‘Why not morphine?’ It was the standard analgesic to use in situations such as this.
‘There’s some evidence it can cause sphincter of Oddi spasm.’
Graham nodded. He eyed Alice thoughtfully and Pip could tell he was trying to assess how much she weighed in order to calculate a dose of the narcotic. Toni picked up the hesitation as quickly as Pip did but showed none of the impatience some consultants might have displayed. Instead, he smiled at his young patient.
‘Do you know how much you weigh, Alice?’
‘No.’
‘I’m sure Mum knows.’
There was a tiny pause as Shona blinked at being the focus of attention. ‘Ah…’ She flicked a puzzled gaze at her daughter. ‘Actually, Pip’s—’
‘She’s about thirty-two kilos,’ Pip interrupted quickly. This was hardly the time or place to correct Toni’s assumption about her relationship with Alice, was it?
‘We’ll start with 25-mg IV,’ Toni told Graham. ‘I’d like to get an abdominal X-ray and then admit Alice to the ward overnight.’ His gaze found Pip. ‘We’ll restrict her fluid intake and make sure we get the pain under control. I want to do an arterial blood gas as well and we’ll see if we can get that ultrasound done first thing tomorrow. We’ll have the blood results back by then, and then we’ll look at what else we need to do.’
A lot seemed to be happening with extraordinary ease as Toni calmly issued instructions and made more than one phone call. Even when everything was sorted to his satisfaction, he didn’t take his leave.
‘How’s the pain now, Alice?’
‘Getting better.’ Alice smiled for the first time since they had arrived and then she yawned.
‘We’ll get you to bed as soon as you’ve had that X-ray and then you can have a proper rest. Would you like your mum to stay with you in the hospital tonight?’
Alice nodded slowly. ‘Mummy?’
Pip gave no thought to the fact that she was about to let Toni learn of the deception she and Alice had allowed to occur. Or that she had complications in her life that were enough to scare most men firmly away. The only thing that mattered right now was Alice. Providing any comfort possible. She squeezed Alice’s hand.
‘What is it, hon?’
Toni’s glance slid from Shona to Pip, a puzzled frown appearing between dark brows.
‘Will you stay with me?’ Alice asked plaintively. The question was clearly directed at Pip rather than Shona.
‘Of course I will, chicken.’
Toni merely raised one eyebrow. ‘If you’d rather have your sister stay with you, Alice, that’s absolutely fine.’
‘Pip’s not really my sister,’ Alice mumbled drowsily. ‘She’s my mother.’
The timing of the radiologist’s arrival to take the abdominal X-ray Toni had ordered was fortunate. He could cover up his reaction to Alice’s startling revelation by moving abruptly to go behind the protective glass screen in one corner of the main resus area. And then he was able to concentrate on the first results coming in from the blood tests.
Or appear to concentrate, at least. Toni was shocked, he couldn’t deny it. Pip had been less than honest with him, hadn’t she? Yes, he had to concede that he had made the assumption they were sisters himself, but she hadn’t made any attempt to correct him, had she?
But, then, he knew that women couldn’t be trusted, didn’t he?
His grandmother would hold the prize of a visit from his parents over him to extract co-operation. He soon learnt, however, that the reality of the reward was so intermittent it could never be completely trusted. Or dismissed.
His mother had always been so believable in her promises that one day—soon—she would take him away with her. That they would be a real family and he would see more of the adored but shadowy figure of his father.
Promises that were never kept.
And there had been Ellen, of course. The woman he had begun to really love. The one who could have restored trust and instead had betrayed him the moment her former boyfriend had called for her to join him in his new life overseas.
Had he expected something different simply because this particular woman was so damned attractive?
If so, he was a fool.
Even more foolish was his decision to stay in the hospital a little longer, knowing that it wasn’t due entirely to a desire to see Alice settled and to try and obtain a definitive diagnosis for what was causing her discomfort.
