The Italian Doctor's Perfect Family

‘I’ll find his mother,’ Suzie offered.

‘And I’ll make sure they’re ready for this young man in ICU.’ Toni moved to follow Suzie but turned a second later. ‘Bravo, Pippa,’ he said quietly. ‘You certainly didn’t need my assistance.’

Warmth from that single, unusual word of praise stayed with Pip until she ended what had been a memorably long day. When her last patient, Elena, had finally been admitted for observation in the chest pain ward and Doris was in Theatre, having her hip joint replaced, Pip took a few minutes to visit the paediatric intensive care unit. She wanted to check up on Dylan and, if she was honest with herself, she wanted to enjoy that sensation of having done something special. And if she was really honest with herself, the possibility of meeting Toni Costa again had to be a distinct bonus, so she was more than happy to find him talking to Jenny and a man she assumed to be Dylan’s father.

‘Oh…it’s you!’ Jenny’s face lit up. ‘He’s going to be all right. Darling…’ She turned to her husband. ‘This is the doctor I told you about. The one who saved Dylan’s life when he’d stopped breathing.’

‘Really?’ The man stepped forward and gripped Pip’s hand with both of his. ‘What can I say? How can I thank you enough? It was…’

It was clearly too much to articulate further. Dylan’s father was overcome by emotion.

‘Sorry…’ he choked out.

‘It’s OK,’ Pip reassured him with a smile. ‘I totally understand. It was a frightening experience.’

For her as well. What would Dr Costa think if he knew that he’d provided the confidence Pip had needed to succeed, even before the surprise of his genuine presence? She didn’t dare look at him.

‘I’m so pleased to hear Dylan’s doing well,’ she added.

‘He’s doing very well.’

Pip had to look up as the paediatrician spoke. She found herself basking in a smile she could remember all too easily.

The warmth of this man!

‘And I must congratulate you again,’ Toni added. ‘I didn’t get the chance to tell you how impressed I was with what I saw. I couldn’t have managed that procedure any better myself. You did, indeed, save young Dylan’s life.’

Pip had never felt so proud of herself. It had taken so much hardship to cope with the long training and compromises in her personal life to get to precisely this point, but Toni’s approval and the gratitude of Dylan’s parents made it all seem worthwhile. More than worthwhile.

But then Pip’s gaze was caught by the sight of the young parents moving to sit with their son. They were holding hands with each other and they both used their free hands to gently touch their child. The bond between the three of them was palpable and Pip was aware of a sense of loss that took the shine off her pride. Life could be so complicated and there was no doubt that sacrifices had been made for her to get to where she was. Sometimes things got lost that could never be replaced.

‘Don’t look so worried,’ Toni said. ‘He is going to be fine.’

Pip nodded. And smiled—happy to let the paediatrician assume she had been thinking of the child they could see. The return smile gave no hint that he might have guessed her real thoughts, although his words were startling.

‘How’s Alice?’ he queried.

Nobody could read minds that well, Pip reassured herself. ‘She seems fine at the moment.’

‘Have you received the appointment for the ultrasound examination?’

‘Yes, it’s next Thursday. Faster than I would have expected.’

Toni didn’t seem surprised but then his attention was being diverted by a nurse approaching with a patient’s chart.

‘Could you sign off these medication adjustments, please, Dr Costa?’

‘Sure.’ But Toni was still looking at Pip as she turned away with a nod of farewell. ‘I’ll try and drop by to see what they find on ultrasound. Ten o’clock, isn’t it?’

Pip’s nod slowed and she left the unit feeling oddly dazed. How on earth had Toni known the time of the appointment? And why would he want to interrupt what had to be a gruelling work schedule in order to attend?

For one, extremely disconcerting, moment, Pip thought that maybe Alice was right. Maybe Toni Costa was attracted to her and was looking for an opportunity to see her again. She couldn’t deny that the possibility of seeing him again had not gone unremarked in her decision to follow up on Dylan Harris’s progress.

How would she feel if that was the case? Pip walked through the hospital corridors barely noticing the people or departments she passed. If the tingling sensation in her body right now, coming in rather pleasurable waves, was anything to go by, she would feel very good about it.

Very, very good!

Alice was not feeling very good. Pip entered her home that evening to find her daughter looking downright mutinous.

‘Nona’s taken my phone,’ she announced by way of greeting for Pip. ‘It’s not fair!’

