THE MAVERICK DOCTOR AND MISS PRIM/ABOUT THAT NIGHT...

by Scarlet Wilson

  Jaja pushed opened the door to the house and engaged in a long conversation with the mother, who seemed more than happy to see them.

  But Evan’s eyes were drawn to the corner of the room, where a small boy was lying on a makeshift bed. His siblings were playing around him and he seemed oblivious to the noise in the room. Evan’s instincts were automatic and he went to the bed of the sickly child.

  “Hi, there, Dumkata.”

  The dark eyes flickered open at the sound of the foreign voice. The little boy’s hands automatically started scratching at his skin, as if he had an uncontrollable itch. It was almost as if Evan’s voice had broken him out of the half-slumber he’d been in.

  Evan turned to face Jaja. “Can you ask the mother if she minds if I take a look at her son?”

  Jaja answered quickly. “She was just asking me the same thing. She knows you’re only here to give the vaccinations and didn’t want to take up your time.”

  “It’s no problem. I’m happy to look at him. Can you organize the polio vaccination for the rest of the family, Jaja?”

  The community worker nodded and pulled out the vaccine carrier and flip book to explain things to the family.

  Evan touched Dumkata’s forehead. It was just as he’d expected. Burning hot. He pulled his medical bag over and took out the tympanic thermometer. It beeped within a few seconds. It indicated that the boy had a temperature.

  He pulled out his stethoscope to sound the little boy’s chest. Dumkata barely responded, he still seemed fixated on the itch in his skin. “Can you ask the mother what he’s been complaining of?”

  Jaja took a few moments to reply. “She says he’s had a terrible headache for the past few days and his joints are painful and sore. Dumkata is usually running about constantly. She says this is not like him.”

  Evan nodded and gestured to Jaja. “Could you help me sit him up for a moment, please?”

  Something was setting off alarm bells in Evan’s head. He had the strangest feeling, and experience told him to go with his instincts.

  He spent some time examining Dumkata’s skin. There were a few angry marks—just like bee stings—along with a rash that was difficult to see on Dumkata’s dark skin and some swelling in the subcutaneous tissues.

  He pressed his fingers gently around Dumkata’s neck and groin, checking the lymph glands and finding them enlarged. It was clear that some type of infection was circulating around the child’s body.

  “Can you go and find Violet for me, please? I’d like to have a chat with her.”

  Jaja nodded and slipped out of the door. Violet had been working in the village today too but their paths had barely crossed. They’d mapped out the village and decided on separate routes to try and cover the majority of people who had requested to be seen. It made more sense for them to split up than work together.

  It also prevented any awkward conversations or, more likely, awkward silences.

  It was almost as if she was deliberately avoiding him. She’d never complained about working with the midwives and birth attendants. She’d just put her head down and got on with the job.

  But he hadn’t forgotten the look in her eyes. Or the way she’d realized that he’d noticed. At some point they were going to have to have that conversation. If he’d learned anything these past few years it was he needed to be sure about the welfare of his team.

  The little form moved on the bed in front of him. He tried to focus on the matter at hand. The niggling feeling he had in his gut about this little boy.

  Violet appeared in the doorway. “Evan? You were looking for me?”

  Pretty as a picture—even after ten hours on the job. She was wearing another of Olibasi’s outfits, this time in pale pink instead of the brighter colours. Her blond hair was swept up in a clip and her normally pale skin was starting to tan slightly.

  Olibasi had been right about the effect of wearing local clothes. Violet seemed to be widely accepted wherever they went. Some reports on previous villages had been a little alarming. But in the past few weeks Violet seemed to be getting good results. The uptake of the polio vaccine was rising in places where it had previously stalled.

  It didn’t make sense that it was all down to the type of clothes that the doctor wore. Violet’s quiet, easy nature and never-ending patience was obviously a major factor. But the fact she wore the clothes so well wouldn’t exactly be a hindrance. He tried to keep the smile from his face.

  “Thanks, Violet. I know we’re just about to finish up but I wondered if you’d mind brainstorming with me for a minute.”

  She looked a little surprised but took it in her stride. “No problem.” She crossed the room and kneeled down next to him at the side of the bed. “Who do we have here?”

  “This is Dumkata—he’s seven. According to his mom he’s usually the life and soul of the party, but he’s been unwell these past few days. He has a temperature, a headache, sore joints with some noticeable swelling, some bites and swollen lymph glands.” He caught Dumkata’s hand as it started to scratch again. “He also seems to have an irritating itch.”

  Violet nodded. “Well, it could be whole host of things with those symptoms. What’s worrying you most?”

  Evan scratched his chin. “Probably the bites.” He turned to face her. “Probably my gut instinct.” He shook his head. “I’m just not happy.”

  She nodded. “Then let’s be methodical about this. Is anything springing to mind?”

  She bent over Dumkata and started examining his skin. The rash was difficult to determine but was widespread across his skin. It appeared mainly to be speading out from the two bite marks on his skin. “Does the mom know what caused these bites? Is there something in particular we should be considering?”