Something other than shock was also undeniable.
Curiosity.
The compulsion to watch, covertly, the way the three generations of this family interacted. To see if it bore any relevance and would thereby confer some understanding of the effects his own, less than usual upbringing had had on his life. Because, if he could understand, maybe he would be able to forgive.
And if he could forgive the two women who had created such misery, maybe he could move on. He might even be able to find what was so painfully lacking in his own life.
On first impression, it was easy enough to equate the kind of matriarchal status his grandmother had wielded within the Costa villa to the position Shona filled. She fussed around Pip with almost the same level of concern she displayed for Alice.
‘I’ll stay with Alice,’ she told her daughter, when the X-ray had ruled out a perforating ulcer or major abdominal bleed. ‘You’ve got work in the morning and you need your sleep.’
‘There’s no way I’m leaving Alice.’ Pip had her arm around her mother’s waist as they prepared to move Alice’s bed to the paediatric ward. ‘Besides, you need rest more than I do. I’m worried about you, Mum. You’ve got to stop trying to do everything. And you’ve got to go and see Dr Gillies. Tomorrow.’
The conversation was muted but Toni’s senses were tuned to more than the verbal exchange between the two women. There was love and support there. A closeness that had never existed between his mother and her mother-in-law. Was that what made the difference?
‘I’ll come up to the ward with you,’ he announced.
‘You don’t have to,’ Pip responded quickly. ‘I can see her settled and try to get that urine sample for testing.’
‘I do have other patients I intended to check on before I leave.’
‘Oh…of course.’
She sounded embarrassed, Toni decided. He hadn’t meant the response as any kind of put-down but maybe the tone had been defensive because he wouldn’t want her to guess the real reason for his interest. He’d never had much patience with people who could lay the blame for any lack of success in their lives at the feet of an unhappy childhood. You dealt with what life threw at you and you coped if you had any kind of strength.
Toni had that kind of strength.
Maybe Pip did as well. She wasn’t exactly unsuccessful, was she? There were a set of parents in the paediatric intensive care ward right now who would be grateful for her skill for the rest of their lives. Being a single mother could be viewed as adversity but she had come through with flying colours. It was quite possible they had something very basic in common, which could explain the attraction.
Having checked on his other patients, Toni went back to the single room Alice had been allocated and once again covered his observation of Pip and her family by apparent absorption in recording his notes.
Alice seemed equally content to receive comfort from both Pip and Shona as they helped her into a hospital gown, persuaded her to provide a urine sample for analysis and then made her as comfortable as possible for the night. It was as though the child had two mothers, and there was no way Toni could relate to abundance like that.
He hadn’t even had one, really.
He’d had a grandmother who’d done her duty, however inconvenient it might have been, and had never hidden her disapproval of her son’s choice of wife. The number of times he’d seen his father could easily have been counted on his fingers and even Toni’s mother, Elizabetta, had been a stranger. A beautiful visitor who arrived in a cloud of perfume and
gifts, created extraordinary tension in the household and then left, never failing to leave behind a sensation of emptiness.
In the short space of less than two hours with the Murdochs, Toni had gained more of an impression of a family bond than he’d ever known himself. It was a compelling warmth that he was standing away from. It was like being in the rain, looking through a window to a room that was filled with firelight and laughter and the smell of something baking. Irresistible.
What made this family unit work when his own had been such a miserable failure? In both cases, the pregnancy had to have been accidental. Elizabetta would never have chosen the disruption to such a successful modelling career and Pippa—well, she couldn’t have been more than in her mid-teens. She wore no wedding ring and Alice’s surname was the same as her mother’s and grandmother’s, so presumably there was no father in the picture.
Toni watched Pip fill a glass with iced water from the jug on the bedside table. Her movements were graceful, her hands managing to look elegant even while performing such a mundane task.
