he was left with the feeling that he’d just made things a hell of a lot worse.
FOR the next couple of days, Natalie successfully continued to avoid Kit. But then they were rostered together again, this time on the paediatric assessment unit.
‘Dr Wilkins, I take it this is your first PAU?’ Kit asked.
On an intellectual level, she knew the formality was the right way to go—keeping a professional distance between them would be a good thing—but, oh, it stung. Had they really been reduced to this, to titles and surnames, after everything they’d shared? ‘Correct, Dr Rodgers,’ she responded, equally coolly.
‘Do you want to do this as a teaching session, or would you like to lead and I’ll back you up?’
He was giving her the choice. Not much of one. Either way, they had to work together. Closely. And she was finding it harder than she’d expected. Every time she glanced up at him she remembered other places, other times, when she’d caught his eye and seen a different expression there. Blue eyes filled with love and laughter. A lazy smile that had promised her some very personal attention once they were alone.
And now he was this cool, remote stranger. Just like he’d been at the end of their marriage. Reacting to nothing and nobody. Closed off.
‘PAU’s where we get the urgent referrals, isn’t it?’ she asked.
‘Yes.’
Where her diagnoses really could mean life or death. She took a deep breath. ‘Right.’ Was she ready for this?
‘Or we could lead on alternate cases. Do it together,’ Kit added.
His tone of voice on the last word made her look at him. The expression in his eyes was quickly masked, but she’d seen something there. Something that surprised her. Regret, wishing things could have been different?
She pushed it to the back of her mind. Of course not. She was just wishing for something that wasn’t there. Kit had shut her out six years ago, and he wasn’t about to invite her back into his life now.
They’d both moved on.
Well, he had.
‘OK.’
‘Want me to take the first one?’ he asked.
‘Whatever you think best, Dr Rodgers,’ she said, her voice completely without expression.
‘In that case,’ Kit said, ‘I’m throwing you in at the deep end. You go first.’
Oh, Lord. She hadn’t been expecting that. But if that was the way he wanted to play it, she’d show him she could do it—that she didn’t need his help.
Their first case was a two-year-old with a fever and a rash. Ross Morley’s eyes were red, as if he had conjunctivitis, although there didn’t appear to be any discharge. ‘He’s had a temperature for a couple of days but he seems to be getting worse,’ Mrs Morley said, twisting her hands together. ‘His hands and feet look a bit red and I’m sure they’re not normally as puffy as this. And then I saw this rash…’
‘And you’re worried that it’s meningitis?’ Natalie guessed.
Mrs Morley dragged in a breath. ‘Don’t let it be that. He’s my only one. Please, don’t let it be that.’
‘Rashes can be scary,’ Natalie said gently, ‘but there are lots of things that can cause a rash like this.’ Gently, she stretched the little boy’s skin over the spotty area. ‘The spots have faded, see? So it’s unlikely to be meningitis— though you’ve done absolutely the right thing to bring him here,’ she reassured Mrs Morley. ‘If it had been meningitis, he could have become seriously ill extremely quickly. Has he been immunised against measles?’
‘Yes. He had the MMR at fifteen months.’
‘It’s unlikely to be rubella or measles, then.’ Natalie swiftly took the little boy’s temperature with the ear thermometer—definitely raised. She continued examining him and noted that the lymph nodes in his neck were swollen. ‘It could be glandular fever—what we call infectious mononucleosis—or this could be his body’s reaction to a virus, most likely an echovirus.’ She swallowed hard. ‘Or Coxsackie virus.’
She couldn’t help glancing at Kit. Saw her own pain echoed in his eyes. And she had to look away and clamp her teeth together so the sob would stay back. Coxsackie B. The tiny, invisible virus that had smashed her life into equally tiny pieces.
She turned back to the little boy and finished her examination. ‘His skin’s starting to peel at the fingertips.’
‘He doesn’t suck his thumb or anything,’ Mrs Morley said. ‘Never has.’
‘I think Ross has Kawasaki disease,’ Natalie said. ‘Peeling skin’s one of the signs, plus he has the rash, the redness and slight swelling in his hands, his eyes are red, his lips are dry and cracked, and he has a fever.’ Kawasaki disease tended to be diagnosed clinically rather than through blood tests, and Ross Morley’s case ticked all the boxes. She glanced at Kit for confirmation.
He nodded, and mouthed, ‘Good call.’
She damped down the feeling of pleasure. She was doing this to help people, not to prove something to Kit.
‘So what happens now?’ Mrs Morley asked.
‘We’re going to admit him to the ward,’ Natalie said. ‘The good news is we can treat the disease. We’ll give him aspirin and a drip with immunoglobulin drugs to fight the disease. Over the next few days, the fever and the swollen glands in his neck will go down and the rash will disappear, but Ross’s eyes will still look a bit red and sore and the skin’s going to continue peeling around his fingers, toes and the nappy area. He might feel some pain in his joints and you’ll probably find he’s a bit irritable, but the good news is that you’ll be able to take him home next week and all the symptoms will gradually disappear. It’ll take him another three weeks or so after that before he’s completely over it, though.’
‘Will there be any complications?’
Possibly myocarditis—inflammation of the heart muscle—but although Natalie’s mouth opened, the words just wouldn’t come out. Couldn’t. The lump in her throat was too big.
‘There can be complications with Kawasaki disease,’ Kit said softly. ‘Some children have arthritis afterwards, and some develop heart problems, but we’ll send him for a follow-up echo to make sure—that’s an ultrasound scan of the heart and it won’t hurt at all, plus you can be with him while it’s being done.’
Mrs Morley swallowed hard. ‘Could he die?’ she whispered.
‘Most children make a full recovery,’ Kit reassured her.
Most children. But myocarditis could be deadly. Sometimes there weren’t even any symptoms. In very small children it was difficult to tell the problem—they couldn’t tell you if they had chest pain, were tired or
