One Night, One Unexpected Miracle

CHAPTER TWO

‘MORNING.’

Alice swallowed a wave of nausea and looked up from her desk.

‘Do you ever knock?’

He went back out of the door, knocked, walked in again and smiled mischievously. ‘Good morning. There, is that better?’

She put her pen down and leant back with a sigh, stifling the urge to smile. ‘You’re supposed to wait for an answer. I assume you want something? And shut the door, please.’

He peered closer, and frowned. ‘Are you OK?’

‘Yes, I’m fine,’ she lied. ‘Thank you for last night—for looking after me—I appreciated it, but I’m fine now. So, what did you want?’

He shrugged as if he didn’t believe her, but he let it pass. ‘Just an update for you. I’ve checked the post-ops from yesterday, spent a few minutes with Amil and his parents in PICU—the boy with Crohn’s?’’

‘I do know who Amil is. How is he today?’

‘OK. He’s had a reasonable night, apparently, which is excellent news, and we should be able to move him out of there later onto a ward. Hopefully the surgery will have done the trick for now and once he’s on the mend we can hand him over to gastroenterology and see if they can get him a bit more settled on a new drug regime. So, boss lady, what’s on the agenda for today?’

She swallowed another wave of nausea and looked down at the file of notes on her desk.

‘Daisy Lawrence. She was diagnosed with malrotation of the gut as a toddler because she was having lots of stomach cramps without any other symptoms, but it wasn’t considered severe enough for surgery at the time and they adopted a watch and wait policy, but she’s flared up again, they’ve got private medical insurance and they wanted a second opinion so they chose us.’

He perched on the corner of her desk beside her and studied the notes. ‘So what are we doing? X-rays, MRI, CT?’

‘I’m not sure. I think we’ll start with a follow-through contrast scan to see what’s going on in there, so I’ve booked that with the imaging suite for this morning, and we’ll review the results and see where we go from there, but I think we need to go and meet them and examine her and talk it through.’

‘Are they here?’

She shook her head. ‘I don’t believe so. They’re not due until nine. I was just going through her notes again.’

‘So—have you had breakfast?’ he asked, and she swallowed again and shook her head.

‘I couldn’t—’

‘Well, isn’t it a good job you have me to feed you?’ he said, passing her a small packet of salty wholewheat crackers.

She eyed them with suspicion. Food? Really—?

‘Eat them,’ he instructed gently, and she tore the bag open reluctantly and tried one.

Surprisingly edible. She had another.

‘OK?’

She nodded. ‘Yes—thanks.’ She took a sip of water and had another one while he flicked through the notes.

‘Apparently watermelon is good if you feel sick,’ he told her without looking up. ‘Just a little piece. I’ve put some in the fridge in the staffroom where you keep your lunch. And you need carbs.’

‘I don’t eat carbs.’

He looked up and met her eyes. ‘I noticed. That’s why you’re feeling sick, because your blood sugar is low because you’re on one of these crazy celebrity diets where your body’s in a permanently ketogenic state. It’s bad for you.’

‘It isn’t. A ketogenic diet means I maintain a healthy weight and keep my blood sugar and cholesterol under control,’ she said, feeling a little flicker of panic because he was getting too close to the truth and she didn’t want to tell him, or at least not yet.

‘Why on earth do you need to do that? You’re not overweight, you’re under if anything, and you spend your free time in the gym.’

‘How do you know that? You’re never in there.’

‘No. I don’t do gyms, but our colleagues use them, and they talk.’

She hated the idea of people talking about her. Speculating?

‘So I keep fit—and I’m not underweight, my BMI is nineteen point five.’

‘That’s borderline underweight.’ He frowned, his voice softening. ‘Alice, is food a problem for you? Do you have an eating disorder?’

She stared at him, stunned. ‘No! Of course I don’t have an eating disorder! I’ve told you, I’m just keeping healthy—’

‘Then why don’t you eat cake if it’s someone’s birthday? Why do you always say no to snacks and biscuits? They won’t kill you occasionally if you make an exception to avoid hurting someone’s feelings.’

She sighed and gave up. ‘Because I have insulin resistance,’ she said flatly, giving him a symptom rather than a diagnosis just to get him off her back, but she could see it wasn’t working. He frowned, looked thoughtful and tipped his head on one side.

‘I just don’t buy it. The only way you have insulin resistance is if you’re borderline diabetic and have metabolic syndrome, which you haven’t because you’re much too thin for that, or you’ve got a hormonal imbalance or something like PCOS...’

He trailed to a halt, frowned again and searched her face, and she could hear the cogs turning as the frown softened into concern.

‘Is that it? Is that why you were so surprised that you were pregnant, because you have PCOS?’

‘That’s a bit of a quantum leap, isn’t it, from insulin resistance to polycystic ovaries?’ she said, flannelling furiously because she wasn’t ready to have this conversation. Wouldn’t ever be ready to have it—

‘Not for a doctor. And I know I’m a paediatric surgeon, but I’m still a doctor and I haven’t forgotten everything I learned in med school. So is this why you were surprised you’re pregnant, and why you’re so convinced you could lose the baby, because of the risk of high blood pressure, pre-eclampsia, gestational diabetes, miscarriage—is there anything else? I’m sure there must be other things you’re torturing yourself with.’

