are many possible diagnoses,’ Ethan said calmly as he walked round the desk. ‘Leukaemia is just one.’
‘I know, but—’ Kyla broke off and bit her lip. ‘You should know that Shelley’s mother, Mary, had a sister with leukaemia. She died about three years ago. Mary hasn’t asked a direct question and obviously she doesn’t want to frighten the child, but I can see from her eyes that she’s frantic with worry.’
Ethan walked towards the door. ‘Then the sooner I see her, the better. I’ll have a better idea once I’ve examined her and obviously I’m going to need to do some blood tests. Bring her in.’ His tone was crisp. Direct. ‘I’ll examine her here. And you’d better stay, if you have the time, given that you know the history.’
‘I’ll stay.’ She wasn’t going anywhere until she knew what was happening.
Ethan examined the child thoroughly, aware of the tension in Mary’s body as she stood to the side of him, watching.
He questioned Shelley at length and then smiled at her. ‘I’m going to need to take some blood from you, just to run a few routine tests. Is that all right?’
Shelley pulled a face. ‘Will it hurt?’
‘A bit,’ Ethan said honestly, reaching behind him for the tray he’d prepared. ‘But not much and not for long. Kyla?’
Kyla handed him a tourniquet and he tightened it round the girl’s arm, stroking the skin as he searched for a good vein.
Kyla kept up a steady stream of chat. ‘So did your netball team go over to the mainland and play the girls at St Jude’s last week?’
A smile spread across Shelley’s face. ‘We thrashed them. Sixteen to one.’
‘Brilliant.’ Kyla turned to Ethan. ‘The school is so small here that every single girl is in the netball team!’
‘But we’re still the best,’ Shelley said quickly, and Ethan smiled, mentally blessing Kyla for her distraction skills.
‘Sharp scratch coming up, Shelley,’ he said smoothly, and slid the needle into the vein.
Shelley didn’t stop talking. ‘Mia Wilson was the best. She got it in the net about fourteen times.’
‘Well, she’s tall, of course, so that helps,’ Kyla murmured, handing him a piece of cotton wool. ‘And her mum is the sports teacher, which is another distinct advantage.’
Shelley laughed and Ethan withdrew the needle and pressed with the cotton wool.
‘I’ll do that while you sort out the sample,’ Kyla murmured, her fingers sliding over his as she took over the pressure.
Her hands were so much smaller than his, her fingers slim and delicate and Ethan felt a sudden burst of heat erupt inside him.
Gritting his teeth and rejecting the feeling, he turned away and labelled the samples carefully. ‘I’m going to send these off. As soon as I get a result, I’ll be in touch.’ Seeing the anxiety in Mary’s eyes, he turned to Kyla. ‘Can you take Shelley to your treatment room and find her a plaster, please? I don’t seem to have one here.’
To her credit, Kyla immediately picked up on his intention. ‘Useless doctors,’ she said cheerfully, slipping her arm through Shelley’s and leading her towards the door. ‘They can do all sorts of fancy, complicated things but when it comes to something simple like a plaster, you can forget it. We girls will see you in Reception in a minute.’
Ethan waited until the door closed behind them and then turned to Mary. ‘I understand that you’re very worried about this.’
Mary was stiff, her fingers gripping her handbag. ‘Do I have reason to be?’
‘Obviously, until I have the results back, I can’t be sure what it is, but I’m pretty confident that it isn’t leukaemia.’
Mary’s teeth clamped on her lips and he could see that she was battling with tears. ‘If it is—’
‘I don’t think it is,’ Ethan said firmly. ‘There are other things that it can be, Mrs Hillier. I’m going to get these results back as fast as possible and then I’ll call you. Is it useless to tell you not to worry?’
‘Completely useless.’ Mary gave a wan smile. ‘But thank you for your thoughtfulness.’
‘So you don’t think it’s leukaemia?’ Kyla closed the door of his consulting room and stood with her back to it. ‘Really?’
‘Shelley looks well and there’s no history of trauma. I’ve examined her thoroughly and her liver and spleen feel normal and there’s no evidence of lymphadenopathy.’
‘So what are the bruises?’
‘Obviously until I see the results of the blood count I can’t be sure, but I think she probably has ITP. Idiopathic thrombocytopenic purpura.’
Kyla frowned. ‘I’ve heard of it but I don’t know much about it and we’ve certainly never had a patient. What’s the treatment?’
‘Depending on the platelet count, it may just be a case of watchful waiting. In someone of Shelley’s age the condition will probably be acute and it will resolve over a few months.’
‘And if it doesn’t?’
He gave a faint smile. ‘What’s happened to your cheerful, optimistic nature, Kyla?’
‘I just like to know the options.’ She looked away, struggling with her body’s powerful response to his smile. He was indecently attractive. ‘Mary is a friend of my mother’s. She had Shelley late in life and she’s very precious. I need to have all the facts at my disposal.’
‘In a small number of children it can be chronic, and she might have to avoid contact sports.’ he shrugged ‘.but so much depends on the blood tests. If her platelets are at a reasonable level then it becomes less of a problem. It’s really too soon to try and predict the future for her.’
‘So you’re saying that she could just recover spontaneously?’
‘That’s right.’ He studied her closely. ‘You look as worried and upset as her mother. It doesn’t do to get too involved with your patients, Nurse MacNeil.’
His comment stung and her shoulders stiffened defensively. ‘Well, that’s the theory certainly.’ She lifted her chin. ‘Try living on an island where you know everyone, Dr Walker. And, then try staying detached. It’s a pretty tall order, I can tell you. And frankly, I don’t think I’d like to be the sort of person who didn’t care what happened to her patients.’
He frowned. ‘Kyla—’
‘And now, if you’ll excuse me, I have things to do.’ She tugged open the door and left the room, taking several deep breaths in an attempt to control her temper. How dared he suggest that she was too involved with her patients?
She cared about them.
What was wrong with that?
Thoroughly
