Have you ever noticed how quickly people detach themselves from you when you are under suspicion?
Most people, at least.
‘On Saturday.’ He watched her face change again into the frosty, polite stare of a stranger.
‘And how was she?’ Her voice was formal.
He drew in a deep breath. ‘She had a nasty boil on her leg,’ he said, ‘I gave her some antibiotics. But there was nothing else I could put my finger on. I expedited her paediatric appointment. She would have seen the paediatrician this week, I would have thought.’ He appealed to her then. ‘But you know what she was like, Lucy. She was always here at the surgery. She’d been in and out of hospital virtually all her life.’ He could feel his anger rising. ‘She’d had every bloody test under the sun. Not one of them was significantly abnormal. No one ever found anything.’
She looked disturbed at his anger. ‘But you say she died.’
His anger increased. He’d tried, for goodness’ sake.
Lucy nodded slowly, the constraint still making her face a strange mask. ‘I’m sorry,’ she said and left it at that.
Daniel felt frustrated. He’d expected Lucy to at least back him up, show him some loyalty.
He regretted that Sammy was on holiday, back in his native New York, visiting family, so he couldn’t speak to him. He wandered into his surgery.
Somehow he got through the day and out the other end. He had booked a few minor surgery cases in the afternoon so didn’t even go home for lunch. He hadn’t fancied running the gauntlet of the High Street anyway, possibly running into Vanda or Bobby or even Arnie all over again. By the time he had finished for the day he felt weary, exhausted and worried. Every time the phone rang he expected it to be the coroner with the results of the post-mortem, but no one contacted him, which left his questions unanswered. What did she die of? Was it preventable? Could I, should I have prevented it?
When he left the surgery he noted that Lucy Satchel’s car had already gone and he felt alone, deserted and isolated. Marie Westbrook was on holiday this week so he couldn’t even confide in her or go for a swift drink. Head down, he walked the short distance home.
The four messages on his answerphone from his mother wondering why he hadn’t been in touch over the Bank Holiday just about put the lid on the dustbin. He sighed. He couldn’t face talking to his mother. Not her. Not now. Not tonight.
He hardly had the heart to open the email, but sat, for a while, staring into the screen, reflecting how very different he felt from this morning. How his optimism and hope had so completely evaporated.
But finally he did.
‘Hi, I’m M. It was nice to get your contact.’ He liked her breezy tone. ‘I’m a professional woman who lives in south Staffordshire and am divorced following a short and very unsatisfactory marriage. I have no children though I’d love some, especially a daughter. I’m 34 years old and have no ties. My family are from London. I enjoy a wide variety of activities: dancing (Salsa especially!), country walks, music Classical and folk, some Pop. I also love reading – mainly modern novels, crime, romances and anything with a historical interest, and of course eating, in particular Italian food and even more when it’s served with a good bottle of red wine.
‘I’d love to meet you. Soon.’
Daniel read the sentence twice. She’d love to meet him. That sounded good. He felt himself cheering up. It was like coming home to a friendly wife. She sounded ideal – and available. Claudine might be his fantasy woman but she had a policeman husband which to the local doctor was a serious impediment. He read on with quickening interest.
‘I enjoy cooking. Now then.’ Her tone had changed. ‘You must be wondering whether I’m attractive. Well – I don’t think people are generally sick when they see me but even I can’t pretend I’m a showstopper. I’m five-foot ten inches tall and quite slim, have medium brown hair cut round my face (medium length and straight). So why don’t we meet for a drink? Next week would be great. Just suggest a pub, Dan, and I’ll be there!
‘Yours, M.’
Daniel read the entire email through twice before hitting the reply button. No point in hesitating.
‘How about Wednesday?’ He named a pub on the outskirts of Stafford. Eccleston was far too public a place to meet someone on a blind date. Particularly now when his reputation was under threat.
In spite of downing almost the entire bottle of wine and yet another spat on the telephone with Elaine about the coming weekend, he woke the next morning feeling buoyant – bullish even. He would sit this one out.
