A Puppy and a Christmas Proposal

by Louisa George

  Her third patient of the day was a four-month-old baby who had been referred to her clinic by the health visitor, on the grounds of possible DDH—developmental dysplasia of the hip. A quick read through the notes ticked all the boxes of a higher risk: Poppy Byford was a first baby, a girl, born at thirty-six weeks and had been in the breech position. So Anna was pretty sure that the health visitor had picked up the problem.

  ‘Good morning, Ms Byford. Do come in and let’s have a look at Poppy,’ Anna said. ‘Hello, you gorgeous girl.’ She cooed at the baby, who giggled and waved her hands. ‘She’s beautiful,’ Anna said, and stuffed the little twinge of longing right back down out of the way. She could enjoy being an aunt and enjoy working with her young patients, and that was enough. Wanting more was greedy and pointless—and the quickest way to get her heart broken.

  ‘Thank you.’ Poppy’s mum looked nervous.

  ‘Your health visitor asked you to bring Poppy to see me because she thinks Poppy might have something called developmental dysplasia of the hip—you might hear it called DDH for short, or “clicky hip”,’ Anna explained. ‘Usually it shows up in a newborn examination, and I can see in Poppy’s notes that the doctor did a hip test at her six-week check and it seemed normal. But the health visitor’s concerned and wants me to do another check.’

  ‘Is Poppy going to be all right?’ Ms Byford asked. ‘I did start looking it up on the Internet, but...’ She grimaced.

  ‘The Internet is a very scary place where medical problems conditions are concerned,’ Anna said. ‘It’s like when you’re pregnant with your first child, and you always hear the horror stories about difficult labours rather than the smooth ones, even though the difficult ones are much rarer. There is a possibility that Poppy might grow out of the condition, but I’d like to examine her properly and then do an ultrasound scan to check how her hip is developing.’ She smiled. ‘I promise what I do isn’t going to hurt her, but she might not appreciate being manipulated and might grumble a bit.’

  ‘All right,’ Ms Byford said.

  ‘Have you noticed when you change her nappy that one hip doesn’t open out quite as much as the other?’ Anna asked.

  Ms Byford wrinkled her nose. ‘Not really. I thought everything was normal. I mean—she’s my only one.’

  ‘So you don’t have anything to compare her with. That’s fine.’ Anna gave her a reassuring smile. ‘Could you take her tights off for me, please?’

  Once Ms Byford had taken the tights off the baby, Anna examined Poppy and cooed at her while she manipulated the baby’s joints, blowing raspberries to make her laugh.

  ‘So do you think she has this clicky hip thing?’ Ms Byford asked.

  ‘I felt a bit of a clunk when I moved her legs just now, so yes,’ Anna said. ‘I can see that her right leg is slightly shorter than the left, and basically I think her thigh bone isn’t moving properly in the socket of her pelvis. We’ll do the scan, and then we can think about treatment. It might be that we do a watch-and-wait thing, or we might put her in a special harness to treat the hip dysplasia, but I’ll be in a better position to know what’ll work best once I’ve seen the scan results. And the scan’s like the one you had when you were pregnant with her, so it won’t hurt,’ she added reassuringly.

  While Poppy was having her scan, Anna saw her next patient. The scan results definitely showed a problem with Poppy’s hip, but whether the harness would be enough or the baby would need treatment with traction, she wasn’t sure.

  ‘I’m going to have a word with one of my colleagues,’ she said to Ms Byford. ‘He’s a specialist in children’s bones, and I’d like to check a couple of things with him. I’m sorry, I’m afraid it means a bit more waiting about for you, but please try not to worry because this really is something we can sort out for Poppy.’

  To her relief, the new paediatric orthopod was in one of the offices, reviewing notes for his operating list the next day. She rapped on the open door. ‘Mr Thurston?’ she asked. ‘I’m Anna Maskell, one of the special regs on the ward, and I’ve got a baby with clicky hip. She’s a borderline case and I’m not sure if she needs an op, so would you mind reviewing her scan and treatment plan with me, please?’

  ‘Sure,’ he said, looking up from his notes.

