by Sarah Morgan
‘Oh, Dr Avanti.’ There was panic in Carol’s voice. ‘Thank goodness you’re here. She’s had this cold and I was up in the night with her and then this morning she just seemed so much worse. Her little chest was heaving so I panicked and called the ambulance but they’re stuck on the coast road and you always know what to do so I just thought I’d come and take a chance in case—’
‘Calma. Try and be calm, Carol.’ Marco’s voice was gentle and reassuring as his gaze rested on the child, his eyes sharp and observant. ‘You did the right thing to come.’
Amy stepped forward, her own problems momentarily forgotten. ‘Let me help. What do you want me to do, Marco?’
He glanced at her and then gave a brief nod. ‘Let’s give her some oxygen straight away.’
Amy located the oxygen and mask. ‘Do you want me to set up a nebuliser?’
‘To begin with I’ll give her a beta 2 agonist via a spacer. It is better at this age than a nebuliser.’ He turned back to the child and stroked his hand over the child’s neck, palpating the neck muscles with gentle fingers. ‘Michelle, what have you been doing, angelo mia? Are you worrying your poor mother?’
No one would have guessed that only moments earlier he’d been braced for a fight. All the hardness had gone from his tone and there was no trace of the anger that had been simmering inside him. Instead, he was kind and approachable, his smooth, confident movements removing the panic from the situation.
He’d always been amazing with children, Amy thought numbly as she handed him the oxygen mask. They found his strength reassuring and responded to his gentleness. Strength and gentleness. A killer combination. When she’d first met him he’d been working as a paediatrician and his skills in that field were very much in evidence as he assessed the little girl.
To someone who didn’t know better it might have looked as though he was simply comforting the child and putting her at ease, but Amy watched the movement of his fingers and the direction of his gaze and knew that in that short space of time he’d checked the little girl’s respirations, her pulse rate and the degree of wheezing.
Carol cuddled the child and looked at him helplessly. ‘She ate a tiny bit of breakfast and then she was sick everywhere. After that she was just too breathless to eat. I’ve never seen her this bad.’
The teenager slumped against the wall and rolled her eyes. ‘For goodness’ sake Mum, stop panicking.’ She broke off and coughed a few times. ‘You make everything into such a drama.’
‘Don’t you tell me to stop panicking, Lizzie,’ Carol snapped angrily. ‘You were giving her breakfast! You should have noticed sooner that she wasn’t breathing properly!’
‘Well, I’m not a bloody doctor, am I?!’ The tone was moody and defiant, but Amy saw the worry in the teenager’s eyes and remembered that this was Carol’s second marriage. Presumably Lizzie was her child from her previous marriage.
Clearly things weren’t altogether harmonious in the household.
‘She is here now and that is what is important.’ Swiftly but calmly, Marco reached for the hand-held pulse oximeter, attached the probe to the child’s finger. ‘I want her as quiet as possible so that I can examine her properly. You will have a nice cuddle with your mama, Michelle. I’m going to help you with your breathing, tesoro.’
Tesoro.
Trying not to remember that he’d called her the same thing in happier times, Amy looked at the pulse oximeter.
‘That’s a neat device.’ It was typical of Marco to have all the latest technology to hand, she mused silently. Oxygen, spacer, pulse oximeter. He may have chosen to move from paediatrics to general practice but he still insisted on having all the latest equipment.
‘It’s a very fast and reliable method of obtaining a reading.’ He glanced at Carol, absolutely offering an explanation. ‘It tells me how much oxygen is in her blood. I’d like the level to be higher than it is. I’m going to give her something that will help her breathing.’
Carol’s face was white and strained. ‘Is it her asthma again?’
‘Sì, it seems that way. She has had a virus and that can some times be a trigger.’ He connected a face mask to the mouthpiece of a spacer.
‘Michelle, I’m going to put this mask over your nose and mouth and I want you to just breathe normally.’ He settled the mask gently over the child’s face and actuated the inhaler. ‘Just breathe for me now. Good girl. We’ll start with this and see if this improves things.’