He had a day’s grace.
He had been waiting for the coroner’s office to contact him about the death of Anna-Louise but it was the pathologist who eventually rang. Even though Daniel had anticipated the phone call he could still feel his hand shake when the receptionist rang through. He spoke into the telephone, deliberately making an effort to make his voice sound confident, deep and fully in control. ‘Doctor Gregory here.’
The pathologist introduced himself as Doctor James McReady, briskly informing Daniel in a rich Scottish accent that he was a locum filling in for Michael Gray. The fact that Daniel didn’t know him increased his unease. At least Gray was familiar ground.
‘I’ll be frank with you, Doctor. The cause of death of the little girl is by no means certain or clear.’ He was choosing his words with precision. ‘Bu-ut…’ There was a wealth of meaning in the strung out word. ‘I have my suspicion that this was not a natural death.’ He proceeded to give Daniel a tutorial.
‘Sudden Infant Death Syndrome is well known amongst the general public.’ Daniel gave a confident murmur of agreement.
‘Reye’s Syndrome is a similar sudden death in older children.’ Like a good professor he paused for his student to absorb this fact before hurrying on. ‘Certain characteristics led me to suspect this diagnosis.’ Another pause. ‘According to her mother, Anna-Louise had a history of apnoeic attacks?’
‘Yes.’
‘Reye’s Syndrome frequently follows a viral infection such as coryza.’
Why couldn’t he just say a common cold?
‘The incidence of Reye’s Syndrome is also greatly increased if there is a history of aspirin ingestion. I spoke to Anna-Louise’s mother on this matter and she admitted she had given her daughter half an adult aspirin, i.e. 37.5 mgms, two hours before the child’s death because the little girl was snuffly.’
Daniel felt a familiar irritation. Don’t they just love the sound of their own voices? Simply half an aspirin would have done.
‘But, you understand, the features of Reye’s Syndrome are quite distinctive.’
Why didn’t he just get on with it?
‘However…’
Daniel fingered his pen impatiently. He was finding his colleague’s tone intensely irritating.
‘…I found none of the usual findings consistent with Reye’s Syndrome, the pâté de foie gras liver, an oedematous brain and so on. Therefore I would have been unhappy to have made this connection without firmer pathological evidence.’
Another pause.
‘The police removed some of the bedding of the child. She slept without a pillow, which is common practice these days. Amongst other items found in the child’s bedroom they also removed a small, embroidered cushion from a chair. This was found to have traces of the child’s saliva on it. I further removed two tiny fibres from one of the child’s nostrils that looked superficially the same as the fibres on the cushion. Of course we will have to wait for microscopic comparison analysis.’
In spite of the gravity of the situation Daniel could not resist a smile. Pathologists are the perfect, indistinguishable mix of lawyer and doctor. A scientific policeman.
‘I have discussed this matter with the police and we are of the opinion that there is a very real possibility that the child was smothered using this cushion, and the finger inevitably points towards the mother. The mother is the usual perpetrator of such an assault. Was there any history of ill
ness or pseudo-illness induced by the mother?’
Daniel felt ice seep up from his feet, slowly permeating through his body as though he had been drinking a glass of hemlock. Something – life – happiness – trust – or a belief that he had a future as a doctor – was draining out of him. If this turned out to be infanticide, he would feel morally responsible but that was preferable to them finding something physical that he had missed through incompetence.
He was honest enough to admit that his feeling of guilt was because he had had his suspicions but hadn’t acted on them. He’d sat back and done nothing. Waited for some proof or indisputable evidence. Now he had it and he was indirectly responsible for the child’s death. He’d never involved the Social Services, even though he had been suspicious that all was not well between Vanda and her silent little daughter whose tongue had merely reddened her chin and cheeks without uttering a single word. He should have protected the child. It was part of his job. His duty. Instead he’d waited and now it was too late.
