by Morgan, Sara
Andreas examined one of Rachel’s eardrums and then waited while Libby helped turn the child round so that he could examine the other ear.
He was very, very skilled with the child. Gentle and swift, with no fumbling.
‘Her ears are fine, and so is her throat,’ he said finally, unwinding the stethoscope from around his neck. ‘I’ll just listen to her chest.’
Finally he rocked back on his heels. ‘Her chest is clear so we need to start thinking about the less obvious.’ He frowned thoughtfully and rubbed long fingers over his darkened jaw. ‘Has she ever had a urinary tract infection?’
Alison’s eyes widened and she shook her head. ‘No. Well, not to my knowledge. Isn’t that something that adults get?’
‘And some children,’ Andreas told her. ‘It can be a cause of unexplained fever and I’m wondering if that could be the case with Rachel. There are some tests I want to do. I need to take some bloods and I want a urine sample.’
Libby pulled a face. ‘That’s never easy in a child of this age, as you well know, but I’ll certainly try. She hasn’t had a wet nappy for a few hours so we might be lucky.’
‘Please.’ Andreas gave her a nod. ‘UTI is one of the commonest bacterial infections of childhood. It accounts for about five per cent of febrile illness. Rachel is very unwell and her temperature is very high. We need a specimen of urine urgently, and in the meantime we’ll give her some ibuprofen to try and bring that temperature down.’
He scribbled on the drug chart and Libby went off to fetch the medicine and the equipment she’d need to take the urine sample.
Andreas caught up with her in the corridor. ‘Your instincts are good. That child is very sick,’ he said quietly. ‘I’ll give you an hour to get that sample and if you don’t have any luck I’ll have to do a supra-pubic aspiration.’
‘An SPA?’ Libby pulled a face. A supra-pubic aspiration meant inserting a needle into the bladder to draw off the sample of urine. It was sometimes used in very small babies when a sample was needed urgently and other methods had failed. ‘Do we have to? That’s invasive.’
‘I’m aware of that.’ Andreas ran a hand over his jaw, his expression serious. ‘I’m also aware that the risk of renal scarring in infants and young children with undiagnosed and untreated UTI is high. I want to start antibiotics as soon as possible and I can’t do that until I’ve taken a specimen. Call me if there’s any change.’
Despite her best intentions, Libby found her eyes drawn to his mouth.
Being kissed by Andreas had been a totally new experience and for a moment she was lost, remembering.
‘Libby?’ His voice prompted her gently and she gave a start and her eyes flew to his, registering the gleam of amusement.
Damn.
He’d caught her staring.
She backed away, totally flustered. ‘I’ll get back to Rachel.’
His smile widened. ‘Fine. Call me if you’re worried.’
Trying to steady her thundering pulse rate, Libby turned and walked away from him, wondering how on earth she was supposed to get any work done with him smiling at her like that.
Determined to forget about him, she focused her attention on Rachel, trying to obtain the sample they needed so badly.
She didn’t succeed and less than an hour later she was forced to find Andreas again.
She came straight to the point, her tone brisk. ‘I’m worried about Rachel. Her temperature isn’t coming down and I’m nursing her in a nappy and a sheet. I’ve tried to get a clean sample of urine but it’s been a nightmare.’
Andreas frowned. ‘Has she drunk anything?’
‘Barely.’
‘And she hasn’t passed urine in the last hour?’
Libby shook her head. ‘Her nappies are dry.’
Andreas nodded. ‘I’ll do a supra-pubic aspiration,’ he said immediately. ‘I know it’s invasive but at least it’s definitive and frankly I’m worried about her condition. We’ll do an ultrasound to check she has urine in her bladder. I’ll need a 21G needle—’
‘I know what you need,’ Libby slotted in, already on her way to gather the right equipment. She just hoped the new consultant knew what he was doing.
She laid up a trolley and was back by the cot minutes later.
‘Someone needs to hold her very firmly in the supine position,’ Andreas said calmly, using the ultrasound to check that the baby had a full bladder.
