Pediatrician's Unexpected Second Chance
Auteur
Kate Hardy
Lezers
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Hoofdstukken
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CHAPTER ONE
‘MUM? WHAT HAVE you done to your eye?’
Mandy stifled a groan. If her bloodshot eye was visible to her daughter on a small phone screen, then it was going to be really obvious in real life. Just what she didn’t need on her first day in her new job. ‘I’m fine,’ she said. ‘I must’ve sneezed in my sleep, or something, and burst a blood vessel in my eye. It’ll go away by itself in three or four days. And, no, it doesn’t hurt. Stop fussing.’
‘I’m nearly seven months pregnant. I’m allowed to fuss,’ Gemma said with a grin. ‘I’m not going to hold you up. I just wanted to wish you good luck on your first day.’ Her grin broadened. ‘Mind you, if you go in with a pirate’s eye patch, it’ll fascinate all the kids. The ones who are crying will stop and ask if you’re Captain Hook’s sister, and the ones who aren’t crying will perk up and ask if you’ve got a ticking crocodile following you. Or perhaps a parrot for your shoulder.’ She squawked meaningfully. ‘You could always pretty up an eye patch. Stick on some sequins and some lace. Actually, no—that can be my class’s task this morning, to design you an eye patch. The prettier, the better.’
‘If I turn up wearing an eye patch covered in sequins, then my new job-share’s going to think the hospital’s hired someone who either won’t take the job seriously, or is trying a bit too hard to get featured on his TV show,’ Mandy said drily.
‘Ah, yes. Dr Sexy.’ Gemma laughed. ‘Do you know how many of my colleagues have asked me if you’ll give him their phone number?’
Daniel Monroe—Mandy’s fellow joint Head of Paediatrics—was also the star of London Victoria Children’s Ward, a documentary that showed life in the Paediatric Department and the sheer bravery of their young patients. He was the epitome of tall, dark—well, with a fair sprinkling of grey in his hair—and handsome. Add twinkling brown eyes behind his glasses, a slight scruffiness to his haircut that made women want to fuss over him, and the kind of smile that made female pulses beat a lot faster, and it was no wonder that most of the press referred to him as ‘the thinking woman’s crumpet’.
Every single female of Mandy’s acquaintance had given an envious sigh when they found out who was going to be her job-share.
Not that she’d actually met him yet, because Daniel had been laid low by a virus the day before she’d gone for her interview so he’d had to drop out of the interview panel. But the senior nurse who’d taken her round the ward afterwards had told her that Daniel was even nicer to work with than he seemed on the TV. Calm, capable and kind. He respected the nursing team, and he gave junior doctors a chance to blossom.
In short, Daniel Monroe was a dream doctor.
And this was a dream job. Mandy would spend two days a week in charge of training, while Daniel headed up the department; two days a week heading up the department, while Daniel filmed his documentary; and the other day working with Daniel on admin and strategy. Though their separate roles would also have a fair amount of crossover.
She shook herself. ‘He’s probably very happily married.’
‘Nope. He’s definitely single,’ Gemma corrected. ‘Angelica at work checked him out on social media. And I’m under instructions that I’m not to go on maternity leave next month without getting at least one person’s telephone number to him.’
‘Tell them your mother’s difficult and you daren’t ask her,’ Mandy said.
‘Too late. They’ve met you. They already know you’re perfect.’
‘Perfect?’ Mandy couldn’t help laughing. ‘Thank you for the compliment, darling, but I’m far from that. I’ll settle for being OK.’
‘You’re more than OK, Mum. You’re going to be a brilliant head of department.’
‘Joint head,’ Mandy reminded her.
‘Still brilliant,’ Gemma insisted. ‘I’m proud of you. So’s Dev—’ her husband ‘—and so’s The Bump.’
Her first grandchild. When had she suddenly become old enough to be a grandmother? She still felt as if she were twenty-five. ‘I’m proud of you all, too,’ Mandy said.
‘Have a fabulous first day, Mum. Dev’s cooking a special dinner so you can tell us all about it tonight. Spiced paneer tikka with baby spinach, lemon dhal, and parathas.’
‘You know I’m only coming for Dev’s dhal, and not to see you or the bump,’ Mandy said, her face deadpan.
Gemma gave a rich chuckle. ‘Dev’s dhal is responsible for the bump.’
