‘How is it that common things can cause harm to some people but not to others?’ Simone’s mother asked. Married to an American, Rosa Stevens’s English was fluent but heavily accented—Simone had been raised speaking both languages.
Rico listened with interest and admiration as Ruth took time to help mother and son understand, her voice friendly and reassuring, but also authoritative.
‘When the immune system thinks that the body is being attacked—when you have a cold or an infection, for example—it sends antibodies, called immunoglobulin E, or IgE, which travel through the bloodstream to find and counteract whatever is causing the damage. Like your Action Man soldier protecting you from dangerous invaders,’ she added, and Simone, who was holding tightly on to his favourite toy with his free hand, nodded vigorously. ‘Sometimes, though, the immune system makes a mistake and overreacts to a substance that is usually harmless and attacks the body’s healthy tissue. Chemicals, including histamine, are released by blood cells, causing allergic reactions such as the rashes and other symptoms Simone’s been having.’
There was no point in filling Rosa’s head with information on the more extreme reactions experienced by some patients, for whom severe anaphylaxis could be fatal, and Rico was pleased that Ruth did not elaborate further at this stage.
‘It is important for us to identify what substance or substances are responsible for Simone’s problems,’ Ruth continued. ‘With so many potential triggers, it can take a while to discover the cause of the intolerance and allergic response, but once we know, we can work out a programme of desensitisation and treatment.’
Having applied a negative control and a histamine control, against which the results could later be assessed, Ruth began the main skin-prick test. One at a time, a small drop of each different allergen was administered to a separate square of the numbered grid that had been marked on Simone’s arm. Next, Ruth used a lancet to prick the sample through the skin. A new sterile lancet was used for each individual site, preventing cross-contamination. The experienced nurse assisting her kept a careful written record and, in fifteen or twenty minutes, they would be able to examine Simone’s arm and determine which, if any, allergens had caused a reaction.
A knock at the door diverted Rico’s attention. Leaving Ruth to her task, he walked across the room and opened the door to discover his second in command waiting for him. Fifty years old and a father of five, Paolo Chiarini was short and rotund, with greying hair and kind brown eyes. A jovial man and top-class doctor, Paolo had been with him since the clinic had opened and Rico trusted him implicitly.
‘Ciao, Rico,’ the older man greeted him with an ever-present smile. ‘Can I speak to you about Valeria Di Maio? Her latest test results have come back.’
‘Of course. Give me a moment.’
Rico returned to the group concentrating on Simone, and rested one hand on Ruth’s shoulder. She tensed under his touch, but he forced himself to ignore the worry her reaction caused.
‘I will be back shortly,’ he told them. ‘Call me if you need anything.’
After a moment’s hesitation, Rico retreated. He had no qualms about leaving Ruth in charge. She didn’t need him in a professional capacity. But he was becoming increasingly concerned that applied personally, too. Since the moment in her kitchen, when she had agreed to come to Florence, he had been on his best behaviour. Her stipulation that the trip was just about the job had upset him, but he had hidden his disappointment—and he had had his hands behind his back and his fingers crossed as he had lied before adding ‘Per ora’…meaning ‘for now’. Not that his plan to win Ruth round was making any headway.
It was killing him not being able to touch her, to hold her, to kiss her, to make love to her. But she had needed time and he had been determined he would give it to her. It was proving much harder than he had imagined. Things had happened so fast when they had met and he had allowed his heart to rule his head. In consequence he had made the mistake of rushing her. He had still not discovered why Ruth had run. One possibility was that the intensity of what they had shared had scared her. He understood that, especially given her past. The other possibility—that she didn’t feel the same way he did—nagged at him. Had he really misjudged things that badly? That Ruth didn’t feel the same connection had been given more credence by her skittishness these last ten days and the distance she kept between them.
‘Ruth is extraordinary,’ Paolo ventured in Italian, curtailing Rico’s introspection.
‘Yes, she is.’
