The Doctor's Secret Family

‘Can I have a look at you now, Jadine? I need to check all those things like your blood pressure and temperature and heart and then I’ll need to feel your tummy.’

Jadine’s eyes filled with tears. ‘Do I have to have a needle again?’

Her mother grabbed a tissue from the box on the locker and was ready to mop her daughter’s face. ‘You’ve got to be brave, Jadie. Dr Hannah’s here to make you better.’

‘You don’t have to have a blood test right now,’ Hannah said soothingly. ‘And if you need one later we’ll make sure we put that special cream on your skin to make it go all numb so it doesn’t hurt.’

Hannah went through the motions of a full physical examination. Consciously trying not to allow any bias towards a psychosomatic cause for the abdominal pain probably made her examination even more thorough than normal. As the commonest acute surgical emergency of childhood and usually seen in children over five years of age, appendicitis was still at the forefront of possible diagnoses but, as with the previous three admissions, there was no associated low-grade fever and no history of vomiting or anorexia. Whilst Jadine seemed to have genuine discomfort on palpation, Hannah could find no ‘guarding’, where the muscles became protectively rigid, when she pressed on the lower right quadrant of the abdomen.

‘Bowel habits normal?’ she queried.

‘Absolutely.’ Jadine’s mother nodded. ‘Colour and everything’s just the same as usual. I always check.’

Hannah hid her surprise. She might not have blinked if an infant’s mother knew more about her baby’s bowel habits than her own but it was a little unusual for a six-year-old not to be demanding some privacy in the toilet. Her own daughter was four and a half now. She might not bother to shut the door and she sometimes forgot to flush but she had been independent as far as toileting went for some time now.

‘Has Jadine had any bugs recently? Coughs or colds?’ An upper respiratory tract infection could cause inflammation of the mesenteric lymph nodes leading to nonspecific abdominal pain but Jadine’s lungs sounded as clear as bells, which fitted with Caroline’s denial of any viral illnesses.

‘You don’t have a family history of migraine, do you, Caroline?’

‘You asked me that last time. I get headaches.’ Caroline’s huff was resigned. ‘Usually when the bills are due to be paid. Wouldn’t call them migraines, though.’

Hannah nodded. Children who went on to have classical migraines commonly presented with recurrent episodes of prolonged abdominal pain but they usually had nausea or other symptoms accompanying the discomfort. As Caroline had pointed out, she was covering the same ground she had been over before.

‘We’ll need to get a urine sample again.’ She smiled at Jadine. ‘Do you remember that test, sweetie? The nurse takes you to the toilet and gives you a wash and you have to wee into the little jar. You don’t mind doing that again for us, do you?’

Jadine shook her head.

‘Good girl. That way we can do another check to make sure there’s no bugs hiding in your waterworks that might be making your tummy sore.’ And it might give Hannah a chance to have a talk to Jadine’s mother privately. ‘You tell me when you think you might be ready to go to the toilet.’

‘I want to go now.’

‘Do you? That’s great.’ Hannah stood up. ‘I’ll call Nina to come and look after you. She’s your nurse today, isn’t she?’

Jadine smiled. ‘Nina’s nice. She likes Barbies.’

‘She looks a bit like Barbie, doesn’t she, with that pretty blond hair?’ Hannah smiled. ‘It’s just like yours, isn’t it?’

Jadine returned the smile happily, which only reinforced Hannah’s impression that there was nothing seriously wrong with this child. ‘I’m going to take Mum off for a cup of tea while Nina’s looking after you,’ she told Jadine. ‘Is that OK?’

‘Sounds good to me,’ Caroline said. ‘I’d love a cup of tea.’ She eyed the notes Hannah was carrying anxiously, however, as the two women took their tea into Hannah’s office a few minutes later. ‘You’ve found something wrong with her, haven’t you? Something you didn’t want to talk about in front of Jadie.’

‘Not at all,’ Hannah said promptly. ‘It was time I had a break and I’m sure you could use one. It’s pretty stressful having your child unwell.’

Caroline sat down on the spare chair in the office. ‘How old is your daughter?’

‘Four and a half.’

‘Ah…nice age.’ Caroline’s smile was poignant. ‘Make the most of it.’ She caught Hannah’s glance. ‘It won’t be long till she starts school,’ she added. ‘And that’s when you really lose your baby.’

