inherited disorders
The Seven Ages of Death
For reasons I won’t go into at this stage I’m back to thinking about death. (I can hear my children groan – they maintained it was my obsession when they were growing up because my research focused on it for many years.) Anyway, in the process I’m hovering up books on all sorts of aspects of the subject.
The first one I want to share with you is The Seven Ages of Death by Richard Shepherd.
I’m instantly intrigued. It starts with that classic speech from Shakespeare‘s As you Like it:
All the world’s a stage … through to Sans teeth, sans eyes, sans taste, sans everything,
and the author uses it as his framework for a vast amount of material accrued from years of clinical experience as a forensic pathologist. It takes us through each of the seven stage of life, from infancy to extreme old age, by means of cases he has investigated, liberally fleshing the facts out with biological and medical explanations alongside personal thoughts and experiences. Delightfully engaging and readable. Well, for me at least (but I suspect my medical background helped here).
His is a fascinating profession working alongside the dead and their grieving relatives.
Death is my life.
Here is the spirit of compassion and scientific discovery.
Grief walking into my office is a familiar sight, but still it never fails to affect me. The office is a place where paperclips and lists and calendars are devoted to the smooth running of our daily lives and yet here is an emotion so immense that it mocks the most carefully planned filing system.
It’s certainly a case of ‘in at the deep end’. Even the most hardened detectives quail at the prospect of entering the mortuary and seeing a tiny scrap of humanity lying on the stark metal bench, minus any soft comforting wraps or toys. What’s more, everyone knows the victim had no say, no choice, in what happened to him. And indeed, there can be a frightening tension between the rights and interests of the parents and those of the baby. This is vividly conveyed by the case of a father who had a deep distrust of conventional medicine, but who failed to recognise a metabolic disorder that would have been picked up on routine tests. The child died at just 6 months of age with nothing more telling externally than a severe case of nappy rash. The collision between the father’s right to reject medicine and the baby’s right to survive is brutal in this case.
We see this conflict too in examples of older children who are the subject of accident or murder by parents who lack the resources or skills to cope. And there’s often a fine line between an accident and murder as Shepherd vividly illustrates with a case of a seven-year-old girl who was reported to have run away from home, and been found in a park apparently strangled by her necklace. But why were her tiny trainers free from mud? And why was her bag neatly packed with grown-up essentials? Because her mother set the scene to cover her crime.
A similar fine line separates the deaths of two teenagers who were camping in a tent. They apparently dragged the smouldering remnants of a cheap barbecue into the tent to warm themselves. The girl’s body showed the clear signs of carbon monoxide poisoning but the boy’s body was found at the foot of cliffs a distance away, with a much lower level of carbon monoxide in the blood. Was it deliberate or a tragic accident? Shepherd takes each tiny piece of evidence and painstakingly pieces a story together. That’s his job. And he must remain calm and resolute in the face of all the other professionals wanting precise and rapid results yesterday. And in the face of the powerful reactions and grief of the bereaved families.
It’s his eagle eye that sees beyond an accusation that a young man pushed his older brother off a wall resulting in a fatal head injury. Never mind the witnesses who corroborated the ‘pushing’ story, Shepherd noticed something odd about the victim’s legs. There was something much more sinister behind this fall than anyone had ever contemplated; something which had far-reaching consequences for this bereaved family – an inherited disorder carried by the mothers and biding its time in the sons.
When it comes to the thirties apparently it’s very often extreme behaviour that kills this cohort. Shepherd introduces a high-profile case to illustrate this; that of Gareth Williams –the so-called ‘Spy in the Bag’. Shepherd was the third pathologist to examine Gareth’s body – already badly decomposed when it was discovered squeezed into a padlocked hold-all in a very hot bathroom in his flat, with the keys to the padlock beneath him inside the bag. At this point a different kind of post-mortem examination comes into play: a psychological one. The victim was found to have spent thousands on women’s designer dresses, shoes and wigs, to have been into bondage and being restrained in tight places. Shepherd meticulously weighed up the evidence to form his considered judgement and presents a compelling argument for auto-asphyxiation in spite of the conspiracy theories abounding in this front-page case.
Such was his reputation that Dr Shepherd was also consulted in the case of the scientist Dr David Kelly, a UK expert in weapons, who was found dead shortly after being publicly humiliated in the matter of the missing Weapons of Mass Destruction in Iraq during Tony Blair’s time as prime minister. The detailed records of what Dr Kelly’s wife said, and the evidence of severe psychological stress Dr Kelly was under, are harrowing and extremely powerful, illustrating the compassionate understanding of humanity alongside impressive medical knowledge that characterise the author’s own modus operandi.
But he is also refreshingly and bruisingly honest in his reflections about his own mistakes and personal issues – drinking, smoking, weight-gain, and he admits to both his own limitations and those of forensic medicine itself. As he gets older he’s also quite brutal about the effects on health and wellbeing which accompany the ageing process. He gave me biological permission to be less than I was, and not to beat myself up about it! I liked that!!
