A clerk moves towards the back of the court. Her robes sweep across the carpet as she brushes past us. She is messing with a computer at the back.
And then Becky’s voice starts to play:
Ambulance. My niece is … she’s not breathing. Oh God, she’s not breathing. Help, please help. How can she not be breathing? I don’t … I can’t … I didn’t …
There is a beat of silence, and then a soothing operator asks for Becky’s address, the address I could rattle off without any thought at all. I always liked the way her postcode tripped off the tongue: BN3 3AA.
Operator: Okay, Becky, how old is the child?
Becky: Eight weeks. Layla.
Operator: Okay. We’re going to perform CPR. Five rescue breaths, into Layla’s mouth. Okay? Make a seal with your mouth around hers. Blow steadily until her chest rises. Has anything happened to the baby that you know of?
Becky: [silence]
Operator: Becky?
Becky: Her skin is totally white. She’s not moving. I … she’s not moving at all.
Operator: Have you done five breaths?
Becky: Yes.
Operator: And now the chest compressions. Two fingers, okay? Just two fingers, not hands. Thirty compressions. Depress the chest by one-third of its own depth. Do you know what that means?
Becky: Oh God, I’ve been using my hands. Oh, two fingers. Okay.
Operator: The ambulance is on its way. How long has she been this way?
Becky: Her skin is totally white.
Operator: Two fingers on the chest and thirty compressions, okay? Push down by one-third of the depth of her chest.
Becky: One-third. Okay.
Operator: Twice per second. To the rhythm of ‘Stayin’ Alive’. Do you know that song, Becky?
Becky: Yes.
Operator: Now, Becky, is the front door unlocked?
Becky: Yes. I’ve sent my son down. I didn’t want him to see … Xander, unlock the door, yes?
Operator: Okay, Becky, I can see the ambulance is less than two minutes away. Keep going with the compressions. Can you see any signs of life?
Becky: Signs of … life? No. None.
Operator: Ambulance is one minute away, Becky.
Becky: She’s not breathing at all. Her limbs are … I think her limbs are stiff. Oh God …
Operator: Keep compressing, Becky. ‘Stayin’ Alive’, yes?
Becky: Yes. Oh God, oh God, come on, Layla …
Operator: The crew have arrived now, Becky, so I’m going to hand you over …
I dart a glance at the jury as the tape stops and the courtroom falls silent. I can’t look at anybody else. Not Becky. Not Scott.
The tape exists in the few minutes right after Layla was found, and right before she was declared deceased in A&E. Right in the middle, where things might have turned out otherwise, though I know they never could have. It is harder to think about what Becky might have done differently in those minutes than it is to think about what she did the night before. I don’t know why.
‘Thank you,’ the judge says to the clerk.
Ellen stands up. ‘The prosecution calls Natalie Osbourne, the attending paramedic.’
A large woman, in a short black skirt, white top and black long-line cardigan is brought in by the usher. Her hair is dark and glossy, curling to her collarbones, and just the ends hint at auburn.
She is sworn in, and confirms she’s a paramedic, and has been for six years. As she confirms it, a flush overtakes my body. It works its way up my torso and down my arms.
This woman in front of me who is self-consciously adjusting her cardigan held my baby in her dying moments.
29
Natalie Osbourne
8.05 a.m., Friday 27 October
They were approaching the house, there within six minutes of the call. It was the very start of her day, and, already, something grim awaited. An unconscious baby, the operator told her. Her skin was white. Not breathing, no pulse. CPR being performed. It didn’t sound good.
Natalie had a head cold. It had kept her up for most of the night. In the end, at four o’clock, Adam had made her up a bowl of Vicks, just like her mother used to do for her.
But she wasn’t fuzzy-headed any longer. She was completely and utterly alert. An unresponsive baby. Adrenaline pulsed through her body.
The house was tall and slim. They abandoned the ambulance on the drive and opened the door. Immediately, Natalie could hear the commotion upstairs.
‘Oh God, oh God, come on, Layla,’ a woman was shouting.