The thought of her being sexually active at such a young age was distasteful and Pip must have felt his stare because she glanced up suddenly. Maybe something of what he was thinking showed on his face, which would explain why she looked away so suddenly, her cheeks flushing uncomfortably.
Except it didn’t fit. Something about this woman made the thought as insulting as it was distasteful.
Toni’s curiosity reached a new high point.
Had she been raped?
Involuntarily, he sucked in his breath, confused by the strong emotion the idea provoked. Disgust? Not really. Anger? No. He watched the way Pip smoothed Alice’s hair as she laid her head back on the pillow, having taken a sip of the iced water.
There was such tenderness there. The kind of caring Pip should have been shown herself. Maybe that odd emotion was, amazingly, regret that she could have been shown something so very different.
And how ridiculous was it to be imagining scenarios and feeling for somebody when he had no idea what the real story was? His voice, when he spoke, was uncharacteristically gruff.
‘I’ll be back in the morning. We’ll arrange whatever other tests need to be done when we get the rest of the blood results.’ Toni avoided meeting Pip’s gaze as she thanked him, in the hope of avoiding any more disturbing sensations. He turned abruptly. ‘Sleep well, Alice. Tell the nurses if your tummy gets sore again and they’ll give you some more medicine.’
He found himself holding the door for Shona when she decided to take her leave at the same time.
‘I’ll get some sleep,’ she told Pip, ‘and then I’ll be back first thing so you can sort things out with your working hours.’
The temptation to escort this exhausted-looking older woman to her car was something Toni tried to dampen. If he did that, he knew he might not be able to resist asking questions that would be satisfying a less than professional curiosity.
If he couldn’t shake this desire to learn more of Philippa Murdoch’s story, he could at least be honourable enough to find a way to do so face to face.
The summons to Toni Costa’s office late the following afternoon was unexpected, and Pip was distinctly nervous as she weaved through the traffic of a busy hospital’s corridors.
Her day had been broken on more than one occasion as she’d accompanied Alice to the various investigations Toni had ordered in the wake of the abnormal liver function test results. Investigations that must have been comprehensive enough to give him a good idea of what they might be dealing with.
To have called her to his office instead of catching her in Alice’s room or coming to find her in the emergency department suggested that it was something serious he wished to discuss.
He looked serious. Disconcertingly, there was almost an air of discomfort as he ushered Pip to a chair and then hooked a long leg up to perch on the corner of his desk as he reached for the set of patient notes. His first words, however, were reassuring.
‘We’ve been able to rule out any indication of a possible tumour.’
‘Thank God for that,’ Pip breathed. ‘I really was worried.’
Toni’s smile revealed that he had shared her concern. ‘We’ve also cleared her for liver disease, peptic ulcer and gastroesophageal reflux.’
Pip was watching his face intently. There was something he was undecided about telling her. ‘Not much left to worry about, then, is there?’
‘I’m happy to discharge her this afternoon.’ Toni nodded. ‘Theoretically, we should wait for a second occasion in which the pain and abnormal liver tests are consistent, but I’m confident that Alice has sphincter of Oddi dysfunction.’
Pip frowned as she searched her memory banks.
‘It’s not that common,’ Toni told her. ‘I’d be surprised if it’s caught your attention yet.’
‘It’s got something to do with the flow of bile from the pancreas, hasn’t it?’
Toni nodded again. ‘The sphincter is a small complex of smooth muscle surrounding the bile ducts. The dysfunction is a benign, noncalculus obstruction, most commonly hypertonic. It can affect people of any age but typically it’s middle-aged females, especially after cholecystectomy.’ He raised an eyebrow. ‘It can be hereditary.’
Pip mirrored his earlier nod, filing the information away. Was it possible that Shona had a similar condition that could explain her own episodes of abdominal pain?
‘What’s the treatment?’ she queried. ‘If this is what Alice has?’
‘There are trials going on for medical therapy that affects smooth muscle structure like nitrates and sublingual nifedipine but, at present, the definitive treatment is endoscopic sphincterotomy with surgical therapy as backup.’
