The Italian Surgeon Claims His Bride

‘A pump. The needle would be there in my skin? All the time?’

‘No. Actually, the whole pump system is placed under the skin. Like a pacemaker. You wouldn’t feel it.’ Jenna’s steps slowed. ‘I should get Ella dressed before we go downstairs.’

‘Why bother?’ Maria ruffled Ella’s curls and kissed her. ‘What’s so wrong with having breakfast in your pyjamas?’

‘Absolutely nothing.’ Laughing, they moved on together towards the stairs. ‘And are you sure you don’t mind me wearing jeans?’

‘You must wear whatever makes you happy, Jenna. I’m going to get into old clothes soon. It’s such a lovely day and I wish to do some gardening.’

‘But it’s Wednesday.’

Maria sighed. ‘Si. So it is.’

Wednesdays weren’t just one of Paul’s heavy days for the operating theatre. It was also one of the weekdays that Louise chose to pay an extended visit to Hamilton Drive.

She arrived while they were still in the kitchen and the laughter Ella had generated with her own attempts to get porridge and stewed apples anywhere but into her mouth faded abruptly.

Louise bent to kiss Ella but drew back. ‘What is that in her hair?’

‘Porridge.’ Jenna grinned. ‘I’ll go and get her cleaned up. It’s time to get dressed anyway.’

‘Yes.’ Louise eyed the jeans Jenna was wearing as she stood up to lift Ella from the high chair. The housekeeper, Shirley, distracted her from making any comment.

‘Coffee, Mrs Gibbs?’

‘Yes. Black. No sugar.’

Shirley caught Jenna’s gaze as she went past the back of Louise’s chair. The subtle roll of the housekeeper’s eyes was eloquent. As if she didn’t know by now how Louise took her coffee. It was also intended to be encouraging, Jenna realised. They were all in for a long day.

One that didn’t start very well.

‘I’ll take Danielle out for her walk,’ Louise announced when Jenna brought her back downstairs.

Weather permitting, the walk was part of the routine on the days Louise visited—at least three times a week.

‘She likes to show her off,’ Shirley had confided to Jenna on Monday evening. ‘That’s why she likes to have her all dolled up in those clothes she keeps buying.’

Like the smocked dress and shiny shoes Jenna had dressed her in that morning.

‘I’ll bet that where she picked up her bug,’ Shirley had added in a mutter.

A bug she wasn’t completely over.

‘I’m not sure it’s a terribly good idea today,’ Jenna said to Louise. ‘She’s been running a temperature and was coughing in the night.’

‘She looks fine to me.’ Louise took Ella from Jenna’s arms. ‘And it’s a glorious day.’

Jenna couldn’t contradict either statement. Ella did look much better, even though very little of that breakfast had made it anywhere near being swallowed. And it was a gorgeous day. One of those autumn gems that was still enough to leave the warmth of the sunshine undiminished. If they stayed at home, she would have encouraged Danielle to spend time playing outside. Was there any real difference in being taken for a walk in her stroller?

She caught Maria’s gaze and the hint of alarm that Jenna, the expert, thought that her precious Ella might still be unwell. If Paul was here, Jenna thought, he would make the decision in an instant and nobody would dare argue. But if Jenna put her foot down, Louise would be very unlikely to comply. Maria would oppose her fiercely and Jenna might find herself caught in the middle of a small domestic war.

‘Maybe just for a little while,’ she heard herself suggesting. ‘It is a lovely day.’

‘I’ll take a complete change of clothes for her.’ Louise had already assumed victory. ‘And a warm jacket. Get them ready, would you, please, Jennifer?’

Jenna climbed the stairs, annoyed with herself. If she had been on the familiar territory of a paediatric ward and wearing a uniform, instead of faded denim jeans, there was no way she would have hesitated to wield authority of behalf of someone as vulnerable as a baby.

