All That Remains: A Renowned Forensic Scientist on Death, Mortality, and Solving Crimes

Introduction

‘Death is not the greatest loss in life.

The greatest loss is what dies inside us while we live’

Norman Cousins political journalist (1915–1990)

Me at about two years of age.

Death and the hyped-up circus that surrounds her are perhaps more laden with clichés than almost any other aspect of human existence. She is personified as sinister, as a harbinger of pain and unhappiness; a predator who haunts and hunts from the shadows, a dangerous thief in the night. We give her ominous and cruel nicknames – the Grim Reaper, the Great Leveller, the Dark Angel, the Pale Rider – and portray her as a gaunt skeleton in a dark, hooded cloak wielding a deadly scythe, destined to separate our soul from our body with one lethal swipe. Sometimes she is a black, feathered spectre that hovers menacingly over us, her cowering victims. And, despite being feminine in many languages where nouns have genders (including Latin, French, Spanish, Italian, Polish, Lithuanian and Norse), she is often none the less depicted as a man.

It is easier to treat death unkindly because in the modern world she has become a hostile stranger. For all the progress humanity has made, we are little closer to deciphering the complex bonds between life and death than we were hundreds of years ago. Indeed, in some respects, we are perhaps further away than ever before from understanding her. We seem to have forgotten who death is, what her purpose is, and, where our ancestors perhaps considered her a friend, we choose to treat her as an unwelcome and devilish adversary to be avoided or bested for as long as possible.

Our default position is either to vilify or to deify death, sometimes vacillating between the two. Either way, we prefer not to mention her if we can help it in case it encourages her to come too close. Life is light, good and happy; death is dark, bad and sad. Good and evil, reward and punishment, heaven and hell, black and white – our Linnaean tendencies lead us to neatly categorise life and death as opposites, giving us the comforting illusion of an unambiguous sense of right and wrong that perhaps unfairly banishes death to the dark side.

As a result we have come to dread her presence as if she were somehow infectious, afraid that if we attract her attention then she might come for us before we are remotely ready to stop living. We may conceal our fear by putting on a show of bravado or poking fun at her in the hope of anaesthetising ourselves to her sting. We know, though, that we will not be laughing when we reach the top of her list and she does finally call out our name. So we learn at a very early age to be hypocritical about her, ridiculing her with one turn of the face and then becoming deeply reverential with another. We learn a new language to try to blunt her sharp edges and dull the pain. We talk about ‘losing’ someone, whisper of their ‘passing’ and, in sombre respectful tones, we commiserate with others when a loved one has ‘gone’.

I didn’t ‘lose’ my father – I know exactly where he is. He is buried at the top of Tomnahurich Cemetery in Inverness, in a lovely wooden box provided by Bill Fraser, the family funeral director, of which he might have approved, although he would probably have thought it too expensive. We put him in a hole in the ground on top of the disintegrating coffins of his mother and father, neither of which will now hold more than their bones and the few teeth they still had when they died. He has not passed, he is not gone, he is not lost: he is dead. Indeed, he better not have gone anywhere – that would be most troublesome and inconsiderate of him. His life is extinct, and none of the euphemistic rhetoric in the world will ever bring it, or him, back.

As the product of a strict, no-nonsense, Scottish Presbyterian family where a spade was called a shovel and empathy and sentimentality were often viewed as weaknesses, I like to think my upbringing has made me pragmatic and thick-skinned, a coper and a realist. When it comes to matters of life and death I harbour no misconceptions and in discussing them I try to be honest and truthful, but that does not mean I don’t care, and it doesn’t make me immune to pain and grief or unsympathetic to that of others. What I do not have is a maudlin sentimentality about death and the dead. As Fiona, our inspirational chaplain at Dundee University, puts it so eloquently, there is no comfort to be had from soft words spoken at a safe distance.

With all our twenty-first-century sophistication, why do we still opt to take cover behind familiar, safe walls of conformity and denial, rather than opening up to the idea that maybe death is not the demon we fear? She does not need to be lurid, brutal or rude. She can be silent, peaceful and merciful. Perhaps the answer is that we don’t trust her because we don’t choose to get to know her, to take the trouble in the course of our lives to try to understand her. If we did, we might learn to accept her as an integral and fundamentally necessary part of our life’s process.

