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The Greek Children's Doctor(9)

By:Sarah Morgan


Despite her best intentions, Libby found her eyes drawn to his mouth.

Being kissed by Andreas had been a totally new experience and for a moment she was lost, remembering.

'Libby?' His voice prompted her gently and she gave a start and her eyes flew to his, registering the gleam of amusement.

Damn.

He'd caught her staring.

She backed away, totally flustered. 'I'll get back to Rachel.'

His smile widened. 'Fine. Call me if you're worried.'

Trying to steady her thundering pulse rate, Libby turned and walked away  from him, wondering how on earth she was supposed to get any work done  with him smiling at her like that.                       
       
           



       

Determined to forget about him, she focused her attention on Rachel, trying to obtain the sample they needed so badly.

She didn't succeed and less than an hour later she was forced to find Andreas again.



She came straight to the point, her tone brisk. 'I'm worried about  Rachel. Her temperature isn't coming down and I'm nursing her in a nappy  and a sheet. I've tried to get a clean sample of urine but it's been a  nightmare.'

Andreas frowned. 'Has she drunk anything?'

'Barely.'

'And she hasn't passed urine in the last hour?'

Libby shook her head. 'Her nappies are dry.'

Andreas nodded. 'I'll do a supra-pubic aspiration,' he said immediately.  'I know it's invasive but at least it's definitive and frankly I'm  worried about her condition. We'll do an ultrasound to check she has  urine in her bladder. I'll need a 21G needle-'

'I know what you need,' Libby slotted in, already on her way to gather  the right equipment. She just hoped the new consultant knew what he was  doing.

She laid up a trolley and was back by the cot minutes later.

'Someone needs to hold her very firmly in the supine position,' Andreas  said calmly, using the ultrasound to check that the baby had a full  bladder.

'I'll hold her,' Libby said immediately, 'and I know her mum will want  to be with her. She's just nipped to the phone to call home.'

At that moment Alison returned and Andreas quietly explained why they needed to aspirate the bladder.

'Her temperature is going up and we need to obtain a sterile specimen of urine.'

Alison looked pale and tired. 'Libby was trying to get a clean catch.'

'I haven't managed it,' Libby said softly, 'and we really, really need  to see if she's got bugs in her urine. In a child of this age this is  the only reliable method and we need to send it to the lab before we  start antibiotics.'

Alison nodded. 'So do it.' Her mouth tightened. 'Can I stay with her?'

'Do you want to?' Andreas spoke gently and Alison sucked in a breath.

'Yes. It's upsetting but I couldn't bear to think that I wasn't there for her when she needed me.'

Andreas exchanged glances with Libby and then turned away to wash his hands, scrubbing them methodically.

Libby prepared the trolley and then held the child while he cleaned the area with alcohol and allowed it to dry.

She watched as he inserted the needle gently, aspirating as he advanced  it into the bladder, speaking softly to the baby as he worked. It was  obvious from the skill and speed of his fingers that he'd performed the  procedure many times before.

When he had the sample he withdrew the needle and his gaze flickered to Libby.

'Can you apply pressure to that site for about two minutes? Then cover  it with a dressing.' He placed the sample on the trolley and turned to  Alison. 'It's possible that she will have a bit of blood in her urine  for the next couple of days so if you notice that in the nappy don't be  alarmed. You can call Libby if you're worried.'

Libby lifted the gauze and checked that the bleeding had stopped and  then applied a dressing. Then she swiftly dressed the sobbing baby and  handed her to her mother for a cuddle.

'Just hold her for a bit and she should settle,' she advised. 'She's had  paracetamol and ibuprofen so hopefully her temperature should come down  soon.'

Alison looked at her. 'And the doctor really thinks that she has an infection in her bladder?'

'Yes, he does. The reason he wants to treat it quickly is because it can spread to the kidneys and cause damage.'

'But with treatment she should be OK?'

Libby nodded. 'Dr Christakos will probably want to do more tests to  check, but you brought her in straight away so the chances are we've  caught it before the infection has had time to spread.'



Satisfied that Alison understood the explanation, Libby followed Andreas  to the nurses' station where he was tapping details into the computer.

'What happens now?'