  Evan wrinkled his nose. “Probably. It’s frustrating. Back home we’ve got everything to hand. Out here it’s much more difficult.”

  Violet gave him a little smile. She understood completely. Back at the DPA they had a computer program for everything. Every tiny sign or symptom all calculated and computed to tell you any possibilities and what to look for next. She pulled a tiny pocketbook from under her traditional skirt. “Want a look at this?”

  It was a copy of a tropical disease handbook—ten years old and obviously well worn. She’d had it since she’d been a student and had hardly looked at it in recent years. But it had been a last-minute addition to her suitcase.

  As Evan turned the pages, one fell out in his hands. “Sorry,” she muttered. “I’m sure I’ve got some sticky tape somewhere.”

  Jaja walked over to them. “The mother has no idea what the bites are. Her son was playing out near the fields a few days ago. He came home with the bites. She hasn’t seen them before and Dumkata just said they were bee stings.”

  Evan’s head shot up. It was almost as if a little light had just gone on in his head. He started muttering and flicking through Violet’s book, “Fields...flies...” His eyes met hers.

  “What about tsetse flies? What about the first signs of sleeping sickness?”

  “Really? I thought that had almost disappeared?”

  Evan pulled out his PDA and looked up some files. He frowned. “Only two cases reported in Nigeria last year. Could it really be something like that?”

  Violet shook her head. “You’ll have to remind me about it. I can’t remember that much.”

  His eyes scanned between the screen and the book he held in his hands. “African trypanosomiasis is a vector-borne parasitic disease, known as sleeping sickness. The parasites are transmitted to humans by the bite of the tsetse fly. Most common in areas of fishing, animal husbandry or—” he lifted his eyes to meet hers “—agriculture.”

  “What do the flies look like?”

  He shook his head. “There aren’t any pictures. It just says they are about the same s
ize as bees and quite aggressive.”

  Violet looked over at the mother. Jaja was doing his best to relay their conversation to her and the distress on her face was visible. She rushed over and put her arm around her child.

  “Help my baby.”

  Violet could feel her stomach muscles clench at her reaction. The instant fear that something could happen to her child—something completely out of her control.

  She took a slow breath. “We need to stay focused. Does it list the signs and symptoms?” She lowered her voice slightly. “How serious is it? Do we have anything to treat it?”

  Evan’s eyes were still flickering back and forth between the book and the screen. “The signs and symptoms are compatible with the first stage. The temperature, itching, joint pains and headaches. They are all signs that the trypanosomes are multiplying in the subcutaneous tissues. It’s called the haemolymphatic phase.”

  Violet could almost feel her own skin start to itch at the thought of parasites circulating around the little boy’s body. It was horrible.

  She tried to pull her doctor’s head back into focus. She was finding it so hard not to look at Dumkata’s mother and see the pain and fear in her eyes. Even though this was an entirely different situation from her own she wanted to reach out and tell her that she understood. That she knew the fear of the unknown, the protectiveness she was feeling and the helplessness at things being out of her control.

  “How do we diagnose this?”

  “We need to take a blood test. It used to be really difficult to diagnose because the number of parasites in the blood can be low and they need to be separated from the red blood cells.” He pointed to something on the screen. “There’s a pan-African campaign on the eradication of trypanosomosis. Let me see if can get some more details.” He pulled out his satellite phone and pressed in a number as he headed toward the doorway. “Give me a few minutes.”

  Violet nodded as she watched him leave. “Jaja, can you come and sit with us? I’d like you to translate for me, please.”

  Violet’s eyes flickered over the screen as she picked up some more details. She finally had the courage to meet Dumkata’s mother’s eyes. “Tell her we need to make a diagnosis and Dr. Hunter is just finding out the best way to do that.” She watched as Jaja rapidly translated. “Tell her we think that if it is sleeping sickness, then it’s been caught at an early stage—a stage that can be treated.”

  Within a few seconds she could see the relief as the woman relaxed her shoulders and shot some rapid questions at Jaja. He gave her a few answers, obviously trying to reassure her, then turned back to Violet. “She wants to know how long it takes and what the treatment is.”

  Violet nodded. It’s the kind of thing she’d want to know too. Evan appeared back in the doorway. He gave her a wide smile—obviously good news. His broad shoulders filled the door way and the tired look that had haunted him for the past few days had disappeared.

  The African sun was agreeing with him. His skin had already been a light golden-brown that was deepening with every day. It only succeeded in making his teeth look whiter than ever and his blue eyes more prominent. His brown hair was lightening in the sun, giving the ends blond tips. She couldn’t have achieved that look even if she’d spent ten hours in the hair salon. Her hair was becoming more brittle day by day. The leave-in conditioner she was using every other day in an attempt to waylay the damage made her hair feel slimy. Hardly a good look, by anybody’s standards. Why did men have things so much easier?

  She was still struggling with the task he’d given her last week. Not that she wanted anyone to know that.

  By anyone else’s standards she was doing fine. She’d reached out to the midwives in the neighboring villages and arranged to spend time with them all.

