that’s where it gets really sore when I get sick.’
The strident beeping at that point made Toni glance at the pager clipped to his belt. Then he raised his eyebrows in Pip’s direction.
‘Sorry. I think ED’s trying to contact me.’
‘Feel free to use the phone on the desk if you wish.’
‘Thanks.’ Pip was embarrassed to interrupt the examination but she couldn’t not take the call. What if her Mr Symes was busy having a cardiac arrest in a side room or something?
Suzie sounded apologetic as well. ‘I’m sure it’s nothing, but Mr Symes is complaining of chest pain now. Says it’s a crushing, central pain that’s radiating to his left arm.’
Classic symptoms. Almost too classic. ‘Any associated symptoms?’
‘Not really. He’s been complaining of nausea since he came in, along with all those aches and pains, but he’s not vomiting or sweating or anything. He reckons this came on suddenly.’
‘I don’t suppose he gave you a pain score without being asked, did he?’
Suzie laughed. ‘Ten out of ten. Do you think he’s been reading the right textbooks?’
‘We can’t afford to make assumptions. Can you do a twelve-lead ECG and put him on telemetry?’
‘Sure.’
‘What’s his blood pressure?’
‘One-fifty over ninety.’
‘Safe to try a dose of GTN, then. Put him on oxygen as well. Six litres a minute.’
‘OK.’
‘We’ll do some more bloods, too, and add in cardiac enzymes. I can do that when I come down. I shouldn’t be much longer.’
In fact, Toni was sitting down to share his findings with her as she hung up the phone, and Pip was aware of a vague feeling of disappointment that the consultation was almost over.
‘Cardiac patient?’ he queried.
‘Probably not, but we’ll have to rule it out.’
‘I won’t keep you too long. Alice seems like a normal, healthy little girl on first impression. The only finding I can make is mild and rather non-specific abdominal tenderness.’
That feeling of disappointment grew. Were her instincts misplaced? And would there be no reason for Alice to see Dr Costa again?
‘Mind you, that’s not an unexpected result and it certainly doesn’t mean I don’t wish to make any further investigations.’
Pip nodded, listening intently.
‘I’d like to do some further blood tests and another urine culture and microscopy. I think a general abdominal ultrasound examination would be a good idea. Maybe even an MRI scan.’ Toni was ticking boxes and scribbling notes on request forms.
‘We might like to consider a carbon-labelled urea breath test and possibly endoscopy to rule out the gastritis and duodenal ulceration that Helicobacter pylori can cause.’
Pip nodded again. This was more than she had expected.
‘Alice hasn’t been hospitalised with any of these episodes, has she?’
‘No. I came close to bringing her in the first time because she was so miserable, but it only lasted about half an hour.’
‘It would be ideal if we could see her and get a blood sample while she was having the pain. To check liver function for elevated blood amylase levels.’
‘So you think pancreatitis is a possibility?’ Pip caught Toni’s gaze and held it. To voice the unthinkable—that Alice could have a tumour of some kind—was unnecessary. The eye contact told her that he already knew her deepest fear.
‘I’m not ruling anything out at this stage. We’ll find out what’s causing the problem and then we’ll deal with it, yes?’
‘Yes.’ Pip dropped her gaze, embarrassed to show how grateful she was. ‘Thank you.’
‘And you’ll bring her in if it happens again? And call me? I’d like to see her myself if it’s at all possible.’
The warm smile that curled around the words made Pip think that this consultant might even get out of bed and come into the hospital at 3 a.m. if that’s when the attack happened to occur.
And that he was really going to do whatever it took to make a diagnosis and then fix whatever was wrong with Alice.
Did all the relatives of his patients feel so cared about?
So…safe?
Pip was smiling back as Alice finished getting dressed and plopped into the chair beside her. She glanced from Toni to Pip and then back again.
‘OK,’ she said. ‘Where’s my bus off to, then?’
Alice was less than impressed with all the tests she might have to undergo.
‘Why can’t they just take an X-ray or something? You know I hate needles.’
‘An ultrasound test is completely painless and it’s better than an X-ray. And an MRI scan is even better. It’s like having photographs taken of what’s inside your tummy. It’s incredibly detailed.’
‘Ooh, gross! Can you see, like, what you had for breakfast?’
Pip laughed. ‘Almost, but I wouldn’t worry about any of it. You might have to wait for weeks to get an appointment for something like an ultrasound. We’ll do what Dr Costa suggests and bring you into hospital next time you get a sore tummy.’
‘Will you come with me?’
‘Of course.’
‘What if you’re working?’
‘Then I’ll stop working to look after you. Like I did today to go to your appointment.’
‘Do you get into trouble for doing that?’
‘Of course not.’ Pip almost managed to convince herself as well as Alice. ‘I just have to make up for it later. Like now. Are you OK to sit in the staffroom and read magazines while I go and look after the patients I still have?’
‘Sure.’
‘You can get a hot chocolate out of the machine. You know how to work it, don’t you?’
‘Yeah.’
They bypassed the main area of the emergency department to reach the staffroom.
‘Hey, Pip?’
‘Yeah?’ When had she picked up Alice’s speech patterns that now came so automatically?
‘Dr
