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Second Thoughts Caroline Anderson Table of Contents ‘WOULDN’T it be nice to be pampered…’ ‘Pampered?’ Andrew flipped the file shut, put the cap on his fountain pen and sat back in his chair, locking his hands behind his head and stretching his long body. ‘I suppose it would.’ He chuckled. ‘I haven’t really thought about it. Too busy.’ Jennifer gave a rueful little laugh. ‘Mmm – and we’re only halfway through. Would you like a cup of tea?’ ‘Life-saver,’ he said with a grin. ‘I missed my lunch. Are you having one?’ She chuckled. On the sly. If the patients and their parents see me sitting down with a cup in my hand while they wait for another ten minutes I’ll be lynched!’ ‘Messy — bring it in here and we’ll tell them we’re having a case conference — on second thoughts, bring in the cup and the next patient. It would be nice to get home tonight.’ ‘My thoughts exactly,’ she said with a laugh. ‘What is it they call Friday? Poet’s Day?’ ‘Push off early, tomorrow’s Saturday.’ He snorted. ‘Fat chance.’ Jennifer picked up the stack of files and went out into the crowded waiting-room to be greeted by a chorus of dissent from the ranks. ‘Sister, are we going to be waiting much longer? We’ve got people for the weekend and we have to meet them off the train,’ one woman asked anxiously. ‘Yeah, if we sit here much longer we’ll be needing geriatrics, not paediatrics,’ a man put in. She smiled assurance at the bored children and disgruntled parents. ‘I’m sorry we’ve had to keep you so long; Dr Barrett had to deal with an emergency earlier and it’s put him back. He’ll be with you all as soon as he can.’ She gave the secretary the pile of notes and picked up the next few, then went into the kitchen and found one of the domestic staff. ‘Beattie, do me a favour, could you? Dr Barrett would love a cup of tea in his office, and I could do with one, but for heaven’s sake don’t take it out of here!’ ‘After you, are they?’ Jennifer laughed and tucked an escaping strand of red-brown hair back under her frilly cap. ‘Aren’t they always? There’s a joker out there, too. “We’ll be needing geriatrics soon”,’ she mimicked wickedly. ‘Just leave my tea on the side, I’ll come and grab it when I can.’ She went back into Andrew’s office and handed him the stack of files. ‘Here you go. William Griffin first.’ ‘Ah, right, our little man who’s failing to thrive. Let’s see what the results turned up.’ They opened the file and pored over the notes. ‘Stool, urine and blood cultures all sterile, no blood in the stools, blood chemistry and liver function all normal, and thyroid, and sweat sodium. That rules out thyroid problems or cystic fibrosis, or any nasty liver problems. The serology all looks good — no sign of infection. Did we get a chest X-ray back? And there should have been a barium meal and follow-through.’ ‘Yes, here we are, here’s the radiologist’s report.’ Jennifer pulled it out and handed it to him just as Beattie brought in the tea. ‘Wonderful, thank you.’ He flashed her a grateful smile and slipped it while he frowned at the report. ‘Do you know what I think?’ he said after a moment. ‘I reckon he’s got an intussusception.’ ‘Really? What about the stools? No sign of occult blood, or abdominal pain or vomiting. I know he had diarrhoea, but what about the cough? And the weight loss?’ ‘That could be due to the anorexia — if he’s off his food, he will lose weight. Anyway, the pain and vomiting and bloody stools are typical of acute, not chronic intussuseption. I think we’ll have another look, perhaps under sedation. Is there a surgeon we can call down?’ ‘Yes, I think it’s Ross Hamilton today. Shall I get him paged?’ ‘Not for a bit. I’d like an ultrasound of that bowel, and I’d like to examine him to see if I can feel anything this time. Could you call him for me?’ ‘Sure.’ She popped her head round the door. ‘William Griffin, please?’ His mother carried him in, a little boy of two and a half who looked at least fourth months younger. ‘Sorry, he’s dozed off,’ the mother explained. Andrew smiled apologetically at her. ‘I’m sorry I kept you waiting; we had a prem baby at lunchtime that needed my attention. Let him sleep for a minute while you tell me how he’s been getting on.’ ‘Oh, I can see him going downhill in front of my eyes — he’s very reluctant to eat, and he’s been sick a couple of times now. I’m so worried…’ Andrew laid his large hand over hers and squeezed gently. ‘Don’t fret. We’ve managed to rule out a lot of very nasty things. There are a couple of other possibilities that I want to eliminate with a few more tests. Has he had any abdominal pain?’ ‘Once or twice he’s complained about tummy-ache, and then a while later he’s had diarrhoea.’ Andrew nodded and made a couple of notes. ‘I’d like to feel his tummy, but I don’t want to wake him if I can avoid it. The more relaxed he is, the more I can feel. Do you think you could lay him down in your arms so I can try?’ She shifted carefully, and William made a tiny noise and remained asleep. ‘He’s out for the count, isn’t he?’ Andrew chuckled softly. ‘OK, let’s see what we can feel.’ He eased up the little T-shirt, slipped the shorts down a fraction and very gently and carefully made a minute inspection of the whole abdomen. After
