Unnatural Causes by Dr Richard Shepherd (2018)
Dr Richard Shepherd is a senior forensic pathologist with over 30 years’ experience, consisting of 23,000 postmortems. His book, Unnatural Causes, explores his career and his devotion to the truth in determining how each of his cases died. Over the course of his career this includes victims of mass disasters, homicides, and those who have died in their own homes from unknown causes. Dr Shepherd’s job is to ascertain a cause of death based upon the facts and data presented. Each case is described with detail and empathy and it’s surprising how much the reader becomes immersed in the methodical approach that each postmortem entails. Furthermore, it is very satisfying to learn of Dr Shepherd’s verdict. However, far from being a technical dissertation on a succession of cases, this is a deeply personal and humane book which addresses the impact of the author’s career upon himself and his family. It is written with a surprising degree of literary flair and is profoundly thought provoking and moving.
There are many standout cases and medical anecdotes throughout Unnatural Causes. Too many to choose from. However, one that proved to be particularly poignant is a case regarding an old lady who lived alone. She was found dead by her cleaner, naked under her kitchen table with the room in a state of disarray. Neighbours implied she may have been going senile and the police suspected a burglary due to the way the furniture and kitchen drawers have been disturbed. The medical conclusion was quite contradictory. The victim had in fact died of hyperthermia. Survivors of this condition have described feeling very hot as their temperature dropped and thought that removing their clothes was an appropriate response. Furthermore, victims of hypothermia will often seek to die in an enclosed space as they lose their cognitive ability. “Hide-and-die” syndrome as it has been named. What made this case especially sad was that it was the first in which Dr Shepherd noticed that there was no family to mourn the bereaved.
As well as exploring interesting medical phenomena and procedures Unnatural Causes is also a rather succinct history of many of the major tragedies that have occurred in the UK between the 1980 and 2015. From the Hungerford massacre and the King’s Cross fire of 1987 to the Clapham Junction rail crash in 1988 and the Marchioness disaster of 1989. Dr Shepherd taps into the mood and shock that each event brought the nation and touches upon the ramifications, such as the creation of modern “health and safety” culture that many of us now just take for granted and complain about. His observations about corporate and state attitudes to risk and the lack of accountability are still very pertinent. His thoughts and reflections upon several high-profile cases are also thought provoking. Such as the carrying out of Stephen Lawrence’s postmortem and that of Princess Diana and Dr Harold Shipman. The political and social fall out of all three cases are still being felt today.
In addition to the wealth of medical analysis and exploration of the duty of care that a forensic pathologist has, Dr Shepherd does not avoid addressing the realities of his work upon himself and the personal cost to his mental health and his immediate family that his career has caused. The very nature of a forensic pathologist means that your work hours are irregular, and this alone will put an immense strain upon any relationship. Then there is the emotional compartmentalisation and the requirement to maintain a professional detachment in one’s work. This is a reflective and poignant memoir and a meditation on the duality of both life and death. It is also an attempt to reconcile the scientific necessity to determine a cause of death with the common misconception that a postmortem is an act of violation. Something that many bereaved families feel at times. Dr Shepherd addresses this wisely and with great sympathy but clearly states that it is an act of great compassion. Determining a cause of death is a sign of a caring society. Unnatural Causes is a moving, informative, and genuinely humane book that will fascinate both medical professionals and casual readers alike.
