The Greek Children's Doctor(8)

'Can you tell me what happened?' Libby spoke softly, her eyes fixed on  the child, assessing her breathing. 'When did she become ill?'

'She was a bit under the weather yesterday morning and then she just got  worse and worse. By teatime she was just lying on the sofa.'

And she was just lying now. Totally unresponsive. It wasn't a good sign.

'Could you get her interested in anything-toys, books?' The mother shook  her head. 'Nothing. She just lay there. Finally I panicked and took her  to the GP and he sent us in here.'

'And when did she last have paracetamol syrup?'

'Two hours ago.' The mother looked at her anxiously. 'What's going to happen?'

'I'm going to check her temperature now and then ask one of the doctors  to see her straight away.' Libby reached for the thermometer. 'Has she  had all her immunisations, Mrs Miller?'                       
       
           



       

'Please, call me Alison and, yes, she's had everything.'

'Good.'

Libby checked the temperature and recorded it on the chart. 'It's very high, as you know. Has she been drinking much?'

'She's just not interested in anything.'

'When did she last have a wet nappy?'

The mother looked startled by the question. 'I don't know … '

'It's a way of judging her fluid output,' Libby explained, and the woman nodded.

'Oh, I see.' She frowned slightly. 'I suppose I changed it about three hours ago.'

Libby checked the child's blood pressure and then gave Alison Miller a brief smile.

'OK, well, the next thing to do is to ask one of our doctors to see her.  We need to find out what's causing this temperature. I'll be back as  soon as I can. If you're worried, press the buzzer.'

She gritted her teeth and went to find Andreas. She would have preferred  to have avoided him completely but that wasn't an option. Bleeping one  of the more junior members of his team would have taken time and she  didn't have time.

And, anyway, she didn't really want one of the more junior members of his team.

She was worried about little Rachel. She needed someone experienced and he was the consultant after all.

She found him at the nurses' station, checking a set of X-rays, his shoulders impossibly wide as he stood with his back to her.

Libby swallowed and dragged her mind back to her work. She already knew  he was a fantastic kisser. It was time to find out what he was like as a  children's doctor.

'I need a doctor to see a new admission for me urgently.' Her tone was  cool and ultra-dignified as she struggled to behave as though she hadn't  kissed him senseless and then woken up half-naked in his spare bedroom.  'I don't like the look of her. Seeing that the rest of your team are  elsewhere, I wondered whether you'd do it.'



Or was he the type of consultant who preferred to delegate to his staff?  He turned and she backed away a few steps, watching him warily.

In work mode he suddenly seemed very imposing.

'I'll see her.' He flicked off the light-box and moved towards her. 'What's the history?'

Relaxing her guard slightly, Libby fell into step beside him as they  walked back to the side ward. 'She was referred by her GP, but the  letter just says that she's worried about the child's temperature. Not  much else. The child is floppy, she's refusing fluids and I don't like  the look of her.'

She'd been a children's nurse long enough to trust her instincts and her instincts were shrieking about Rachel.

'Great.' He shot her a wry smile. 'It's wonderful to be a GP, isn't it?  If in doubt, refer to hospital and let someone else make the decision.'

'Before you insult GPs, you should probably know that my brother is doing a GP rotation-'

He lifted an eyebrow and his mouth twitched in humour. 'This is the same brother who forgot to buy you last night?'

Libby gave a wry smile at the reminder. 'I still have to speak to him  about that. But despite his shortcomings as a brother, he's a very  dedicated doctor. I expect he was caught up with a patient, which was  why he didn't show up. Unluckily for me.'

'But luckily for me,' Andreas breathed softly, his eyes narrowing as he looked at her.

She blushed hotly. 'Stop it!'

'Stop what?' He dealt her a slow smile. 'Libby, I haven't even begun yet.'

Without giving her a chance to speak again, he walked into the side ward  and introduced himself to Alison Miller before bending over the cot.

His swift shift from professional to personal and back again flustered  her more than she cared to admit, and Libby struggled to concentrate as  she followed him into the room.

Andreas didn't seem to be suffering from the same affliction. His eyes were on his tiny patient.