‘It’s perfectly fair.’ Shona appeared in the kitchen doorway. ‘You spend half your life texting your friends. You’ll get it back when you’ve finished your homework.’ She smiled at Pip. ‘You’re home, finally! Wash your hands, love, it’s almost dinnertime.’

The tone Shona used to speak to both Pip and Alice had been…well…motherly. Caring but firm. Possibly a little close to the end of a tether. Alice and Pip exchanged a glance. They both knew it would be a good idea to smooth potentially troubled waters. Alice disappeared upstairs, to at least look like she was doing some homework. Pip followed her mother to the kitchen.

‘You OK, Mum?’

‘I’m fine. Bit tired, I guess.’ Shona pushed strands of her greying hair behind her ears as she bent to open the oven. ‘It’s just casserole and baked potatoes. Hope that’ll do.’

‘It’ll be fantastic,’ Pip said sincerely. How many other overworked and stressed junior registrars could bank on going home to a warm house and delicious hot meal? Or having their laundry done or messages run when time simply wasn’t there for mundane chores?

But, then, how many twenty-eight-year-olds would want to be still living in their childhood home?

It wasn’t that Pip resented the security and comfort of being mothered. It was just that—sometimes—it would be nice to choose entirely for herself. To maybe sit down and chill out with a glass of wine instead of being immediately sucked into a predictable family routine.

A routine that had been the only way she could be doing what she was doing, Pip reminded herself. And look what she’d achieved today. A life saved. A family who would be only too happy to return to a normal routine. Pip gave her mother a one-armed hug as Shona stood up to place a tray of hot baked potatoes onto the bench.

‘What’s that for?’ But Shona didn’t sound displeased.

‘Just because I love you,’ Pip responded. She grinned. ‘And because I had a great day today. I had to do a really tricky emergency procedure on a little boy, Mum. He’d stopped breathing. He could have died but he’s going to be fine.’

‘Well done, you!’

Shona’s smile was proud but Pip could detect an undertone. ‘You sure you’re all right? Is that pain back again?’

‘No, not really. Just a bit of an ache.’

‘Have you made another appointment with Dr Gillies yet?’

‘No. I’ll do it tomorrow.’

‘That’s what you said yesterday. And last week.’ Pip eyed her mother with concern. She looked a bit pale. And tired. ‘Is Alice giving you a hard time about doing her homework?’

Shona smiled again. ‘No more than usual. We’ll get it done.’

That ‘we’ didn’t need to include Pip, but she brushed aside any feeling of being left out. ‘Anything I can do to help in here?’

‘Have you washed your hands?’

‘Mum, I’m twenty-eight! If I want to eat dinner with dirty hands, I’m allowed to.’ Pip sighed fondly. ‘OK, I’ll go and wash my hands.’

‘Good girl. Tell Alice to wash hers as well. Dinner will on the table in five minutes.’

Alice was brushing her hair and staring at herself in the bathroom mirror.

‘Dinner in five,’ Pip told her. ‘Wash your hands.’

‘Hey, Pip—can we watch “Falling Stars” after tea? In your room?’

‘Sure.’ Although half an hour of watching a gossip show about Hollywood celebrities wasn’t Pip’s cup of tea, time cuddled up on her double bed with Alice, watching the tiny screen of her portable television, had to be a highlight of any day. It was usually after Shona had gone to bed and often with illicit bowls of popcorn or a packet of chocolate biscuits to share.

Their time—with no parental type obligations to fill, for either of them.

Alice bolted her dinner with one eye on the kitchen clock.

‘It’s nearly 7.30,’ she announced finally, with a meaningful glance at Pip.

‘I know. I’m sorry I was a bit late today. Things got really busy.’

‘“Falling Stars” is on at 7.30.’

‘I know. You can go and watch it if you like, and I’ll come after I’ve done the dishes.’

Shona was only halfway through a plateful of food she had been picking at without enthusiasm. ‘Have you finished that assignment you have to hand in tomorrow, Alice?’

‘I’ll do it later.’

‘No, you won’t. You never do. You’ll have to get it done before you do anything else, and that includes watching television. Especially watching television.’

‘But it’s my favourite programme!’

‘It’s a load of rubbish.’

‘Mum said I could watch it.’

Alice only called Pip ‘Mum’ when she wanted to play one of the adults in her house off against the other, a habit that had formed over the last few months—ever since she had decided it was cool to call Pip by her given name.

