Hazel McHaffie

Harold Shipman

Unnatural Causes

Richard Shepherd was just 9 years old when his mother died. He was in his early teens when a friend – the son of a GP – smuggled one of his father’s medical textbooks into school to spook his pals. The book was Simpson’s Forensic Medicine – and the young Richard was mesmerised.

‘Even the most amateur psychologist must deduce that my need to explore death’s presentation was the reason for my extraordinary interest in that copy of Simpson’s Forensic Medicine. More than an interest, it was a fascination. It went further than prurience and much further than the other boys’ eagerness to be horrified.’

Richard fell in love with the way this great pathologist ‘rushed to crime scenes, often in those days by steam train, and then used his medical skills to help detectives reconstruct homicides, solve the unsolvable, exonerate the innocent, argue the case in court and bring to justice the perpetrator.’

But it wasn’t until 16 years after he first entered medical school that he finally became a forensic pathologist himself. The stardust that magical book had sprinkled in his eyes as a teenager lingered, fuelling excitement when calls to examine bodies came. He loved the mixture of medical knowledge and detective work. He was firmly wedded to absolute integrity.

‘I was determined to adhere to the truth, with its beautiful simplicity, and not allow emotion, with all its treachery, to muddy that simplicity.’

But gradually experience changed his naive trust and confidence in his own principles and knowledge.

‘I became a forensic pathologist to be a seeker of truth. That meant I must stand up for the truth whatever the pressure I was placed under to massage it. I see now that this is the sort of noble thought a keen young man of limited experience might have. I had not worked on enough cases to know how malleable a concept truth is for some people, nor how open to interpretation, instinct and inclination are all truths, even those that appear to be scientific fact … I was still deluding myself that it was always possible to find a moral pathway that everyone would recognize as clear and correct.’

And the emotional payload death carried for the living, took a heavy toll. He forced himself to detach from it. One of the most harrowing times was being confronted by 137 young people from many different countries aboard a party vessel, the Marchioness, mowed down by a dredger on the Thames. 51 died. Systematically and doggedly identifying and doing autopsies on so many young healthy people had repercussions – both short and longer term.

‘It was an extremely intense week. To see so many young people here was not just unusual, it was shocking. I was aware, as though in my peripheral vision, of the intense misery of parents, fearing the worst, waiting for news.’

One such repercussion related to identification. Being in the water meant the fingers were not amenable to the usual fingerprint checks. Dr Shepherd was obliged to cut off hands and send them elsewhere for specialised testing. Some were stitched back on, but not all. And this became one of many times when the consequences of exposing the truth was seen in the fall out the pathologist was subject to. Caught in the crossfire between both warring barristers and rival pathologists, he had to account for what he did as well as what he omitted to do. Some of his cases were very high profile indeed – the Hungerford massacre, the Rachel Nickell and Stephen Lawrence murders, Harold Shipman’s victims, Joy Gardner death, the 7 July Islamic attacks in London – dragging his name into the public eye. At times he felt helpless in the face of miscarriages of justice, courtroom humiliations, and it was inevitably hard to maintain a dispassionate stance and defend the truth as he saw it.

‘When I chose this career, I thought that I would be conveying the truth about the dead to the living – who would be grateful to hear it. But, as we approached the new century, I instead was starting to feel like the faithful dog that proudly lays a stick at the feet of his master only to receive a hearty kick for his efforts.

In places the level of detail is quite lurid and not for the squeamish, but the book is beautifully written and humbly insightful. I learned some fascinating facts about interpretation of detail at the scene of crimes or in the mortuary, gleaned from forty years experience and over 23,000 autopsies. And the whole story is a salutary reminder of how much we owe to the dedication and commitment of the emergency services and out of hours work of the whole team. Gruelling hours, unwholesome tasks, unjustified criticism, and precious little thanks. I salute this honest, clever, dedicated man.

Reading the end from his own perspective, the hideous injustice of his whole career being besmirched by accusations of misconduct with respect to a dead baby’s injuries, first to the Home Office and GMC, and thence to the Medical Practitioners Tribunal Service, seems monstrously unfair. Small wonder that he was immobilized by dread, haunted by the clawing stench of decay, a hell-hole of body parts and distorted corpses, tormented by self-doubt. He seriously contemplated suicide. He was paying a heavy price for compassion and caring. It took time and compromise and many hours of flying a plane to restore a measure of equilibrium.

It’s a seeringly honest, sobering account, and I was left in awe of the writer who never gave up on searching for the real truth in spite of the personal and professional cost, determined to give understanding and a degree of closure to devastated families. Its strapline reads: The Life and Many Deaths of Britain’s Top Forensic Pathologist. A perfect summary. Justifiably a bestseller.


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Innocent until proven guilty

Imagine you are sitting in court … a stern faced judge is condemning the young man in the dock to life imprisonment, to serve a minimum of 30 years. He’s only in his 30s. He’ll be almost 70 when – if – he is ever released. Horrendous. And that young man is … your son. Already the hate mail is arriving, your own private life is becoming public, you are personally reviled and shunned … for giving birth to a monster.

Life imprisonmentNow imagine that you are totally, utterly convinced that your boy is innocent of the alleged crime. You know him, his nature, his attitudes. He’s chosen nursing as his career; he’s spent his life caring for people; he’s incapable of hurting anyone. And yet … the evidence is spelled out by the lawyers and police: what he said; what he did; the links between him and so many deaths in mysterious circumstances. The prosecution describe him as a ‘thoroughly evil and dangerous man … arrogant and manipulative’ – a fiend who deliberately and maliciously injected insulin into elderly patients in his care. The press liken him to Harold Shipman, but in this case he’s been stopped in his tracks after just four murders, possibly five. The jury with no vested interest either way, listen carefully, objectively, to the evidence, and they conclude that he is guilty beyond reasonable doubt.

