More than anything, though, I want to impress him. He’s never forgotten a very early mistake I made: the sort of bad call that follows you round in this profession. I desperately want him to think I’m good at my job.
But this phone call – required because no one wants to give a ten-month-old a dose of radiation unnecessarily – will do nothing to endear me.
‘Cockerill,’ he growls, when I finally steel myself to dial his number.
‘Dr Cockerill.’ I lower my voice, intensely deferential. ‘I’m sorry to disturb you this late at night.’
‘It’s morning now.’ His voice bristles with bad temper. ‘It’s nearly half past midnight. Christ, I was asleep.’
‘I’m so sorry’ – I keep my voice low and calm – ‘but I wanted your advice. I’ve admitted a ten-month-old with bruising and a suspected skull fracture to the back of her head so I thought we should scan her to see what’s going on.’
‘Mmm.’ His irascibility hums down the line. He asks if there is any sign of a rare fracture to the base of the skull – black eyes; bleeding from the nose and ears – or of a leakage of cerebral spinal fluid, and we discuss her GCS rating, a neurological measure of how conscious she is.
‘Anything else we should be concerned about?’ A pause, pregnant with irritation, and I imagine his knees jiggling as they do when he’s frustrated in a departmental meeting: energy pulsing through his legs.
‘She has vomited,’ I say. ‘Mum says just the once.’ ‘And did she say how it happened?’
‘She didn’t see it – she had her back turned – but the baby was crawling and either slipped, or fell after pulling herself up on the side of the fridge.’
‘It would be quite some fall from that low height to create a skull fracture with, what, some bogginess?’
‘Yes.’ I need to be honest. ‘There’s something else. Mum didn’t notice the trauma, or mention she’d fallen, until I pointed it out to her.’ The words rush from me as if they will sound less incriminating said at speed.
‘And you’ve put a call in to social services?’
‘No I haven’t. Not yet.’
‘You don’t think it’s a safeguarding issue?’
‘No. I know the mum. Don’t worry: I won’t treat the baby once you’re in, and Ronan was present at all times, but she’s a good mother. I just can’t imagine that she would harm her child.’
His disbelief is clear from his too-long silence.
‘And she came in immediately?’
‘No. It happened around four . . . She came in at some point after ten.’
Another pause, steeped in suspicion.
‘I don’t like the sound of this, Elizabeth.’ No one calls me Elizabeth, except Neil when he’s angry. ‘I don’t like the sound of this at all. A delay of six hours in bringing the baby in; Mum’s failure to notice a trauma to her head; a mechanism – falling from crawling – that doesn’t necessarily fit with the injury, and a skull fracture to the back of the head? You do realise what that could indicate?’
I remain silent. Of course I bloody well know what this indicates.
A fracture to the back of the head is commensurate with a child being slammed down hard on a changing table.
‘She should be scanned, and I’ll take over at eight.’
*
The radiology pictures are available shortly after Betsey is wheeled down for her scan.
They seem unequivocal. A depressed fracture to the back of her skull, some bruising, and a subdural haematoma: a pool of blood accumulating beneath the skull and pushing inwards, compressing the brain.
I so wanted this not to be the case. For there to be no break and the bruising to be superficial. For Betsey to be discharged as soon as possible, and for neither she nor Jess to have to go through this.
But now this scan, viewed through a series of filters on the computer, confirms this is a head injury and makes the situation far more serious. I flick back to the bone filter. Indisputable: a textbook case. Instead of the nice, curved white line of the skull, there are two black cracks, and a crescent of white, a segment of bone, which has slipped from the skull like a jagged piece of a jigsaw dislodged from its space.
I switch filters to the one that lets me assess any damage to the soft tissue and shows whether there’s bleeding inside or outside the brain. The white cracks fade out of focus as I assess the patches of grey. Again, it’s incontrovertible: a grey oval blob, one centimetre across, is pushing outside the surface of the brain. I phone the radiologist on call just to check there’s nothing I’m missing and he talks me through his report as we assess the scan together. There’s no anodyne explanation. It’s all as the pictures suggest.
I feel very cold and simultaneously conscious that I need to remain calm and professional: to not be swayed by the emotions provoked by this. We have this scan showing an unequivocal skull fracture and we have Jess’s odd, evasive behaviour but that doesn’t mean we have to think the worst of her, does it?
Because most skull fractures are caused by accidents, and though I suspect Jess is lying, there’ll be a reason she has done so and an innocent explanation for all of this. But there’s only a tiny window in which I can help, before Neil sweeps in and claims Betsey as his patient.
If there’s something Jess needs to tell me, she must do it now.
*
Jess is waiting in Betsey’s bay, and sits straight up as I walk towards her. She’s been crying. A silt of mascara clings to her bottom lashes. ‘Is she OK?’
‘The CT scan showed what we thought: that Betsey has a skull fracture. There’s no long-term damage but obviously it’s worrying.’
‘Oh my God,’ she whispers. ‘Oh my God, oh my God.’ She bends over as if to retch. The vertebrae at the top of her back form a string of small, tender bumps. I want to hold her close to me, just as she held me in those first awful months of motherhood, when I couldn’t cope with Rosa’s inability to sleep. Instead, I crouch down next to her, as she might with her children, and look her straight in the face.
‘Jess,’ I say. ‘Look. There’s no easy way to say this but when a child sustains a head injury like this it raises questions, and we have to think about whether this was an accident or whether it could have happened some other way.’
‘I don’t understand.’ She looks at me blankly.
‘The thing is, it’s quite unusual to have an injury like this caused by this mechanism,’ I plough on, reverting in my embarrassment to doctorese.
‘This mechanism?’
‘I’m sorry. It’s unusual for this injury to be caused like this. Are you sure that nothing else happened? That nothing was different from how you described? I know it’s hard to think about but could someone have hurt Betsey?’ I pause – and she looks stunned that I could suggest it. I touch her on the forearm, and try one last time: ‘Or is there anything else you want to tell me?’
And this is it, her chance to open up. To say: Look – I didn’t want to say but she was crawling up the stairs and she tumbled when I wasn’t watching, when I wasn’t focused, when I was distracted by the boys arguing. Or, quite simply: Oh, Liz, I’m so embarrassed but she rolled off the bed.