The Coroner's Inquest

The Coroner's Inquest into Steve's death took place on Wednesday, 6 July.  Such inquests are routine in the UK when someone dies as a result of mesothelioma, because it's usually caused by exposure to asbestos in the course of employment and is therefore classed as an "industrial injury"....something which could have been prevented had the proper safety procedures been in place.  

In the past, mesothelioma has mainly affected been people working in industry, the building trades and manufacturing - ship builders, boiler makers, carpenters, electricians, people in the railway and automotive industry and such like.  However, there is an increasing number of cases where exposure has been second hand e.g wives washing husband's contaminated clothes, children hugging parents with dusty clothes, or has arisen in the teaching environment because of the number of educational establishments built during the 50s and 60s when asbestos products were widely used and which have become disturbed over a period of time, exposing teachers, pupils and others in schools.  Google "Asbestos in Schools" if you want to know more about this.

As an architect and artist, Steve's employment history didn't fall neatly into any of the above categories, so there was always a chance that his death would not be classed as an industrial injury when the evidence was placed before the Coroner, even though we had a clear idea about the circumstances of his exposure in the early 1970s.  So I felt that I had to go to the Inquest, even though there was no requirement to attend.

Inquests in the UK are formal legal procedures.  They take place in a courtroom with all the associated legal niceties, such as standing up when the Coroner enters, the reading out of evidence and the recording of the procedures.  I have to say however, that the Coroner, the Coroner's officer, the court officials and the Coroner's Court volunteers were kindness personified.  I couldn't have asked for a more sensitive and supportive approach from those involved.  Nevertheless it was tough.

I have lost count of the number of Hearings, Inquiries and Examinations in public I have run personally in the course of my professional career, so the legal nature of the proceedings didn't bother me at all. Been there. Done that. Knew what to expect.  

The Inquest took place some five months after Steve's death, so the process of healing after the grieving has already started.  In recent times, I have been able to talk to people about Steve's death without dissolving into tears.  I thought I could handle it on my own, and declined the offers by two dear friends to come with me on the day.  I was treating the Inquest as a formality - important to ensure the record was correct, but otherwise not a big deal.

I had written sone of the evidence myself and had seen all the evidence submitted by others.  None of its was unexpected; there were no nasty surprises lurking in the words. I was prepared. Or so I thought....

What I was not expecting and was not prepared for, was the tidal wave of emotion which swept over me as I entered the building.  Suddenly, this was real.  It was official.  It was important.  The tears were welling up, even as I was introduced to the Coroner's Court volunteer who was there to support me.  I declined the offer of coffee and by the time we entered the "Family Room" tears were streaming down my face.  It was like the pressure valve had blown and the tap of emotion was running wide open. My reaction surprised me.  There I was.... thinking I could deal with the event in a cool, professional manner as if I was at work, and instead I found myself in tears and the Inquest had not even started.

I began to understand the importance of the volunteer's role.  She was wonderful.  From finding me a box of tissues to reassuring me that my reaction was entirely "normal" in the circumstances. We had a quick peep in the Court Room, so I knew what to expect....not an unfamiliar set up to someone who has been to Council meetings and run planning appeal hearings.  The Court Officer appeared next to explain the procedure, and to tell me that the press were present.  I said I didn't wants to talk to the press (indeed, I could hardly string two words together at that stage and was fearful that I might say something in haste to a reporter that I would later regret...)

When I was ready, we entered the Court and sat down at the front, facing the Bench, waiting for the Coroner to arrive, when we all asked to stand up.  

To put it simply, the Coroner has to ask and answer four questions about the death.  Who? When? Where? How?  The answers to the first three questions are usually easy.  Steve was identified by name, date and place of birth and death based on my evidence and that of the paramedic and GP who attended of the morning of his death at home.  However, it was a bit harrowing hearing the evidence read out...I found myself vividly reliving that morning again....

The how question was more complicated - first, there was evidence about his diagnosis and treatment, including all the clinical trials he had taken part in as well,as the chemotherapy, radiotherapy and pleurodesis he had undergone as part of his palliative treatment....then his employment history, including details of the event which we believed led to his exposure to asbestos as a student, when he was part of a group paid cash for a vacation job in 1971 knocking down walls at the School of Architecture where he studied, to create a large open plan studio.  Plus, of course, the building surveys he carried out as an architectural assistant where he may have been exposed to asbestos dust in service ducts and boiler houses and such like.  

I have written about all this stuff in the blog over the last seven years, and talked about it endlessly with anyone who asked or would listen, so it wasn't news.  However, hearing someone read it out in a Court of Law took me back in time, and it was upsetting.  The good bits ....about all the traveling we had done, the socialising, the creativity and the experiences we had enjoyed since diagnosis....were not there.  It was just all the bad, challenging, difficult bits of our lives since diagnosis to death...the bits you try to forget.  But it had to be said.

Having gone through the evidence, the Coroner gave her verdict.  Steve's death WAS a result of an "Industrial Injury" and would be recorded as such.  In summing up, she paid tribute to Steve's courage taking part in clinical trials which would help others in future, even though they didn't save his life.  That was nice of her.  

I am pleased with the verdict, although acknowledging that his death was avoidable made me angry, upset and frustrated in equal measure.  The chances are he would still be alive today, had it not been for events in the early 1970s.  That hurts.  That's not fair.  That should not have happened.  That was avoidable.  That's why it's taken my a while to write this blog post.  

I was too upset when faced again with the stark reality which I've known since 2009 but have somehow managed to overlay with positive experiences and thoughts...which was the way we got through and somehow managed to enjoy almost seven years life together after hearing the worst possible news.

However, I have now spent a couple of days calming down, reflecting, enjoying the garden and taking my frustration out on wall paper stripping as part of the bedroom refurbishment which is my next house project. Now I feel ready to share with you. 

This phase of Steve's story is nearly over.  Now the Corner has given her verdict, the information will be passed on to the Registrar of Birth, Deaths and Marriages, who will certify the death.  I can buy the Death Certificate (up to now, I've been using an interim death certificate for probate and related purposes).  That's my next little job, then I file the paperwork away for future generations.

Steve is now an official Industrial Injury statistic as well as a certified death.  

Time to look forward...be sociable, creative, travel, enjoy family, friends and Jack's Etape du Tour on Sunday in Steve's memory, raising funds for Mesothelioma UK.  

Allez Jack!  Good luck!!!