Michelle stared up at him in terror, her breath coming in rapid, rasping gasps.
Equally terrified, Carol rubbed her back gently. ‘It’s all right, darling. Dr Avanti is going to make you better. He always does, you know he does.’
The little girl clawed at her face, trying to remove the mask, and Marco gently took her hand and squatted down so that he was level with the child. ‘Don’t pull it off, cucciola mia.’ His voice was deep and soothing. ‘This mask is going to help you breathe and I want you to try and relax and forget it is there. You’re going to listen to me instead of thinking of the mask. The mask is doing magic.’ Still stroking the child’s fingers with his own, he lifted his head and looked at Carol. ‘What’s her favourite story?’
‘Story? I—I don’t know…’
‘“Sleeping Beauty”,’ Lizzie muttered, and Amy glanced towards her, surprised.
So she wasn’t as in different as she seemed, then.
Assessing Michelle and sensing that Marco was going to choose to put a line in, Amy turned away and prepared an IV tray and then reached into the cupboard for hydrocortisone, which she was sure he was going to need.
‘Ah, “Sleeping Beauty”. That is my favourite, too.’ Marco gave a smile that would have captivated the most cynical princess and stroked the little girl’s blonde curls away from her face, his eyes flicking to her chest as he watched her breathing. ‘So now I will tell you my version of the story. Once upon a time there was a beautiful princess called Michelle who lived in a wonderful castle by the sea— Amy?’ His voice lowered. ‘Can you get me a 24-gauge needle and fifty milligrams of hydrocortisone? Normally I would try oral medication but if she’s vomiting, we’ll go straight to IV.’
Their differences momentarily for got ten, Amy handed him the tray that she’d already prepared and he took it from her, still telling the story. ‘Princess Michelle was very loved by her mummy and daddy and they decided to give her a big party for her birthday. Everyone was invited.’ He was a natural storyteller, his Italian accent curling around the words as he calmed the child. She looked at him, clearly listening as he spoke, and Marco stroked the back of the little girl’s hand, searching for a vein. Then he gave a nod and looked at Amy. ‘Can you squeeze for me? Michelle, I’m just going to put a little tube into the back of your hand so that I can give you some extra medicine to make you feel better. More magic.’
Amy stared at Michelle’s plump, tiny hand and was suddenly relieved that she wasn’t the one searching for a vein.
Carol looked the other way, her teeth clamped on her lower lip. ‘There isn’t another doctor in the world I’d allow to do this,’ she muttered, screwing up her face in trepidation. ‘It’s only because you used to be a kids’ doctor and I know you’ve done it before. Her hands are so small, let alone her veins. I can’t even think about it.’
Amy was inclined to agree.
She never could have chosen paediatrics as a speciality.
But Marco’s expression didn’t flicker and it was obvious that he wasn’t concerned. This was where he excelled—where he was most comfortable. ‘And Princess Michelle invited all her friends to her party and her big sister Princess Lizzie, who she loved very much.’ He lifted his head briefly and flashed a smile at Lizzie, who blushed furiously under his warm, approving gaze.
‘Michelle, you might feel a little scratch now.’ The movement of his fingers was deliberate and confident as he slid the tiny needle through the child’s skin and checked that he was in the vein. The child barely whimpered and
Marco picked up the syringe of hydrocortisone, swiftly checked the ampoule and injected it into the child, barely pausing in his rendition of the story. ‘And it was the biggest and the best party that anyone had ever been to. Everyone was in pretty dresses and there was dancing and Princess Lizzie met a handsome prince.’
‘Not likely in boring old Penhally,’ Lizzie muttered, and then started to cough again.
Marco dropped the empty syringe back onto the tray and lifted his gaze to the teenager. ‘The prince was in disguise, passing through on his way home to his castle.’ His eyes were amused and Amy watched as Lizzie gave a reluctant smile.
It was impossible not to respond to him, Amy thought helplessly. He charmed everyone, whatever their age. And he did it all while managing a potentially serious asthma attack.
