Unlocking the Italian Doc's Heart

by Kate Hardy

  ‘Perfect timing,’ Lucy said with a smile, and served up.

  Jenna took one mouthful and sighed in bliss. ‘You really do make the best lasagne in the world.’

  ‘And at least I know you’re going to eat properly when you have dinner with us on Monday nights,’ Lucy said.

  ‘I do eat properly,’ Jenna protested.

  ‘Not when you’re really busy on the ward, you don’t. You grab a chocolate bar or a bowl of cereal.’

  Jenna grinned. ‘You do exactly the same when you’re up to your eyes in baseline assessments in the first three weeks of the new school year and Will’s forgotten the time and that it was his turn to cook that night.’

  ‘I don’t forget the time,’ Will protested.

  The sisters looked at him and laughed. ‘Oh, you do, honey,’ Lucy said, and leaned over to kiss him. ‘Half the time you live in the first century, not the twenty-first.’

  ‘It’s my job,’ Will said. ‘And I’ll join Lu in nagging you about eating properly, too, Jen.’

  ‘Oh, give me a break!’ But Jenna was laughing, knowing that her brother-in-law meant well. ‘Now the new senior reg has started, it should be a bit less frantic on the ward.’

  ‘So what’s the new doctor like?’ Will asked.

  ‘He’s good with kids. He has two packs of cards in his pockets as distractions—one with cars and one with puppies. It came in handy today when we had a toddler who slipped on the stairs and banged his head badly enough to need stitches,’ Jenna said.

  ‘Cars,’ Will said dryly, ‘shouldn’t be gender specific.’

  ‘Agreed, and Renzo isn’t sexist. He says that girls also like cars.’ Jenna smiled. ‘But that might be because he’s Italian and he loves fast cars and thinks everyone else does, too. He and little Billy—the lad who needed stitches—were practically drooling over this sports car.’

  ‘I’d be drooling over that, too. Except we wouldn’t be able to fit a baby seat in it,’ Will said.

  ‘Italian,’ Lucy said thoughtfully.

  ‘No, no and no,’ Jenna said, knowing exactly what was going through her twin’s mind. Tall, dark and gorgeous. Which pretty much summed up Lorenzo Conti. She definitely wasn’t going to tell Lucy that he was single, because she knew her sister would go straight into matchmaker mode. ‘But he did agree to help at the danceathon.’

  ‘That’s good. Though I still feel guilty about not being able to make it,’ Lucy said.

  ‘You have Will’s niece’s wedding in Edinburgh. And Will’s parents need some catch-up time with Ava,’ Jenna reminded her. ‘You both gave me a massive donation and a raffle prize, so you’ve more than done your bit.’

  ‘We wanted to help,’ Will said.

  ‘And you have. A lot,’ Jenna said. ‘So how’s your day been, Will?’

  ‘Full of deciphering illegible student handwriting—I swear it’s twice as bad on exam papers,’ Will said with a groan.

  ‘Ah, the joys of May,’ Jenna teased, laughing; she knew how much her brother-in-law loved his job and he adored his students—just as they adored him.

  It was the perfect family evening, and Jenna was thoroughly relaxed by the time she got home. Though she couldn’t quite get Lorenzo Conti out of her head. He’d been very adamant about being single and not looking for a partner; it sounded to her as if someone had really hurt him. Or maybe he’d lost someone to illness or an accident and didn’t want to risk his heart again because the loss had hurt him too much. Not that it was any of her business. And she absolutely wasn’t interested in anything other than a professional relationship with her new colleague. After Danny, as far as she was concerned, love was completely off limits. She didn’t trust her judgement any more, not after she’d got it so badly wrong with him. She had a family she adored and a job that fulfilled her. She was lucky. Wanting to have the same kind of closeness with someone that Lucy had with Will, and a baby of her own—that would just be greedy.

  * * *

  Jenna’s first patient in clinic the next morning, eight-year-old Maddie Loveday, was a puzzle.

  ‘It started six weeks ago,’ Maddie’s mum said. ‘She’d been at football club and came home with really red cheeks. It looked a bit like windburn, but it seemed a bit odd because it’s not that cold and windy at the end of April. Then she went down with a really nasty virus. It hit the whole family and even I was in bed for three days with it.’

