‘Jane?’
‘Nate, you’d better come. I need you here now.’ She sounded rushed and that was all she had time for. The phone went dead before he learned any more.
Mia? Was there something wrong with Mia? His feet were taking him out the door before his phone had been clipped back on his belt. What was wrong?
When he had a call there was always tension—but not like his.
His daughter…
But it wasn’t his daughter. It was Cady.
‘I don’t know what’s wrong.’ Gemma was beside herself. She was sitting in Emergency looking as sick as the child in her arms. ‘He’s just… Nate, he’s hardly conscious. I thought it was weariness but this is much more than weariness.’
Nate was still in his dinner suit. He looked handsome—absurdly handsome—but Gemma didn’t notice. She didn’t see Nate the man. She saw Nate the doctor, and the doctor was what she needed most at this moment. A doctor with skills. Please…
‘Tell me what happened.’ Nate’s voice was curt and decisive, cutting through her fear. Or trying to. She might be a doctor herself but this was her beloved Cady and her medical judgement couldn’t surface through her terror.
Somehow she forced herself to be calm. To give Nate the facts.
‘We stopped a few miles down the road. I wanted to get a little distance between us…between the baby and us…before we ate. And Cady was really, really quiet but I thought, well, it was his little sister we’d just left. And we’d grown so fond… Regardless of what I told you…’
She was almost incoherent, Nate thought. She was hugging the little boy to her as she spoke and their faces were a matching chalky white. Jane had pressed Gemma into a chair and was taking Cady’s blood pressure. She’d called Nate as soon as she’d seen Cady. The dance hall was only a few hundred yards from the hospital so he’d arrived there in minutes.
Nate listened to the fear in Gemma’s voice. He stooped before them, lifting the boy’s wrist and feeling his racing pulse. His breathing was deep and gasping—as if it hurt.
‘OK, Cady, we’ll have you feeling better in no time,’ he told the little boy, sensing the rigid fear in the child’s body. Obviously there were things happening that Cady didn’t understand.
Neither did Gemma. ‘OK, Gemma, just take it slowly,’ he told her. ‘Calm down.’ His voice insisted she do just that. ‘Tell me what happened next.’
She hiccuped on a sob. ‘He said he couldn’t see. He said everything was fuzzy. And then…he was violently ill and now he’s limp…’
‘OK.’ This could be a number of things. The tension of the past hour had fallen away now to be replaced with a different sort of tension. Nate was back in medical mode and nothing else mattered. What was happening here? What did he have? One limp kid?
Meningitis? Maybe it was, and he could tell by the fear in Gemma’s voice that that was what she was terrified of.
Okay. Worst case scenario first. Rule of thumb—look for the worst and work backwards.
‘There’s no temperature,’ Jane told him, showing him the thermometer. ‘High blood pressure. Rapid pulse. But no temp.’
OK. Breathe again. That should rule out meningitis.
But Cady certainly looked sick.
The child was thin, Nate thought, sitting back on his heels and really looking. Taking his time. He’d learned in the past that unless airways were threatened, such examinations were important. So he took the child in from head to toe—examining him with his eyes instead of his hands.
What did he have?
Thin child. Fuzzy vision. Sick. Tired, and drifting into semiconsciousness.
Diabetic mother…
And a little voice was recalled from nowhere. The memory slammed home.
‘Gemma, I’m thirsty.’
Click.
‘Jane, I want a blood sugar,’ he said curtly. He put his hand over Cady’s and gripped, hard. ‘Cady, your eyes are a bit funny, are they? Can you hear me, Cady? Can you tell me what’s happening?’ The little boy seemed as if he was drifting in and out of consciousness.
‘I can’t… Everything looks funny.’ Cady’s voice was a bewildered whisper and Nate’s eyes met Gemma’s. The child’s confusion was reflected in hers.
‘Cady, I’m going to take a tiny pinprick of blood,’ he told the little boy. ‘Not much. It’ll be a tiny prick. I think you might have too much sugar in your blood and I want to find out if I’m right. If that’s what’s making you sick.’
‘Oh, no…’ Gemma’s voice was so distressed he could tell she was near breaking point, but she’d realised where he was headed. Blood sugar… ‘Of course,’ she whispered, distressed beyond measure. ‘How can I have been so stupid…? It’ll be ketoacidosis.’
Diabetic ketoacidosis.
Nate thought it through, but the more he thought the more it fitted with what was happening. Diabetes meant the pancreas stopped producing insulin—and if insulin wasn’t available the body couldn’t absorb food and started using its own fat for energy. The result was a poisonous accumulation of ketones. Ketoacidosis. And in its early stages ketoacidosis looked just like this.
‘We don’t know yet,’ he told her.
But Jane was moving as he spoke, fetching the equipment he needed. A urine sample would check for ketones, but taking a urine sample from Cady now would be difficult. So he’d test the blood sugar and assume the rest.
The sugar reading took seconds. He took a drop of blood from the little boy’s listless hand, placed it on the testing strip and set the machine in motion.
And five seconds later there was the answer.
‘Thirty-two…’
They had their diagnosis.
‘Dear God!’ Gemma was rocking the little boy back and forth in her arms with anguish. Thirty-two! She knew all too clearly what that meant. A normal range was from four to eight. No wonder his vision was blurred. No wonder he was sick. ‘He’s diabetic. Dear God… How could I not have known? How could I not have guessed?’
‘You’ve had just a bit on your mind lately,’ Nate said gently. She certainly had, and here was another load for her to bear. What on earth had her sister landed her with? ‘But let’s not worry. Let’s just get Cady feeling better. I need to ring a specialist paediatrician for some up-to-date advice but I think I can handle this here.’ He smiled down at the bewildered Cady. Even though he wasn’t sure whether the little boy could hear him he spoke anyway, and maybe it was more for Gemma than for Cady.
‘Cady, there’s something in your tummy called a pancreas. It isn’t doing its job so we’ll have to fix that. The
