To add to my previous thoughts; wasnt she also messaging her mum afterwards about loosing child C; didn’t she say something along the lines of “new girl was devastated”.. I’m assuming new girl was the designated nurse working alongside MT for support.. but it still doesn’t explain why, if MT then took over the care as designated nurse, why LL kept going back into the family room.
UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #5
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Perhaps as a phone conversation where you make notes? I wonder if the previous “confession” type note was taken from a phone call too; maybe solicitor or union rep which is taken out of context when we read it how it’s presented.. was saying saying on the phone something like “they believe you did it on purpose” sort of scenario. Was it meant as “they say I did it on purpose because I couldn’t care for them”. That said, even if this is the case, it doesn’t explain why she would keep going back into the family room (after being told more than once not to) when another more poorly baby as designated nurse needed care and attention. It seems a very odd thing to be doing. MOOBesides the "confession" note, one of the notes found in her house read as follows:
Lucy Letby: police found note saying ‘I killed them on purpose’, court hears
Nurse accused of murdering seven babies on neonatal ward also wrote ‘I am a horrible evil person’, jury toldwww.theguardian.com
I speculated at the time that this could be a note of a conversation with a solicitor or union rep.
notsure
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Maybe she just thought she could offer additional support.
True. That said; if your superior has asked you more than once not to and to attend the other baby your designated to, who is quite unwell, I struggle to understand why someone would keep going against that. There was also the conversation via message with her colleague where she had requested to be in a certain room and she was also told no. It could be completely innocent of course, but I’m struggling to make sense of why she would keep going against her superior.
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The three full-stops are just there to indicate text that has been removed for some reason
Perhaps it’s the lead nurse who was not mentioned in todays hearing? We hear of her colleagues but the lead nurses name was not disclosed.
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Yes, agreed. It definitely sounds like notes one would make in order to pursue an employment grievance. If it were me in that situation those are essentially the exact words I'd use if I were intending to speak to whomever was acting on my behalf.Besides the "confession" note, one of the notes found in her house read as follows:
Lucy Letby: police found note saying ‘I killed them on purpose’, court hears
Nurse accused of murdering seven babies on neonatal ward also wrote ‘I am a horrible evil person’, jury told
I speculated at the time that this could be a note of a conversation with a solicitor or union rep.
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This is incorrect. I am sorry but this will be very long.
Everyone's lungs can exhale the air in an air embolism, IF the heart is still beating (to move the air), AND the air has entered through venous circulation (because it will go to Right Atrium, Right Ventricle and lungs), AND there is not too much air AND there are no connections between venous and arterial circulation in the heart. Every one of these conditions must be met for the lungs to POTENTIALLY be able to filter out the air before it reaches the arteries feeding oxygen to the heart, and the brain. In this case, the embolism may not cause much damage. I will explain why in a moment. On the other hand, ONCE air has entered arterial circulation through the heart or lungs, the air will go to the coronary artery (which feeds oxygen to the heart) and to the brain. Both of these circumstances will cause (potentially fatal) damage to the heart muscle and to the brain.
Whether or not it is fatal depends on HOW MUCH AIR and HOW FAST IT GETS IN. A lot of air getting to the heart or brain will kill a lot of cells in the heart or brain. A small amount of air will kill a small amount. It is not mysterious or confusing that sometimes air embolism is fatal and sometimes it is not. (Please let me know if you need elaboration after reading the rest of this post.)
Now I will explain the differences between normal newborn circulation and anatomically normal adult circulation. Then I will explain why babies are MORE (not LESS) susceptible to venous embolisms than adults. Then I will explain why in most cases of collapse, newborn babies respond to CPR even temporarily and why they might not respond if the cause of collapse is an air embolism.
Normal adult circulation follows this pathway: Blood that is at the edges of the body comes from the capillaries to the veins. All the veins travel back towards the heart. These veins are carrying blood whose oxygen has been used up by the body. All this blood meets at the right atrium of the heart. The blood then goes to the right ventricle of the heart. Then it travels through the pulmonary artery to the lungs. The blood circulates in the capillary bed of the lungs and exchanges gas there through the alveoli (tiny air sacs in the lungs). This is where carbon dioxide goes out, and oxygen comes in. This is where an air embolism could potentially be filtered. Then freshly oxygenated blood returns to the left atrium of the heart by the pulmonary vein. Then blood goes into the left ventricle. From the left ventricle, blood goes into the aorta.
Now, this is really important! When blood comes to the aorta, the VERY FIRST PLACE vessels that branch off the aorta go to the heart! All this fresh oxygenated blood feeds the coronary arteries, which feed the heart. If this circulation is blocked, the heart muscle is starved of oxygen. It cannot beat and then it stops. This is commonly known as a heart attack. Those coronary arteries can be blocked by air or clots (emboli), or they can be blocked by plaque that forms on the walls of those arteries. After the heart has gotten it's share of the blood, the next branch takes blood to the brain. And after that blood goes to all the arteries of the body, down to the tissues, where it meets venous circulation in the capillaries, and the cycle starts all over again. (Although really, the cycle properly starts in the heart, I chose to start from the capillaries because that is the route that medicines administered through an intravenous line will travel.)