  A rash and a virus. Two things that were really hard to narrow down, and half the time there wasn’t an effective treatment and you just had to wait it out. Jenna smiled and waited for Mrs Loveday to continue.

  ‘The rash didn’t go away and it spread down her arms and legs. She said her legs hurt, she had pains in her tummy, and it hurt to swallow.’ Mrs Loveday grimaced. ‘Then she was really down and a bit weepy—which just isn’t my Maddie. I took her to the doctor.’

  ‘What did your GP say?’ Jenna asked.

  ‘He thought it might be allergic eczema, but my youngest has eczema and I’m really careful with laundry detergent and conditioner. Maddie’s never had any kind of reaction to food, and that rash didn’t look like any eczema I’ve ever seen.’ Mrs Loveday sighed. ‘I think he referred Maddie here just to shut me up.’

  Seeing that she was close to tears, Jenna put a reassuring hand on her arm. ‘Mrs Loveday, when our mums tell us that their kids aren’t right, we listen. You’re the experts on your kids, so you know when there’s something wrong. It’s our job to listen and help you.’

  ‘Thank you.’ Mrs Loveday swallowed hard. ‘I know you can’t believe everything you read on the Internet, but I wondered if the rash was some kind of autoimmune thing.’

  ‘That’s a possibility,’ Jenna said. ‘Rashes have lots of different causes and they can be really tricky to diagnose. And you’re absolutely right not to believe everything you read on the Internet, because there are a lot of scaremongering stories out there.’ She turned to the little girl. ‘Maddie, is it OK if I examine you?’

  Maddie nodded.

  Jenna looked at the rash. Coupled with the pain in Maddie’s legs and tummy, and her difficulty in swallowing, the rash could well be a sign of an autoimmune problem, but Jenna wasn’t sure quite which one. ‘I’ve not seen a rash like this before,’ she said. ‘I think you’re right, Mrs Loveday, and it’s very likely an autoimmune disease. Do you mind if I have a quick discussion with one of my more senior colleagues?’

  ‘As long as you can find out what’s wrong with Maddie and make her better, then do whatever you need to,’ Mrs Loveday said.

  Jenna headed for the offices. None of the consultants was around, but Lorenzo was in his office. Given that he was her senior and had three or four years’ more experience than she did, there was a chance that he’d seen a condition like Maddie’s before. She rapped on his office door. ‘Renzo, have you got a minute, please?’

  ‘Sure,’ he said.

  ‘How are you on autoimmune diseases?’

  ‘I’ve treated a few in my time,’ he said. ‘What are you looking at?’

  ‘I’m not entirely sure.’ She filled him in on Maddie Loveday’s medical history and symptoms. ‘I can see you’re busy, so I’m sorry to ask, but I’m a bit stuck. I don’t suppose I could borrow you to come and have a look at her, could I?’

  ‘Sure,’ he said, to her relief, and saved the file he was working on.

  After Jenna had introduced him to the Lovedays, Lorenzo examined Maddie’s skin. ‘Mrs Loveday, has anyone talked to you about juvenile dermatomyositis or JDM?’ he asked.

  Mrs Loveday looked surprised. ‘No. The GP just sent me here.’

  ‘It’s pretty rare, with about three in a million children being affected, and girls are twice as likely as boys to have it,’ Lorenzo said. ‘Basically “dermatomyositis” means inflammation of the skin and muscles, and from what Jenna’s already told me a
nd what I can see here, it looks to me as if that’s what’s happening to Maddie.’

  ‘What causes it?’ Mrs Loveday asked.

  ‘We don’t actually know,’ Lorenzo said. ‘Jenna told me about Maddie’s virus, and in the cases we know of there was a virus involved.’

  ‘So how long does it last? Will it ever go away? Is she going to get worse?’ Mrs Loveday asked.

  ‘Sometimes a child has one episode of JDM that lasts for a couple of years and then goes away for ever; sometimes it comes back again after a few years of remission; and sometimes it doesn’t go away at all and needs managing for the rest of the child’s life,’ Lorenzo said. ‘I’m sorry to be so vague, but the way the condition develops really varies. What I can promise is that we’ll sort out some treatment so Maddie can live her life just as if she hasn’t got JDM.’

