style="font-size:15px;"> He nodded. ‘I had it once before, when I was ten, but it went away. This is a lot worse.’
‘Oh, dear.’ She sent him a sympathetic glance. ‘We’ll have to find out what’s wrong and put it right, then, won’t we?’ She studied his chart for a moment or two and then asked, ‘Would it be all right if I examine you, Matt?’
‘It’s okay.’
Katie was as gentle as she could be, taking her time to assess the boy’s condition. When she had finished she asked a few general questions about his symptoms.
‘Has the swelling in his abdomen come on recently?’ she said, looking at his mother.
Mrs Goren shook her head. ‘It started just over two years ago. He says it isn’t painful. To be honest, we didn’t think anything of it at first—we just thought he was putting on a bit of weight around his tum.’
Katie nodded and glanced at the results of the ultrasound scan on the computer monitor. ‘The spleen is definitely enlarged,’ she said in a low voice, looking at Nick.
‘Take a look at the radiographs and MRI films,’ he suggested. ‘It looks to me as though there’s a patchy sclerosis in the left femoral head… and abnormalities in the bone-marrow density.’
Katie studied the films. ‘That could suggest replacement of the marrow fat by an infiltrate,’ she said thoughtfully.
‘That’s the conclusion I came to.’ Nick frowned. ‘This isn’t something I’ve ever come across before, but if my suspicions are correct it could mean subjecting the boy to more invasive tests, like a bone-marrow biopsy. I’m reluctant to do that.’
‘That’s understandable.’ She looked over the boy’s notes once more then said quietly, ‘You’re right—this is very rare, but given the increased erythrocyte sedimentation rate, the history of nosebleeds and two separate incidents of bone pain a year apart, I’d suggest you do a blood test for glucocerebrosidase enzyme in white blood cells.’
He pulled in a deep breath. ‘So you’ve come to the same conclusion as me—thanks for that, Katie. I was reluctant to order specialised tests on an instinctive diagnosis, but you’ve picked out the associated patterns of disease and helped me to make my decision. I’ll go ahead with the enzyme test.’
He turned once more to his patient and spoke to the boy’s mother. ‘I think we’ll admit Matt to hospital overnight so that we can keep him under observation and try to reduce the inflammation in his thigh. I’ll arrange for a nurse to wheel him up to the ward—I’ll go and organise that now—and then, once he’s settled, I’ll order another blood test to check for an enzyme deficiency. The sample will have to be sent off to a specialised centre for testing, but as soon as we have the results, in maybe a week’s time, I’ll be able to tell you more about what’s going on.’
He looked at Matt. ‘In the meantime, you have to rest…so that means lots of boring things like playing games on your portable computer and watching videos or TV.’ He gave an exaggerated wince, and the boy laughed. ‘We’ll give you some tablets to take away the pain and bring your fever down,’ Nick added. ‘Once the leg starts to feel more comfortable, you should be up and about again—I’m hoping that will be fairly soon.’
A few minutes later, Katie said goodbye to the boy and his mother and made her way to the door. Nick excused himself and went with her, leaving the two of them to talk about Matt’s hospital stay.
‘Would you let me know how he goes on?’ she asked, and he nodded.
‘Of course.’ He smiled. ‘I knew I could rely on you to pinpoint the essentials,’ he said as they went out into the corridor. ‘You may not have been here long, but your reputation for being an excellent doctor is already hailed throughout Paediatrics and Emergency.’
‘Is it?’ Katie was startled. ‘I’m pleased about that, of course, but I’m just doing my job, the same as everyone else.’ She sent him a fleeting glance. ‘Anyway, you do pretty well yourself. I thought you were brilliant with my father the other day. He hates fuss and feeling as though he’s putting people out, but you handled him perfectly and you had him feeling better in very quick time. I was impressed.’
He smiled. ‘We aim to please.’ Then his expression sobered and he asked, ‘How is Jack? Is he coping all right with his new medication?’
She nodded. ‘On the whole, it’s been working well, but I think he had a bit of a setback earlier today. He wasn’t feeling too good first thing, apparently.’
Katie recalled the phone conversation she’d had with her father that morning. She’d sensed he’d been holding something back, but, then, he probably kept a good deal of his thoughts hidden from her. He wouldn’t want her to know the full extent of his disability, and that saddened her. He was her father, and yet there was so much that they kept hidden from one another. How could she confide her uncertainties, and how could he share his problems with her, if no bond had built up between them over the years?
‘He didn’t sound quite right, and I could hear the breath rasping in his lungs, but he wouldn’t admit to anything more than being a bit under the weather.’ She frowned. ‘I know he’s using his oxygen every night, and sometimes in the daytime, too, and he seems more frail every time I see him. Of course, he never tells me any of his problems. He hates being vulnerable, and it’s difficult for me to reach through to him sometimes.’
‘Yes, I wondered about that.’ Nick sent her an oblique glance. ‘Are you and he getting on all right? I know it must be difficult for you. At the hospital the other day it was fairly obvious you and he still had a lot of issues to resolve.’
She wondered how much of their conversation he had overheard. ‘That’s true enough.’ She frowned. ‘To be honest, I don’t know how I feel. I’ve made a real effort to break down the barriers between us lately, and I think it’s beginning to pay off. I’ve definitely grown closer to him over these last few weeks.’ Even so, doubt clouded her eyes.
‘Learning to forgive must be the hardest thing of all.’ Nick’s gaze trailed over her features, lingering on the vulnerable curve of her mouth. ‘You’ve had to come to terms with two betrayals, haven’t you. your ex’s and your father’s? That’s why you have so much trouble contemplating any new relationship.’
‘I suppose so.’ She pressed her teeth into the fullness of her lower lip. ‘I hope I’m succeeding with both of those. At least with James I’m beginning to see that there were already cracks in our relationship. Maybe I was too ambitious, path... whereas James was more easygoing, taking life as it came. I’m wondering if he simply wasn’t the type to settle down. He had a child, but he didn’t have much contact with him.’
‘Much like your father.’ Nick’s expression was sombre. ‘No wonder your ex’s weakness hit you so hard. Your father had done exactly the same thing... followed his own path and then abandoned you.’
‘Yes.’ She was silent for a moment, mulling things over. Could any man be trusted? Could Nick? Not according to her father.
She frowned. ‘Where my father’s concerned, I still don’t really understand what goes on in his head. He treats me as though he’s very fond of me and has my welfare at heart…but after all those years of little or no contact it takes a bit of getting used to, to believe that he cares.’ And yet only yesterday he had told her how proud he was of her, how much
