Ghost Child Page 6

  ‘Harley.’

  Harley had been standing behind my legs. I stepped to the side, so he could be seen. In the glare of the TV lights, his white hair gleamed. He put half a foot forward, but was mute.

  I said, ‘Harley, you can just tell these folk what it was that you saw yesterday.’

  There was a moment of awkward silence, but finally, he said, ‘We got bashed up, me and Jake.’

  The press waited, but that seemed to be all Harley wanted to say. He dropped to his haunches to inspect something on the porch. Lisa lifted him by the top of his pants.

  ‘He hit Jake, didn’t he?’ she said. ‘Where did he hit him?’

  Harley said, ‘Tummy.’

  I said, ‘All right, Harley, that’s fine, and now, Mrs Cashman, if you could just speak?’

  Lisa looked at me and then stepped forward. Now, we are talking here about a time before obesity became the scourge of the working class. Lisa was scrawny and pale and wearing a dress that was basically a column of terry-towelling material, held up by a band of elastic. She was a mother of four, and four pregnancies had taken a bit of a toll. Whatever she’d had up top before the kids arrived was well and truly gone. There wasn’t enough in her boobs to hold up the dress, so it was kind of hanging from her nipples. Later, when I saw the TV footage, which showed just Lisa’s head and shoulders as she spoke, I thought, ‘Oh no, she looks naked.’

  What else can I tell you about her? Well, people don’t like to admit there’s a class system in Australia, but as a cop, I can tell you it’s a fact. You’ve got crime at the top end, but it’s white-collar crime and tax evasion and the occasional jealous rage. At the bottom, you’ve got Indigenous families living on welfare – frankly, nobody is all that surprised when their kids get it in the neck. Lately, you’ve got more refugees – Sudanese and Somalis, the tallest, blackest, lankiest men you’ve seen in your life, all spider limbs, and the women dressed up like pepper grinders. They get into their own version of strife, belting each other over some ancient tribal problem. And then you’ve got Australians themselves, the white ones, the bogans I suppose you’d call them, who it’s apparently okay to have a bit of snicker at, who would snicker at themselves because they’re quite proud of the fact that they’ve got no airs and graces. They’re the people who wear ugg boots to the milk bar; they’re the people who you see today draped in the Australian flag, naked but for their stubbies and the Southern Cross tattoo on Australia Day.

  Lisa was firmly in the bogan camp, and I knew exactly what the good folk of Australia would see when she appeared later that night with Brian Naylor on the six o’clock news. She had that bad dress, that skinny body, and skinny fingers with cheap rings on all of them. Her nails were painted to look like the tail of a peacock, and her arms were bare from armpit to wrist. Her hair had been permed, dyed, bleached and then dyed red, and was now growing out like a mullet down the back of her neck. Her eyebrows were plucked into a single line of hair, and the smokes had forced her gums back so she had that witchy look that you get when your teeth are too long.

  There would be a fair amount of sympathy for her plight – it was obvious she had no education and was struggling by with all those kids – but on some other level she would have been repellent. There would have been a feeling that she’d brought much of this on herself. The only thing that saved her, I think, was that her voice wasn’t strangled. You know the way the mums in the suburbs whine? It wasn’t like that. Lisa had a voice that was deep and smoky. It sounded kind of hot.

  She looked out at the cameras and said, ‘My boy Jake got bashed yesterday. I want to know who bloody did it, and why! Why bash an innocent five-year-old boy!’

  I’d encouraged Lisa to appeal for information in a calm manner, to suppress whatever emotion she felt. I’d told her, ‘Nobody likes a lynch mob.’

  Lisa had nodded, but now, in front of the cameras, she was letting the tears come, and she was letting her anger show. Why wouldn’t she? Lisa Cashman was generating more respect and attention in front of those cameras than she’d been paid in her whole life.

  She said, ‘I want this bloke caught! I want to find out what kind of mongrel would do this! He should rot in hell.’

  She was crying now and her make-up had started to run. I put my hand on her shoulder and gently moved her back to stand with me.

  ‘We’ve got time for a question or two,’ I said.

  To myself, I thought, ‘Here come the cynics.’