‘I’ll hold her,’ Libby said immediately, ‘and I know her mum will want to be with her. She’s just nipped to the phone to call home.’
At that moment Alison returned and Andreas quietly explained why they needed to aspirate the bladder.
‘Her temperature is going up and we need to obtain a sterile specimen of urine.’
Alison looked pale and tired. ‘Libby was trying to get a clean catch.’
‘I haven’t managed it,’ Libby said softly, ‘and we really, really need to see if she’s got bugs in her urine. In a child of this age this is the only reliable method and we need to send it to the lab before we start antibiotics.’
Alison nodded. ‘So do it.’ Her mouth tightened. ‘Can I stay with her?’
‘Do you want to?’ Andreas spoke gently and Alison sucked in a breath.
‘Yes. It’s upsetting but I couldn’t bear to think that I wasn’t there for her when she needed me.’
Andreas exchanged glances with Libby and then turned away to wash his hands, scrubbing them methodically.
Libby prepared the trolley and then held the child while he cleaned the area with alcohol and allowed it to dry.
She watched as he inserted the needle gently, aspirating as he advanced it into the bladder, speaking softly to the baby as he worked. It was obvious from the skill and speed of his fingers that he’d performed the procedure many times before.
When he had the sample he withdrew the needle and his gaze flickered to Libby.
‘Can you apply pressure to that site for about two minutes? Then cover it with a dressing.’ He placed the sample on the trolley and turned to Alison. ‘It’s possible that she will have a bit of blood in her urine for the next couple of days so if you notice that in the nappy don’t be alarmed. You can call Libby if you’re worried.’
Libby lifted the gauze and checked that the bleeding had stopped and then applied a dressing. Then she swiftly dressed the sobbing baby and handed her to her mother for a cuddle.
‘Just hold her for a bit and she should settle,’ she advised. ‘She’s had paracetamol and ibuprofen so hopefully her temperature should come down soon.’
Alison looked at her. ‘And the doctor really thinks that she has an infection in her bladder?’
‘Yes, he does. The reason he wants to treat it quickly is because it can spread to the kidneys and cause damage.’
‘But with treatment she should be OK?’
Libby nodded. ‘Dr Christakos will probably want to do more tests to check, but you brought her in straight away so the chances are we’ve caught it before the infection has had time to spread.’
Satisfied that Alison understood the explanation, Libby followed Andreas to the nurses’ station where he was tapping details into the computer.
‘What happens now?’
‘She’s dehydrated so I’m going to put a line in and get some fluid into her. I’m also going to start her on IV antibiotics. When she’s picked up a bit we can give her the rest of the course orally.’
‘You’re not going to wait for the results?’
He shook his head. ‘It’s important to treat her fast. If necessary we can change the antibiotics when the results come back. If the UTI is confirmed, we’ll need to do more tests.’ He didn’t lift his eyes from the screen. ‘All young children have to be investigated for vesicoureteric reflux.’
‘So will you do an ultrasound?’
‘Amongst other things.’ He looked up and smiled briefly. ‘Reflux and scarring can be missed by ultrasound in this age group so she will have to ha
ve cystography.’
‘And you’ll send her for a DMSA scan?’
‘Yes. And, Libby…’ He sat back in his chair. ‘We need to try and get her to take oral fluids.’
‘I know.’ Libby nodded, well aware of that fact. ‘Now we’ve got the urine sample I’ll concentrate on that. I’ve explained the importance of fluids to the mother.’
‘Is she breast-feeding?’
Libby shook her head. ‘Bottle.’
Andreas finished what he was doing and stood up. ‘Let’s get that drip up.’
‘I’ll get a trolley ready.’
Libby spent the rest of the shift looking after Rachel, reassured by the fact that Andreas was within shouting distance if the baby’s condition worsened. Apart from one trip down to the A and E department to assess a child, he spent most of the day on the ward, getting to know the children and meeting his team.
Libby tried hard to forget what had happened the night before but it was difficult to concentrate with those sexy dark eyes following her round the ward.
He was a man, she reminded herself firmly. Which meant only one thing as far as she was concerned.
