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‘It’s just a shock, you know?’ Mrs Bruce clung to Alice’s arm like a lifeline and Gio nodded as he pulled out another chair and sat down next to her.
‘First let me tell you that I trained as a plastic surgeon,’ he said quietly, ‘and I specialised in the repair of cleft lips and palates so I know a lot about it.’
Mrs Bruce crumpled the tissue in her hand. ‘Why are you a GP, then?’
Gio pulled a face and spread his hands. ‘Unfortunately life does not always turn out the way we intend. I had an accident which meant I could no longer operate for long periods. So I changed direction in my career.’
‘So you’ve operated on children with this? Can you make them look normal?’
‘In the hands of a skilled surgeon the results can be excellent but, of course, there are no guarantees and there are many factors involved. A cleft lip can range in severity from a slight notch in the red part of the upper lip…’ he gestured with his finger ‘…to a complete separation of the lip, extending into the nose. The aim of surgery is to close the separation in the first operation and to achieve symmetry, but that isn’t always possible.’
He was good, Alice thought to herself as she sat quietly, listening along with the mother. Really good.
Mrs Bruce sniffed. ‘Will they do it straight away when she’s born?’
‘They usually wait until the baby is ten weeks old. The repair of a cleft palate requires more extensive surgery and is usually done when the child is between nine and eighteen months old so that it is better able to tolerate the procedure.’
‘Is it a huge operation?’
‘In some children a cleft palate may involve only a tiny portion at the back of the roof of the mouth or it might be a complete separation that extends from front to back.’ Gio reached for a pad and a pen that was lying on Alice’s desk. ‘It will make more sense if I draw you a picture.’
Mrs Bruce watched as his pen flew over the page, demonstrating the defect and the repair. ‘How will she be able to suck if her mouth is—?’ She broke off and gave a sniff. ‘If her mouth looks like that?’
‘There are special bottles that will help her feed.’ Gio put the pad down on the desk. ‘Looking after the child with a cleft lip and palate has to be a team approach, Mrs Bruce. She may need help with feeding, with speech and other aspects of her development. The surgeon is really only one member of the team. You will have plenty of support, be assured of that.’
Alice sat patiently while Gio talked, reassuring the mother, answering questions and explaining as best he could.
Finally, when she seemed calmer, he reached for the pad again and scribbled a number on a piece of paper. ‘If you have other worries, things you think of later and wish you’d asked, you can call me,’ he said gently, handing her the piece of paper.
She stared at it. ‘You’re giving me your phone number?’
He nodded. ‘Use it, if you have questions. If the hospital tells you something you don’t understand. Or you can always make an appointment, of course.’
‘Thank you.’ Mrs Bruce gave him a shaky smile and then turned to Alice and squeezed her hand. ‘And thank you, too, Dr Anderson.’
‘We’ll tackle the problem together, Mrs Bruce,’ Alice said firmly. ‘She’ll be managed by the hospital, but never forget that you’re still our patient.’ She watched Mrs Bruce—a much happier Mrs Bruce—leave the room and then turned to Gio. ‘Thanks for that. I didn’t have a clue what to say to her. And I don’t know much about cleft palates. Will the baby have long-term problems?’
Gio pulled a face. ‘Possibly many. They can be very prone to recurrent middle-ear infections, which can lead to scarring of the ossicular chain in the middle ear, and that can damage hearing or even cause deafness.’
‘Why are they susceptible to ear infections?’
‘In cleft babies, the muscle sling across the palate is incomplete, divided by the cleft, so they can’t pull on the eustachian tube,’ he explained. ‘Also, scar formation following the postnatal correction of cleft lip and palate can lead to abnormal soft tissue, bone and dental growth. There has been some research looking at the possibilities of operating in utero in the hope of achieving healing without scarring.’
This was his area. His speciality. And she was fascinated. ‘What else?’
‘Sometimes there is a gap in the bone, known as the alveolar defect. Then the maxillary facial surgeon will do an alveolar bone graft.’
There was something in his face that made her reach out and touch his arm. ‘Do you miss it, Gio?’
‘Sometimes.’ He gave a lopsided smile. ‘Not always.’
‘Well, you were great with her. I knew you would be.’
‘You were good with her, too.’ He shot her a curious look. ‘Do you even realise how much you’ve changed.’
‘Changed? How have I changed?’ She went back to her chair and hit a button on her computer.
‘You were touching a patient and you were doing it instinctively. You were offering physical comfort and emotional support.’
