The Watchful Eye

‘The Watchfull Eye

The Silent Tongue

And the Secret Heart.’

Taken from a Staffordshire jug, circa 1820.

The child lay in her cot, eyes frozen, as the door opened quietly. She watched the shadow darken her view as the door was closed equally quietly. She moved her head to follow the shape as it approached her, hardly breathing as the shadow loomed over her cot, stretching a hand out. She whimpered but was still. Only her tongue flicked around her mouth as the hand descended slowly to cover her face. She was helpless and dumb. Only her eyes could move – that and her tongue, flicking uselessly, doing little more than reddening her mouth. It was an impotent thing.

3 p.m. Monday afternoon surgery.

The toddler was sitting on her mother’s lap, watching the proceedings with wary, suspicious eyes. She was, he thought, a very beautiful child, with her fair, curling hair, yet eyes so dark there was almost no discernible difference between iris and pupil. But the feature that made this child stand out from other sweet-looking children was her lips, which were very full and red because she had a habit of continually licking them. Doctor Daniel Gregory was fascinated by the pink tongue flicking in and out of the tiny mouth. She even sucked her bottom lip in so she could wipe her tongue almost all the way down her chin. It disfigured her face, drew the eye towards it so you disregarded an otherwise sweet face and appealing eyes. The little girl should be discouraged from this habit and a barrier cream applied before it led to impetigo, an ugly skin infection.

The child’s mother was speaking to him, in a shrill, loud voice which demanded his full and immediate attention. Reluctantly he took his eyes away from the child and transferred
his gaze instead to her mother, Vanda Struel. From the day he had first heard it he had considered it a very ugly name. Vanda Struel looked as her name suggested. She was small, skinny and tense, mean-looking, with a thin, hard mouth. She was dressed in ill-fitting jeans which had slipped low down her scrawny haunches as she had sat down on the chair, the smallness of her frame making the two-year-old on her lap look outsized.

Dropping his eyes from Vanda’s wan little face with its tired, smudgy eyes, Daniel could see the string of a grubby white thong riding defiantly over the top of her jeans. He adjusted the knot on his tie. He tried to concentrate on the mother’s words but his mind was struggling to connect them, his attention divided between the child with the watchful eyes and the careless mother with her anxious face and alarming story.

‘She stopped breathing, Doctor. She actually…stopped…breathing.’

The words startled him out of his reflections.

He leant forward to be sure of catching every syllable. ‘What did you say?’

‘She stopped – breathing.’ Vanda’s mouth was open, waiting for his reaction. Like her daughter’s restless habit, her pink tongue flicked from side to side, rasping across lips as dry as bark.

Daniel focused back on the child, who had stopped looking at him and had transferred her curious gaze to her mother. He frowned. Anna-Louise appeared both normal and healthy. Superficially he could detect no obvious sign of serious disease. Nothing unusual apart from the active, anxious tongue and the shuttered expression on the little girl’s face.

A two-year-old is unable to relate a history. It must all come from the mother. ‘Tell me exactly what happened.’

Vanda crossed her legs, bumping the child against her in an awkward movement. ‘We was watchin’ telly last night,’ she said. ‘
Stars in Their Eyes
. Anna-Louise was in ’er cot. My mum says she’ll check on ’er. Right?’ It was as though she was worried that Daniel might not understand her story.

‘Next thing is my mum’s shoutin’ for me, sayin’ Anna-Louise isn’t breathin’. I went in and she was sort of flopped in the cot, lyin’ on ’er back, pale and awful quiet. I picked ’er up, Doctor. She was still as…’ Vanda Struel cast her eyes around the room for something suitably motionless. ‘As still as your desk,’ she finally came up with.

‘And
was
she breathing?’

Vanda shook her head solemnly, scattering her honey-coloured hair. ‘She weren’t.’ Her eyes were wide, round and puzzled. Unlike the child’s they were dirty blue and she was looking to him for an answer. ‘My mum had to give her the kiss o’ life, Doctor. Her lips was navy blue.’

Anna-Louise, star of the drama, sat impassively throughout, her eyes wandering between the two adults in the room, her tongue still exploring as much of her face as it could reach.

‘And did she breathe after you’d given her the kiss of life?’

‘After a while she did, Doctor, but it took ages.’

‘How long?’

‘Five–ten minutes.’

Daniel’s mind was already rejecting this. Five or ten minutes without breathing starves the brain of oxygen. And a brain starved of oxygen begins to die. Fast. He gave her a chance to retract or modify her statement.