Natalie ran up the stairs. The nursery was the first door on the right. Her eyes were on the baby, and the woman who she presumed to be the mother. Her colleague saw the other child, the nine-year-old, tear-stained and standing on the landing, peering in horror at his mother, and took him downstairs.
They didn’t call the deaths of babies. That was Natalie’s immediate thought when she saw the body. And, later, she wished she hadn’t had it, that she hadn’t been so pessimistic. Would she have done anything differently, she thought, later? No. She wouldn’t. She knew she wouldn’t, and yet … she couldn’t help but relive it again, just to see.
That baby. She stood on the landing and stared at it, for just a second. You learnt to spot it. You learnt to spot the signs. Not blue as she would have presumed, when she first started out in the job. Not blue, no: white. Floppy.
The room was almost empty: a makeshift nursery, it looked like. A Moses basket. A chest of drawers. A faded carpet, worn in patches in the middle of the room and good as new at the edges.
Natalie was measuring doses and felt a lurch of sympathy and wished she could tell the mother, then. To save her the hope of the resuscitation, of the ambulance journey, of the cold, sterile resus room in A&E, the doctor’s sombre expression and, finally, the baby being wheeled away to the morgue. They could do it now; a black body bag might be kinder, in a way. But she couldn’t: the list of deaths she could call was minuscule. Dead on arrival: it was the doctor’s job.
It was rhythmic. Natalie moved in. The air bag. The adrenaline. It came naturally to her. But the whole time, she was thinking: This is futile. Absolutely futile.
Natalie glanced at the mother. She was ashen, a tissue clutched in her fist, brought up to her face. She was shivering violently, pulling a cardigan around herself as she turned and closed the bedroom window. The sound of it closing seemed to reverberate around the bedroom.
The finality of it.
30
Martha
‘No questions,’ Harriet says demurely, standing briefly before settling back into her seat.
Ellen rises. ‘The prosecution calls Amanda Thompson,’ she says. ‘The treating doctor in A&E.’
I am determined to stay for the entire examination, which will be led by the prosecution. I am pinned to my seat as though forced to watch a beheading, although I will never be able to unknow what she tells the courtroom.
I turn my eyes away from Ellen and watch as Amanda Thompson collects herself, ready to give her initial evidence. I look down at my hands. Everybody’s eyes are on me.
Scott’s kind gaze.
Becky’s.
The jury’s.
I hear Amanda clear her throat. She must know the pain she is going to cause me. She’s a doctor.
And then, I can’t resist any longer, and I look up at Becky. When she sees me looking, she takes a step closer to the dock and holds a palm up. The guard removes it. It leaves a misted, sweaty mark against the glass, which fades after a few seconds.
31
Amanda Thompson
8.20 a.m., Friday 27 October
Amanda hung up the red telephone: the ambulance was on its way into A&E, carrying an unresponsive eight-week-old baby.
She reached for the alcohol gel dispenser and squirted a generous amount into the palm of her hand. It was cold.
People were right to revere medics, she thought. Amanda’s colleagues said they were tired of being treated li
ke demigods, of being asked questions of life and death at New Year’s Eve parties, but the reality was they did know stuff. Amanda knew, for example, that a call at eight in the morning about an unresponsive baby was almost always a bad outcome. She knew exactly what had happened. The parents had woken up, and had found that the baby was dead. It was as simple as that: Amanda would bet her career on it. Not that she was too fond of that asset – particularly at the moment.
She found the senior house officer eating toast in the kitchen. He was seriously young, a bespectacled child prodigy, she assumed. ‘Is there a paeds nurse on?’ she said to him.
He started, butter dripping down his chin. ‘Fiona’s off,’ he said. ‘Costa del somewhere.’
‘Damn. Thanks. Red phone’s gone – get ready. Happy Friday …’ she said grimly. It was usual, in a hospital, this black humour, gallows humour. But there was nothing funny about this.