Trouble.
Libby was updating Rachel’s charts at the nurses’ station when she glanced up and saw a young girl hovering by the entrance of the ward.
Her eyes widened.
‘Adrienne?’ She recognised Andreas’s niece immediately, dropped her pen onto the desk and walked across to her. ‘Hi, there. Aren’t you supposed to be at school?’
The girl glared at her defiantly but her lip wobbled slightly. ‘I’ve run away. And I’m not going back. Ever. I hate it there.’
Oops.
Her dark hair looked more unruly than ever and there were red rings around her eyes where she’d been crying. She looked very vulnerable and very young.
Libby leaned against the wall, her expression sympathetic. ‘Do you want to tell me why?’
Adrienne shrugged and stared at her shoes. ‘I don’t fit in.’
Libby frowned. ‘In what way?’
Adrienne didn’t look up. ‘I’m…different.’
‘We don’t all have to be the same. Being different can be good,’ Libby said softly, but Adrienne shook her head.
‘It isn’t. It’s horrible.’ Her voice cracked slightly and she rubbed the toe of her shoe along the floor. ‘I’m not trendy. I don’t know how to be trendy. I tried to do my hair differently and wear make-up but Andreas made me wash it before I left the house. I hate him.’
Remembering the badly applied make-up, Libby privately thought that Andreas had made totally the right decision.
‘How old are you, Adrienne?’
‘Twelve. But I’m nearly thirteen,’ she added quickly.
Libby nodded. ‘It can be really tough being thirteen. I remember it well.’
‘You?’ Adrienne looked at her in disbelief and Libby nodded wryly.
‘I had a terrible time. I was skinny as a rake, had a brace on my teeth and I wore glasses. And, to make it worse, my sister was stunning. Trust me—the other kids had a really big choice of names to call me. I know all about being different.’
Adrienne stared. ‘But you’re trendy.’
‘Now maybe, but not then,’ Libby assured her dryly. ‘Who goes shopping with you?’
‘Yiayia—I mean, my grandmother, and she’s very, very conservative,’ Adrienne said gloomily. ‘Or Andreas, and he’s even worse. He’s so strict and traditional he won’t let me buy anything remotely daring. Given the chance, he’d dress me in a sack.’
‘Hmm, I can see that neither of those would be decent shopping partners,’ Libby agreed, examining her nails thoughtfully. ‘You know, if you wanted to, I could pick you up from school one day and take you shopping.’
The minute she’d uttered the words, part of her wanted to withdraw the offer. What on earth was she thinking? Offering to help Adrienne would inevitably bring her into contact with Andreas and she’d already decided to avoid him as far as possible.
Adrienne’s gasp of delight made it obvious that there was no going back. ‘You? Why would you want to do that?’
Because she was a total idiot and a sucker for any unhappy child.
Libby gave a weak smile. ‘I adore shopping. Ask my brother or sister. I’m a shopaholic. There’s nothing like a bit of retail therapy to cheer a girl up.’
Adrienne’s eyes were huge. ‘You’d take me shopping? Really?’
‘Sure.’ Touched by the girl’s gratitude, Libby decided that she’d done the right thing. ‘As long as you promise to smile and not argue with my taste. And then, when we’ve shopped, I’ll do your hair. I’m great with hair. I’ve been practising for twenty-nine years on my own.’
Before Adrienne could reply, Andreas strode up and Libby stiffened, wondering how he’d react to the fact that his niece had run away from school. She remembered with appalling clarity her father’s furious response when she’d done the same thing. She’d never, ever done it again.
But Andreas didn’t look furious at all. He looked concerned.
‘Adrienne?’ His tone was incredibly gentle as he stopped in front of the trembling girl. He said something to her in Greek and she took a shuddering breath and looked him in the eye, replying in English.
‘I’m so homesick. I want to live with you. Please, let me live with you—I won’t be any trouble, I promise. I know that it’s supposed to be temporary but I can’t bear it. Please, don’t send me back there.’