  ‘So what does this JDM do?’ Mrs Loveday asked.

  ‘It makes the muscles weaker and causes pain, so that’s why Maddie’s talked about her legs hurting and having tummy pains,’ Lorenzo said. ‘The inflammation tends to affect the large muscles around the hips and shoulders, so that means it’s harder for Maddie to walk, climb the stairs, get up from the floor or lift her arms. And it’ll make you tired, Maddie.’

  The little girl nodded. ‘Since I got the rash and tummy pains, I can’t run as fast when I play football, and I’m really tired by the end of the match.’

  ‘So how do you treat it?’ Mrs Loveday asked.

  ‘Medication and physiotherapy. I’d like to admit her to the ward for now,’ Lorenzo said. ‘Maddie might need to stay for a couple of weeks so we can get her condition under control—we can give her some medication to help, but there will be other treatments as well. We’ll start with steroids at first and that’ll really help with her muscles and her skin.’

  Mrs Loveday looked shocked. ‘Steroids? Isn’t that the stuff bodybuilders use?’

  ‘No, these are corticosteroids,’ Jenna explained. ‘They’re naturally produced by the body, too, and we use them to bring down inflammation—that will stop Maddie’s muscles hurting and it will also sort out the rash.’

  ‘We’ll also need to do some tests, including an EMG,’ Lorenzo said. ‘That’s a special scan which shows us the electrical activities in your muscles—and I promise it doesn’t hurt, Maddie.’

  ‘Good,’ the little girl said. ‘Because I really, really hurt right now and I hate feeling like this every day. I just want to play football.’

  ‘We’ll make it stop hurting,’ Jenna promised.

  ‘We have physiotherapists here who can teach you some exercises, Maddie, to make your muscles work better,’ Lorenzo said.

  ‘They’ll make you work hard,’ Jenna added, ‘but they’ll make it fun. You can come along, too, Mrs Loveday, and learn how to do the exercises at home with Maddie.’

  ‘Will they be like the exercises I do at football?’ Maddie asked.

  ‘Possibly,’ Jenna said.

  ‘Because I don’t want to stop playing football. I want to be a footballer when I grow up and be captain of the women’s team for England. I won’t have to stop playing, will I?’ she asked, looking miserable at the thought of giving up the sport she clearly loved more than anything else.

  ‘Definitely not,’ Lorenzo said. ‘And I know it’s horrible feeling so ill, but I reckon you timed getting ill just right—the football season’s over, so it means you won’t miss out on matches over the summer.’

  ‘But there’s football training camp in August. Will I be better for that?’ Maddie asked.

  ‘Right now, we don’t know how you’re going to respond to the treatment and if we’ll need to change your medication, but we’ll do our best to make you well enough for the camp,’ Jenna said.

  ‘Once we’ve got the rash and the pain under control with the steroids,’ Lorenzo said, ‘you might need some other medication, Maddie. We’ll see how things go, but you might need to have methotrexate injections once a week—the nurse should be able to do that at your family doctor’s surgery, so you won’t have to come back to hospital for it—and an anti-sickness medication.’

  ‘Steroids sometimes affect your bone density—that means how strong your bones are—so we’ll also need to give you special calcium and vitamin D supplements,’ Jenna said.

  ‘And, once you’re responding to the treatment, we’ll decrease the steroids gradually,’ Lorenzo explained. ‘If you do have a flare-up in the future, then we’ll know which drugs work best for you and we can make sure you get the right ones to treat any future episodes.’

  ‘You’ll need to make sure you use plenty of sun cream and wear a hat in the summer,’ Jenna added.

  ‘Coach always makes us put sun cream on before training,’ Maddie said.

  ‘That’s good. So we’ll admit you to the ward now,’ Lorenzo said, ‘and try and get you all ready for football camp. Once you’re home, we’ll see you every few months to see how you’re getting on and if we need to change your medication at all.’

  Once Jenna had got one of the nurses to settle Maddie on the ward, she arranged the tests that Lorenzo had recommended. The EMG confirmed Lorenzo’s diagnosis; and she noticed that he gave up his lunch break to sit and chat to the little girl about football.