Which served her right for teasing. ‘TMI!’ Mandy said, making exaggerated gestures of horror. ‘It’s supposed to be my generation making yours cringe, you know, not the other way round.’
‘Bring it on,’ Gemma said, her eyes sparkling. ‘Right, your challenge is to date someone. For the first time in about—well, you’d need a whole library of calendars to calculate how many years it’s been since you last dated someone.’ Worry bubbled up from behind her daughter’s teasing. ‘Mum. I really hate to think of you being lonely.’
‘Of course I’m not lonely,’ Mandy said. ‘I have you, Dev, the bump-to-be, Aunty Jen, Gran and Linda. I have book club on the first Monday of the month, ballet class on Fridays, and dance aerobics on Tuesday and Thursday. I’ll be your permanent babysitter on Wednesdays so you and Dev get a date night every week, and I’m just about to start a new job. Between my family, my social life and work, I don’t have time to be lonely.’
‘That’s not what I...’ Gemma stopped herself and sighed. ‘Love you, Mum.’
‘Love you, too,’ Mandy said. ‘I’ll see you tonight.’
‘We’re eating at seven. Come whenever you like. And have a brilliant, brilliant day.’
Wearing glasses instead of contact lenses meant that Mandy could get away without wearing eye make-up, and hopefully the tortoiseshell frames of her narrow glasses hid some of the redness in her right eye. Thankfully her skin wasn’t having a bad menopause day, so a tinted moisturiser and a neutral lip colour were enough to make her look professional.
Her mum and her sister Jen both texted.
Good luck on your first day!
Her best friend Linda sent a picture of a cute spaniel puppy with the message:
You’ll be pawsome!
And even the weather was on her side; although it was grey and a bit on the chilly side, a typical October London day, it wasn’t raining. She caught the Tube from King’s Cross to Victoria, and walking briskly to the hospital meant she didn’t feel the cold.
Mandy had to check the hospital map in the reception area to remind herself where the children’s ward was. Hopefully it wouldn’t take too long before these corridors felt as familiar as those of Muswell Hill, the hospital where she’d worked for the last fifteen years, she thought as she headed down the corridor.
Before she had the chance to start feeling nervous, she pressed the intercom button on the wall outside the ward.
‘Good morning. How can I help?’ a voice crackled through the grille.
‘Good morning. It’s Amanda Cooke. I’m starting work here today, so I don’t have my staff card yet and I need someone to let me in,’ she said.
‘Great—we’re expecting you. I’ll buzz you in. I’m Khaj, one of the nurses. You’ll see me as soon as you walk in. I’m updating the whiteboard.’
The door buzzed, and Mandy made sure she closed it again behind her without anyone following her in; security in vulnerable wards was important. She glanced over towards the reception desk and saw a cheerful-looking nurse in scrubs writing names on a whiteboard, which showed which team members were looking after the patients in each bay.
‘Welcome to the London Victoria, Ms Cooke,’ the nurse said with a smile.
Mandy smiled back. ‘Nice to meet you, Khaj. And please call me Mandy.’
‘Mandy.’ Khaj looked concerned. ‘What happened to your eye?’
Oh. So her glasses really weren’t enough to hide the redness. It looked as if she was going to be explaining this all day, then. ‘Subconjunctival haemorrhage. I woke up with it this morning so I must’ve sneezed in my sleep,’ Mandy said ruefully.
‘Poor you,’ Khaj said sympathetically.
‘My daughter said I should wear an eye patch,’ Mandy said. ‘I have the nastiest feeling she’s going to get her class to design one today. And a five-year-old’s idea of an eye patch means I’m definitely going to regret buying that pack of offcuts in the fabric shop for her class’s craft box.’
‘You sew? Oh, you’re definitely going to go down well here,’ Khaj said, looking pleased. ‘There’s a teenager I need to introduce you to later. Now, let’s get you loaded up with coffee before I take you through to Daniel.’
‘Thank you.’ Mandy indicated the bag she was carrying, containing a plastic tub, a box and a bag of apples. ‘I brought goodies to say hello to the team. Can I leave them in the staff kitchen?’
‘You most certainly can,’ Khaj said. ‘By the way, your ID card isn’t here yet, but I’ll get someone to chase that up for you. In the meantime, just buzz the intercom when you need to be let back in on the ward.’
