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‘Just hold her on your lap,’ she suggested, fetching a chair to make it easier. ‘Dr Christakos needs to examine her ears, and it’s easier if you hold her like this, and like this…’ Libby demonstrated and Alison did as she’d requested.
Andreas examined one of Rachel’s eardrums and then waited while Libby helped turn the child round so that he could examine the other ear.
He was very, very skilled with the child. Gentle and swift, with no fumbling.
‘Her ears are fine, and so is her throat,’ he said finally, unwinding the stethoscope from around his neck. ‘I’ll just listen to her chest.’
Finally he rocked back on his heels. ‘Her chest is clear so we need to start thinking about the less obvious.’ He frowned thoughtfully and rubbed long fingers over his darkened jaw. ‘Has she ever had a urinary tract infection?’
Alison’s eyes widened and she shook her head. ‘No. Well, not to my knowledge. Isn’t that something that adults get?’
‘And some children,’ Andreas told her. ‘It can be a cause of unexplained fever and I’m wondering if that could be the case with Rachel. There are some tests I want to do. I need to take some bloods and I want a urine sample.’
Libby pulled a face. ‘That’s never easy in a child of this age, as you well know, but I’ll certainly try. She hasn’t had a wet nappy for a few hours so we might be lucky.’
‘Please.’ Andreas gave her a nod. ‘UTI is one of the commonest bacterial infections of childhood. It accounts for about five per cent of febrile illness. Rachel is very unwell and her temperature is very high. We need a specimen of urine urgently, and in the meantime we’ll give her some ibuprofen to try and bring that temperature down.’
He scribbled on the drug chart and Libby went off to fetch the medicine and the equipment she’d need to take the urine sample.
Andreas caught up with her in the corridor. ‘Your instincts are good. That child is very sick,’ he said quietly. ‘I’ll give you an hour to get that sample and if you don’t have any luck I’ll have to do a supra-pubic aspiration.’
‘An SPA?’ Libby pulled a face. A supra-pubic aspiration meant inserting a needle into the bladder to draw off the sample of urine. It was sometimes used in very small babies when a sample was needed urgently and other methods had failed. ‘Do we have to? That’s invasive.’
‘I’m aware of that.’ Andreas ran a hand over his jaw, his expression serious. ‘I’m also aware that the risk of renal scarring in infants and young children with undiagnosed and untreated UTI is high. I want to start antibiotics as soon as possible and I can’t do that until I’ve taken a specimen. Call me if there’s any change.’
Despite her best intentions, Libby found her eyes drawn to his mouth.
Being kissed by Andreas had been a totally new experience and for a moment she was lost, remembering.
‘Libby?’ His voice prompted her gently and she gave a start and her eyes flew to his, registering the gleam of amusement.
Damn.
He’d caught her staring.
She backed away, totally flustered. ‘I’ll get back to Rachel.’
His smile widened. ‘Fine. Call me if you’re worried.’
Trying to steady her thundering pulse rate, Libby turned and walked away from him, wondering how on earth she was supposed to get any work done with him smiling at her like that.
Determined to forget about him, she focused her attention on Rachel, trying to obtain the sample they needed so badly.
She didn’t succeed and less than an hour later she was forced to find Andreas again.
She came straight to the point, her tone brisk. ‘I’m worried about Rachel. Her temperature isn’t coming down and I’m nursing her in a nappy and a sheet. I’ve tried to get a clean sample of urine but it’s been a nightmare.’
Andreas frowned. ‘Has she drunk anything?’
‘Barely.’
‘And she hasn’t passed urine in the last hour?’
Libby shook her head. ‘Her nappies are dry.’
Andreas nodded. ‘I’ll do a supra-pubic aspiration,’ he said immediately. ‘I know it’s invasive but at least it’s definitive and frankly I’m worried about her condition. We’ll do an ultrasound to check she has urine in her bladder. I’ll need a 21G needle—’
‘I know what you need,’ Libby slotted in, already on her way to gather the right equipment. She just hoped the new consultant knew what he was doing.