‘It’s a big milestone,’ Hannah agreed. ‘But we’re both looking forward to it.’

‘Are you?’ Caroline sounded surprised. ‘I cried for days. It wasn’t until I started being a mother help at school every day that things started to get better.’

‘Oh?’ The sound was intended to be encouraging but a warning bell was going off for Hannah. Just how deeply centred on her child was Caroline Briggs’s life? Munchausen syndrome by proxy was an unusual and bizarre form of child abuse that could possibly be triggered by a parent’s need for some form of attention. Was Jadine Caroline’s primary source of relationships with others?

Given Caroline’s concern about a prolonged and unexplained illness in her child, the syndrome needed consideration. And hadn’t Jadine said her symptoms disappeared when she stayed with her grandmother? It was highly unlikely that she was being cured by some magic ingredients in the puddings. Hannah would need to seek assistance from other medical professionals, as Peter had suggested. A conversation with the grandmother was probably overdue as well but now seemed like a good opportunity to gather some more background history.

‘Tell me about Jadine when she was a baby,’ Hannah invited. ‘Did everything go well with your pregnancy and her birth?’

‘Depends what you mean by ‘‘well’’,’ Caroline said heavily. ‘Getting pregnant was an accident, you know. I was only eighteen.’

Hannah nodded sympathetically. She had been twenty-eight and old enough to have known better, but she had learned the hard way about accidental pregnancies herself.

‘Dave, my boyfriend, wanted me to have an abortion but it was too late by then and, anyway, I didn’t want one.’

Hannah nodded again. It was an issue that had to be confronted by virtually every woman with an unplanned pregnancy but it had never rated more than a dismissive thought from herself. Maybe it had been easier being the only person involved in the decision-making process.

‘And I really wanted to marry Dave. I thought the baby would keep us together.’

Maybe the pregnancy hadn’t been so accidental in Caroline’s case. Hannah couldn’t imagine wanting to marry the father of her child. In the weeks before she had discovered she was pregnant, she had been more than happy with the thought that she would never have to see or speak to him again.

‘I never did well at school,’ Caroline continued. ‘Dropped out when I was fifteen. I knew I could be a good mum, though. It was all I ever really wanted to be.’

Hannah was silent. If feelings of self-worth came only from motherhood then a child starting school and beginning to move towards independence could present a problem. Not one that Hannah had ever had to face, however. She had worked hard at school and done exceptionally well. Her dream of going to medical school and becoming a doctor had been too much a part of her to be anything but temporarily superseded by becoming a parent. Not that Livvy wasn’t just as important in her life as her career but they represented totally different parts of who she was. And it didn’t make her a bad mother. Hannah knew she did both her ‘jobs’ well.

‘It worked for a while,’ Caroline sighed, ‘but he walked out on us when Jadie was two.’

‘That must have been tough.’

‘Yeah.’ The tone was bitter. ‘If it hadn’t been for my mum, I wouldn’t have survived.’

‘You were lucky to have her, then.’ Hannah had had no family to help her. She had had to cope on her own. Emotionally, financially, physically. It hadn’t been easy but it had made her strong and in retrospect Hannah was glad it had been that way. She could handle whatever life chose to throw at her now, which was why the odd feeling that there was something looming to be afraid of was so disconcerting. She had been through so much— what could happen that would be worse?

She tuned out the sound of Caroline’s voice listing the various crises with unpaid bills and the usual medical woes involved in raising a child as the horrible thought struck. Had she been tempting fate telling William about her daughter’s fantastic immune system? Or boasting that she never got sick? Livvy could get sick. Really sick. That would be the worst thing that could happen. A need to see her child and reassure herself followed hot on the heels of acknowledging that fear, and Hannah stole a glance at her watch. At this rate it might be hours before she could leave to collect her daughter.

‘I did most of it by myself.’ Caroline sounded defensive now. ‘I’m a good mother. I never put Jadie in child care. I did everything for her. I still do.’

Hannah simply nodded again. She wasn’t going to allow her own guilt buttons regarding child care to be pushed. She’d never been lucky enough to have a choice. Not with the kind of debt that medical training had left her with. She focused on Caroline as she finished her cup of tea. There were enough clues to make Hannah believe that a psychiatric evaluation of Jadine’s family circumstances would be worthwhile.