‘Cheers,’ Mandy said.
While Khaj made two mugs of coffee—one of which was bright orange and emblazoned with the words ‘Dr TWC’, which told Mandy that Daniel’s colleagues ribbed him mercilessly about his reputation as the Thinking Woman’s Crumpet in the media—Mandy put the tub of home-made brownies on the worktop so anyone who walked into the staff kitchen would see them, along with a couple of packets of individually wrapped gluten-free lemon cakes, and some apples for anyone who didn’t eat cake. Hopefully she’d covered all dietary requirements and not left anyone out. She left a note on top of the tub:
Look forward to meeting everyone on the ward. Brownies are egg-free and dairy-free; lemon cakes are GF. Cheers, Mandy
‘Do you know if Mr Monroe would prefer brownies or lemon cake?’ she asked.
Khaj laughed. ‘Daniel likes anything sweet. He really deserves to be thirty pounds heavier than he is. We’d hate him for being able to scoff cake with impunity, except he’s one of the good guys.’
Brownies, Mandy decided, and wrapped one in a piece of paper towel. And it was good to have reassurance that her new job-share partner was well liked.
She followed Khaj down the corridor, and the nurse rapped on an open door. ‘Good morning, Dan. Here’s your first appointment of the day. Don’t dump all your filing on her.’
‘As if I’d do something so underhand,’ Daniel drawled, looking up from his desk.
Daniel Monroe on screen was a heartthrob; Daniel Monroe in the flesh was utterly gorgeous. And Mandy really hoped her face didn’t look as red as her eye, because it certainly felt hot enough.
‘You must be Amanda Cooke. Lovely to meet you at last.’ His eyes narrowed. ‘What did you—?’
‘—do to my eye?’ she finished wryly. ‘I woke up with it this morning. It could’ve been a cough, a sneeze, carrying a heavy bag—anything.’
‘Subconjunctival haemorrhage,’ he said with a grimace. ‘Sorry. You’ve probably had to explain it to half a dozen people already.’
‘Yes, and no doubt I’ll have to do it for the rest of the day. Still, it’s a way of breaking the ice. Have a home-made brownie,’ Mandy said, and gave him the paper towel containing the cake. ‘I made them last night to say hello to the department.’
‘You brought in home-made cake on your first day? Oh, I like you already,’ he said with a grin. ‘Welcome to the department. I think she’s a keeper, Khaj,’ he added in a stage whisper.
‘Don’t badger her into doing your filing,’ Khaj repeated sternly. ‘I’ll leave you with him, Mandy.’
‘Of course I won’t expect you to do my filing,’ Daniel said, rolling his eyes when Khaj had left. ‘Though I admit I need nagging to do it. I’d rather clean up projectile vomit, poonami diarrhoea or a pus-filled wound than... Well.’ He indicated his very full in-tray.
‘We all have bits of the job we hate,’ Mandy said lightly.
‘Welcome to the London Victoria. We use first names rather than formality here, so may I call you Amanda?’ He stood up and held his hand out.
‘Mandy,’ she said, taking his hand and shaking it. His handshake was firm and dry, but his smile disconcerted her because it really did make her heart feel as if it had just throbbed. She hadn’t felt a pull of attraction like this to someone in years, and she was going to have to get a firm grip on that reaction. He was her new colleague, and—even though she knew he was single—she wasn’t looking for any relationship other than a professional one. She’d learned the hard way that charm was usually partnered with unreliability, and she wasn’t going to forget it.
Oh, help. Amanda Cooke’s handshake was firm and professional, but her skin was warm and soft—and it made Dan feel all quivery. The kind of quiver he hadn’t felt towards anyone in a very long time, because he always kept his relationships light and fluffy and very, very short. And that meant not dating anyone he worked with.
This woman could be seriously dangerous to his peace of mind.
He shook himself mentally. Talk about an inappropriate reaction—and it was bad timing as well.
Focus, he told himself. She’s your new job-share. You’ve just met her. You don’t want her to think you’re a total numpty.
‘Everyone calls me Dan,’ he said. ‘Sorry I didn’t meet you at your interview.’
‘I completely understand. They told me you’d gone down with a virus,’ she said.
‘The usual occupational hazard of working in Paediatrics,’ he said with a rueful smile. ‘I probably could have dosed myself up and dragged myself in, but I didn’t want everyone who’d been in the same room as me to feel grim as I did, the next morning.’