  A reporter from The Sun – from memory, it was old Frank Postle – was first to speak. He said, ‘Where were you when this happened, Mrs Cashman?’

  Lisa said, ‘At home!’ and Frank, quick as anything, said, ‘Do you often send the boys to the shops on their own?’

  Lisa was fired up. ‘Whaddaya mean by that?’ she said, but before she could say more, I stepped in to defuse the situation. I said, ‘Look, I think you’ll appreciate that Mrs Cashman is extremely upset, the whole family is very upset. You’ll appreciate that we want to get Mrs Cashman back to the hospital to see young Jacob as soon as we can. Thank you very much.’

  Frank tried to interject but the bloke from media liaison stepped in. I heard him say, ‘That’s it, folks. I know you’ve got more questions and as soon as we’ve got more information we’ll let you know.’

  I rounded Peter, Lisa and Harley into a group, and pushed them back through the front door, into the lounge. I stayed on the porch for a moment longer. A cameraman, reaching down to release the hold on the telescopic legs of his tripod, said, ‘Sounds like so much bullshit.’

  Frank said, ‘Stranger, my arse. It’ll be the boyfriend. Always is.’

  Did he mean me to hear these things? I suppose he did, but I wasn’t concerned. His doubts were my own.

  Robert John Bird, Surgeon

  I remember the day that Jacob Cashman, aged five, came to the Royal Children’s Hospital, because it was Remembrance Day. I’ve observed Remembrance Day since I was a boy at school in the 1950s. At 11 a.m. precisely we were required to stand behind our wooden desks, a framed portrait of Queen Elizabeth before us. We were silent for exactly one minute, and then we would say, ‘Lest we forget.’

  As a boy, I wasn’t quite sure what I was supposed to be remembering. Doubtless there were times when I spent the minute of silence thinking something inappropriate. Now I’m older I understand. My grandfather was an army cook and my father also served in the army, so I’m not exactly short of people to think about.

  My own profession has been medicine. Like all the boys at my school, I was given a choice of three professions: medicine, the military or the law. I chose medicine, and I am now a paediatric surgeon. My clients are children: I operate on them; I try to make them well.

  In any case, on the day that Jacob came to the hospital the parade of retired servicemen from the Shrine of Remembrance on St Kilda Road to Young and Jackson Hotel on the corner of Flinders Street had taken place in the morning, and I had gone along to pay my respects.

  I seem to remember that it was a hot day, seasonally hot, for this was November. There was a feeling that rain might come – storm clouds had gathered and darkened the sky – but that feeling had been with us for many weeks. Rain would not come to Victoria until December, ruining my wife’s preparations for a seafood meal served outdoors on Christmas Day.

  The clinical notes show that Jacob arrived at the Emergency Department shortly after 7 p.m. In those days, calls to triple-O were monitored by staff able to give basic First Aid instructions, but generally unable to make an assessment of the patient’s condition.

  Paramedics aboard the ambulance could tell us more: that a child had been found floating in a swimming pool, for example, or that a woman had gone into labour and was threatening to deliver. Paramedics aboard the ambulance with Jacob Cashman told me they had applied what we then knew as the PGCS scale or (Paediatric) Glasgow Coma Scale. Jacob had scored a five, and that was troubling. A score of three on the PGCS is a patient either dead or in a very deep
coma, while a score of fifteen is a fully awake individual. A score of five meant Jacob was unconscious: his eyes may well have been open but he would not have been able to see; he would make no sound or movement; and he would respond to no stimuli. There were signs of hydrocephalus, or fluid on the brain, too. The boy’s head and face were swelling, his fontanelle (almost fused, since he was five) was bulging; and the veins across his skull were engorged.

  Then, too, there was the indentation to his skull, barely perceptible, except by touch.

  My initial diagnosis, subsequently confirmed, was that Jacob had suffered more than a head injury. He had suffered a brain injury. Let me explain that distinction. The term ‘head injury’ is generic – it describes any type of trauma to the head or skull. It does not necessarily mean the brain has been injured. Indeed, there are two basic types of head injury, one of which is closed head trauma, which does not feature penetration of the skull. (This may occur, as an example, when a man in a fist fight is punched in the head. He is bruised and sore, certainly, but his brain is likely all right.) The second type of head injury is known as penetrating trauma, where the skull itself is broken open, such as with a gunshot wound or a knife.

