Little Disasters

by Sarah Vaughan

  Fousia, the registrar who’s taking over my on-call, and Rupert, the most junior member of the team, look at me enquiringly and I fill them in on Betsey’s history, detailing the results of the scan, my discussion with the radiologist, and my conversations with Jess.

  ‘And you’ve put in that call to social services?’ Neil says, his tone light as if he’s mentioning this in passing because of course I’ll have done so.

  ‘Um, no. I haven’t.’

  ‘You haven’t?’ He raises an eyebrow. He has particularly bushy eyebrows, like a horned owl’s, and while this might sound grandfatherly, they just make him seem more formidable than ever.

  ‘I wanted to discuss it further. I’m still not convinced there’s a safeguarding issue here.’

  He leans back in his chair and rolls his Cross pen in and over his fingers. Most of us use biros: Neil has this glossy black fountain pen which he fiddles with whenever he’s thinking or irritated, his two regular states of mind. Over and over it goes now. It’s both annoying and strangely mesmerising.

  ‘So let’s get this straight . . .’ His voice drips sarcasm. ‘Mum delays bringing baby in; she claims not to have seen the trauma to the back of the head; her explanation for how it happened doesn’t necessarily fit – and yet you don’t think it’s a safeguarding issue?’

  Put like this, my judgement sounds skewed. But Neil’s determination to think the worst of Jess makes me want to defend her. If medicine’s a science, it’s also an art: one in which personal judgement and intuition play a part in determining how you act. And I’ve known Jess for a decade. Surely I would have an inkling if I thought she might harm her own child?

  ‘I hope you’re not letting your personal feelings for your friend get in the way of your professional responsibilities?’

  ‘No, of course not.’

  And yet that’s precisely what I am doing.

  ‘I have to say I’m concerned about your judgement here,’ my consultant says. A pause. ‘It’s not the first time, is it?’

  At that moment I think I might actually hate him. That he would do this to me in front of my colleagues is mortifying. Rupert is sniggering – the nervous laugh of a new boy trying to ingratiate himself with the boss – and even Fousia looks embarrassed. She shoots me a look of sympathy that I fail to acknowledge, wary of appearing weak in front of Neil.

  ‘I have never made an error of judgement over safeguarding,’ I manage to say.

  ‘Not over safeguarding,’ he concedes. ‘But none of us are infallible. We all make mistakes and your judgement’s been off before.’

  And here it is. That mistake I made when I was a very junior doctor in that first A&E job, just twelve months after finishing medical school. A potentially fatal error that he can use as collateral and that even now is proving hard to shake off.

  The meningitis rash is harder to detect on darker skin and I didn’t spot it on eighteen-month-old Kyle Jenkins, misdiagnosing the markings on the soles of his feet and his hands as a common virus: hand, foot and mouth disease. With the memory of Neil’s JFDI still fresh in my mind, I didn’t want to bother him and was about to discharge Kyle when Kate, one of the senior paediatric nurses, recognised the rash for what it was and called Neil herself. Being saved by a nurse is something that’s always remembered. An indelible black mark. But I was just relieved Kate spotted my mistake in time. And I learned never to put my fear of being humiliated before my concerns about a patient again.

  ‘I acknowledge I made a terrible mistake then but I think my judgement has been sound ever since.’

  He raises one of those intimidating eyebrows and glances at the others as if to shore up his argument. Rupert simpers; Fousia looks steadfastly down at her lap.

  ‘If you’re not being swayed by personal loyalty, I can’t for the life of me see why you don’t believe this merits investigation. I’d argue it’s negligent not to do so. Let’s not forget to whom we owe a duty of care. Referring this on doesn’t mean we think someone fractured this baby’s skull. All we’re saying is that we think there’s something that needs investigating.’

  And he’s right; much as I hate to admit it, of course he’s right. Putting in that call doesn’t mean we’re blaming Jess – just that red flags are fluttering fiercely. And, deep down, I can’t be one hundred per cent certain that no one hurt this child. I can’t imagine it was Jess or Ed – but parents can do terrible things in a moment of frustration, as I know from my own mother. Is it completely inconceivable that something like that happened here?

