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‘Let’s have a look at her,’ Natalie said. She knelt on the floor so she was nearer to the little girl’s height. ‘Hello, Charlene.’
‘’Lo.’ The little girl looked at her and scowled.
OK, she could do this. Thin, small for dates. The little girl was quite pale—perhaps she just didn’t get to play outside very much, or her mum was rigorous with a high protection factor suncream. Or maybe it was anaemic pallor. Natalie needed to check for icterus—or a yellowish colour—too. Starting with the child’s fingernails, palms, mucous membranes of the mouth and the conjunctiva. The conjunctiva would be the tricky part—children hated having their eyes fussed with.
‘Can you open your mouth for me and say “a-ah”?’ she asked.
A-ah.’ It lasted all of half a second, but it was enough to show Natalie that there was slight pallor in Charlene’s mouth but no icterus. It didn’t look as if there were any ulcers, but if Natalie saw any other sinister signs in the rest of the examination she’d try for a second look.
‘And can I look at your hands now?’
Charlene scowled at her and tried to climb back on her mother’s lap.
‘Charlene, be nice for the doctor,’ Ella admonished her.
‘It’s not fair. I want to sit on your lap. He always does.’ Charlene shoved at her brother, who promptly fell off Ella’s lap and started howling.
Kit stepped in smoothly. ‘Hey. How about I read you a story, Jayden, while the doctor talks to your mum and your sister?’ He took two shiny stickers from his pocket. ‘And if you can both sit really still while the doctor’s talking— and while the doctor’s looking at you, Charlene—you can both have a special sticker.’
Why hadn’t she thought of that? Natalie wondered. And as a distraction technique it clearly worked, because Charlene immediately nodded, climbed onto her mother’s lap and sat still, while Jayden plonked himself on Kit’s lap so he could see the pictures in the story book. Ella, who’d looked close to tears, suddenly relaxed.
Teamwork. Good teamwork. And Natalie wasn’t going to let herself think about the fact that Kit was reading a story to a little boy.
‘OK, Charlene. Shall we see if your hands are bigger than mine?’
‘Don’t be silly. They’ll be smaller.’
‘Bet they’re not,’ Natalie said, putting her own hands behind her back.
Charlene giggled. ‘They are.’
‘Show me, then.’
To Natalie’s relief, when she brought her hands round again, Charlene splayed her palms and pressed them against Natalie’s.
‘Side by side now. Palm up,’ Natalie said.
The little girl, clearly thinking it was a game, did as she asked. Her palms were definitely pale, though at least there was no sign of yellowness.
‘And the back, to see if you have princess nails?’
‘You haven’t got princess nails. They’re not glittery,’ Charlene said.
Natalie was glad that Charlene’s weren’t either: it gave her the chance to notice that the little girl’s fingernails were concave.
‘Can I look at your tummy now?’
‘Can I look at yours?’ Charlene asked.
‘Not this time,’ Natalie said with a smile. She definitely wasn’t baring any flesh in front of Kit. ‘But if you want to play doctors while I talk to your mummy, you can look at a doll’s tummy and see what you can hear through my stethoscope.’
Charlene wriggled a bit, but submitted to an examination. Natalie palpated her abdomen gently. She didn’t think there was a problem with the spleen, but maybe she should ask Kit for a second opinion. No sign of petechiae, reddish-purple pinhead spots, which would lead to a more sinister diagnosis. And, she was pleased to note, there were no signs of enlarged lymph nodes in Charlene’s neck.
As soon as she’d finished, Charlene was wriggling around on Ella’s lap again, and Ella pressed one fist into her lower back for support. Natalie gave Ella a sympathetic smile. It must be hard, dealing with small children when you were heavily pregnant and tired.
‘She’s a handful for such a little scrap,’ Ella said, looking embarrassed.
Oh, no. That hadn’t been what she’d intended at all. Or maybe Ella was just used to being defensive about her little girl. ‘Lively, the medical term is,’ Natalie said with a smile. ‘How’s she eating?’
Ella grimaced. ‘She’s picky. She won’t eat any vegetables—she just throws them on the floor—and she doesn’t like anything with meat in it, even if I try to hide it. But I can get her to eat potatoes and eggs, and she drinks milk and fruit juice.’
