Richard Shepherd Penguin, 2019, PB, 464pp, £8.99, 978-1405923538
Unnatural Causes begins with the words of Alexander Pope written in 1709: “Tis not enough, Taste, Judgement, Learning, join; In all you speak, let Truth and Candour shine.’
Dr Richard Shepherd is a leading forensic pathologist with over 30 years and 23 000 postmortems under his belt. Unnatural Causes charts his relentless pursuit of the truth in determining how each of his patients died.
From the victims of mass disasters, to homicides, to those who have died in police custody or in their own homes from unknown causes, it is Shepherd’s job to ascertain a cause of death. Each case is described with intrigue and detail, and it is surprisingly satisfying to learn of the methodical approach and routine that each postmortem entails, and even more satisfying to learn of Shepherd’s verdict.
From a medical perspective it was a delight to learn new things, for example, the difference between somatic death and cellular death; that a common response to hypothermia is to actually take off one’s clothes, that survivors have described feeling very hot as their temperature dropped and believed that stripping off was an appropriate response, and that victims of hypothermia will often seek to die in an enclosed space such as in corners or under tables — so-called ‘hide-and-die’ syndrome; that post-death the blood vessels provide easy channels for bacteria inside the body to spread, resulting in an ‘extraordinary and beautiful fern-like pattern of the veins … clearly etched on the skin as though tattooed in brown.’
As well as learning interesting medical phenomena I learnt a lot about the history of Britain over the last few decades. From the Hungerford massacre in 1987 to the King’s Cross fire of the same year, to the Clapham Junction rail crash in 1988 to the Marchioness disaster of 1989, Unnatural Causes offers almost a capsule of British history from the 80s onwards. Shepherd describes with great clarity the shock each event brought the nation and the ramifications of each, as well as the birth of health and safety culture that many of us not just take for granted now but also bemoan. His observations about corporate and state attitudes to risk and responsibility ring true even today.
Shepherd shares with us some of his most high-profile cases. At the time of carrying out Stephen Lawrence’s postmortem he could not have predicted the significance of the patient he was working on. When describing carrying out the postmortem on Princess Diana he states:
‘The general rule when presented with a high profile death is to stop. Do everything slowly … you are under pressure to get things done right now. In half the usual time and with half the usual information. I have learned the hard way that no one says thank you in these cases. Ever.’
This is pertinent advice for every doctor in every specialty.
The part of this book that evoked the most visceral reaction in me was not the florid description of the process of putrefaction or the appearance of a body after drowning; it was when Shepherd discloses to us how and when he became the subject of a GMC investigation. The injustice of a life served to seeking the truth that is then almost dismissed over the quality of some photographs will remind this audience of the thin line that ultimately all doctors tread.
In addition to the professional turmoil, Shepherd does not shy away from describing the personal cost to his sanity and his family that his career has caused him. From the beginning, family and medicine have been closely intertwined and from the death of his mother at 9 to the emotional abyss in his own marriage we understand the conflict and tension there is between the love for one’s family and the love for one’s vocation and calling.
This is a reflective and poignant memoir; a meditation on mortality and its alter ego life; a love letter to forensic pathology; a fascinating collection of case studies and vignettes, and a snapshot of British history in the late 20th century.
Unnatural Causes will move, inform, and captivate both medical and lay readers alike.
- © British Journal of General Practice 2019
