by Sarah Morgan
‘No, but when it happens at school they give me a bowl, just in case.’
Amy looked at Sue. ‘And how long has he been getting headaches?’
‘It’s hard to say.’ Sue bit her lip. ‘I mean, children get headaches, don’t they, so I didn’t really think about it at first. Then it became more frequent and when he gets them he’s sobbing and crying and it’s quite scary. And I started to think—I mean—you’re going to think I’m completely paranoid. A headache is just a headache isn’t it? It’s just that—’ She broke off and glanced at the boy, clearly concerned about saying too much in front of him.
Amy leaned forward and wrote on a piece of paper. Then she leaned forward and gave it to the child. ‘Harry, would you be kind enough to take this to the lady behind Reception for me? And then come back here. Thank you, sweet heart. That’s really helpful.’
Eager to please, Harry left the room and Amy turned to the mother. ‘I sense that there are things that you don’t want to say in front of him.’
‘Well, I don’t want to worry him. And I’m probably just being paranoid but it’s hard not to be with my history. I was diagnosed with bowel cancer two years ago and everyone told me that it couldn’t possibly be anything serious. And then it was. I’ve had chemo and operations and—well, it’s been really, really hard. And it makes you realise that things go wrong. People say, “Oh, it won’t be anything,” but that’s what they said about me and they were wrong. It was something. And when that happens you can’t just look at a headache and think headache, can you? I try and do that and all the time I’m thinking brain tumour.’
‘You’re not alone in that and you have more reason than most to worry, given everything that has happened,’ Amy said softly, feeling her heart twist with sympathy. ‘You’ve obviously had a terrible time. I’m so sorry.’
‘It’s not too bad now, things have gone quiet. But now this.’ Sue looked at Amy and her eyes filled. ‘I can cope with anything that happens to me but if anything happens to my child—to Harry—that’s it, I’m telling you that now. That’s it for me. No more. If my baby is ill, then I’ll…’ Tears poured down her cheeks and Amy reached out and gave her hand a squeeze.
‘It is very unlikely that this is anything serious, but I can understand why you’re worried, so this is what we’re going to do. We’re going to take a very, very good look at him and if necessary we’ll refer him to the paediatrician for a specialist opinion. Anything we need to do to reassure you.’
‘And how long will that take?’ Sue reached into her bag for a tissue and blew her nose hard. ‘I’m not sleeping at night because I’m so worried.’
The door opened and Harry bounced back into the room. ‘She said, “thank you.”’
Sue absolutely pulled herself together, her smile just a little too bright as she scrunched up the tissue and pushed it up her sleeve. ‘Good boy.’
‘Yes, thank you, Harry.’ Amy smiled and then turned back to Sue. ‘Let’s start by taking some history. Does anyone in the family suffer from migraines?’
‘My mother and my sister. But not for years. I did take Harry to have his eyes tested because I thought it might be that, but the optician said that his eyes are fine. I brought you the report, just in case you wanted to see it.’ She rummaged in her bag and pulled out a piece of paper.
Amy glanced at the results and nodded. ‘Yes, they’re fine. Nothing there that should cause a headache.’ She asked a few more questions, recorded the answers carefully and then smiled at the boy. ‘Hop on my couch, Harry, and I’ll take a look at you.’
She examined the child thoroughly, found nothing that alarmed her but saw the desperate worry in Sue’s eyes.
Amy thought for a moment. ‘Sue, I can’t find anything that would lead me to believe this is anything other than a straight-for ward headache, but given your history I think it would be reassuring for you to have a second opinion. Dr Avanti is a qualified paediatrician, as you know. I think what we might do, given how worried you are, is to ask him to take a look at Harry.’
‘Would he have time?’
Amy looked at the clock. ‘Well, it’s the end of surgery so let me just pop in and ask him and see how he’s fixed.’
She left the room and found Marco in his consulting room, talking on the phone. He waved a hand towards a chair, finished the conversation and then looked at her expectantly. ‘Problems?’
‘I have Sue Miller in my room.’
‘Sue?’ His gaze sharpened. ‘What’s the matter with her? She was diagnosed with colorectal cancer a couple of years ago. I know Lucy did some follow-up with her.’