‘That’s considerate,’ she said. ‘Thank you.’
He looked at her. ‘I thought we’d take today to settle you in and plan workloads. I’ve been muddling along for a while; it’s going to be so much better for the team having you here. Obviously the ward needs one of us in charge while the other one’s teaching or filming, and we need a day together to make sure we iron out any issues that crop up and deal with the suits, plus share the on-call rota at weekends. I normally film on Thursday and Friday when we’re working on a series—the new one starts next week—but we can move things round if that doesn’t work with your teaching commitments. And I thought we could alternate weekends on call; we can always swap if one of us has something special on.’
She looked surprised, as if she’d expected him to dictate the schedule to her. ‘That all works fine for me,’ she said.
‘Good. And please don’t feel awkward about the TV stuff. If you’ve got an interesting case, I’d be delighted to look at including it on the show; but if you’d rather avoid the cameras completely, that’s also fine.’ He indicated the orange mug with a sigh. ‘As you can see, the team won’t let me get away with trying to be a luvvie. That was last year’s Secret Santa present. I still can’t work out who got it for me; I think they were all in cahoots because they all really enjoyed watching me open it.’ He grinned. ‘But I’ll forgive them for teasing, because they also filled it with caramel chocolates.’
‘Chocolate’s the way to your heart? I’ll remember that.’
Daniel really hoped that he didn’t look as red and flustered as he felt. Because the glint in her lovely brown eyes made him imagine lying against a pillow while she fed him squares of caramel-filled chocolate, teasing him by rubbing it along his lower lip and then holding it just out of reach and demanding a kiss before she handed over the chocolate...
Oh, for pity’s sake. He was fifty-five, not fifteen. Fantasies like that shouldn’t be filling his head, particularly in work hours. Despite her red eye, Mandy looked completely cool, calm and professional: which was what he needed to be, too. Preferably right now.
‘Let me introduce you to the team,’ he said. ‘Then we’ll grab something to drink—the canteen here does decent coffee—and we can talk about your teaching, training plans for the staff here, and work out our schedules.’
‘Sounds good to me,’ she said.
Daniel was as good as his word, introducing Mandy to the whole team—from the most junior health care assistant up to the senior consultants. Not only was he on first-name terms with everyone, it was clear from the way he talked that he actually knew all the staff and what mattered to them. They all seemed to bloom in his presence. The patients, too, all had a smile for Dr Dan, whether they were an out-of-sorts toddler or a grumpy teenager.
Perhaps she’d been unfair to him, assuming that his charm meant he was like all the other charming but shallow men she’d met; maybe there really was depth underneath Daniel’s surface allure.
Finally, they went into the Paediatric Intensive Care Unit.
‘Mo, this is Amanda Cooke, who’s sharing the Head of Department role with me,’ he said, introducing her to the consultant on the unit. ‘Mandy, this is Mohammed Singh, our paediatric intensive care specialist.’
‘Nice to meet you—and please call me Mandy,’ she said, shaking Mo’s hand. ‘I’d like to have a meeting with you at some point in the week to discuss training, whenever works for you, to talk about the new intake of students at the university and what we can offer them here. Plus I’d like to know what your team’s needs are so I can make sure they’re covered.’
‘That sounds good,’ he said. ‘Nice to meet you, too, Mandy.’ He looked at Daniel. ‘I’m glad you’re here, Dan, because I’ve got a potential case for your show. Though it’s a tricky one and I haven’t got a firm diagnosis at the moment.’
‘That’s unusual for you. Want to pick our brains?’ Daniel asked.
‘Definitely,’ Mo said. ‘I’ll give you the background: the Emergency Department sent eight-month-old Noah Carmichael up to us this morning. His parents took him to the walk-in centre yesterday because he seemed lethargic, was a bit constipated and wasn’t feeding well. His mum also thought his cry sounded funny and a bit weaker than normal. The GP told them to keep a close eye on him and bring him to the Emergency Department here if he got any worse. They didn’t sleep much last night, worrying about him, and about five o’clock this morning the mum went in to check on him and discovered he was floppy. They rushed him straight here.’
From years of experience, Mandy knew that very young children could become very unwell, very quickly, and a floppy baby usually meant the little one was really poorly. ‘Good call,’ she said. ‘Does he have any other symptoms?’