But she had no authority here. Or not enough. Louise would be a formidable adversary and quite apart from the stress a disagreement with Maria could cause, her discontent had seen the last nanny sent packing. Jenna couldn’t understand why Louise was accorded the power she seemed to have—it was a piece of the puzzle she had yet to find. And it was a power bestowed purely by default. Paul could remove it with a click of those long surgeon’s fingers any time he chose.

So why didn’t he?

Whatever the reason, if Jenna wanted to keep this job and succeed in the challenge she had set herself, she would have to choose any battles with care, and the evidence that Ella needed to be kept within the confines of her own home today was not strong enough. Even Paul had seemed happy enough that morning with the improvement in Ella’s condition.

The phone call at 11.30 a.m. to pass on the information that Louise had met a friend and would be lunching at a café was no surprise but it was a worry. The easterly breeze that had sprung up was cool enough to bring Maria in from tending her basil and tomato plants.

Jenna passed on the message, adding that she hoped Louise would not have Ella sitting outside.

‘Surely not!’ But Maria cast an anxious glance at the clock. ‘She will need to have her back in time for her sleep.’

‘There’s a man involved,’ Shirley warned. ‘You mark my words.’

Jenna had lunch in the kitchen with Maria and Shirley and Shirley’s husband, John, who helped in the garden. She couldn’t help casting frequent glances through the windows at scudding clouds that were now blocking the sunshine at regular intervals. By 1.30 p.m. the temperature had dropped significantly and there was still no sign of Ella’s return.

‘Maybe I should go and collect them in my car,’ Jenna said finally. ‘Even if they had lunch inside, it’s a good fifteen-minute walk home and I’m really not happy about Ella being outside. It looks like it could start raining at any minute.’

‘We could ring her cellphone,’ Shirley suggested, ‘and find out what café they’re in.’

But there was no need, because they heard the sound of the front door and a moment later Louise pushed the stroller into the kitchen. A stroller that contained a wailing baby.

‘She’s just a bit tired,’ Louise said defensively, as Maria rushed to pick up and comfort her grandaughter.

‘Dio mio! She’s cooking!’

‘It got cold. She needed her jacket on.’

‘Jenna?’ The plea from Maria was almost desperate but Jenna was already in action, her instincts sounding a loud alarm.

She took Ella from Maria, quickly removing her outer clothing, but it did little to cool her and she was too distressed to swallow the liquid paracetamol Shirley fetched under Jenna’s direction. What worried Jenna more, however, 58 was the rate and depth at which the child was breathing.

Trying to calm her down had to be the first priority. Jenna cradled Ella in her arms, letting the small head snuggle into her shoulder. She rocked her and made soothing sounds.

‘It’s OK, sweetie…Everything’s OK…’

Maria stood nearby, twisting her hands, her forehead creased with worry. Shirley stared at Louise between helping Jenna by fetching the medication and supplying a damp facecloth, but Louise was ignoring everybody. She helped herself to coffee and then sat down at the table.

Ella’s exhausted sobbing finally ebbed and it was then that Jenna could assess what she had instinctively feared. The baby was in quite severe respiratory distress. Tiny nostrils were flaring and the muscles around her ribs retracting with the effort to breath. It was taking longer for her to breathe out than in and Jenna could now hear a faint wheeze. And the rate was high. Far too high.

‘We need to take Ella to hospital,’ she announced.

Maria went pale and crossed herself. Louise lifted her head sharply.

‘Don’t be ridiculous! She’s just got a bit of a sniffle and she’s tired. I’m sorry we didn’t get back earlier but I met…Gerald, the man I had dinner with last week and he asked me to have lunch and…well, I could hardly refuse, could I?’

Shirley gave a soft I-told-you-so sort of snort but nobody bothered answering Louise.

‘Could someone bring a car around?’ Jenna asked. ‘I don’t want to put Ella down until I have to. Getting upset again is only going to aggravate the trouble she’s having with her breathing.’

