Thursday, November 13, 2008

evidence

Frank is on his knees in the living room, a stethoscope connecting him to the chest of a tiny, seven week old baby boy lying quietly on the sofa in front of him. A woman and a man stand either side of him, looking on.
‘Hi Frank. What’s happened?’
He unplugs his ears and sits back on his heels. There is something wrapped up about the way he talks to us, a coded, guarded Frank, a ‘read between the lines’ Frank that I haven’t seen before.
‘This is little baby Pete. Mum left Pete in the pram outside a house – not this house, one further up the road – whilst she went in to look for something.’
‘I went in to help my mum look for her keys. It was only for a second.’
She hooks some loose strands of hair back behind her ear and smiles at me. Her expression seems curiously measured, as if she’s reading out words that someone else has written out in crayon.
‘I won’t bother next time,’ she says.
‘Anyway. What happened was that the brakes were not on fully for whatever reason…’
‘I did put them on. They just must have come off again.’
‘…the pram rolled down the slope, tipped over, and baby Pete was pitched out into the road. Unwitnessed. Mum came out after a minute or two and found him sprawled on his front beneath the pram, crying. They put him back in the pram, brought him home. Thought he’d only scratched his forehead, but after about half an hour they also noticed that he had a big swelling coming up on the back of his head. As you can see – look.’
Very gently supporting the baby, Frank turns him sufficiently for me to see an angry haematoma about a quarter the size of the baby’s head.
‘I definitely put the brakes on. I remember doing it.’
‘He’s been crying off and on since then – about half an hour, all told.’
‘We didn’t think he was hurt. I didn’t want to bother anyone.’
The father – a squashed-up looking guy with worrying scars along the inside of his forearms – leans in and touches the baby’s head.
‘I put some Germolene on him, look,’ he says.
‘Sats fine, no obvious neurological deficit, equal air entry, pupils reactive, follows my light with his eyes. A bit quiet, though. I had a quick look, and there don’t seem to be any other injuries. But Spence I think we need to get going with this one. Could you get me a medium vacuum splint? I think that’ll do to immobilise the poor little chap.’
The parents stand back whilst we work quickly to bundle Pete up and get him out to the vehicle. They chat casually as I carry him out, passing the offending pram in the kitchen. I know that suspicion is an infectious entity. I know that once an impression something is wrong takes root, you start to see only what you expect to see, to bend everything to fit the tenor of your concern. But I can’t help thinking that the pram looks as if it has been in the kitchen for a while, like a boat silted up in an old harbour, and that the parents are remarkably unconcerned.

A quick blue light drive through town and we arrive at A&E. There is an impressive team waiting for us – Consultant Paediatricians, specialist nurses, doctors, even porters and admin staff to expedite the reception of this little fellow. The parents stand to the back of the group as I give a handover, and expert hands begin plugging the baby in to the monitors, and assessing his injuries.

Outside resus, I take the senior A&E sister aside. I tell her that we have some misgivings about this case, and want to report them to the appropriate figures here at the hospital, on top of the forms that we’ll fill in back on base for suspected non-accidental injury.

After five minutes or so, the Consultant comes out of resus and we all go into a quiet room. He listens to our concerns with an air of cool appraisal.

‘This is a supremely difficult area,’ he says, cupping his hands around his knee and rocking gently on the chair. ‘Supremely difficult. I think firstly, as far as the delay in calling you guys to this accident, that doesn’t surprise me. You see it a lot. Because parents often think – consciously or unconsciously – that if their child has had an accident, they will be blamed or fall under suspicion, and the child may, in the worse case scenario, be taken away from them. So I suspect they probably suffered this accident, and waited a bit until the extent of the injuries became undeniable, and then they had to call for an ambulance. Skull fractures take a little while to appear. I bet they really did think the baby had escaped with only a scraped head. What will really be interesting to see is if their stories change over time. That’s what we must pay attention to. That’s such a good indicator. So please – write down exactly what was said, and we’ll see how it matches up later on. Your impressions, too, of course. It’s all grist to our mill. Thank you gentlemen.’