'She's dehydrated so I'm going to put a line in and get some fluid into  her. I'm also going to start her on IV antibiotics. When she's picked up  a bit we can give her the rest of the course orally.'

'You're not going to wait for the results?'

He shook his head. 'It's important to treat her fast. If necessary we  can change the antibiotics when the results come back. If the UTI is  confirmed, we'll need to do more tests.' He didn't lift his eyes from  the screen. 'All young children have to be investigated for  vesicoureteric reflux.'                       
       
           



       

'So will you do an ultrasound?'

'Amongst other things.' He looked up and smiled briefly. 'Reflux and  scarring can be missed by ultrasound in this age group so she will have  to have cystography.'

'And you'll send her for a DMSA scan?'

'Yes. And, Libby … ' He sat back in his chair. 'We need to try and get her to take oral fluids.'

'I know.' Libby nodded, well aware of that fact. 'Now we've got the  urine sample I'll concentrate on that. I've explained the importance of  fluids to the mother.'

'Is she breast-feeding?'

Libby shook her head. 'Bottle.'

Andreas finished what he was doing and stood up. 'Let's get that drip up.'

'I'll get a trolley ready.'

Libby spent the rest of the shift looking after Rachel, reassured by the  fact that Andreas was within shouting distance if the baby's condition  worsened. Apart from one trip down to the A and E department to assess a  child, he spent most of the day on the ward, getting to know the  children and meeting his team.

Libby tried hard to forget what had happened the night before but it was  difficult to concentrate with those sexy dark eyes following her round  the ward.

He was a man, she reminded herself firmly. Which meant only one thing as far as she was concerned.

Trouble.

Libby was updating Rachel's charts at the nurses' station when she  glanced up and saw a young girl hovering by the entrance of the ward.

Her eyes widened.

'Adrienne?' She recognised Andreas's niece immediately, dropped her pen  onto the desk and walked across to her. 'Hi, there. Aren't you supposed  to be at school?'

The girl glared at her defiantly but her lip wobbled slightly. 'I've run away. And I'm not going back. Ever. I hate it there.'

Oops.

Her dark hair looked more unruly than ever and there were red rings  around her eyes where she'd been crying. She looked very vulnerable and  very young.

Libby leaned against the wall, her expression sympathetic. 'Do you want to tell me why?'

Adrienne shrugged and stared at her shoes. 'I don't fit in.'

Libby frowned. 'In what way?'

Adrienne didn't look up. 'I'm … different.'

'We don't all have to be the same. Being different can be good,' Libby said softly, but Adrienne shook her head.

'It isn't. It's horrible.' Her voice cracked slightly and she rubbed the  toe of her shoe along the floor. 'I'm not trendy. I don't know how to  be trendy. I tried to do my hair differently and wear make-up but  Andreas made me wash it before I left the house. I hate him.'

Remembering the badly applied make-up, Libby privately thought that Andreas had made totally the right decision.

'How old are you, Adrienne?'

'Twelve. But I'm nearly thirteen,' she added quickly.



Libby nodded. 'It can be really tough being thirteen. I remember it well.'

'You?' Adrienne looked at her in disbelief and Libby nodded wryly.

'I had a terrible time. I was skinny as a rake, had a brace on my teeth  and I wore glasses. And, to make it worse, my sister was stunning. Trust  me-the other kids had a really big choice of names to call me. I know  all about being different.'

Adrienne stared. 'But you're trendy.'

'Now maybe, but not then,' Libby assured her dryly. 'Who goes shopping with you?'

'Yiayia-I mean, my grandmother, and she's very, very conservative,'  Adrienne said gloomily. 'Or Andreas, and he's even worse. He's so strict  and traditional he won't let me buy anything remotely daring. Given the  chance, he'd dress me in a sack.'

'Hmm, I can see that neither of those would be decent shopping  partners,' Libby agreed, examining her nails thoughtfully. 'You know, if  you wanted to, I could pick you up from school one day and take you  shopping.'

The minute she'd uttered the words, part of her wanted to withdraw the  offer. What on earth was she thinking? Offering to help Adrienne would  inevitably bring her into contact with Andreas and she'd already decided  to avoid him as far as possible.