‘Jadine should be back in her room by now.’ Hannah stood up to signal an end to the conversation. ‘Will you be staying in with her tonight?’

‘I can’t.’

Hannah couldn’t help looking surprised. During the previous three admissions, it had been an uphill battle to persuade Caroline to even take an extended break from being with her daughter.

‘I’ve got a…date,’ Caroline confessed as she followed Hannah from the office. ‘He lives in Wellington and doesn’t get down this way very often. I’ll be back first thing in the morning, though.’

‘That’s fine,’ Hannah said calmly. ‘We’ll take good care of Jadine.’

She tucked the additional snippet of information away. So Caroline’s attention was being diverted to some extent away from her daughter. Munchausen’s was still a possibility but maybe it wasn’t by proxy. Perhaps Jadine was trying to find a way of dealing with the competition or a perceived rejection by her mother. Hannah’s query as the two women neared Room 4 was deliberately casual.

‘Does Jadine’s father still see her at all?’

‘No.’ The response was vehement. ‘And I intend to keep it that way, thanks.’

Hannah was quite grateful for an interruption from William, which precluded digging any further into the new can of worms she had opened regarding Jadine Milton’s family problems. He waited until Caroline had gone through the door of Room 4.

‘I’ve got Jamie’s serum electrolyte results. Sodium’s well above 150 mmol per litre so he’s hypernatraemic.’

‘Have you adjusted the IV solution?’

‘I’ve started 0.2 normal saline in 4.3 per cent glucose.’

‘Plus KCl?’

William nodded. ‘Thirty to 40 mmol per litre.’

‘Good. Restrict fluid to 150 mmol per kilo for the first twenty-four hours. We need to aim for total correction over about forty-eight hours. How’s he looking?’

‘A lot better.’

‘That’s good.’ Hannah was eyeing her open office door and thinking of the phone on her desk. A quick call to the Maysfield Child Care Centre to set her own mind at rest would make her feel a lot better. ‘Anything else going on that I should know about?’

‘No. Things are pretty quiet generally. About time you headed home, isn’t it?’

‘I won’t argue with that.’ It was only 4 p.m. but Hannah always started at 7.30 a.m. so she could leave before 5 when she wasn’t on call and get a few hours with Livvy before bedtime. She could take her paperwork home with her. It might take a while to find an appropriate way to document her suspicions about Jadine Milton, and a quiet hour late this evening would be a lot easier than trying to do it here, with the inevitable interruptions that would occur.

It would also mean she didn’t have to appear overanxious by ringing the child care centre with no reason other than to enquire whether her daughter looked healthy. She would find out soon enough for herself. Prompted by her desire to get away, Hannah hurriedly bundled up the paperwork she needed from her desk, stuffing it into her briefcase as she headed briskly for the door. She hadn’t quite secured her armload as she entered the corridor and turned to pull her door shut. Her movements were still swift. Far too swift to prevent a near collision as she swung around again to move towards the exit.

‘Whoops!’ Peter Smiley’s tone commiserated for the fact that Hannah’s paperwork was now strewn all over the floor but Hannah couldn’t have cared less about the mishap. She hadn’t even seen the shower of paper. She was too stunned to move her gaze away from the man standing beside Peter.

‘I was just coming to find you,’ Peter said cheerfully. ‘We’re doing the tour.’ Anything odd about Hannah’s expression was apparently being dismissed as embarrassment due to a clumsy moment. ‘This is our new consultant surgeon for Paediatrics, Hannah…Jack Douglas.’

Suddenly Hannah knew that her premonition had had nothing to do with her job application. Or any challenging case. Or her daughter’s state of health.

She had been right to trust her instincts because the premonition of disaster had been spot on.

The disaster was standing right in front of her. As large as life. And its mouth was moving. A rich, deep rumble of words sent reinforcements to enhance the paralysing visual effects Hannah was still experiencing.

‘Hello, Hannah,’ Jack Douglas said. ‘This is a bit of a surprise, isn’t it?’

CHAPTER TWO

IT WASN’T a surprise.

A surprise, in Hannah’s book, carried the connotations of something pleasant. An unexpected bonus. A small gift, perhaps. Or discovering the first daffodil in bloom beneath the huge old copper beech tree, as she and Livvy had done only yesterday. Or even finding that a young patient was doing better than expected on a chosen course of treatment.