As he stepped out of the room, Rico allowed himself one last lingering look at the woman who had turned his world upside down, then he closed the door. As well as proving her worth as a doctor, and her potential for excelling in the fields of immunology and allergy, Ruth had won the hearts of all the clinic staff.
‘Is she going to stay?’
Rico shrugged his shoulders, trying to hide how important Ruth’s decision was to him—and not because of the job. ‘I don’t know. All we can do is hope.’
‘You must talk to her. She will do wonders here when trained.’ The older man paused a moment, a speculative expression in his brown eyes. ‘It is obvious that you care for her. Speaking as your friend, do not let Ruth slip through your fingers.’
‘I am doing my best, Paolo.’
But was his best good enough? Ruth was worth any effort or sacrifice and, no matter the cost to himself, he was trying to do the right thing and not push her too far again. But he was troubled. The only physical contact he had managed was holding hands on the sightseeing trips they had shared. Increasingly Ruth was avoiding every casual touch and it was playing havoc with his hope and confidence that he could eventually win her round.
He didn’t know what he would do if Ruth decided that a career change was not for her. Or how he could bear it if she accepted the job but rejected him. One thing was certain. He was running out of time. It was Wednesday. And Ruth was due to meet up with Seb, Gina and Maria when they came over from Elba on Sunday morning. Then they would fly back to Scotland together.
What the hell was he going to do?
‘You are enjoying the work at the clinic, mia cara?’ Sofia queried.
‘Very much,’ Ruth answered truthfully. ‘I am learning so much every day. And everyone has been kind. I just wish that I spoke the language so that I could help more.’
Sofia smiled and patted her hand. ‘You will be surprised how quickly you pick it up when you are living here full time. Besides Italian, all the clinic staff speak English and at least one other language—patients of many nationalities come to the clinic for help. Language will not be a barrier for you.’
Unsure what to say, Ruth remained silent. Nothing had yet been decided about her future but Sofia’s words, taking it for granted that she would stay, brought a mix of nervousness, confusion and excitement. They were sitting out on the veranda at the rear of the Linardi family’s luxurious Florentine villa, having enjoyed a light meal at the end of another busy day.
Ruth was tired but professionally satisfied. All had gone well with little Simone’s tests, and they were closer to finding an answer and identifying what was causing his symptoms. Later, she had also learned that there was news on Valeria Di Maio’s test results. Valeria was the woman Rico had told her about at the conference, the new patient with severe photosensitivity. Hers had been the first case Rico had taken on when they had arrived in Florence after the wedding, and Ruth had found herself in the thick of things straight away.
Having done some research after Rico had first mentioned the woman’s symptoms, Ruth had ventured an opinion during a clinic meeting on Valeria’s case, that the problem could be systemic lupus erythematosus, or SLE. The room had fallen silent and she had been uncomfortably aware that everyone was staring at her. It had probably only been a few seconds before Paolo and the other staff had praised her, but to Ruth it had felt like an hour, and her heart had threatened to jump right out of her chest. Then she had looked at Rico. She woul
d never forget the warmth of his smile or the approval in his hazel eyes.
‘Well done, Ruth.’ Although understated, Rico’s words and the tone of his voice had made her glow. ‘SLE is a great mimic,’ he had continued. ‘Many patients do not fit the criteria of the disease and many doctors are confused and misled by the variety and often complex combination of symptoms. No two cases are the same. Because of this, eleven classic criteria were established to help aid the diagnosis. There are exceptions, of course, but if a patient has four or more of these, then it suggests systemic lupus is likely.’
Today, the final results from the battery of tests Valeria had undergone had come back, confirming photosensitivity, blood-count abnormalities, mucous-membrane ulcers, a positive antinuclear antibody or ANA test, and discoid skin rash. In other words, Valeria satisfied five of the eleven classic criteria, a strong guide that the diagnosis of SLE was correct. There was no cure, and she had a difficult journey ahead of her, but Ruth knew the woman was in the very best place to receive first-class care, support and treatment to relieve her symptoms. The plan would be to prevent increases in the level of autoimmune activity and to decrease inflammation, so protecting the body’s organs and minimising periods when the disease was active.
