The Italian Doctor's Perfect Family

by Alison Roberts

  ‘Now, cara, it’s time I had a good look at this tummy of yours. Can you climb up onto the bed for me?’

  But Alice was staring at him now. ‘Why did you call me Cara? My name’s Alice.’

  ‘Sorry, it’s Italian. It means…sweetheart.’

  ‘Oh…’ Alice dropped her gaze shyly as she moved to climb onto the examination couch. ‘That’s all right, then.’

  There weren’t many people that could have won Alice Murdoch’s full co-operation so easily. Pip stayed where she was, seated by the desk, while Toni began his examination. Close enough for support but far enough away to allow closer interaction between doctor and patient. Pip was more than happy to observe an examination that was thorough enough to be both impressive and a learning experience for her. She would make sure she remembered to apply the same principles for her next paediatric patient.

  Toni did a head-to-toe check of Alice with astonishing efficiency, covering a basic neurological, cardiovascular and respiratory assessment before concentrating on Alice’s abdomen. He also fired questions at Pip. Fortunately, the focus of his attention and the distance across the consulting room meant he probably didn’t notice anything unusual in her responses.

  But, then, he wouldn’t be expecting her to be able to answer them easily, would he?

  ‘Do you know if there were any difficulties associated with Alice’s birth and the pregnancy?’

  ‘Ah…’ Pip had to stifle a kind of incredulous huff of laughter. ‘Difficulties’ couldn’t begin to cover the emotional and physical trauma of a sixteen-year-old girl discovering she was pregnant.

  Having the father of that baby abdicate any kind of responsibility or even acknowledgement of his child.

  Being forced to burden her own mother who was still trying to get her life back together after the tragic loss of her husband and Pip’s father only the year before.

  Suffering a labour that had been so badly managed, prolonged and horrendous that Pip had known ever since that it was an experience she could never face repeating.

  Her hesitation was interpreted as a negative response, but Toni’s nod indicated it was only to be expected. ‘I imagine you would have known if there had been anything seriously amiss.’

  ‘Yes, I think I would have.’

  ‘Normal milestones?’ he asked, after listening to Alice’s chest and heart with a stethoscope. ‘Do you remember what age Alice started walking, for instance?’

  ‘She was just over twelve months old.’

  Twelve months that had been the hardest in Pip’s life. The responsibility and practical skills of caring for a baby would have been totally overwhelming and dreadful if it hadn’t been for Shona. In a way, though, it had been a wonderful twelve months because Shona had forged an even closer bond with her daughter and then rediscovered her joy in life through her granddaughter. That she had become more of a mother to Alice than Pip had been gradual but inevitable as Pip had been encouraged to finish her schooling and even chase her dream of going to medical school.

  ‘What about talking?’ Toni asked, as he let down the pressure from the blood-pressure cuff around Alice’s arm.

  ‘I’m not so sure about that. Around two, two and a half.’ Hard to confess her lack of certainty but it was true—she wasn’t sure. Alice hadn’t been stringing more than a few single words together when Pip had headed away for her first term at university, but she had been chattering by the time she’d headed home for her first holiday break.

  ‘Childhood illnesses? Measles, mumps, chickenpox and so on?’

  ‘She’s fully vaccinated. She had chickenpox when she was…oh, about four. The whole kindergarten class came down with it, I seem to remember.’

  Not that Pip had been there to help run baths with soothing ingredients or apply lotion or remind Alice not to scratch. The letters and phone calls from her mother had made her feel guilty she hadn’t been there to help and share the worry. Worse than the poignancy of missing the joy of other milestones. But, as Shona repeatedly said, it wasn’t because she didn’t love Alice. She was doing what was best for both of them. For their futures. It couldn’t be helped that she had to be away so much.

  No wonder their relationship worked so much better as sisters now. They all knew the truth, of course, but it worked so well for all of them the way it was.

  Pip had the niggling feeling that Dr Toni Costa might not think it was an ideal arrangement. He already thought it strange that Alice called her mother ‘Nona’ and there had been something hidden in the tone which with he’d shared the information that he’d been raised by his grandmother. She wasn’t about to try and analyse why she didn’t want to be thought less of by Alice’s paediatrician but it was enough to prevent her correcting his initial assumption that was now making answering his questions rather uncomfortable.

