Diabetic ketoacidosis.
Nate thought it through, but the more he thought the more it fitted with what was happening. Diabetes meant the pancreas stopped producing insulin-and if insulin wasn’t available the body couldn’t absorb food and started using its own fat for energy. The result was a poisonous accumulation of ketones. Ketoacidosis. And in its early stages ketoacidosis looked just like this.
‘We don’t know yet,’ he told her.
But Jane was moving as he spoke, fetching the equipment he needed. A urine sample would check for ketones, but taking a urine sample from Cady now would be difficult. So he’d test the blood sugar and assume the rest.
The sugar reading took seconds. He took a drop of blood from the little boy’s listless hand, placed it on the testing strip and set the machine in motion.
And five seconds later there was the answer.
‘Thirty-two…’
They had their diagnosis.
‘Dear God!’ Gemma was rocking the little boy back and forth in her arms with anguish. Thirty-two! She knew all too clearly what that meant. A normal range was from four to eight. No wonder his vision was blurred. No wonder he was sick. ‘He’s diabetic. Dear God… How could I not have known? How could I not have guessed?’
‘You’ve had just a bit on your mind lately,’ Nate said gently. She certainly had, and here was another load for her to bear. What on earth had her sister landed her with? ‘But let’s not worry. Let’s just get Cady feeling better. I need to ring a specialist paediatrician for some up-to-date advice but I think I can handle this here.’ He smiled down at the bewildered Cady. Even though he wasn’t sure whether the little boy could hear him he spoke anyway, and maybe it was more for Gemma than for Cady.
‘Cady, there’s something in your tummy called a pancreas. It isn’t doing its job so we’ll have to fix that. The pancreas makes stuff called insulin that keeps you well, and because your pancreas isn’t making any insulin I’m going to pop a tube into your arm so we can give you some.’ Heaven knew if the child could make sense of this.
But Cady was one brave kid and he was trying. He was struggling to focus on Nate’s face but it was beyond him. ‘Will it hurt?’ he quavered, and Gemma hugged him tight and kissed him on the top of his head.
‘It’ll be a small prick just like the last one-and it’ll make you feel so much better,’ she told him. He’d need a drip, she knew. They had to get some nourishment into the child to stop the deadly breakdown of body fat and they’d need intravenous insulin to get the blood-sugar level down. ‘Dr Ethan will pop a tube into your hand so the medicine can go in really quickly.’ There were myriad blood tests to be done but the blood could be taken as the IV line was put in. ‘Then we’ll pop you in bed and let you sleep, Cady. For just as long as you need to sleep to be well again.’
‘You won’t be taking him back to Sydney any time soon.’
‘I know.’ With Cady safely tucked into a ward bed Gemma seemed to have lost the last of her energy. She slumped forward on her chair, her shoulders sagging and her whole body spelling defeat. ‘I almost killed him.’
‘You did no such thing.’
‘I’m a doctor.’ She was very close to tears, Nate thought. She was very close to breaking down altogether. ‘I should have noticed. Of all the stupid…’
‘You know as well as I do that diabetes is insidious,’ he said gently. ‘He’ll have been eating and doing everything he normally does… There are no overt signs.’
‘But he’s thin. I thought… I thought he was just having a growth spurt.’
‘And you were taken up by a dying sister and a newborn baby.’
‘I let it go so far. I could have killed him.’
‘No!’ He stooped and took her shoulders and gripped, hard. ‘You didn’t. Diabetes in children is hard to pick before it becomes an acute problem. You think a kid’s having a growth spurt-they’re suddenly taller and thinner and tired, and you put two and two together and get four-but the answer’s six. I’ve seen this before, Gemma.’
‘As bad as this?’
‘Worse.’ His hands still gripped her too-thin shoulders. Did she have any time to look after herself? he wondered. And then he thought… What was her blood sugar?
‘Can we test you?’ he asked, and she gave a laugh that was almost hysterical.
‘I’m not diabetic.’
‘How do you know?’
‘I…’ She took a grip. ‘I guess I don’t. But I’m not thirsty like Cady. And I’m not losing weight.’
‘You mean you’ve always been this thin?’
‘I eat on the run,’ she told him. ‘But Cady…’
‘Will be fine.’
‘His body must have been producing ketones for weeks.’
‘Kids get sick fast,’ he told her. ‘It’s my guess that further blood tests will tell us this is recent. You would have noticed if he’d been tired for months.’
‘But not weeks. I’ve been so caught up-’
‘With your sister and the baby.’ He was still holding her. She hadn’t noticed-or rather she had, but she needed the contact. She needed the warmth.
‘I…’ For the first time she seemed to surface. She shook herself like she was clearing fog and she looked at him. And saw Nathan for the first time. Really saw him.
‘You’re in a dinner suit,’ she said stupidly, and he grinned. It really was the most gorgeous grin. It warmed places in her heart she hadn’t known were cold.
‘It’s a bit more formal than a white coat,’ he told her. ‘I put it on for my favourite patients.’
There was an attempt at a smile. ‘I’ve dragged you away from something.’ And then her mind focused even more. ‘Where’s Mia?’ Her voice cracked and his grip on her shoulders tightened.
‘Hey, hang on. I haven’t abandoned her.’
‘Where is she?’ She rose, and so did her voice.
‘In the next cubicle,’ he told her.
‘You admitted her to hospital? Why? What’s wrong?’
She was so close to the edge… ‘Nothing’s wrong,’ he said flatly, checking the hysteria before it started. ‘I had a date so I left her in kids’ ward.’
‘You had a date…’
‘A jazz ball.’ He motioned to his dinner suit. ‘You see? The pieces of the jigsaw fit together.’
Gemma took a deep, searing breath and regrouped. But the anger didn’t fade. ‘You mean you went to a ball-and left Mia in hospital?’ All the emotions of the last few weeks were contained within the fury of her voice. Nate saw anger surge and resurge. ‘Of all the stupid, selfish, arrogant… You have a precious new daughter and you put her in hospital. In hospital! She’s not sick. You know about Golden Staph. You know kids can get sick in hospital even if they’re well to begin with. And she’s yours. She’s your daughter and you dump her-’
‘Shush…’
‘Don’t shush me.’ Her anger had built to boiling point. Her eyes were flashing fire. She took a step back and if looks could have killed, he’d have been dead on the floor right now. ‘You toad. You uncaring, unfeeling, insensitive toad. You and Fiona. You’re a type. Bring a baby into the world and then you don’t give a toss. Hand her over to the nearest stupid person who’ll take on your responsibilities-’
That was a bit much. ‘Hey, Jane’s not stupid.’ He was nettled. After all, he’d handed Mia over to his most trusted nurse. ‘And this is a tiny country hospital, Gemma. It’s not a big city hospital where infections are a problem. Until Cady came in Mia was the only child in the kids’ ward. Infections are hardly an issue. Touch wood, but we’ve never had a case of Golden Staph and, please, God, we never will. So.’ He paused and his eyes met hers and held. Challenging. ‘Any other complaints?’
He was smiling at her, she thought incredulously. The fink. He was smiling!
‘You’re laughing. How can you laugh?’ Her anger was building even more, rather than waning. ‘You have a baby and you just dump her…’