‘So what if I have got it?’ she asked, suddenly sick of not telling him and wanting to get the revulsion over, but there was no revulsion, to her surprise. Instead he shrugged away from the desk, put his arms round her and hugged her, tutting softly.

‘Oh, Alice. Is this why you’re not married? Why you’re so defensive? Because some idiot didn’t want a wife who couldn’t be sure of giving him children?’

She eased out of his arms, her emotions all over the place, and if she stayed there with her head against him, she’d lose it and blub all over him. ‘No. I’m not married because he didn’t want a wife who was fat and hairy and had more testosterone than he did.’

He sat back on the edge of the desk, his eyes wide. ‘But that’s not you! You’re not fat, and I can’t believe you ever were because you’re far too well controlled. Besides, most people don’t have all those symptoms, if any. It’s rubbish.’

‘You don’t have to tell me that, I know, but he didn’t and once he’d researched it—which he did there and then on his phone, the minute I told him—he didn’t hang around long enough for me to put him right,’ she said, grabbing her pager like a lifeline as it bleeped.

‘Daisy’s here,’ she said, sliding her chair back, and she stood up, picked up the notes and headed for the door, pausing to look over her shoulder. ‘Well, are you coming, or are you going to stay here all day making annoying comments and quizzing me about my medical history?’

He rolled his eyes. ‘Yes, of course I’m coming.’ He straightened up, grabbed the bag of savoury crackers and followed her.

* * *

Polycystic ovary syndrome.

He never would have guessed if he hadn’t pushed her, but now so much of her defensive behaviour made sense, especially in the light of some ignorant—

His thoughts lapsed into Italian, because he had a better grasp of the language he’d need to sum up someone that ignorant and cruel. No matter. He, whoever he was, was in the past, and now was for them. He’d look after her, take care of her and the baby, go to all her antenatal appointments with her and support her in any way she’d let him.

Assuming she’d let him, which was a big assumption.

He fell into step beside her. ‘So, how old is Daisy?’

‘Four. She’s seeing us first and then being admitted to the assessment unit until we have a better idea of what’s going on, and if and when we’ll need to operate. She’s coming in without breakfast ready for the contrast scan, so I don’t want to keep her hanging about long because it’s a slow process and she’ll be hungry.’

‘OK, so we’ll go from there. Do you want me in on the consult?’

She stopped and turned to face him. ‘Yes, because if she needs surgery, I’ll want you in on it, and you’re good with the children. And besides, I value your opinion.’

He resisted the overwhelming urge to smirk, restricting himself to a slight smile and a tiny shake of the head. ‘Did that nearly kill you?’

She looked away, but not before he saw her mouth twitch. ‘Don’t be ridiculous. Your ego’s showing again.’

‘Oh, dear. Me and my ego. We’re always in trouble.’

He swiped his lanyard, held the door open for her and followed her through to the consulting room waiting area.

A couple were sitting there, a small girl with long blonde hair cuddled on the woman’s knee, and he thought they looked uncomfortable, strained. With worry?

‘Mr and Mrs Lawrence?’ Alice said. They got to their feet and she held out her hand to them. ‘Welcome to Hope Hospital. I’m Alice Baxter, the senior gastro-intestinal surgeon, and this is my colleague Marco Ricci. And you must be Daisy,’ she said, bobbing down to the child’s level. ‘Hi, Daisy. You can call me Alice, if you like.’

‘I’m Olive, and this is Dan,’ Mrs Lawrence said, and smiled down encouragingly at Daisy. ‘Daisy, say hello.’

But Daisy had obviously had enough of doctors, and she turned her face into her mother and hid, so Alice straightened up and smiled at her parents. ‘Shall we go on through to the consulting room and talk through what we’re planning to do today? And if it’s all right, I’d like us to have a look at Daisy.’

She ushered them into the room, and Marco scooped up Daisy’s forgotten teddy and followed them into the very room where he’d accidentally got Alice pregnant just over five weeks ago.

Was that really all it was? Thirty-eight days?

Trying not to look at the couch, he let Alice do the talking, taking the opportunity to sit on the floor and prop his back against the wall. Daisy was looking withdrawn and wary, so he hid the teddy behind his back and brought it out in surprising places. Under his other arm, behind his legs, upside down and sideways, and all the time Daisy watched him, warily at first, and then with a glimmer of anticipation.

And then finally she giggled, and he felt as if the sun had come out.

‘Does your teddy have a name?’ he asked her softly, and she nodded and moved a little nearer him—but not too near.

‘He’s called Wuzzle.’

‘Wuzzle? What a lovely name. Hello, Wuzzle. Nice to meet you. I’m Marco. So, Wuzzle, what can you tell me about Daisy?’