‘That’s where it gets weird,’ Mo said. ‘He’s drooling, his eyelids are droopy and his pupils are a bit sluggish. I was thinking it might be some kind of cerebral virus, except he hasn’t got even a hint of a fever.’
‘So it’s unlikely to be one of the usual viruses, then,’ Daniel said, frowning.
‘There are signs of bulbar palsies,’ Mo added. Bulbar palsies were a set of clinical conditions that occurred when the lower cranial nerves were damaged, possibly by a stroke or a tumour. ‘There’s also moderate hypotonia.’
Muscle weakness, Mandy thought. The baby was constipated, drooling, not feeding, and had droopy eyelids. No fever. Mo was right; it was an odd set of symptoms. With a virus, she would’ve expected a fever. But something rang a bell in the back of her head.
‘We’ve intubated him and put him in an induced coma while we run some more tests,’ Mo said. ‘Starting with a CT scan to see if there’s anything obvious causing the bulbar palsies. That’s where he is at the moment. He’s due back on the ward any minute now.’
‘Were there any complications with the birth?’ Daniel asked.
‘No. Labour and birth were both as standard as it gets, and he’s been between the fiftieth and sixtieth centile on all the development charts all the way along,’ Mo said. ‘His parents didn’t have a thing to worry about until yesterday.’
‘You mentioned hypotonia. Is there any evidence of paralysis, especially if it’s symmetrical and heading downwards?’ Mandy asked. ‘And do his facial features look flattened at all?’
‘His face does look a bit flat, yes,’ Mo said. ‘Paralysis...obviously he’s in an induced coma at the moment, but that’s a good point.’
‘What are you thinking, Mandy?’ Daniel asked.
‘It’s something a friend came across when she did a couple of years on a job-swap in America,’ Mandy said. ‘It’s really rare here in England, but I think we might be talking about infant botulism.’
‘That’s so rare I’ve only ever read about it in medical journals,’ Daniel said. ‘I’ve never actually seen a case.’
‘Me neither,’ Mo said. ‘And I’ve been qualified for twenty years.’
‘I haven’t seen one myself, either,’ Mandy said. ‘But this sounds really like the case my friend told me about. If someone’s given Noah some honey, he might have swallowed Clostridium botulinum spores.’
‘In an adult or a baby over the age of one, those spores would go through the digestive system too quickly to cause a problem. But Noah’s digestive system is still immature, so the spores would’ve had time to colonise his large intestine and produce botulinum neurotoxin,’ Daniel said thoughtfully.
‘Which affect the nerve endings—and that would account for the hypotonia and bulbar palsies,’ Mandy agreed.
‘Given the other differential diagnoses, I’m not sure if that makes me feel more or less worried,’ Mo said. ‘The Carmichaels seem pretty switched on, the sort who read every parenting book and magazine going. I can’t imagine they would’ve allowed anyone to give their infant son honey, not when all the health visitors and GPs are so clear with the message about not giving honey to babies under the age of one.’
‘They might not have been the ones to give it to him. If a well-meaning older friend or relative took the view that they’d had honey as a baby and it hadn’t hurt them, so it wouldn’t hurt Noah...’ Daniel spread his hands. ‘Then his parents wouldn’t have known anything about it until it was too late.’
‘We need to get a stool sample to the lab,’ Mandy said. ‘And, if I’m right, we’ll need to start treating him with antitoxin.’ She grimaced. ‘The only thing is, because infant botulism is so rare over here, it’s unlikely that any of the hospitals in this country has a stock of infant antitoxin. We certainly didn’t have any at Muswell Hill.’
‘Where’s likely to have it?’ Mo asked.
‘The head of Pharmacy will know—or at least know where to check,’ Daniel said.
‘Worst-case scenario, we’ll have to ask the pharmacy to talk to the public health department in California, and have the antitoxin couriered here and expedited through Customs,’ Mandy said. ‘What I do know is that it could take a few days to get the lab results back, and we can’t wait for them. The quicker we can start the treatment, the quicker Noah will recover.’
‘Including from the paralysis?’ Mo asked.
‘Yes, but it could take a while, depending on how long it takes for his nerve endings to grow again,’ Mandy warned. ‘Can we talk to his parents?’
