An Inescapable Temptation

Elena nodded. Francesca noted that her hands were positioned carefully over her stomach, obviously trying to keep her pain in check. ‘It was diagnosed last year after I had very painful periods.’ She lifted her shirt and pointed to a little scar next to her belly button. ‘I had a camera in there.’

Francesca nodded. If Elena had had a laparoscopy done and the diagnosis confirmed then it was likely that her symptoms were related to her endometriosis.

‘Do you normally use painkillers?’ Elena nodded and fumbled in her bag, pulling out a battered box with the name written in Spanish. Francesca took the box, looking at it and writing the name down in the notes. It was a commonly used non-steroidal anti-inflammatory drug that was effective in treating endometriosis.

‘We will be able to give you something similar,’ she reassured Elena, ‘but the box may look a little different. Have you tried anything else?’

Elena pulled a second, slightly more battered cardboard box from her bag. ‘I stopped taking these,’ she said, ‘as they made me feel unwell.’ As she didn’t recognise the name on the box Francesca opened it and pulled out the foil strip with the twenty-eight tablets enclosed. Around half were missing and she realised immediately what they were. Oral contraceptives were commonly used to treat endometriosis in women who weren’t trying to start a family. They worked by regulating the hormone levels to stop the production of oestrogen in the body. Without exposure to oestrogen, the endometrial tissue could be reduced and this helped to ease symptoms.

‘Do you remember when your last period was?’ Francesca asked.

‘I’m not sure. I had some bleeding yesterday and a little this morning, but it wasn’t much.’

‘I’m so sorry, but I’m going to have to get a urine specimen from you. Do you think you can manage to go to the toilet for me?’

Elena grimaced as Francesca helped her to the toilet. It only took a few minutes before she was back on the couch and Francesca reattached her to the blood-pressure cuff. BP was ninety over sixty. Hypotensive. Colour poor. Alarm bells started to go off inside Francesca’s head.

The amount of pain that Elena was exhibiting was more than would be expected. Elena nodded, still clutching her stomach.

Francesca’s spider sense was tingling. Her instinct—the thing she’d thought she’d lost.

This wasn’t right. This didn’t feel right. Elena’s pain seemed too severe and too localised to be endometriosis. Francesca knew that endometriosis was a painful condition in which the endometrial cells that would normally be present within the lining of the womb could be deposited in other areas around the body. These cells were still influenced by the female hormones and could cause pain in various areas, particularly around the pelvis.

And she knew how painful it could be—one of her friends spent a few days every month doubled up in bed. But this just didn’t add up.

She checked the urine sample for infection and it was clear. Francesca opened the nearby cupboard and pulled out another test. It was only a hunch and she could be wrong. Using a little pipette she dropped a few drops of urine onto the test and checked her watch. A little line appeared.

Her heart gave a flutter in her chest. She hadn’t been wrong and for a second she felt almost elated. Then common sense pulled her back to reality.

She needed help. And no matter how much he irritated her, she knew who to call.

The pager sounded again.

Gabriel was annoyed. What would be the reason for this ridiculous callout? A stubbed toe? A grazed elbow? He was going to have serious words with the team in the morning if this was what they normally dealt with.

He glanced at the number on the pager. The medical centre. Francesca. Now, that was a surprise. She’d looked as if she’d rather set her hair on fire than ask him for help earlier.

And as for the media request…

It made his blood boil. His family were constantly in the paper—particularly in Italy. With the words ‘tragic’ usually appearing in the second sentence. Twenty-five years ago the media had been all over them and their ‘tragic’ loss. Every time they were mentioned in the press it was all raked over again.

The last thing they needed was more painful reminders.

Didn’t they get that the loss of Dante was imprinted on them for life, seared on their very souls?

Gabriel had never once given an interview to a journalist.

Correction. Gabriel had never knowingly given an interview to a journalist. The ugly remnants of a faked past relationship by an aspiring reporter burned hard. That, and his experience with Jill and a few others like her, told him that women weren’t to be trusted. Under any circumstances.

It only took him a few moments to reach the medical centre.

‘What’s wrong?’

Francesca was waiting at the door for him, some notes in her hands and a worried expression on her face.

