At the breakfast table Nicholas watched Jonny eating. He seemed to concentrate intently on his bowl of cereal. Nana had been out and bought a selection pack of miniature cereal boxes, by some distance the most expensive way to buy cereals, but what child can resist those miniatures? His features seemed to sharpen when he was engaged in a task, as if absolutely everything in the world at that point was focused on his successful consumption of breakfast. His cheekbones seem to angle forwards, his lips reach out and actively seek the spoonful of cereal. There had been a question mark at one point over whether he might be on the spectrum for autism, according to the Adoption Agency, but this had been ruled out. There was nothing wrong with him that hadn’t been directly caused by the trauma he had witnessed and experienced.
‘Is that nice, love?’ Nana asked.
She was sitting, arms folded on the table in front of her, across from Jonny.
‘Yes, Nana.’
‘Yes, thank you, Nana,’ Nicholas corrected him.
‘Yes, thank you, Nana,’ said Jonny through a mouthful of Coco Pops.
Nicholas had suggested that Jonny call his adoptive great-grandparents Nana and Grandad, just like he did.
‘What’s all this about not going on long journeys, Nana?’ Nicholas asked.
‘It’s my heart, love. I’ve got this heart-valve problem. You know about it.’
‘Mitral stenosis,’ Grandad’s voice announced as he appeared in the kitchen doorway.
‘Aye, well. It means I’m at high risk of blood clots.’
‘Arterial thrombosis,’ added Grandad.
‘I know,’ said Nicholas.
‘And I used to take warfarin for it, but the GP says that can interact with my arthritis tablets, so he took me off it. Off the warfarin, you know. So I’m at high risk of blood clots.’
‘To the brain, causing a stroke,’ elaborated Grandad.
‘Hmm.’ Nicholas studied Jonny’s empty cereal packet. ‘You should have a chat with Liz, you know, Nana. Get a second opinion.’
‘Can I have some orange juice?’ Jonny asked.
‘Can I have some orange juice, please?’ Nicholas reminded him. ‘I’ll get it,’ he added, addressing Nana.
He squeezed past Grandad in the doorway and took the orange juice from the fridge. When he had returned and poured Jonny a glass, he spoke again.
‘Fridge is looking a bit bare, Nana. Why don’t you let us do a bit of shopping for you while we’re here?’
‘All right, love. You can take the car. It needs a run out. I don’t know when it last had one, to be honest.’
‘Great. I’ll just get His Lordship dressed. Come on, sunshine. Let’s get cracking.’
Liz stirred while Nicholas was getting clothes for Jonny, who was in the bathroom.
‘You have a lie-in,’ Nicholas said, lying down next to her for a minute. ‘Give us a kiss.’
‘Mmm,’ Liz said, pulling up the blanket and sheet, and adding sleepily, ‘I wonder if we should buy your grandparents a duvet for Christmas.’
Nicholas got Jonny ready and they headed downstairs. Nana had produced the car key. It was sitting on the kitchen table.
‘It ought to start all right,’ said Grandad. ‘There should be petrol in it.’
‘Don’t worry, Grandad.’
Nicholas took Jonny outside.
He unlocked the car and it was only at that point that he realised he didn’t have any kind of child seat. He wondered if it would be OK to go ahead without one. But very soon it became clear that this was a side issue.
The moment he opened the back door of the car and encouraged Jonny to get in, the boy refused.
‘Come on, Jonny. We’re going to get some shopping for Nana and Grandad. You don’t want them to go hungry, do you? And anyway, we’re staying with them for the weekend, so if we don’t get any shopping there’ll be nothing for us to eat either.’
But Jonny turned his back on the car and crossed his arms.
‘Come on, Jonny,’ Nicholas said, trying to turn him around and push him lightly in the direction of the car.
His face wore that mask of concentration that Nicholas had seen at the breakfast table. He seemed quite determined not to get in the car. Nicholas released his pressure and knelt down in front of his son.
‘What’s up, mate? Why don’t you want to get in the car?’
‘No,’ Jonny said, stamping his foot. ‘No no no no no no no.’
‘What’s the matter?’
Jonny started screaming. ‘No! No! No!’
‘Look, this is ridiculous,’ Nicholas said, getting cross. ‘I think you’re a bit old for tantrums, sunshine. You are five, remember. Five-year-olds don’t generally behave like this. If they don’t want to do something, they give you a reason and they do it without screaming. Also, if Daddy wants you to get in the car, I really think you should just, you know, get in the car, don’t you?’
Jonny screamed.
Nicholas took hold of his shoulders and the boy squirmed and fought to get free. Nicholas tried to keep hold of him, but the boy bit his hand and managed to break away, running back to the front door and when he found it closed he tried to get around the side of the house.
‘Jonny,’ Nicholas shouted, ‘Jonny. Stop it. Forget the car. I’m not going to make you get in the car, OK, but you have to stop screaming and fighting and especially biting. Right? You have to stop all that right now.’
The front door opened and Nana appeared.
‘I don’t know what’s going on,’ Nicholas said to her. ‘I opened the car door and he went ballistic. I don’t think we’ll be going in the car.’
When Jonny saw that Nana had appeared, he ran to her and threw his arms around her legs. Nicholas caught his breath when he saw her rest her hand instinctively on top of Jonny’s head.
Jonny eventually calmed down, but he stayed in the house with Liz and Nana and Grandad, while Nicholas drove off on his own, puzzling over what had happened and feeling depressed by the incident.
Later, when they were in bed and Jonny was asleep, Nicholas talked to Liz about Nana and her various tablets, those she was taking and those she was not.
‘It’s true what she says, that warfarin can interact with what she’s taking for her arthritis,’ Liz said, ‘and it’s also true that taking her off it increases the risk she’ll get an arterial thrombosis. She could have a stroke. But she could have one whether she sits on a train to London or not. That seems a bit odd.’
‘Really?’
‘I suppose if she’s got bad arthritis, she can’t really be getting up for a walk around while on the train, so maybe it makes a kind of sense. But still…’
‘Is it worth her asking for a second opinion?’
‘It depends. I’m sure she doesn’t want to get the GP’s back up.’
‘Yes, but how often do people die because they don’t question the advice they are given? Because they don’t ask for a second opinion?’
‘Only once.’
‘Very funny.’
‘Sorry. I don’t know, but not often, I wouldn’t think,’ Liz said. ‘If you’re worried I can ask around about him.’
‘Thanks. Just to set my mind at rest.’
Liz did ask around — making a number of phone calls first thing in the morning while Nicholas was getting Jonny up and dressed — and most of the feedback was good. The doctor was well liked by patients, maybe less so by colleagues, one or two of whom thought him a little odd. But these were people who didn’t work with him closely, other Manchester GPs who did occasional locum work at the surgery.
They were due to return to London in the afternoon. Nicholas proposed that they drive out towards the Peaks and find a nice pub for lunch, but there was the question of whether his nana and grandad would want to, and, more to the point, whether Jonny could be persuaded to get in the car without another screaming fit. In the end, Nicholas’ nana suggested that Nicholas and Liz take Jonny for a walk in the park while she prepared a salad for lunch.