rel="nofollow" href="#ud8c05ef2-8193-56c2-97a6-0ea244eb0452">Dedication
‘HOW ARE THE ward Christmas things coming on, Anna?’ Robert Jones asked.
‘Brilliant, thanks.’ Anna smiled at the head of the Children’s Department. ‘The Secret Santa is pretty much sorted, we’ve got Christmas dinner booked and most people have given me their deposits and menu choices, and the only thing I’m short of now is someone to be Father Christmas on Christmas Day.’ Her smile broadened. ‘Seeing as our usual Santa has let us down horribly.’
Robert held up both hands in a ‘stop’ gesture and laughed. ‘Anna, you know why I can’t do it this year. I’d have to fly back from New York. And that’s more than my life is worth, on my silver wedding anniversary.’
‘Even for the ward? Even for me?’ she teased.
‘Even for the ward and even for you,’ Robert said. ‘Actually, Anna, I did want to ask you a bit of a favour. Jamie Thurston—the new paediatric orthopod who’s covering Nalini’s maternity leave for the first three months—is joining us today.’
‘And you want me to show him around and help him settle in?’ Anna guessed.
‘Would you?’ Robert asked.
‘Of course.’ She smiled at him again. ‘I’m in the PAU this morning. I’ll leave a message with whoever is on the desk to ask him to meet me at one and I’ll take him to lunch.’
‘Great.’ Robert patted her shoulder. ‘Thank you.’
‘Pleasure,’ Anna said, and had a quick word with Lacey on the reception desk before she headed for the Paediatric Assessment Unit.
Her third patient of the day was a four-month-old baby who had been referred to her clinic by the health visitor, on the grounds of possible DDH—developmental dysplasia of the hip. A quick read through the notes ticked all the boxes of a higher risk: Poppy Byford was a first baby, a girl, born at thirty-six weeks and had been in the breech position. So Anna was pretty sure that the health visitor had picked up the problem.
‘Good morning, Ms Byford. Do come in and let’s have a look at Poppy,’ Anna said. ‘Hello, you gorgeous girl.’ She cooed at the baby, who giggled and waved her hands. ‘She’s beautiful,’ Anna said, and stuffed the little twinge of longing right back down out of the way. She could enjoy being an aunt and enjoy working with her young patients, and that was enough. Wanting more was greedy and pointless—and the quickest way to get her heart broken.
‘Thank you.’ Poppy’s mum looked nervous.
‘Your health visitor asked you to bring Poppy to see me because she thinks Poppy might have something called developmental dysplasia of the hip—you might hear it called DDH for short, or “clicky hip”,’ Anna explained. ‘Usually it shows up in a newborn examination, and I can see in Poppy’s notes that the doctor did a hip test at her six-week check and it seemed normal. But the health visitor’s concerned and wants me to do another check.’
‘Is Poppy going to be all right?’ Ms Byford asked. ‘I did start looking it up on the Internet, but…’ She grimaced.
‘The Internet is a very scary place where medical problems conditions are concerned,’ Anna said. ‘It’s like when you’re pregnant with your first child, and you always hear the horror stories about difficult labours rather than the smooth ones, even though the difficult ones are much rarer. There is a possibility that Poppy might grow out of the condition, but I’d like to examine her properly and then do an ultrasound scan to check how her hip is developing.’ She smiled. ‘I promise what I do isn’t going to hurt her, but she might not appreciate being manipulated and might grumble a bit.’
‘All right,’ Ms Byford said.
‘Have you noticed when you change her nappy that one hip doesn’t open out quite as much as the other?’ Anna asked.
Ms Byford wrinkled her nose. ‘Not really. I thought everything was normal. I mean—she’s my only one.’
‘So you don’t have anything to compare her with. That’s fine.’ Anna gave her a reassuring smile. ‘Could you take her tights off for me, please?’
Once Ms Byford had taken the tights off the baby, Anna examined Poppy and cooed at her while she manipulated the baby’s joints, blowing raspberries to make her laugh.
‘So do you think she has this clicky hip thing?’ Ms Byford asked.
‘I felt a bit of a clunk when I moved her legs just now, so yes,’ Anna said. ‘I can see that her right leg is slightly shorter than the left, and basically I think her thigh bone isn’t moving properly in the socket of her pelvis. We’ll do the scan, and then we can think about treatment. It might be that we do a watch-and-wait thing, or we might put her in a special harness to treat the hip dysplasia, but I’ll be in a better position to know what’ll work best once I’ve seen the scan results. And the scan’s like the one you had when you were pregnant with her, so it won’t hurt,’ she added reassuringly.
While Poppy was having her scan, Anna saw her next patient. The scan results definitely showed a problem with Poppy’s hip, but whether the harness would be enough or the baby would need