  As a general rule, Australian children do not get shot or stabbed in the head with knives – and for this may we remain grateful, and vigilant. The most common type of head injury in children is therefore a linear skull fracture: in other words, a simple break along the lines of the bones that form the skull. It occurs when a child is hit with a rock or a ball. Such injuries are not normally serious. Bed rest may be all that is required.

  A depressed skull fracture is more serious. It occurs when the force is more significant, and it means what it says: the trauma results in a dent in the skull bone, often to the thickness of the bone itself. This type of fracture may be associated with a brain injury – in particular, an intracranial haemorrhage, or bleeding of the brain – and this is very serious indeed.

  When a patient with a head injury arrives at the Children’s Hospital, a simple X-ray will normally be ordered, to detect any fractures to the skull. To detect a brain injury, we need a computed axial tomography, more commonly known as the CAT scan, where a series of photographs of the brain are taken from many angles and then reassembled, by computer program, to make a three-dimensional image. An intracranial probe, or ICP, may also be used. This instrument measures the pressure caused by swelling of the brain tissue, a common side-effect of brain injury. On the other hand, we might try an electroencephalogram, or EEG, which will measure electrical impulses produced by the brain to ascertain how it is working.

  For Jacob, I ordered all three tests: CAT scan, EEG, and ICP, and the results were not encouraging. In short, there were few signs that his brain was actually working as it should. I operated within the hour, to drain some fluid from it, but I was not hopeful of a recovery. Indeed, I had no doubt that Jacob was lost to us.

  Jacob’s mother had travelled to the hospital in the ambulance and rested in the waiting room while her boy was in the operating room on a ventilator. She was given permission to see Jacob briefly in intensive care. By then Jacob had the appearance of a child who was deeply asleep: his chest rose and fell, and his skin was pink. I suggested to Lisa that she go home, get some rest and return early the next morning for what I imagined would be a difficult discussion.

  I left the hospital at midnight. The following morning, while still in my kitchen, I skimmed through coverage of Jacob’s injuries in The Sun. I noted that Jacob’s mother was claiming that her son had been set upon by a person unknown. I made no comment about that to my wife – she had peppered me with questions while I prepared her orange juice and porridge – but I had my own point of view. Upon arrival at the hospital, nursing staff had stripped Jacob’s clothing from his body. I’d run my hand lightly over his limbs and his collarbone, and formed the conclusion that somebody had tortured this boy before. There were signs of damage – bumps and breaks – that had been left to heal, probably without medical attention.

  I returned to the hospital at the normal time, around 8 a.m., and checked on Jacob. I recall now how moved I’d been by the quiet dignity of his small body. Jacob was the marvel that is a child of five. He was slimmer than boys today; his chest was a perfect cradle of bone, his jaw was delicate, his hands as smooth as soap. I remember the great regret I’d felt at shaving his hair, which was white and fine, almost like that of a distinguished gentleman of eighty, and at having to leave a jagged line of stitches, black and fierce as bull ants, marching around his ear.

  His condition was unchanged except that now he had a white turban of bandages. I left him in peace.

  I did rounds. Perhaps I saw to a broken bone or to a child who needed a transfusion. Perhaps I conversed with a set of worn-out parents slumped in cushioned chairs. Lisa arrived for her meeting with me mid-morning. I understood that she was delayed because she had already conducted a press conference from home. Part of it had played on the TV at the nurses’ station. Lisa had reiterated her claim that Jacob had been assaulted by a person unknown. From her voice, I deduced that she was in an agitated state and I told nursing staff that I would be available to her upon her arrival.

  When Lisa and her partner arrived they were directed to the office put aside for me. I gave them time to compose themselves before entering the room. I took my chair out from behind the desk so there would be no barrier between us. We sat in a semi-circle, facing each other. It’s difficult to recall every detail but I would have been wearing a surgical apron and had mesh socks over my shoes, and this would have been a matter not of haste but of choice. I believe that a parent whose child is going to die not only deserves but wants to see a proper surgeon, somebody with some seniority, and the message that I’m that person can most quickly be conveyed by my wearing the surgeon’s costume. For much the same reason I take care with my appearance. I have barely any hair at all any more, only a ring of white that my wife, perhaps cynically, describes as my halo, but I keep it short and neat, just like my fingernails.

