Their Christmas Dream Come True

‘Dr Wilkins, I take it this is your first PAU?’ Kit asked.

On an intellectual level, she knew the formality was the right way to go—keeping a professional distance between them would be a good thing—but, oh, it stung. Had they really been reduced to this, to titles and surnames, after everything they’d shared? ‘Correct, Dr Rodgers,’ she responded, equally coolly.

‘Do you want to do this as a teaching session, or would you like to lead and I’ll back you up?’

He was giving her the choice. Not much of one. Either way, they had to work together. Closely. And she was finding it harder than she’d expected. Every time she glanced up at him she remembered other places, other times, when she’d caught his eye and seen a different expression there. Blue eyes filled with love and laughter. A lazy smile that had promised her some very personal attention once they were alone.

And now he was this cool, remote stranger. Just like he’d been at the end of their marriage. Reacting to nothing and nobody. Closed off.

‘PAU’s where we get the urgent referrals, isn’t it?’ she asked.

‘Yes.’

Where her diagnoses really could mean life or death. She took a deep breath. ‘Right.’ Was she ready for this?

‘Or we could lead on alternate cases. Do it together,’ Kit added.

His tone of voice on the last word made her look at him. The expression in his eyes was quickly masked, but she’d seen something there. Something that surprised her. Regret, wishing things could have been different?

She pushed it to the back of her mind. Of course not. She was just wishing for something that wasn’t there. Kit had shut her out six years ago, and he wasn’t about to invite her back into his life now.

They’d both moved on.

Well, he had.

‘OK.’

‘Want me to take the first one?’ he asked.

‘Whatever you think best, Dr Rodgers,’ she said, her voice completely without expression.

‘In that case,’ Kit said, ‘I’m throwing you in at the deep end. You go first.’

Oh, Lord. She hadn’t been expecting that. But if that was the way he wanted to play it, she’d show him she could do it—that she didn’t need his help.

Their first case was a two-year-old with a fever and a rash. Ross Morley’s eyes were red, as if he had conjunctivitis, although there didn’t appear to be any discharge. ‘He’s had a temperature for a couple of days but he seems to be getting worse,’ Mrs Morley said, twisting her hands together. ‘His hands and feet look a bit red and I’m sure they’re not normally as puffy as this. And then I saw this rash…’

‘And you’re worried that it’s meningitis?’ Natalie guessed.

Mrs Morley dragged in a breath. ‘Don’t let it be that. He’s my only one. Please, don’t let it be that.’

‘Rashes can be scary,’ Natalie said gently, ‘but there are lots of things that can cause a rash like this.’ Gently, she stretched the little boy’s skin over the spotty area. ‘The spots have faded, see? So it’s unlikely to be meningitis— though you’ve done absolutely the right thing to bring him here,’ she reassured Mrs Morley. ‘If it had been meningitis, he could have become seriously ill extremely quickly. Has he been immunised against measles?’

‘Yes. He had the MMR at fifteen months.’

‘It’s unlikely to be rubella or measles, then.’ Natalie swiftly took the little boy’s temperature with the ear thermometer—definitely raised. She continued examining him and noted that the lymph nodes in his neck were swollen. ‘It could be glandular fever—what we call infectious mononucleosis—or this could be his body’s reaction to a virus, most likely an echovirus.’ She swallowed hard. ‘Or Coxsackie virus.’

She couldn’t help glancing at Kit. Saw her own pain echoed in his eyes. And she had to look away and clamp her teeth together so the sob would stay back. Coxsackie B. The tiny, invisible virus that had smashed her life into equally tiny pieces.

She turned back to the little boy and finished her examination. ‘His skin’s starting to peel at the fingertips.’

‘He doesn’t suck his thumb or anything,’ Mrs Morley said. ‘Never has.’

‘I think Ross has Kawasaki disease,’ Natalie said. ‘Peeling skin’s one of the signs, plus he has the rash, the redness and slight swelling in his hands, his eyes are red, his lips are dry and cracked, and he has a fever.’ Kawasaki disease tended to be diagnosed clinically rather than through blood tests, and Ross Morley’s case ticked all the boxes. She glanced at Kit for confirmation.

He nodded, and mouthed, ‘Good call.’

She damped down the feeling of pleasure. She was doing this to help people, not to prove something to Kit.