‘Are you sure it was
that
long?’

The smudgy eyes looked straight into his, opened very wide to coax him into believing this fantastic story. ‘Yeah. My brother kept his eye on the clock. Said he’d give us ten minutes and if she hadn’t of started breathing again he was going to ring the ambulance.’

‘So what did you do?’

‘Kept her warm.’ Vanda’s eyes flickered away as though she suspected he disbelieved her story.

‘
Did
you call an ambulance?’

‘My mum said it weren’t necessary. Breath-holding, she called it. She said I’d done it a time or two when I was a kid and it never seemed to do me any harm.’ She hitched her jeans up self-consciously, tucking her thumb in the hip band to push the string of her thong out of sight. Daniel’s eyes flickered away.

‘But if you hadn’t been there?’ He was already fingering his stethoscope.

Vanda shrugged.

‘Has she ever done this before?’

Vanda shook her head, moving the thin strands of hair from side to side.

‘Did she shake or twitch?’

Another bemused shake of the head.

‘Did she wet herself?’

‘No, Doctor.’

‘Were her eyes open or closed?’

Vanda leant forward. ‘
That
was the funny thing,’ she said dramatically, as though she had waited for this question. ‘They were open – all the time. Like she was staring at me but not quite all there.’ She tried to make a joke of it. ‘You know – the folk was home but the lights was out.’

Daniel didn’t smile. ‘Has she been ill recently?’

‘No more than usual. She’s always a bit sickly, if you know what I mean.’ She looked at him with a plea in her eyes.

Now both of them were studying him. Mother and daughter. Complicit.

He made his decision. ‘I think I’d better examine the little lady,’ he said. ‘Take her into the examination room, if you like, and undress her. I need to take a quick look at her notes.’

He scrolled quickly down the computer screen, his chin propped on his palm. The consultations were many and various. Stomach pain, constipation, diarrhoea, uncontrollable screaming, listless, off her food, temperature, rash, headache (Vanda had reported she had been clutching her head and crying). Anna-Louise had been subject to investigations but so far all had been normal. The temperatures had always settled, the rashes disappeared, the constipation unsupported by physical examination, the screaming child now recorded as silent. And now Anna-Louise had allegedly stopped breathing for ten minutes.

Daniel glanced at the examination room door. Not a sound was coming from behind it. No child struggling or crying at being undressed in a strange place. It struck him as unusually passive behaviour.

He thought for a moment.

It was possible that Vanda was simply overcaring and lacking in confidence with her first child. This sometimes happened with young, single mums. All their maternal instincts came to the fore while they had little experience. But in one way Vanda was lucky. Her mum lived in the same block of flats as she did and was a frequent visitor to her
daughter. He’d often seen them together, shopping, little Anna-Louise wrapped up in a pushchair.

Even better – Roberta Millin, Vanda’s mother, having divorced and remarried since Mr Struel, was a health care assistant at a local nursing home. Daniel often saw her when he made his visits. A competent, big-bosomed woman with a deep-throated chuckle and a noisy, friendly personality. Popular and extroverted, Bobby, as she was generally known, was the life and soul of The Elms Nursing Home, contributing much towards its cheery atmosphere.

So Vanda had good maternal support in the upbringing of her daughter. She was not alone.

Which gave rise to the thought that if Bobby Millin had witnessed the apparent breath-holding in her little granddaughter it was surprising that she hadn’t insisted they take the child to hospital.

It would have been the natural thing to do.

Daniel abandoned the computer and walked into the examination room. Before making any assumptions he must be sure that no organic illness had been missed.

The first thing that struck him as he entered the room was Anna-Louise, wearing only a disposable nappy, sitting still and erect on the couch, eyeing the door with the same wary expression. She did not move her head as he approached but her eyes never left him. Vanda was sitting in a chair in the corner of the room, a good six feet from the edge of the couch. Instinctively he darted towards the child and put his hand on her shoulder. What if she tumbled off?

He was puzzled. With Vanda’s heightened awareness of danger, had she not seen that a normal two-year-old might easily wriggle and fall off the couch? For ease of examination
it was more than three feet off the floor. And for hygiene the floor was tiled. Hard, ceramic tiles. It would have been quite a bump had she fallen. At the same time as he grappled with this anomaly he was aware that Anna-Louise had not moved or flinched or screamed when he had grasped her. Her only movement had been a curious swivel of her head so she could continue to regard him with those solemn eyes as though she didn’t dare to stop watching him. She didn’t try to wriggle away from his grasp like a normal two-year-old but submitted herself to his touch. She didn’t cry or object. Perhaps it was then that he began to realise just how very different Anna-Louise was from a normal two-year-old. She was a vigilant toddler who had learnt to sit sphinx-still. Why?

