LITMIR.BIZ

      Smiling, Harriet breezed into the cubicle, introducing herself to the patient who lay on the trolley. As Ciro had said, she was swathed in legwarmers and a thick cardigan. Her dark hair was drawn back in a small bun and gorgeous velvet-brown eyes, huge in her face, were blinking in confusion as Harriet produced a gown. Without pausing for breath, as if the entire conversation with Ciro hadn’t happened, as if she had no idea that the mother and patient were resisting treatment, Harriet explained in clear terms what was going to happen.

      ‘Mrs Harrison.’ Smile still in place, Harriet faced the well-groomed, heavily made-up woman. ‘We’re concerned that Alyssa’s heartbeat is rather irregular at times, so I’m just going to pop her into one of our gowns and then the doctor can examine her properly.’

      ‘No!’ Mrs Harrison’s voice was firm, her bracelets jangling as she went to grab at the gown, rouged lips furious, but Harriet’s smile remained intact. ‘I’ve already been through all this. I want to take my daughter home.’

      ‘Of course you do,’ Harriet replied sweetly, ‘but it really is imperative that Alyssa be examined thoroughly. Hopefully it’s nothing serious, but, as I’m sure you’ll understand, Mrs Harrison, we can’t just ignore an irregular heartbeat.’

      ‘As I’ve explained,’ Mrs Harrison snarled, ‘on several occasions, I’d rather my daughter was seen by our family doctor. I’ll take her there first thing tomorrow—’

      ‘This can’t wait till tomorrow.’ Harriet’s smile was still intact, but the slightly dizzy air to her tone had gone. Her voice was firm, holding the woman’s gaze as she spoke. ‘Your daughter has a cardiac arrhythmia.’ Still she stared directly at Mrs Harrison. ‘It has to be dealt with tonight. I’m going to get Alyssa into a gown and put her onto one of our monitors so we can keep a closer eye on her.’

      And something in her unequivocal stance, something in her voice, must have told the woman that this was non-negotiable, and even though Harriet would never have forced Alyssa to undress, she demanded the mother’s co-operation, told her with her eyes that this had to be confronted. Finally, after the longest time, she felt an inward sigh of relief as Mrs Harrison gave a tiny reluctant nod and turned to her daughter.

      ‘Listen to the sister, Alyssa.’

      ‘Harriet,’ she offered, her smile softer now, her eyes kind as she approached the young girl. If Alyssa was, as Ciro suspected, suffering from anorexia nervosa then being undressed and exposed would be traumatic for her, and Harriet was determined to make the entire procedure as gentle and as unintrusive as possible, covering the young girl with a blanket as she helped her out of her clothes. Harriet had to keep her own emotions firmly in check as she briefly witnessed the stick-thin limbs. She talked in gentle soothing tones as she gently leant her patient forward to tie up the gown and even though there hadn’t been much room for doubt, any that might have lingered was quashed as she saw the length of Alyssa’s spinal column, vertebrae protruding, dry, flaky skin hanging off. Glancing up at Mrs Harrison, Harriet saw a flash of shock on the woman’s face but she didn’t comment.

      Now wasn’t the time.

      ‘Well done,’ Harriet reassured the girl. ‘Now, these sticky things just go onto your chest, and it lets us keep an eye on your heartbeat.’ Placing the dots and leads on Alyssa’s frail chest, Harriet quickly covered her back up, before turning on the cardiac monitor. As Ciro made his way in he gave Harriet a brief appreciative nod when he saw that the family was now being more co-operative.

      ‘Alyssa, Mrs Harrison.’ Ciro smiled warmly. ‘I know you are both keen to go home, but first we need to ensure that Alyssa is well enough. Now, I know you’ve already been through this, but, given the doctor that first treated you has gone home now, can you tell me again what happened this evening when you cut your head?’

      ‘I was at rehearsal—we’ve got the first performance next Saturday.’ It was the first time Harriet had heard Alyssa speak, her voice, small and breathless, almost drowned out by the busy background noise of the emergency department.

      ‘She’s the lead,’ Mrs Harrison explained. ‘That’s why I want to get her home. She needs her sleep so she can practise tomorrow. It’s a very demanding role—’

      ‘Alyssa,’ Ciro broke in, ‘why did you fall?’

      ‘She landed awkwardly…’ Mrs Harrison started, but her voice trailed away as Ciro and Harriet both looked at Alyssa for the answer.

      ‘I was halfway through my routine and I just got a bit dizzy. It only lasted a second, but I was in the middle of a jump, so I fell awkwardly.’

      ‘How often do you get dizzy?’ Ciro asked, and Harriet could only admire his questioning, assuming, as was probably rightly so, that this was probably fairly normal for Alyssa.

      ‘A bit…’ She gave a tiny shrug.

      ‘OK.’ Ciro nodded. ‘Alyssa, I’m going to examine you, it’s nothing to worry about, and then I’m going to take some blood from you. Harriet has put you onto one of our heart monitors so that we can see what your heartbeat is doing and maybe find out why you’ve been getting dizzy.’

      Infinitely reassuring, still he was commanding, his voice firm but somehow soothing. His hands were gentle as he first pulled down Alyssa’s lower eyelids, examining the conjunctiva, then her hands and nail beds. Lifting the blanket and checking her reflexes, his middle finger probed the swollen ankles that looked out of place on such thin legs.

      ‘You have some fluid retention. Does this happen often?’

      ‘Sometimes,’ Alyssa answered, ‘but Mum gives me—’

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