lot more relaxed.'

Graham chuckled at this and nodded enthusiastically. 'He was so relaxed he used to fall down a lot.'

Clive explained, 'Mitch arrived p.i.s.sed in the morning and just got more rat-a.r.s.ed as the day went on. When he did a post-mortem, he'd be smoking a f.a.g which he'd rest on the side of the dissection table while he worked. Health and Safety would have had a fit. Couldn't really do the job properly half the time. Got so bad he used to hide the slides from the cases that he found too hard in his desk drawer next to the bottle of whisky. When he retired, what with all the empty bottles and those slides, there was more gla.s.s in his office than in Pilkington's factory.'

Graham said, 'Least he was a decent bloke. Not like Dr McDougall.'

Clive shook his head. 'That man was a complete b.a.s.t.a.r.d,' he told us. 'I haven't got a good word to say for him.'

Ed's wife asked, 'Why?'

'Didn't like anyone, as far as I could tell. Some disgusting habits, too. Used to write the organ weights in blood on the walls, until I b.o.l.l.o.c.ked him about it. Never forgave me for that. He crossed me right off his Christmas card list.'

Ed said, 'Tell them about d.i.c.k Romney.'

Clive sighed happily. 'Good old d.i.c.k. Thin as a rake, he was; I used to worry when he had a shower in case he stepped on the plughole and fell through.'

'He had a shower once, all right,' Graham chipped in.

'That's right, he did, didn't he?' Clive laughed. 'He was getting the kidneys off the pluck once when he stuck his finger through this big renal cyst filled with urine. Shot right into his face and soaked him; he swallowed some, too.' Anne Burberry made a face, as did Maddie. Clive went on, 'Never drove above forty miles an hour, even on the motorway, because of all the car crashes he'd had to look at.'

'Don't forget the trousers,' put in Ed.

'G.o.d, yes, the trousers!' At our blank looks, Clive explained. 'Never changed his trousers; he must have worn the same pair every day for ten years. Got so that they could stand up on their own. You learned never to look below his waist because of all the odd stains.'

We were laughing so hard at this that we were getting some looks, but no one minded much by then and the conversation moved on to some of Clive's old technician colleagues. 'When I first started here, I had to work with Alf and Bert. Alf wasn't too bad a bit like a caveman, but able to do the job when he could be bothered but Bert was something else. He was the stupidest man who ever lived; couldn't tie his own shoelaces and had to stop walking whenever he let one rip. He was married to a Thai woman and everyone but Bert knew that she earned some pocket money on her back with her legs akimbo; he just thought she was careful with the housekeeping. He used to go on regular holidays to Thailand on his own with just a change of clothes in a carrier bag; he'd come back and spend the next six weeks giving employment to the clap clinic staff.

'He and Alf used to get up to some outrageous scams. I know for a fact that they used to eviscerate the bodies the night before and leave them out; sometimes, on hot summer nights, some of them started to go off' Clive turned to Maddie and me sternly. 'Don't ever do that, girls. Not b.l.o.o.d.y professional. Not b.l.o.o.d.y professional at all.'

Ed said, 'They used to get the organs mixed up, didn't they?'

'Nothing was ever proved, but people did wonder . . .' He shook his head. 'Bert finally left when he hatched this cunning plan to get his pension and carry on working. It required him to resign, stay off work for a couple of months, and then get his old job back. Simple really, except that it meant asking Alex McDougall, then the head of department, to re-employ him, and he refused.'

Listening to all this, I was amazed at how life must once have been in the mortuary. It seemed to be much more regulated and controlled these days, something I thought could only be for the good. At least, though, it made the evening fly past and, what with the wine and the food, it was a brilliant night.

THIRTY-SIX.

Ed and I were having a beer evening, something which we had taken to doing on odd occasions since becoming good friends. As we sat in the Cross Keys in the early evening after work, he supping a lager shandy and I a diet c.o.ke (without ice), we tried to put the world to rights, or at least to our sort of rights. I suppose it's our way of de-stressing, as there aren't many people on the same wavelength in this type of job. The day ought not to have been hard only two autopsies and neither of them messy or emotional but it had not been straightforward.

Ed said, 'The thing is, Mich.e.l.le, both of them basically died of drinking too much.'