We view birth as the beginning of life and death as its natural end. But what if death is just the beginning of a different phase of existence? This, of course, is the premise of most religions, which teach that we should not fear death as it is merely the gateway to a better life beyond. Such beliefs have brought solace to many through the ages, and perhaps the vacuum left by the increasing secularisation of our society has contributed to the resurgence of an ancient, instinctive but unsubstantiated aversion to death and all its trappings.

Whatever we believe, life and death are unquestionably inextricably bound parts of the same continuum. One does not, and cannot, exist without the other and, no matter how much modern medicine strives to intervene, death will ultimately prevail. Since there is no way we can ultimately prevent it, perhaps our time would be better spent focusing on improving and savouring the period between our birth and our death: our life.

Herein lies one of the fundamental differences between forensic pathology and forensic anthropology. Forensic pathology seeks evidence of a cause and manner of death – the end of the journey – whereas forensic anthropology reconstructs the life led, the journey itself, across the full span of its duration. Our job is to reunite the identity constructed during life with what remains of the corporeal form in death. So forensic pathology and anthropology are partners in death and, of course, in crime.

In the UK, anthropologists, unlike pathologists, are scientists rather than doctors and are therefore unlikely to be medically qualified to certify a death or the cause of death. In these days of ever-expanding scientific knowledge, pathologists cannot be expected to be experts in everything, and the anthropologist has an important role to play in the investigation of serious crimes involving a death. Forensic anthropologists assist in unravelling the clues associated with the identity of the victim and may aid the pathologist to reach his or her final decisions about the manner and cause of death. Each discipline brings its own complementary and specific skills to the mortuary table.

On one such mortuary table, for example, a pathologist and I were faced with human remains in an advanced stage of decomposition. The skull was shattered into over forty jumbled fragments. As the medically qualified practitioner, her remit was to determine the cause of death and she was pretty sure it was going to be gunshot injury. But she needed to be certain. Surveying with dismay the multitude of fragments of white bone on the grey metal tabletop, she said, ‘I can’t identify all the pieces, let alone try to stick them together. That’s your job.’

The forensic anthropologist’s role is first to help establish who the person may have been in life. Were they male or female? Tall or short? Old or young? Black or white? Does the skeleton show evidence of any injuries or disease that might be linked to medical or dental records? Can we extract information from bones, hair and nails about their composition which might tell us where the person was living and the type of food they ate? And in this case, could we undertake a three-dimensional human jigsaw puzzle to allow us to reveal not only the cause of death, which was indeed gunshot injury to the skull, but also the manner of death? By gathering this information and completing the jigsaw we were able to establish the identity of the young man and to corroborate eyewitness testimony by confirming a ballistic entry wound to the back of the head and its exit from the forehead above and between his eyes. This was a close-range execution, in which the victim had been kneeling when the firearm was placed directly against the skin at the back of his head. He was just fifteen and his crime was his religion.

Another illustration of the symbiotic relationship between anthropologist and pathologist concerned an unfortunate young man who was beaten to death after confronting a group of youths intent on vandalising a car in the street outside his house. His body had been kicked and punched, he had suffered fatal impact trauma to his head and he exhibited multiple skull fractures. In this case we knew the identity of the victim, and the pathologist was able to determine the cause of death as blunt-force trauma, resulting in massive internal haemorrhage. But she also wanted to report on how his death was brought about and, in particular, on the type of implement most likely to have been used to kill him. We were able to identify every fragment of the skull and to reconstruct it, enabling the pathologist to confirm that there had been one primary blow to the head, made by a hammer, or something of similar shape, which had caused a focal depressed fracture and multiple radiating fractures leading to the fatal intracranial bleeding.

For some, the distance between the beginning and the end of life will be lengthy, perhaps over a century, whereas for others, like these murder victims, the two events will occur much closer together. Sometimes they may be separated only by a fleeting but precious few seconds. From the point of view of the forensic anthropologist, a long life is good news, as the longer it has been, the more scars of experience will be written and stored within the body, and the clearer their imprint on our mortal remains will be. For us, unlocking this information is almost like reading it in a book, or downloading it from a USB stick.