‘Of course. They’re waiting in the relatives’ room while Noah’s having his scan,’ Mo said. ‘I’ll introduce you.’
As Mo introduced them to Lucy and Rob Carmichael, Mandy thought Noah’s parents both looked worn out with worry, their faces pallid with dark shadows smudged beneath their eyes. And what she was about to tell them was a parent’s worst nightmare.
‘Hang on—aren’t you the doctor off that telly programme?’ Rob asked, looking at Daniel.
‘Yes, but I’m also a qualified senior doctor who works here, so please don’t worry about the TV presenter stuff,’ Daniel said. He gave them both a reassuring smile. ‘Mo’s told us about your son, and you did absolutely the right thing bringing Noah here when you were concerned.’
Rob looked miserable. ‘He’s so poorly. Dr Singh had to put him in a coma, and nobody seems to know what’s making Noah sick.’
‘We’re running tests to rule some things out, and the CT scan will hopefully give us a better idea of what might be causing Noah’s symptoms,’ Daniel said gently. ‘The three of us have been talking about his symptoms, and my colleague Mandy might have worked out what the problem is.’
‘It’s a strange question, but is there any chance that someone might have given Noah honey or any kind of preserved food in the last couple of days?’ Mandy asked.
‘Honey?’ Lucy looked shocked. ‘Of course not. You’re not supposed to give a baby honey because it might make them ill.’
Exactly what Mo had suggested Noah’s mum’s response would be. But Daniel had also had a suggestion about where the honey might have come from. ‘We were wondering, could someone else have given him anything with honey in it? A cookie or a piece of cake, maybe?’ Mandy asked. ‘Something that somebody made at home, perhaps, or maybe from a toddler group bake sale? And Mo said it was yesterday he started being ill, so maybe he ate something on Friday or Saturday that started affecting him yesterday?’
‘He was with us on Saturday,’ Lucy said. ‘But on Fridays, we both work and my mum has him for the day. She takes him to a baby music class and they both love it because a few other grannies go, too.’ Her eyes widened in horror. ‘If one of them brought in some home-made snacks and sweetened them with honey instead of sugar, thinking it was healthier...’
‘Your mum dotes on Noah,’ Rob said. ‘You know she’d never willingly let anything happen to him.’
‘I’ll call her now,’ Lucy said. ‘Do I need to go into the corridor to use my phone? You know, so it doesn’t interfere with any of the equipment?’
‘You’re fine in here,’ Mo said. ‘We’ll give you both some space.’
Ten minutes later, Lucy came out of the relatives’ room with Rob holding her hand and tears running down her cheeks. ‘Mum says she went to her friend’s for lunch after the class, and Noah ate half a cookie there. It never occurred to her to ask what was in it—Mum didn’t eat one because she’s on a diet—but it’s the only thing she can think of that might’ve had honey in it. She rang her friend to ask her, and Mum just called me back to say yes, there was honey instead of sugar in the cookies.’ She dragged in a breath. ‘What’s in honey that’s made Noah ill like this?’
‘Not all honey,’ Mandy said, ‘but some raw honey has been shown to contain botulin spores.’
‘Botulin?’ Rob looked horrified. ‘But that kills people, doesn’t it? Are you telling us that Noah’s going to die?’
‘No. He should make a full recovery, over the next couple of months,’ Daniel said. ‘A century ago, you’re right, the outcome wouldn’t have been so good; but thankfully medicine has advanced in this area. We can get some special infant antitoxin for him. We’re going to talk to the pharmacy now, because we think it’ll have to be shipped here from abroad.’
Lucy’s eyes widened. ‘Why isn’t there any of this antitoxin stuff in a London hospital?’
‘It’s not a stock item because infant botulism is really rare in this country. It’s less rare in America, so we’ll contact the public health team in California that produces the antitoxin,’ Mandy explained. ‘We’re going to test Noah’s stools for the bacteria, but the lab results might take a few days. We won’t wait for the results before we start treating him. The clinical diagnosis makes a lot of sense where his symptoms are concerned. Basically, the toxin stops the nerve endings telling the muscles to contract, so the first symptoms of the illness will be the baby finding it hard to suck or swallow, and being a bit constipated—which is what you reported.’
‘Plus it doesn’t cause a fever,’ Mo said.
‘This thing with the nerve endings—is that why Noah’s floppy?’ Lucy asked.