We leave the room. I arrange with control to come off the road to return to base and make our report. Outside A&E, the father is smoking, chatting on a mobile phone. He sees me and nods once, a perfunctory little bob of the head, like I’m a guy he thinks he recognises from the pub.

Not what you might call evidence.

7 comments:

Kaz said...

Very powerful Spence.. and in light of recent news stories very topical, I hope baby Pete dosn't fall through the cracks.

Spence Kennedy said...

Hi Kaz
Such a grim story about Baby P in the news recently. Absolutely appalling.

Just going by what I read in the papers (which admittedly is not the most reliable source), I don't understand how things were ever left to get that bad. I think Haringey needs a thorough-going shake-up - but then, that was supposed to have happened after Climbie...

It's a difficult area, no question. And it'll never be 100% perfect. All you can do is act on your feelings, even if they turn out to be groundless. I'd rather risk upsetting a few parents than think I'd allowed a child to be abused.

Louise said...

I have a similar experience to blog about but I'm holding off as there is a court case pending.

Same situation if the parents had just held their hands up the accident in the first place the resultant consequences would not necessarily have occurred.

loveinvienna said...

I hope the Consultant was right but you do wonder... the calmness of the parents, the slightly odd story, the fact the father was chatting outside on his phone whilst his child was being checked over by a team of specialists...

But like you say, not evidence in itself. Any idea how it turned out?

Liv xxx

Anonymous said...

And then there's the flip side.

When our youngest was three, my wife and I were out shopping with him and his brother. My wife was holding his hand as he walked along.

Suddenly, the Little Fellow bent his knees and lifted his legs up, putting all his weight on his right arm. His elbow joint dislocated and he proceeded to scream the shop down.

If we thought the reaction of other shoppers was bad, even worse was to come at the A&E. We were both calm (I have a lot of first training and even more experience, my wife is a professional who works with children), we had a child with a dislocated arm and we were under immediate suspicion. We were questioned, popped into the "special" waiting room (spot the semi-concealed camera time), questioned more, had him taken away and questioned, etc.

Throughout all this, the Little Fellow's arm went untreated. Then, he tripped, caught his arm on a chair, and his elbow popped back in.

We finally managed to get out of the hospital, thinking the problems were over.

Six months passed, and my wife had taken both our sons to visit her parents. Grandma took the boys to the park and the Little Fellow ran in the end of a see-saw, seriously gashing his forehead.

Grandma took him home so his Mum could take him to hospital to get his forehead glued. Cue even more suspicion, especially when they called up the records and discovered a "previous incident". It didn't matter that the Little Fellow said he was with Grandma when he gashed his head, no, all that mattered was that they'd found another child abuser.

We eventually got this sorted, but we now dread having to take either of the boys to the doctor or a hospital after any sort of typical childhood incident.

They're both active boys who spend a lot of time playing outside (which some of people who questioned us seemed to find suspicious in itself) and they do get bumps and scrapes. And before anyone jumps in, most of them are suffered in the school playground.

My wife and I both worry that cases like Baby P are swinging the pendulum very firmly into the guilty until proven innocent corner.

Spence Kennedy said...

Hi Anon,

I'm really sorry to hear you went through that. It's every parent's nightmare - dealing with the injury in the first place, and then falling under suspicion. So many people I've spoken to have said how worried they were that their kid presented at A&E a few times, and maybe there was a case file growing fat somewhere.

Obviously it's fraught - for everyone concerned. The hospital / police / social services don't want to let a genuine case of abuse go unaddressed; the parents don't want to be falsely accused. At hospital they're very experienced at spotting NAIs (non accidental injury), and some of them are quite obvious / symptomatic. Quite a few are not, though, and the only thing to do in those cases is build up a profile over time.

I suppose you'd want to avoid the extremes - at one end of the scale, the terrible case of Baby P, who went without help despite dreadful injuries, and at the other, several families in the Orkneys who had their kids taken into care after flawed allegations of satanic abuse.

From the ambulance point of view, we can only act on our concerns, balancing the needs of the parents with the needs of the child. Very difficult, though!

Thanks v much for the comment.

Spence Kennedy said...

Postscript: An investigation by social services concluded that this was an accident, and no further action was taken.