  It was a relief when he concentrated totally on Alice again for a few minutes.

  ‘Show me where you feel the pain in your tummy.’

  Alice pointed vaguely at her midriff.

  ‘Does it hurt if I press here?’ His hand was on the upper middle portion of Alice’s abdomen.

  ‘A little.’

  Pip could see how gentle he was being, however. How sensitive his touch was. It was hard to look away from that hand, in fact. The olive skin with a dusting of dark hair. Long fingers and neatly manicured nails. Movements that were confident but careful.

  ‘What about here?’ He was trying the upper right quadrant now. The area that pain would be expected if Pip’s suspicions had any grounds.

  ‘Yes,’ Alice said quickly. ‘That hurts.’

  ‘A little or a lot?’

  ‘Not too much. But that’s where it gets really sore when I get sick.’

  The strident beeping at that point made Toni glance at the pager clipped to his belt. Then he raised his eyebrows in Pip’s direction.

  ‘Sorry. I think ED’s trying to contact me.’

  ‘Feel free to use the phone on the desk if you wish.’

  ‘Thanks.’ Pip was embarrassed to interrupt the examination but she couldn’t not take the call. What if her Mr Symes was busy having a cardiac arrest in a side room or something?

  Suzie sounded apologetic as well. ‘I’m sure it’s nothing, but Mr Symes is complaining of chest pain now. Says it’s a crushing, central pain that’s radiating to his left arm.’

  Classic symptoms. Almost too classic. ‘Any associated symptoms?’

  ‘Not really. He’s been complaining of nausea since he came in, along with all those aches and pains, but he’s not vomiting or sweating or anything. He reckons this came on suddenly.’

  ‘I don’t suppose he gave you a pain score without being asked, did he?’

  Suzie laughed. ‘Ten out of ten. Do you think he’s been reading the right textbooks?’

  ‘We can’t afford to make assumptions. Can you do a twelve-lead ECG and put him on telemetry?’

  ‘Sure.’

  ‘What’s his blood pressure?’

  ‘One-fifty over ninety.’

  ‘Safe to try a dose of GTN, then. Put him on oxygen as well. Six litres a minute.’

  ‘OK.’

  ‘We’ll do some more bloods, too, and add in cardiac enzymes. I can do that when I come down. I shouldn’t be much longer.’

  In fact, Toni was sitting down to share his findings with her as she hung up the phone, and Pip was aware of a vague feeling of disappointment that the consultation was almost over.

  ‘Cardiac patient?’ he queried.

  ‘Probably not, but we’ll have to rule it out.’

  ‘I won’t keep you too long. Alice seems like a normal, healthy little girl on first impression. The only finding I can make is mild and rather non-specific abdominal tenderness.’

  That feeling of disappointment grew. Were her instincts misplaced? And would there be no reason for Alice to see Dr Costa again?

  ‘Mind you, that’s not an unexpected result and it certainly doesn’t mean I don’t wish to make any
further investigations.’

  Pip nodded, listening intently.

  ‘I’d like to do some further blood tests and another urine culture and microscopy. I think a general abdominal ultrasound examination would be a good idea. Maybe even an MRI scan.’ Toni was ticking boxes and scribbling notes on request forms.

  ‘We might like to consider a carbon-labelled urea breath test and possibly endoscopy to rule out the gastritis and duodenal ulceration that Helicobacter pylori can cause.’

  Pip nodded again. This was more than she had expected.

  ‘Alice hasn’t been hospitalised with any of these episodes, has she?’

  ‘No. I came close to bringing her in the first time because she was so miserable, but it only lasted about half an hour.’

  ‘It would be ideal if we could see her and get a blood sample while she was having the pain. To check liver function for elevated blood amylase levels.’

  ‘So you think pancreatitis is a possibility?’ Pip caught Toni’s gaze and held it. To voice the unthinkable—that Alice could have a tumour of some kind—was unnecessary. The eye contact told her that he already knew her deepest fear.