Amy looked at him curiously. ‘Do you know everyone’s patients?’
‘Sì, if they have a history of serious illness, it’s my business to know. It’s important that all the partners are aware of what is going on.’ He shrugged. ‘She was discussed in a practice meeting a while ago. She’s always a priority patient for us. So, why is she seeing you today?’
‘It isn’t about her. It’s about Harry. He’s seven and he’s been having headaches.’
Marco gave a slow nod. ‘And she thinks this is symptomatic of a brain tumour, no? I’m sure she is very anxious.’
‘Exactly. Understandable in the circumstances.’
‘Of course. And you’ve examined him?’
‘Yes. I can’t find anything, but I can see that she’s very worried. I could always refer her to a paediatrician, but that would take time and given that you are a paediatrician, I thought you might look at him for me. Provide instant reassurance.’ She frowned. ‘Always assuming that there isn’t anything to worry about.’
‘Now who is being paranoid?’ Marco said softly, a faint flicker of humour in his eyes. ‘Less than one percent of headaches are caused by a brain tumour. I think you know that statistic.’
‘Yes.’ Amy gave herself a little shake. ‘But try telling that to a thirty-five-year-old woman who developed cancer when she shouldn’t have done. I don’t think she’s a big believer in the relevance of statistics.’
‘Point taken. Of course I will see him. Your room or mine?’
His voice was silky smooth and Amy felt the colour flood into her cheeks and cursed herself for reacting so strongly. Why couldn’t she be in different? Why?
‘You may as well come to my room. Harry is playing happily and it might be less unsettling for him.’
Marco picked up his stethoscope and auriscope and followed her out of the room.
‘By the way…’ He paused outside the door. ‘They’re having a New Year’s Eve party at the Penhally Arms. We’re both invited.’
‘Thanks, but no.’ Amy shook her head. ‘I’m here to work, not to party. You go. I’ll stay at home and catch up on some paperwork.’
‘You need to be there. You’re a member of the community now. You need to make a showing.’
‘I’m only here for a short time.’
‘If you don’t go, people will say that we’re afraid to be seen together. We need to present a united front. They don’t want to think that there’s dissent at the surgery.’
Feeling trapped once again, Amy paused with her hand on the door. ‘I can’t go to a party with you, Marco.’
‘Why not?’ He looked genuinely puzzled. ‘We’re friends and colleagues. Why wouldn’t you? We can spend a pleasant evening together. What’s the problem? Let’s go and take a look at Harry.’ And he pushed open the door of her consulting room and walked inside, leaving her staring after him with frustration.
CHAPTER SIX
HE ALWAYS seemed to get his own way.
She’d come to Penhally planning to stay for an hour and here she was, working in the surgery, living with him in their old house and now contemplating going to a party with him. It was ridiculous!
Amy watched as he spoke quietly to Sue and then dropped into a crouch next to Harry.
‘Hi, there, Harry.’ His voice was good-humoured. ‘Good Christmas? What did Father Christmas bring?’
‘The most
amazing remote-control car. You should see it, Dr Avanti, it’s so cool.’
‘You didn’t bring it with you?’ When Harry shook his head, Marco looked disappointed. ‘Shame. Never mind. Next time I see you perhaps you’ll have it with you.’ He asked Harry a few questions and then did the same of Sue. ‘I’m going to take a look at you, Harry. Can you take off your jumper and shirt and sit on that couch, please?’
Marco listened to the child’s heart and lungs and then laid him down and examined his abdomen. ‘How long have you been at your school, Harry?’
‘Oh…’ The boy thought for a moment. ‘Pretty much my whole life.’
‘Since nursery,’ Sue muttered, a soft smile on her face as she looked at her child. ‘Age four.’
Marco felt the femoral pulse. ‘And who lives at home with you?’
‘Well, my mum mostly.’ Harry wrinkled his nose thoughtfully. ‘And my dad comes home in the evenings.’
‘Because he’s at work all day,’ Sue interjected hastily, and Marco smiled.
‘Children are very literal. Any brothers or sisters, Harry?’