  I rub my eyes. My mind tilts with tiredness, those four consecutive night shifts weighing down on me so that my brain feels smudged.

  ‘All right,’ I say, swallowing down a lump that feels like a physical manifestation of my betrayal. I know that if I don’t Neil will put in that call to social services anyway. But, in his not-so-subtle power play, he wants consensus. This is a decision that will impact dramatically on this family. If we all shoulder the responsibility, it will feel a little easier.

  ‘All right,’ I repeat, looking at Neil, and hating myself for doing this. ‘I’ll make the call.’

  JESS

  Saturday 20 January, 9 a.m.

  Six

  ‘Would you like some tea, love?’

  A healthcare assistant pushing a trolley with a vast metal pot hovers near Jess.

  ‘Toast?’ She gestures to pieces of dried white cardboard-like bread and sachets of margarine and Marmite.

  ‘Tea, thank you.’ Jess takes a cup, teak in colour, and puts it by the side of Betsey’s bed.

  The tea and toast are reassuringly ordinary in this world where nothing feels normal. Not the wires and buttons, or the rest of the hospital paraphernalia: the oxygen canisters and drips. Not the children, either. Very old people should be in hospital, or pregnant women – or, occasionally, as she knows herself, postnatal mothers. Not children. That subverts the natural order of things.

  She hates hospitals. That was part of the reason she resisted bringing in Betsey. The stench, the institutionalism, the uncertainty, the knowledge that the place reverberates with sickness – and she can sense bacteria and viruses multiplying a thousand-fold each second, burgeoning through the air. When she rang Ed, she had to stop at each hand hygiene station to slather antibacterial gel in between her fingers. An elderly man was slumped on a plastic chair by a pump, the sweet stench of urine emanating from him, and she imagined his germs rising up towards her. And this was just part of the problem. Beyond the swing doors, in the unknown world of the operating theatres, she knows there is anarchy: blood spewing, hearts stopping, bowels and stomachs emptying in a chaotic mess of bodily fluids. So different to the calm and order required by a hospital. So different to everything she craves.

  She reaches into her bag for some more gel; welcomes the stinging. This acute fear of hospitals began ten years ago, when she had Kit. ‘Take Dettol wipes,’ Liz had told her, but with no knowledge of the shock and awe of childbirth, of the sheer bloody mess of it, she hadn’t seen the need. The hospital was a flagship one: gleaming, state of the art, with an atrium and two coffee chains; and a prime minister’s son among its recent deliveries. She had been unprepared for another woman’s blood studding the shower floor. Unprepared, too, for the sound of other women in the late throes of labour: guttural, animalistic noises she’d not been warned about in those antenatal classes. She had thought she would give birth with lavender candles burning and the slow movement of Bach’s Double Violin Concerto in the background, the strings lifting her to a birthing climax. How incredibly naive.

  In the end, Kit’s was a textbook delivery: apt for her easy, uncomplicated eldest. And so she insisted on having Frankie at home. It was an ideal birth. She had the soft lighting, the music playing, and Ed, who had vigorously opposed a home birth, was so proud, so supportive as this slight, slender baby – a different child entirely from his placid, nine-pound brother – slithered out of her. She felt . . . well, she felt as if she had got it right f
or once.

  She had wanted to have Betsey at home, too. But then things started to go wrong: the baby was bigger than anticipated, Jess panicked, was blue-lit to St Joseph’s, the head got stuck and they had to cut her and use forceps; were brutal – or so it felt at the time. Then things grew worse. A rush of people in the room, an urgency once they realised Betsey’s shoulders were held fast. The focus on the registrar’s face as he rummaged inside her so aggressively she felt violated. The pain. The sheer, burning pain.

  They had between three and five minutes to get Betsey out, she later learned. It’s a fact she can’t forget. Other aspects she can’t remember and had to be told later: having a massive haemorrhage tends to distract you, to muddle your mind. She only knows that as soon as she could be discharged, after a hefty blood transfusion, she was frantic to get out of there.