Eight weeks. The baby would be about five kilograms. Amanda worked out the drug doses and lined them up. Adrenaline, glucose, fluid volume, sodium bicarb, calcium gluconate. She hoped the baby wasn’t very fat or very thin, or she would have to recalculate, and there wasn’t time for that. Or perhaps, she thought, perhaps there was no rush at all. Perhaps it was all over. Her hands stilled over the drugs as she thought it, and she shook her head. Concentrate.
The team arrived quickly. They had been well trained by her. They formed around her, becoming a functioning unit, like a swarm of honey bees, caring only about the good of the group.
‘You take the airway,’ she said to the anaesthetist. He immediately walked around to the head of the bed in the resus room, a curtained-off area in A&E where people came to live or die. Afterwards, after the resuscitation, it would be littered, like a war zone of plastic packaging, blood, bodily fluids. Nobody knew about the indignity of it, except the medics. The medics knew. People were deposited in here by paramedics, splayed naked, catheterized, bruised by paddles on their bare chests. They coughed and vomited and wet themselves, and afterwards, it was swept away, mopped up, like it had never happened.
‘Paeds reg – sorry, I don’t know your name – please do circulation. Nurse, take times and scribe. Please.’
‘Okay,’ the staff nurse said.
Shame she didn’t have paeds experience. Amanda could do with the help.
‘We have a baby, eight weeks. Found unresponsive this morning,’ Amanda said to the team.
‘Shit,’ the paeds registrar said.
Quite right, she thought.
The second staff nurse arrived, and Amanda told her to get the Hartmann’s fluid bags ready: pump them full, get them warm. The first rule of A&E medicine. Especially with children. Everybody thought medicine was the job of brainiacs, but it wasn’t, not really. It was largely as rudimentary as plumbing. Luckily, it was usually more interesting. Though, like most truly interesting things, it broke your fucking heart.
‘I’ll lead the resus,’ Amanda said. She checked the watch in the top pocket of her scrubs. They’d be here any second now.
They had asked her what drew her to A&E in her registrar interview, and the truth was that Amanda was better in a crisis than anywhere else. Without a deadline almost upon her, she did nothing. She had two switches: workaholic and complete dosser. She never occupied the middle ground. She needed blood and gore and red telephones. She used to occasionally crave a car crash to occupy her night shift. Now, she didn’t recognize that crass woman in her registrar interview. But what would she say, today? ‘They die,’ she would say simply. ‘Don’t give me the job. I can’t handle death.’ Why had she thought she could handle it? She didn’t remember even thinking about it at medical school, but wasn’t death at the very centre of her occupation? Death, not life, as she had previously thought.
The ambulance arrived outside and the paramedic, Natalie, rushed in to hand over to her. Amanda didn’t look at the baby, not yet. She looked at Natalie’s brown eyes, ringed with thick kohl, and she listened intently. This was the second rule of A&E: bleed your handover dry. They always knew more than you.
The nurses moved Layla on to the resus trolley while Amanda listened.
‘This is Layla,’ Natalie said. ‘She is eight weeks and two days old. Normally fit and well. Found unresponsive in her Moses basket. No signs of life. CPR commenced eight minutes ago with no ROSC. Adrenaline given.’
Her anaesthetist bagged and intubated immediately, as instructed, but Amanda stood there, watching, deciding what to do. That was the third rule of A&E: always think, even just for a second, before acting. That valuable second’s thinking time had saved lives, before. ‘Wait,’ she had said a few weeks ago, looking at the way a middle-aged woman who had fallen off a horse held herself. ‘Scan again,’ Amanda had said. And there it was, on the second X-ray. A slight misalignment of the spine which would have left her paralysed if they had relied on the first X-ray and discharged her with analgesics.
She turned her gaze to baby Layla. And there it was. The evidence that she had been right to pause, momentarily. She took a deep breath. Right: at least now she knew.
‘Adrenaline,’ the paediatric registrar said.
She reached an arm out to him, and one out to the anaesthetist, too, both of her arms stretched wide like a bird’s wings. ‘Stop,’ she said.
