keep a closer eye on her.’
And something in her unequivocal stance, something in her voice, must have told the woman that this was non-negotiable, and even though Harriet would never have forced Alyssa to undress, she demanded the mother’s co-operation, told her with her eyes that this had to be confronted. Finally, after the longest time, she felt an inward sigh of relief as Mrs Harrison gave a tiny reluctant nod and turned to her daughter.
‘Listen to the sister, Alyssa.’
‘Harriet,’ she offered, her smile softer now, her eyes kind as she approached the young girl. If Alyssa was, as Ciro suspected, suffering from anorexia nervosa then being undressed and exposed would be traumatic for her, and Harriet was determined to make the entire procedure as gentle and as unintrusive as possible, covering the young girl with a blanket as she helped her out of her clothes. Harriet had to keep her own emotions firmly in check as she briefly witnessed the stick-thin limbs. She talked in gentle soothing tones as she gently leant her patient forward to tie up the gown and even though there hadn’t been much room for doubt, any that might have lingered was quashed as she saw the length of Alyssa’s spinal column, vertebrae protruding, dry, flaky skin hanging off. Glancing up at Mrs Harrison, Harriet saw a flash of shock on the woman’s face but she didn’t comment.
Now wasn’t the time.
‘Well done,’ Harriet reassured the girl. ‘Now, these sticky things just go onto your chest, and it lets us keep an eye on your heartbeat.’ Placing the dots and leads on Alyssa’s frail chest, Harriet quickly covered her back up, before turning on the cardiac monitor. As Ciro made his way in he gave Harriet a brief appreciative nod when he saw that the family was now being more co-operative.
‘Alyssa, Mrs Harrison.’ Ciro smiled warmly. ‘I know you are both keen to go home, but first we need to ensure that Alyssa is well enough. Now, I know you’ve already been through this, but, given the doctor that first treated you has gone home now, can you tell me again what happened this evening when you cut your head?’
‘I was at rehearsal—we’ve got the first performance next Saturday.’ It was the first time Harriet had heard Alyssa speak, her voice, small and breathless, almost drowned out by the busy background noise of the emergency department.
‘She’s the lead,’ Mrs Harrison explained. ‘That’s why I want to get her home. She needs her sleep so she can practise tomorrow. It’s a very demanding role—’
‘Alyssa,’ Ciro broke in, ‘why did you fall?’
‘She landed awkwardly…’ Mrs Harrison started, but her voice trailed away as Ciro and Harriet both looked at Alyssa for the answer.
‘I was halfway through my routine and I just got a bit dizzy. It only lasted a second, but I was in the middle of a jump, so I fell awkwardly.’
‘How often do you get dizzy?’ Ciro asked, and Harriet could only admire his questioning, assuming, as was probably rightly so, that this was probably fairly normal for Alyssa.
‘A bit…’ She gave a tiny shrug.
‘OK.’ Ciro nodded. ‘Alyssa, I’m going to examine you, it’s nothing to worry about, and then I’m going to take some blood from you. Harriet has put you onto one of our heart monitors so that we can see what your heartbeat is doing and maybe find out why you’ve been getting dizzy.’
Infinitely reassuring, still he was commanding, his voice firm but somehow soothing. His hands were gentle as he first pulled down Alyssa’s lower eyelids, examining the conjunctiva, then her hands and nail beds. Lifting the blanket and checking her reflexes, his middle finger probed the swollen ankles that looked out of place on such thin legs.
‘You have some fluid retention. Does this happen often?’
‘Sometimes,’ Alyssa answered, ‘but Mum gives me—’
‘Just some vitamins,’ Mrs Harrison said quickly. ‘I get them at the chemist.’
‘OK.’ Ciro didn’t push for any further details, acted as if the information barely merited a comment, but Harriet knew, just knew, it had been noted, but that for now he was focussed on the important task of gaining Alyssa’s trust.
He listened to her chest, warming the stethoscope in his palms first, all the while keeping as much of Alyssa covered as possible. When he’d finished listening he probed her abdomen for a moment before replacing the blanket.
‘Thank you, Alyssa. I know that wasn’t pleasant for you, but it was necessary. I’m going to take some blood now. I’m going to insert a small cannula and leave it there, but from that I can take blood, and if we need to give you any fluids or medication we can do it all through there, so at least you’ll only get one needle. I’ll try not to hurt you.’
He didn’t. Slipping the needle in neatly, he collected several vials of blood before unclipping the tourniquet and flushing the bung to keep it patent with the heparin flush Harriet had pulled up. Only when the blood had been taken, when the IV was in and Alyssa attached to a monitor did he approach the most difficult part of the whole subject. ‘How much do you weigh, Alyssa?’
‘I’m not sure…’
‘Would you get the scales?’ Ciro asked Harriet.
‘Alyssa knows her weight,’ Harriet responded without looking up at him, keeping her eyes on Alyssa. It would be easy to go and get the scales, but Harriet also knew that the delay and interruption could ruin the relatively compliant mood that they had somehow managed to foster, and it would be far better to forge ahead while the going was good. So instead she broached her patient, knowing, somehow knowing, this was what Ciro wanted her to do. Effective interview skills in Emergency required as much teamwork and synchrony as a surgeon and scrub nurse required, and with some doctors it took for ever—if ever—to perfect, yet with Ciro they fell into it easily, Harriet handing him the metaphoric scalpel without him needing to ask for it. ‘How much do you weigh, Alyssa?’
‘Forty kilos.’ When still Harriet held her gaze, she answered again. ‘Thirty-eight and a half.’
Deliberately Harriet didn’t flinch and she was thankful that, when Ciro spoke, his voice was matter-of-fact.
‘We’ll need to check it before we give any medication,’ he said, more to Harriet, ‘but whatever way you look at it, this is very underweight.’
‘She’s a ballet dancer.’ Mrs Harrison’s voice was terse. ‘She has to watch her weight.’
‘Of course.’ Ciro nodded, smiling at the agitated woman. ‘But Alyssa is extremely underweight. I’m going to run some tests and then I’ll ask one of my colleagues to come down.’
‘And how long is that going to take?’
‘It might take a while,’ Ciro admitted, ‘but I will tell you that it is my belief that Alyssa needs to be admitted—’
‘No!’ Furiously Mrs Harrison shook her head. ‘This can all wait.’
‘I’m afraid not.’ Ciro shook his head. ‘Look, I understand—’
‘No, Doctor, clearly you don’t!’ Mrs Harrison angrily interrupted. ‘My daughter is dancing next week in a role that could see her getting into the most elite dancing school in Australia. She has to