  And now she is back. In this ward filled with over-used air and slumbering children. Sitting by her baby, who she dare not leave in case her condition gets worse. Disorientated and exhausted, her mouth tastes metallic and her calves tingle. Gingerly, she flexes her ankles and pushes down to ease out the cramp.

  A tall, grey-haired man is tramping down the ward towards her.

  ‘Dr Neil Cockerill, paediatric consultant,’ he says, and holds out his hand. She stands and takes it uneasily. ‘I’ll be taking over Betsey’s care, since I understand you and Dr Trenchard are friends?’

  She nods. Liz has distanced herself these last few hours. It’s the nurses who have roused Betsey, every hour, and Jess isn’t stupid. Her friend might be preoccupied – in work mode – but still, she would hardly say she seemed particularly warm.

  ‘As I’m sure you’re aware, it’s not good practice to treat patients we know.’ Dr Cockerill is still talking. ‘We’ll arrange for Betsey to be scanned to check for any retinal haemorrhage, and for a possible skeletal survey. These are all standard tests in a situation like this.’ He smiles, his eyebrows knitting together. ‘Now, all OK?’

  She nods. Is he asking for her consent or just checking she understands? His words blur, the medical terminology and the supposedly familiar phrases that string them together all meaningless. Betsey being here, and this torrent of information, feels unreal.

  His next question makes absolutely no sense at all.

  ‘I’m sorry,’ she says, and her scalp prickles with apprehension. ‘I didn’t quite catch that. Please could you repeat it?’

  ‘I need to ask if there has ever been any social services involvement with your family at all?’

  She is blindsided; her chest tight; her mind befuddled as if she’s been knocked over by a colossal wave and all she can hear is the thud and rush of water.

  ‘No. No, of course not,’ she manages eventually.

  He gives a quick, business-like smile as if he doesn’t believe her.

  ‘Betsey has a skull fracture and we are concerned about how this might have happened,’ he says.

  She doesn’t react.

  When he continues, his tone is soft, his speech slow. ‘I’m sorry, Mrs Curtis, but we have to look at the possibility someone harmed your little girl.’

  *

  Somehow she gathers that she will need to be seen by a police officer. ‘It’s standard practice when we’re looking into this. They need to check what happened,’ says Dr Cockerill. He or Liz must have contacted the police because by ten o’clock, two officers have appeared.

  They’re detective constables. One male, one female. Neither seems threatening. They’re almost mundane. And yet the sight of them, with their innate authority and their intention of seeing right through her until they get to the heart of the matter, makes her crumple like a marionette whose strings have been dropped abruptly, and she finds she is fumbling towards a chair.

  ‘Jess? May I call you that? Jess? Are you OK?’ The female detective lowers her into it, watching her intently. Somehow, through the fog of her anxiety, she nods her head.

  ‘I’m DC Cat Rustin and this is my colleague, DC Steve Farron.’ The officer pauses. ‘We need to ask you a few questions about what happened yesterday afternoon to Betsey. Is that all right?’

  Jess nods again then starts to shake as they take her to a side room. A voice singsongs in her head, like a child desperate for attention – you’re a bad, bad mother - and she tries to shove it away.

  ‘I’m wearing a Body Worn camera on my chest,’ DC Rustin says. Her hair’s parted severely in the middle and hangs to her shoulders; she wears no make-up; looks competent, officious. ‘It will record our interview, so that there’s no dispute about what’s happened if we ever need to refer to this.’

  If you ever need to refer to it as evidence - that’s what she wants to say.

  Her colleague, DC Farron, clears his throat. Tall and slim, with hair the colour of weak Earl Grey and a spray of sandy freckles across the bridge of his nose, he asks if she would like a glass of water. His voice is soft with a faint West Country burr and, as he places the plastic cup in front of her, he seems quietly courteous. Perhaps he will treat her more gently, she thinks.

  ‘If we can go back to the beginning: when Betsey sustained her injury,’ DC Rustin begins, and Jess tries to reorder her thoughts, to think back to her narrative.

  ‘I was making a smoothie. She was crawling around on the floor. She must have slipped or maybe she tried to pull herself up on the fridge and fell . . .’ Is that what she told Liz? Tiredness turns her thoughts sluggish but DC Rustin is watching, and her directness forces her to focus. ‘I’m sorry. I had my back turned so I can’t say exactly.’