‘Just Beth. She’s two. She doesn’t say much but she bites a lot. I suppose she’s all right.’ Harry looked a bit unsure on that point and Sue gave him a quick hug.
‘She doesn’t mean to bite, sweet heart. She’s very little and her teeth are hurting.’ She gave Marco an apologetic look. ‘Beth is going through a biting phase at the moment. I’m talking to the health visitor about her in clinic next week.’
‘Good idea.’ Marco picked up the patella hammer and gently rolled up Harry’s trouser leg. ‘And what’s your favourite subject at school?’
‘Science.’ Harry giggled as his leg jumped. ‘Are you going to break my leg?’
‘Definitely not.’ Marco smiled and tested the reflexes in the child’s feet. ‘Doctors don’t break legs, they fix them. Do you like your school, Harry? Are you happy?’
‘Yes. Except for the lunches. The lunches are gross.’
‘What do they give you for lunch?’
‘Slugs and snails.’
Marco looked interested. ‘Cooked or raw?’
Amy smiled. He was so good with children and they just adored him.
Harry was giggling. ‘And worms. They call it spaghetti but it’s definitely worms.’
‘In Italy, where I come from…’ Marco picked up the child’s T-shirt and handed it to him ‘…we eat a lot of worms. You can get dressed now.’
‘You eat worms?’ Harry shuddered and pulled on his clothes. ‘Weird.’
‘Very weird,’ Marco agreed. ‘Now, I want you to sit up and play a few games with me.’
‘Games? Cool.’ Harry sat up cheerfully, his legs dangling over the edge of the trolley, his expression enthusiastic. ‘Now what?’
Marco stood in front of him, legs planted firmly apart, supremely confident. ‘I want you to touch my finger and then touch your nose—that’s good. And now with the other hand. Faster. Oh, you’re good at that.’
‘It’s easy.’
‘Now look at me.’ Marco held his hand to the right of the boy’s head and wiggled his finger. ‘Tell me if my finger is moving or still.’
‘Moving.’
‘And now?’
‘Still.’
Marco switched sides, performed a few more tests and then reached for the ophthalmoscope. ‘And now I want to look in the back of your eyes. Amy, can you close the curtains for me, please? Look straight ahead at the picture on the wall, Harry. Keep looking at it even if I get in the way.’ He examined the back of both eyes and then put the ophthalmoscope down and drew the curtains.
‘Can you see my brain with that light?’
Marco smiled. ‘Not your brain exactly but the back of your eye tells me things about your brain. Now put your arms up.’ He carried on with the examination while Sue watched anxiously and Amy watched with interest. ‘Sit on the floor for me, Harry.’
Eager to please, the little boy slid off the couch and sat on the floor. ‘This is fun. Now what?’
‘Now stand up as fast as you can.’
The boy leapt to his feet. ‘I’m the quickest at gym.’
‘I can see that.’ Marco walked across to him, putting his heel directly in front of his other foot. ‘Can you do this? It’s like walking on a tight rope.’
‘You mean like in the circus?’ Harry chuckled and walked, arms out stretched like an acrobat. ‘Like this?’
‘Perfect. You’re good at that. Better than me. So—we’re finished. Good boy.’ Marco sat down in the chair opposite Sue. ‘All right. I don’t see anything that worries me. I don’t think this is what you’re afraid it is, but if you want more definite reassurance I can refer him for an MRI scan.’
Sue pulled a face. ‘I was scanned so many times. I wouldn’t want him to have that. It’s radiation, isn’t it?’
‘You’re talking about CT scans. An MRI scan is different.’ Marco’s voice was calm and patient. ‘There is no radio activity, no risk to the patient and Harry is old enough to tolerate it with no problem.’
Sue looked at him and her eyes filled. ‘You don’t think it’s…anything? Truly?’
Amy knew she was avoiding saying the word ‘cancer’ because the little boy was still in the room.
‘I don’t think so, although medicine is never an exact science, as you are well aware.’ Marco’s sympathetic smile indicated that he was referring to her own medical history. ‘I think Harry might be suffering from migraines. Not an easy diagnosis to make in a child because the pattern of headaches is not always predictable, but what you describe—the drilling pain, the very definite episode, which is relieved by paracetamol, the fact he needs to lie down…’ Marco shrugged his shoulders. ‘This sounds to me like migraine and there is some family history to support the theory.’