‘So what happens now?’ Mrs Morley asked.

‘We’re going to admit him to the ward,’ Natalie said. ‘The good news is we can treat the disease. We’ll give him aspirin and a drip with immunoglobulin drugs to fight the disease. Over the next few days, the fever and the swollen glands in his neck will go down and the rash will disappear, but Ross’s eyes will still look a bit red and sore and the skin’s going to continue peeling around his fingers, toes and the nappy area. He might feel some pain in his joints and you’ll probably find he’s a bit irritable, but the good news is that you’ll be able to take him home next week and all the symptoms will gradually disappear. It’ll take him another three weeks or so after that before he’s completely over it, though.’

‘Will there be any complications?’

Possibly myocarditis—inflammation of the heart muscle—but although Natalie’s mouth opened, the words just wouldn’t come out. Couldn’t. The lump in her throat was too big.

‘There can be complications with Kawasaki disease,’ Kit said softly. ‘Some children have arthritis afterwards, and some develop heart problems, but we’ll send him for a follow-up echo to make sure—that’s an ultrasound scan of the heart and it won’t hurt at all, plus you can be with him while it’s being done.’

Mrs Morley swallowed hard. ‘Could he die?’ she whispered.

‘Most children make a full recovery,’ Kit reassured her.

Most children. But myocarditis could be deadly. Sometimes there weren’t even any symptoms. In very small children it was difficult to tell the problem—they couldn’t tell you if they had chest pain, were tired or had palpitations. You just noticed the difficulty in breathing, which could be caused by just about any of the viruses causing a cough or cold in a little one. The over-fast heartbeat could only be picked up by monitoring. And the average person in the street wouldn’t even know what S1 and S4 were, let alone that S1—the first heart sound, when the mitral and tricuspid valves closed—was soft if there was myocarditis, and S4— the fourth heart sound—made a galloping noise, like ‘Tennessee’, when tachycardia was involved. And then the heart stopped pumping efficiently. Failed. And finally stopped.

Just as Ethan’s had. And all she’d been able to do had been to hold her little boy in her arms as his heart had finally given out and the life had seeped from his body. Natalie clenched her fists hard, willing herself to stay strong.

Though she was sure that Kit was thinking of Ethan, too. Especially because she noticed the tiniest wobble in his voice when he added, ‘We’ll get Ross booked onto the ward, Mrs Morley, and one of the nurses will take you up and help you settle him in.’

‘Can I—can I ring my husband? He’s at work. I was just so worried about Ross this morning, I couldn’t wait for him to get home.’

Oh, yes. Natalie had been there, too. So sure that something was wrong, she hadn’t waited for Kit. She’d left a message for him at work and taken Ethan to the emergency department. A mother’s instinct was usually right: it was one of the things she’d been taught at med school. Parents knew when something was wrong with their children—they couldn’t always put their finger on it, and the words ‘he’s just not right’ were usually justified, on examining the child.

‘No problem,’ Kit said. ‘I’ll get our nurse to show you where the phone is. There’s a special phone on our ward, too, which we keep as the parents’ phone—you can give the number out if people want to ring you for an update, and you don’t have to worry about blocking the ward’s main line.’

When they handed Mrs Morley and Ross over to the liaison nurse, Kit turned to Natalie. ‘Are you OK?’

‘Sure,’ she lied. ‘Why shouldn’t I be?’ Though she could hear the cracks in her own voice. Ha. At least he wasn’t bawling her out for not doing her job properly. He could have picked her up on the fact that she hadn’t told Mrs Morley what the complications were. But he clearly understood how hard she found it to say the words. How she could barely breathe—it felt as if someone had put her whole body in a vice and was slowly, slowly squeezing it.

‘If you want to take five minutes, have a glass of water or what have you, that’s fine,’ Kit said.

But that would be showing weakness. As good as saying that she couldn’t cope with her job. And she could. It had just caught her unawares this time. Next time she’d handle it better. ‘No, I’m fine,’ she said tightly. ‘I’m doing my job. I don’t need mollycoddling.’

Perhaps she was being a little bloody-minded. But it jarred that Kit was trying to soften things for her now. When she’d needed his support, six years ago, he hadn’t been there.

‘If you’re sure.’

She couldn’t stand him being so nice to her. Kindness wasn’t what she wanted from Kit.