Now you can see if there is only a small amount of air, it can be filtered by the lungs. If there is a very LARGE amount of air, it will still get into arterial circulation (like a cup overflowing) and then it can cause problems.
Newborn circulation is a little different. Before babies are born, they do not use their lungs to exchange gases. Mom's placenta does that. So babies have a special vessel called a ductus arteriosus. It lets blood flow between their main lung artery (pulmonary artery) and their main body artery (aorta). Very little blood goes to the lungs. It goes around the lungs through the DA. (There are vessels that travel to and from the placenta bringing oxygenated blood to the heart.) When the baby is born, the baby begins using their lungs and their circulation begins to resemble adult circulation. It no longer flows through the placental circuit, which I am omitting here for brevity. Over the first week of life or so, that DA starts to close off and become non functional. Eventually it no longer exists as a vessel, although early on, a respiratory or cardiac arrest can lead to it opening up again.
Preterm babies may take longer to close the ductus arteriosus than term babies.
This DA, which is still open at birth, is what makes newborns MORE vulnerable to air entering the veins. There is a place for the air to get to the heart and brain without going to the lungs first.
Now, why do most newborns need CPR? (NRP). At birth, when placental circulation is interrupted, the first thing the baby must do is take a big breath, inflate the lungs, and send oxygenated blood to the heart. Premature babies lack a protein in the lungs called surfactant. This is kind of like soap. It reduces surface tension in the lungs and lets the lungs inflate easily. Without surfactant, the lungs stick together and they are hard to inflate. We can help inflate the lungs using a bag mask setup that pushes air into the lungs.
If a newborn baby was experiencing low oxygen below birth, they may not have the urge to take a breath. Then they may need an inflating breath to get the oxygenated blood to the heart and and brain so they can get the urge to take more breaths.
Sometimes if a baby has been without oxygen for too long, an now the heart is beating to slowly to move any oxygen that does get into the lungs around the body. This baby needs chest compressions in addition to positive pressure ventilation.
The primary cause of cardiac arrest in adults is cardiac failure. The heart is not working. Adults usually need extensive chest compressions to survive after a heart attack. It matters more whether you give good quality chest compressions than it does that you give rescue breaths.
The primary cause of cardiac arrest in newborn babies is RESPIRATORY FAILURE. The baby is not breathing for one reason or another or the lungs are not working. As soon as the lungs are inflated and air is moving, the heart can start working again. Most babies who need resuscitation at birth or while in the NICU will recover once there is enough air going in and out of the air sacs in their lungs. They ONLY NEED BREATHS. This can be done with mask breaths, or through a breathing tube. Chest compressions are only needed to keep the blood circulating while the heart is beating too slow. After a couple rounds of chest compressions and breath cycles, the baby's heart is beating fast enough to carry blood, and they are breathing on their own or with assistance. Sometimes the baby is very sick and they will die later, often not in another code but because it is judged to be not in their best interests to escalate care.
It is uncommon for the baby's heart not to beat at all during heart rate checks. Compressions are usually given because the heart is beating too slow, not because it is not beating at all. Now, why might a baby's heart stop and not recover with standard resuscitation efforts? There are many reasons, usually having to do with a baby who is very sick. Very very sick. But also, if the coronary arteries were all full of air and too much of the heart muscles have stopped working (died), that would unfortunately do it.
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I’d really like to see the original version of that text, even if they had to put (name redacted) instead of … . Being able to clarify if LL had said she’d asked the family regarding handprints etc, vs saying someone else had done so makes a massive difference when looking at motive imo.
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Decompression of the stomach is standard during resuscitation.
So, I said I was searching for patterns, and I have found some.
Baby I, a girl, collapsed five times, the last time fatally.
The first collapse was on 30 Sep, dayshift, when she was over a month old.
The second collapse was two weeks later on 13 Oct, nightshift. 2 weeks without collapsing.
The third collapse was on 14 Oct, nightshift. 24 hours - all day - without collapsing.
The fourth and fifth (final) collapse was on 22/23 Oct. 8 days since the third collapse, without collapsing.
What are the chances of 5 collapses happening when the same nurse was intervening, designated or not, over a period of 2 months, and NOT collapsing in between under other nurses' care?
Baby N, a boy, collapsed three times.
The first collapse was on 3 Jun 2016, nightshift.
The second and third collapses were on 15 Jun 2016, dayshift. Nearly two weeks without collapsing in between.
Baby G, a girl, collapsed three times.
The first collapse was on 7 Sep, nightshift.
The second and third collapses were on 21 Sep, dayshift. Two weeks without collapsing in between.
Baby H, a girl, collapsed twice.
The first collapse was on 26 Sep, nightshift.
The second collapse was on 27 Sep, nightshift. 24 hours without collapsing in between.