With an odd, cold feeling, he scrutinised her face. What was it she could not tell him? Something in her passive, returned stare chilled him.

An examination room is small, which concentrates atmosphere, sounds and presence and he was aware that there was an abnormal detachment between this mother and child. His presence was doing nothing to help. Rather he was adding to the tension.

But he was a doctor and a scientist with a job to do: exclude organic illness.

It was his habit to dangle toys in front of a child he was about to examine, play a little, make friends with them, gain their confidence. One learnt to do that when still a medical student on the paediatric wards. Mothers appreciated it, pushing themselves to the fore because they wished to reassure their offspring, but Vanda remained in the corner, taking no part in the consultation, as though she wished to detach herself from the events.

Daniel was thorough. He listened carefully to the child’s heart and lungs: the heart was beating normally – there were no murmurs; the lungs were clear. He peered into her pupils, tested her reactions and responses, palpated her abdomen, felt for her liver, stomach and spleen, all the time asking Vanda questions.

‘Waterworks all right?’

Vanda gave a jerky nod.

‘Is she eating normally?’

Silence.

Daniel turned around. Vanda was shaking her head sadly, a mournful expression in her eyes. ‘She don’t eat nothing,’ she said.

He turned his attention back to the couch. The child was not skinny but slim. She lacked the podgy arms and legs of some toddlers but she was not undernourished.

She was eating
something
.

Finally he felt for glands in her neck, under her arms, in her groin. Again nothing.

And yet instinct told him something was wrong with this child. For a start she was too submissive. The tongue licking around her mouth was a sign of nervousness. He could not hold her gaze. Her eyes slid away from his. When he touched her she might not pull away or object but there was the faintest hint of a shudder, a small ripple which moved all the way down the small body.

Putting it all together, this toddler troubled him. He handed Vanda her daughter’s clothes so she could dress her.

‘I can’t find anything obviously wrong,’ he said, ‘except that Anna-Louise needs some barrier cream for the area around her mouth. She keeps licking it, you see, which I
think is probably a nervous habit.’

He stole a look at her. Vanda was fumbling with the clothes, her mouth hanging open. He couldn’t be sure whether she had understood what he had said. He let the words hang in the air for a while and when there was no response, he spoke again. ‘Vanda,’ he said slowly, ‘are you sure she didn’t breathe for as long as you said? Was it really ten minutes or did it simply seem like ten minutes because you were worried?’

He was giving her a chance to retract her statement with dignity.

‘It
was
that time,’ she said defiantly. ‘I know it.’ She hesitated. ‘It wasn’t just because I was worried. I mean, I was, but Arnie was keeping an eye on his watch for me.’

Arnie was her brother. The town psychopath. A bodybuilding toughie who worked for a local building firm – when he
was
working. More than half the time he was cadging sick notes from Daniel claiming he had a bad back.

‘Right then,’ he said.

All doctors worry about failing to reach a diagnosis – particularly in a two-year-old. Daniel was no exception to this tendency; neither were any of the paediatricians he would refer Anna-Louise to. In these days of scans and tests, enough to fill a hundred textbooks, she must be subjected to some more of them. Anna-Louise would now run the gauntlet of the entire National Health Service. But he had his suspicions that however many tests were performed on this small child no pathology would be unearthed, and so his letter would begin with the words that conveyed a secret message to his colleagues: ‘This child’s mother claims…’

When Vanda returned to his consultation room, Daniel told her he would be referring her daughter to the hospital,
hiding behind the tired old cliché, ‘Best be safe than sorry.’

At the news her face altered. Vanda lost the pinched, worried look. ‘All right,’ she said, breaking into a smile. ‘Thanks, Doctor.’

The atmosphere in the room had melted. Vanda could look quite pretty when she smiled, he thought. She had a sort of cheeky, challenging expression on her face and quite big teeth, but they were surprisingly white and regular. Her eyelashes were long and thick, and her skin was still blooming in its youth. Born to a different mother and father, given a different start in life, had she taken other chances, she could have done something else. Perhaps she could have been a dancer, Daniel thought. She had a certain lithe grace which complemented her size.