The God of Small Things...

[Overheard conversation in the lab]

“Do you put them all in the same container?”

“Yes, all samples go in the same container”

“Why don’t you use separate containers for each individual’s samples?”

“We just use one to send them all up” 

One of my favourite reads in the last 10 years has been the novel The God of Small Things by Arundhati Roy. In it she talks of “…the laws that lay down who should be loved, and how. And how much”.

Many of us will have personal experience of the sort of love she writes about here, or have read about it. I In this blog I want to explore this in relation to how we love those we have lost, and what we expect from the custodians of their remains.

You may need to bear with me on this for a bit, but this is the literary conceit around which this blog is structured.

Chapter 1. What I observed on inspection

The remembered conversation above was what I overheard whilst observing an inspection at one of our establishments that holds an HTA post-mortem licence. It was between one of our HTA Regulation Managers and a member of staff who worked in the laboratory.

The conversation took place early in the afternoon, after I had observed my colleagues talking with a range of staff in the mortuary, looking at policies and procedures, interviewing key members of the team.

What I observed and experienced during this time was a group of committed, compassionate professionals, who were on the whole doing their best to do the best for the deceased. I was very impressed with how they conducted themselves and how they were focused on the important role they had for those in their care.

Chapter 2. Dignity

It may seem a fairly innocuous conversation, but it goes to the heart of what we at the HTA do in our regulation of establishments who work with human bodies, body parts, and tissue.

What had developed as a pragmatic process, in a lab in the bowels of an internationally renowned teaching hospital, underlines exactly why we exist at all – to ensure the public can have confidence in how human bodies, organs, and tissue is treated.

One of the key principles that underlies our regulation of mortuaries here at the HTA is dignity, preserving the dignity of the deceased.

Chapter 3. Context

Since I joined the HTA three years ago, the most common media enquiry has been about the post mortem sector, notably concerning the number of serious incidents that each year.

It appears to be a perennial news feature on at least a yearly basis. Although the numbers involved look large, with over 300,000 bodies going through mortuaries annually, it is something like 0.01% of bodies that may be involved in a reportable incident.

Of course, despite the rarity, for every family whose loved one’s body has, for example, been subject to accidental damage when being moved, this is a distressing time, and we work with establishments to ensure they put in procedures and processes to mitigate potential reoccurrences.

We are also here to ensure suitable processes and procedures are in place across the board to so that the use and handling of bodies, body parts, and tissue is undertaken in a responsible and dignified manner.

And finally to the point

So why was this conversation important, you may still be asking…

It’s one of a number of “small things” that can easily be overlooked. Something which may go beyond notice as it happens far away from where the focus is, or done with good intentions.

Those of you old enough will remember what happened in the 1990s in the NHS, where consent was not sought when body parts and organs were used without permission. Some said this was because that conversation was just too difficult, or would bring further pain to the family.

Sometimes we make mistakes through thinking we are doing the right thing, whether big or small.

We at the HTA have been involved in producing guidance for professionals who work with women who have experienced a loss, or termination. The core of this guidance is that any decisions need to include the mother, and be sensitive to their own wishes.

See the great work Death Before Birth project is doing up in Birmingham, looking at how language and culture matters when dealing with such sensitive matters. There cannot be a one size fits all approach to how we manage what we euphemistically call “remains”, or in this case “specimens”, not when that material may be considered by some to be a part of their loved one.

This is the God of small things the HTA plays a part in regulating. We do not decide how or if, what some may consider, a miniscule or irrelevant part of a human being should be loved. We are here to ensure no one ever feels that their loved one has been treated in anything but a dignified way.

Working in a mortuary is a tough job, caring for people whether dead or alive is not a simple, linear, predictable, straightforward thing. We are here to ensure all things great and small come together to ensure above all things people can be confident that those who care for those dear to them are cared for as they would wish.

Thank you for reading this, and I’d love to hear any thoughts you have on this matter below.