‘Well, Harry missed his second immunisation because he had a cold and I didn’t want to bring him...’ Anna shifted him on her lap ‘...so I wondered if you’d do him today?’
‘Of course, although for future reference a cold doesn’t usually mean that he can’t have his injection.’ Holly called up the notes and then went to the vaccine fridge to find the correct vaccines. ‘He has exactly the same as last time, Anna. Diphtheria, tetanus, whooping cough, polio, meningitis C and Hib. And then the same again at four months.’
Anna pulled a face. ‘It seems like such a lot for a small baby—I’ve read that some people are worried about a young baby’s immune system being battered by so many vaccines at once.’
‘Well, a baby’s immune system is tested every time he goes out of the house,’ Holly pointed out gently, ‘and when he’s in the house as well, when you think about it. Babies are constantly bombarded by germs. At the moment there’s no medical evidence to suggest that having the vaccinations together overloads the immune system. And, of course, without the immunisations, they’re at risk of catching the disease.’
Anna gave a groan and bit her lip. ‘I know. It feels like such an enormous decision. I’ll be glad when they’re all finished. It’s just one more lot, isn’t it?’
‘That’s right,’ Holly gave the injections quickly and popped the polio drops into Harry’s mouth. ‘Then he has his MMR between thirteen and fifteen months.’
‘Oh, well, I’m not worrying about that one now,’ Anna said, rolling her eyes as she patted and soothed the disgruntled baby. ‘There. All over now.’
Holly asked Anna to stay in the waiting room for five minutes in case Harry had an adverse reaction to the injections and called her next patient.
‘Helen!’ She smiled, surprised and pleased to see the little girl she’d met on her first day at the practice. But one glance told her that the girl was feeling poorly. ‘What’s been happening to you?’
‘She’s been complaining of terrible earache and her temperature is up in the roof.’ Alison Brown ushered the little girl into the room and onto the nearest chair. ‘The receptionists told me that the doctors are really busy this morning so I asked to see you. I hope that’s OK.’
‘That’s fine,’ Holly assured her, picking up an auriscope. She’d been trained to examine ears so she was more than confident to perform the task herself. ‘I’ll just have a q
uick look at her and then if necessary I can interrupt one of the doctors. Does she often have ear infections?’
‘Hardly ever.’ Alison screwed up her face and racked her brains. ‘Once, I think, when she was two.’
‘OK.’ Holly crouched down and gave the little girl a soft smile. ‘You poor thing. Earache is awful, I know! I used to have it when I was tiny. Will you let me look in your ear, Helen? I promised to be very gentle.’
The little girl sniffed and cuddled against her mother, giving Holly perfect access to her ear. Knowing that she wouldn’t be given the opportunity for a leisurely examination, she worked as quickly as possible, wincing slightly as she saw the bulging eardrum. No wonder the child was in pain.
‘It’s very red, Mrs Brown,’ she murmured, popping the auriscope back onto the tray. ‘That’s definitely the problem.’
‘Oh, dear.’ Alison looked guilty. ‘She’s had it for a few days but I was hoping it would clear up by itself. Should I have brought her down sooner?’
‘No, not really.’ Holly entered the results of her examination into the computer and then paused to give Alison her full attention. ‘Most cases of otitis media—that’s the medical name for an ear infection—are mild and will resolve on their own with just some pain relief. Unfortunately a small number don’t resolve on their own, and those cases need to be given antibiotics. What normally happens in this practice is that in a child of Helen’s age, with her symptoms, they advise you to use Calpol for the first two days to see if it resolves by itself.’
Alison pulled a face. ‘She’s been complaining for a couple of days already.’
Holly nodded. ‘So what we need to do is give her a short course of antibiotics. I’ll just see if one of the doctors is free.’
After asking Tina, she was hugely relieved that it was Ian who strode into the room a few minutes later and not Mark.
‘What can I do for you?’ He smiled at her with his usual warmth and listened as she quickly outlined the problem. ‘So you think she needs some antibiotics?’
‘She’s had earache for two days already,’ Holly told him, trying not to dwell on how much she’d hate to leave the practice. ‘Her ear drum is red and bulging. I thought maybe she should have a course of amoxicillin?’
He nodded briefly. ‘I’ll take a quick look myself, although I’m sure you’re right. Hello, trouble.’ He crouched down and touched Helen’s face gently. ‘What have you been up to, then?’
Gently and skilfully he checked the ear and then nodded. ‘Yes, I agree.’ He straightened and slipped the auriscope into his pocket. ‘Have you run off a prescription for me?’
Holly nodded and handed it to him to sign.
‘Keep up the Calpol,’ Ian advised, handing Alison the prescription, ‘and you can try wrapping a warm hot-water bottle in a towel and holding it next to her ear. She might find that soothing. If she’s no better in two days, bring her back.’
Alison nodded gratefully. ‘Thanks so much, Dr Hughes.’
Holly showed them out, aware that Ian seemed in no hurry to leave the room.
Closing the door carefully, she turned back to face him and looked at him warily, wondering what he wanted.