A brief smile touched the little girl’s pale face and she lay still as Andreas started to examine her, whimpering occasionally with pain.

Libby watched as he used his fingers to gently palpate the child’s abdomen.

‘She has oblique muscle rigidity,’ he murmured, ‘which is a sign of peritoneal irritation.’

Libby looked at him, trying to read his mind. He obviously didn’t think that Melanie had gastroenteritis.

Mrs Palmer was biting her nails in agitation. ‘What does that mean?’

‘I don’t think she has a stomach bug, Mrs Palmer,’ Andreas said gently. ‘I think that she has appendicitis and unfortunately it has burst, which is why her stomach is so very painful and swollen. Libby, can you bleep the surgeons urgently, please, and then come back and help me? I need to get a line in. Mrs Palmer, when did she last have something to eat or drink?’

‘She had a few sips of water in the night,’ Mrs Palmer told them, ‘but nothing to eat since breakfast yesterday morning.’

Leaving Andreas to finish his questioning, Libby hurried out onto the ward and rang the switchboard, asking them to bleep the on-call surgeons.

While she was there she gathered up the distraction box and the rest of the equipment she needed and then returned to the room.

Andreas was talking to Melanie, his deep voice gentle and soothing. ‘I need to put a plastic tube in your arm, sweetheart.’

Melanie stared at him. ‘Will it hurt?’

‘Yes, a bit,’ Andreas said honestly. ‘But we need to do it to make you better.’

Libby looked at him. ‘We could use a local anaesthetic cream.’

‘No time.’ Andreas reached for a swab and a venflon. ‘It takes at least half an hour to work and I need to get this line in now. She needs to go to Theatre.’

Libby looked at the mother. ‘If you find this too upsetting you could go and get a cup of coffee while we put the drip up.’

Mrs Palmer shook her head, her eyes glistening with tears. ‘No. I can’t leave her. Do whatever you have to do.’

‘Right, then, Melanie.’ Libby sat on the bed and put the distraction box next to the little girl. ‘Let’s have a look in here and see what we can find.’

‘Balloons!’ Melanie reached into the box and pulled out a pink balloon. ‘Can I have it?’

‘Of course. Why doesn’t Mummy blow it up while we sort you out?’

Libby handed the balloon to Mrs Palmer who obligingly took it and blew.

Seeing that the child was distracted, Andreas searched for a vein.

‘OK—squeeze there for me, Libby, and don’t let go.’

Libby knew what he was saying. If they missed the vein on the first attempt, it would be doubly difficult to persuade a child of this age to co-operate, and it was distressing for everyone.

She hoped Andreas was good at finding tiny veins in tiny hands.

He was.

He swabbed the skin, grabbed the child’s hand firmly and slid the needle in with the minimum of fuss.