‘She was just over twelve months old.’
Twelve months that had been the hardest in Pip’s life. The responsibility and practical skills of caring for a baby would have been totally overwhelming and dreadful if it hadn’t been for Shona. In a way, though, it had been a wonderful twelve months because Shona had forged an even closer bond with her daughter and then rediscovered her joy in life through her granddaughter. That she had become more of a mother to Alice than Pip had been gradual but inevitable as Pip had been encouraged to finish her schooling and even chase her dream of going to medical school.
‘What about talking?’ Toni asked, as he let down the pressure from the blood-pressure cuff around Alice’s arm.
‘I’m not so sure about that. Around two, two and a half.’ Hard to confess her lack of certainty but it was true—she wasn’t sure. Alice hadn’t been stringing more than a few single words together when Pip had headed away for her first term at university, but she had been chattering by the time she’d headed home for her first holiday break.
‘Childhood illnesses? Measles, mumps, chickenpox and so on?’
‘She’s fully vaccinated. She had chickenpox when she was…oh, about four. The whole kindergarten class came down with it, I seem to remember.’
Not that Pip had been there to help run baths with soothing ingredients or apply lotion or remind Alice not to scratch. The letters and phone calls from her mother had made her feel guilty she hadn’t been there to help and share the worry. Worse than the poignancy of missing the joy of other milestones. But, as Shona repeatedly said, it wasn’t because she didn’t love Alice. She was doing what was best for both of them. For their futures. It couldn’t be helped that she had to be away so much.
No wonder their relationship worked so much better as sisters now. They all knew the truth, of course, but it worked so well for all of them the way it was.
Pip had the niggling feeling that Dr Toni Costa might not think it was an ideal arrangement. He already thought it strange that Alice called her mother ‘Nona’ and there had been something hidden in the tone which with he’d shared the information that he’d been raised by his grandmother. She wasn’t about to try and analyse why she didn’t want to be thought less of by Alice’s paediatrician but it was enough to prevent her correcting his initial assumption that was now making answering his questions rather uncomfortable.
It was a relief when he concentrated totally on Alice again for a few minutes.
‘Show me where you feel the pain in your tummy.’
Alice pointed vaguely at her midriff.
‘Does it hurt if I press here?’ His hand was on the upper middle portion of Alice’s abdomen.
‘A little.’
Pip could see how gentle he was being, however. How sensitive his touch was. It was hard to look away from that hand, in fact. The olive skin with a dusting of dark hair. Long fingers and neatly manicured nails. Movements that were confident but careful.
‘What about here?’ He was trying the upper right quadrant now. The area that pain would be expected if Pip’s suspicions had any grounds.
‘Yes,’ Alice said quickly. ‘That hurts.’
‘A little or a lot?’
‘Not too much. But that’s where it gets really sore when I get sick.’
The strident beeping at that point made Toni glance at the pager clipped to his belt. Then he raised his eyebrows in Pip’s direction.
‘Sorry. I think ED’s trying to contact me.’
‘Feel free to use the phone on the desk if you wish.’
‘Thanks.’ Pip was embarrassed to interrupt the examination but she couldn’t not take the call. What if her Mr Symes was busy having a cardiac arrest in a side room or something?
Suzie sounded apologetic as well. ‘I’m sure it’s nothing, but Mr Symes is complaining of chest pain now. Says it’s a crushing, central pain that’s radiating to his left arm.’
Classic symptoms. Almost too classic. ‘Any associated symptoms?’
‘Not really. He’s been complaining of nausea since he came in, along with all those aches and pains, but he’s not vomiting or sweating or anything. He reckons this came on suddenly.’
‘I don’t suppose he gave you a pain score without being asked, did he?’
Suzie laughed. ‘Ten out of ten. Do you think he’s been reading the right textbooks?’
‘We can’t afford to make assumptions. Can you do a twelve-lead ECG and put him on telemetry?’
‘Sure.’
‘What’s his blood pressure?’
‘One-fifty over ninety.’
‘Safe to try a dose of GTN, then. Put him on oxygen as well. Six litres a minute.’
‘OK.’
‘We’ll do some more bloods, too, and add in cardiac enzymes. I can do that when I come down. I shouldn’t be much longer.’
In fact, Toni was sitting down to share his findings with her as she hung up the phone, and Pip was aware of a vague feeling of disappointment that the consultation was almost over.
‘Cardiac patient?’ he queried.
‘Probably not, but we’ll have to rule it out.’
‘I won’t keep you too long. Alice seems like a normal, healthy little girl on first impression. The only finding I can make is mild and rather non-specific abdominal tenderness.’
That feeling of disappointment grew. Were her instincts misplaced? And would there be no reason for Alice to see Dr Costa again?
‘Mind you, that’s not an unexpected result and it certainly doesn’t mean I don’t wish to make any further investigations.’
Pip nodded, listening intently.
‘I’d like to do some further blood tests and another urine culture and microscopy. I think a general abdominal ultrasound examination would be a good idea. Maybe even an MRI scan.’ Toni was ticking boxes and scribbling notes on request forms.
‘We might like to consider a carbon-labelled urea breath test and possibly endoscopy to rule out the gastritis and duodenal ulceration that Helicobacter pylori can cause.’
Pip nodded again. This was more than she had expected.
‘Alice hasn’t been hospitalised with any of these episodes, has she?’
‘No. I came close to bringing her in the first time because she was so miserable, but it only lasted about half an hour.’
‘It would be ideal if we could see her and get a blood sample while she was having the pain. To check liver function for elevated blood amylase levels.’
‘So you think pancreatitis is a possibility?’ Pip caught Toni’s gaze and held it. To voice the unthinkable—that Alice could have a tumour of some kind—was unnecessary. The eye contact told her that he already knew her deepest fear.
‘I’m not ruling anything out at this stage. We’ll find out what’s causing the problem and then we’ll deal with it, yes?’
‘Yes.’ Pip dropped her gaze, embarrassed to show how grateful she was. ‘Thank you.’
‘And you’ll bring her in if it happens again? And call me? I’d like to see her myself if it’s at all possible.’
The warm smile that curled around the words made Pip think that this consultant might even get out of bed and come into the hospital at 3 a.m. if that’s when the attack happened to occur.
And