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.