She thrust the notes towards him. ‘Elena Portiss, twenty-seven, severe abdominal pain, past history of endometriosis.’

‘Have you given her some analgesics?’

‘Not yet.’

‘Why not?’

She hesitated just for a second. ‘Because she’s pregnant and she doesn’t know it. I think it may be an ectopic pregnancy,’ she said tentatively.

Gabriel’s eyes skimmed over the notes in front of him. He’d no idea why she looked like a deer currently caught in the headlights. She’d done everything he would have expected. ‘Let’s find out.’

Francesca caught his arm as he walked past her. ‘I haven’t given her any indication about what I think may be wrong.’ Gabriel caught the worried expression in her eyes. He understood completely. Endometriosis was frequently associated with infertility. To tell the patient that she was pregnant but that the pregnancy was ectopic would be a devastating blow. He strode through to the treatment room and spoke to Elena, who was lying on the examination couch, her face still racked in pain.

‘Hello, Elena,’ he said confidently, ‘my name is Dr Russo. I’m one of the ship’s doctors. Nurse Cruz has asked that I take a little look at you.’ He shook Elena’s trembling hand. As he placed his hands very gently on her stomach he noticed her visibly flinching. ‘I promise you, I will be very gentle.’

He moved lightly across her abdomen, pressing gently with his fingertips from one side to the other. ‘Where is the pain worse? Here? Here?’

Elena shook her head tensely, and then grimaced again in pain as his fingers reached her right side. The clinical signs were all present. She was pale, hypotensive, with lower abdominal tenderness and distension. That, together with a positive pregnancy test, gave an almost conclusive picture.

Francesca watched him from the corner of the room. Had she been wrong to mention her tentative diagnosis? Other doctors might have thought she was stepping on their toes to make such a suggestion.

But Gabriel hadn’t even blinked. He didn’t seem offended or annoyed with her suggestion. His only concern seemed to be for the patient.

Given the hostility between them it could have been a perfect opportunity for him to take her to task.

But apparently not. This man wasn’t exactly how she’d imagined him to be.

‘Okay, that’s me finished.’ He took his hands from Elena’s abdomen and stood next to her.

‘Do you know the date of your last period, Elena?’

She shook her head miserably. ‘I have been bleeding on and off for several months. I can’t say for sure. I was taking the Pill, too, but it made me feel unwell, so I stopped. Then I had some light bleeding yesterday. I’m not sure when my last period was.’

Gabriel nodded, ‘That’s okay’. He turned to Francesca. ‘Can you check her BP and pulse again for me, please, and draw some bloods? I’ll need her urea and electrolytes, but more importantly a full blood count, please.’

Francesca nodded and set the monitor to retake Elena’s blood pressure while she opened the nearby drawer to find the blood bottles. Once the blood pressure had been recorded she removed the cuff and replaced it with a tourniquet to facilite taking some blood. It only took her a matter of seconds to locate a vein. ‘Just a little prick,’ she said to Elena as she gently slid the needle into the vein and attached the bottle to collect the blood samples. Francesca released the clip on the tourniquet, letting it spring apart, relieving the pressure on Elena’s arm. She placed the needle in the nearby sharps box and gave Gabriel a quick glance as she left the room. ‘I’ll phone Kevin and get him to do the blood results for us.’

She wondered if he realised how quickly her heart was beating in her chest. Elena’s blood count would be a good indicator of whether her diagnosis was correct or not.

It could also prove that her instincts were still completely off.

The medical centre was equipped with a wide range of laboratory equipment that allowed the staff to carry out many diagnostic tests that were essential to diagnosing and treating patients. Kevin arrived a few minutes later, hair mussed, took the blood samples and prepared them for testing. When she returned to the room Gabriel was sitting next to the examination trolley, talking to Elena. Francesca could see the serious expression on his face and watched as he gently took Elena’s hand to explain her condition. Gabriel was surprising her. He was taking time to talk to Elena, to hold her hand and explain clearly what was happening. For some reason she found it almost the opposite of what she’d expected. This was a man who’d flung her friend out on the street at three o’clock in the morning yet here he was as a doctor, doing everything he should and showing empathy for his patient. In her head that just didn’t fit. Her curiosity was piqued.