The Children's Doctor's Special Proposal

His voice was suddenly cool, breaking the light-hearted mood, and Katrina winced inwardly. Hadn’t Lynne said yesterday that the man was very guarded about his private life? ‘Sorry. I wasn’t fishing. Just that Will always says his wife and kids buy his loudest ties, and I assumed if you had a collection like his it’d be from the same kind of source.’ She raked a hand through her hair. ‘Look, I didn’t mean to pry. I apologise.’

‘No offence taken.’

But that invisible barrier was back between them again. And this time it felt a tiny bit wider.

Katrina tried her best to keep it professional in the assessment unit, though she was very much aware of Rhys’s presence—far more than she usually was with Tim or whoever else worked with her. Even when her back was to the room, she knew the precise moment that Rhys left his cubicle and went to call his next patient. And that was worrying. Why was she so aware of the man?

Her third patient that morning worried her even more. Petros was six, and looked very poorly.

‘He’s been a bit off-colour for the last two days, tired and feeling sick,’ his mother said. ‘And his back hurts.’

‘His temperature’s up and he’s a bit short of breath,’ Katrina observed.

Mrs Smith nodded. ‘And his wee’s very dark, even though I’ve tried to get him to drink plenty of water.’

The little boy had olive skin but there was a definite pallor around his mouth, and the whites of his eyes were slightly yellowish. ‘Hello, Petros. I’m Dr Katrina,’ she said softly. ‘Would you mind if I had a little look at you, please?’

He shrugged listlessly.

‘He’s really not himself,’ Mrs Smith said, biting her lip. ‘He’s always on the go. He’s never this quiet and still.’

Katrina squeezed Mrs Smith’s hand. ‘Try not to worry,’ she said gently. ‘He’s in the right place. Has anyone else in the family or any of his friends had similar symptoms?’

‘Everyone’s fine.’

So it was unlikely to be a virus, then. The most likely culprit was a urine infection, but the paediatric nurse had already done a dipstick test and it was clear. She didn’t like his breathing rate or temperature, though. ‘I’m going to listen to your heart and your breathing now, Petros. And afterwards, if you like, you can listen to Mummy’s.’

Petros shook his head but didn’t say a word.

‘OK. I’ll be as quick as I can,’ she said, and listened through the stethoscope. ‘Big breath in? And out. And in. And out. That’s lovely. Well done, sweetheart.’ His heart, at least, sounded fine. She was still thinking infection, though. ‘Can you open your mouth for me and say “ahh”?’ she asked.

Petros did so—the quietest ‘ahh’ Katrina had heard from a child in a while. There was no sign of infection in his throat, but his mouth and tongue definitely looked pale. ‘I’m going to need to take a blood test,’ she said to Mrs Smith. ‘I think he might be slightly jaundiced, because his eyes are a little bit yellow, so I want to check for that and anaemia.’

‘He had jaundice when he was born,’ Mrs Smith said. ‘But the midwife said it was really common with babies.’

‘It is—usually, if they get a bit of sunlight, the jaundice goes away within the first week,’ Katrina said.

‘It did.’

There was something nagging in the back of Katrina’s mind, but she couldn’t quite place it. ‘It’s been a lovely sunny few days, hasn’t it?’ she asked. ‘Have you been doing anything special, Petros?’

‘I went to Granddad’s garden,’ Petros said. ‘He grows magic beans.’

‘Like Jack and the Beanstalk? Wow. Did you meet the giant?’ Katrina asked.

The little boy didn’t even crack a smile, merely rubbed at his back.

‘OK, sweetheart. I’m going to give you something to take that pain away,’ she said gently, and gave him two spoonfuls of children’s paracetamol syrup. ‘This will help you to stop feeling quite so hot, too. Do you like your granddad’s garden?’

Petros nodded.

‘My father-in-law got an allotment this summer,’ Mrs Smith explained. ‘He’s been growing vegetables and Petros has been helping him. We call the broad beans “magic beans”—you know what it’s like, trying to get little ones this age to eat vegetables.’

‘Don’t I just.’ Katrina had played the ‘magic’ card herself before now with a variety of vegetables and a variety of patients.

‘Can I interfere?’ Rhys said, coming over to Katrina’s workspace.

Well, he was her senior. He had several years’ more experience than she did. And if he had any bright ideas, she was willing to listen: in Katrina’s view, the patient took priority. ‘Be my guest.’

He introduced himself swiftly. ‘Mrs Smith, these broad beans you mentioned—has your little boy eaten them before?’

‘No. Do you think he might be allergic to them?’

‘Not allergic, exactly. Petros is a Greek name, yes?’

She nodded. ‘It’s my grandfather’s name.’

He smiled at her. ‘May I ask, which part of Greece does your family come from?’

‘My husband’s from the East End—well, with a name like Smith that’s pretty obvious,’ she said wryly, ‘but my family’s originally from Cyprus. My grandparents came over to London just after the war and started a restaurant.’

‘Katrina, when you do that blood sample, can you get it tested for G6PD as well?’ Rhys asked.

‘Of course.’ The pieces clicked into place. ‘You think it’s favism?’

‘Yes—I’ve seen a few cases in Wales,’ he said.

‘What’s favism?’ Mrs Smith asked. ‘And what’s G6PD?’

‘G6PD is a chemical in your body—it stands for glucose 6 phosphate dehydrogenase, but it’s a bit of a mouthful so it’s known as G6PD for short,’ Rhys explained. ‘Some people have less than normal amounts in their red blood cells, and it’s quite common in people who have a Mediterranean origin. If you don’t have enough G6PD, then if you get a fever or take certain medicines or eat broad beans—what they call fava beans in America, which is why it’s called “favism”— then the body can’t protect your red cells properly and you become anaemic.’

‘With this condition, you might also get jaundice—and the symptoms mean you get backache and your urine looks the same colour as tea before you add the milk,’ Katrina added.

Mrs Smith nodded in understanding. ‘Like Petros’s does right now.’

‘Obviously we need to check the results of the blood tests,’ Katrina said, ‘but I think Rhys is right.’

‘So can you give him this G-whatever stuff in tablets or something?’ Mrs Smith asked.

‘I’m afraid there aren’t any supplements,’ Rhys said. ‘We’ll check how much iron is in his blood, and if there isn’t enough he might need a transfusion—but the good news is that Petros will feel a lot better with some rest and a little bit of oxygen to help him breathe more easily.’

‘The condition’s not going to affect him day to day,’ Katrina explained, ‘but he’ll need to avoid certain medications—aspirin, some antibiotics and some antimalarial drugs. I can give you a leaflet explaining all that so you know what to avoid.’

‘You’ll need to tell your GP as well so it’s on his medical record and he isn’t given any of the medications he needs to avoid by mistake,’ Rhys added. ‘And we should warn you now that if he gets an infection in future, it might mean his red cells are affected and he’ll get anaemia and jaundice again.’

‘And definitely no more broad beans,’ Katrina said.

‘Best to avoid Chinese herbal medicines, too,’ Rhys continued. ‘And, would you believe, mothballs? They contain a chemical in that can affect people with G6PD deficiency.’