Mrs Loveday looked surprised. ‘No. The GP just sent me here.’
‘It’s pretty rare, with about three in a million children being affected, and girls are twice as likely as boys to have it,’ Lorenzo said. ‘Basically “dermatomyositis” means inflammation of the skin and muscles, and from what Jenna’s already told me and what I can see here, it looks to me as if that’s what’s happening to Maddie.’
‘What causes it?’ Mrs Loveday asked.
‘We don’t actually know,’ Lorenzo said. ‘Jenna told me about Maddie’s virus, and in the cases we know of there was a virus involved.’
‘So how long does it last? Will it ever go away? Is she going to get worse?’ Mrs Loveday asked.
‘Sometimes a child has one episode of JDM that lasts for a couple of years and then goes away for ever; sometimes it comes back again after a few years of remission; and sometimes it doesn’t go away at all and needs managing for the rest of the child’s life,’ Lorenzo said. ‘I’m sorry to be so vague, but the way the condition develops really varies. What I can promise is that we’ll sort out some treatment so Maddie can live her life just as if she hasn’t got JDM.’
‘So what does this JDM do?’ Mrs Loveday asked.
‘It makes the muscles weaker and causes pain, so that’s why Maddie’s talked about her legs hurting and having tummy pains,’ Lorenzo said. ‘The inflammation tends to affect the large muscles around the hips and shoulders, so that means it’s harder for Maddie to walk, climb the stairs, get up from the floor or lift her arms. And it’ll make you tired, Maddie.’
The little girl nodded. ‘Since I got the rash and tummy pains, I can’t run as fast when I play football, and I’m really tired by the end of the match.’
‘So how do you treat it?’ Mrs Loveday asked.
‘Medication and physiotherapy. I’d like to admit her to the ward for now,’ Lorenzo said. ‘Maddie might need to stay for a couple of weeks so we can get her condition under control—we can give her some medication to help, but there will be other treatments as well. We’ll start with steroids at first and that’ll really help with her muscles and her skin.’
Mrs Loveday looked shocked. ‘Steroids? Isn’t that the stuff bodybuilders use?’
‘No, these are corticosteroids,’ Jenna explained. ‘They’re naturally produced by the body, too, and we use them to bring down inflammation—that will stop Maddie’s muscles hurting and it will also sort out the rash.’
‘We’ll also need to do some tests, including an EMG,’ Lorenzo said. ‘That’s a special scan which shows us the electrical activities in your muscles—and I promise it doesn’t hurt, Maddie.’
‘Good,’ the little girl said. ‘Because I really, really hurt right now and I hate feeling like this every day. I just want to play football.’
‘We’ll make it stop hurting,’ Jenna promised.
‘We have physiotherapists here who can teach you some exercises, Maddie, to make your muscles work better,’ Lorenzo said.
‘They’ll make you work hard,’ Jenna added, ‘but they’ll make it fun. You can come along, too, Mrs Loveday, and learn how to do the exercises at home with Maddie.’
‘Will they be like the exercises I do at football?’ Maddie asked.
‘Possibly,’ Jenna said.
‘Because I don’t want to stop playing football. I want to be a footballer when I grow up and be captain of the women’s team for England. I won’t have to stop playing, will I?’ she asked, looking miserable at the thought of giving up the sport she clearly loved more than anything else.
‘Definitely not,’ Lorenzo said. ‘And I know it’s horrible feeling so ill, but I reckon you timed getting ill just right—the football season’s over, so it means you won’t miss out on matches over the summer.’
‘But there’s football training camp in August. Will I be better for that?’ Maddie asked.
‘Right now, we don’t know how you’re going to respond to the treatment and if we’ll need to change your medication, but we’ll do our best to make you well enough for the camp,’ Jenna said.
‘Once we’ve got the rash and the pain under control with the steroids,’ Lorenzo said, ‘you might need some other medication, Maddie. We’ll see how things go, but you might need to have methotrexate injections once a week—the nurse should be able to do that at your family doctor’s surgery, so you won’t have to come back to hospital for it—and an anti-sickness medication.’
‘Steroids sometimes affect your bone density—that means how strong your bones are—so we’ll also need to give you special calcium and vitamin D supplements,’ Jenna said.
‘And, once you’re responding to the treatment, we’ll decrease the steroids gradually,’ Lorenzo explained. ‘If you do have a flare-up in the future, then we’ll know which drugs work best for you and we can make sure you get the right ones to treat any future episodes.’
‘You’ll need to make sure you use plenty of sun cream and wear a hat in the summer,’ Jenna added.
‘Coach always makes us put sun cream on before training,’ Maddie said.
‘That’s good. So we’ll admit you to the ward now,’ Lorenzo said, ‘and try and get you all ready for football camp. Once you’re home, we’ll see you every few months to see how you’re getting on and if we need to change your medication at all.’
Once Jenna had got one of the nurses to settle Maddie on the ward, she arranged the tests that Lorenzo had recommended. The EMG confirmed Lorenzo’s diagnosis; and she noticed that he gave up his lunch break to sit and chat to the little girl about football.
Lorenzo Conti was definitely one of the good guys.
She liked the way he worked, reassuring both their patients and their parents; and with him she really felt part of a team. It felt as if she’d worked with him for years, rather than only a couple of days. Which was crazy. She couldn’t have that kind of rapport with him so soon.
In their afternoon break, she caught him just as he was heading for the staff room. ‘I owe you cake for helping me with Maddie,’ she said.
‘You really don’t. I was just doing my job, the same as you,’ he said with a smile.
‘You taught me something new today and I appreciate that, plus I happen to know you didn’t have a lunch break—you spent it talking to Maddie about football,’ she pointed out.
He shrugged. ‘Maddie was fretting and I wanted to help her settle in to the ward. We had a fabulous argument about whether Italian football players were better than English ones, and that really cheered her up.’
Jenna could just imagine. Lorenzo had worked out the best way to take the little girl’s mind off her illness and played his part with gusto. He was the kind of colleague it was a joy to work with. ‘I just want to say thank you—I didn’t want you to think I’m taking you for granted,’ she said.
There was an odd expression on his face, but for so briefly that she thought she might have imagined it.
‘I know you’re not taking me for granted. We’re colleagues. I’m just doing my job,’ Lorenzo said. ‘You really don’t need to buy me cake.’
Then a really nasty thought hit her. Did he think that she was coming on to him? But she wasn’t. ‘I’d make the same offer to any of my colleagues who helped me like that,’ she said. ‘Regardless of gender or age.’ And she hoped he’d follow through with