“HERE’S THE BREAK POINT.”
Luca followed Dr. Murro’s finger as he pointed out the T11 vertebra on the X-ray.
“Hard to miss, isn’t it?” he replied grimly. “Severed right in two. No chance of recovering function below the waist.” Luca shook his head. Off-road vehicles could be dangerous things. “She’s lucky the vertebra didn’t rupture her aorta.”
“Has Francesca done any work with her?”
“I don’t think so.” Luca shook his head. “She usually submits a report as soon as she’s worked with a patient, and I haven’t seen one for Maria yet.”
“She’ll be staying on?”
“Who? Maria? Of course. She’s only just arrived.”
“Francesca,” Dr. Murro corrected.
Ah. That was a more complicated answer.
“The whole staff seem to have really taken to her,” Dr. Murro continued.
So have I. Too much.
“She has commitments back in the States, making it impossible.”
“Shame. Someone like that—a triple threat—is going to be difficult to replace.”
“Triple threat?” He’d not heard that turn of phrase before.
“Physio, hydro and canine therapist in one. She’s a league above most. A real asset to Mont di Mare.”
“That she is,” Luca conceded. “That she is...”
A sharp knock sounded on the exam room door. “Dr. Montovano? It’s Cara Bianchi. Francesca has found her out by the meadows, indicating with possible autonomic dysreflexia.”
Luca shot from his chair. “Where is she? Have you brought her in?”
“Si. One of the doctors is seeing her now, in the Fiore Suite, but it’s probably best if you take a look.”
“On my way.” He stopped at the doorway, “Dr. Murro, are you all right to meet with Maria? Talk through her treatment program?”
“Absolutely, Doctor. And if you could send Francesca to meet me when you’re done, that’d be great. Well-done for hiring her, by the way. She’s a real catch.”
Luca nodded, striding out of the office before the scowl hit his lips.
Francesca was more than an asset. She was a woman. One who once you caught hold of, you’d be a fool ever to let go. But he would have to do just that if he was ever going to stand on his own two feet. Provide for his niece. Be the man his family had always believed him to be.
* * *
Doctors and nurses were already surrounding Cara on an exam table, where Francesca and a nurse were holding the girl in an upright position.
“She’s bradycardic. Blood pressure is one-four-five over ninety-seven,” the nurse said as soon as she saw Luca enter.
“Any nasal stuffiness? Nausea?” Luca asked.
“No, but she’s complained to Francesca about a headache.”
He glanced to Fran, who gave a quick affirmative nod.
“When I saw the goose bumps on Cara’s knees and felt how clammy her skin was I brought her in here.”
“My head is killing me! And my eyes feel all prickly!” Cara wailed from the exam table. “All I wanted to do was lie in the meadow!”
“It’s all right... We’ll ease the pain. Can we get an ice compress for Cara’s face, please?” Luca smiled when he saw that one was being slipped in place before he’d finished speaking. “Autonomic dysreflexia.” He gave Fran a grateful nod. “You were right. Can we strap her in and tilt the exam table up?”
“Has anyone checked her urinary bag?”
“Just emptied it. She had a full bladder.”
“Bowels need emptying? Any cuts, bruises? Other injuries?”
“Nothing that I could see,” said Fran. “But Cara hadn’t voided her bladder in a while and was lying down, which I’m guessing exacerbated the symptoms.”
She looked to Luca for confirmation. A hit of color pinked up her cheeks when their eyes met.
“Exactly right,” Luca confirmed grimly.
It sounded like a simple enough problem, but for a paraplegic it was potentially lethal. Francesca had done well. His eyes met hers and he hoped she could read the gratitude in them.
“That’s all it was?” Cara’s voice turned plaintive as she scanned the faces in the room. “I just had to pee but it felt like I was going to die?”
“That’s the long and short of it, Cara. If you like...” Luca flashed the group a smile, trying to bring some levity to the room, and dropped Cara a quick wink. What he had to say next was a hard bit of information to swallow. Something she’d have to live with for the rest of her life. “Tell the others it was autonomic dysreflexia. Sounds much cooler.” The smile dropped from his lips. “But you should also tell them how quickly it can turn critical. All those symptoms are warning signs of a much more serious response.”
