of his age.’ Ezra nodded. ‘I’d try to keep it under control for the moment. Most children recover from juvenile arthritis within a few years and are left with little or no disability. Only a very small minority go on to develop an adult form of arthritis.’
She’d been telling Toby’s parents that for weeks, but the minute Simon and Elspeth had heard the word ‘arthritis’ they’d instantly assumed their son would be crippled for life, and nothing she’d said had persuaded them otherwise. Which was why, when Ezra drew his car to a halt outside the Ralstons’ home, she found herself turning to him and saying on impulse, ‘Would you like to come in—see him yourself?’
‘I’m not a doctor any more.’
‘I know, but I wondered—’
‘No!’ He bit his lip as she stared up at him, startled by his vehemence. ‘No,’ he repeated more evenly. ‘I’ll wait outside in the car if you don’t mind.’
Jess didn’t mind at all. It wasn’t as though she didn’t know what was wrong with Toby, but what really intrigued her was why Ezra had reacted as he had. OK, so he didn’t practise medicine any more but he’d seemed not only angered by her suggestion but also strangely upset by it.
It didn’t make any sense, but she had no time to think about it. Elspeth was already on the doorstep and Toby was bouncing towards her, his white-blond hair gleaming in the sunlight, his large blue eyes alert and full of mischief.
‘It’s his chest, Doctor,’ Elspeth explained, ushering her son back into the sitting room, concern plain on her face. ‘He got up this morning with the most dreadful cold, and I know we have to be careful, what with his condition and everything.’
Jess would have been amazed if Toby’s abundantly runny nose had meant anything other than one of the many colds which were plaguing the islanders this winter, and a quick check with her stethoscope revealed she was right.
‘You don’t think he needs a chest X-ray, then?’ Elspeth said after Jess had given her the good news. ‘Or perhaps some antibiotics?’
‘Elspeth, he has a cold,’ Jess said firmly. ‘If I give him antibiotics every time he’s snuffly, they won’t work when he really needs them. How’s the physiotherapy going?’ she continued, determinedly changing the subject.
‘All right, I guess. He’s not very happy about the night splints.’
Which meant he probably wasn’t wearing them, Jess thought with a deep sigh. ‘Elspeth, you know he has to wear them in bed, whether he wants to or not. The physiotherapy he’s getting will maintain muscle strength and joint mobility, but the splints are equally important to prevent joint deformity.’
‘I suppose so,’ the woman muttered. ‘I still don’t know how he’s got this juvenile arthritis. Simon’s phoned round all our relatives—even contacted his uncle in Australia—but none of them can remember anybody in the family ever having had it.’
‘Elspeth, I only said it might be inherited,’ Jess reminded her. ‘The initial joint inflammation can also be triggered by a viral infection, but the truth is we really don’t know why some children are affected and others aren’t. But as I told you before, there’s every chance he’ll grow out of it.’
And Elspeth still didn’t believe her, Jess thought wearily when she left the house and Ezra drove her to her next call. Neither did Denise Fullarton after she’d examined her, but at least the local dentist’s wife had more cause to be concerned.
‘She’s had three miscarriages in five years?’ Ezra exclaimed when she explained the situation. ‘No wonder she was too terrified to walk to the surgery for a confirmation of her pregnancy. How far on is she?’
‘Seven weeks.’
‘Has she ever carried a baby to full term?’
Jess shook her head. ‘I’ve had her tested for everything—fibroids, uterine abnormality, genetic abnormalities—but the muscles of her cervix just seem to be too weak to support her uterus when she’s pregnant. I’ve told her I’ll put a stitch in her cervix to keep it closed when she reaches the end of her first trimester, but the trouble is she doesn’t usually make it to twelve weeks.’
‘Have you tried taking blood tests at the start of her menstrual cycle to see whether her progesterone levels are raised?’ Ezra suggested. ‘I believe there’s some evidence to suggest women who miscarry a lot don’t produce enough progesterone after ovulation to help the embryo.’
She looked up at him enquiringly. ‘I thought that was usually linked to polycystic ovarian disease?’
‘It is,’ he said nodding, ‘but I also remember reading that giving gonadotrophin-releasing hormones to women who repeatedly miscarry can help. It’s obviously too late to try that now, but if—and hopefully it doesn’t happen again—your patient has another miscarriage it might be worth a try.’
It would, just as she’d dearly have liked to have asked him what kind of doctor he’d been before he’d decided to stop practising medicine.
Not a GP, that was for sure. This was a man who was used to giving orders—orders that were instantly obeyed.
A special registrar, perhaps? But, then, why had he given it up? He didn’t look like the kind of man who would throw in the towel on a whim. Dedicated, she would have said. Focused.
Could she ask him—did she dare?
Awkwardly she cleared her throat, but before she could say anything someone called her name and she turned to see Louise Lawrence striding determinedly across the road towards her, her youngest daughter in tow.
‘I wish you’d take a quick look at Sophy’s head, Doctor,’ Louise said irritably. ‘Scratch, scratch, scratch. She’s been doing it for a couple of days now and it’s driving me mad.’
Obediently Jess parted Sophy’s long black hair and saw the cause immediately. ‘I’m afraid your daughter has lice, Mrs Lawrence—head lice.’
Sophy’s mother was outraged. ‘But she can’t have! My daughter has clean hair—’
‘Which is just the sort lice prefer,’ Jess interrupted gently. ‘They generally travel from head to head when children share combs or hats—’
‘But Sophy never does that,’ Louise protested. ‘I’ve warned her time and time again about the dangers, and I can assure you she doesn’t do it.’
Sophy’s swiftly averted gaze suggested that the warning had gone unheeded, but Jess saw no point in commenting on it. The most important thing now was to treat the condition.
‘Do people often do that—ask you for a consultation on the street?’ Ezra asked, clearly bemused, as an obviously furious Mrs Lawrence bore Sophy off in the direction of the village shop with instructions to buy a special head-lice shampoo and to remember to treat everybody in the family.
‘And how!’ Jess chuckled. ‘My most potentially embarrassing case happened not long after I came back to the island. It was an old fisherman who thought he had a hernia but didn’t want to take time off work to come into the surgery to confirm it. Honestly, if anyone had seen the two of us down this side street—me on my knees in front of him—well, you can just imagine
