What have you done so far?’
‘GCS 11, pupils equal and reactive, ears OK.’ Hugh frowned. ‘But I’m not happy with his blood pressure, pulse or respirations.’
‘Checked the eyes with an ophthalmoscope?’ she asked.
‘Yep. I think the intracranial pressure’s rising, but I want a specialist’s opinion.’
‘OK. I’ll take a look. I think a CT scan’s a good idea—can you organise one?’
‘Already booked.’
Vicky smiled. Just what she liked to see: a junior doctor who knew what he was doing and who had the confidence to act on his own initiative. If this was the way Hugh Francis usually worked, he’d be in the running for the next registrar’s post in ED. ‘Well done.’ She walked with him to the cubicles. A pale, gangling boy was lying on the bed, and a worried-looking woman was sitting next to him.
‘Mrs Foster, this is Dr Radley. She’s a neurology specialist,’ Hugh introduced her. ‘Dr Radley, this is Declan.’
‘Hello, Declan—Mrs Foster.’ Vicky sat down on the side of Declan’s bed and held the boy’s hand. ‘My name’s Vicky, and I’m going to be looking after you for a bit. I hear you’ve had a bit of an argument with a skateboard ramp. I’m just going to have a look in your eyes, if that’s all right with you, and then we’re going to send you for a scan to see if there’s anything making you feel rough.’
‘I’m sorry,’ he mumbled. ‘Don’t want to be any trouble.’
‘Hey, that’s what I’m here for.’ She squeezed his hand. ‘We’ll sort it out, sweetheart.’
Hugh handed her the ophthalmoscope. She checked in Declan’s eyes, and nodded. ‘Yes, I definitely want to see a scan. Do you know what a CT scan is, Declan?’
‘No.’
‘It’s a special sort of X-ray that takes pictures of your head from lots of different angles—it pictures slices inside your head. I’ll show you them later on a computer, if you like—not many people get to see inside their own heads. And I might be able to arrange a film to be printed for you so you can show your mates later.’
‘Haven’t got any mates.’
It was said without any emotion, as if he didn’t care, but Vicky would bet otherwise. She remembered that feeling herself, only too well. Being an outsider, the last person picked for a team, and trying to pretend to everyone else that it didn’t matter…when it did. ‘Do you go to an all-boys school?’ she asked.
‘No.’
Half her problems had stemmed from going to a single-sex school where she just hadn’t fitted in. If she’d gone to a co-ed school, things might have been very different. ‘Let me give you a little bit of advice,’ she said softly. ‘Try chatting to the girls.’ Ten was an awkward age: boys still thought that girls were silly, and it was uncool to be seen talking to them. But what did Declan have to lose? Nothing but his loneliness. ‘You might find some of them like the same things you do.’
‘Girls don’t like Game Boys,’ Declan said. ‘Or the Romans.’
‘I liked computers when I was your age,’ Vicky told him. ‘So I reckon you might be in for a nice surprise. Give it a try. What have you got to lose?’ She smiled at him. ‘Now, Hugh here’s going to take you off for a scan, and I’m going to have a chat with your mum.’
‘Don’t tell school,’ Declan said. ‘Don’t tell them.’ He nearly choked. ‘Don’t say what I told you. Please, don’t.’
‘It’s OK,’ Vicky soothed. ‘There’s nothing to worry about, I promise.’
Mrs Foster had clearly only just been holding it together, because a tear leaked down her face when Hugh wheeled Declan out. ‘I’m sorry,’ she said, wiping a hand across her face. ‘I just feel so useless. I had no idea he was being bullied—what kind of parent does that make me?’
‘A normal one,’ Vicky reassured you. ‘Believe me, it can be very hard to tell if kids are being bullied. Sometimes they go a bit quiet, sometimes they go the other way. But until they’re ready to tell you, you won’t know.’ She’d done that herself. Kept it in, because she’d believed it was her fault and if anyone knew they’d despise her and treat her like dirt, too.
‘Oh, God. I don’t know what those little bastards have done to him. Or how long it’s been going on—he won’t say.’
‘When you’re bullied, you try to hide it—you don’t want anyone knowing, in case the bullies get in trouble, because you’re scared that then it’ll get worse,’ Vicky said gently. ‘Or that somehow it’s your fault, because you’re different in some way—whether it’s the way you talk, the colour of your hair, or you’ve got freckles. Whatever distinguishes you. But at least you know now, so you can help him. Keep his self-esteem high by praising him and making it specific so he knows you mean it and you’re not just being nice, and maybe get him some martial arts lessons.’
‘So he can hit back, you mean?’
‘So he can defend himself against physical stuff,’ Vicky corrected her dryly. ‘Mrs Foster, I need to know a few things about Declan before I can do anything to treat him. Would you mind answering a few questions for me, please?’
Mrs Foster nodded. ‘If I can.’
‘Has he had any previous head injuries?’
‘Not that I know of.’
Good. ‘Is there any family history of easy bruising, or bleeding that doesn’t stop?’
‘No.’
Even better. ‘Has Declan ever had a cerebral shunt?’
‘What’s one of those?’ Mrs Foster asked.
‘If he’d had hydrocephalus as a child, we would have operated to put a special valve in his head to drain off excess fluid—and it would have been replaced several times before now as he grew bigger,’ Vicky explained. And Mrs Foster would definitely have known what a cerebral shunt was—the fact she’d asked meant it was highly unlikely Declan had had one.
Mrs Foster shook her head. ‘No, nothing like that.’
‘Does he have any allergies—penicillin or anything like that?’
‘No. He’s always been so healthy.’
Even so, Vicky needed to ask the last question. ‘Is he taking any medication?’
‘No. What’s wrong with him?’
‘I’ll know more when I see the results of his scan, but I think he’s got a subdural haematoma. That’s a blood clot between the tissue of his brain and the membrane called the dura mater, which goes between his brain and his skull. It sometimes happens after someone bangs their head hard—the bridging veins between the brain and the membrane stretch and tear, a bit of blood leaks out and forms a clot.’
Mrs Foster’s face turned