'I thought you'd told the Coroner that you couldn't be sure why either of them had died,' I replied.

'I can't prove it yet, but I think both of them died of overdoing the bottle, only in different ways.'

He finished his shandy and looked around him. 'No good for you, this, ethanol.'

Mr Alfred Norris was well known about the town; as soon as he saw the name, Clive had said, 'I bet that's Fred. Did you ever see him? Bet your dad knows him, Mich.e.l.le, he used to hang about the park, muttering and moaning to himself. Usually had a bottle of sherry or, if he was really lucky, Special Brew in his hand. If he caught anyone looking at him, he'd quite likely turn on them, but he would always be too wasted to get up off the bench to do anything; there was no real harm in him.'

When Clive opened up the body bag and we saw the grubby, unkempt little man, I certainly did remember him. Dad had often had to turn him away from the pub because he was bothering the other customers and one time he actually lost control of his bowels in the back bar. The smell had been vile and hung about for days, so Dad was not pleased, as you can imagine. I saw from the information supplied by Bill Baxford that he had recently been living at a hostel for the homeless not far from the hospital, but had just been thrown out for stealing from the other residents. I wondered what had happened in his life to lead him to such a state. He had been found in the park in the early morning, lying on a bench. I was actually surprised that he had lived so long after the incident in the back bar. That was ten years ago, and he had certainly smelt very unwell, so I had been sure he was on his way out even then.

The other post-mortem that day was on Mrs Jennifer Bartram, who had lived in a much nicer part of the town, in a small town house. She had been a prominent member of the local community, a school governor at one of the better local schools in the area. She had not been seen for over a day when her neighbours became concerned because she had missed a dinner party with them. The police had attended, found the house secure and then broken in. They had found her in bed, but fully clothed. On the bedside cabinet was an empty bottle of gin and another was found in the kitchen. There were a few empty bottles of sherry around the place, too.

Maddie said, 'So she liked a tipple, too.'

Clive said, 'Looks like it. You can never tell.' Then he added, 'b.l.o.o.d.y awful stuff, sherry, though it should only be used for cooking, girls but gin's something else. I don't mind a good G&T now and again; got to be a decent one, mind.' Clive and Ed nodded in agreement while Maddie and I made faces and muttered about how both our mothers had warned us individually about 'mother's ruin'.

I was fairly certain that I would find a very ugly liver when I came to do the evisceration on Fred Norris, so it was something of a surprise when I exposed the abdominal organs and the liver did not have the look that I had come to know was cirrhosis. Ed and Peter had taught me about cirrhosis that it is basically scarring of the whole liver with the formation of thousands of tiny nodules where the liver tries to renew itself and I have to say, it is one of the things that turns my stomach in the PM room, because it does look so abnormal it is horrible. But this liver was huge and pale yellow, and very, very smooth. As soon as Clive saw it, he said, 'An expensive liver, that.'

By this he meant, as I have subsequently learnt, that you had to spend a lot of money on alcohol to achieve it but, not knowing this at the time, I asked, 'What's up with it, then?'

'It's a fatty liver.'

Ed came in at that moment and said at once, 'Pate de fois gras! My favourite.'

I continued to eviscerate the body. The smell of alcohol was still strong; it is almost a rotten fruity smell, like rotten apples. I handed the organs over to Ed. The liver weighed nearly two and half kilos, twice as much as normal. 'Why has his liver gone like that, Ed?' I asked.

'It's a sign that the liver isn't working normally. Alcohol can do it, but so can diabetes; and obese people may have similar changes.'

'Is it related to cirrhosis?'

'Not always, Mich.e.l.le,' 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 h.e.l.l 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 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.' 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 pus.h.i.+ng up daisies.'

'Then why's she dead?'

'Well, if I can find nothing else to have done it, I'll have to a.s.sume 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 a.s.sumption.'

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 a.s.sumes it kills you just by causing cirrhosis, but it's a lot more subtle than that. Cirrhosis is bad, 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 pancreat.i.tis, 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.' 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 pancreat.i.tis, 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, Mich.e.l.le.'

'Thank G.o.d,' I said, thinking of the gla.s.s 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 b.o.l.l.o.c.king. He looked across at us as this was going on and the expression on his face told me immediately that serious s.h.i.+t 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.