Unnatural Causes: The Life and Many Deaths of Britain's Top Forensic Pathologist

"First of all, I’d like to tell you about Richard Shepherd, or ‘Dick’. I know him very well; he was the first pathologist that I worked with in London. We’ve shared 30 years of a career together, which is a delight because he’s brilliant company. I’ve always respected his expertise as much as I cherished his friendship, but he surprised me. I’d never known that he was going through the personal difficulties conveyed in this book, in relation to coping with the cumulative trauma that he had experienced over his professional life. At one point, he said to me: ‘It isn’t natural for anybody to do 20,000 post-mortems in their lifetime’. And he’s absolutely right—it isn’t natural. These are unnatural causes being looked at in unnatural circumstances by somebody who is trying to be very natural in their profession. You can see the tension and the conflict in this. He’s very open in his dialogue. In fact, I wrote the little puff on the front of the book which describes it as “heart-wrenchingly honest”. He talks about how, for example, he’d bring his work home, sit down at the family dinner table and look to see, while carving the roast joint in front of him, what sort of a wound different knives left. Looking back, he could see these crossovers between his personal and professional life. Though they seemed perfectly normal to him at the time, when looked at cumulatively, he could see how others might perceive abnormalities. “He said to me at one point ‘it isn’t natural for anybody to do 20,000 post-mortems in their lifetime’. And he’s absolutely right. It isn’t natural. ” He could see how crucial the decision was: do I go out to the police call and leave my family behind, or do I stay at home? There’s a dreadful adrenaline rush accompanying any police call that asks, ‘Can you help us? We’ve got an incident and we need you here’. It’s human nature: wanting to be needed, knowing that you’ve got a skill you can bring to a problem. But in prioritising that, what you’re doing is de-prioritising the most important things any human being can have in life—the love and care of those around you. Your job will never love you back in your old age; only your family will do that. It took Dick a long time to reach that realisation. He talks very candidly about his descent into post-traumatic stress and how, for him, its trigger was something so simple: it was just somebody dropping ice cubes into a glass. Since the Bali bombings, which he’d been around for, he had flashbacks. Within our field, we try to be these terribly brave warriors who say, ‘No, this doesn’t affect us. I’m perfectly okay with the horrors that we see.’ I once heard somebody liken us to modern day sin-eaters: we are the people who consume the sins of the rest of the world, so that other people don’t have to deal with them. But that has its toll. “He talks very candidly about his descent into post-traumatic stress and how the trigger for him was something that was so simple.” It was a huge surprise for me that somebody like Dick—who I never anticipated would have experienced that level of trauma and stress—could be so open about it. It is a real beacon to the professionals in the world to say: you are not immune. We are all potentially open to this form of self-destruction, and need to be ever-wary and conscious of it. Dick’s book was a real warning and a real eye-opener to the professionals, but it also gave the public a realistic representation of how our job is not normal. While going into court looks like this wonderful battle, it’s sometimes the professionals in there who are the punching bag. So many of our practitioners leave the profession because ( a ) the courtroom is so adversarial for us that they don’t want to put themselves through it; and ( b ) they’ve just got to a point of enough where they can’t consume any more sins of the world. It’s a beautiful book but, my goodness, it is heart-aching. Get the weekly Five Books newsletter That’s a really good question. I don’t think that there is an answer to it because it is so personal. Some people cope with it in entirely differently ways. Desensitisation came for me as a child; I was responsible for gutting and skinning rabbits because my mother was too squeamish to do it. Throughout my time at school I worked in a butcher’s shop, so I was always up to my elbows in blood and bones and viscera. Later, in the anatomy department, I learnt how to dissect a human and then, in the mortuary, I learnt how to investigate the body for evidence. So, I had these learning steps into that field. For a student, that’s often quite difficult because they haven’t experienced death until they’ve stepped into a dissecting room. With practitioners who aren’t anatomists, often the first time they’re confronted with it is in a mortuary. The more you can lead yourself into it, the more you have two opportunities: either to get yourself out because you realise it’s not for you; or to acclimatise yourself to what it is you’re seeing and what you’re doing. How you then cope with this on the ground is entirely individual. Some people shut it away and pretend it didn’t happen. Others face it, identify it, suppress it, and get on with the job that you need to do. For me, it’s about thinking that I have a clinical box inside my head. When I go into a job, I walk into that space, physically in my own mind, and shut the door behind me. And I leave my own world behind me. I deal with what I have to do inside that clinical box, and when I’m finished, I come out and close the door. The demons of my professional world are inside the box, and the demons of my personal world are outside the box. What I’m very careful about is who opens the door of the box—who do I let in, and who do I not?—because I don’t want my two worlds to bleed into each other. But Dick’s book taught me that, with the best will in the world, sometimes you risk not shutting the door properly. You have to be prepared for the aftermath of what is, fundamentally, Pandora’s box. “When I go into a job, I walk into that space, physically in my own mind, and shut the door behind me. And I leave my own world behind me.” It’s a beautifully written book. The shock for me in it was more personal—in not knowing that this man, who I consider to be such a good friend of mine, had been going through this. If I had, I’d have reached out to him. I’ve metaphorically slapped him about the face a few times since we’ve met: Why didn’t I know? Why didn’t you tell me? And he said that he couldn’t; he had to get through it on his own. That, I think, is a real lesson. If you love somebody enough, you have to let them do some things on their own. But other times, I think that if I’d maybe asked certain questions of him earlier, I could have been there, and helped. If you look beyond the fact that this is a book about forensic pathology, you see there’s a huge lesson for everybody in its humanity."