  ‘I’m not ruling anything out at this stage. We’ll find out what’s causing the problem and then we’ll deal with it, yes?’

  ‘Yes.’ Pip dropped her gaze, embarrassed to show how grateful she was. ‘Thank you.’

  ‘And you’ll bring her in if it happens again? And call me? I’d like to see her myself if it’s at all possible.’

  The warm smile that curled around the words made Pip think that this consultant might even get out of bed and come into the hospital at 3 a.m. if that’s when the attack happened to occur.

  And that he was really going to do whatever it took to make a diagnosis and then fix whatever was wrong with Alice.

  Did all the relatives of his patients feel so cared about?

  So…safe?

  Pip was smiling back as Alice finished getting dressed and plopped into the chair beside her. She glanced from Toni to Pip and then back again.

  ‘OK,’ she said. ‘Where’s my bus off to, then?’

  Alice was less than impressed with all the tests she might have to undergo.

  ‘Why can’t they just take an X-ray or something? You know I hate needles.’

  ‘An ultrasound test is completely painless and it’s better than an X-ray. And an MRI scan is even better. It’s like having photographs taken of what’s inside your tummy. It’s incredibly detailed.’

  ‘Ooh, gross! Can you see, like, what you had for breakfast?’

  Pip laughed. ‘Almost, but I wouldn’t worry about any of it. You might have to wait for weeks to get an appointment for something like an ultrasound. We’ll do what Dr Costa suggests and bring you into hospital next time you get a sore tummy.’

  ‘Will you come with me?’

  ‘Of course.’

  ‘What if you’re working?’

  ‘Then I’ll stop working to look after you. Like I did today to go to your appointment.’

  ‘Do you get into trouble for doing that?’

  ‘Of course not.’ Pip almost managed to convince herself as well as Alice. ‘I just have to make up for it later. Like now. Are you OK to sit in the staffroom and read magazines while I go and look after the patients I still have?’

  ‘Sure.’

  ‘You can get a hot chocolate out of the machine. You know how to work it, don’t you?’

  ‘Yeah.’

  They bypassed the main area of the emergency department to reach the staffroom.

  ‘Hey, Pip?’

  ‘Yeah?’ When had she picked up Alice’s speech patterns that now came so automatically?

  ‘Dr Costa’s nice, isn’t he?’

  ‘Very nice.’ Her agreement was deliberately casual. What an understatement!

  ‘Is he married?’

  ‘I have no idea.’ Liar! Pip knew as well as most women on the staff of Christchurch General that Toni Costa was single.

  ‘Maybe you should find out.’

  ‘Why?’

  ‘’Cos it’s about time you got a boyfriend and I think Dr Costa’s hot.’

  Pip wasn’t about to engage in that kind of ‘girl-talk’ with any twelve-year-old but most especially not her own daughter. ‘I’m way too busy to fit a boyfriend into my life.’

  ‘If you leave it too long, you’ll get old and crusty and no one will want you.’

  ‘Oh, cheers!’ But Pip was grinning. ‘For your information, kid, twenty-eight isn’t old!’

  They had reached the staffroom now but, as usual, Alice had to have the last word.

  ‘Well, he likes you. I could tell.’

  Toni sat back in his chair and sighed with relief as the shrieking toddler who had been the last patient in today’s clinic was removed from his consulting room.

  He eyed the pile of manila folders and patient notes on his desk and pulled a pen from his pocket. While it would be nice to escape the hospital completely and revel in the peace and quiet of his home, he never left a clinic until he’d expanded his rushed notes to make a detailed summary of each visit. It wouldn’t take long.

  When he got the Alice Murdoch’s file, however, he found himself simply staring into space, fiddling with the pen instead of writing efficiently.

  How long would it be before he saw the Murdoch sisters again? Not that he’d wish an episode of acute abdominal pain on Alice, of course.

  He could always find another reason to visit the emergency department, couldn’t he? A consult that he didn’t send a registrar to do, for example.

  It wasn’t as though he intended to ask Pippa out or anything. Good grief, she was the relative of one of his patients.

  Only the sister, though, not the mother. Did that somehow make it more acceptable?

