chromosome is lost.’
Ed frowned. ‘So what does that mean?’
‘There are twenty-three pairs of chromosomes in the human body, and pair twenty-three is the one that decides if you are a girl or a boy. For a girl, chromosome pair twenty-three is XX, and for a boy it’s XY. The results of Charlotte’s karyotype—that’s what we call the chromosome analysis—show that her X chromosome is missing in number forty-five. So, instead of being XX, she’s just X.’
‘So that’s my fault?’ Fran asked.
If it had been Jennifer sitting there with Andrew, she wouldn’t have asked that question—because he would have made the accusation first. They didn’t know her background, so it was all her fault.
‘It’s nobody’s fault. The missing X can come from the father’s sperm or the mother’s egg. We don’t know which.’ Ramón spread his hands. ‘It happens in one in two thousand girls.’
‘What about boys?’ Ed asked.
‘A boy can’t have Turner’s syndrome,’ Ramón said quietly. ‘The Y chromosome can’t survive on its own, so the male foetus would be miscarried.’
‘But Lottie seems so normal. Just a bit shorter than the other little girls in her class.’ Fran sighed. ‘I thought the health visitor was making a fuss over nothing.’
‘No. With Turner’s syndrome, the gene responsible for long bone growth is missing, so without any help Lottie wouldn’t grow any taller than one metre forty-three—that’s about four foot eight,’ Jennifer said.
‘So she’s always going to be small?’ Ed asked.
‘She’ll always have Turner’s syndrome,’ Ramón said. ‘But we can help with the height. We can give her some growth hormone, starting around her sixth birthday, though it’s quite a long course of injections.’
‘And then she’ll be normal height?’ Fran asked hopefully.
‘A little shorter, but not as small as if she’d had no treatment at all. Provided the treatment is consistent, of course. If she starts missing injections, it won’t work as well. There’s also the possibility of using an anabolic steroid to boost her growth.’ Ramón shifted in his seat. ‘She’ll also need oestrogen treatment from around the age of thirteen.’
‘Why?’ Ed asked.
‘Nearly all girls with Turner’s syndrome have a problem with their ovaries,’ Jennifer said. ‘They don’t function, so Lottie won’t have periods or develop breasts if she doesn’t have oestrogen and progesterone treatment.’
Fran shook her head, clearly finding it hard to take in. ‘So she can’t have children?’
‘She may be able to, with IVF treatment,’ Ramón said. ‘But she needs oestrogen for another reason—without it, her bones won’t mineralise properly and she’s more likely to have osteoporosis when she’s older.’
‘There are side effects with oestrogen treatment,’ Jennifer added. ‘She might get headaches, feel bloated or a bit sick, but that will go away within a couple of weeks.’
‘But she’s not going to die early or anything?’ Ed asked. ‘Or be slow at school? Her teacher said she wasn’t good at building things, but we thought that was…well, because she was a girl. She’s never been into Lego or anything, not like our son.’
‘She’s not going to die early,’ Ramón said. ‘Not from Turner’s syndrome, at least. Her body doesn’t have any oestrogen, though, so she may have memory problems, and she’ll find maths and spatial tasks harder.’
‘But with support she can do well. There are support groups for families and we can put you in touch with them,’ Jennifer said. ‘Plus Lottie can come to a clinic here to smooth her path through to adolescence and adulthood.’
‘There are some things you need to watch for,’ Ramón said. ‘Girls with Turner’s syndrome have a lot of middle ear infections and that can lead to deafness, so you must take her to the doctor whenever you think she might have an ear infection.’
‘Regular hearing checks are a good idea, too,’ Jennifer added. ‘As well as checking her blood pressure. She’s also more likely to get diabetes and thyroid problems, but we can do regular checks at clinic.’
‘So where do we start?’ Fran asked.
‘We can book you into clinic and give you some leaflets about the condition from the support groups,’ Jennifer said. ‘You need some time to think about it, decide what you want to do and what’s best for Lottie.’ She gave the little girl a hug. ‘Well done, Lottie. Show Mummy what a lovely picture you’ve drawn.’
‘It’s me, you, Daddy and Raphie,’ Lottie said, handing her mother a piece of paper. ‘Our family.’
A tear trickled down Fran’s cheek. Jennifer stood up and placed a hand on her shoulder. ‘I know it’s a bit of a shock, but, honestly, Lottie can lead a perfectly normal life. As long as she’s got a family who loves her, she’ll be fine.’
A family who loves her. Something Jennifer had never had. She pushed the thought away. She didn’t need a family. She had the ward. And that was enough. It had to be.
If he didn’t get a move on, he’d miss her. Ramón stuffed his white coat in his locker, grabbed his briefcase and made his way to Jennifer’s office. It was empty. Maybe she was changing. He had no idea which way she’d go home—did she live near enough to walk, or did she park in the staff spaces next to the old Victorian entrance to the hospital?—but she would definitely have to go through the reception of the paediatric ward.
He lingered deliberately, pretending to check through some leaflets. And then the back of his neck heated. He turned round to find that his early-warning system was spot on. She was just leaving the ward.
Her out-of-uniform clothing was just as unassuming as he’d expected. A pair of jeans, a loose navy T-shirt and flat shoes. She was a million miles away from the fashion clotheshorses he’d dated in the past. And yet she still had the power to make his heart miss a beat. What was it about her?
As she pushed through the double doors, he fell into step beside her. ‘Jennifer, I didn’t have a chance to thank you properly for your help with the Harpers.’
She shrugged. ‘It’s my job.’
‘But it was appreciated.’
‘Fine,’ she said coolly.
‘Jennifer, is there a problem?’ he asked.
‘Only the memo I received this afternoon. I don’t like being manipulated, Ramón.’
She’d said his name without prompting this time. That was a good sign…but her eyes said otherwise. She was furious with him. ‘I didn’t mean to manipulate you.’
‘No? So you didn’t pull strings to get Pete to write that memo, then?’
He sighed. ‘How else was I going to persuade you to go out with me, except to treat it as work?’
‘By asking me.’
‘I did. You refused.’
‘Exactly. And don’t use that “I’m a lonely Spaniard in a strange city” line with me. You could have asked anyone else on the ward.’
‘True.’
‘So why didn’t you?’
‘Because I wanted you,’ he said softly.
‘Well, you can’t have me.’
‘Your blood sugar’s low.’
She frowned. ‘What?’
‘You’re grumpy. It’s a side-effect of low blood sugar—therefore you clearly need some food. Let me take