‘He’s been having these screaming fits that last a few minutes and then…’ Carol shrugged helplessly. ‘The GP said they were probably just tantrums, but he looks as though he’s in pain to me. He just isn’t himself. Normally he’s cheeky, lively and into everything. Now it’s as if he just doesn’t have the energy.’
‘Give me details, from the beginning.’
‘Well, he had a bit of a cold—I didn’t really think anything of it to be honest, and then he started holding his stomach and moaning that it hurt. It seemed to only last a few minutes and then it would go and he carried on as if nothing had happened.’
Nikos questioned her about the child, and about the consultation she’d had with her own doctor.
‘Did he examine Harry’s stomach?’
‘No. He said it was just a virus and that I should have waited until after the weekend to bring him back.’ Carol’s eyes filled again. ‘So I took Harry home, but he looked so awful and all morning he’s been getting worse. I didn’t know what to do so I just thought I’d bring him here. I know you probably want to yell at me too…’
As if on cue, another toddler in the waiting room started to cry and Nikos winced.
‘As you can hear, it’s the children that do the yelling in this department.’ His tone dry, he rose to his feet and closed the door of the cubicle. ‘I want to examine Harry properly, Carol. Can you lift him onto the trolley for me? Ella, do we have any toys? Something to distract him?’ His smile was disarming. ‘Normally I have toys, but I have just come from a meeting with the hospital manager and I have never yet persuaded them to take play seriously.’
Ella fished a different car out of the box and then tried a puppet, but in the end no distraction was needed because Harry lay quietly on the trolley while Nikos gently examined his stomach. Watching his skilled, confident hands move gently over the toddler’s tiny body, Ella felt some of the tension leave her. She had no doubt whatsoever that he’d be able to identify the problem.
He was a brilliant doctor.
Had he dismissed Carol? No. He’d taken her concerns really seriously.
‘His temperature is normal.’ Ella wondered if he was finding it as hard to concentrate as she was. ‘Do you think it’s a virus?’
He didn’t answer for a moment, his expression thoughtful as he felt the toddler’s abdomen with gentle fingers. ‘No,’ he said finally. ‘I don’t. The signs aren’t classic, but…’ his eyes narrowed thoughtfully as he studied the pale, listless child. ‘I wonder…? Ella, ring Ed Green for me. Ask him to come down.’
Ed Green was the paediatric surgeon and Ella hurried to the phone and made the call, wondering what was going through Nikos’s mind.
Nikos was talking to Carol. ‘You were right to bring him,’ he said quietly, ‘and to trust your instincts.’
Carol looked at him anxiously. ‘It isn’t a tummy bug?’
‘No. Harry has something called intussusception.’ He reached for a pen and a piece of paper and quickly drew a diagram. ‘This is the bowel, yes? Sometimes one segment of the bowel can telescope into the next part—this is what we call intussusception.’
‘And Harry is showing signs of that?’
‘Actually no,’ Nikos conceded, returning the pen to his pocket. ‘He isn’t showing any of the classic signs.’
‘Then how do you know what it is?’
‘I just know.’ Nikos gave a ghost of a smile. ‘You have maternal instincts that told you something was wrong, and I have instincts also. Doctor instincts. A gut feeling, I think you call it.’
‘Is it something serious?’
‘It can be,’ Nikos said carefully, ‘but in this case I think we have caught it early, thanks to those instincts of yours. My colleague is on his way now, and—’
‘Nikos?’ Ed, the paediatric surgeon, strode through the door, a slight man with glasses and sandy-coloured hair. ‘What can I do for you?’
Nikos briefly outlined the history and Ed walked to the side of the trolley.
‘Intussusception?’ He checked the observation chart that Ella had completed.
‘Harry is displaying none of the classic signs,’ Nikos said in a cool tone. ‘No temperature, a small amount of diarrhoea yesterday, but nothing since, one episode of vomiting and no abdominal mass.’