‘She’s my best friend,’ he said, pretending to be a ventriloquist and making Daisy giggle again.

‘And what else can you tell me, Wuzzle?’

‘She’s got a sore tummy.’

He put the teddy down and looked at Daisy. ‘Is that right, Daisy? Do you have a sore tummy?’

Daisy nodded and sat down facing him. ‘Sometimes, especially when I’ve had my dinner.’

‘Oh, no. That’s a pity. So do you just have a little bit of dinner then?’ he asked, because she was a skinny, lanky little thing and it could have been because she’d had a growth spurt or because her appetite was off. Especially if she was afraid to eat. And she was pale and wan. Worryingly so.

She nodded. ‘If I eat too much, my tummy hurts.’

‘OK, Daisy, I have an idea. Will you let me and Alice try and find out what’s wrong with your tummy?’ he asked gently. ‘Because we can’t have you hurting, can we, when you eat?’

She shook her head. ‘Wuzzle’s tummy hurts, too.’

‘Does it? Can you show me where?’

Daisy pressed her fingers gently onto Wuzzle’s soft, furry body, around about what would be his epigastric region if he wasn’t a teddy bear. ‘Here,’ she said, and pressed again to the right. ‘And here.’

‘Is that the same place as your tummy?’

She nodded, and snuggled Wuzzle tight against her chest.

‘OK. Daisy, do you mind if I have a little feel of your tummy now? See if I can feel anything wrong? Would that be OK?’

She nodded again, her brown eyes soft and wounded, and he felt his heart wrench for her.

‘Come on, then, poppet. Let’s help you up onto the bed and I can have a look at both of you, OK?’

He stood up, pulled Daisy to her feet, handed Wuzzle to her and lifted them easily onto the couch. The couch where he and Alice had made not only love, but a baby. Amazing...

‘Now, let’s have a look at Wuzzle first, shall we?’

* * *

Alice’s eyes strayed to him, to his gentle, careful hands examining first the teddy and then little Daisy, with just the same thoroughness and attention to detail he’d brought to their lovemaking right there on the edge of that couch.

Did he realise it was the same room?

‘He’s so good with her,’ Olive said quietly, and she nodded.

‘Yes, he is.’ Good with everything...

She turned away from Marco and gave the Lawrences her undivided attention. ‘Has anybody explained to you what malrotation of the gut is, exactly?’

Daisy’s mother nodded. ‘Something to do with the way she formed as an embryo, they said, and I’ve worried ever since that it was something I ate or did—’

‘No. It was nothing you did. There’s no evidence to suggest anything of the sort. What happens is that the cells that become the gut migrate up into the umbilical cord at about ten weeks of pregnancy, and then at around eleven weeks they migrate back down again, and coil into the area that becomes the abdomen. And sometimes, about once in every five hundred babies, they coil the wrong way, because our bodies aren’t symmetrical inside.

‘The liver is on the right, the spleen and pancreas and stomach on the left, and the small intestine starts at the bottom of the stomach and curls around past the liver, picking up the bile and pancreatic ducts, and then this great tangle of small intestine wriggles around inside and joins the large bowel down on the right, where we get appendicitis.

‘In children with malrotation it coils the other way, so that join in the gut can end up near their stomach or even on the other side, so diagnosing appendicitis is difficult, and that’s often when asymptomatic malrotation is diagnosed.

‘The problem arises when the part that is trying to be the right way round gets twisted somehow in a bit of a conflict of interests with the other bit, and that twisting process can lead to what’s known as a volvulus, which means the blood supply to that part is kinked and cut off by the twisting, and that’s a life-threatening emergency.

‘Daisy is not at that stage, but she may be approaching it, because she could have bands of fibrous tissue called Ladd’s bands holding her intestines in the wrong place. That’s what our tests today are going to look for, to find out exactly how her gut is coiled inside her, and where the pinch points or twists might lie so we can rearrange her gut to relieve that, if it’s what’s causing her pain. Does that make sense?’

They nodded, but she noticed they didn’t offer each other any support or interact in any way, which seemed odd.

‘Is there anything else we can tell you before we admit her and she goes down for her scan?’

They shook their heads, again not conferring.

‘OK, that’s good. Feel free to ask, though, at any time, because I know it’s a lot to take in. So, Dr Marco, what’s the verdict?’ she asked lightly, turning to face the examination couch again. ‘Do Daisy and Wuzzle need to have some pictures taken?’

He turned his head and smiled. ‘Yes, I think they do. I think we need to find out why they’ve got tummy ache. So, Dr Alice, how are we going to take the pictures?’

‘Well, Daisy, after you’ve been checked in by a nurse we’ll take you downstairs, and a lady there will give you a special drink, and then we’ll take pictures of the drink all through the morning as it moves through your tummy. It’s called a follow-through contrast scan, and it’s very good at showing us where things aren’t working quite like they should be. Is that OK?’

‘Will Wuzzle have some to drink, too?’

‘I’m sure he can. Would you like strawberry, blackcurrant or chocolate flavour?’

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