  ‘Where was she when you found her: in what position?’

  ‘Um . . .’

  ‘Take your time,’ DC Farron intervenes.

  ‘I think she was raising herself up on her front . . . hence my thinking she was crawling and slipped forwards.’

  DC Rustin does not let her gaze shift. ‘And yet the skull fracture is to the back of her head?’

  The air is heavy with suspicion. Jess can taste it: earthy, ferric. Her skin goosefleshes, the fine hairs on her arm standing on end.

  ‘I . . . yes . . . You’re quite right. I was confusing it with her slipping forwards, the day before. She was on her back.’ The bruising was to the back of Betsey’s head. She knows that. She mustn’t forget it. ‘She was lying on her back,’ she says, more confident this time.

  ‘And what made you turn to see her?’

  ‘Well, there was a thud and she started crying. I was in the same room with her: I’d just turned my back for a minute while I was cooking. I picked her up immediately . . .’

  Never over-explain, Ed once told her, after she was stopped for speeding and had three points added to her licence. And yet she can’t help it. Her explanation floods out, casting doubt on what she previously said.

  DC Rustin leans back and she can feel the waves of disbelief rolling off her: a gentle lapping at first, but building in intensity.

  ‘So we know that she banged the back of her head . . .’

  ‘Yes.’

  ‘And yet you didn’t mention this when you came into A&E and saw the first doctor, Dr O’Neill, nor when you were seen by Dr Trenchard?’

  ‘No.’

  ‘Why was that?’

  ‘I . . . I guess I didn’t think it was important. I didn’t think it was connected.’ She weighs each word like ingredients for a recipe she must get right.

  A pause. DC Rustin glances down briefly then looks straight back at her, her eyes a dull, dishwater grey.

  ‘And you didn’t notice that the back of her head was tender: that it felt – I think Dr Trenchard describes it as squishy or boggy?’

  ‘No, I didn’t,’ she says.

  Another few seconds of silence while DC Rustin assesses her, and heat threads up Jess’s neck.

  ‘Presumably you would have cradled Betsey’s head when you got her into the car seat, or held her in the hospital?’

  ‘Yes.’

  ‘But even then you didn’t notice
this tenderness?’

  ‘No, I didn’t, no.’ Her voice swoops and catches, and she knows she sounds flaky. ‘I was in such a rush to get here.’

  ‘You were in a rush to get here, and yet you left it six hours I think to bring her in?’

  ‘Yes.’

  A pause during which DC Rustin does not let her gaze shift.

  ‘I think earlier you said Betsey may have pulled herself up on the fridge and then fallen?’

  ‘Yes.’

  ‘But you didn’t see her do that either?’

  ‘No.’

  A pause.

  ‘So why did you say it?’

  ‘I just . . .’

  DC Rustin’s tone has segued from quizzical to confrontational and Jess hears herself faltering.

  ‘I just . . . I suppose it was an option. She’s started to pull herself up quite a lot, recently, and I thought that if she’d done so that might account for the thud. If she’d fallen from standing, she’d have fallen more heavily. That’s what usually happens because there’s further to fall.’

  ‘So this has happened before?’

  Jess gives a short laugh, harsh and off-key. It sounds mad, even to her. ‘Well, yes. I mean, of course it’s happened before. All babies fall over when they’re pulling themselves up or crawling.’ She forces herself to smile. ‘I have three children and they do fall over, they do slip and hurt themselves. They’re more robust than you might think.’

  DC Rustin smiles encouragingly. Perhaps they’ll be satisfied now. But no, the questions keep coming, and with each one, the detectives’ scorn increases. A mother who doesn’t watch her baby. Who can’t even accurately describe how she found her. Think, for God’s sake, think.

  ‘Please,’ she appeals to DC Farron, and she is suddenly engulfed by a fresh fear. She has no idea what is happening to Betsey or if her injury has got worse. ‘Please. Could I find out what’s happening to my baby? I just want to see how she is . . .’

  DC Farron’s young face softens. Perhaps saying that was canny, though the request was instinctive.