The Doctor's Secret Family. Alison Roberts

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СКАЧАТЬ ‘You’ve got to be brave, Jadie. Dr Hannah’s here to make you better.’

      ‘You don’t have to have a blood test right now,’ Hannah said soothingly. ‘And if you need one later we’ll make sure we put that special cream on your skin to make it go all numb so it doesn’t hurt.’

      Hannah went through the motions of a full physical examination. Consciously trying not to allow any bias towards a psychosomatic cause for the abdominal pain probably made her examination even more thorough than normal. As the commonest acute surgical emergency of childhood and usually seen in children over five years of age, appendicitis was still at the forefront of possible diagnoses but, as with the previous three admissions, there was no associated low-grade fever and no history of vomiting or anorexia. Whilst Jadine seemed to have genuine discomfort on palpation, Hannah could find no ‘guarding’, where the muscles became protectively rigid, when she pressed on the lower right quadrant of the abdomen.

      ‘Bowel habits normal?’ she queried.

      ‘Absolutely.’ Jadine’s mother nodded. ‘Colour and everything’s just the same as usual. I always check.’

      Hannah hid her surprise. She might not have blinked if an infant’s mother knew more about her baby’s bowel habits than her own but it was a little unusual for a six-year-old not to be demanding some privacy in the toilet. Her own daughter was four and a half now. She might not bother to shut the door and she sometimes forgot to flush but she had been independent as far as toileting went for some time now.

      ‘Has Jadine had any bugs recently? Coughs or colds?’ An upper respiratory tract infection could cause inflammation of the mesenteric lymph nodes leading to nonspecific abdominal pain but Jadine’s lungs sounded as clear as bells, which fitted with Caroline’s denial of any viral illnesses.

      ‘You don’t have a family history of migraine, do you, Caroline?’

      ‘You asked me that last time. I get headaches.’ Caroline’s huff was resigned. ‘Usually when the bills are due to be paid. Wouldn’t call them migraines, though.’

      Hannah nodded. Children who went on to have classical migraines commonly presented with recurrent episodes of prolonged abdominal pain but they usually had nausea or other symptoms accompanying the discomfort. As Caroline had pointed out, she was covering the same ground she had been over before.

      ‘We’ll need to get a urine sample again.’ She smiled at Jadine. ‘Do you remember that test, sweetie? The nurse takes you to the toilet and gives you a wash and you have to wee into the little jar. You don’t mind doing that again for us, do you?’

      Jadine shook her head.

      ‘Good girl. That way we can do another check to make sure there’s no bugs hiding in your waterworks that might be making your tummy sore.’ And it might give Hannah a chance to have a talk to Jadine’s mother privately. ‘You tell me when you think you might be ready to go to the toilet.’

      ‘I want to go now.’

      ‘Do you? That’s great.’ Hannah stood up. ‘I’ll call Nina to come and look after you. She’s your nurse today, isn’t she?’

      Jadine smiled. ‘Nina’s nice. She likes Barbies.’

      ‘She looks a bit like Barbie, doesn’t she, with that pretty blond hair?’ Hannah smiled. ‘It’s just like yours, isn’t it?’

      Jadine returned the smile happily, which only reinforced Hannah’s impression that there was nothing seriously wrong with this child. ‘I’m going to take Mum off for a cup of tea while Nina’s looking after you,’ she told Jadine. ‘Is that OK?’

      ‘Sounds good to me,’ Caroline said. ‘I’d love a cup of tea.’ She eyed the notes Hannah was carrying anxiously, however, as the two women took their tea into Hannah’s office a few minutes later. ‘You’ve found something wrong with her, haven’t you? Something you didn’t want to talk about in front of Jadie.’

      ‘Not at all,’ Hannah said promptly. ‘It was time I had a break and I’m sure you could use one. It’s pretty stressful having your child unwell.’

      Caroline sat down on the spare chair in the office. ‘How old is your daughter?’

      ‘Four and a half.’

      ‘Ah…nice age.’ Caroline’s smile was poignant. ‘Make the most of it.’ She caught Hannah’s glance. ‘It won’t be long till she starts school,’ she added. ‘And that’s when you really lose your baby.’

      ‘It’s a big milestone,’ Hannah agreed. ‘But we’re both looking forward to it.’

      ‘Are you?’ Caroline sounded surprised. ‘I cried for days. It wasn’t until I started being a mother help at school every day that things started to get better.’

      ‘Oh?’ The sound was intended to be encouraging but a warning bell was going off for Hannah. Just how deeply centred on her child was Caroline Briggs’s life? Munchausen syndrome by proxy was an unusual and bizarre form of child abuse that could possibly be triggered by a parent’s need for some form of attention. Was Jadine Caroline’s primary source of relationships with others?

      Given Caroline’s concern about a prolonged and unexplained illness in her child, the syndrome needed consideration. And hadn’t Jadine said her symptoms disappeared when she stayed with her grandmother? It was highly unlikely that she was being cured by some magic ingredients in the puddings. Hannah would need to seek assistance from other medical professionals, as Peter had suggested. A conversation with the grandmother was probably overdue as well but now seemed like a good opportunity to gather some more background history.

      ‘Tell me about Jadine when she was a baby,’ Hannah invited. ‘Did everything go well with your pregnancy and her birth?’

      ‘Depends what you mean by ‘‘well’’,’ Caroline said heavily. ‘Getting pregnant was an accident, you know. I was only eighteen.’

      Hannah nodded sympathetically. She had been twenty-eight and old enough to have known better, but she had learned the hard way about accidental pregnancies herself.

      ‘Dave, my boyfriend, wanted me to have an abortion but it was too late by then and, anyway, I didn’t want one.’

      Hannah nodded again. It was an issue that had to be confronted by virtually every woman with an unplanned pregnancy but it had never rated more than a dismissive thought from herself. Maybe it had been easier being the only person involved in the decision-making process.

      ‘And I really wanted to marry Dave. I thought the baby would keep us together.’

      Maybe the pregnancy hadn’t been so accidental in Caroline’s case. Hannah couldn’t imagine wanting to marry the father of her child. In the weeks before she had discovered she was pregnant, she had been more than happy with the thought that she would never have to see or speak to him again.

      ‘I never did well at school,’ Caroline continued. ‘Dropped out when I was fifteen. I knew I could be a good mum, though. It was all I ever really wanted to be.’

      Hannah was silent. If feelings of self-worth came only from motherhood then a child starting school and beginning to move towards independence could present a problem. Not one that Hannah had ever had to face, however. СКАЧАТЬ