  But a few had made it clear she’d need to see them on their own terms. Which was likely to mean in the middle of someone’s home or the local birthing room.

  All things that made her bristle with nerves and wonder if she could manage this.

  Having Evan here today had been a welcome break from her other work. Even though they hadn’t been working side by side today it was almost a comfort to have him around. To know that another doctor had her back in case they got into any difficulties.

  It gave her even more of a buzz to know that he’d wanted her opinion—had valued her opinion on a case. He had confidence in her abilities, even if she sometimes doubted them.

  Evan crossed the room toward them. “The news is good. All I need to do today is take a blood sample. It used to be difficult to separate the parasites from the blood cells but we’re in luck. Some Swedish scientists have developed a microfluidic device that separates the parasites from the blood cells using their shape, because parasites and red blood cells are very difficult to separate by size. It’s being trialed in one of the local labs and they’re going to arrange to pick up our sample.” He placed his hand on Dumkata’s mother’s shoulders. “We should have the results very soon.”

  Jaja was speaking quickly, translating everything that Evan had said. She asked another question and he turned back to Evan. “And the treatment?”

  Evan nodded. “We’ll need to do one other test if the blood test is positive—a lumbar puncture. Tell her we’ll take a little sample of Dumkata’s spinal fluid. It gives a clear indication of what stage the disease is at. We suspect it’s in the first stage and if that’s confirmed, the treatment is relatively simple, a drug—pentamidine, which is supplied free of charge by the Healthy World Federation.”

  He waited a few minutes for Jaja to relay the news. Dumkata’s mother seemed satisfied with the answers but Violet stood up in front of him.

  “It all seems too good to be true. What happens if the disease is further on than we expect?”

  Evan frowned and lowered his voice. “I’m pretty sure it’s not. We’re lucky they are trialing the new diagnosis system here. It should give a much more accurate result.”

  Violet raised her eyebrow. He still hadn’t really answered her question, and it was the second time she’d asked. It was as if he were playing a careful game of dodgeball with her. She looked over her shoulder. Dumkata’s mother couldn’t hear them speak right now.

  “I can’t remember, but is sleeping sickness fatal if it’s not diagnosed early enough?”

  His eyes fixed on hers and he gave a little sigh. “Well, yes, it can be. The second stage isn’t too pleasant. The parasites cross the blood-brain barrier and infect the central nervous system. It causes neurological damage, bringing confusion, sensory disturbances, poor co-ordination and disturbance of the sleep cycle—it’s what gave the disease its name.” His eyes drifted over to the other side of the room to the little figure huddled up in the bedclothes. “At that stage, it can be fatal.”

  She reached over and touched his arm, trying to ignore the way the hairs on her own arm reacted. “But we’re not at that stage, are we?” She gave his arm a little tug to move outside. “How do you feel about doing the lumbar puncture? Are you happy to do it? I can do it if you want. I have to put my hands up and admit it’s been a little while since I’ve done one.”

  He shook his head, his eyes fixed on the fact she still had her hand on his arm. She hadn’t really wanted to move it but the intensity of his gaze made her pull her hand away.

  “No, it’s fine, Violet. I cover on a regular basis on a pediatric unit. I’m happy to do the lumbar puncture.”

  She tried not to let the sense of relief she felt show. “You do? Why have you never mentioned it?”

  He sighed, his eyes on her face. “We don’t exactly have these social conversations, do we?”

  She felt her face flush. He wasn’t saying the words but he didn’t have to. She was always quick to rebuff any of Evan’s attempts at small talk. It was her own small measure of self-protection. The less she knew about him, the les
s she could feel.

  But she was moving on. She was attempting to feel in control again.

  He was still staring at her and she felt very self-conscious under his gaze. She couldn’t imagine how she looked after ten hours in the claustrophobic heat. She probably looked like the equivalent of a well-cooked sausage. Hardly an attractive prospect.

  But the timing felt right. The way Evan was looking at her was speaking volumes to her. She glanced over her shoulder. And it was just them. No one else was around.

  She took a step forward. It was tiny—literally just a few inches. But it felt like jumping off the edge of a cliff.

  She put her hand back on his arm, well aware of the way it would make heat run up her arm and her skin tingle. She was ready for it. She was prepared for it.

  “Maybe it’s time to start.” She hesitated for a moment. If she waited to see how he would react she might never continue. “So, why do you cover in a pediatric unit, Evan?”

  She held her breath and watched as his pupils dilated ever so slightly, and he leaned toward her, closing the space between them.

  “So, we’re going to have those kinds of conversations?” It was a simple enough sentence. But it meant much more than those few words.

  She took a deep breath. “I think we should try.”

  There. She’d said it. She’d taken that giant step. What did it really mean?

  Evan was as cool as a cucumber. His eyes were steady. If he stayed still much longer she would start to count the flecks in his eyes.

  He blinked and straightened his shoulders.

  “I trained in pediatrics before I joined the DPA. My friend Tyler is a doctor at the Memorial Hospital in Atlanta. He’s had skin cancer these past few months and needed surgery and treatment. I’ve been covering some of his shifts.”