Pip took one look at her mother’s drawn face and knew it had been the wrong button to push tonight.

‘Mum’s right. You have to get your homework done, Alice. I’ll tape the programme and we can watch it later.’

‘But I want to watch it now! I’ve been looking forward to it all day!’ Alice looked at Pip with the face of someone unexpectedly betrayed.

Shona said nothing but her lips were a tight line.

‘Please, Pip?’

It was tempting to give in to that plea and maybe negotiate a compromise, like supervising the homework being done later, but Pip could sense a disturbing undercurrent to what should have been an average family-type wrangle. Roles were being challenged.

Alice expected her support but maybe she was too used to getting her own way by pulling the ‘friends’ card out.

Shona expected her support as well. Pip was Alice’s mother after all, and maybe Shona was feeling too tired or unwell not to play the ‘mother’ card.

Pip was caught in the middle but it was perfectly clear which way she had to jump.

‘No,’ she said firmly to Alice.

‘But you said—’

‘I know what I said, but I didn’t know you hadn’t done your homework.’

‘Yes, you did! You heard—’

‘That’s enough!’ Shona’s fork hit the table with a rattle. ‘I’m sick of this.’

Alice jumped up and stormed from the room, slamming the door behind her.

‘Sorry, Mum,’ Pip said into the silence that followed. She sighed. ‘I’m not very good at the parent bit, am I?’

‘We’re getting to the difficult stage, that’s all.’ Shona echoed Pip’s sigh. ‘I’d forgotten what it was like, living with a teenager.’

‘Was I so awful?’

‘No.’ Shona smiled wearily and reached out to touch her daughter’s hair. ‘You were great.’

That touch took Pip instantly back to childhood where the gesture could have provided comfort, communicate pride or been as loving as a kiss. The love she had for her mother welled up strongly enough to bring a lump to her throat.

‘I wasn’t that great. Remember the fuss I made when you wouldn’t let me get my ears pierced? I kept it up for a week.’

‘It wasn’t your ears I minded—it was the belly-button ring you wanted.’

‘And what about that first rock concert I was determined to go to?’

‘I seem to remember you getting your own way in the end that time. Thanks to your dad.’

They were both silent for a moment. The memory of that terrible wrench when Jack Murdoch had died so suddenly was still painful. A period neither of them liked to dwell on. Pip skipped it entirely.

‘And then I got pregnant.’ She snorted softly. ‘I have no idea how you coped with that so well, Mum.’

‘When you have to cope, you do. That’s all there is to it, really.’

‘And you’re still coping. Far more than you should have to at your time of life.’ Pip couldn’t brush aside the pangs of guilt. ‘I should be taking full responsibility for Alice by now. I should have a house of my own and not make you live with all her mess and angst.’

‘And how would that help while you’re still finishing your training?’ Shona straightened visibly in her chair. ‘I wanted to do this, Pip. I still do. I want to see you settled into the career you’ve always dreamed of. Into a relationship, even.’

Pip rolled her eyes. ‘Yeah, right! Just what every man my age wants—a woman who’s still living at home and relying on her mum and a package deal with an angsty teenager thrown in.’

‘Don’t judge all men on what James thought. He was an idiot.’

‘An idiot I wasted four years on at medical school. I’m in no hurry to go back there.’

‘It might have helped if you’d told him about Alice a bit earlier.’

‘Getting pregnant at sixteen isn’t something I’m proud of, Mum.’

‘Maybe not, but Alice should be,’ Shona said quietly. ‘You can be very proud of her.’

Shona’s words stayed with Pip as she tidied up after dinner. They could both be proud of their girl, but the credit had to go largely to Shona for the successful upbringing of Alice. Imagine what a disaster it would have been if it had been left entirely to her? But she was much older now. Hopefully wiser. And it was way past time she took more of the burden from Shona’s shoulders.

The silence from her daughter’s room had been deafening and, having finished her cup of tea, Pip left Shona in the living room and went and tapped on Alice’s door. It might be a good time to try and have a real ‘motherdaughter’ type talk. To start a new phase in their relationship.

‘Alice?’

There was no response.

Pip tapped again and opened the door. Alice was curled up on her bed and had her face turned away from the door.

‘Alice?’ Pip stepped closer. She could see that Alice’s arms were locked tightly around her slight body. ‘We should talk, hon.’

Alice rolled and Pip saw that her face was scrunched into lines of what looked like severe pain. Reaching to smooth the hair from her forehead, Pip felt the damp skin and then Alice groaned.

