LITMIR.BIZ

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or simply not understanding the relevance of the history and range of symptoms because of lack of training and knowledge—you trusted your instincts and you didn’t give up until you had solved the puzzle. And, with immunology, making a diagnosis is often a case of detective work, of sticking in there and not giving up. You did that, Ruth. On your own. I think—in fact, I know—that you are amazing.’

      ‘Thank you.’

      Two little words and yet they revealed so much, especially an inner aloneness that tightened a knot in his stomach and made him want to pull her into his arms and hug her tight. Her smile was tremulous, while the emotion in her voice, and the expression in eyes glimmering with a suspicion of unshed tears, brought the instinctive knowledge that support of her and belief in her had been in short supply in the past. He didn’t yet know why, but he intended to find out. And then he would ensure that she knew her own worth in the future.

      ‘Where do things stand with Pippa now?’ he asked, forcing himself to keep things professional.

      ‘We are waiting for the hospital appointment to come through. I saw Judith last week and she has lots of questions about what will happen when Pippa goes for assessment, and what is involved if the consultant confirms that it is CVID.’ It was through Rico’s help that Ruth had been able to determine that common variable immunodeficiency or CVID, was the most likely diagnosis. She paused, tucking a strand of hair back behind her ear, an endearing knot of consideration creasing her brow. ‘I’ve tried to reassure her as best I can, but I can’t answer everything for her.’

      ‘Have Pippa’s symptoms improved at all?’ he asked, happy to help Ruth set Judith and Pippa’s minds at rest about what might lie ahead for them.

      ‘There has been a small lessening in the severity of some of the symptoms now she has started the broad-spectrum antibiotics you recommended,’ Ruth told him, gratitude evident in her smile. ‘After her years of recurring infections and other problems, I’m hoping that there hasn’t been any permanent damage and that she hasn’t developed bronchiectasis.’

      Rico nodded as Ruth expressed her worries about the chronic condition that caused widening and scarring of the structures of the bronchi, or breathing tubes. It was one of his concerns for Pippa, too. ‘You said that the blood tests showed low levels of serum immunoglobins.’

      ‘That’s right. Very low.’ She glanced at him, then away again, but not before he had noted the flash of indecision in her eyes. A small sigh escaped and she seemed to be wrestling with something, but before he could question her, she grimaced and began speaking again. ‘I had a few problems getting the blood tests done.’

      ‘How do you mean?’ Rico frowned.

      ‘They are not tests that would usually be requested from a general practice surgery.’

      Rico’s frown deepened. ‘You had trouble from the hospital when you asked for the tests? Or from your own practice?’

      ‘Questions were asked. But the tests got done, that’s what matters. And it told us what we needed to know to help Pippa,’ Ruth said, but Rico was certain she was glossing over much of the struggle she had faced. He wanted to know who had put obstacles in her way. And why. But he let it go…for now.

      ‘The consultant immunologist will test Pippa’s antibody levels. The vaccine tests can take up to six weeks, which I know is frustrating, but it is important to define the degree of immunodeficiency,’ he explained, seeing the sharp intelligence in Ruth’s eyes and knowing she was absorbing all the information. ‘If the final diagnosis is CVID—as we believe it will be—Pippa will have immunoglobin replacement therapy, which should help end the cycle of recurring infections.’

      ‘I read that the immunoglobin infusions can be delivered either intravenously or subcutaneously?’ Ruth commented, a query in her voice.

      Rico nodded, unsurprised by her thoroughness. ‘That is so. At first Pippa will have regular treatment at the hospital, but once she is stabilised, and if both mother and daughter can cope, they can be taught how to administer the subcut treatment at home.’

      ‘The subcut sounds scary,’ Ruth pointed out. ‘Especially for an eight-year-old.’

      ‘Patients generally find it easier than they first think and it is well tolerated. It is better than prolonged IV access, which can increase the risk of infection and also becomes difficult if the veins are hard to find. And, because the home infusions are given once a week, they help to keep the levels more constant than with the IV infusion in hospital,’ he reassured her, although her desire to keep her patient informed was typical of the caring doctor he was coming to know.

      Aware that time was running out, he ran through some advice and suggestions that Ruth could pass on and which might help the Warrens as they faced the next stage of the journey in gaining a diagnosis and an ongoing treatment programme for Pippa.

      A high-voltage smile hit him full on, testing his restraint. ‘I’m very grateful, Rico. You’ve given so much of your time and I know how Judith and Pippa really appreciate your advice. As do I,’ she added shyly, touching his heart. And he loved the way she said his name, how her refined English voice, melodious but throaty, made it sound.

      ‘It has been my pleasure to help, carissima. And I shall be interested to hear how things progress in the weeks and months ahead. You must keep me up to date.’

      ‘Yes, of course. I’ll do that,’ she promised.

      Rico knew that whatever happened between Ruth and himself in the next couple of days, the Warrens’ case would keep their link intact and the avenue of communication open. He obviously didn’t like the fact that Pippa was ill, but without Ruth being concerned and searching the internet for information, he would never have met her. And even after a very short time in her company, he could not now imagine his life without Ruth in it. He just hoped he didn’t mess things up.

      Rico wished the moment of intense closeness could go on forever but, much to his regret, the call came to announce the start of the conference’s second session that would take them up to lunch.

      ‘As I have told you in our email exchanges, I am genuinely impressed by your skills. You have an innate gift for learning, Ruth, and for caring, for healing.’ Aware of people moving around them and returning to their places in the main room, Rico leaned closer and focused on Ruth. ‘We have no more time now, and this afternoon I have the workshop.’

      ‘I’m looking forward to it,’ she admitted, making him smile.

      Private time with Ruth would be scarce, at least until the evening, but he was determined to be alone with her so he could learn all about her and do everything possible to persuade her to come and work with him. And be with him. Once more the line between professional and personal blurred.

      ‘We can continue our discussion later.’ He drew in a deep breath, realising how nervous he was, how desperate to get things right and not scare her away. ‘Will you have dinner with me tonight, Ruth?’

      Time seemed suspended as he waited for her answer. He felt each beat of his heart beneath his ribs, was sure she must hear its anxious pounding. He watched her changing expressions, wondering what more he could do to convince her, nearly groaning aloud as she nibbled at her bottom lip, making him yearn to taste her, kiss her.

      ‘Yes…I will.’

      The whispered words brought untold relief and gratitude that this first hurdle had been crossed. But he knew more lay ahead. They could sort out the details of the evening later. Now he had a few short hours in which to plan his campaign to get Ruth to say yes to a whole lot more than dinner.

      ’

      CHAPTER THREE

      FOR the tenth time in as many minutes, Ruth checked her watch. Any moment now, Rico would arrive to escort her to dinner and her anxiety was growing. As was her excitement. Her whole body felt alive with anticipation, her breathing was too fast and too shallow,

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