‘She can’t breathe? Oh…’ Maria was hovering like a mother hen.

‘What’s wrong with her?’ Louise demanded.

‘I think she may have bronchiolitis.’

‘But she seemed so much better this morning,’ Maria almost wailed. ‘I don’t understand!’

‘It often presents as a mild viral illness and the symptoms were well controlled with the paracetamol. If it had just been a cold, she wouldn’t have deteriorated like this.’

‘You should have known it was more than a cold. You’re a nurse, aren’t you?’ Louise was getting to her feet. ‘I hope you’re not suggesting this is my fault.’

‘What’s important right now is that we get Ella to hospital so she can be monitored properly and treated if this gets any worse.’

‘I’ll get the car,’ John offered.

‘I’m coming, too,’ Maria said firmly.

‘So am I,’ Louise snapped.

Maria paused with dramatic suddenness in her route to the door. She waved her arms in the air. ‘Wait! I must ring Paolo and let him know we’re coming.’

Jenna blinked. Of course Paul should know his daughter was about to turn up in the emergency department, but what would he think if he received an alarmed call from his mother—probably in voluble Italian? Keeping everybody calm was part of her job in order to prevent the atmosphere around Ella becoming overly tense.

‘Maybe Shirley could do that,’ she suggested. ‘That way we won’t be held up.’ She caught the housekeeper’s gaze. ‘Just let him know I’m a bit worried so we’re coming in to get Ella properly checked.’

‘Sure.’ Shirley nodded. ‘I guess they’ll let me leave a message if he’s busy in the operating theatre or something.’

This wasn’t the way Jenna would have wanted any of them to see more of Paul Romano. She should have been more careful what she wished for.

Both grandmothers had been asked to wait in the relatives’waiting area and Ella was sitting on Jenna’s knee in an emergency department cubicle. This was due solely to the fact that if anyone tried to remove her from Jenna’s arms she immediately began to cry. With her nanny, she was calm enough to allow oxygen tubing to be held in the vicinity of her face in an attempt to bring up the level of oxygen circulating in Ella’s blood.

‘What’s the saturation now?’

‘Ninety per cent.’ The paediatric registrar summoned to examine Ella flinched visibly at the unexpected, crisp query coming from behind his back. Paul had finally appeared, still dressed in his theatre scrubs and clearly impatient to find out what was going on.

Jenna was thankful she had her arms full of Ella and something she could at least pretend to be completely focussed on. She was also thankful for the conversation now going on between the consultant and the registrar, however, because it gave her a legitimate excuse to steal frequent glances at Paul.

She had never seen him looking like that.

She had never seen anyone looking like that.

The suggestion of weariness and, undoubtedly, anxiety for his daughter had given the surgeon an even more sombre professionalism. Or was it because they were now on his working turf?

Jenna was struck anew by this man’s apparent aloofness to his child. He was acting like any other doctor might in discussing a patient. Apart from his customary flick of Ella’s curls in greeting, Paul had made no attempt to comfort his sick daughter. No cuddles. No soothing words.

Was Jenna dreaming in thinking she could establish a loving connection if there was so little to build on?

The aloof, professional demeanour was at complete odds with his appearance. Too many hours under a theatre cap would have flattened those black curls. Had Paul run distracted fingers through his hair to make it look so tousled and unruly?

And the scrub suit was baggy. A deep V-neck revealed dark curls on his chest and his bare arms also had a covering of fine, very dark hair.

Jenna felt almost embarrassed. It felt like catching her employer on the way out of the shower with just a towel wrapped around his waist. Much worse than a casual chat in the kitchen of his own home. Worse even than idle curiosity about what he might wear to bed. She could feel herself flushing, as though at any moment Paul would look over to see her thoughts in a bubble over her head.

How ridiculous! As if she hadn’t seen surgeons around hospitals or in wards, still wearing theatre clothing.