I’m a fan of the BBC series Silent Witness and Forensics: The Real CSI, both based around forensic pathology, and this book took me through the same process of deeply insightful detective work to reveal the lives as well as the deaths of those who end up on the post mortem table.
Lost in Translation
One of the bonuses of this time out due to Covid-19 has been reading books quite outside my usual milieu, and taking the time to appreciate different skills and talents. This week it’s the amazing skill of translators.
Jo Nesbo is a Norwegian writer and his work has been translated into English by Don Bartlett, a freelance translator who lives in Norfolk. And boy, the result is so impressive I just had to consume two Nesbo novels consecutively – meaty tomes though they be. 
Both feature Harry Hole – a detective inspector in the Crime Squad in Oslo, loner, obsessive, recovering alcoholic, always seemingly a whisker away from being thrown out of the police force.
The Redeemer is full of subtle moral and religious analogies and paradoxes, which I found intriguing. The plot is tortuous, the unravelling complex and detailed. Picture the scene. Shortly before Christmas, the Salvation Army, resplendent in their distinctive uniforms, are playing traditional music outside in one of Oslo’s most famous streets. Without warning, a man in a black raincoat and black woollen hat with a red neckerchief, takes aim at short range and kills one of the players with a single bullet through the head, before vanishing from sight. But it’s the wrong target. And thus begins a trail of devastation and horror.
The assassin – given the name The little redeemer – is cold, ruthless, fearless and driven. As writers, we’re always told to utilise all the senses in writing, so I was particularly taken by one particular characteristic of this man. His mother had told him that ‘the human brain can reproduce detailed images of everything you have seen or heard, but not even the most basic smell.’ He has grown up, since, unusually alert to smells. ‘His nostrils flared and drew in the faint smell of damp cement, human perspiration, hot metal, eau de cologne, tobacco, sodden wool and bile, a smell they never managed to wash out of the train seats, or to ventilate.’
He had learned to shut out noises – screams and artillery – but not smells, and he was acutely aware of this feature in the hospital where he was a teenage errand boy. One smell above all others haunted him – the smell of burnt flesh and blood from the operating theatre. It was ‘like nothing else’. Can’t you just feel the elements assembling that will drive this budding killer to hunt down and take life?
And it’s this amazing facility with language in a translated work which caught my attention. Nesbo’s background is as a singer/songwriter, and I wonder if this contributed to his ear for the lyrical in language. It’s not just the choice of words, but he uses uniquely clever and ingenious transitions between sections, beautiful linkages which serve to add to the intrigue. A couple of examples to illustrate … At the end of one section the detective presses his thumb against a cold metal button; at the beginning of the next section a different person altogether takes his finger off the button, puts down his heavy bags and gazes up at the block of flats above him. Then later, one of the Salvation Army officers says, ‘You’re lying.‘ The next section begins with the detective saying, ‘No I’m afraid I’m not’, but in answer to a completely different conversation. Brilliant. I loved it!
In The Snowman, a young boy wakes to find his mother has vanished, but her favourite pink scarf – the one he’d given her for Christmas – has been wrapped around the neck of a snowman in the garden. By the time Inspector Harry Hole arrives, everything is starting to drip and sigh in the thaw, and the snowman has ‘a slight list and poor future prospects‘. When a second woman goes missing, Hole fears he has a serial killer operating on his patch. And this conviction is strengthened when one of his colleagues traces back a whole series of women who have mysteriously disappeared. What kind of monster emerges on the day of the first snowfall, creates snowmen, and abducts women – married women with children? The Snowman. But who is he … or she?
It’s a devilishly plotted tale, with false trails, deception and suspects aplenty. Just when you think we’re about to see the monster unmasked, another set of wet slushy footprints lead off at a tangent. In this one, the plotting is the main attraction, but again the language in places is lyrical. How about this for the police inspector’s job?: he stared ‘into others’ faces to find their pain, the Achilles heels, their nightmares, motives and reasons for self-deception, listening to their fatiguing lies and trying to find a meaning in what he did: imprisoning people who were already imprisoned inside themselves. Prisons of hatred and self-contempt he recognised all too well.’
Brutal murders and serial killers aren’t my usual bag, but this is one author and one translator who have inspired my admiration. And I was taken by surprise by an unexpected phenomenon: both feature medical syndromes and inherited diseases … Now, I’m listening, even if the detail isn’t strictly accurate in one place! It’s close enough for purpose, and I never was a reader on the hunt for mistakes or anachronisms; I have too much respect for the hard work that goes into writing a book or a drama to nit pick.
Psychiatrically disturbed personalities unnerve me somewhat too: and as one such character says in The Snowman: ‘My psychiatrist says I’m just a few notches more extreme than most people’. Just what I was always afraid of!
Jo Nesbo’s novels are published in 48 languages. That’s a lot of translators. I salute them all.