It was nowhere near a balanced diet, and Ella was clearly aware of it—distressed about it, too, so Natalie decided to take the gentle approach. ‘Kids are notorious for that—one day they’ll eat something, and the next they won’t touch it,’ she said reassuringly. ‘How about you take me through right from the start, from when she was first born?’ She could already see that Charlene had had a low birthweight, something that could predispose her to anaemia. ‘Did she have any jaundice afterwards?’
‘She was a bit yellow, but the midwife said it was normal.’
Natalie nodded. ‘Most babies have it to some extent.’ Though Ethan hadn’t. He’d been a perfect seven and a half pounds. No problems at all. Prolonged jaundice in the newborn could suggest congenital anaemia. ‘How long did it last?’
‘A week or so.’
‘How was she feeding?’
‘I breastfed her for about a week.’ Ella grimaced. ‘I tried so hard, but I just couldn’t manage it. My husband works long hours and it was too much for me. I got so tired—she seemed to be constantly attached to me, just taking little bits here and there, and I never got a break. And I was so sore.’
No support at home, and a husband who wasn’t there more often than not. Yeah, Natalie could empathise with that one. Really empathise. She couldn’t help glancing at Kit— and looked away again the second she met his cornflower-blue gaze. She just hoped she wasn’t blushing. Hell. This was meant to be about her patient, not about her and Kit.
‘So I switched her to formula milk,’ Ella continued.
And felt she’d failed as a result. It was very clear in Ella’s face—guilt, worry that she’d done the wrong thing, that she’d given up at the first hurdle without really trying. ‘Hey, that’s fine,’ Natalie said. ‘I know you read everywhere that breast is best, but you have to do what works for you as a family. Don’t listen to anyone who tries to make you feel bad or says you did the wrong thing. How did she take to formula milk?’
‘OK. I started putting a bit of rice in to her milk when she was two months old, to help her sleep a bit better and stop her being hungry in the night.’
Ouch. That sounded as if Ella had been desperate and had taken advice from the older generation—probably someone who’d gone on and on and on when Ella had been tired, about how Ella had been a baby who had always woken in the night and a bit of rice had never hurt her. Nowadays, the recommendation was to wait until at least four months before weaning.
Careful not to pass judgment, Natalie asked, ‘What happened then?’
‘She slept through, but she dropped a bit of weight then, and when she was three months the health visitor said maybe we’d be better off with a soya-based formula.’ Ella bit her lip. ‘But her charts still kept doing down.’
‘Do you have the charts with you, by any chance?’ Natalie asked.
‘Oh, yes. I’ve got her red book.’ Ella dug in her handbag and eventually brought out a slightly dog-eared book with a C written neatly on the front. Natalie flicked to the charts. At birth, Charlene’s weight had been a little below average, on the fortieth centile: meaning that sixty per cent of babies at the same age would be heavier than she was. By three months, Charlene had dropped to the tenth centile, from six to twelve months her weight was on the third centile, and the measurement the paediatric nurse had done a few minutes before showed she’d dropped below even that. Charlene’s height, too, was below average, on the twenty-fifth centile. But Ella had clearly taken care to have her daughter’s height and weight measured regularly, and as Natalie flicked through the book she noticed that all the immunisations were up to date.
‘She’s a bit of a tomboy,’ Ella said apologetically as Charlene stopped fidgeting, wriggled off her lap and headed straight for the toybox, emptying the entire contents out. ‘I’ve stopped trying to keep her clean all day. She starts out with fresh clothes, but if I changed her every time she gets grubby…well. I’d never have the washing machine off. So I just put her in the bath every night and give her a good wash.’ She bit her lip. ‘I was wondering if she had—’ her voice lowered in obvious embarrassment ‘—worms, or something. If that’s why she’s skinny. Can you do an X-ray or something to check?’
‘An X-ray’s probably not going to be very helpful right now,’ Natalie said gently, ‘and we don’t want to expose Charlene to radiation if we don’t really have to. As for the other problem—’ she’d picked up on how awkward Ella clearly felt ‘—you’d be surprised at just how common it is. Kids pick them up really easily. Does she talk about itching at all? Or do you see her scratching her bottom?’
‘Well, no,’ Ella admitted.
