Beth told her.
Susie was looking at Charles now. And then at Jill. ‘Is everything all right? What’s happened to your cheek?’
‘It’s nothing. But, no, everything’s not all right.’ For a second it looked as though Jill might lose the extraordinary control she seemed to have. ‘Lily’s sick. She’s about to have a lumbar puncture.’
‘We could use your help, if you’re free,’ Alex said to Susie. ‘We might need extra staff to help position her.’
‘Oh…’ Compassion made her eyes an even darker blue, but Alex couldn’t afford any further distraction. ‘Not our Lily.’ She hugged Jill.
‘Let’s get on with it,’ Alex said brusquely. He didn’t want to stand there watching Susie hug people. No wonder Jill was looking ill with worry. Reminding her that Lily would have to be restrained to make the procedure safe hadn’t exactly helped, had it? He gave her a sympathetic smile.
‘Don’t worry,’ he said. ‘Let’s assume this is a needless test, taken to be on the safe side. I’ll use plenty of local and make it virtually painless. With so many people around who know and love her, she’ll be just fine.’
A few minutes later Alex was gowned and gloved. So was everybody else in the now crowded room. Lily stared at them all, wide-eyed and frightened. The tension was palpable and the sooner they got this over with, the better.
‘What gauge needle have you got there, Beth?’
‘A twenty.’
‘Does the stylet fit the barrel?’
‘All checked. We’re good,’ Beth assured him.
‘Right. Lily, let’s get you lying on your side, sweetheart. We’re going to do a test on your back that’ll help us find out what’s the matter with you. It’ll tell us which medicine is right for you. OK?’
‘OK…’
‘Jill, you stay close to her head and hold her hand. Charles, can you keep a hand on Lily’s hip and the legs? Marcia? Legs for you, too, and Susie, I’ll get you beside me with extra support for Lily’s chest and arms.’ He gave them all a significant nod. They would be responsible for holding the child absolutely still.
Beth swabbed the area of Lily’s lower back with disinfectant and Alex pressed along the spine, counting carefully. He knew Susie was watching him.
‘I’m looking for the space between the third and fourth lumbar vertebrae,’ he told her. ‘Have you seen a lumbar puncture before?’
Susie shook her head.
‘It’s not too major.’ Alex spoke very quietly, and Lily was turned the other way, listening to something Jill was saying. ‘The local’s the worst bit.’ He raised his voice. ‘Small scratch,’ he warned Lily.
He felt the girl stiffen as he injected the local anaesthetic and he heard her whimper. He could also feel the change in the firmness of the hold of his assistants. Jill was still talking to Lily but he couldn’t hear what she was saying.
Alex picked up the needle and stylet. Angling the needle in the direction of the umbilicus, he advanced it slowly, withdrawing the stylet often to check for the drip of any cerebrospinal fluid. He knew precisely when he was in the right place, however, with that familiar decrease in the resistance to the needle. Clear fluid dripped easily and Beth had the required three serial tubes ready. Then the stylet was replaced, the whole system withdrawn and a sterile swab pressed to the puncture site.
‘All over,’ Alex said. ‘You were a very brave girl, Lily. Well done.’
‘Well done, you,’ Susie murmured. ‘I barely heard a squeak.’ She helped Jill roll Lily over again. ‘You’re a wee champion, Lily, aren’t you?’
‘What about blood tests?’ Charles asked.
Alex stopped watching Susie smiling. ‘Let’s get an IV line in and collect the bloods at the same time.’
‘Antibiotic of choice?’
‘Benzylpenicillin. IV. She’s going to need half- hourly neurological checks. Response to light and verbal commands, hand grip on both sides—you know the drill. Fluid restriction for the moment, as well, until we get a better idea of what we’re dealing with.’
‘We’ll get the samples away on the next ferry or flight,’ Beth confirmed.
‘Mike can take them now.’ The command was issued with a vehemence that made everybody look at Charles, and his grin was a little embarrassed. ‘I know. But this is my kid. I help fund the service—it cares for my kid.’
Beth was smiling. ‘That’s great. It’ll mean we should get the first results back later today.’
Susie was still helping Jill settle Lily so Alex got her to keep the girl’s arm still while he slipped a small IV cannula into place. Again, Beth had the tubes ready. Lily barely noticed the procedure and seemed to be listening to what Beth was saying to Jill.
‘It’s so good you got over to be with Lily. Poor little Robbie Henderson’s come in with a bug and his mother’s a single mum and there’s no way she can leave four other children to be here.’
‘What’s wrong with Robbie?’ Lily asked. ‘Is he sick like me?’
‘Kind of. Susie, do you know Robbie? Is he one of your patients?’
‘Robbie? Ten-year-old with dark hair? Cerebral palsy?’
‘That’s him.’
Alex had the line secure and the giving set attached. The necessary blood samples had been drawn and the antibiotics started. There was no reason for him to stay and listen to this conversation but he didn’t want to leave quite yet. Was that because of the sound of Susie’s voice? The way her ponytail swung when she shook her head?
‘I do know him,’ Susie said. ‘There were no requests for any special programme for him. He did join in with my swimming pool group once but camp activities have been enough to keep his joints mobile. Has he got flu?’
‘He started vomiting in the night. He’s running a temperature and complaining of a headache and sore eyes.’
‘I’ve got sore eyes,’ Lily said. ‘But I haven’t vomited.’
Charles was moving away from the bedside. ‘You probably won’t,’ he reassured her. ‘I’ll see you later, Lily. I’ve got to go and get things ready for our big opening this afternoon. Jill’s going to stay with you, aren’t you, Jill?’
‘Of course.’
Alex had been listening to the exchange about the new inpatient. ‘Maybe it’s the same thing. You want me to take a look?’
‘If it gets any worse, yes, please,’ Beth responded.
‘If you have an influenza virus doing the rounds, it’s not that uncommon to get meningoencephalitis.