You watch your boy being taken away to serve this terrible sentence, your precious son locked away with criminals, his life and future in tatters.

Small wonder that you don’t accept this verdict … that you seek an alternative explanation. There must be one. Years pass. Eventually there’s a new investigation. The enquiry reveals that there is no direct forensic evidence connecting your son to any of those deaths; that there was no trace of insulin in any of the patients allegedly murdered; that tests used in evidence were invalid; that mathematical calculations reveal it is unfeasible and unrealistic that the level of insulin needed to effect these deaths could have been injected; that naturally-occurring hypoglycaemia happens more often than was thought in the frail elderly non-diabetic sick patient; that eminent experts do not believe there were any murders committed at all. Indeed, new data suggest that these four women died from a condition called insulin auto immune syndrome.

It looks as if your boy has spent six years waiting for his case to come to court, a further six years in prison, for a crime he did not commit. That he has lost his career, his good name, his freedom, and yet he has done nothing wrong. That he only came to attention because he predicted the death of an old lady (something nurses often do), and he just happened to be on duty when these four people died.

A novel I’ve dreamed up? No – although I’d have been jolly pleased with the plotting if I had made it up! No, it was a case discussed on BBC 1 on Monday evening: The Innocent Serial Killer? At once fascinating, frightening and disturbing. Scottish nurse Colin Norris was arrested in 2002. His case came to court in 2008. He is still in prison. His mother has actually lived through this nightmare scenario I’ve just described. She’s living it still.

The results of the BBC investigation were mesmerizing. I found myself identifying with everyone concerned – as a patient, as a grieving relative, as a nurse, as a mother, as a juror, as a writer. And I was appalled. I wanted to march into Durham prison and demand his instant release at least until his case is reheard. OK, I don’t know him; I can’t vouch for him personally; and this programme was presenting a certain line in evidence; but there does seem to be more than enough doubt over this conviction to suggest a possible – maybe even probable – miscarriage of justice, and don’t we Brits pride ourselves on our scrupulously fair innocent-until-proven-guilty system? Besides, there but for the grace of God go I. I’ve predicted deaths. I’ve been on duty when a spate of deaths has occurred. I’ve joked about jinxing the ward. It’s what nurses do. It’s how they survive in a workplace where the grim reaper stalks the corridors.

Stranger than fiction indeed and much much more tense and terrifying.

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Angels of death

I have a row of folders beside my desk containing ideas for future novels. Twenty-plus at the last count. (20 more novels? Who am I kidding?) They’re the accumulation of more than ten years’ collecting, started back in the days when I fondly imagined publishers would keep up with manuscripts!

Plots, issues, twists and facts, all find their way into these covers. From newspaper articles and erudite scientific papers to scribbled flashes of inspiration, even cartoons that spark a different train of thought. Some of the folders are actually breaking under the swell of information. But I don’t want to replace the files because their very state tells me something about the urgency of the subject. With a sieve where my brain used to be there’s no chance I would remember all this stuff years on from now when/if I get around to writing that book, so these are my aide-mémoire and my research notes.

One of these said folders contains outlines for a novel about a healthcare professional who goes off the rails. So, of course, my ears pricked at the news this week that something sinister was going on in a hospital in the Manchester area. Patients dying unexpectedly. Low sugar levels being recorded. Tampering with saline suspected. Sabotage by insulin. Police standing guard checking all incomers. Staff under suspicion. Postmortem examinations of other patients underway. A nurse being held for questioning. Then charged.

So many questions flood the brain. What makes a young nurse deliberately contaminate medical supplies and risk the lives of genuine patients? How much knowledge of dosages would she need? How could she cover her tracks? How far could she get without discovery? How much evidence would she leave behind? How would she react to accusation? How would her family and closest associates respond to the revelations and suspicions? How would the law deal with her? How would the victims’ relatives react? What should be her punishment? What are the risks of a copycat crime?

Curiously the issue of trust in the medical fraternity has been in my mind quite a bit recently. I’ve been undergoing a series of examinations and tests myself, and it’s been rather like detecting a crime. I was both witness and victim. My GP was the sleuth listening to the evidence, piecing together a couple of possible scenarios, testing them out, trying to reach a conclusion. Various other professionals were the experts called in to run specific examinations, rule out possible solutions. My relatives were in the gallery responding to the different accusations. And through it all I had to trust the doctors and their allies would all act honourably and ethically and legally.

OK, I guess we all instinctively trust some more than others. But deliberate harm? It doesn’t enter your head, does it? Best confined to the pages of novels. After a decent interval, if I’m still able to marshall a coherent thought or two and get my creaking fingers to hammer on the keys, I might yet return to this embryonic plot. And why not? After all we’ve already had Joseph Mengele and Charles Cullen and Jack Kevorkian and Harold Shipman. And Beverley Allitt and Anne Grigg-Booth and Stephan Letter and Donald Harvey and …

The list is horribly long. And gruesome. And not a little disturbing. So many?

But then, as the writer of Ecclesiastes said,
What has been will be again,
what has been done will be done again;
there is nothing new under the sun.


No, it would not be unethical to concoct a story of murder and mayhem in a busy hospital. The trick for a novelist is to package the story in an original way that has the reader on the edge of their seat. Now let me see …

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