Melanie Palmer was lying on the bed, crying and clutching her stomach.
Her mother was sitting next to her, her face drawn with worry. She stood up when Andreas entered the room.
‘She’s been like this since yesterday morning, and she’s getting worse,’ she told them, her eyes pleading. ‘What do you think it is?’
‘I’m going to take a look at her now,’ Andreas said immediately, walking over to the sink to wash his hands. ‘How did it start, Mrs Palmer?’
The mother closed her eyes briefly, battling with tears. ‘Sorry,’ she muttered, ‘but I’ve been up all night with her…’
Her face crumpled and Libby slipped an arm around her shoulders. ‘Don’t apologise. We understand how stressful it is when your child is sick. Take your time.’
‘It started yesterday,’ Mrs Palmer told them. ‘She seemed a bit tired when I left her at Sunday school but nothing that made me anxious.’
‘And when you picked her up, how did she seem?’
‘She was white as a sheet and complaining of pain in her stomach, but I assumed that was because of the vomiting,’ Mrs Palmer said. ‘I left it for a few hours, but then her temperature shot up and she seemed so poorly I called the GP. He just said it was a stomach bug and to give it twenty-four hours to settle.’
Andreas walked across to the bed. ‘But evidently it didn’t settle.’
‘She was dreadful in the night. Moaning and crying and clutching her stomach. And her stomach seemed really swollen.’ Mrs Palmer bit her lip. ‘I didn’t know what to do with her so I called the GP again this morning. I think he’s probably going to strike me off his list for being such a nuisance.’
‘You were right to call him again.’ Andreas caught Libby’s eye and she knew that he was thinking the same thing as her. That the GP had been too dismissive of Melanie’s symptoms.
‘Whereabouts was the pain in her stomach?’ Andreas asked. ‘Did she tell you?’
Mrs Palmer shrugged helplessly. ‘Everywhere, I think.’
Andreas nodded and settled himself on the edge of the bed.
‘Hello, Melanie.’ He spoke softly to the little girl. ‘Mummy tells me you’ve got a tummyache. Can I take a look?’
Libby watched him, full of admiration for the way that he dealt with children. She’d worked with so many doctors who didn’t have the first clue how to relate to children. They just waded in with their tests and examinations and then wondered why the child wouldn’t co-operate.
But fortunately Melanie was obviously smitten with the handsome Greek doctor.
She looked at Andreas trustingly. ‘I’ve got a poorly tummy.’
Andreas nodded, his dark eyes warm. ‘I know you have, sweetheart.’
‘Are you going to make it better?’
‘I’m certainly going to try, but you’ll have to help me.’ He lifted his stethoscope out of his pocket. ‘First I’m going to listen and then you’re going to listen.’
A brief smile touched the little girl’s pale face and she lay still as Andreas started to examine her, whimpering occasionally with pain.
Libby watched as he used his fingers to gently palpate the child’s abdomen.
‘She has oblique muscle rigidity,’ he murmured, ‘which is a sign of peritoneal irritation.’
Libby looked at him, trying to read his mind. He obviously didn’t think that Melanie had gastroenteritis.
Mrs Palmer was biting her nails in agitation. ‘What does that mean?’
‘I don’t think she has a stomach bug, Mrs Palmer,’ Andreas said gently. ‘I think that she has appendicitis and unfortunately it has burst, which is why her stomach is so very painful and swollen. Libby, can you bleep the surgeons urgently, please, and then come back and help me? I need to get a line in. Mrs Palmer, when did she last have something to eat or drink?’
‘She had a few sips of water in the night,’ Mrs Palmer told them, ‘but nothing to eat since breakfast yesterday morning.’
Leaving Andreas to finish his questioning, Libby hurried out onto the ward and rang the switchboard, asking them to bleep the on-call surgeons.
While she was there she gathered up the distraction box and the rest of the equipment she needed and then returned to the room.
Andreas was talking to Melanie, his deep voice gentle and soothing. ‘I need to put a plastic tube in your arm, sweetheart.’
Melanie stared at him. ‘Will it hurt?’
‘Yes, a bit,’ Andreas said honestly. ‘But we need to do it to make you better.’
Libby looked at him. ‘We could use a local anaesthetic cream.’