  His eyes were the most piercing cornflower blue, and Anna felt her pulse leap.

  How completely inappropriate.

  For a start, they were at work, and her patients always came first. Secondly, given that Jamie Thurston looked to be in his mid-thirties, he was probably already involved with someone; but, even if he wasn’t, Anna wasn’t looking for a relationship. Love wasn’t on her list of things to do, not any more. It had taken her two years to put her heart back together since Johnny’s affair and the disintegration of her marriage, and she wasn’t planning to risk her heart breaking ever again.

  ‘Thank you. Robert asked me earlier if I would show you around,’ she added. ‘I was due in the Paediatric Assessment Unit before you arrived, so I asked Lacey to pass on a message inviting you to lunch, as it’s your first day and you probably haven’t had a chance to find your way around yet.’

  * * *

  So this was Anna Maskell, the woman who’d left him that kind message, Jamie thought.

  She was taller than average with broad shoulders, a shock of dark curly hair she’d tied back at the nape of her neck, and eyes the same green as the sea on a summer day; she was more like an Artemis than a delicate nymph, though it shocked him he was even thinking that way. For a moment, his tongue felt as if it had stuck to the roof of his mouth. Then he pulled himself together. ‘Yes, she did tell me. Thank you. That was kind.’

  ‘Pleasure. My patient?’ She sounded businesslike, but kind rather than snippy.

  ‘Of course.’ He logged out of his screen and shifted his chair so she could draw up the scan for her patient.

  ‘Poppy Byford is four months old,’ Anna said. ‘She has all the risk factors for DDH, but her newborn and six-week checks were completely normal. The health visitor was concerned that one hip wasn’t opening out properly and referred her. I definitely felt a clunk when I manipulated her legs, and I don’t think watch-and-wait is the right way forward for her, but I’m not sure whether to try a Pavlik harness for a couple of months or whether traction would be a better option—I’m hoping we might be able to get away without an operation, but I could really do with an orthopod’s view. As I said, she’s borderline.’

  Jamie liked the way she was so clear in giving him the information he needed to help him make the clinical decision—and that she’d clearly thought the treatment options through before coming to see him.

  ‘I agree, it looks borderline,’ he said. ‘As she’s younger than six months, I agree that it would be better to start with something less invasive than an operation. Let’s try a harness for three months,’ he suggested, ‘and we can give an ultrasound review of how her hips are developing every month.’

  ‘Great. Thank you.’ She smiled at him.

  How strange that a smile could almost make him feel warm inside.

  He hadn’t felt warm since Hestia had died, three years ago.

  Before he realised what he was doing, Jamie found himself looking at Anna’s left hand. Ridiculous. Apart from the fact that not wearing a ring didn’t mean she wasn’t already committed elsewhere, he wasn’t looking to get involved with anyone. No way could he face the emptiness of losing someone again and having to try to put his life back together again afterwards.

  Work.

  This was strictly work. End of.

  ‘Would you like me to come and talk to Poppy’s mum and fit the harness?’ he asked.

  ‘Would you mind?’

  ‘Sure. I was only reviewing tomorrow’s list, and that can wait. I’ll come now.’

  In the assessment unit, Anna introduced him swiftly to Poppy and her mum.

&nb
sp; ‘The good news is,’ Jamie said, ‘we’re not necessarily looking at an operation to help Poppy’s hips. We can fit something called a Pavlik harness; it will keep her hips in the right position so they can develop properly.’

  ‘Will it hurt?’ Ms Byford asked.

  ‘No. It’s lightweight and made of fabric,’ Anna said. ‘You might find it a bit upsetting to see it, and Poppy might be a bit grizzly for the first few days, but it won’t hurt her and she’ll soon get used to it.’

  ‘She’ll need to wear it all the time,’ Jamie added. ‘It will be easier for you to put her in loose clothes while she’s got the harness fitted.’

  ‘Do I take it off when she has a bath?’ Ms Byford asked.

  ‘No. Just top and tail her rather than giving her a full bath,’ Jamie said. ‘We’ll see you every week to adjust the harness as she grows, and she can have a proper bath here when we take the harness off, before we do the adjustment.’