‘It’s unlikely to be worms, then,’ Natalie reassured her. ‘Though if you really want to be sure, when she’s asleep tonight, take a torch and shine it on her bottom. If you see anything white and wriggling, you’ll need to nip into the chemist and get some worming treatment—and do the whole family, not just Charlene. You’ll also need to keep her nails really short and get a soft nailbrush to keep them clean. What happens with worms is that a child scratches their bottom and some tiny eggs—so small you can’t see them—can end up beneath their nails. Kids that age normally have their hands in their mouth half the time so the eggs come out again, and the whole cycle starts again. It’s not anything you’ve done, so don’t worry.’ She paused. ‘Does Charlene eat anything odd?’ She was pretty sure the problem was chronic iron deficiency, and pica—eating abnormal things that weren’t food, such as coal—often went with it.
Ella shook her head. ‘I try and keep her off chips but sometimes it’s just easier to give in. At least then I know she’s eaten something.’
‘What about the toilet? Is she dry at night?’
‘Been out of nappies for ages. Just as well—Jayden isn’t, and I don’t think I could cope with three of them in nappies,’ Ella admitted.
Natalie smiled at her. ‘That’d be quite a tough call. Tell me, is anyone else in the family very light, or quite short?’
Ella shrugged. ‘We’re all pretty average, really.’
Not a genetic thing, then. The next thing to rule out was the possibility of a developmental disorder. She doubted it, because she’d heard for herself that Charlene’s speech was clear and her words were average for a three-year-old. ‘Is there anything you’ve noticed about the way she behaves, or the way she speaks?’
Ella shook her head. ‘She’s just a bit lively and a bit of a tomboy.’ She frowned. ‘You don’t think she has that thing where she’ll have to go on Ritalin, do you?’
‘ADHD? No,’ Natalie said, shaking her head. ‘I think it’s all to do with her being a fussy eater. It means she isn’t getting a balanced diet, and her iron stores are too low.’ Plus she’d been weaned too early. ‘She’s probably anaemic and iron deficient. It’s not serious,’ she reassured Ella, ‘and I can give you some iron supplements to help that. She’ll need to take them for about three months. But I’ll also refer you to a dietician, so she can help you with a few coping strategies to persuade Charlene to eat some meat and a few more vegetables.’
‘I do try,’ Ella said.
‘Of course you do. But sometimes you can do with a helping hand,’ Natalie said. ‘Being a parent’s one of the hardest jobs on earth.’ Though not being a parent could sometimes be even harder. She shook herself. ‘I’d like to take a blood sample and a wee sample, so I can check the chemicals in Charlene’s blood and that her kidneys and liver are working as they should be. I’ll give you a follow-up appointment for a fortnight’s time so I can check her weight and height and how she’s responding to treatment.’ She paused. ‘When are you due?’
‘In a month, though Jayden was three weeks early and this one might be the same.’
‘Maybe Charlene’s dad can bring her in?’ Natalie suggested.
‘He’s busy at work,’ Ella said swiftly. ‘And he never remembers appointments anyway.’
Unsupportive husband. Oh, Natalie knew all about that.
The sympathy must have shown on her face, because Ella added, ‘But I’ll try.’ With the same defensive note Natalie remembered in her own voice when she’d been the one making excuses.
Natalie took the blood sample—following it up immediately with one of Kit’s stickers—and talked Ella through taking the urine sample, then directed her to the reception area to book the next appointment.
‘What are you going to order?’ Kit asked as Natalie labelled the sample.
‘Full blood count, differential, electrolytes, calcium, phosphate, magnesium, iron, ferritin, folate, albumin and total protein, plus renal and liver function.’
He smiled. ‘Perfect.’
‘I didn’t miss anything, then?’
He spread his hands. ‘Maybe the involvement of Social Services?’
Natalie stared at him. ‘You must be joking. You don’t seriously think this is abuse by neglect, do you?’
‘Convince me,’ Kit said, his voice and face completely neutral so she couldn’t even guess what he was thinking.
‘In a month’s time, Ella Byford will have a newborn, a toddler and an under-four. Her partner clearly doesn’t pull his weight with the kids and she’s making excuses for him—sure, she’s having trouble coping right now and she needs a bit of support, but it’s definitely not neglect. Firstly, she’s the one who went to her GP because she was worried—it wasn’t the health visitor or GP prompting the appointment. Secondly, Charlene’s vaccinations are all up to date—which they wouldn’t be if she was being neglected. And, thirdly, Ella’s been meticulous about recording weight measurements. It’s not just the health visitor or GP’s measurements on the chart—some of the entries had Ella’s initials against them. This isn’t a mum who’s neglecting her kids, it’s a mum who’s having a rough time and needs support she isn’t getting from her partner.’