  Lorenzo Conti was definitely one of the good guys.

  She liked the way he worked, reassuring both their patients and their parents; and with him she really felt part of a team. It felt as if she’d worked with him for years, rather than only a couple of days. Which was crazy. She couldn’t have that kind of rapport with him so soon.

  In their afternoon break, she caught him just as he was heading for the staff room. ‘I owe you cake for helping me with Maddie,’ she said.

  ‘You really don’t. I was just doing my job, the same as you,’ he said with a smile.

  ‘You taught me something new today and I appreciate that, plus I happen to know you didn’t have a lunch break—you spent it talking to Maddie about football,’ she pointed out.

  He shrugged. ‘Maddie was fretting and I wanted to help her settle in to the ward. We had a fabulous argument about whether Italian football players were better than English ones, and that really cheered her up.’

  Jenna could just imagine. Lorenzo had worked out the best way to take the little girl’s mind off her illness and played his part with gusto. He was the kind of colleague it was a joy to work with. ‘I just want to say thank you—I didn’t want you to think I’m taking you for granted,’ she said.

  There was an odd expression on his face, but for so briefly that she thought she might have imagined it.

  ‘I know you’re not taking me for granted. We’re colleagues. I’m just doing my job,’ Lorenzo said. ‘You really don’t need to buy me cake.’

  Then a really nasty thought hit her. Did he think that she was coming on to him? But she wasn’t. ‘I’d make the same offer to any of my colleagues who helped me like that,’ she said. ‘Regardless of gender or age.’ And she hoped he’d follow through with the rest: regardless of marital status, because it was a platonic offer rather than a come-on.

  ‘It’s fine,’ he said.

  ‘Well, thanks. I really did appreciate your help,’ she said. ‘I thought Maddie might have some kind of rheumatology issue, but I haven’t come across JDM before.’

  ‘To be fair, I’ve only seen one case, and I wasn’t the lead doctor in the case,’ Lorenzo said.

  ‘I’ll look it up in my books tonight after salsa class.’ She smiled. ‘Which is a double-win situation for me, because it means I can find out what I need to know for Maddie’s treatment, and revise for my paediatrics exams.’

  Lorenzo stared at her. ‘You’re, what, three or four years younger than me?’

  ‘I’m thirty-two.’

  ‘Three years, then. I’m surprised you’re not through all your exams already.’


  ‘That’s because I took a year’s sabbatical,’ she said.

  ‘Sabbatical?’

  His voice was soft and gentle, and Jenna almost confided in him about why she’d taken time off work. Then Danny’s voice echoed in her head: ‘You’re going to be a surrogate mum for your sister? That’s the most stupid idea I’ve ever heard. What about your career? How can you throw all that away just for a kid that you’re not even keeping?’

  She didn’t think Lorenzo was anything like Danny, but the situation wasn’t exactly the easiest to explain. She didn’t want him thinking that either she was a saint—because she was far from that—or the naive idiot Danny had called her when she’d refused to give in to his haranguing. ‘Life throws up unexpected stuff, sometimes,’ she said with a smile, fudging the issue.

  * * *

  Lorenzo had seen Jenna work with their patients. He knew she was competent, and also she was confident enough to admit when something was outside her experience, as Maddie had been today—so he didn’t think she’d taken a year off because she’d been struggling with her work and needed to think about her future. So why had she taken a year’s sabbatical? Had it been a career break to have a baby, perhaps?

  Though, in his experience, when his colleagues had children, they tended to talk about them. Jenna hadn’t said a word about having children of her own.

  Maybe she’d had a child, then lost it.

  He knew how that felt, and he didn’t talk about it. He could understand why someone just wouldn’t want the constant reminders of the empty spaces in their lives. So he wasn’t going to push her about it. Besides, she’d hit the nail on the head about his own situation. Unexpected stuff. In his case, it had been something he’d been too naive and stupid to work out for himself. That his wife had cheated on him with her ex, and the little girl he’d believed was his was actually another man’s daughter. ‘Very true,’ he said. ‘Life can be unexpected.’ And sometimes it took you a while to pick yourself up and dust yourself off again. ‘If you want anyone to test you on stuff before the exams, give me a yell.’