Sue looked at him. ‘If he were your child, what would you do?’
Amy felt her stomach flip. Marco’s child.
His mind clearly in tune with hers, Marco’s gaze flickered to hers momentarily and something burned, slow and hot, in the depths of his eyes. Amy swallowed, knowing that he was thinking of the plans they’d made to have a family.
‘If he were mine…’ Marco dragged his gaze from Amy’s and glanced across at the little boy, who was playing happily on the carpet. ‘If he were mine, I would watch him for a while, see how he goes. I think you should keep a diary of the headaches so that we can assess exactly how many he is getting, how long they last and whether there are any obvious triggers. Do that for six weeks and then make an appointment with one of us to go through the diary. We can look at the frequency and decide whether to refer him to the paediatricians at the hospital for them to take a closer look.’
‘But you don’t think—’
‘No.’ Marco’s voice was firm. ‘I don’t. But we will watch him. And if you decide that you would be happier if he had an MRI scan, you have only to let me know and I will arrange it.’
Sue closed her eyes for a moment and let out a long breath. ‘Thank you for that. I’ll pass on the scan for the time being. But what could be causing the migraines, do you think?’
‘It’s hard to say.’ Marco watched the child play. ‘Often we underestimate children, especially very young children. We imagine that because they are young, they are somehow not aware of what is going on around them, but that is rarely the case. Most children are extremely intuitive and even if they don’t pick up on conversations they pick up on atmosphere. Is he a sensitive child, would you say?’
‘Very.’ Sue looked at her son. ‘He’s a worrier. And very caring. Even in the play ground at school, he’s always watching out for other children.’
Marco nodded slowly. ‘So—we know that the past two years have been very hard for you personally and also for your family. It would be almost impossible for that not to have had an impact.’
‘I suppose so. We’ve done our best to protect the children, but inevitably some of it filters through.’ Sue rose to
her feet and managed a smile. ‘But things are going better now. I’m hoping this is going to be our lucky year. Will you be in the Penhally Arms on New Year’s Eve, Dr Avanti? I hear they’re planning quite an evening.’
‘Sì. Where else would I be on New Year’s Eve when the drink is free?’ Marco winked at her. ‘I’ll be there.’
‘Then we might see you. Thank you, both of you. Harry…’ Sue held out a hand to her son. ‘Let’s go and write a few more thank-you letters for all those Christmas presents.’
Harry gave an exaggerated shudder but followed his mother out of the room with a wave at Marco.
‘Sweet boy,’ Amy said quietly, and then realised that Marco was watching her.
‘I thought you didn’t like children?’
She stiffened. ‘I never said I didn’t like children. I just said I didn’t want any of my own. That’s completely different.’ Uncomfortable under his scrutiny, she turned away. She couldn’t live like this. Couldn’t be on her guard the whole time. It was exhausting and she was a useless, terrible liar. ‘So we’ll keep an eye on him, then. Thanks for looking at him. You really think he’s all right?’
‘Who?’ It was as if his mind was somewhere else entirely. Then he sighed. ‘Oh, Harry—yes. Amy, his neurological examination was normal, there was no evidence of poor co-ordination, ataxia or nystagmus. His peripheral nervous system was normal. His cardiovascular system was normal. Personally, I wouldn’t even scan him, but if Sue carries on worrying, it’s worth arranging it.’
‘I’ll do that. Or I suppose the locum can do it if I’ve gone. I’ll make sure the notes are detailed. Thank you, Marco.’
He studied her in brooding silence. ‘My pleasure.’
The antenatal clinic was held that afternoon and Amy spent her entire lunch hour wondering whether there was any way she could get out of it without drawing attention to herself.
Five minutes before it was due to start she was still sitting in the staff room when Kate hurried in. ‘You haven’t for got ten your clinic, Amy?’
If only.
‘No.’ Amy forced a smile. ‘Just having five minutes’ rest before I start.’