To the uninitiated it might have seemed as though he was just looking at  the baby, but Libby knew that he was accumulating vital pieces of  information. She saw his eyes rest on the child's chest, assessing her  breathing, saw the way that he noted her skin colour and the way she lay  limp and unresponsive in the cot.

He lifted his head and looked at Libby, the humour gone from his eyes. 'Temperature?'

'Forty point seven,' Libby said immediately, and his mouth tightened.

'How did you take it?'

'With a tympanic membrane thermometer. I find it the best method in a child of this age.'

It gave an accurate reading of a child's core body temperature and didn't cause undue distress.                       
       
           



       

Andreas nodded his approval and looked at the chart Libby handed him,  his eyes scanning the detail. Then he lifted his head and talked to the  mother about the illness, questioning her about immunisations and family  history.

As he finished scribbling on the notes, the baby started to cry fretfully.

Alison looked at them. 'Is it OK to pick her up?'

'Of course.' Andreas answered her with a reassuring smile before  slipping his pen back into his pocket. 'Cuddle her. Then I will examine  her. Libby, can I take a look at the letter from the GP?'

Libby handed it over. 'She did speak to Jonathon, your SHO.'

Alison scooped the baby out of the cot and looked at them anxiously.  'She said that it was probably just a virus but that it was best to be  safe as her temperature was so high.'

It didn't sound as though the GP had even examined the child.

Libby glanced briefly at Andreas but his expression didn't flicker.

'Right.' He checked in the notes and frowned. As Libby had commented,  there was virtually nothing in the referral letter. 'I'd like to examine  her again, please. I'll go and fetch my things while you get her  ready.'



Libby nodded and spoke quietly to Alison, explaining what was going on.

'Just hold her on your lap,' she suggested, fetching a chair to make it  easier. 'Dr Christakos needs to examine her ears, and it's easier if you  hold her like this, and like this … ' Libby demonstrated and Alison did  as she'd requested.

Andreas examined one of Rachel's eardrums and then waited while Libby  helped turn the child round so that he could examine the other ear.

He was very, very skilled with the child. Gentle and swift, with no fumbling.

'Her ears are fine, and so is her throat,' he said finally, unwinding  the stethoscope from around his neck. 'I'll just listen to her chest.'

Finally he rocked back on his heels. 'Her chest is clear so we need to  start thinking about the less obvious.' He frowned thoughtfully and  rubbed long fingers over his darkened jaw. 'Has she ever had a urinary  tract infection?'

Alison's eyes widened and she shook her head. 'No. Well, not to my knowledge. Isn't that something that adults get?'

'And some children,' Andreas told her. 'It can be a cause of unexplained  fever and I'm wondering if that could be the case with Rachel. There  are some tests I want to do. I need to take some bloods and I want a  urine sample.'

Libby pulled a face. 'That's never easy in a child of this age, as you  well know, but I'll certainly try. She hasn't had a wet nappy for a few  hours so we might be lucky.'

'Please.' Andreas gave her a nod. 'UTI is one of the commonest bacterial  infections of childhood. It accounts for about five per cent of febrile  illness. Rachel is very unwell and her temperature is very high. We  need a specimen of urine urgently, and in the meantime we'll give her  some ibuprofen to try and bring that temperature down.'

He scribbled on the drug chart and Libby went off to fetch the medicine and the equipment she'd need to take the urine sample.

Andreas caught up with her in the corridor. 'Your instincts are good.  That child is very sick,' he said quietly. 'I'll give you an hour to get  that sample and if you don't have any luck I'll have to do a  supra-pubic aspiration.'

'An SPA?' Libby pulled a face. A supra-pubic aspiration meant inserting a  needle into the bladder to draw off the sample of urine. It was  sometimes used in very small babies when a sample was needed urgently  and other methods had failed. 'Do we have to? That's invasive.'

'I'm aware of that.' Andreas ran a hand over his jaw, his expression  serious. 'I'm also aware that the risk of renal scarring in infants and  young children with undiagnosed and untreated UTI is high. I want to  start antibiotics as soon as possible and I can't do that until I've  taken a specimen. Call me if there's any change.'