I have a theory, if LL is found guilty, that she was not motivated in an ego-stroked kind of way by the attention she was receiving from doctor choc, but she was motivated to take advantage of his blindness to anything that was happening being caused by her and his endorsement of her utter brilliance and faultlessness, to be able to increase her (alleged) attacks. I think she wasn’t so much compelled to act that frantically, as much as she saw the opportunities, had carte blanche with doc choc on duty, and the cover he provided her, to take advantage of.
He provided her with not just endorsement of her skills in meetings with consultants, but he was also feeding her information from higher up which empowered her to feel invincible and protected from suspicion.
I don’t think she was the only one to have a short sharp shock when she was barred from the unit, I think he had closed his mind completely, lost all ability to make judgements and to be objective about what was happening. I think that’s why their communications were deemed relevant to the case, and admitted into evidence, to show how she seized opportunities and took advantage of situations and colleagues, particularly doc choc, if guilty.
JMO
Letby says she had reassurance from a doctor colleague, and was "close to him in the later stages".
Letby said after a difficult day at work, she would 'seek reassurance', including a doctor colleague, and she would seek information about some debriefs when babies had died in which she had been involved in their care.
her notes
“I trusted you with everything”
"I wanted you to stand by me but you didn’t"
some of doctor's communications to LL
15th June – after baby N
'Oh Lucy, poor little thing and you.
Your day sounds as though as it's been horrible. Poor you. Are you going to be OK? I'm sure he's had the best care possible today and that you will have done everything you can for him.
'Look on the top shelf. Right hand side. For the walk home. Your [sic] still welcome to the car.' 'Chocolate makes bad days a little better. 'It was well deserved today. Are you OK?
LL: 'What do you think caused his (Child N's) bleed?'
22nd June – day LL flew back from Ibiza
“I like it when you're in itu - everything feels safe and well organised"
23rd June - after death of baby O
I was glad you were there, everything felt safe. Thank you for looking out for me.
I was trying to say thanks for checking I was okay. We do work well together
The doctor messages LL to say the debrief didn't find anything that was missed for the events of O.
24th June
doctor messages LL again that morning asking how she slept and letting her know that a medical director has been on ward
Baby P - Dr Ukoh responded to the crash call and he said one of the nurses asked if doc [choc] could attend. The nurse wanted doc [choc] in particular, so he was bleeped
25th June - After baby Q
There is nothing to worry about
You can't be with two babies in different nurseries at the same time, let alone predict when they're going to crash
Nobody has accused you of neglecting a baby or causing a deterioration
Lucy, if anyone knows how hard you've worked over the last three days it's me. The standard of care delivered is tertiary nicu level. if *anybody* says anything to you about not being good enough or performing adequately I want you to promise me that you'll give my details to provide a statement. I don't care who it is and I don't care if I've left the trust. Promise?
You didn't miss anything that I would expect an experienced itu trained nurse to spot. From a resus point of view you were flawless. It's why I am so happy to work with you. You don't flap, you give perfectly sensible suggestions and things run seamlessly. (You must be good Rackham said so (seldom praises)). No more doubt - it's not you, it's the babies.
I do wonder if they may have had adenovirus - it's terrible in neonates / perinates.
LL: Thanks, really appreciate you saying that. So relieved that it's you who has been there throughout.
It's true. You are one of a few nurses across the region (I’ve worked pretty much everywhere) that I would trust with my own children. If you're worried - I'm worried. You should do the APNP course, you'd be excellent. (In a second reference to his children he adds) They’re possibly a bit too big now.
26th June
LL: 'Bloody hell. It's not safe is it especially with what's gone on'. 'I worry that we have got a bug or virus on the unit'.
27th June
Please don’t worry. I’m expecting the same conversation tomorrow. As the medical lead for Thurs/Fri I’m expecting they’ll want a chat.
LL: I can't do this job if it's going to be like this. My head is a mess. Why is she ringing at this time. There must be a problem.
Lucy - you did nothing wrong at all. It is an odd time to ring, but you've had a rough few days and a good manager would realise that. There is no problem. I suspect my head is in about the same place. The management was appropriate and your recognition of an unwell baby was spot on. The care delivered was quick and accurate. I can't fault anything with your delivery of care to either baby last week. If there was anything I would have said so.
There isn’t anything to question. You’ve already done what anybody with neonatal knowledge would do. Look at the situation, look at the intervention and look at the response. You didn’t give any drugs that haven’t been checked or made by anyone else, you didn’t delay any treatment and your suggestions were all perfectly appropriate. There is nothing that could have been done differently.
30th June
It seems that on the SHO (senior house officer) grapevine somebody at LWH (Liverpool Women’s Hospital) has said that one of the triplets was found to have a ruptured liver. J was upset that this may have been caused by her chest compressions.
I’m not sure I believe it. It was a coroner’s PM (post-mortem). It usually takes weeks to get any report.
6th July
You need to keep this to yourself. The meeting this afternoon looked at everything with Baby O & Baby P from birth onwards. We reviewed everything. Room / meds / medical reviews and actions. We looked at all documentation med & nur. If you've any doubt about how good you are at your job - stop now.
‘so sorry that you were upset when Eirian called about that when I knew you’d done a perfect job’. There are going to be some recommendations based on staffing / kit but there was no criticism of either resus. This is staying quiet until has been to exec's.
I was invited to attend because SB and A thought it was good consultant preparation for me. There were a few questions which were easy to answer. I felt proud for both of us.
LL: That’s good to hear. I’m glad you’ve had positive feedback too. You were fantastic. It was an awful situation but I wouldn’t have wanted anyone else to be there. I now feel confident that we did absolutely everything and it’s reassuring to know that the documentation reflects that.
I wouldn’t have wanted anyone else but you to be looking after baby O or baby P. We do work well together.
LL is sent a confidential email addressed to the doc from Dr Stephen Brearey, advising that the deaths of Child O and Child P were likely to result in an inquest
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