“Like what?” Her eyebrows shot up.
“Internal bleeding, stroke and even death.” He let the words settle before he continued. These kids already had so much to deal with. Worrying about dying simply because their brain couldn’t get the message that they needed to pee seemed cruel. Cara had been snowboarding less than a year ago, and now the rest of her life would involve wheelchairs, assistance and terrifying moments like these that, if she were left unattended, might lead to her death.
“You use intermittent catheterization, right?” Luca asked.
Cara nodded, a film of tears fogging her eyes.
Luca turned to the staff. No need for an audience. “I think we’re good here. Cara and I might just have a bit of a chat and then...”
He scanned the collected staff including Gianfranco Torino—a GP who had retrained in psychotherapy when he’d suffered his own irrecoverable spinal injury. He, too, would be in a wheelchair for the rest of his life.
“Dr. Torino, would you be able to meet up with Cara later today? Maybe for an afternoon roll around the gardens?”
“Absolutely.” Dr. Torino gave Cara a warm smile. “Three o’clock at the pergola? Is that enough time?”
Cara nodded. “Si, Dr. Torino. Grazie.”
“Prego, Cara. See you then.”
Luca scanned the staff, everyone of them focused on Cara as a unit.
This is the Mont di Mare I imagined.
His eyes lit on Francesca, who lifted her gaze from Cara’s hair. She’d been running her fingers through the girl’s long dark locks. Soothing. Caressing. When she saw him looking at her and smiled, it felt as if the heat of the sun was exploding in his chest.
Perfection.
And perfectly distracting. Smiles didn’t pay bills. Patients did.
He moved his hands in a short, sharp clap. Too loud for the medium-sized exam room. Too late to do anything about it.
“All right, everyone. I think Cara and I need to chat over a couple of things.”
Cara reached over her shoulder and grabbed Francesca’s hand, shooting Luca an anxious look. “Can Fran stay? She was going to plait my hair—right, Francesca?”
“Ah! You’re a hairdresser now?”
He saw the flutter of confusion in Fran’s eyes and then the moment she made her decision.
“One of my hidden talents.” She gave Cara a complicit wink and gathered her hair together as if it were a beautiful bouquet of wildflowers. “I promise I won’t distract you from what you two are talking about.”
Her pure blue eyes met his. There were a thousand reasons he should say no, she couldn’t stay, and one single reason to say yes. His patient.
The motivation behind everything. Not Fran. Not desire. Not love.
The thought froze him solid for an instant, but quickly he forced himself into motion.
“I may need you to help for a moment before the hairstyling session begins.”
“Of course,” Fran replied. “Anything you need.”
Despite himself, he risked another glance into her eyes and saw she meant it. She wasn’t there to take. To demand. To change him. She was simply there to help.
Removing the cold compress from Cara’s face, Luca ran a hand across the girl’s brow, satisfied the hot flush was now under control. With Fran’s help, they triple-checked for bedsores and ensured her clothing was fitting comfortably. A tight drawstring on a pair of trousers could trigger one of these potentially deadly incidents.
Once they were settled, and Fran had magicked a hairbrush from somewhere, he brought over the portable blood-pressure gauge, straddled a stool and wheeled himself over to Cara.
“Arm.” He gave her a smile and held out the cuff.
“You already took my blood pressure.”
“It’s good to do it every five minutes or so when this happens. Here—let’s slip your legs over the edge of the table to help your blood pressure. C’mon. Stretch your arm out.”
Cara obliged him with a reluctant grin and soon he was pumping up the pressure in the cuff.
“I know you’ve had a lot to get used to since the accident, and this is another one of those scary learning curves. Basically, your bladder can’t tell your brain it’s full, so it’s best if you have some sort of schedule. Have you ever set up a regular voiding timetable?”
“I did for the couple of months I was back in school, but over the summer I guess I let it lapse a bit.” She shot him a guilty look.