In the eyes of most people, the worst outcome of this earthly adventure is a life cut short. But who are we to judge what is short? What is not in doubt is that the longer we survive beyond birth, the higher the probability will be that our lives will end sooner rather than later: we are more likely, in most cases, to be closer to death at ninety than we are at twenty. And logic tells us that we will never again be further away from a personal acquaintance with death than we are right at this moment.

So why are we surprised when people die? Over 55 million of us around the world do it every year – two a second – and it is the one event of our lives that we know with absolute certainty is going to happen to every single one of us. This by no means diminishes our sadness and grief when it happens to someone close to us, of course, but its inevitability demands an approach that is both practical and realistic. Since we can’t influence the creation of our lives, and their end is unavoidable, perhaps we should be focusing on what we can regulate: our expectations of the distance between them. Perhaps it is this we should be trying to manage more effectively by measuring, acknowledging and celebrating its value rather than its duration.

In the past, when death was less easy to postpone, we may have been better at this. In Victorian times, for example, when infant mortality was high, nobody was surprised if a child did not reach its first birthday. Indeed, it was not unusual for several children in a family to be given the same name to ensure that it survived, even if the child did not. In the twenty-first century, infant death is more shocking, but to be stunned when someone dies at the age of ninety-nine defies all logic.

Society’s expectations are the battleground of every medical expert who aims to force death into a retreat. The best they can hope to do is to buy more time and expand the distance between our two mortal events. That they will ultimately always lose the fight should not stop them from trying, and it does not – lives are prolonged every day in hospitals and clinics around the world. Realistically, though, some of these medical achievements may amount to no more than a stay of execution. Death is coming, and if it wasn’t today, it might be tomorrow.

Over the centuries, society has catalogued and measured life expectancy, by which we mean the age at which we are statistically most likely to die – or, to look at it more positively, the length of time we are likely to spend living. Life tables are interesting and useful tools but they are dangerous, too, in that they create an expectation that will not be reached by some and will be exceeded by others. We have no way of knowing whether we are the average Joe who will conform to the norm or whether we will be an outlier at one end or the other of life’s bell curve.

And when we find ourselves to one side or other of the curve, we take it personally. We are proud of ourselves when we exceed our life expectancy because it makes us feel that we have somehow beaten the odds. When we don’t reach the age anticipated for us, those we leave behind may feel that they have been robbed of the life of someone dear to them and experience anger, bitterness or frustration. But of course that is simply the nature of the life curve: the norm is just the norm, and most of us will fall into the variations around it. It is unfair to blame death and accuse her of cruelty and larceny when she has always been honest in demonstrating that our life spans can be anywhere within the range of human possibilities.

The longest-living person in the world whose age could be verified was Frenchwoman Jeanne Calment, who was 122 years and 164 days of age when she died in 1997. In 1930, the year of my mother’s birth, female life expectancy was sixty-three, so on her death at seventy-seven she exceeded the norm by fourteen years. My grandmother fared even better: when she was born, in 1898, her life expectancy would have been only fifty-two. She lived to be seventy-eight, outstripping that by twenty-six years, which may in part be a reflection of the huge number of medical advances during her lifetime – although her cigarettes didn’t help her in the end. The prediction for me, when I arrived in 1961, was a life that might be seventy-four years long. That would leave me now with just seventeen to go. My goodness me, how did that happen so quickly? However, based on my current age and lifestyle, I can now realistically expect to reach eighty-five, and I may have another twenty-nine years or more to look forward to. Phew.

So, during the course of my life, I have gained the prospect of an additional eleven years. Isn’t that great? Not really. You see, I didn’t get those extra years when I was twenty, or even forty. If I am given them, it will be when I am seventy-four. Would that we could be granted more time in our prime, where youth continues to be wasted on the young.