  ‘So how long will she have to wear this harness?’ Ms Byford asked.

  ‘Maybe for two or three months,’ Jamie said. ‘We’ll give Poppy an ultrasound scan every month to see how her hips are developing, and you’ll see a physiotherapist with her here every week.’

  Ms Byford frowned. ‘What if the harness gets dirty?’

  ‘The harness can be sponge cleaned,’ Anna said. ‘And some of my parents have put long socks over the baby’s legs to protect the harness during nappy changes.’ She smiled. ‘One of my mums calls them the “poo socks”.’

  Ms Byford looked close to tears. ‘Only a few days ago, everything was fine. And now...’

  ‘The good news is that Poppy might not need an operation,’ Jamie said gently. ‘And a harness is a lot easier to manage than a plaster cast. Hopefully, wearing the harness will encourage her joints to develop as they should. I know this has been a shock to you, but she’s going to be fine. The earlier we pick up something like this, the quicker it is to treat.’

  ‘And she’ll be all right?’ Ms Byford asked.

  ‘She’ll be absolutely fine,’ Anna reassured her. ‘I know right now it feels as if you don’t know anyone else going through this and it’s a bit daunting, but Poppy’s not the only baby I’ve seen with clicky hip, and all my former patients with it have gone through treatment and are just the same as their peers now. The next thing you know, Poppy will be crawling and you’ll be shocked at just how fast a determined baby can move.’

  Between them, Jamie and Anna fitted the harness. Poppy protested, and her mum watched them with silent tears rolling down her cheeks, looking anxious.

  Anna gave her a reassuring hug. ‘I know right now it feels a bit scary and overwhelming, but you’ll both get used to it and she’ll be back to her usual smiley self before you know it. I’ll book you in with the physiotherapist and my clinic for a week’s time, and in the meantime if you’ve got any questions just ring in.’ She took a leaflet from a drawer. ‘This will tell you all about the harness and what it does, if anyone asks you and it’s gone all fuzzy because right now you’re worrying too much about Poppy to take everything in.’

  Jamie glanced at her. Anna Maskell was kind as well as professional. And he could already see the difference that kindness had made to the patient’s mother; Ms Byford had stopped crying and was asking questions.

  Anna, he thought, was going to be good to work with.

  Not that he intended getting close to her or to any of his other colleagues in the Muswell Hill Memorial Hospital. He’d agreed to cover maternity leave here for three months, and that was all. He didn’t need to make new friends. He was absolutely fine on his own.

  ‘All the best, Ms Byford. I’ll see you later, Dr Maskell,’ he said. And he left the room before he was tempted to blow a raspberry at Poppy and make the baby laugh.

  Babies.

  How ironic that this was his vocation, the job he loved so much.

  After losing Hestia and the baby, Jamie hadn’t wanted to see another baby or child ever again. But he wasn’t going to throw all those years of hard work and studying away and change his career. Hestia would never have forgiven him for that. But, unable to face the pity of his team at the hospital where he’d worked in south London, he’d switched to working as a locum. No involvement, no closeness, no risk of heartache. He stayed for no longer than three months in one place; as soon as his locum cover was finished, he moved on to the next job. That was how his life had been for the last two and a half years, and that was how he intended it to stay. Utterly within his comfort zone.

  * * *

  Anna finished writing up her notes for the last patient of her morning’s clinic, then headed to the office where she’d met Jamie Thurston earlier. ‘Ready?’ she asked from the doorway.

  ‘Yes.’ He logged out of the files he’d been reviewing, then came to join her.

  ‘Did Robert introduce you to everyone when you started this morning, or would you like to meet everyone now?’

  ‘Robert introduced me,’ Jamie said.

  ‘That’s great. OK. I’m assuming he also showed you the staff kitchen?’

  ‘Yes.’

  ‘Just the canteen, then,’ she said, ‘and filling you in on the social side of the ward.’

  ‘Social side?’

  Was it her imagination, or did Jamie look a bit antsy? ‘We’re a close team. We do a lot of things together outside work,’ she said. ‘And we try to do stuff that includes partners and children.’

