LITMIR.BIZ

       CHAPTER THREE

      THE triage nurse took one look at Alice and sent them straight to a resus bay.

      The registrar on duty, Graham, was right behind them.

      ‘Let’s get some oxygen on,’ he ordered a nurse, ‘and I want some vital sign baselines. What’s going on, Pip?’

      ‘This is Alice, she’s twelve,’ Pip responded. ‘She’s got acute epigastric pain radiating to her back with associated nausea and vomiting.’

      ‘First time this has happened?’

      ‘No. She had an appointment with Toni Costa recently because we want to find out what’s causing it. He asked me to bring her in when it happened again so we could get bloods to check amylase levels.’

      ‘Right. I’ll get a line in straight away.’

      But Alice jerked her hand away from the registrar. ‘No,’ she said fiercely. ‘I want Dr Costa.’

      ‘He doesn’t work in Emergency, love,’ Graham said patiently. ‘Come on, this won’t hurt for more than a moment, I promise.’

      ‘No.’

      ‘We’ll be able to give you something for that pain after I’ve put this little tube in your vein.’

      ‘No!’ Alice’s sobs turned to a choking sound and Pip held her daughter’s head as she vomited yet again. Shona took a dampened towel from the nurse, ready to wipe Alice’s face.

      ‘Sorry,’ Pip said to Graham, ‘but Toni did ask us to call him if we came in acutely. Alice was expecting to see him, I guess.’

      ‘It’s 9.30 p.m. Not much chance of him being in the building.’

      ‘I know.’

      Graham looked at the sobbing, unwell child on the bed and his expression revealed his reluctance to force treatment on someone who was very unlikely to be co-operative. He looked down at the IV cannula in his hand and then glanced at Pip.

      ‘I could try beeping him—just in case.’

      ‘Good idea.’ Pip smoothed damp strands of Alice’s hair back from her face. ‘It’s worth a try.’ At least that way Alice would know they had tried to get the person she wanted to look after her. When she knew it was impossible, she might be prepared to let Pip put a line in her hand if Graham still wasn’t acceptable.

      She wasn’t prepared for the look of surprise on Graham’s face when he reappeared less than a minute later. ‘He was in ICU. He’s on his way down now.’

      ‘Hear that, Alice?’ Pip could allow herself to sound delighted on her daughter’s behalf. ‘Dr Costa’s coming to see you.’

      Alice hiccuped. ‘Good.’

      It was good. Better than good. Pip had no disagreement with Alice’s conviction that Toni was the top of the list of desirable people to care for her. The worry that the paediatrician might have been in the intensive care unit because Dylan had taken a turn for the worse was dismissed with only a small pang of guilt. Pip’s attention had to be focused much closer to home for the moment and she wanted the best for her own daughter.

      Their confidence did not appear to be misplaced. Toni took over the resus bay from the moment he arrived and managed to exude an air of authority tempered with a charm that reduced the stress levels for everybody concerned. He actually managed to both reassure Alice and gain the information he wanted at the same time. Pip could see Alice visibly relax when the doctor smiled at her and patted her hand before his fingers rested lightly on her wrist.

      ‘Heart rate?’

      ‘One-twenty,’ Graham supplied.

      ‘Respirations?’

      ‘Twenty-eight.’

      ‘Temperature?’ The touch on Alice’s forehead was hardly necessary but Pip could see that it was appreciated. Alice closed her eyes and, just for a moment, the lines of pain on her face almost vanished.

      ‘Thirty-seven point four.’

      ‘Blood pressure?’

      ‘Eighty over fifty.’

      ‘Bit low. Postural drop?’

      ‘We haven’t tried assessing that.’

      Pip was still watching quietly, enjoying the sensation of having an expert take over. As a doctor, it was a good learning experience, being on a parent’s side of this equation. Her anxiety was actually receding to the point where Pip could register how impressive Toni’s clinical skills were. He was able to palpate an invisible, tiny vein in Alice’s forearm and then slip a small-gauge cannula into place without eliciting more than a squeak from his patient.

      Worry kicked in again with his latest question, however. A drop in blood pressure from a change in posture could be serious and the paediatrician seemed to be looking for signs of hypovolaemic shock. What could Alice be bleeding internally from? A perforated peptic ulcer? Something as nasty as acute haemorrhagic pancreatitis?

      ‘She said she felt dizzy when she had to sit in the car,’ Pip told Toni as he taped the cannula into place.

      ‘We’ll get these bloods off and then I’d like some fluids up,’ Toni said to Graham. He smiled at the nurse who was holding a page of sticky labels already printed with Alice’s details and hospital ID number, ready to label test tubes.

      The smile was warm. Appreciative of her readiness and inviting the junior nurse to consider herself a valuable colleague. For an idiotic moment Pip actually felt something like jealousy.

      ‘We need amylase levels, haemoglobin and haematocrit, electrolytes…’ The list seemed to go on and on as the nurse plucked tubes with different coloured stoppers from the tray. ‘And we want blood cultures as well,’ Toni finished.

      ‘Goodness!’ Shona’s eyes had widened at the mounting pile of test tubes.

      That smile appeared again. ‘Don’t worry, Mrs Murdoch. It looks like we’re taking a lot of blood but it’s less than a teaspoonful in each tube.’

      ‘Why the cultures?’ Pip queried. ‘Wouldn’t Alice be running more of a temperature if this pain was caused by infection?’

      Toni nodded. ‘We still need to rule it out. We’ll do a dipstick test on her urine as soon as we can as well.’ The quick smile was almost a grin this time—faintly conspiratorial. ‘I like to be thorough,’ he confessed.

      Thorough.

      And gentle.

      Pip watched Toni’s hands as he carefully examined Alice’s abdomen. She had watched him doing this once before and, unbidden, the memory had already returned more than once.

      If only Alice hadn’t planted that absurd suggestion of Toni as potential boyfriend material. If only Pip hadn’t found herself remembering those hands and their touch in the middle of the night. Wondering how it feel to have them touching her.

      It had been all too easy to imagine. And highly inappropriate, given the current setting, so it was easy to dismiss. It evaporated more than convincingly as Alice cried out in pain. Toni’s voice was now as gentle as his touch but excited no odd tingles in Pip. Her focus was firmly on her daughter as she stepped forward to take the small, outstretched hand.

      ‘It’s OK, hon,’ she said. ‘I’m here.’

      ‘I know it hurts, cara,’ Toni added in an equally soothing tone. ‘We’re going to do

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