But she had never been involved in their private lives, had she? Jenna felt uncomfortable. Like she was stepping over a boundary of some kind. Only she didn’t know what the boundaries were.

‘You’ll have to admit her, then,’ Paul was saying.

‘Yes.’

‘Provisional diagnosis?’

‘Bronchiolitis. Probably RSV. We’ll try a viral nasal wash to identify the causative pathogen but it won’t make any difference to treatment at this stage.’

‘Which is?’

‘We’ll give oxygen to keep the sats above ninety-two per cent. IV or nasogastric fluids at seventy five per cent maintenance and we’ll keep a careful watch on her and transfer her to the paediatric ICU if she deteriorates.’

‘Chest X-ray?’

‘Not indicated, given that she has typical clinical features.’

Those typical clinical features that were listed in any paediatric textbook were feeling far more personal to Jenna. This was Ella in her arms. Feeling too hot, her nose rubbing against Jenna’s shoulder as her head twisted in discomfort. Feeling heavy and exhausted but forced to continue the laboured breathing.

Poor little thing. Jenna had never experienced empathy with her patients to quite this degree—even the ones that had stolen her heart. She rocked Ella gently and shifted the end of the oxygen tubing a little closer to the baby’s flushed features.

Paul’s attention, with startling suddenness, was transferred to Jenna. ‘Why did you leave it so long to bring her in?’

The scrub suit and the body it revealed were forgotten instantly. So was any embarrassment. The unfairness of apportioning blame for Ella’s condition got her back up just as instantly.

‘We came as soon as I saw she was in respiratory distress.’

His gaze didn’t leave hers but Jenna wasn’t going to be the first to look away. To imply guilt. It wasn’t easy. The weight of Ella in her arms and her concern for the child was making her feel bad enough already. Guilt was only a heartbeat away, even if it was unjustified.

‘You’re a paediatric nurse. I would have expected you to pick this up well before it required urgent hospital admission.’ The approval of her care of Ella that he had expressed only that morning seemed long forgotten.

He was a paediatric surgeon, for heaven’s sake. He had seen how well Ella had looked at 6 a.m., stuffing a piece of toast into her mouth, and he must know just how quickly the condition of young children could deteriorate.

Then again, maybe Ella hadn’t gone downhill so suddenly. There had been a period of several hours when she had been away from the observation of trained eyes.

‘Mrs Gibbs had taken Ella out for a walk.’

‘And you allowed this?’ Paul looked astonished. And then disappointed. Jenna felt a wave of shame. He had every right to be disappointed in her. The fact that she had let herself down in a professional capacity was bad enough to make Jenna feel that disappointment like a physical blow.

She hated that Paul thought less of her. There was no point trying to defend herself or, worse, suggest that he had been in a position to make the judgement call himself.

Or to explain that there had been no clinical grounds on which to forbid the outing later in the morning and that she had been trying to act as a professional and keep her own emotions out of an already volatile mix. That she had been trying to act as a nanny and not a substitute mother.

She may have nothing to feel guilty about but from Paul’s point of view, she had failed in her duty to his child. Bad enough for a nanny to be negligent but for someone who was supposed to be a senior paediatric nurse, it was inexcusable.

The bright flush in her cheeks might have gone unnoticed except that Paul paused, having flicked back the cubicle curtain. He turned once again.

‘My mother tells me that Ella prefers your care to anyone else’s at present.’

Jenna lifted her chin but said nothing. Did he really have to sound as though the idea that she could still do any part of her job well enough was surprising?

‘She will need someone to stay in hospital with her during this admission. Day and night.’

Jenna nodded her agreement. She had no argument with his statement. She approved of the fact that Paul recognised its importance. Maybe he did care, just a little. Many babies were left to the care of nursing staff overnight because family circumstances made it necessary. Some even had to be separated from their family members during the day as well, but the cooperation and recovery of children who had a familiar, loving presence with them at all times was measurably better.

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