Swallowing back an unexpected lump in her throat, Libby glanced at Andreas, noting the tension in his wide, muscular shoulders.
‘You’re too young to be in the house on your own, koratsaki mou, and I haven’t found a suitable housekeeper yet,’ he said roughly.
Adrienne wrapped her arms around her waist. ‘I don’t care about being on my own. I’d rather be on my own than with those—those…’ Her English failed her and she looked pleadingly at Libby. ‘Tell him not to make me go back. Please.’
Libby glanced at Andreas helplessly. She really had no idea what to do or say. She knew nothing about the situation but she did know that Adrienne was obviously miserable.
Before she could speak, Bev hurried up, looking worried. ‘Dr Christakos, A and E are looking for you. They’ve got a child with a nasty asthma attack. They want you down there urgently.’
Andreas sucked in a breath and cast a look at Adrienne. ‘Of course.’ He raked long fingers through his black hair, his frustration evident. ‘Adrienne, we can’t sort this out now. You’ll have to wait in the staffroom until I finish.’
‘Why don’t I take her home with me?’ Libby said quickly, putting a protective hand on the child’s arm. ‘I’m off duty now anyway and it would be much nicer for her. You can collect her from my flat when you’re ready. Bev will give you my address.’
His mouth tightened. ‘I’ll have to take her straight back to school—’
Adrienne gave a moan of protest. ‘No!’
‘Adrienne, I have no choice!’ He sounded tired and frustrated. ‘If I could see another way, believe me, I’d take it. It’s just for the short term.’
Libby wondered exactly what was going on.
Why was his niece living with him?
Bev touched his arm. ‘Dr Christakos—’
‘I’m on my way. Adrienne, we’ll discuss this later.’ His dark eyes rested on Libby. ‘I don’t particularly want her waiting around here so if you’re sure it’s all right, I’ll take you up on your offer. Thank you.’
‘You’re welcome.’
She watched as he strode out of the ward and then turned to Bev who was watching open-mouthed. ‘What are you staring at?’
‘You.’ Bev’s eyes twinkled merrily. ‘So you’re definitely avoiding him, then.’
Libby gritted her teeth. ‘This is nothing to do with Andreas.’
Bev nodded solemnly. ‘Of course it isn’t. I’m sure you’ll manage to avoid him when he comes to pick her up from your flat.’
This had absolutely nothing to do with Andreas, she repeated firmly to herself.
Nothing.
Chapter 3
Libby let herself into the flat.
‘Let’s get something to eat. I’m starving.’ She dropped her keys on the hall table and walked through to the kitchen.
A dark-haired man with wicked blue eyes was lounging at the table, nursing a cup of coffee and reading a medical journal.
‘You’re in big trouble, buster,’ Libby muttered, glaring at him as she tugged open the fridge door. ‘This is Adrienne, by the way. Adrienne, this is my brother, Alex. Don’t be taken in by the blue eyes and the charismatic smile, he’s a total menace and I’m about to kill him.’
‘Hello, Adrienne.’ Alex smiled easily and then glanced back at his sister. ‘Why are you going to kill me? You should be thanking me.’
‘Thanking you?’ Libby removed an armful of food from the fridge and slammed the door shut with such force that the contents rattled ominously. ‘Where the hell were you last night?’
‘Language, Elizabeth, language,’ Alex reproved mildly, his eyes flickering to Adrienne. ‘And to answer your question, I was in the middle of a tricky delivery. My legendary skills as a doctor were in demand. I was saving lives—snatching the innocent from the jaws of death—’
‘Yes, yes, spare me the drama,’ Libby interrupted him impatiently, and deposited the food on the kitchen table. ‘For your patients’ sake, I hope you’re a better doctor than you are a brother.’ She reached into the cupboard for some plates. ‘Here we are, Adrienne. Help yourself. Food always helps in a crisis. Smoked salmon, ham, cheese, salad, chocolate, more chocolate…’
Adrienne sat down at the table and glanced between them, her face slightly pink. ‘I’m not very hungry,’ she said shyly. ‘I’m really sorry if I’m in the way.’