Anyone who said that men were incapable of multi-tasking had never seen Marco dealing with an emergency. Perhaps that was one of the advantages of having spent so long in hospital medicine. Or perhaps he was just the sort of man who coped well under pressure.
Carol was still watching him anxiously. ‘Will she have to go to hospital? My husband is waiting at the house to tell the ambulance where we are. Lizzie can run back and tell him what’s going on.’
‘Why me? Use the phone, Mum!’ Lizzie’s momentary good humour vanished and her tone was impatient. ‘It’s freezing out there!’
‘Why can’t you ever just help?’ Clearly at the end of her tether, Carol snapped, and then pressed her lips together. ‘All you ever think about is yourself!’
‘Well someone has to because you obviously don’t give a damn about me!’
Carol gasped. ‘Elizabeth!!’
‘Oh, get off my back!’ Coughing again, Lizzie turned and stamped out of the consulting room, slamming the door behind her.
Carol flinched, her face scarlet with embarrassment and anger. ‘As if I haven’t got enough on my plate,’ she said in a shaky voice. ‘I’m very sorry about that. I just don’t know what’s happening to Lizzie. She’s under gone a complete personality change over the past few months. She used to be so sweet and loving. And she just adored Michelle. Now it’s like living with a hand grenade.’
‘She is a teenager,’ Amy said quietly, aware that Marco was writing a letter to the hospital and needed to concentrate.
‘She explodes at the slightest thing, she’s out all hours and I never know where she is. She used to be top of her class and her marks have plum meted.’ Carol cuddled Michelle closer. ‘And she’s been mixing with those awful Lovelace children and everyone knows what they’re like. I see them on a Saturday night, just hanging around on the streets. I wouldn’t be surprised if they’re taking drugs…’
Reminded of the complexities of working in a community practice, Amy lifted a hand to her aching head and wondered how Marco managed to stay so relaxed.
He tapped a key on the computer and glanced at Carol. ‘Have you spoken to the school about Lizzie?’
‘Twice. They just gave me a standard lecture about handling teenage girls.’
The printer whirred into action. ‘How bad are her mood swings?’
‘Very.’
‘I noticed she was coughing.’ He took the letter from the printer and signed it. ‘How long has she had that?’
‘Coughing?’ Carol looked a little startled. ‘I don’t know, really. A while, I think, now you mention it. Just an irritated sort of cough. I even asked her if she was smoking but she just gave me one of her looks and stomped out of the room.’
Marco put the letter in an envelope and handed it to her. ‘Lizzie is reaching a difficult age, that’s true,’ he said softly. ‘Not quite a woman but no longer a child. Unsure of who she is. A little rebellion is natural and good.’
‘You think that’s all it is?’ The faith in Carol’s eyes surprised Amy. It was quite obvious that the woman was ready to believe anything Marco told her.
‘I think we should talk about it properly when there is more time.’ He slipped his pen back into his pocket. ‘For now your priority is Michelle. She has not improved as much as I would have liked so I want her to go to the hospital. In all probability she will be fine and we could monitor her here, but if we send her home, you will be worried.’ He gave an expressive shrug that betrayed his Latin heritage. ‘And you have already had enough worry for one day. So, we will send her to the hospital and then they can do the worrying. That will leave you free to give some attention to Lizzie.’
‘I don’t know what attention to give her,’ Carol said flatly. ‘It’s like communicating with a firework. One minute she’s inanimate, the next she’s exploding in my face. I find it easier coping with toddlers than teenagers.’
Marco listened and then gave a lopsided smile. ‘Being a mother is the hardest job in the world because your skills have to change all the time. You are a good mother and good mothers always find a way—remember that.’
Amy saw the gratitude on Carol’s face and turned away for a moment, struggling with a painful lump in her throat. Why couldn’t Marco have been careless and unfeeling? Even in a crisis he could see the bigger picture. He didn’t just deal with the small child—he also handled the teenager and the worried mother.
She’d needed him to be unskilled and insensitive.
It would have made everything so much easier.