  Lisa had changed her clothes since the press conference. On the television she had appeared to be nearly naked, and I’d wondered what she was wearing, since so much skin was exposed, but she was dressed now in a vinyl suit with shiny iron marks on the fabric. I could tell that sexual allure was important to Lisa: the stocking-socks underneath her suit were fishnets, and she was overly made up.

  Lisa’s partner, Peter, was a young man – essentially, he was a very large boy – and he had a disconcerting way of abruptly raising one shoulder when he talked. He tapped his feet constantly. The back of his neck was pock-marked; here was a man who once suffered terribly from acne. His hair already receded at the forehead; to compensate, he wore it long and curled at the back.

  I began by saying, ‘Let’s start with the nature of the injury to Jacob’s brain.’

  They did not speak so I continued.

  ‘Often, in very young children, when the skull is still soft and the bones have not fused, there can be a blow to the head from one direction – say, if a child falls from a tree – and although the brain can be pushed from one side of the skull to the opposite side of the skull, the softness of the skull provides some cushioning.’

  As I said the words, I knew they were misleading. That circumstance was irrelevant to Jacob. His skull was not soft. The bones had basically fused. In attempting to explain, I had put myself at risk of blurring the message. Lisa’s face was full of confusion.

  I moved to correct myself.

  ‘Jacob is an older child,’ I said. ‘His skull is well-formed. His skull is not soft enough to allow the brain to swell or to move without injury.’

  Lisa said, ‘Will he be okay?’

  I wanted to be as clear as I could.

  ‘There is a great deal of swelling in his brain,’ I said. ‘Jacob’s brain tissue has been pushed up against his skull, and in the process Jacob has suffered a brain injury. I believe he is brain damaged.’

 
; Lisa said, ‘What can you do?’

  Now came the important part – and the hardest part. I said, ‘I’m sorry, Lisa. Jacob will not recover.’

  I expected at that moment that Peter would reach for Lisa’s hand. Such a movement between couples in trauma is so common that I’ve come to regard it as a reflex. Where there is a diagnosis of cancer, for example, the partner who is least invested – and that may be the cancer sufferer – will reach for the other partner’s hand, and press down upon it. The idea, I suppose, is to anchor both people to the room, to prevent either of them from fleeing. It did not happen between Lisa and Peter, and I was so used to seeing it that I was momentarily caught short. I rose from my chair and took the leather-bound box of tissues, a gift from my colleagues, off the desk. This, I handed to Lisa. She set it upon her lap, like a child might hold a pet.

  I continued, ‘In a situation like this, I would like to be able to give you a best-case scenario. Unfortunately, today I have only a worst-case scenario. Jacob is currently breathing with the aid of a respirator. When the respirator is removed, he will be unable to breathe on his own.’

  Peter said, ‘He’s not breathing?’

  I said, ‘That’s correct. He is not breathing unassisted, and he cannot breathe unassisted.’

  Lisa said, ‘Can you keep him on the respirator – ’ It came out something like respa-rader – ‘until …’

  I waited.

  ‘Like, until he comes around or whatever?’ she said.

  The tissue box was still on her lap, and Lisa had begun to wrap herself around it. It was to me a familiar pose: a human being under attack will cover their central region as best they can, to shield the tender organs, not least the heart.

  As gently yet firmly as I could, I said, ‘Jacob’s brain injury is irreversible. He will not recover.’

  In forty years in the medical profession, I’ve never overcome the guilt I feel at having to break news of this type. Obviously, children die every day, and it is surely conceivable to every one of us that one of our children will pre-decease us. Nevertheless, it is the thing we most fear. It is the thing we in modern medicine devote our greatest energy toward preventing. In modern times, it still seems to most of us that the death of a child is a gross violation of the pact we have with our God. He gives us children. We should, therefore, be allowed to raise them. That is the natural order of the world.