‘Yes, and it’s also why he might have trouble breathing,’ Daniel said. ‘We’ll keep him in the coma for now, to keep him comfortable and support his breathing. It’ll take him a little while to recover, because the nerve endings need to regrow before they can send the right signals to his muscles; we’ll need to give him support for breathing and feeding until he can do it himself, but over the next few weeks he’ll get better.’
‘And it won’t affect him...the way he develops?’ Rob asked.
‘The toxin doesn’t go into his brain or anything like that. He’ll develop completely normally,’ Mandy said. ‘The only thing that will need to be delayed a bit are his immunisations, until six months after we’ve treated him, because the antitoxin would interfere with the live virus vaccinations—that’s the MMR and varicella. We’ll make sure your GP and health visitor know.’
‘So he’s going to be all right?’ Lucy asked.
‘He’s going to be all right,’ Mo confirmed.
‘Thank God,’ Lucy whispered. ‘But right now I don’t think I want Mum to look after him ever again.’
‘It wasn’t done deliberately, and your mum wasn’t to know,’ Daniel said gently. ‘Remember, you’re her baby, and my guess is she’ll be in bits at the idea of being responsible for something that hurt your baby and therefore hurt you. Don’t be too hard on her.’
‘But if Dr Cooke here hadn’t realised what it was, Noah might’ve become too ill to be treated,’ Rob said. ‘He might have...’ He shook his head, clearly unable or unwilling to voice his deepest fears.
‘I’m going to be a grannie in a few weeks’ time,’ Mandy said, ‘and Dr Monroe’s absolutely right in what he said. If I inadvertently do anything that hurts my daughter’s baby, I’ll never forgive myself for that—or for the pain and worry I caused my daughter. Your mum will be hugely upset about this, Lucy.’
‘I don’t have children,’ Daniel added, ‘but I have nieces and nephews, and I feel the same way about them.’
Something in his expression, quickly hidden, made Mandy wonder what he wasn’t saying. Had it been his choice not to have children? Not that it was any of her business.
‘You’ll see Noah recover a little bit more every day,’ Mo said. ‘He’ll need to be in hospital for a few weeks yet, but you can have as much involvement as you like in his care. The nurses will help you set up a routine. You’ll be able to give him baths, feed him and cuddle him. Though for the next three months or so you’ll need to be super-strict about handwashing after you’ve changed his nappy, because the toxins will come out in his faeces. If you’ve got an open cut on your hands, I’d wear gloves when you change him, to make sure the bacteria doesn’t spread to you.’
‘So we could catch it from Noah?’ Rob asked.
‘With an open wound, yes. But it won’t affect you in the same way,’ Mo said.
Once the Carmichaels were reassured that Noah would still be poorly for a little while but was going to make a good recovery, Daniel took Mandy to meet the pharmacy team.
‘Baby botulism antitoxin? We’ll definitely have to talk to California for that,’ Navreen, the head of Pharmacy, said. ‘Actually, this’ll be good training for my team, because we haven’t got well-established processes for getting something like this from abroad. We’ll need to coordinate authorisation and Customs.’
‘But you can definitely do it?’ Mandy asked.
‘We’ve done it a couple of times in the past. The systems have probably changed since the last time we did it; but don’t worry, we’ll get it sorted.’ Navreen glanced at Daniel. ‘Is this case going on your show?’
‘Maybe,’ Daniel said. ‘I need to talk to the baby’s mum and dad about it, but I think they could do with a bit of time to come to terms with what’s happening before I ask their permission.’
Navreen nodded. ‘If they say yes, we’re happy for you to film here, too.’
‘Great. Thank you.’ He smiled at her. ‘It’d be good to showcase other bits of the hospital, so the audience realises how wide our team is.’ He gave her a hammy wink. ‘Not just Dr Charming showing off and hogging the screen.’
Navreen laughed. ‘Dan, we all know you’re not like that.’ She checked something on her computer. ‘I was about to say the bad news is, we’re eight hours ahead of California and we’ll have to wait to get hold of them; but the good news is that their helpline is twenty-four-seven and we can call them now.’ She glanced back at her screen. ‘Though it looks as if you’ll have to talk to their doctors about your clinical findings before they’ll agree to let us have the antitoxin.’
‘We can do that. Let’s make the call,’ Daniel said.