The words echoed between them and she couldn’t meet his eyes.
But Kit’s voice was perfectly level as he said, ‘Good call. I agree with your assessment. But,’ he added, ‘remember that you’re dealing with patients. You need to keep your personal feelings out of it.’
The rebuke stung, the more so because she knew it was merited. She was bringing her personal feelings into it, and it was the wrong thing to do.
‘I’ll bear it in mind,’ she said, matching the coolness of his tone.
‘Good. Next patient, I think.’
They got through the rest of the clinic, and Kit surprised her at the end by saying, ‘You did well.’
‘Thank you.’ Though she didn’t meet his eyes.
He sighed. ‘Tal—’
‘Natalie,’ she corrected swiftly. ‘My name is Natalie.’
‘Natalie.’ He gritted his teeth. ‘Look, we’re going to have to work together for a while. Six months, at least. So maybe we should just…I dunno. Clear the air between us.’
She thought not. Some things couldn’t be cleared. Ever.
‘We’re both due a break. Let’s go and have a coffee,’ he said.
She didn’t want to. How could she possibly sit across the table from Kit and pretend everything was all right? Because it wasn’t all right. Never would be.
He sighed. ‘Natalie, if we leave this, it’s just going to get worse. We need to set some ground rules. And it won’t kill you to sit at a table with me and drink coffee.’ His mouth gave the tiniest quirk. ‘Though I’d appreciate it if you drank it rather than threw it at me.’
‘Since when did you learn to read minds?’
‘It’s written all over your face,’ he said wryly.
At the canteen, she refused to let him pay for her cappuccino, and he didn’t press the point. He still drank black coffee, she noticed—obviously he hadn’t broken the habit from his student days. Or his habit of snacking on chocolate: he’d bought a brownie with his coffee.
‘So what made you become a doctor?’ he asked when he’d taken his first sip of coffee.
She exhaled sharply. ‘What do you think?’
‘The same reason I switched from surgery to paediatrics,’ he said softly. ‘It won’t change the past. But I might be able to help someone in the future. Stop them going through…’
He left the words unsaid, but she knew exactly what Kit was thinking. He could have been speaking for her. His voice had even held that same hopeless yearning when he’d said it—knowing he couldn’t change the past, but wanting to anyway. And wanting other people not to have to go through what they’d been through.
Natalie willed the tears to stay back. She’d cried all she was ever going to cry over Kit Rodgers. No more.
‘You’ve done well,’ Kit said. ‘Lenox was telling me how you were the star student of your year.’
Natalie shrugged. ‘I studied hard.’ And it hadn’t been completely new ground. She could remember some of it from the time when she’d helped Kit revise for his finals.
Tally really wasn’t going to make this easy. Not that he could blame her. He’d let her down when she’d needed him most.
But seeing her again, like this…It made him realise how much he’d missed her. How empty his life had been without her. And why he hadn’t bothered dating very often, let alone having a serious relationship. He’d always claimed once bitten, twice shy, and all that, but now he had to admit there was a little more to it than that.
Simply, nobody had ever been able to match up to Tally.
He understood why she hated him. He’d hated her, too, at one point. Especially the day she’d walked out on him and left him that bloody note saying she wanted a divorce and her solicitor would be in touch. But he’d missed her. Missed the way she’d said his name. Missed her smile, missed her quick wit, missed her touch.
Part of him thought that everything would be all right if he could just touch her, hold her, say he was sorry and ask her to wipe the slate clean.
But he knew that slate could never be wiped clean. And touching her was out of the question. There was a brick wall twenty feet high between them, with an enormous ditch either side filled with barbed wire.
Ah, hell. They were supposed to be clearing the air between them—his idea—and now he was tongue-tied. He made an effort. ‘Where are you living now?’
‘Birmingham.’
She wasn’t giving a millimetre—wouldn’t even tell him where she lived. Birmingham was a city of almost a million people, so she could be living just about anywhere within a radius of twenty miles of St Joseph’s.
‘Me, too. I’m renting,’ he said.
No response—no ‘Me, too’ or ‘I’m in the middle of buying a flat’. She was freezing him out. Frustration made him sharp. ‘I thought about seeing if there was anywhere to rent in Litchford-in-Arden,’ he said, watching her closely.
