Buch lesen: «The Italian Doctor's Perfect Family»

CHAPTER ONE

THE nudge from a small elbow demanded attention.

‘Pip?’

Philippa Murdoch turned her head swiftly. ‘Sorry, hon—I was miles away.’

In the emergency department, no less, where she’d had to leave a patient who hadn’t been overly impressed by the disappearance of his albeit junior doctor.

‘I think they’re calling me.’

‘Alice Murdoch?’

Everyone in the packed waiting room of the paediatric outpatient department was looking at each other with a vaguely accusatory air. Maybe they’d all had the same kind of hassle as Pip in fitting in their appointments and they didn’t appreciate the possibility of further delay due to a less than co-operative patient.

‘Here!’ Pip stood up hurriedly, wishing she’d left her white coat downstairs. The woman who’d been trying to negotiate a truce between three small children fighting over the same toy in the corner gave her a suspicious look that made her feel as though she was somehow jumping the queue by means of professional privilege.

As if! They’d probably waited as long as anybody here for an appointment with the most popular paediatrician in the city. Which was why Pip had been forced to abandon her own duties to make sure the consultation wasn’t lost.

Had she missed something in that initial assessment of her last patient? The symptoms had been non-specific and unimpressive and too numerous to find one that seemed significant, but maybe she should have taken more notice of that toothache he’d mentioned? What if Pip had left him under observation while he was busy having a heart attack? She should have ordered a twelve-lead ECG and some bloods rather than more routine vital sign observations.

She and Alice were ushered into a small room with three chairs in a triangle on one side of a desk and a couch against the opposite wall. The nurse deposited a plain manila folder with Alice’s name on the front onto the desk.

‘Have a seat,’ she invited. ‘Dr Costa won’t be long.’

Alice raised her eyebrows. ‘Funny name, isn’t it?’

‘It’s Italian.’

‘Why can’t I just go back to Dr Gillies?’

‘Dr Gillies is our family doctor. Part of his job is to get someone else to see his patients if he’s not sure what’s wrong. It’s called referral.’

Alice absorbed the information with a small frown. Then her face brightened.

‘Knock, knock,’ she said.

‘Who’s there?’ Pip responded obligingly.

‘Dr Costa.’

‘Dr Costa who?’

‘Dr Costa lotta money.’

Pip’s grin faded with astonishing rapidity as she realised she wasn’t the only one to have heard Alice’s joke, but the tall, dark man, whose sudden presence seemed overwhelming in the small consulting room, was smiling.

‘I don’t really cost much at all,’ he said to Alice as he eased his long frame into the remaining empty chair and leaned forward slightly. ‘I’m free…and I’m all yours.’

Alice was staring, open-mouthed, and Pip could sympathise with the embarrassed flush creeping into the girl’s cheeks. She would have been thoroughly disconcerted to have a dose of masculine charm like that directed at her. Poor Alice would have no idea how to respond.

The soon-to-be-teenage girl was currently the sole focus of attention from a man who had to be far more attractive than any one of the pictures of the movie-star and pop idols that Alice and her friends already enjoyed discussing at length.

With hair and eyes as dark as sin, a killer smile and that intriguing accent, it was no wonder that one of the senior ED nurses had sighed longingly when Pip had explained the necessity of accompanying Alice to this appointment.

‘I wouldn’t miss that opportunity myself.’ Suzie had laughed. ‘In fact, I wonder if I could borrow someone’s kid?’

‘It’s only because my mother’s got some kind of horrible virus that’s making her vomit and Alice is too young to go by herself.’

‘It’s not a problem,’ Suzie had assured her. ‘Your voluble Mr Symes has probably only got a virus as well. I’ll keep a close eye on him while you’re gone.’ She waved Pip towards where Alice was waiting patiently on a chair near the door. ‘Go. Enjoy!’

And with that smile from Dr Costa now coming in her own direction, it was impossible not to feel a curl of very feminine pleasure. Philippa could hear an echo of Suzie’s sigh somewhere in the back of her head as she returned the smile.

‘And you must be Alice’s…sister?’

The noticeable hesitation was accompanied by a spark of curiosity in those dark eyes, but who wouldn’t wonder about such an obvious age gap between siblings? There was also a subtle frown that suggested the doctor was puzzled by the somewhat unorthodox situation of a sibling accompanying a new patient to a medical consultation.

That inward curl shrivelled so fast it was a flinch, but Pip managed to keep her smile in place for another heartbeat. About to correct his assumption, she was interrupted by Alice.

‘Mum’s sick,’ Alice informed Dr Costa. ‘Isn’t she, Pip? She couldn’t come with me today ’cos she’s got some horrible bug that’s making her throw up all the time.’