He’d failed her. ‘There was a history of repeated illnesses,’ he replied lamely. ‘She’d been admitted to hospital on numerous occasions but nothing concrete was ever found.’
The pathologist hesitated before continuing smoothly. ‘We-ell, you obviously know the family better than I. So I wondered what your opinion is of this theory. Of course it’s possible that little Anna-Louise slobbered over the cushion on some other occasion, bu-ut the presence of the particles in her nostrils appears quite damning. Can you answer me these questions: Is Miss Struel capable of smothering her own child? Had you any prior suspicion that all was not well between Vanda Struel and her daughter? Is there anyone else in the picture who might have been involved? The police told me the child’s uncle was resident with them and was in the house when Anna-Louise died. Have the Social Services ever been involved with the family? Have you had suspicions on other occasions of non-accidental injury? We took the precaution,’ he added quickly, ‘of X-raying her entire body and failed to find any old fractures, which tends not to support my theory. Also there were none of the other signs of traumatic smothering – bruising inside the mouth, etc. The lungs were congested but there are other causes of that and I cannot give a cause of death with any certainty on that sign alone.’
Daniel couldn’t remember what exactly he muttered in response. The questions he could answer honestly he did: that the Social Services had not been involved in the case; that he had toyed with the idea that Vanda might have been capable of causing her own child’s illnesses; that there was a question mark over whether mother and daughter had truly bonded but that he had never sensed any ill feeling on Vanda’s part towards Anna-Louise – rather an indifference; that Vanda lives with her brother, who is an aggressive drunk who pumps up his body with exercise and anabolic steroids which are well known to shorten the fuse of their takers. ‘But I’ve only ever seen him display a certain…’ His mind drifted to the image of the tiny child propped up on the sofa, her cardigan wrongly and clumsily buttoned, ‘tenderness towards her.’
He ignored the pathologist’s snort of doubt. But he hadn’t seen the two together, the town thug and the tiny, vulnerable two-year-old. He had.
Other questions he could not answer. Was Vanda capable of harming her own child deliberately?
He didn’t know. How can a family doctor make this judgement when all their training is to trust what their patient tells them?
He needed time to think before he started making rash statements. He fobbed the pathologist off with something about needing to search through his records, tagging on the fable that he would ring him back later.
Anything to get him off the hook and give him time to stew through his thoughts.
But his bad luck was far from over.
Ill winds were gusting around him.
On Friday, as his mind was busily planning the menu for the following night, Christine, the receptionist, met him in the corridor. ‘The coroner wants you to ring him after surgery,’ she said.
It rang no alarm bells. He assumed it would be a further enquiry about Anna-Louise.
There is nothing unusual about a telephone conversation with the coroner in general practice. Any unexplained death is referred to him. As it is often the GP who has vital information about the patient he is frequently the first port of call so the lines are open between the coroner’s office and the doctor’s surgery.
When he had seen his morning’s patients Daniel dialled the number.
Tom, the coroner’s assistant, answered. ‘Oh yes, Doctor Gregory,’ he said. ‘It’s about an old lady, Mrs…’ Daniel heard him shuffle through some papers.
‘Allen.’
Daniel felt initially puzzled, then, as Tom proceeded in his slow Staffordshire voice, he began to feel upset. ‘What? I only saw her yesterday. She looked well. I hadn’t expected…’ His voice trailed away as his foreboding increased. ‘What happened?’ he asked sharply.
‘It looks very much like an overdose of some medication, Doctor. Tablets were found at the side of her bed. You’d prescribed some tranquillisers?’
Daniel felt a snag of concern. ‘She was naturally anxious and was having trouble sleeping,’ he said defensively. ‘But she was too lucid a woman to take the wrong dose of tablets.’
‘Well…’ Tom paused. ‘There was a note. The relatives say she’d been a bit distracted. Apparently she’d recently been diagnosed with cancer.’