  But what would be the point of starting something that would go nowhere? He’d done that too many times already. And she was a doctor. A career-woman. Toni wasn’t about to break his number-one rule. However ready he might be to find his life partner, the mother of his children was going to have to be as devoted to them as he intended to be.

  As devoted as his own parents had always failed to be.

  But he was going to have a career, wasn’t he? Wouldn’t any intelligent woman also want a career—at least part time?

  Maybe this Pippa Murdoch was planning to go into general practice some time.

  Part time.

  Toni tried to shake off his line of thought. Tried, and then failed, to complete the task waiting for him on his desk.

  There was just something about the bond between those sisters that was very appealing. It was something special. Unusual.

  Her family was clearly very important to her. She had left a patient who sounded as though he could be having a heart attack to accompany Alice to the appointment, and she was concerned enough to be determined to get a more definitive diagnosis than her family doctor had supplied.

  He respected that.

  And there was no getting away from the fact that she was a beautiful woman.

  Different.

  Stunning, in fact.

  Toni reached for the phone and punched in an extension number.

  ‘Ultrasound Reception, Marie speaking.’

  ‘Hello, Marie. It’s Toni Costa here, Paediatrics.’

  There was a small noise on the other end of the line. Almost a squeak.

  ‘You’ll be getting a request for an abdominal ultrasound on a twelve-year-old patient of mine, Alice Murdoch.’

  ‘Yes?’ Marie sounded keen to be helpful.

  ‘I’d like you to let me know when you schedule the examination. If I’m available, I’d like to come and watch.’

  ‘Really?’ Marie recovered from her surprise. ‘Of course, I’ll let you know as soon as it’s in the book. Is it urgent?’

  Toni considered that for a moment. ‘It’s important rather than urgent,’ he decided aloud. ‘But it would be very nice if it could happen within the next week
or two.’

  And it would be very nice, albeit unlikely, if he happened to be free at the time of the appointment. That way, there was at least a chance he might see Pippa again in the not-so-distant future.

  He went back to finishing his paperwork.

  Quite oblivious to the half-smile that occasionally played at the corners of his mouth.

  CHAPTER TWO

  THE child looked sick.

  Pip had gone past the mother, sitting with a boy aged about two on her lap, twice. They had been there for nearly half an hour and should have been seen before this, but a major trauma case had come in and a significant percentage of the senior emergency department staff were tied up with several badly injured patients in the main resus bays.

  The department had been crazy all day. Pip currently had three patients under her care and they were all genuinely unwell. Seventy-five-year-old Elena was having an angina attack that was much worse than usual and could herald an imminent myocardial infarction. Her investigations were well under way and adequate pain relief had been achieved, but Pip was trying to keep an eye on her ECG trace as she waited for blood results to come back and the cardiology registrar to arrive.

  Doris, in cubicle 3, was eighty-four and had slipped on her bathroom floor to present with a classic neck of femur fracture. The orderlies had just taken her away to X-Ray and then she would most likely need surgical referral for a total hip replacement.

  Nine-year-old Jake had had an asthma attack that hadn’t responded well to his usual medications and his frightened mother had rushed him into Emergency just as the victims from the multi-vehicle pile-up on the motorway had started arriving. Judging the attack to be of moderate severity, Pip had started Jack on a continuous inhalation of salbutamol solution nebulised by oxygen. She had also placed a cannula in a forearm vein in case IV drug therapy was needed, but his oxygen saturation levels were creeping up and the anxiety levels dropping in both mother and child.

  Pip was about to check on Jake again and consider whether he needed admission to the paediatric ward.

  Toni Costa’s ward.

  Seeing another child waiting for assessment made her think of Toni again, but Pip was getting quite used to that. It wasn’t just Alice’s fault for making that unwarranted but rather delicious suggestion that he’d been attracted to her. Pip preferred to think the explanation was because she’d been so impressed with the man as a paediatrician. How good he was with interacting with his young patients and what a good example he’d set in making such a thorough assessment of a new case. How he’d taken Pip’s unspoken concerns seriously and made her feel that her daughter was in safe hands.