‘I’m sorry to hear that!’

He really sounded sorry, too. Pip took a deep breath.

‘We didn’t want to miss this appointment.’ She didn’t need to catch the meaningful glance from Alice that pleaded with her not to make any corrections. It could be their secret, couldn’t it? Dr Costa wasn’t the first person to assume they were sisters and it was much cooler than reality as far as Alice was concerned.

It seemed perfectly reasonable. Secrets were fun after all, and if they were harmless, they only added to bonds between people.

‘There’s quite a waiting list to get into one of your clinics, Dr Costa,’ Pip added calmly, as she shot Alice just the ghost of a conspiratorial wink.

‘Call me Toni. Please.’ He was eyeing her white coat. ‘You’re on staff here, Pippa?’

‘It’s Pip. Short for Philippa.’ Though she liked Pippa rather a lot more, especially delivered with that accent. ‘And, yes, I’ve just taken up a registrar position here. I’m a month into my run in the emergency department.’

Alice was watching the exchange with keen interest.

‘I thought you were supposed to be Italian,’ she said to her doctor.

‘I am. I come from Sardinia, which is a big island off mainland Italy.’

‘Tony doesn’t sound very Italian.’

‘It’s Toni with an “i”,’ she was told. ‘Short for Antonio. Will that do?’

Alice returned the smile cautiously. ‘I guess.’

It was Pip’s turn to receive another smile. ‘Thank goodness for that. What would I have done if I couldn’t have established my credentials? Now…’ He reached for the manila folder on the desk. ‘Tell me, Alice, how is it that you’ve come to see me today?’

Alice looked puzzled. ‘I came on the bus from school. I often do that now so that Pip can give me a ride home in her car. I used to have to catch two buses.’

Pip caught the unspoken appeal as the paediatrician opened the file. He wasn’t getting the short cut he might have hoped for in this consultation.

‘Alice’s GP made the referral,’ she said helpfully. ‘He’s been trying to find a cause for recurrent abdominal pain with associated nausea and vomiting and some general malaise that’s been ongoing for several months now.’

Toni Costa was nodding as he skimmed the referral letter. ‘No evidence of any urinary tract infections,’ he noted aloud, ‘but your doctor’s not happy to settle for a diagnosis of childhood migraine or irritable bowel syndrome.’

‘Mmm.’ Actually, it had been Pip who hadn’t been happy to settle for an umbrella diagnosis, but she didn’t want to have anyone else thinking she was interfering because of her training.

The swift glance she received from her senior colleague conveyed a comprehension of her thought that was instant enough to be unsettling, but his expression suggested a willingness to respect her opinion that Pip appreciated enormously. The invitation to say more was irresistible.

‘Mum had a cholecystectomy for gallstones a few years ago,’ she told Toni. ‘And she had an episode of pancreatitis last year. The symptoms were rather like what Alice seems to experience.’

Pip paused, waiting for the kind of reaction Dr Gillies had made to the suggestion. The unsubtle query of how soon after Shona’s illness Alice’s symptoms had appeared. As though Alice was disturbed enough to be suffering from Munchausen’s syndrome and had latched onto a known condition. As if you could fake the symptoms like tachycardia and pallor and vomiting that could come with real, severe pain!

‘And you’re concerned about a possibility of an hereditary condition?’

‘Yes.’ The tension in Pip evaporated. Toni Costa was going to take her concerns seriously. Her opinion of this man shot up by several notches.

‘What’s a hairy-de-tairy thing?’ Alice demanded. She gave Pip a suspicious glare. ‘You never said I might have that.’

Toni was smiling…again, and Pip decided that was just the way his face naturally creased all the time. Did smiling always make those almost black eyes seem to dance? No wonder he was so popular with his patients.

‘Hereditary just means it’s something you were born with,’ he was explaining to Alice. ‘You get a whole parcel of genes when you born and some of them come from your parents and grandparents and something hereditary means it came in the parcel.’

‘Is it bad?’

Toni shook his head, making sleek waves of rather long, black hair move. ‘It doesn’t mean anything by itself, Alice. It’s like catching one of your buses. If it’s hereditary it just means you already had your ticket. If it isn’t, you’re buying the ticket when you jump on the bus instead. It’s the bus we’re interested in, not the ticket.’

Was he always this good at explaining things to children? Further impressed, Pip watched the satisfied nod that made Alice’s ponytail bounce.

‘So what’s my bus, then?’ she asked. ‘Where’s it going to take me?’

‘That’s what we’re going to try and find out.’ Toni Costa folded his hands on his lap and leaned forward a little. ‘Tell me all about these sore tummies you’ve been getting.’

