Margaret McDonagh - Italian Doctor, Dream Proposal

The buzz of awareness and charge of desire were ever-present, but he also felt edgy with tension, knowing he was stepping into the unknown. He was in danger of breaking all his rules about any kind of involvement with a colleague…or potential colleague. But the rules he had lived by until now went out of the window when faced with the reality and the temptation of Ruth. He had never felt like this before, had never experienced this rush of emotion and out-of-control need. Somehow he had to find a way to reconcile work life and private life because now that Fate had delivered Ruth to him, he was not letting her go.

Pushing his coffee aside, no longer needing the caffeine as Ruth was the only stimulant he required, he indulged in studying her. If she wore any make-up at all, it was done with such a light touch it was unnoticeable. There was nothing worse in his opinion than kissing a woman and getting a mouthful of gunk, of tasting powder and grease instead of her sweetness. That would not happen with Ruth. Close up he could see that a faint dusting of freckles was scattered across her cheekbones and the bridge of her nose, and her skin was flawless, almost translucent, incredibly fair.

He was relieved to see no wedding or engagement ring on her finger, but confirming there was no one in her life at the moment was a top priority. Aside from the delicate platinum chain around her neck—her jumper hiding whatever was suspended from it—and the inexpensive watch on her right wrist, she wore no adornment. She didn’t need any.

Rico was disappointed as the other tables began to fill up around them and their moment of seclusion was lost. He wanted to keep Ruth all to himself. But several people stopped to speak to him and it was some minutes before he could politely extract himself and return his full attention to her.

‘I am sorry, cara . If we are visible here we will not be able to avoid interruptions,’ he told her with a mix of apology and frustration.

‘It’s all right.’ Her smile was shy and tentative but so pure it sucked the air from his lungs and left him feeling as if he had been punched in the gut. ‘I’m sure you’re in demand and lots of people will want to discuss things with you. Events like this must give you the chance to catch up with colleagues and exchange views on the run.’

Relieved she was relaxing a little, Rico nodded in agreement, enjoying the sound of her voice, which was melodious yet throaty, her English tones clear and refined, and without an identifiable regional accent. ‘You are my guest, Ruth, and my time is devoted to you. These days conferences are thankfully shorter and more focused than they used to be as we are all too busy to be away from our posts for long.’

‘You must have a full list of patients awaiting you in America,’ she suggested, demonstrating how much they had yet to discover about each other.

‘Not in America.’ He paused a moment, thanking the waitress who came to clear away their cups and saucers. ‘I was there for a few weeks giving lectures and training sessions, as well as consulting on a couple of cases, but my home and my clinic are in Italy.’

‘Oh! I didn’t realise. When you said you were flying in from New York, I assumed that was where you were based.’

Before he could explain, a German colleague wanted to exchange a few words about the workshop Rico was leading that afternoon. Instead of the enjoyment he normally felt in being able to meet up and talk shop with fellow doctors, now it was impatience that gripped him. He wanted everyone to go away so that he could have time alone with Ruth. But he was destined to be thwarted. For now.

The temptation to escape and miss the rest of the programme was great, but he couldn’t yet succumb to the urgent desire to forget everything else and carry Ruth off to bed. Not only did he have his own commitments but it was important for Ruth to learn and absorb as much as she could, both in terms of increasing her knowledge and being able to make a decision on whether or not to consider a change of direction in her career. However difficult, it was work first and pleasure second—when he had worked out a plan to win her trust and her heart.

‘There is much we don’t yet know about each other,’ he said when they were left alone again. ‘I am looking forward to learning all about you, but unfortunately I will have to wait a little longer.’ He smiled, noting the mix of anxiety and anticipation that warred in her expression. ‘We will have time when conference business has finished for the day—I’m sure we can slip away a bit early. But there is much for us to discuss on a professional level.’

‘Pippa Warren,’ Ruth ventured, mentioning the eight-year-old girl whose illness had been the catalyst, causing Ruth to email him in the first place.

‘Indeed, yes. Sadly her situation is far from rare. I learn about cases of delayed or incorrect diagnoses all too often, both in adults and children. And, with the latter, there are parents who are often at the end of their tether, with no idea which way to turn,’ he explained, momentarily distracted by the shimmering colours as Ruth nodded her head and her pale gold hair glinted in the sunlight.

‘That was certainly how Pippa’s mother Judith appeared when I first met her,’ Ruth agreed, a tiny frown knotting her brow. ‘She had been passed from pillar to post for several years, with various doctors insisting that Pippa was fine and telling Judith that she was fussing unnecessarily and an overanxious mother.’

Rico heard similar stories far too frequently. ‘A mother’s instinct should never be dismissed out of hand. Judith and Pippa struck gold the day they walked into your surgery,’ he praised, seeing the hint of a blush colour her cheeks.

‘I don’t know about that.’

