that morning, Judith rapped on the door of Kieran’s office. ‘Got a minute?’
‘Sure.’ More than a minute, where she was concerned.
But this was a professional question. It deserved a professional answer. ‘What’s up?’
‘I’ve just had a mum admitted—Pippa Harrowven. She’s thirty-five weeks. She rang her midwife because she wasn’t feeling well, and the midwife sent her straight here. I’ve examined her and I’m not happy. Her temperature’s up, her heart rate’s up and so is the baby’s. She’s feeling sick but not actually vomiting, she says it hurts to pee and when I examined her there was some muscle guarding—I think it’s more than just cystitis.’
‘Has anyone done an MSU?’
A mid-stream urine sample could tell them if Pippa had an infection and what had caused it. ‘Yes—I’ve sent it to the lab for culture and sensitivity tests. Her urine’s cloudy, but when Daisy tested it, it wasn’t acid, so it’s not E. coli.’
‘Are you thinking acute pyelonephritis?’ Kieran asked.
She nodded. ‘I was. Except it’s not E. coli, so that rules it out.’
‘Not necessarily. I know E. coli accounts for eight-five per cent of cases, but it could be three or four other organisms, including Klebsiella and Proteus,’ he reminded her. ‘Any other symptoms?’
‘She’s complaining of pain and tenderness around the loins, and it seems to be following the path of the ureters. She said it started last night and it’s just got a lot worse.’
Kieran nodded. ‘It sounds very like acute pyelonephritis.’
‘I’ve asked Daisy to do her obs, and keep an eye on her temperature and pulse. But if it is pyelonephritis, we’re talking possible problems with growth and preterm labour, aren’t we?’
‘Yes.’ Kieran couldn’t figure it out. Judith had reached a diagnosis, and from what she’d told him it sounded like the correct one. So why was she still so unsure? She was the daughter of an obstetric professor. She must have grown up hearing obstetric terms bandied about the house—so surely she should be too confident, if anything.
Unless she’d once been overconfident and had made the kind of mistake that made you question every action for a very, very long time afterwards. And Bella had said that Judith didn’t want to work with her father. Kieran had worked with Ben for years and found him very fair. There was definitely more here than met the eye, and it intrigued him. ‘Want me to come and have a look?’
Her brow smoothed with relief. ‘Please.’
‘Sure.’ He followed her into the ward and Judith introduced him to Pippa.
‘I’m just going to examine you, Pippa, if that’s all right?’ He paused for the young mother-to-be’s agreement. ‘OK. Tell me if it hurts.’ Gently, he palpated her abdomen. As he moved along the path of the ureters, Pippa flinched.
‘It hurts. And I need to pee again. Except I probably won’t be able to—I couldn’t last time, and I haven’t had anything to drink since then. And…’ She turned her head and a stream of vomit splashed over Kieran’s shoes and trousers.
‘Oh, no, I’m so sorry,’ she said miserably.
‘You’re not feeling well. There’s no need to be sorry.’ He nodded to Daisy to fetch a cloth and water, then mopped Pippa’s face. ‘I’ve had worse over me.’
‘But—’
‘But nothing.’ He smiled at her. ‘We’ll have you feeling better soon, though I’m afraid you’ll be on bed rest for a while. As soon as the lab results come back, we’ll know which antibiotics to give you.’
‘But aren’t antibiotics dangerous for the baby?’
‘We’re going to keep a very close eye on you both,’ Kieran promised. ‘Jude thinks you’ve got something called pyelonephritis, and I think she’s right. It’s an infection of the kidney and the tubes that carry urine away from the kidneys, so we’ll need to give you antibiotics to stop it. I can also give you something to bring your temperature down, and we’ll put you on a drip to make sure you don’t get dehydrated.’
‘We can give you a heat pad for your back, to help with the pain,’ Judith added. ‘And Daisy’s going to keep an eye on your temperature and your pulse rate.’
‘You said bed rest. How long will I be in?’
‘A week or so,’ Kieran said.
‘But I can’t be! I—I’ve got a pile of work to do. I’m a freelance artist. If I don’t work, I don’t get paid and I’ll probably lose my client, and…’ Pippa’s lower lip trembled.
‘Is there someone we can call for you?’ Kieran asked. ‘And maybe your partner can explain to your client.’
Pippa shook her head. ‘He left me when we found out I was pregnant. He doesn’t want a baby to complicate things. But I couldn’t bring myself to have a termination. And…’ She shook her head, choked by tears.
‘How about your mum?’ Judith asked gently. ‘Or a good friend?’
‘My mum’s in Lincolnshire. I can’t drag her all the way up to London.’ Pippa wiped her hand across her eyes. ‘There’s my best friend. Except she’s busy and—’
‘If my best friend was in hospital, pregnant and ill and scared, I’d be there for her,’ Judith cut in. ‘It wouldn’t matter how busy I was.’
‘Sorry, I’m not usually this pathetic,’ Pippa said.
‘Hey. You’re not feeling well, and your hormones are all over the place,’ Kieran told her. ‘So you’re not being pathetic at all.’
‘How did I get it?’ Pippa asked.
‘You’re more likely to get it in pregnancy because urine moves more slowly from the kidney to the bladder, due to hormone changes. As your uterus gets bigger, it puts more pressure on your ureters—they’re the tubes that connect your kidneys to your bladder. And that means it’s easier for germs to grow.’
‘So it’s not something I did?’
‘No,’ Kieran reassured her.
‘Is the baby going to be all right?’
Judith nodded. ‘There’s a risk you might go into labour early, but you’re thirty-five weeks now, so your baby’s got a good chance.’
‘But you need to tell us if you feel any tightening around your uterus or stomach cramps or a low ache in your back,’ Kieran added. ‘We’ll test another urine sample forty-eight hours after we start giving you the antibiotics, and you need to have a sample tested every time you see your midwife. It might come back, so you’ll need to take antibiotics for about six weeks after you have the baby, and your GP should book you in for a check six weeks after that so we can make sure you’re not going to have any more problems.’
‘A week.’ Pippa shook her