‘What about dietary modification? I know Mum found it helpful to go very low fat and avoid alcohol when she had problems initially.’
‘Alice isn’t drinking alcohol yet, surely?’
‘I hope not,’ Pip agreed fervently, ‘but you never know with teenagers these days. She’s already talking wistfully about the parties some of her friends are allowed to go to.’
‘But she’s not allowed to go?’
‘No.’ Pip smiled fondly. ‘Mum’s always been very strict about things like that.’
There was a moment’s rather thoughtful silence and Pip watched, fascinated at the play of emotion on Toni’s face. Indecisiveness which looked totally uncharacteristic and then the beginnings of a smile that played at the corners of his mouth.
‘And you, Pippa?’ The question was spoken softly. ‘Are you allowed to go out?’
Pip’s jaw dropped a fraction. ‘Excuse me?’
The hand movement Toni made was nonchalant, as though the startling query was of little importance. The intensity of the gaze Pip found herself subjected to, however, suggested something very different.
‘I’m going to refer Alice to one of our paediatric surgeons, Greg Murray,’ Toni said. ‘He’s going to look in on her and possibly have a chat to you about her management before she goes home this afternoon.’
Pip waited, her bewilderment increasing.
‘Which means,’ Toni continued, ‘that…professionally speaking Alice isn’t strictly my patient any longer.’ He cleared his throat. ‘Which also means that you, Pippa, are not—strictly speaking—the mother of one of my patients.’
She loved the way he continued to call her Pippa unless he caught himself. It went with that delicious accent that made everything he said sound somehow exotic and more interesting.
Not that she was sure what he was talking about right now. She knew what she hoped he might be talking about, but what kind of idiot would she appear if she was coming to a wrong conclusion? She felt obliged to say something in the short pause that followed his reasoning.
‘Ah…yes. I suppose it does,’ she managed lamely. ‘Does it matter?’
‘Oh, yes.’ Toni let out an audible breath that was almost a sigh. ‘I think it does matter.’
‘Why?’
‘Because it means I can ask you out. For a drink, perhaps. Or dinner.’
‘You mean…on a date?’ Pip felt faintly dizzy. Her blood sugar must be really low, she decided. If she’d found time to have lunch, she might have coped with something this unexpected without this peculiar physical effect.
‘Yes,’ Toni said calmly. ‘That is precisely what I mean.’
Oh, Lord! Echoes of those fantasies Alice had stirred rushed to fill Pip’s brain and she could feel herself blushing.
This had to be unprofessional on some level, surely? Should she say no?
But was it the stuff of long-forgotten teenage dreams, not to mention more recent ones? Should she say yes as decisively as possible?
In the end, neither word emerged. Pip opened her mouth and surprised both of them by saying, ‘But…why?’
It was Toni’s turn to look astonished. ‘I’m sure a woman as attractive as you are doesn’t need to ask such a question! You must be well used to being asked for dates.’
Well, no, but Pip wasn’t about to admit to how many years it had been since someone had asked.
‘I meant,’ she said quickly, ‘why you asked. I just…ah…wasn’t expecting it.’
What an understatement! That look she had caught last night, well after Toni had had time to get used to the information regarding her real relationship to his patient, when they had been settling Alice in her room for the night, had been almost—and hardly surprisingly—one of something akin to disgust.
He was giving her a mildly amused look right now and Pip realised how ungracious she was being. It was probably a first for Toni Costa to have his motives for asking a woman out questioned.
But he didn’t seem fazed. ‘That’s easy to answer,’ he responded smoothly. ‘You interest me, Pippa.’
His expression had an edge to it that Pip had not seen any hint of before this. An edge that had probably made many women in his past go rather weak at the knees.
His tone had the same silky, seductive quality as he added just another couple of words.
‘A lot.’
The Italian Doctor's Perfect Family Page 5