The chances of this pattern happening with baby I, baby N, baby G, and baby H, collapses happening when the same nurse was intervening, designated or not, moving with that nurse's shift changes from nightshift to dayshift, or vice versa, with weeks or days in between without collapse, must be astronomically small.
Then there is another pattern, and that is that from the 17 babies she is charged with, only one baby at a time was unexpectedly collapsing. None of the charges overlap in terms of the cases with multiple collapses.
I've noticed that the Chester Standard reporter has in the past not managed to get down the full wording of LL's text exchanges, and I've had to fill in the gaps from finding other reports. When he is reporting a party who cannot be named he uses square brackets to write, for example, [designated nurse], so I don't think the dots are a redacted name. I think there is probably more text missing, probably due to the speed of having to type all the information displayed on the court screen before it's removed. Things like text messages are only briefly displayed on screen for the jury, for as long as they need to read through it, because it will be included in their evidence bundles anyway.
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Just been doing some research using the cases notes. In terms of any pattern in method it isn’t obvious if it’s there. If guilty apparently LL used less lethal methods more often than not and most fatalities are clustered around Baby A, early on.
Cases involving a fatality are baby A,C,D,E,I,O and P.
Notice how significant margin is clustered around Baby A. Most fatal method so far is stomach air embolism suspected in four cases (c,I,o,p) followed by vein embolism with three (a,d,e). Other suggested attempted methods are all surviving insulin (f,l), excessive feeding (g,q), sabotaging equipment, moving air tubes, unknown causes of desats and collapses (h,j,k,n). Baby G is said to be brain damaged. There are also three strong instances of a child being attacked multiple times again suggesting concerted efforts on the part of the accused (e,h,o).
Greater lethality is associated with the earlier cases suggesting if killing was the intention, the method did not change upon learning of babies surviving. There is one instance of note in terms of lethality, baby O actually received both venous embolism and stomach air embolism as well as being the baby with liver trauma and being the brother of another fatality in child p. If guilty Baby O got way more of LL than others, I wonder why?
IMO.
Cases involving a fatality are baby A,C,D,E,I,O and P.
Notice how significant margin is clustered around Baby A. Most fatal method so far is stomach air embolism suspected in four cases (c,I,o,p) followed by vein embolism with three (a,d,e). Other suggested attempted methods are all surviving insulin (f,l), excessive feeding (g,q), sabotaging equipment, moving air tubes, unknown causes of desats and collapses (h,j,k,n). Baby G is said to be brain damaged. There are also three strong instances of a child being attacked multiple times again suggesting concerted efforts on the part of the accused (e,h,o).
Greater lethality is associated with the earlier cases suggesting if killing was the intention, the method did not change upon learning of babies surviving. There is one instance of note in terms of lethality, baby O actually received both venous embolism and stomach air embolism as well as being the baby with liver trauma and being the brother of another fatality in child p. If guilty Baby O got way more of LL than others, I wonder why?
IMO.
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Same here pattern checking. I excluded from my stats of multiple attacks instances where the desats and collapses were not strongly linked to an attack by evidence, there may be more may be less but without knowing how normal collapses are it’s difficult to draw conclusions.
Then there is another pattern, and that is that from the 17 babies she is charged with, only one baby at a time was unexpectedly collapsing. None of the charges overlap in terms of the cases with multiple collapses.
That's an interesting thought
I do feel the defence need to have some real evidence up their sleeve to get past these patterns if they continue along the lines of babies AB and C. They will need a lot more than continually banging on about staffing levels and the usual problems of premature babies.
Will be interesting to hear the defence witnesses.
Will be interesting to hear the defence witnesses.
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Interesting point about the lethality.
These less lethal attacks (apart from baby o like you have spotted) could be a way of tipping these fragile babies over the edge.
Perhaps she was experimenting, and this is a horrible thought (and speculation), did she enjoy the suffering that they would barely survive and then she would go back again the next time she was alone with them. Like an enjoyment of the pain, torture you could say.
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Three dots is known as ‘ellipsis’ and it means some text has been removed - usually t at least a sentence or phrase, but often more. It tells us we are not seeing the whole text exchange here and they’ve edited it down to the key parts they want us to see.
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ACK! I made a mistake in my reply to Sweeper2000, as far as the ductus arteriosus goes. While I was typing, I was thinking of the coronary arteries and brachiocephalic artery (goes to brain) as coming off the aorta after the ductus arteriosus. But they are PRE-ductal (and I should have remembered this ). So air should not be able to get into the coronary artery directly across the ductus arteriosus. It would only get across the usual way, through the lungs, or possibly through a Patent Foramen Ovale (a communication between right atrium and left atrium that exists before birth specifically for blood to flow across) but the PFO usually "functionally" closes after birth. It would have been more accurate to say that newborns are more susceptible due to their small size. At only 100mL/kg of blood, and 800g baby has about 80mL of blood, and as little as 4mL of air could be fatal. Sorry, Sweeper!
She strikes me as what my friend terms a "grief vampire"
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