It certainly wasn’t being faced with a man Hannah had had no expectations of ever seeing again. A man who had no knowledge of the very real and solid connection he had with her life. A man who had the potential to cause untold damage if he learned about that connection now. This was no surprise. It was a shock. A stunning blow that was now causing a horrible crawling sensation through Hannah’s limbs as its paralysing effects wore off. It took only another split second to realise she was in command of her facial features again and Hannah hoped that the cool smile she summoned would cover up her initial response to this encounter.

‘It certainly is a surprise,’ she murmured. ‘How are you, Jack?’

‘Surprised.’ Dark brown eyes were regarding Hannah with a faintly wary expression. Was he waiting for a signal of some kind? Or was the ‘surprise’ as unpleasant from his side as it was from Hannah’s? ‘I’ve spent the last few years imagining you living in Auckland,’ he added. A question was lurking in those dark eyes now but Hannah was not about to answer it. What could she say, anyway? That she had turned the job offer down because the thought of working in close proximity to him had been too offputting?

Peter had watched the brief exchange with raised eyebrows and a grin that indicated at least one person found this encounter a pleasant surprise. ‘You two know each other,’ he said unnecessarily. ‘This is great. As friendly faces in this department go, Jack, Hannah is top of the list.’

‘I’m sure she is.’ Jack’s observation was polite but definitely reserved.

‘We don’t know each other that well.’ Hannah was finally able to drag her gaze away from Jack’s face. To stop the unconscious catalogue of the minor changes that five years had wrought. A little grey amongst the dark brown curls that were shorter than they used to be. A network of fine lines at the corners of those deceptively warm eyes. A subtle change in the overall relationship between his features that gave the impression that Jack Douglas had done a lot of living in the last five years and that tears as well as laughter had been involved. She stamped firmly on the twinge of curiosity that surfaced. She didn’t want to know. ‘We met briefly, a few years ago.’ Hannah kept her words directed at Peter. ‘We were both applying for positions at the same hospital.’

What did Jack mean, he had been imagining her working in Auckland? National Children’s Hospital was large but not large enough to simply not notice a member of staff for years. She was able to look at Jack again now without revealing anything more than a polite interest. ‘Have you had enough of the ‘‘City of Sails’’, then?’

‘I didn’t take the surgical residency in Auckland,’ Jack responded. ‘I was called back to England and had to remain there due to family commitments.’

Ah, yes…the family commitments. The family Jack had denied having. No wife, he had confirmed blithely when Hannah had specifically asked. No kids. And she had believed him. The recollection of her gullibility made her tone tight.

‘And you’ve brought your family with you this time?’

‘Of course.’

‘Jack has a son,’ Peter informed Hannah. ‘He’s seven.’

‘How nice.’ Hannah’s smile was as tight as her tone. As if she didn’t know. ‘He should enjoy living here.’

‘He’s a bit older than Livvy,’ Peter added sociably.

‘Who’s Livvy?’ Jack queried.

‘Olivia…my daughter,’ Hannah was forced to respond. So much for hoping to avoid this area of her personal life, but maybe it was just as well to get it out of the way. Alarm that she might not succeed in letting Jack know this was none of his business made her tone sharp, but it was impossible to speak of Olivia without an emotional response and her smile loosened just a little.

‘How old is Olivia?’

The alarm bells clamoured with more urgency. If Hannah told the truth then Jack would probably put two and two together in a matter of moments. They had been together just over five years ago. Olivia would turn five in a few months. It was hardly rocket science.

Peter filled the fractional gap with ease. ‘She’s just a wee dot,’ he said warmly. ‘Seems like only yesterday she was born. How long ago was it, Hannah? Three years?’

Bless Peter’s vagueness about anything personal rather than professional. Hannah’s smile was far more relaxed this time. ‘She’s four,’ she said. ‘Just,’ she added hurriedly, for good measure.

She could see the lightning-fast calculations going on in Jack’s mind, and she saw the flash of what could have been pain cross his features momentarily. She welcomed the sense of being in control it gave her. The last time she had felt in control like this had been the moment she’d walked out on Jack and taken charge of her life to prevent history repeating itself. Hannah had coped then and she was damned well going to cope now.