It was a relief to slide into a routine initial assessment of a new patient. Toni could now completely ignore the slightly odd atmosphere in his consulting room.

‘And how often do you get the sore tummy, Alice?’

The young girl screwed up her nose thoughtfully. ‘The last time was the same day as Charlene’s party because I couldn’t go.’

‘And how long ago was that?’

‘Um…well, it’s Jade’s party this weekend and she’s exactly a month older than Charlene.’

‘Older?’

‘I mean younger.’

Toni nodded. ‘So the last episode was a month ago. And the one before that?’

‘I had to miss school and they were going on a trip to the art gallery that day.’

Toni raised an eyebrow at Alice’s sister and could see the smile in her eyes. She had to know exactly what it was like, chasing the information he required, and how frustrating the process could be sometimes.

‘They’re happening at four-to-six-week intervals,’ she supplied readily. ‘And it’s been ongoing for nearly six months now.’

With a quick, half-smile by way of thanks, Toni turned his attention back to his patient. ‘It must be annoying to miss special things like your friends’ parties,’ he said sympathetically.

‘Yes,’ Alice agreed sadly. ‘It really is.’

‘So the pain is quite bad?’

‘Yes. It makes me sick.’

‘Sick as in being sick? Vomiting?’

‘Sometimes.’

‘Is the pain always the same?’

‘I think so.’

‘How would you describe it?’

The girl’s eyes grew larger and rounder as she gave the question due consideration. Pretty eyes. A warm, hazel brown with unusual little gold flecks in them.

Her sister had eyes like that as well. Very different.

Intriguing.

Toni cleared his throat purposefully. ‘Is it sharp?’ he suggested helpfully into the growing silence. ‘Like someone sticking you with a big pin? Or is it dull, like something very heavy sitting on you?’

Alice sighed. ‘Kind of both.’

Toni gave up on getting an accurate description for the moment. ‘Is it there all the time or does it go away and then come back—like waves on a beach?’

‘Kind of both,’ Alice said again. She bit her lip apologetically and then tried again. ‘It doesn’t really go away but it gets worse and then not so worse.’ She shook her head. ‘It’s really hard to remember.’

‘I know, but it’s important you tell me everything you can remember about it. Does it stay in one place?’

‘Yes. In my tummy.’ Alice gave him a long-suffering and eloquent look. Did he really expect a tummy pain to go somewhere else—like her head, maybe?

Toni smiled. ‘What I meant was, does it stay in exactly the same place? Does it get bigger and go to more places in your tummy, or does it make your back feel sore?’

Alice’s face brightened. ‘Sometimes it helps if I put the hottie on my back instead of my front. Is that what you mean?’

‘Yes. Knowing that sort of detail is very helpful.’

Radiation of abdominal pain to the back could well point to something like pancreatitis and the thought automatically took Toni’s gaze back to the older woman sitting in front of him.

She had to be quite a lot older than her sister. Late twenties probably, which was why he had been initially hesitant in querying their relationship to each other. Far better to assume they were siblings than to insult a woman by suggesting she looked old enough to be someone’s mother.

The resemblance was certainly marked enough to make them believable siblings. Pip had those same astonishing eyes. Her hair was a lot darker—a real chestnut instead of red-gold—but the genetic inheritance in the soft waves was also apparent.

And should be of no interest whatsoever in this interview.

‘Any associated symptoms other than the vomiting?’ he found himself asking steadily. ‘Diarrhoea, headache, temperature?’

Pip shook her head.

‘And no family history of migraine?’

‘No.’

‘Peptic ulcers? Gastrointestinal reflux?’

‘No. And she’s been trialled on antacid medications.’

‘Any unusual stress factors or family circumstances?’

Pip looked startled. Almost taken aback.

How curious.

‘I don’t have an ulcer,’ Alice said firmly. ‘That’s silly. Only old people get ulcers. They thought Nona might have one once.’

‘Nona?’

‘Mum’s name is Shona,’ Pip put in quickly. ‘For some reason, that’s what Alice started calling her when she learned to talk, and it stuck.’

‘Oh?’ The extra distraction from professionalism was unavoidable. ‘How strange!’

Pip’s gaze was shuttered and her tone guarded. ‘Is it?’

‘Only to me, maybe.’ Toni smiled reassuringly. ‘I was largely brought up by my grandmother. Nonna.’

‘Was her name Shona, too?’ Alice sounded fascinated. ‘How weird!’

Toni shook his head. ‘No. Nonna is Italian for grandmother.’

And that was more than enough personal stuff. So odd that sharing something so private had seemed compelling. Almost as odd as the glance now passing between the Murdoch sisters. Toni stood up in an attempt to get completely back on track.

‘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.’