‘How do you mean?’
‘Is it more likely to happen, say, on a Monday? Or a weekend?’
‘I don’t know. She’s been missing an awful lot of school, though.’
‘Do you like school, Jadine?’
Jadine nodded again. ‘My friend Georgie and me play Barbies at lunchtime.’
It was not the kind of response she would have expected from a child who might be experiencing problems like bullying at school. Hannah glanced up at Caroline.
‘Have you noticed anything that seems to make any difference?’
‘Like what?’
‘Changes in her diet, maybe?’
‘The only real change she gets is when she goes to stay with my mum.’ Caroline sighed. ‘For some reason she’ll always eat her veggies when she’s staying with Grandma. She never does it at home.’
‘Don’t you like veggies, Jadine?’
‘I like Grandma’s veggies.’
‘I cook them exactly the same way,’ Caroline protested.
‘They don’t taste the same. And you don’t make pudding. I have to eat veggies for Gran or I don’t get the pudding.’
‘I don’t have time to make puddings. And, anyway, they’re not good for you.’
‘Gran’s puddings are good for me. They make my tummy stop being sore.’
Hannah stayed silent, observing the undercurrent between mother and daughter. The significance of another family member being involved was not something she had thought of pursuing in this case but there was clearly something going on here that could be important. She made a mental note to follow it up.
‘Have you been back to your GP before today?’
‘We’ve been at the medical centre every other day. They’re getting sick of seeing us turn up and it’s costing me a fortune.’
Hannah smiled sympathetically. The referral note from the GP had suggested that Jadine’s mother needed more reassurance than they were able to supply. ‘Is she eating all right?’
‘She’ll eat anything that looks like a hamburger or chips. Her appetite seems to vanish in front of a plate of vegetables, though.’ Caroline sighed again. ‘I do try.’
Hannah smiled as she sat on the edge of the bed close to Jadine. ‘My little girl likes chips, too.’ She leaned forward. ‘She’s got a Barbie doll as well, only she left hers in the water trough out in our paddock the other day and now Barbie keeps leaking.’
Jadine stared at Hannah. ‘What’s a troff?’
‘A big drinking bowl. Like cows or horses need.’
‘Have you got a cow?’
‘No. I haven’t got a horse either, but I do have a donkey.’
‘What’s its name?’
‘Joseph.’
Caroline was also staring at Hannah. ‘Why do you have a donkey?’
Hannah laughed. ‘Just for a pet. I’d always wanted one.’
‘Why?’
‘They’re lovely animals. Very gentle and friendly and they’re kind of peaceful to be around.’
‘Really?’ Caroline still looked unconvinced. ‘I thought they made a horrible noise.’
‘Joseph is very quiet. Except for when he sees us coming and wants to say hello.’ Hannah pulled her stethoscope from its position around her neck. Chatting with her patient might make for a relaxing atmosphere but it was time she got on with her job.
‘Can I have a look at you now, Jadine? I need to check all those things like your blood pressure and temperature and heart and then I’ll need to feel your tummy.’
Jadine’s eyes filled with tears. ‘Do I have to have a needle again?’
Her mother grabbed a tissue from the box on the locker and was ready to mop her daughter’s face. ‘You’ve got to be brave, Jadie. Dr Hannah’s here to make you better.’
‘You don’t have to have a blood test right now,’ Hannah said soothingly. ‘And if you need one later we’ll make sure we put that special cream on your skin to make it go all numb so it doesn’t hurt.’
Hannah went through the motions of a full physical examination. Consciously trying not to allow any bias towards a psychosomatic cause for the abdominal pain probably made her examination even more thorough than normal. As the commonest acute surgical emergency of childhood and usually seen in children over five years of age, appendicitis was still at the forefront of possible diagnoses but, as with the previous three admissions, there was no associated low-grade fever and no history of vomiting or anorexia. Whilst Jadine seemed to have genuine discomfort on palpation, Hannah could find no ‘guarding’, where the muscles became protectively rigid, when she pressed on the lower right quadrant of the abdomen.
‘Bowel habits normal?’ she queried.
‘Absolutely.’ Jadine’s mother nodded. ‘Colour and everything’s just the same as usual. I always check.’
Hannah hid her surprise. She might not have blinked if an infant’s mother knew more about her baby’s bowel habits than her own but it was a little unusual for a six-year-old not to be demanding some privacy in the toilet. Her own daughter was four and a half now. She might not bother to shut the door and she sometimes forgot to flush but she had been independent as far as toileting went for some time now.
‘Has Jadine had any bugs recently? Coughs or colds?’ An upper respiratory tract infection could cause inflammation of the mesenteric lymph nodes leading to nonspecific abdominal pain but Jadine’s lungs sounded as clear as bells, which fitted with Caroline’s denial of any viral illnesses.
‘You don’t have a family history of migraine, do you, Caroline?’
‘You asked me that last time. I get headaches.’ Caroline’s huff was resigned. ‘Usually when the bills are due to be paid. Wouldn’t call them migraines, though.’
Hannah nodded. Children who went on to have classical migraines commonly presented with recurrent episodes of prolonged abdominal pain but they usually had nausea or other symptoms accompanying the discomfort. As Caroline had pointed out, she was covering the same ground she had been over before.
‘We’ll need to get a urine sample again.’ She smiled at Jadine. ‘Do you remember that test, sweetie? The nurse takes you to the toilet and gives you a wash and you have to wee into the little jar. You don’t mind doing that again for us, do you?’
Jadine shook her head.
‘Good girl. That way we can do another check to make sure there’s no bugs hiding in your waterworks that might be making your tummy sore.’ And it might give Hannah a chance to have a talk to Jadine’s mother privately. ‘You tell me when you think you might be ready to go to the toilet.’
‘I want to go now.’
‘Do you? That’s great.’ Hannah stood up. ‘I’ll call Nina to come and look after you. She’s your nurse today, isn’t she?’
Jadine smiled. ‘Nina’s nice. She likes Barbies.’
‘She looks a bit like Barbie, doesn’t she, with that pretty blond hair?’ Hannah smiled. ‘It’s just like yours, isn’t it?’
Jadine returned the smile happily, which only reinforced Hannah’s impression that there was nothing seriously wrong with this child. ‘I’m going to take Mum off for a cup of tea while Nina’s looking after you,’ she told Jadine. ‘Is