‘Oh, no!’ Pip took hold of her daughter’s wrist, knowing she would feel the tattoo of an overly rapid heart rate. ‘Is it your tummy again? Why didn’t you come and tell me?’

‘It just started.’ Alice broke into sobs. She didn’t look anything like her twelve and a half years right now. She looked like a sick frightened little girl. And along with her maturity had gone any desire for a ‘cool’ relationship with her mother. ‘It hurts, Mummy. Make it go away…please!’

‘Right.’ Pip pulled the duvet around Alice. ‘Put your arms around my neck. I’m going to carry you to the car and then I’ll take you into the hospital.’

‘No-o-o!’

Shona had heard the noise. ‘What’s happening?’

‘Tummy pain again. I’m going to take her into Emergency.’

‘Should I call for an ambulance?’ Shona asked anxiously.

‘It’ll be quicker if I take her.’

‘I’ll get the car out,’ Shona offered. ‘I can drive.’

‘You don’t have to come. It could be a long night.’

‘Of course I’m coming.’

‘I don’t want to go,’ Alice sobbed. ‘I don’t want to move!’

‘I know, hon, but we have to. We need to do what Dr Costa asked us to do. When you’re in the hospital you’ll be able to have some medicine that will take the pain away completely.’

Alice’s arms came up to lock around Pip’s neck. She braced herself to take the weight.

‘You promise?’

‘Yes.’ Pip lifted the girl. ‘I promise.’

‘Will Dr Costa be there, like he said he would?’

‘I don’t know, hon. Let’s hope so but it’s late and he’s probably gone home by now.’

Alice was still sobbing. ‘But I want him to be there.’

‘Mmm.’ The strength of her own desire to have Toni Costa there was overwhelming. Pip had to close her eyes and try very hard to sound casual. ‘Me, too.’

CHAPTER THREE

THE triage nurse took one look at Alice and sent them straight to a resus bay.

The registrar on duty, Graham, was right behind them.

‘Let’s get some oxygen on,’ he ordered a nurse, ‘and I want some vital sign baselines. What’s going on, Pip?’

‘This is Alice, she’s twelve,’ Pip responded. ‘She’s got acute epigastric pain radiating to her back with associated nausea and vomiting.’

‘First time this has happened?’

‘No. She had an appointment with Toni Costa recently because we want to find out what’s causing it. He asked me to bring her in when it happened again so we could get bloods to check amylase levels.’

‘Right. I’ll get a line in straight away.’

But Alice jerked her hand away from the registrar. ‘No,’ she said fiercely. ‘I want Dr Costa.’

‘He doesn’t work in Emergency, love,’ Graham said patiently. ‘Come on, this won’t hurt for more than a moment, I promise.’

‘No.’

‘We’ll be able to give you something for that pain after I’ve put this little tube in your vein.’

‘No!’ Alice’s sobs turned to a choking sound and Pip held her daughter’s head as she vomited yet again. Shona took a dampened towel from the nurse, ready to wipe Alice’s face.

‘Sorry,’ Pip said to Graham, ‘but Toni did ask us to call him if we came in acutely. Alice was expecting to see him, I guess.’

‘It’s 9.30 p.m. Not much chance of him being in the building.’

‘I know.’

Graham looked at the sobbing, unwell child on the bed and his expression revealed his reluctance to force treatment on someone who was very unlikely to be co-operative. He looked down at the IV cannula in his hand and then glanced at Pip.

‘I could try beeping him—just in case.’

‘Good idea.’ Pip smoothed damp strands of Alice’s hair back from her face. ‘It’s worth a try.’ At least that way Alice would know they had tried to get the person she wanted to look after her. When she knew it was impossible, she might be prepared to let Pip put a line in her hand if Graham still wasn’t acceptable.

She wasn’t prepared for the look of surprise on Graham’s face when he reappeared less than a minute later. ‘He was in ICU. He’s on his way down now.’

‘Hear that, Alice?’ Pip could allow herself to sound delighted on her daughter’s behalf. ‘Dr Costa’s coming to see you.’

Alice hiccuped. ‘Good.’

It was good. Better than good. Pip had no disagreement with Alice’s conviction that Toni was the top of the list of desirable people to care for her. The worry that the paediatrician might have been in the intensive care unit because Dylan had taken a turn for the worse was dismissed with only a small pang of guilt. Pip’s attention had to be focused much closer to home for the moment and she wanted the best for her own daughter.