As it was, just ten minutes in his company had confirmed her biggest dread. That two years of self-enforced absence had made no difference to her feelings. She would love Marco Avanti until she took her dying breath.
Marco picked up the phone and spoke to the paediatrician at the hospital, keeping one eye on Michelle. He was concerned that her breathing didn’t seem to be improving as much as he would have liked.
Had he missed something?
Was there something else he should have done?
He didn’t usually have reason to question his medical skills but neither was he usually expected to handle an emergency while dealing with the unexpected appearance of his wife. Or was she now an ex-wife? It was obvious that she considered their relationship dead. And so had he. Until she’d walked into the room and asked for a divorce.
Seriously unsettled for the first time in his adult life, he ground his teeth, under no illusions that his concentration had been severely tested by Amy’s sudden and unannounced arrival. Given that she clearly had no intention of leaving until she’d said what she’d come to say, he needed to somehow forget that she was there.
Forcing his mind back to Michelle, he ended the phone call and then mentally ran through the algorithm for handling an acute asthma attack in a toddler and assured himself that he’d done everything that should be done.
The child needed to be in hospital. And his wife was watching him, waiting for the right moment to ask him for a divorce.
Why now? Why did she have to pick what must be the busiest week of the year? And not only that, but they were a doctor down. He didn’t have the time to argue with her. Their relationship was in its death throes and he didn’t have the time to try and save it.
Which had presumably been her intention. Why else would she have picked this particular moment out of all the moments that might have presented themselves over the past two years? Was she hoping that the pressures of work would make him easier on her?
Was she hoping that he’d just sign on the dotted line and sever all ties? Kill everything they’d ever shared?
The door opened and Kate bustled in. ‘Carol, your husband redirected the ambulance and he’s holding on right now on the phone. I have a paramedic in Reception, wanting to know if they’re still needed. Are you planning to send Michelle to the hospital, Dr Avanti?’
Carol looked at Marco. ‘You really think she should go in?’
Pushing aside his own problems, Marco gave a decisive nod. ‘Definitely. I called the paediatrician and she’s expecting Michelle. They’ll admit her overnight, monitor her breathing and then assess her in the morning. We might need to change her medication. I’ll s
peak to her once she’s had a chance to examine Michelle.’
Carol closed her eyes briefly. ‘It’s so hard,’ she whispered. ‘She’s so tiny and it’s so, so scary. Worry, worry, worry, that’s all I seem to do. I just want her to live a normal life and be like any other toddler. What’s going to happen when she goes to school?’
‘Carol, I know that you’re worried but you have to take it one step at a time—isn’t that the phrase you English use?’ He placed a hand on her shoulder, his touch gentle. ‘I will discuss her management with the hospital and you and I will watch her and see how she goes as winter progresses. And if, from time to time, she has a few problems then we will deal with those problems together. We are a team. If you have a worry, you make an appointment to see me and we sort it out. And soon we will find time to talk about your Lizzie.’
Carol’s eyes filled and she bit her lip. ‘Don’t be kind because you’ll make me cry.’ She pressed a hand to her mouth. ‘Sorry. You must think I’m such an idiot.’
‘I think you’re a loving mother who is tired and worried,’ Marco said quietly, his gaze flicking to Michelle. An uneasy feeling stirred inside him. The little girl was pale and her respiratory rate was more rapid than he would have liked. Making a swift decision, he looked at Kate. ‘I want to go in the ambulance with her.’
The practice manager didn’t manage to hide her dismay. ‘You’re leaving in the middle of your surgery?’
Aware that Carol was listening, Marco tried humour. ‘Not in the middle,’ he drawled, reaching for his bag. ‘I haven’t actually started yet.’
Kate shook her head, despair in her voice. ‘Marco, we have patients queuing halfway back to the next county. Dr Tremayne and Dr Lovak are already seeing patients and with Lucy gone—’
‘We have a sick child here who needs my care,’ Marco reminded her softly, dropping a bronchodilator into his bag.
Kate gave him a desperate look and then sighed. ‘Of course. Go with Michelle. That has to be the priority. We’ll manage here. Somehow.’