“Did your doctors explain what might happen if your bladder was full and you didn’t empty it?”
Another guilty look chased up the first. “I forget...”
“They’re pretty strong symptoms—as you just found out. I know you’ve only been here a few days, but if you have a voiding timeline in your schedule it’s a good idea to follow it.”
“I was just waiting for my parents to go. You know—making the most of the time they were here.”
“I thought you were out in the field on your own? That Francesca found you?”
Instinctively, his eyes flicked up to Fran’s. The soft smile playing on her lips as she listened to them talk reminded him to do the same. A smiling doctor was much easier to listen to than the furrowed-brow grump he’d been of late.
Cara was remaining stoically tight-lipped.
“Either way, here’s what’s happening. Autonomic dysreflexia is your body’s response to something happening below your injury level. You’re a C6, C7 complete, right?”
Cara gave him a wry grin. “Can’t get anything past you, can I, Dr. M?”
“Let’s hope not, if it means getting you to a place where you’re in charge of your own life. So.” He gave the reading on the gauge a satisfied nod and took off the cuff. “I’m sure you’ve heard it before, but this time let it sink in. There are any number of things that can kick off an AD response. Overfull bladder or bowel.”
“Ew!”
“I know—it’s gross.”
“No grosser than picking up dog poop who knows how many times a day!”
* * *
Fran’s fingers flew to cover her mouth. Oops! So much for staying out of the doctor-patient talk!
Cara gave her a toothy grin. One Fran was pretty sure contained a bit of bravura.
“Actually...do you think an assistance dog would be able to remind me?” Cara had switched from doleful teen to bargaining expert.
Ah! That was why the teen had asked her to stay. Not for her sure-handed approach to a fishtail braid.
“That’s not really my terrain.” Luca pressed his lips together. “Francesca?”
Fran shook her head in surprise. Was Luca including her in this?
“Sorry, hon. What exactly is it you want to know?”
“If an assistance dog—one like Edison, maybe—were to help me, couldn’t he remind me of things?”
Fran’s instinct was to look to Luca, seek guidance. But to her surprise he just smiled, then widened and raised his hands, as if opening the forum to include her.
She gulped. This was... This was getting involved. Becoming interwoven in the fabric of things here on a level she’d told herself was a danger zone. A little dog training here. A bit of physio there. But advising a patient...?
“Francesca?” Luca prompted. “This is your area of expertise.”
Dropping her gaze from his, she stared at the plait her fingers was weaving by rote and started speaking.
“Of course assistance dogs can certainly respond to alarms, and help you to remain upright in your wheelchair if you were ever to slump down. They can do a lot. But this sounds to me like something you and Dr. Montovano had better work out.”
“But couldn’t a dog have told you if I was dead or dying?”
“You mean when I found you out in the field? Absolutely. It would’ve barked. Tried to get someone to come and see you straightaway.”
“Like Lassie?” Cara’s voice squeaked with excitement. “If you hadn’t found me then a dog could have saved my life!”
“Well...” Fran’s fingers finished off the plait and she swirled a tiny elastic band she’d dug out of her pocket onto the end.
She’d overstepped the boundaries before. She really didn’t want to do it again.
“Cara, you’re with us for the rest of the summer, right?” Luca interjected. Mercifully.
Cara nodded.
“How about you and Fran spend a bit of time with Pia’s dogs—if it’s all right with Pia, of course. See how you go. I’m sure assistance dogs suit some people and aren’t quite right for others. Am I right, Francesca?”
She’d expected to see some sort of triumph in his eyes. A way to catch her out. But there was nothing there but kindness. Possibility. Respect.
And for one perfect moment she was lost in the dark chocolate twinkle holding her rapt like a... Ha! The irony. Like a giddy teen.
Her phone buzzed. She glanced at the screen and frowned. Her father didn’t normally ring this early.
“Sorry, I’ve just—”
Luca waved her apologies away. “I think Cara and I have plenty to talk about.”
She gave Cara a quick wave, then accepted the call, closing the door softly behind her as she went.
“Si, Papa? Va tutto bene?”