She flinched at the name of the village.
Good. So she wasn’t entirely frozen, then.
‘I drove through the village yesterday.’ He waited a beat. ‘Past our house.’
She still said nothing, but he noticed she was gripping her coffee-mug and her knuckles were white. She was clearly trying not to react, but he wasn’t going to let her do it. He’d get over the barrier between them, even if he had to make her crack first. He’d make her talk to him.
‘There was a…’
But there was a lump in his throat blocking the words. He couldn’t say it. It hurt too much, and at the realisation his anger died. What was the point of this? It was hurting both of them, and it wasn’t going to solve a thing.
‘A child. About six years old. Playing in the garden. I know,’ Tally said, her voice shaky as she continued what he’d been about to say. ‘I…went back, too. A couple of weeks ago. The woman was weeding the garden.’ Her breath hitched. ‘She was pregnant.’
Kit could remember Tally, pregnant, weeding their garden. Tending her flowers—she’d made it a proper cottage garden with hollyhocks and lavender and love-in-a-mist. To see another woman doing the same thing, in their garden—pregnant, with a child around six years old cycling round the garden—must have burned like acid in her soul. He’d found it hard enough to handle, seeing someone else living their dreams. For Tally, it must have been so much worse. And he hated the fact that he hadn’t been there to hold her, comfort her when she’d discovered it.
But he was here now. He could do something now. He reached out and took her free hand. Squeezed it gently. ‘It should have been us, Tally,’ he said quietly. ‘It should have been us.’
She wrenched her hand away. ‘But it isn’t. Wasn’t. We can’t change the past, Kit. We can’t go back. Someone else lives there now.’
In their house. The house where they’d made love. The house where they’d made a baby.
The house where their dreams had died. Where their love had been reduced to solicitors’ letters. Cold legal words. The end of everything.
‘We have to work together,’ Tally said, ‘but that’s as far as it goes. I’m sure we’re both mature enough to be civil to each other.’
‘Of course.’
A muscle flickered in her jaw. ‘I don’t think there’s anything left to say. We’ve both moved on.’
Had they? Are you married?’
‘That’s not relevant.’
Which told him nothing. And she clearly didn’t want to know whether he was or not, because she didn’t ask. He really, really should let this go.
So why couldn’t he?
‘Tal— Natalie,’ he corrected himself swiftly, ‘It doesn’t have to be like this.’
She pushed her chair back. ‘Let’s just agree to disagree, hmm?’
And then she was walking away from him.
Again.
And he was left with the feeling that he’d just made things a hell of a lot worse.
CHAPTER THREE
FOR the next couple of days, Natalie successfully continued to avoid Kit. But then they were rostered together again, this time on the paediatric assessment unit.
‘Dr Wilkins, I take it this is your first PAU?’ Kit asked.
On an intellectual level, she knew the formality was the right way to go—keeping a professional distance between them would be a good thing—but, oh, it stung. Had they really been reduced to this, to titles and surnames, after everything they’d shared? ‘Correct, Dr Rodgers,’ she responded, equally coolly.
‘Do you want to do this as a teaching session, or would you like to lead and I’ll back you up?’
He was giving her the choice. Not much of one. Either way, they had to work together. Closely. And she was finding it harder than she’d expected. Every time she glanced up at him she remembered other places, other times, when she’d caught his eye and seen a different expression there. Blue eyes filled with love and laughter. A lazy smile that had promised her some very personal attention once they were alone.
And now he was this cool, remote stranger. Just like he’d been at the end of their marriage. Reacting to nothing and nobody. Closed off.
‘PAU’s where we get the urgent referrals, isn’t it?’ she asked.
‘Yes.’
Where her diagnoses really could mean life or death. She took a deep breath. ‘Right.’ Was she ready for this?
‘Or we could lead on alternate cases. Do it together,’ Kit added.
His tone of voice on the last word made her look at him. The expression in his eyes was quickly masked, but she’d seen something there. Something that surprised her. Regret, wishing things could have been different?
She pushed it to the back of her mind. Of course not. She was just wishing for something that wasn’t there. Kit had shut her out six years ago, and he wasn’t about to invite her back into his life now.
They’d both moved on.
Well, he had.
‘OK.’
‘Want me to take the first one?’ he asked.