Midway through surgery I get a call from Peter, a GP at a nearby practice. “Hi, Phil. Can you do a Part Two for me?”
It’s on an 80-year-old patient of his, Brenda Roy, who has passed away at ten to one that morning. Peter gives me a summary: she went through the chemotherapy mill after lymphoma was diagnosed last year; when the disease recurred, she decided she’d had enough and declined further active treatment.
“She’s at Francis Kennearly’s. I’ll leave the paperwork there.”
Cremation is our most popular mode of dealing with mortal remains: around three-quarters of British funerals are now held at crematoriums, a sea change from sixty years ago, when burial was the default option. Worldwide, cremation rates vary markedly, reflecting cultural and religious traditions. Burial is virtually unheard of in Japan, whereas in strongly Catholic countries such as Ireland and Italy cremation follows fewer than two in every ten deaths. Practical considerations play their part, too: cremation in the west is most frequent in cities, where cemetery plots are often in short supply.
From a UK jurisprudence perspective, cremation entails the permanent loss of potential forensic evidence. To guard against miscarriages of justice, two medical practitioners must complete a form that is scrutinised by an independent referee. The first part is filled in by the doctor who cared for the deceased. “Part Two” must be given to a practitioner with no prior involvement in the case.
Peter practises in a large village set among rolling hills, a long way from any A-roads. It is not especially picturesque; it’s a working community with few holiday and weekend cottages, and the local businesses and shops are still thriving. Francis Kennearly has been the undertaker here for twenty-odd years. The door of his funeral parlour is locked when I arrive. I ring him on his mobile, and it’s a somewhat dusty Frank who gets out of his van a few minutes later. Although he conducts virtually all the funerals in the village, there aren’t enough to keep his own body and soul together, so he undertakes various other jobs on the side. Today, I’ve interrupted him plastering someone’s living room.
He takes me inside and I perform a brief examination of the deceased, confirming her identity and excluding neglect or foul play in the absence of any obvious signs. In truth, it’s a redundant exercise. Frank gives me a swift run-down of Brenda’s life story, family connections and notable contributions to the village. He’s always known his deceased personally, often for many years, and nothing untoward would make it past his eye. His trusted place in his community has more than a little to do with the affection and respect he always shows towards the recently departed.
Following the Harold Shipman affair – in which the GP serial killer repeatedly evaded the checks in previous cremation certification procedures – the Part Two doctor is now obliged to make additional inquiries of someone who nursed the deceased during his or her final illness. This can be delicate when it is a family member: something about asking whether there was anything untoward about the way their loved one died generates an undercurrent of suspicion no matter how carefully the question is phrased. Again, Frank proves invaluable, not only tracking down Brenda’s daughter (she wasn’t on the number Peter had given me) but putting her at ease before handing the phone across. The only thing she has to tell me is how fantastically well Peter and his district nursing colleagues cared for her mother.
Part Two completed, I pop next door to the village shop to get some lunch. The assistant and the customer in front are ruefully discussing Brenda’s demise. The news has spread quickly; they even know the time of death. Living and dying in such a close-knit place might be too claustrophobic for some, but there is a connectedness and belonging here that seems the very essence of community, something increasingly rare in this country of ours.
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