  He said nothing, simply nodded.

  ‘Locums count as part of the team,’ she said softly. But she shut up when she noticed his slight frown. Maybe he was shy. And it was his first day on the team, so she should cut him some slack.

  She left it until they’d bought lunch and found a quiet table in the canteen. ‘I guess it’s because I have bossy tendencies,’ she said, smiling to take the sting from her words, ‘but I organise most of the ward’s social stuff. I’ve had the venue for the team Christmas dinner booked since July, but I don’t have to give the absolute final numbers or confirm everyone’s menu choices to the pub for another week or so.’

  * * *

  Jamie’s wrap stopped tasting like sweet chilli chicken and turned to ashes in his mouth.

  Christmas.

  No.

  Since Hestia’s death, he didn’t do Christmas. There weren’t tidings of comfort and joy, as far as he was concerned. Just the bleak midwinter, and the radio playing songs saying how it would be lonely at Christmas, or begging the singer’s loved one to come home for Christmas, or, worse still, the song Hestia had loved and danced around the house to with him, making him sing along with her. The most popular modern song, the one that seemed to be playing all the time in December, no matter which radio station he chose.

  All Hestia had wanted for Christmas was him. And their baby.

  That was what he’d wanted, too.

  What he’d actually got was a double funeral. All those plans, all the happiness and excitement, had sunk into a black hole. It was just over three years ago now, and everyone had expected him to move on. But he couldn’t. It was too, too hard.

  Which was why he worked as a locum.

  And why he flatly refused social invitations from family and friends alike, since the time they’d all clearly talked about him and decided he needed help to move on, and had set him up at a dinner party with a suitably single woman. A nice, sweet woman who deserved so much more than the wreckage that had once been Jamie Thurston. He’d been polite, the first couple of times it had happened, but then he’d refused invitations so he wouldn’t be put in an awkward position again. He didn’t need to be fixed up with anyone. He didn’t want anyone else in his life.

  ‘Sorry. I don’t think—’ he began, but Anna had already fished her phone out of her pocket.

  ‘It’s very much a foodie pub, so the food’s utterly amazing,’ she said. ‘Th
e smoked salmon pậté is to die for.’

  Die. Yeah. Jamie knew all about dying and death. Though this wasn’t Anna’s fault. She didn’t know him, so she’d have no idea how inappropriate that phrase was.

  ‘If you’re veggie or vegan, the avocado on toast with chilli jam is fantastic. Or the spiced pumpkin soup,’ she continued.

  He didn’t want to even think about a ward Christmas dinner, let alone go to one.

  ‘They do the best roast potatoes in the world—better even than my mum’s, which is saying a lot,’ she said. ‘Crispy on the outside and fluffy in the middle. And they stir-fry the Brussels sprouts with lemon and chilli. There’s traditional turkey, sea bass if you prefer fish, or parsnip and chestnut Wellington for the veggie/vegan option.’ She passed her phone to him so he could see the menu for himself. ‘Obviously there’s traditional Christmas pudding or cheese, but I guarantee the chocolate Venetian cake will ruin you for any other pudding.’

  He blinked at her.

  ‘Or I can email everything over to you, if you want to take a bit of time choosing. It’s the first Friday evening in December, at half-past seven,’ she said. ‘And we do a Secret Santa on the ward, too—you pick a name out of the hat, leave your labelled parcel with the secretaries, and Robert puts the ward’s Father Christmas outfit on and dishes them out on the night. Anyone who can’t make it to the dinner gets their parcel at the start of their next shift.’

  This was going way, way too fast for him.

  She gave him a speculative look. ‘Actually... Robert usually dresses up as Father Christmas for us on the ward on Christmas Day, but this year he’s disappearing off to New York.’ She smiled. ‘I guess his silver wedding anniversary’s a good enough excuse for him not to do it this year. But it means I need a replacement Father Christmas. You’re about the same height as Robert, so the costume would fit you perfectly.’

  What? Jamie could barely process this. She wanted him to dress up as Father Christmas?