The clinic itself was fabulous, the best she had ever seen. The facilities were outstanding. And so were the staff. All of them had welcomed her openly and had gone out of their way to help her find her feet and settle in, expressing their hope that she would decide to join them on a permanent basis. It was what Ruth wanted, too. Rico’s enthusiasm was infectious. She had learned so much in the last ten days, and her respect for him as a doctor was boundless. The chance to change direction and work with Rico was a once-in-a-lifetime opportunity. And Rico was a once-in-a-lifetime man.
The job was hers for the taking.
The man, she feared, was not.
She was confused. At work, Rico was patient, informative, supportive and encouraging. He challenged her, but she thrived on it, absorbing as much knowledge from him as she could. Away from work, he was attentive, funny and considerate. He had determined that her trip was not all about work, and ensured they take time each day for sightseeing so he could show her the city. As well as customary tourist venues—from the impressive cathedral and the treasures in the famous Uffizi gallery to the magnificent statue of Michelangelo’s David, which stood in the square outside the town hall as defender of the city, and the plethora of shops on the Ponte Vecchio, many of them selling gold and jewellery—Rico had shown her many exquisite things off the beaten track that she would never have found alone. They had walked for hours, recharging their batteries with ice cream or coffee and cake. He had held her hand, taken care of her, devoted time to her, and treated her like a sister or best friend. He hadn’t kissed her…or given any sign that he wanted to. While her awareness of him magnified and her body yearned for his, he appeared to have forgotten that their explosive night of passion had ever happened.
Rico had not only taken her in at the clinic, he had insisted that she live in his home. He had been the perfect host and the perfect gentleman. And she had slept alone every night. Or had tried to sleep. It had proved nearly impossible when she ached so much with wanting him. His room was mere feet away from hers, but they might have been on different continents for the distance there was between them. Being so close to him and yet so far away was as difficult as she had expected it would be. She wanted to go to him, to ask for more, but she didn’t have the confidence to do it. And so she had devoted herself to the clinic and to learning.
‘Could you live here, mia cara? What do you think of our city?’
Easily, was the quick answer to the first question from Sofia that drew Ruth from her thoughts. Rico and his father were yet to join them and she was alone with Rico’s mother and his grandmother, Emanuela. The elderly lady was a real character, and it was touching to see the bond Rico shared with her. An ear infection, now much improved, had prevented her flying to Scotland for Seb and Gina’s wedding, but she had been keen to hear all about it. And she had eagerly shown Ruth photographs of the family villa where Seb, Gina and Maria were staying.
‘I love Florence,’ Ruth answered with enthusiasm. ‘It’s a beautiful city. The art and architecture are amazing, and the history is fascinating. I’ve thoroughly enjoyed walking by the river, doing some window-shopping, and exploring the museums, galleries and chapels. I don’t think I could see all I wanted to in a lifetime.’
Living here wasn’t the problem. She would do it in a heartbeat. She did love Florence, just as she loved the job, loved Rico’s family—who had shown her the acceptance and affection she had never known from her own parents—and she loved Rico. Everything had happened so fast and been so intense between them from the start, and one benefit of the last ten days had been time. Time, without other pressures or expectations, to slow things down, which had allowed her to get to know Rico as a person—as well as a superb doctor. And having done so, she could no longer deny her real feelings. Not to herself. But how could she reconcile things? How could she stay and take the job that excited her so much when it meant seeing Rico all the time and knowing she could never have him? Yet the thought of giving it all up was heartbreaking.
‘I think if I lived here all the time, I would end up the size of a house,’ she continued, trying to make light of things.
Emanuela waved a hand to dismiss her suggestion. ‘You will never be anything but beautiful to us.’