The calculations of life expectancy given at birth are slowly becoming more accurate and we know that among the next two generations, those of my children and grandchildren, there will be more centenarians than have ever before existed in human history. Yet the maximum age to which our species is capable of living is not increasing. What is changing dramatically is the average age at which we die, and therefore we are seeing an increase in the number of individuals falling into the far right regions of the bell curve. In other words, we are changing the shape of human demography. The rapidly expanding health and social issues created by the growth of an ageing population are starting to give us a glimpse of the resulting impact on society.

While longer lives are for the most part to be celebrated, I do wonder at times if, in striving to stay alive for as long as possible at all costs, all we are in fact doing is prolonging our dying. While life expectancy may be variable, death expectancy remains unchanged. Should we ever actually conquer death, the human race and the planet would be in real trouble.

Working every day with death as my companion, I have come to respect her. She gives me no cause to fear her presence or her work. I think I understand her reasonably well because we choose to communicate in direct, plain and simple language. It is when she has done her job that I am permitted to do mine and, thanks to her, I have enjoyed a long, productive and interesting career.

This book is not a traditional treatise on death. It does not follow the well-trodden path of examining lofty academic theories or quirky cultural variations or offer warm platitudes. Instead I will simply try to explore the many faces of death as I have come to know them, the perspectives she has shown me and the one she will ultimately reveal to me some time in the next thirty years or so, if she chooses to spare me that long. And it is, like forensic anthropology itself, which seeks to reconstruct through death the story of the life lived, as much about life as about death – those inseparable parts of the continuous whole.

In return, I ask only one thing of you: suspend your preconceptions of death for a moment, any sense of distrust, fear and loathing, and perhaps you will begin to see her as I do. You may even begin to warm to her company, get to know her a little better and cease to be afraid of her. In my experience, engaging with her is both compelling and fascinating, and never dull, but she is complex and sometimes wonderfully unpredictable. You have nothing to lose – and in your own encounters with her, surely it is better to be dealing with the devil you know.

CHAPTER 1

Silent teachers

‘Mortui vivos docent’

(The dead teach the living)

Origin unknown

An articulated adult human skeleton which hangs in my laboratory.

From the age of twelve, I spent every Saturday and all my school holidays for five years up to my elbows in muscle, bone, blood and viscera. My parents had a fearsome Presbyterian work ethic and I was expected to get myself a part-time job and start earning some money as soon as I was old enough. So I went to work at the butcher’s shop at Balnafettack Farm on the outskirts of Inverness. It was my first and only job as a schoolgirl and I loved every single minute of it. I was utterly oblivious of the fact that most of my friends, who preferred to work in pharmacies, supermarkets or clothes shops, considered it an odd choice, not to say vaguely distasteful. In those days I had no inkling that the world of forensic science was waiting for me but, looking back now, I see this as part of the pattern for my life that was hidden from me, and from them, at the time.

A butcher’s shop was an extremely useful training ground for a future anatomist and forensic anthropologist and a happy and fascinating place to work. I loved the clinical precision involved in the butcher’s craft. I learned a multitude of skills: how to make mince, how to link sausages and, most importantly, how to make regular cups of tea for the butchers. I learned the value of a sharpened blade as I watched them manoeuvre their knives swiftly and skilfully around irregularly shaped bones, paring away the dark red muscle to reveal the startling clean white skeleton beneath. They always knew exactly where to cut so that the meat could be rolled artistically into brisket or sliced evenly into stewing steak. There was something reassuring about the certainty that the anatomy they encountered would be the same every time. Or almost every time: I do remember the odd occasion when a butcher would curse under his breath about something not being ‘quite right’. It seems cows and sheep have their anatomical variations, just like humans.

I learned about tendons and why we cut them out; where, in the space between muscles, there are blood vessels that need to be excised; how to remove the confluence of structures at the hilum of the kidney (too tough to eat) and how to open the joint between two bones to reveal the glassy, viscous fluid of the synovial joint space. I learned that when your hands are cold – and they always seem to be cold in a butcher’s shop – you look forward to the delivery of fresh livers, still warm from the abattoir. For a fleeting moment, when you dipped your hands into the box, you could feel them again, thanks to the warm cow’s blood de-icing your own.