‘I do,’ he insisted, refusing to let her play down her achievements. ‘Many doctors, including those with far more experience than you, would not have recognised what you did, never mind follow it through with such tenacity.’

Looking embarrassed, she shrugged. ‘I was just lucky.’

‘Luck had nothing to do with it,’ Rico chastised, determined that she acknowledge what she had done for Pippa and her mother. ‘You are a special doctor, Ruth. And equally as important as your academic excellence is that you really care about your patients. You listen to them and you give them your time—not easy given the pressures doctors are under and the limited period alloted to each consultation. But you go the extra mile, just as you demonstrated with Judith and Pippa. Whereas many others had taken the easy way out—treating only what they saw on the surface, or simply not understanding the relevance of the history and range of symptoms because of lack of training and knowledge—you trusted your instincts and you didn’t give up until you had solved the puzzle. And, with immunology, making a diagnosis is often a case of detective work, of sticking in there and not giving up. You did that, Ruth. On your own. I think—in fact, I know —that you are amazing.’

‘Thank you.’

Two little words and yet they revealed so much, especially an inner aloneness that tightened a knot in his stomach and made him want to pull her into his arms and hug her tight. Her smile was tremulous, while the emotion in her voice, and the expression in eyes glimmering with a suspicion of unshed tears, brought the instinctive knowledge that support of her and belief in her had been in short supply in the past. He didn’t yet know why, but he intended to find out. And then he would ensure that she knew her own worth in the future.

‘Where do things stand with Pippa now?’ he asked, forcing himself to keep things professional.

‘We are waiting for the hospital appointment to come through. I saw Judith last week and she has lots of questions about what will happen when Pippa goes for assessment, and what is involved if the consultant confirms that it is CVID.’ It was through Rico’s help that Ruth had been able to determine that common variable immunodeficiency or CVID, was the most likely diagnosis. She paused, tucking a strand of hair back behind her ear, an endearing knot of consideration creasing her brow. ‘I’ve tried to reassure her as best I can, but I can’t answer everything for her.’

‘Have Pippa’s symptoms improved at all?’ he asked, happy to help Ruth set Judith and Pippa’s minds at rest about what might lie ahead for them.

‘There has been a small lessening in the severity of some of the symptoms now she has started the broad-spectrum antibiotics you recommended,’ Ruth told him, gratitude evident in her smile. ‘After her years of recurring infections and other problems, I’m hoping that there hasn’t been any permanent damage and that she hasn’t developed bronchiectasis.’

Rico nodded as Ruth expressed her worries about the chronic condition that caused widening and scarring of the structures of the bronchi, or breathing tubes. It was one of his concerns for Pippa, too. ‘You said that the blood tests showed low levels of serum immunoglobins.’

‘That’s right. Very low.’ She glanced at him, then away again, but not before he had noted the flash of indecision in her eyes. A small sigh escaped and she seemed to be wrestling with something, but before he could question her, she grimaced and began speaking again. ‘I had a few problems getting the blood tests done.’

‘How do you mean?’ Rico frowned.

‘They are not tests that would usually be requested from a general practice surgery.’

Rico’s frown deepened. ‘You had trouble from the hospital when you asked for the tests? Or from your own practice?’

‘Questions were asked. But the tests got done, that’s what matters. And it told us what we needed to know to help Pippa,’ Ruth said, but Rico was certain she was glossing over much of the struggle she had faced. He wanted to know who had put obstacles in her way. And why. But he let it go…for now.

‘The consultant immunologist will test Pippa’s antibody levels. The vaccine tests can take up to six weeks, which I know is frustrating, but it is important to define the degree of immunodeficiency,’ he explained, seeing the sharp intelligence in Ruth’s eyes and knowing she was absorbing all the information. ‘If the final diagnosis is CVID—as we believe it will be—Pippa will have immunoglobin replacement therapy, which should help end the cycle of recurring infections.’

‘I read that the immunoglobin infusions can be delivered either intravenously or subcutaneously?’ Ruth commented, a query in her voice.

Rico nodded, unsurprised by her thoroughness. ‘That is so. At first Pippa will have regular treatment at the hospital, but once she is stabilised, and if both mother and daughter can cope, they can be taught how to administer the subcut treatment at home.’

‘The subcut sounds scary,’ Ruth pointed out. ‘Especially for an eight-year-old.’

‘Patients generally find it easier than they first think and it is well tolerated. It is better than prolonged IV access, which can increase the risk of infection and also becomes difficult if the veins are hard to find. And, because the home infusions are given once a week, they help to keep the levels more constant than with the IV infusion in hospital,’ he reassured her, although her desire to keep her patient informed was typical of the caring doctor he was coming to know.

Aware that time was running out, he ran through some advice and suggestions that Ruth could pass on and which might help the Warrens as they faced the next stage of the journey in gaining a diagnosis and an ongoing treatment programme for Pippa.