‘I’ve become addicted to the gelato,’ Ruth explained, trying to blink away the tears that the elderly woman’s words had caused. ‘There are so many flavours to try. Then I discovered zuccotto!’ She moaned theatrically, making Sofia chuckle and Emanuela laugh aloud and clap her hands in delight. ‘And there are Luciana’s spectacular chestnut pancakes.’
Rico’s housekeeper, Luciana Malavolti, who cared for the inside of the house with as much dedication as her husband, Alessandro, cared for the outside, had promised to show her how to make the pancakes. Chestnuts were a local crop, and some were made into a flour that was used for baking and in all sorts of recipes.
‘Tuscan gastronomy may be more simple than that of some other regions, but to the people here, food is an art,’ Emanuela told her.
The food might be considered simple, but it was delicious…and plentiful! Ruth was getting used to the different way things were done in Italy. Breakfast, as she knew it, was almost non-existent, little more than a coffee on the run, while dinner at night was light and often eaten very late. At lunchtime, however, everything seemed to shut down and people came together to relax and enjoy a big meal with many courses.
Ruth was savouring new food experiences but, as she had told Sofia and Emanuela, the things she was finding it impossible to resist were the outstanding home-made gelato,orice cream and the zuccotto…a dome-shaped sponge cake filled with a mixture of almonds, hazelnuts, chocolate and cream. The first time she had tasted it she thought she had died and gone to heaven!
The sound of the villa’s entryphone pierced the silence on the terrace, and Sofia excused herself, rising gracefully from her chair and heading indoors. Ruth looked out into the rapidly darkening night, enjoying the lights of the city. She very much hoped this was not the last time she would be able to visit the Linardis in their lovely home.
‘We have a moment alone. May I speak with you, Ruth?’
‘Of course,’ she responded, taken by surprise at the serious tone of Emanuela’s voice.
‘I may be an old woman, but my eyes still function!’ A customary chuckle rumbled from inside her. ‘I see how you look at Riccardo.’
Ruth blushed and her heart sank. Clearly she had not been as adept at hiding her feelings as she had thought. ‘I—’
Emanuela took her hand. ‘Do not look so worried, figliola. It would make me very happy to see you together.’
‘Rico doesn’t feel that way about me.’ Somehow she forced the words out, even though saying them tore at he
r heart. ‘I’m just here for the job.’
‘Sciocchezzel! What nonsense! If Riccardo only wanted for you to work at the clinic, why would he have you live at his house out of the city?’ the elderly lady protested with spirit.
‘But—’
‘Riccardo has never taken another woman to his home. Does that not tell you something?’
Ruth shook her head, puzzled because Emanuela’s comments were at odds with Rico’s behaviour. ‘I don’t know.’
‘You fear rejection, yes?’ the woman asked, giving her fingers a gentle squeeze.
Overcome by her insight and the affection she had shown her, Ruth nodded.
‘Take my advice, figliola. Do not risk losing what is within your grasp. Some things are not as they seem,’ she added mysteriously. ‘Have the courage to reach for what you want. I think you will be surprised by the results!’
‘Ruth is doing well at the clinic?’
‘Very well.’ His answer to his father’s question was a gross understatement, Rico allowed. He stood at the window in the study, watching Ruth talk with Nonna Emanuela as they sat on the terrace. ‘I have never met anyone as gifted as Ruth. She is a remarkably quick learner and wonderful with patients.’
‘Do you not think it is time to stop tiptoeing around?’ his father asked.
Frowning, Rico dragged the fingers of one hand through his hair and finally turned away from the view outside the window. ‘What do you mean, Papà?’
‘When you first introduced us in Scotland, you said that Ruth was the woman you hoped to marry.’
‘That is so.’ He sighed and sank down on to a chair on the other side of the desk. ‘But Ruth is only interested in the job.’
His father’s sudden bark of laughter took him by surprise. ‘Rico!’
‘What?’ he demanded, frustration making him uncharacteristically irritable.
Italian Doctor, Dream Proposal / Wanted: A Father for her Twins Page 15