I learned not to bite my fingernails, never to place a knife on the block with the blade facing upwards and that blunt knives cause more accidents than sharp ones – although sharp blades leave a much more spectacular mess when a mistake is made. I still find it tremendously satisfying to see the neat array of anatomy on display in a butcher’s shop, always laid out precisely, cut and prepared the way it should be, and to catch that slight whiff of iron in the air.

I was sad when I had to give up the job. I idolised my biology teacher, Dr Archie Fraser, to such extent that whatever he said I should do, I did it. So when he told me I must go to university, off to university I went. As I had no idea what I ought to study, following in his footsteps and opting for biology seemed a good idea. I spent my first two years at the University of Aberdeen in a bored haze of psychology, chemistry, soil science, zoology (which I failed first time round), general biology, histology and botany. At the end of it all I found I was best at botany and histology, but the pro-spect of studying plants for the rest of my life made my eyes bleed. That left histology, the study of human cells. Having completed the histology module, I felt I never wanted to have to look down a microscope again – everything seemed to consist of amorphous blobs of pink and purple. It was, though, my route into anatomy, where I would be able to dissect a human cadaver. I was only nineteen and had never seen a dead body before, but for a girl who had spent five years of her life cutting up animals in a butcher’s shop, how hard could it be?

Perhaps my Saturday job prepared me in a very minor way for what lay ahead. The first experience of a dissecting room is, though, daunting for everyone. It is one of those moments nobody forgets because it assaults every single sense. There were only four of us in the class and I can still hear the echoes that reverberated round that vast, grand room which, with its high, opaque glass windows and intricate Victorian parquet floor, might have served in different circumstances as a conservatory. I can still smell the formalin, a chemical stench so thick you could taste it, and see the heavy glass and metal dissecting tables with their peeling green paint – forty or more of them, set out in regimented rows and shrouded in white sheets. On two of the tables, hidden under their sheets, were the bodies that were waiting for us, one for each pair of students.

It is also an experience that immediately challenges your perceptions of yourself and others. You feel very small and insignificant when it dawns on you that here is someone who, in life, made the choice to give themselves in death to allow others to learn. It is a noble deed that has never lost its poignancy for me. If ever I lose sight of the miracle of that gift, it will be time to hang up my scalpel and do something else.

At random, my dissection partner, Graham, and I had been assigned the cadaver of this selfless donor – a body expertly prepared for us by the anatomy technician that would be our world of investigation for a full academic year. Not knowing his real name, we rather unoriginally called him Henry, after Henry Gray, author of Gray’s Anatomy, the text that would come to dominate my life. Henry, a man who hailed from the Aberdeen area and was in his late seventies when he died, had elected to bequeath his body to the anatomy department at the university for the purposes of education and research. My education, and Graham’s, as it turned out.

It was sobering to think that at the time Henry had made his decision, I, his future pupil, was completely unaware of the amazingly generous act that would shape my entire life. I would have been busy bemoaning my lot of having to dissect rats in zoology, which I loathed.

When he died, I was probably cutting up another of the university’s apparently endless supply of plant stems to study their cellular structure, oblivious of his passing. Every year, when I talk to my first- and second-year students preparing to go into anatomy dissection in their third year, I tell them that the person they will study with, and learn from, is currently still alive. Perhaps that very day someone will be making the decision to bequeath his or her remains for the benefit of their education. I am always reassured when there are a few sharp intakes of breath as the enormity of that concept sinks in. There are inevitably a few who well up at the idea of a person they might have walked past on the street that morning ending up on their dissection table – and so they should. Such a huge gesture by a total stranger should never be taken for granted.

Henry’s cause of death was registered as myocardial infarction (heart attack) and his body had been collected from the hospital where he had died and then transported by the funeral director into the care of the anatomy department. Whether he had family, whether they supported him in his decision or how they felt about the lack of the normal ritual of a funeral, I would never know.