Jack’s expression hardened and it was easy to see what he was thinking. She had gone from him straight into the arms of another man. What they had had together had meant nothing to her. Hannah lifted her chin. Why should she care what he thought of her? Far better to believe that than learn the truth.

‘Excuse me.’ The approach of Caroline Briggs made Hannah realise that they were blocking a significant portion of the corridor and her scattered papers were littering the only available route past. ‘I don’t want to tread on anything important.’

Some of the papers were copies from Jadine’s file and Hannah didn’t want Caroline to think that her daughter’s privacy was unprotected. She stooped hurriedly to rescue some of the paperwork. ‘Sorry, Caroline. We’re a bit in the way here, aren’t we?’

‘No problem. Can I help?’

‘I’ll manage.’ Hannah glanced up to smile at Caroline. ‘Are you heading home now?’

‘I’m off to the hairdresser, actually.’ Caroline looked a little defensive. ‘I might even get my nails done. Jadie’s sound asleep so there didn’t seem much point in waiting.’

‘Sounds like a good idea,’ Hannah said reassuringly. She couldn’t help noticing her own nails as she reached for another sheet of paper. Short and practical, they were as bare of any colour as her fingers were of rings. One nail was badly broken, thanks to having to fix the blockage in that pipe that fed the water trough last weekend. She hadn’t noticed what a contrast they presented to Caroline’s hands. Jadine’s mother’s fingertips looked as though a session at a beauty salon was not an unusual experience. ‘Enjoy your night out,’ she added. ‘And don’t worry about Jadine. We’ll call you if there’s any change.’

Peter watched Caroline as she walked away from them. ‘That’s the mother of our frequent flyer, isn’t it?’

Hannah nodded. She picked up the last of her papers and shoved them into the side pocket of her briefcase. Glancing up, she caught sight of Caroline’s back as she waited for the lift. The curls in her blond hair also advertised careful maintenance but the dark line at the roots suggested that putting off an appointment might have been inconvenient. Especially with an important date lined up tonight.

The less than charitable thought was uncharacteristic enough to astonish Hannah. Had Jack’s appearance rattled her enough to provoke such an unprofessionally judgmental attitude? Or was it more that he had made her aware of her own appearance? Could he see the extra lines that the years had undoubtedly etched into her own face? At least she had no grey hairs visibly lightening the dark honey blond, but compared to Caroline’s Hannah’s hair was as boring as her nails. Dragged back into a practical ponytail, the dead straight tresses were only this long because Hannah couldn’t be bothered going to a hairdresser very often. The uncomfortable ability to see herself as Jack probably did made it difficult to concentrate on what Peter was saying.

‘Any reason to suspect this visit is genuine?’

‘Oh, I think it’s genuine enough,’ Hannah responded. ‘I’m just not convinced that it’s medical. I think I’ll take your advice and bring the psych services in on this one.’

Jack had been watching Caroline enter the lift and Hannah found a curiosity she thought she had extinguished years ago resurface. What was his wife like? Carefully groomed, she suspected, as befitted a surgeon’s partner. No broken nails for her and no schoolgirl hairstyle tied with one of her daughter’s scrunchies which sported a bright red teddy-bear ornament. Peter had only mentioned the child she’d already known about so maybe Jack and his wife hadn’t been lucky enough to add a daughter to their family. Well, he would just have to do without, in that case. No way was he going to lay any claim to Livvy.

‘Are the psych services intended for the mother or the child?’ Jack’s interest was courteous but Hannah had no desire to continue this conversation. Shades of her talk with Caroline earlier today about the difficulties of being a solo parent were haunting her now but instead of feeling proud of having coped so well by herself Hannah was aware of a rapidly building resentment.

It was because of this man standing in front of her that she had had to fight to keep her career alive. Had struggled to keep a roof over her head and pay the bills and keep herself and Livvy clothed and fed. She had managed to get through the episodes of illness, including that nasty dose of chickenpox last year. Had survived countless sleepless nights with a tiny baby and the worries of new parenthood without the kind of relief or simply support a loving partner could have provided. Life over the last five years—and for the foreseeable future— would have been very different indeed if it hadn’t been for Jack Douglas.

‘Possibly for the doctor at this rate,’ she said lightly in response to Jack’s query. ‘You’ll have to excuse me but I don’t want to be late collecting my daughter from day care.’