Italian Doctor, Dream Proposal. Margaret McDonagh

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СКАЧАТЬ couldn’t yet succumb to the urgent desire to forget everything else and carry Ruth off to bed. Not only did he have his own commitments but it was important for Ruth to learn and absorb as much as she could, both in terms of increasing her knowledge and being able to make a decision on whether or not to consider a change of direction in her career. However difficult, it was work first and pleasure second—when he had worked out a plan to win her trust and her heart.

      ‘There is much we don’t yet know about each other,’ he said when they were left alone again. ‘I am looking forward to learning all about you, but unfortunately I will have to wait a little longer.’ He smiled, noting the mix of anxiety and anticipation that warred in her expression. ‘We will have time when conference business has finished for the day—I’m sure we can slip away a bit early. But there is much for us to discuss on a professional level.’

      ‘Pippa Warren,’ Ruth ventured, mentioning the eight-year-old girl whose illness had been the catalyst, causing Ruth to email him in the first place.

      ‘Indeed, yes. Sadly her situation is far from rare. I learn about cases of delayed or incorrect diagnoses all too often, both in adults and children. And, with the latter, there are parents who are often at the end of their tether, with no idea which way to turn,’ he explained, momentarily distracted by the shimmering colours as Ruth nodded her head and her pale gold hair glinted in the sunlight.

      ‘That was certainly how Pippa’s mother Judith appeared when I first met her,’ Ruth agreed, a tiny frown knotting her brow. ‘She had been passed from pillar to post for several years, with various doctors insisting that Pippa was fine and telling Judith that she was fussing unnecessarily and an overanxious mother.’

      Rico heard similar stories far too frequently. ‘A mother’s instinct should never be dismissed out of hand. Judith and Pippa struck gold the day they walked into your surgery,’ he praised, seeing the hint of a blush colour her cheeks.

      ‘I don’t know about that.’

      ‘I do,’ he insisted, refusing to let her play down her achievements. ‘Many doctors, including those with far more experience than you, would not have recognised what you did, never mind follow it through with such tenacity.’

      Looking embarrassed, she shrugged. ‘I was just lucky.’

      ‘Luck had nothing to do with it,’ Rico chastised, determined that she acknowledge what she had done for Pippa and her mother. ‘You are a special doctor, Ruth. And equally as important as your academic excellence is that you really care about your patients. You listen to them and you give them your time—not easy given the pressures doctors are under and the limited period alloted to each consultation. But you go the extra mile, just as you demonstrated with Judith and Pippa. Whereas many others had taken the easy way out—treating only what they saw on the surface, or simply not understanding the relevance of the history and range of symptoms because of lack of training and knowledge—you trusted your instincts and you didn’t give up until you had solved the puzzle. And, with immunology, making a diagnosis is often a case of detective work, of sticking in there and not giving up. You did that, Ruth. On your own. I think—in fact, I know—that you are amazing.’

      ‘Thank you.’

      Two little words and yet they revealed so much, especially an inner aloneness that tightened a knot in his stomach and made him want to pull her into his arms and hug her tight. Her smile was tremulous, while the emotion in her voice, and the expression in eyes glimmering with a suspicion of unshed tears, brought the instinctive knowledge that support of her and belief in her had been in short supply in the past. He didn’t yet know why, but he intended to find out. And then he would ensure that she knew her own worth in the future.

      ‘Where do things stand with Pippa now?’ he asked, forcing himself to keep things professional.

      ‘We are waiting for the hospital appointment to come through. I saw Judith last week and she has lots of questions about what will happen when Pippa goes for assessment, and what is involved if the consultant confirms that it is CVID.’ It was through Rico’s help that Ruth had been able to determine that common variable immunodeficiency or CVID, was the most likely diagnosis. She paused, tucking a strand of hair back behind her ear, an endearing knot of consideration creasing her brow. ‘I’ve tried to reassure her as best I can, but I can’t answer everything for her.’

      ‘Have Pippa’s symptoms improved at all?’ he asked, happy to help Ruth set Judith and Pippa’s minds at rest about what might lie ahead for them.

      ‘There has been a small lessening in the severity of some of the symptoms now she has started the broad-spectrum antibiotics you recommended,’ Ruth told him, gratitude evident in her smile. ‘After her years of recurring infections and other problems, I’m hoping that there hasn’t been any permanent damage and that she hasn’t developed bronchiectasis.’

      Rico nodded as Ruth expressed her worries about the chronic condition that caused widening and scarring of the structures of the bronchi, or breathing tubes. It was one of his concerns for Pippa, too. ‘You said that the blood tests showed low levels of serum immunoglobins.’

      ‘That’s right. Very low.’ She glanced at him, then away again, but not before he had noted the flash of indecision in her eyes. A small sigh escaped and she seemed to be wrestling with something, but before he could question her, she grimaced and began speaking again. ‘I had a few problems getting the blood tests done.’

      ‘How do you mean?’ Rico frowned.

      ‘They are not tests that would usually be requested from a general practice surgery.’

      Rico’s frown deepened. ‘You had trouble from the hospital when you asked for the tests? Or from your own practice?’

      ‘Questions were asked. But the tests got done, that’s what matters. And it told us what we needed to know to help Pippa,’ Ruth said, but Rico was certain she was glossing over much of the struggle she had faced. He wanted to know who had put obstacles in her way. And why. But he let it go…for now.

      ‘The consultant immunologist will test Pippa’s antibody levels. The vaccine tests can take up to six weeks, which I know is frustrating, but it is important to define the degree of immunodeficiency,’ he explained, seeing the sharp intelligence in Ruth’s eyes and knowing she was absorbing all the information. ‘If the final diagnosis is CVID—as we believe it will be—Pippa will have immunoglobin replacement therapy, which should help end the cycle of recurring infections.’

      ‘I read that the immunoglobin infusions can be delivered either intravenously or subcutaneously?’ Ruth commented, a query in her voice.

      Rico nodded, unsurprised by her thoroughness. ‘That is so. At first Pippa will have regular treatment at the hospital, but once she is stabilised, and if both mother and daughter can cope, they can be taught how to administer the subcut treatment at home.’

      ‘The subcut sounds scary,’ Ruth pointed out. ‘Especially for an eight-year-old.’

      ‘Patients generally find it easier than they first think and it is well tolerated. It is better than prolonged IV access, which can increase the risk of infection and also becomes difficult if the veins are hard to find. And, because the home infusions are given once a week, they help to keep the levels more constant than with the IV infusion in hospital,’ he reassured her, although her desire to keep her patient informed was typical of the caring doctor he was coming to know.

      Aware that time was running out, he ran through some advice and suggestions that СКАЧАТЬ