In a tiled, dark and clinically soulless room in the basement of the anatomy department at Marischal College, hours after Henry’s death, Alec the mortuary technician had removed Henry’s clothing and personal effects, shaved his head and attached four brass identification discs – each threaded with a piece of cord and stamped with a sequential identification number – to his smallest fingers and toes. These would stay with Henry throughout his time at the university. Next Alec would have made a cut in the skin of Henry’s groin, about 6cm in length, and dissected away the overlying muscle and fat until he could locate the femoral artery and vein in the region of the thigh known as the femoral triangle. He would then have made a small longitudinal incision in the vein, and another in the artery, where he inserted a cannula, securing it in place with some more cord. When a tight seal had been achieved, a valve in the cannula would have been opened and a solution of formalin would have perfused gently through Henry’s arborescent arterial system, driven from a gravity-feed tank above him.

The embalming fluid would have found its way via the blood vessels to every single cell in his body – to the neurons in his brain, where he used to think about all the things that mattered to him; to his fingers, which had held the hand of someone he cared about; to his throat, through which his last words had been spoken, perhaps only hours before. As the formalin solution slowly pushed its way onward, in an irreversible wave, the blood in his vessels would have been purged and eventually much of it would have washed away. After only two or three hours of this quiet, peaceful embalming process, his body would have been wrapped in plastic sheeting and stored until it was needed, maybe days, maybe months later.

In that short interval, Henry had been transformed, of his own volition, from a man known and loved by his family into an anonymous cadaver identified only by a number. That anonymity is important. It protects the students and helps them to mentally separate the sad death of a fellow human being from the work they are doing. If they are to dissect a cadaver for the first time without experiencing crippling empathy, they must, while remaining respectful and ensuring that dignity is preserved, be able to train their minds into viewing the body as a depersonalised shell.

When the time came for Henry’s body to play its part in our first anatomy class, he had been placed on a trolley, brought upstairs to the dissecting room in the old, rickety, noisy lift, transferred on to one of the glass-covered dissecting tables and covered with a white sheet to wait, quietly and patiently, for his students to arrive.

Today we go to great lengths to make our students’ first dissection as memorable and atraumatic as possible. Most of them, like me, will never have seen a dead body before this moment. In 1980, when I embarked on anatomical dissection, there were no introductory sessions, no gradual process of getting to know the cadaver that would be our silent teacher for the next few months. We were four very scared third-year undergraduates who, on arriving that Monday morning armed only with our copies of Snell’s Clinical Anatomy for Medical Students, a dissection manual – G.J. Romanes’ Cunningham’s Manual of Practical Anatomy – and a selection of scary dissecting instruments wrapped up in a khaki-coloured cloth roll, were pretty much left to just get on with it, beginning at page 1 of the manual. We didn’t use gloves or wear eye-protectors, and our laboratory coats very soon became an utter disgrace as we were not allowed to take them out of the building to wash them. How times have changed.

On our table, Graham and I found an array of sponges, which we quickly learned were essential for mopping up excess fluid as the dissection progressed. They had to be wrung out frequently. Underneath it was a stainless-steel bucket for collecting pieces of tissue when our dissection was complete for the day. It is important that all the parts of a body remain together, even when they amount to no more than small bits of muscle or skin, so that when it is sent for burial or cremation it will be as complete as possible. Standing sentinel at our side, watching and waiting, was a second influential tutor: an articulated human skeleton, there to help us understand what we would see and feel under Henry’s skin and muscles.

The first thing to master was how to put on a scalpel blade without slicing your finger off. Lining up the narrow slit on the blade with the ridge of the handle, then guiding it with forceps until it clicks into place, takes some dexterity and practice. As does removing it again. I often think to myself that surely someone could come up with a better design.

If you cut into the cadaver and noticed it starting to bleed with bright red arterial blood, I was warned, just remember that cadavers don’t bleed. What you will have cut is your own finger. The scalpel blades are so sharp and the room so cold that you don’t feel them slicing into your skin. So the first indication that you have injured yourself will be the sight of scarlet living blood pooling against the pale brown of the cadaver’s embalmed skin. Contamination is not as much of a concern as it would be if we were handling unembalmed bodies because the process renders the tissue virtually sterile. Just as well, since dealing with fiddly little blades when your fingers are cold and slippery with body fat is not easy. These days we begin the academic session with a vast supply of sticking plasters and surgical gloves.

Once the blade is finally on your scalpel handle and your finger has stopped pumping blood, you lean over the table and immediately your eyes start to water from the