Right now, Drew was showing most of the signs and symptoms of appendicitis, but the pain for appendicitis was associated with radiating to the right, not the left.
She bent down and whispered in Drew’s ear. ‘Okay, I know I’m a lady doctor but I need to have a little check of your testicles. Do you know what they are?’
He shook his head.
She lifted her eyebrows. ‘Your balls.’
He gave a little giggle.
She nodded. ‘All I’m going to do is have a little feel to make sure they are where they’re supposed to be. It will only take a few seconds, and it won’t hurt, okay?’
He nodded and she checked quickly. It was important with boys to rule out a twisting of the testes, but everything seemed fine.
She did another few tests, one—the McBurney’s—the classic indicator of appendicitis. But nothing was conclusive.
Drew’s guarding was evident. Something was definitely going on.
The nurse appeared at her side. ‘Drew’s blood tests are back. They’re on the system.’
Jessica gave a nod. No wonder the junior doctor had been puzzled. She was puzzled. ‘Let’s get an IV up on Drew and I’m going to order an abdominal ultrasound to see if we can get a better idea of what’s going on.’
She walked over to the nearest computer and pulled up Drew’s blood results. His white-cell count was up, just as expected in appendicitis. She gave a little nod of approval as she saw the junior doctor had grouped and cross-matched his blood too, in case surgery was needed at a later time.
She looked over at Drew again. He was curled up in a ball, guarding his stomach like a little old man. And the strangest feeling came over her.
She unhooked her pink stethoscope from her neck. ‘Drew, I’m just going to have a listen to your chest. It will only take a few seconds.’
She placed her stethoscope on his chest, waited a few seconds then took a deep breath and repositioned it.
She looked sideways at Callum. ‘Has Drew ever had a chest X-ray?’
He shook his head. ‘I don’t think so. He’s never had any problems with his chest. Why? What’s wrong?’
Jess signalled to the A and E nurse. ‘Can you arrange a portable chest film for me—right away?’
The nurse nodded and disappeared for a few minutes. There was always a portable X-ray machine in the emergency department.
Callum walked over to her. ‘What is it?’
She placed her hand on his chest. ‘Give me a minute. I need to check something.’ She wrinkled her nose. ‘Have you ever had a chest X-ray?’
He rolled his eyes. ‘Jess, I’m a fireman. I spent years working with a regular fire crew. Every time I came out of a burning building I had a chest X-ray.’
She nodded, it made sense, ‘Right. So you did. And no one ever mentioned anything?’
He shook his head. ‘Are you going to tell me what’s going on? I’m going crazy here.’
She reached over and touched his hand. It didn’t matter how upset she was right now. She’d even pushed aside the conversation she wanted to have with him right now. ‘Callum, do you trust me?’ Drew was the only thing that currently mattered.
His eyes flitted from side to side. Panic. Total panic. He ran his hand through his hair. ‘Yes, of course I do, Jess. Why do you think I brought Drew here and asked to see you? There’s nobody I trust more.’
The horrible reality right now was that she understood. She understood that horrible feeling of parental panic. That out-of-control sensation. She did. More than he would ever know.
She wrapped her other hand over his. ‘Then just give me five minutes. Let me have a look at a chest X-ray for Drew. I promise, I’ll explain everything.’
She saw his shoulders sag a little, saw the worried trust in his eyes.
She was telling herself that she would do this for any parent. That she had done this for any parent. But her conflicting emotions were telling her something else entirely.
The X-ray only took a few minutes and she pushed the film up onto the light box. It took her less than five seconds to confirm her diagnosis.
‘Can you stay with Drew?’ she asked the nurse.
‘What is it?’ The stricken look had reappeared in Callum’s eyes, but she shook her head, pulled the chest X-ray down from the box and gestured with her head for him to follow her.
She opened the door to a nearby office and pushed the film back up on the light box inside. She flicked the switch and turned to face Callum.
‘Drew has a condition called situs inversus.’
‘What? What is that?’
She took a deep breath. ‘It literally means that all his organs are reversed, or mirrored from their normal positions. Everything about Drew’s symptoms today screamed appendicitis. Except for the positioning of the pain. Most people have their appendix on the right side. One of the true indicators of appendicitis is pain in the right iliac fossa.’ She pointed to the position on her own abdomen to show him what she meant. ‘But Drew’s pain is on the other side—because his appendix is on the other side.’
‘What does this mean? Is it dangerous? And how can you tell from a chest X-ray?’
She placed her hand on his shoulder. ‘Slow down, Callum. One thing at a time.’
She pointed to the chest X-ray. ‘Drew’s heart is on the right side of his chest instead of the left. I can see that clearly in the chest X-ray.’ She pointed at the lungs. ‘I can also see that his left lung is tri-lobed and his right lung bilobed. That’s the reverse of most people. This all gets a little complicated. It means that Drew’s condition is known as situs inversus with dextrocardia, or situs inversus totalis.’
She tried to explain things as simply as she could. ‘This is a congenital condition, Callum, it’s just never been picked up. It could be that either you or his mother has this condition. It seems less likely for you as it would have been picked up in a routine chest X-ray.’ She gave her head a little shake. ‘It could be that neither of you has it. It’s a recessive gene and you could both be carriers. Around one in ten thousand people have this condition.’
‘Is it dangerous?’
She bit her bottom lip. ‘It can be. Particularly in cases like this, when things can be misdiagnosed. But Drew’s been lucky. Some people with this condition have congenital heart defects, but as Drew’s been relatively unaffected that seems unlikely. It’s likely if he had a congenital heart defect he would have had other symptoms that meant the condition would have been picked up much sooner. We’ll do some further tests on him later. Right now we need to take him for surgery. His appendix needs to come out. How about we take care of that now, and discuss the rest of this later?’
He was watching her with his deep green eyes. She could see that he’d been holding his breath the whole time she’d been talking. He let it out in a little hiss. ‘Will you do the surgery?’
The ethics of this question were already running through her mind. She had treated the children of friends on a number of occasions. It wasn’t something she particularly liked to do—but in an emergency situation like this, the child’s health came first.
‘I’m the physician on call tonight. So it’s up to me to perform the surgery. Would you like to find someone else to do it? That’s always an option if