The Doctor's Tender Secret

She nodded.

He held out his hand. ‘Brad. I prefer working on first-name terms.’

She shook his hand and he almost flinched as a large dose of static electricity discharged. At least, he assumed it was static electricity. The alternative was something he didn’t want to consider right now.

‘What can I do for you?’

‘I’d like a second opinion on a case.’

‘Sure. Though from what I’ve seen of you this morning, you don’t need it.’

‘Um. Thanks for the compliment. But…’

Those pink spots in her cheeks were cute. She looked young for a registrar, which meant she was clever. But the blush at his compliment proved she’d kept at least a trace of humility, so she’d treat her patients as human beings, not just academic cases. ‘OK. What have you got?’

‘Michael Phillips, aged twelve months. According to the notes, he was a floppy baby. He’s had problems feeding right from the start, with poor sucking and chronic constipation; he smiled late and didn’t roll over until he was eight months old. He’s just starting to crawl now, but it’s commando-crawling—’ in other words, he lay on his stomach and propelled himself along with his arms, like a commando under a net ‘—and if you hold him up to stand, his reflexes aren’t what you’d expect.’

‘And you’re thinking?’ Brad prompted.

‘Cerebral palsy. Probably a mixture of spastic and athetoid.’

That would account for the late development. ‘What do the parents think?’

‘The mum’s worried sick because he’s not hitting the milestones in her parenting books. The dad’s in denial and saying everyone’s making a fuss over nothing, his son is perfectly all right and will catch up by the time he goes to school.’

‘OK. I’ll come over.’

Zoe introduced him to Jenny and Dave Phillips. Brad examined little Michael. ‘Tell me, does he have any problems eating?’ he asked.

‘Of course he does. He’s a baby,’ Dave said. ‘They all dribble their food, don’t they?’

‘Michael doesn’t like finger food,’ Jenny said. ‘He likes yoghurt and he’ll eat purées, but he’s not keen on lumps.’

‘He’ll grow out of it,’ Dave insisted. ‘You’re making a fuss, Jen. He’s perfectly all right.’

She shook her head. ‘There’s something wrong, Dave. I know it.’

‘Tell her, Doc,’ Dave pleaded. ‘Tell her she’s fussing over nothing.’

‘Actually,’ Brad said, ‘I think she’s right.’

Panic flowed in Dave Phillips’s eyes. ‘What’s wrong with him, then?’

‘We’re pretty sure it’s cerebral palsy,’ Brad said.

‘But—Are you telling me my son’s…?’ Dave trailed off, as if not voicing his fears would mean that it wasn’t true. That it was only a bad dream. That everything was going to be all right.

Zoe squeezed his hand. ‘You’re both right, actually. Michael will be fine—but he’ll need some help as he grows older.’

‘But…cerebral palsy? He doesn’t even look like a retard! He’s bright, he points to things,’ Dave burst out. ‘It can’t be that!’

‘Cerebral palsy’s a motor disorder,’ Brad explained. ‘It’s Michael’s movements that are affected, not his intellect.’

‘A lot of children with cerebral palsy have normal or above average intelligence. There’s every chance Michael will be able to go to a mainstream school rather than a special school,’ Zoe added. ‘The condition really varies—it can be very severe, but it can also be so mild that you hardly notice.’

Dave didn’t look convinced. ‘So what is cerebral palsy, then?’

‘There are three types,’ Brad said, ‘and they all jumble the messages from the brain to the muscles. The most common form is called spastic cerebral palsy, and it’s caused by an impairment in the cerebral cortex—that’s the outer layer—of the brain.’

‘Spastic?’ Dave squeezed his eyes tightly shut. ‘Oh, no. At school, we used to say…’ He stopped, his face bright red with what Brad guessed was a mixture of shame and embarrassment.

Zoe must have guessed it, too, because she stepped in fast. ‘The word “spastic” just means “stiff”. It’s referring to his muscles—they get stiff and shorten, so the child finds it hard to control his movements. It means he has to work harder than the average kid to walk or move.’

‘The second sort’s called athetoid cerebral palsy, and it’s caused by an impairment in the basal ganglia area of the brain,’ Brad said. ‘It affects the child’s posture and, because the muscles change from being floppy to being stiff, it causes these jerky movements and the child doesn’t have any control over them. A child with athetoid CP often has speech problems because it’s hard for him to control his tongue, vocal cords and breathing. He might also have problems eating and may drool. And he’ll seem restless, as if he’s constantly moving—as if he’s only really relaxed when he’s asleep.

‘The third type,’ he continued, ‘is really rare and affects less than ten per cent of children with CP—it’s called ataxic cerebral palsy, and it’s caused by an impairment in the cerebellum part of the brain. This affects the child’s co-ordination and balance. He often has shaky hand movements and his speech is irregular, and he’ll find it hard to judge the position of things round him.’

‘Which type has Michael got?’ Jenny asked.

‘It’s very hard for us to say,’ Brad admitted. ‘The condition affects each child individually and he might have more than one type, in varying degrees.’

‘So he’s going to drool and he won’t be able to walk?’ Dave asked.

Zoe shook her head. ‘We really can’t tell at the moment. The main problem is difficulty in controlling his movements and facial expressions. He might have some learning problems—it all depends on which part of his brain has been affected. His speech might be a bit unclear, and he might find it hard to communicate—or he might have what we call a specific learning disability, say, a problem with maths or reading or drawing, if a specific part of his brain has been affected.’

Dave took a deep, shuddering breath. ‘And that’s it? Or can it get worse?’

‘Worst-case scenario,’ Brad said, ‘is that he might also have a squint or hearing loss. And around a quarter to a third of children with CP have epilepsy.’

‘But there’s a lot we can do to help, and we can put you in touch with the local support group,’ Zoe added, ‘so you can talk to other parents who’ve been through what you’re feeling right now, and they can help you.’

‘Is it curable?’ Jenny asked.

‘There’s no cure,’ Brad said gently, ‘but the good news is that it won’t get any worse. Treatment can help to improve Michael’s condition, and his disability really doesn’t mean that he can’t lead a full and independent life when he gets older.’

‘Doesn’t it?’ Dave rubbed a hand across his face.

‘The earlier we start treatment, the more we can help him,’ Zoe said.

‘So what causes it? Is it anything I did while I was pregnant?’ Jenny asked.

‘No, it wasn’t your fault at all. The risk factors include if either of you were under twenty, he was your fifth or later child, he was a twin and the other twin died, he was very light when he was born—that’s under one and a quarter kilos—or he was born more than three weeks early. Around one in four hundred babies are affected,’ Brad reassured her. ‘What happens is that part of the brain—the bit that controls muscles and body movements—fails to develop either before birth or in early childhood. It can be caused by a blocked blood vessel or a bleed in the brain, or a difficult labour, if he was very premature or ill after the birth, or he had an infection during early childhood, such as meningitis.’

‘I can’t take this in,’ Jenny said. ‘I knew there was something wrong. I knew it. But nobody would listen to me.’

‘Your health visitor did,’ Zoe said softly. ‘She referred you to us. And sometimes it’s hard to pick up—it might not show until the baby’s twelve to eighteen months old. She said that he was hypotonic when he was born—that his muscles were floppy.’

‘And sometimes you might find his muscles are spastic, or tight.’ Brad looked at Dave. ‘You might prefer the word “hypertonic”. It’s the same thing.’