‘We-ell.’ Daniel was finding it difficult to know what to say. ‘Not exactly. I’d had my suspicions and I’d referred her for an opinion but I hadn’t had the results back yet from the hospital so the diagnosis hadn’t been confirmed.’ He felt bound to add something more. ‘But she was an intelligent woman. I think she knew she had cancer and probably realised that I suspected it had spread.’
‘Right.’ Tom’s voice leaked no emotion. ‘Well, I shall relay this to the coroner and in all probability he will request a post-mortem and some toxicology reports. That’s all then, Doctor Gregory – for now.’
Daniel put the phone down with a growing feeling that something here was not quite right. In his mind he revised his physical findings, together with the initial prescription. Then he sat down at his desk. She had asked for the sleeping tablets, he realised now, not because she was having trouble sleeping but because she intended to take her own life. He recalled their final encounter, outside the supermarket, her vote of confidence in him.
He put his head in his hands and remembered her interest in Holly. He felt a stab of grief for the passing of yet another from that brave, resourceful and inherently decent generation. Even the way she had elected to take her own life rather than allow the cancer to destroy her inch by inch, little by little, reflected her character, her dignity. She had known how cruel this disease could be.
What he did not yet understand was how this would affect him.
Chapter Eleven
Monday, 8th May
The weekend with Holly did something to allay his anxiety. He heard nothing from Claudine and as though Holly sensed that something was not quite right she didn’t even mention her new friend. But his problems were only beginning.
Monday morning brought further trouble.
The day began badly with a telephone call from the pathologist who had performed the post-mortem on Maud Allen. Dr Gray was back.
Such specialists frequently adopted a condescending manner towards their colleagues in general practice and Doctor Michael Gray was no exception. Although he’d known Daniel for a number of years he cut straight to the chase without preamble.
‘I understand that you had made a diagnosis of breast cancer which had metastasized to the lymph gland and the spine.’
The back of Daniel’s neck felt suddenly hot. ‘No I hadn’t,’ he said defensively. ‘Not exactly. I’d examined her and found a breast lump which I felt to be suspicious. She was complaining of backache and I also found an enlarged lymph node in her neck. I’d done some blood tests and referred h
er to the rapid-access breast lump clinic. That was what I’d done.’ He was tempted to add, Have you got a problem with that? but knew there was no point in antagonising his colleague.
Michael Gray cleared his throat noisily and Daniel just knew he was building up to something. ‘Well – for a start I did find a cystic lump in her breast,’ he began slowly. ‘It was quite large, about the size of a golf ball. I’ve taken a section and sent it for histology but I’d bet my bottom dollar that it wasn’t malignant. It looked perfectly innocent to me.’ His tone was smug.
It took the wind out of Daniel’s sails. He felt his face contort into a hostile scowl.
‘Well, of course,’ he finally spluttered, ‘you had the advantage on me. You actually saw the wretched thing.’ He thought how peevish and petty he sounded. ‘I didn’t.’
The pathologist took absolutely no notice but ploughed on – with increasing malice. ‘I also understand from the relatives that you suspected that the lump in her neck was a secondary deposit from this primary.’ It was a statement not a question.
‘It was a natural assumption.’ Daniel winced at the resentful tone in his own voice.
‘Oh.’ The pathologist pulled out his trump card. ‘Well – it looked like an old fractured clavicle to me. The relatives tell me that Mrs Allen fell off her horse when she was about fourteen. She broke her clavicle and it was badly set. She’d had a lump there for years.’
‘When I touched it,’ Daniel said, ‘she didn’t say anything.’
He could already guess where this was heading.
‘But of course Mrs Allen didn’t die of misdiagnosed cancer, did she?’
‘Come on.’ Daniel felt bound to defend himself. ‘I couldn’t possibly have anticipated that she would commit suicide on the back of my findings. I made my examination and acted on it. I referred her. I was doing my duty as her GP to give her the best possible chance of life. When she said she couldn’t sleep I naturally prescribed what I thought was appropriate treatment for her.’
The Watchful Eye Page 13