Their confidence did not appear to be misplaced. Toni took over the resus bay from the moment he arrived and managed to exude an air of authority tempered with a charm that reduced the stress levels for everybody concerned. He actually managed to both reassure Alice and gain the information he wanted at the same time. Pip could see Alice visibly relax when the doctor smiled at her and patted her hand before his fingers rested lightly on her wrist.

‘Heart rate?’

‘One-twenty,’ Graham supplied.

‘Respirations?’

‘Twenty-eight.’

‘Temperature?’ The touch on Alice’s forehead was hardly necessary but Pip could see that it was appreciated. Alice closed her eyes and, just for a moment, the lines of pain on her face almost vanished.

‘Thirty-seven point four.’

‘Blood pressure?’

‘Eighty over fifty.’

‘Bit low. Postural drop?’

‘We haven’t tried assessing that.’

Pip was still watching quietly, enjoying the sensation of having an expert take over. As a doctor, it was a good learning experience, being on a parent’s side of this equation. Her anxiety was actually receding to the point where Pip could register how impressive Toni’s clinical skills were. He was able to palpate an invisible, tiny vein in Alice’s forearm and then slip a small-gauge cannula into place without eliciting more than a squeak from his patient.

Worry kicked in again with his latest question, however. A drop in blood pressure from a change in posture could be serious and the paediatrician seemed to be looking for signs of hypovolaemic shock. What could Alice be bleeding internally from? A perforated peptic ulcer? Something as nasty as acute haemorrhagic pancreatitis?

‘She said she felt dizzy when she had to sit in the car,’ Pip told Toni as he taped the cannula into place.

‘We’ll get these bloods off and then I’d like some fluids up,’ Toni said to Graham. He smiled at the nurse who was holding a page of sticky labels already printed with Alice’s details and hospital ID number, ready to label test tubes.

The smile was warm. Appreciative of her readiness and inviting the junior nurse to consider herself a valuable colleague. For an idiotic moment Pip actually felt something like jealousy.

‘We need amylase levels, haemoglobin and haematocrit, electrolytes…’ The list seemed to go on and on as the nurse plucked tubes with different coloured stoppers from the tray. ‘And we want blood cultures as well,’ Toni finished.

‘Goodness!’ Shona’s eyes had widened at the mounting pile of test tubes.

That smile appeared again. ‘Don’t worry, Mrs Murdoch. It looks like we’re taking a lot of blood but it’s less than a teaspoonful in each tube.’

‘Why the cultures?’ Pip queried. ‘Wouldn’t Alice be running more of a temperature if this pain was caused by infection?’

Toni nodded. ‘We still need to rule it out. We’ll do a dipstick test on her urine as soon as we can as well.’ The quick smile was almost a grin this time—faintly conspiratorial. ‘I like to be thorough,’ he confessed.

Thorough.

And gentle.

Pip watched Toni’s hands as he carefully examined Alice’s abdomen. She had watched him doing this once before and, unbidden, the memory had already returned more than once.

If only Alice hadn’t planted that absurd suggestion of Toni as potential boyfriend material. If only Pip hadn’t found herself remembering those hands and their touch in the middle of the night. Wondering how it feel to have them touching her.

It had been all too easy to imagine. And highly inappropriate, given the current setting, so it was easy to dismiss. It evaporated more than convincingly as Alice cried out in pain. Toni’s voice was now as gentle as his touch but excited no odd tingles in Pip. Her focus was firmly on her daughter as she stepped forward to take the small, outstretched hand.

‘It’s OK, hon,’ she said. ‘I’m here.’

‘I know it hurts, cara,’ Toni added in an equally soothing tone. ‘We’re going to do something about that very soon. It’s a bit mean, isn’t it, but we need to try and find out what’s causing it before we take the pain away.’ He turned to the registrar who was adjusting the flow on the IV line attached to a bag of fluids. ‘I think we could get some pethidine on board now.’

‘Why not morphine?’ It was the standard analgesic to use in situations such as this.

‘There’s some evidence it can cause sphincter of Oddi spasm.’

Graham nodded. He eyed Alice thoughtfully and Pip could tell he was trying to assess how much she weighed in order to calculate a dose of the narcotic. Toni picked up the hesitation as quickly as Pip did but showed none of the impatience some consultants might have displayed. Instead, he smiled at his young patient.