PROLOGUE
The cry builds. At first it is pitiful. A creak and a crackle. Tentative, tremulous, just testing how it will be received.
The doubt quickly flees. The whimper becomes a bleat, the catch hardening as the cry distils into a note of pure anguish. ‘Shh . . .’ her mother pleads, reaching into the cot and holding the baby at arm’s length. The sound buttresses the space between them. ‘It’s OK, baby. Mummy’s here now. Mummy’s going to make it OK.’
The child stares at her. Eleven weeks old; in the fierce grip of inconsolable colic; her eyes two beads that glower, incredulous and intense. Don’t be ridiculous, these eyes say. I am livid and I’m livid with you. Her face folds in on itself and her Babygro dampens as if the rage that is turning her body into a white-hot furnace is so intense it must escape.
‘Shh, shh. It’s OK,’ the mother repeats. She is suddenly wary. Sweat licks the child’s brow and her fontanelle pulses like some alien life form just beneath the surface of her skin. Evidence of her pumping heart, of the blood which courses through her veins and could burst through this translucent spot, as delicate as a bird’s egg, so fragile the mother daren’t touch it in case it ruptures. The beat continues, insistent, unrelenting. Like this baby’s uncontrollable rage.
The cry cranks up a gear and she draws the baby close. But the child writhes against her, fists balled, torso arching backwards in anger or pain.
‘It’s OK.’ Who is she trying to convince? Not this baby, who has been crying for the past eight weeks. And not herself because every time she thinks she’s found a fresh solution – a hoover sucking at the carpets; an untuned radio hissing white noise – the rules of this particularly cruel game shift and she has to think again.
‘Shh, shh.’ Her eyes well with self-pity and frustration and an exhaustion so entrenched she is sometimes knocked off balance. Please be quiet, just for a minute. Be quiet. Just SHUT UP! she wants to say.
The wails seem to mock her. A terrible mother. Not even your first. You’re meant to know how to comfort your baby. What will next door think?
‘OK. OK! ‘ She is shouting now. The baby squirms. She is pressing too tightly: frightened, she releases her grip. And as she does her baby’s lungs expand so that she erupts in a blast of fury that turns her tiny body rigid, fierce energy pulsing from the tips of her toes all the way along the length of her spine.
‘OK, OK.’ Like an addict desperate for a fix, she will do anything now for silence, and so she stumbles to the bathroom; strips down to her bra and pants. Then she flings a heap of clothes into the washing machine, switches it on and, huddling in the darkness, pulls her daughter close.
The machine starts up: a rhythmic swish as the drum fills with water then turns, noisy and repetitive. White noise that is the most potent balm. The cries catch, falter, stop, as the swish and the slosh and the dull clunk of the spinning clothes fill the damp, dark room.
She risks glancing down. Two eyes stare back. Please don’t cry, please don’t cry, the plea is automatic. The baby’s bottom lip quivers and the uneasy quiet is broken with a bleat. Great gulps of rage soon drown out the heavy lullaby. Please be quiet. Just be quiet. Be quiet, won’t you? Just be quiet, for God’s sake!
It’s no good. The walls push in; the heat bears down and the noise – the terrible crying that has been going on for three hours – engulfs her. Her eyes burn and she feels like joining in. She cannot cope with this: she cannot cope. She does not know how much more she can bear.
They say you should leave your baby when you feel like this. Put her down, close the door, and walk away. Remain elsewhere until you feel calmer. But then the crying will continue; the baby quivering more with anger than a cause that can be fixed, like a wet nappy or pain. Doesn’t it make sense to hold her tight, to plead, to bargain, perhaps to shout? To try to shake a little sense into her? No, not that: she knows she mustn’t hurt her baby – though if she could shock her into silence, if she could stifle that noise again . . .
At moments like this, her mind fills with toxic thoughts. You’re a bad mother. She’d be better off without you. And then, insidiously, the more shameful ones that she tries to shake away.
Thoughts she can barely acknowledge, let alone express, about the desire – just for a moment – for this child to be silent always.
LIZ
Friday 19 January, 2018, 11.30 p.m.
One
It is definitely the short straw of hospital medicine. A&E in a trauma centre on a Friday night in late January; almost midnight, and the waiting areas are rammed. Patients glazed with boredom slump on every available chair, a queue is waiting to be triaged and we’re nearing the mayhem that descends when the drunks and the lads whose fights have turned a bit nasty roll in, lairy, disruptive, laughing in the face of reason. If the abuse turns physical – walls punched, a nurse shoved, a Sri Lankan doctor spat at – security will have to be called.
A cold January means that the hospital is already busy: filled to ninety-nine per cent capacity. A&E is on the brink of turning away ambulances: almost on red alert. Many patients don’t need to be here: not least those who couldn’t get – or didn’t think to get – a GP’s appointment and who now realise that a long and uncomfortable weekend stretches ahead of them unless they hotfoot it to A&E in the belief that doing so will make their virus swiftly better. They’re the ones who are the most vocal about the long wait, who hover by the nurses’ station ready to harangue them. The properly sick don’t have the energy to complain.
I wouldn’t go near an A&E in a busy trauma centre on a Friday night unless my life depended on it. Nothing short of a cardiac arrest, a stroke, a fracture or a massive haemorrhage would force me through the automatic doors. So why am I here, breathing in the fetid fumes of others’ illnesses; tramping the corridors; peering at the faces of the frustrated, and those with life-threatening conditions who wait, two, three, four hours – or sometimes more?
Well, I don’t have a choice. This is my job. Senior registrar in paediatrics at St Joseph’s, west London: a major acute general hospital and trauma centre at the cutting edge of clinical care. My career hasn’t been meteoric: two babies and two six-month maternity leaves plus disappearing down a cul-de-sac of research mean I’m still not a consultant, unlike the men I studied with at med school. But I’m only a year off and then I’ll have reached the giddy peaks of medicine’s hierarchy. Twenty years of study and I’ll finally be there.
I’m not a doctor who works full-time in A&E. I’m here because I’ve been called down from the children’s ward to see a patient. But I’m the sort of doctor on which every hospital depends. Sufficiently senior to make crucial decisions; sufficiently junior to be based in the hospital during long nights and weekends on call. Dressed in periwinkle blue scrubs, what you see is what you get: someone pragmatic, no-nonsense, approachable, empathetic; occasionally a little blunt, according to my teacher husband, but a good person. (I work with sick children and deal with distressed parents, after all.) Physically unremarkable: five foot six, wiry dark brown hair scraped into a ponytail, a permanent crease between my hazel eyes. Negligible make-up, no jewellery except for a thin gold wedding band, worn and scratched. White hospital crocs: good for running. Easy to wash when splattered with blood.