The anaesthetist looked up at her, both of his hands around the endotracheal tube. His hands stilled around it. It was impossibly small. Only 3.5mm; the third-smallest size.
‘No more,’ she said softly, and the registrar stopped fussing with the joules setting for the paddles. ‘She has rigor.’
Rigor. The paramedics couldn’t call death – that was Amanda’s job – but there it was, right in front of her. Layla’s arms were frozen, held rigid by her sides, as though she was steeling herself against the cold; tiny frozen fists against her fat thighs.
The nurse was still determinedly working on her, stripping her yellow Babygro off – it had bear patterns on the feet – ready for more CPR, but Amanda just repeated herself, calmly but firmly: it took different staff different amounts of time to accept it. It always had.
Layla’s skin was already mottled and blemished. The blood had slowed, stopped, and was settling in the dips and undulations of her body like snow in valleys and at the bottom of hills. Her lips had turned a darker, deeper shade of red. Burgundy.
Amanda blinked slowly. ‘Please stop, now,’ she said to the nurse. ‘It’s inappropriate.’
That was the word that did it. Inappropriate. It meant something to medics. It carried weight: it meant cruel and futile and not in the child’s best interests. They had all attended lectures on the meaning of these phrases. Nurses, doctors, paramedics. Separate lectures, the same meanings. Ethics.
Amanda couldn’t help but reach out a hand to touch Layla, though. Not to assess her. Not for any science. Just to comfort her in her final moments. Even though Amanda knew that those moments had taken place long before she got there.
Layla’s skin was waxy, and room temperature, like a doll’s. Amanda always found it so very strange to reach out and touch a body and it not be warm. Like a bubble bath that was cold upon entering. It was always a shock.
Amanda said a small prayer for Layla. Another thing she never would have done, back then, when she was an ambitious registrar.
‘Eight thirty-two,’ she said. ‘Pupils fixed and dilated.’
Another death.
Called.
She took the baby’s rectal temperature. The police would want it to time the death. If it was suspicious. They used a nomogram, which Amanda vaguely recalled learning about in some extra training session given on an evening a couple of years ago. Some calibration between the ambient temperature of the room where the death occurred, the rectal temperature in the body upon discovery, and the weight of the body. With that, they were able to estimate the time of death to within minutes.
Layla was taken to the morgue by a porter, her skin now the exact shade of the grey linoleum floor pa
ssing quickly underneath her. Just hours previously, she had slept in a Moses basket. Amanda blinked, and thought perhaps she wouldn’t be a doctor for much longer. She shook her head, trying to clear her thoughts. She should go home; get some sleep.
She left the resus room and had a moment to herself, just for twenty seconds. Deep breaths in and out. Feelings weren’t feelings. They were tangled mixtures of hormones: cortisol, adrenaline, rushing through her system, telling her lies. She knew this, and still they felt real.
It was time to tell the parents.
She didn’t immediately spot the mum. She usually did straight away – it was obvious. Maybe she was tired, at the end of a night shift, her body wrecked and tense. But no, she thought afterwards. Really, it was because the woman – Becky, she later learnt – was acting strangely.
It had been something about her stance. Too upright, and expectant, like somebody waiting to make a complaint, not to hear the fate of their child.
‘Yes?’ Becky said, when Amanda ventured forwards, which Amanda thought was stranger still.
‘Are you the mother?’
‘On a plane. I’m the aunt,’ Becky said.
She would have to do this twice. For just a moment, Amanda felt like she could never do it again.
‘I’m very sorry …’ Amanda said.
And that was all it took. The rest of it was normal. The immediate bending over double that everybody did upon being told of a death. The hollowing of the cheeks, as though the wind had been knocked out of them. Eyes downcast, darting, thinking: Can this be?
And so it followed the usual patterns. Becky’s tears. The hysterical call to Martha, the mother, as her aeroplane taxied along the runway. Becky had to repeat herself three times to get the message across to her sister.
But Amanda had not forgotten those initial reactions. And then, when the scans were done, the post-mortem complete, and the arrest had taken place, she had thought: Yes.
No Further Questions Page 15