All the way to Greater Ashfields, Tess couldn't stop thinking about what Spike had said. It was hard to imagine him being the little kid, after he'd been so mature all the time she had known him. The first time they met, he had been stepping in to protect her from bullies, and he'd never stopped doing what needed to be done. But the more she thought about it, the more she realised that he'd never chosen that role. He acted mature and responsible because he didn't have any choice in it; and when it came to the really tough stuff, like his passport and reporting Duke to the police, the cracks had started to show. He was struggling to cope, and needed some support. An opposite to Tess in many ways: He would never have chosen to take all those responsibilities on himself, but when somebody needed help he wouldn't give up.
It made sense then to think that he'd miss being a child. How could she have failed to see that? And that time when he had listened to Ffrances's recording before coming to watch TV, he had seemed so happy and comfortable in the child role. So maybe that was a sign of who he was on the inside, beneath all the mental walls he had put up to protect himself from his stepfather and brothers. The real Spike, even. She was glad that he had found the courage to share that with her, and she hoped that she could find the confidence to help him enjoy not being in charge.
Ten minutes after getting off the bus, Tess was walking between shabby and run-down buildings. These were the shops that weren't popular enough to have a prime site in the city centre, and their frontages didn't have to attract passing trade because the intended customers already knew where they were. Or they were manufacturing units that were just barely scraping by on the cheapest premises they could manage. It wasn't like it was a bad neighbourhood, but there was a general air of desperation about the place. Tess pulled her coat tight around her shoulders, feeling a little chill even if it was just psychological. And then she came to the now-familiar door with the letters 'ADCCG' displayed beside it. Nobody could know what she was here for unless she told them; and most people wouldn't even know that those letters stood for 'Ashfields District Confidential Clinic for Girls'.
Tess had been here nearly a dozen times now, but it didn't stop her being embarrassed. She hated the thought that somebody might know she was coming here, as if they might magically be able to guess what was embarrassing her so much. Still, there was nobody on the street today, and she told herself that she didn't need to be embarrassed.
"Hey Tess!" She froze when she heard the cheerful voice. Somebody recognised her, anyway. She turned to see Mindy Ciertowczki, sitting near the door to the main waiting room. "I didn't expect to see you here."
"Yeah, same," Tess said with a blush. She hoped that Mindy wouldn't ask why she was here; but at the same time she wondered what would bring Mindy here. She knew that was a hypocritical thought, but somehow it embarrassed her even more. After a little hesitation, she told the receptionist she was here and sat down near Mindy. It would have been rude to walk away after saying 'hi'.
"Looks like you come here often," Mindy said with a little smirk. "You went right to the desk without looking around."
"Yeah," Tess nodded. "The doctor wants to do some more tests. The last set were inconclusive. You know what it's like." She could say that without blushing; just so long as Mindy didn't ask what they were testing for.
"Yeah," Mindy said, and nodded. "Well, no. This is my first time here. It's not like I... well... I'm not the kind of girl who needs to come in here. I'm careful. But you're the last person I would have expected to see. I mean... Sorry, I guess that's kind of rude. But I thought you were too shy to... you know..."
"It's nothing like that!" Tess said, blushing furiously. "Look, I... I just got something and I thought I should see a doctor. And I don't want my cousin sticking her nose in, so I need to go see a doctor somewhere she doesn't know about." As she said it, she realised that wasn't really true. It probably would have been so much easier to pay a visit to the walk-in clinic at Pine Ridge, where they had better equipment and more doctors. Even if Ffrances found out, it wouldn't be a surprise to her. More than anything, Tess was realising she was embarrassed because she didn't want Ffrances and Gabby to know that this problem was seriously worrying her. Ffrances acted like it was something that would pass on its own, and Gabby must have been delighted to see Tess acting more like a baby than she had expected. Which made it really awkward any time she had to speak to either of them.
"I understand. Sorry, I just... I never thought I'd end up here, and I'm kind of ashamed. It's hard to think of something to talk about. I just... I got this rash, and I thought I should see a doctor. It's been years now, and a dozen guys never even noticed. Maybe it's like a birthmark or something, but we're going to that new dessert bar on friday. Ice cream and chill, compare our experiences growing up, kind of thing. And if it goes well... I know Rachel's the kind of person who'd pay attention to every detail. I have to be able to say it's just eczema, or something. I think I'd be too embarrassed to lie to her if I don't know."
"Good luck," Tess said. "I'm sure it's nothing, you just need to know, right? And maybe they'll give you some cream or something to make it disappear. I mean, when you–"
"Tess Naylor?" the receptionist called, and Tess looked around. It was time for her to go in.
"Good luck," Mindy said. "Hope you can get a cure for, well, whatever it is."
Tess didn't think that was likely, but she was hopeful that Dr Lutwa would be able to tell her something useful. There were more test results from her last visit, although she was already sure there would be nothing useful in any of them. If there had been, the doctor would have called right away rather than waiting for her to ask for another appointment.
As expected, the tests only helped them to rule out a couple of rarer parasites or infections that could have weakened her pelvic floor muscles. Dr Lutwa also pointed out that the muscle biopsy, the most painful of the tests so far, indicated that her muscles were neither distorted nor fatigued.
"At this point, I think we can be certain that the problem is not in your bladder," she said. "The remaining options are neurological, and psychological. Although proving either would be quite difficult."
"Where's Doctor McScotty when you need him?" Tess said, trying to lighten the mood. But the joke fell flat, as it seemed Dr Lutwa didn't get the reference. Seeing the look of confusion, Tess felt she had to explain: "A sitcom my dad used to watch when we were in Gibraltar. Set in a hospital. McScotty was a genius doctor who couldn't get a job because he won't respect authority, so he works as a hospital janitor. Sometimes he'll walk into an office, look at a patient's file, and immediately diagnose them when all the doctors are stumped. He gets promoted to consultant, then gets busted down to janitor again by the end of the episode for pulling childish practical jokes on the other staff or swearing at members of the hospital board. I mean, in all those TV shows, you never see the cases where they just don't know what's wrong."
"It can be frustrating at times. But I gather you had some more clues that might bring us closer to an answer?"
"I was in hospital recently," Tess said. "I mean... I was okay. I was staying with my... with Spike. His stepdad beat him up, and they were really worried about him. I wouldn't leave his side, so I was sleeping in a chair in the hospital room for nearly a week. I never even thought to bring the... my diapers. It didn't occur to me until I got back that I hadn't had any problems all the time I was there. A whole week without accidents, that has to mean something, right?"
"It's possible," she said, with a nod. "So... were you eating normally while you were there?"
That wasn't one of the questions that Tess had been expecting, but she did her best to answer. She answered everything that Dr Lutwa wanted to know, and hoped that this was bringing them somehow closer to a solution. From the methodical way they went into everything that had happened during her days at Pine Ridge, it really seemed that this could be a worthwhile discovery.
"Well," Dr Lutwa said eventually, and then paused before continuing: "I would expect that the most significant detail is that you weren't in such a comfortable position to sleep. You would have been under more stress as well, I suspect, both of which can mean that you don't sleep so deeply. Now, if this was just a problem with bedwetting, my understanding would be that certain sensations aren't getting through to you while you are asleep; which is often the case for younger children. So a lighter sleep could help with that. However, that doesn't explain your daytime problems."
"Yeah," Tess mumbled. "So what else would it suggest?"
"Well, there is a possibility that there's something related to... There are a couple of conditions where organs aren't anchored properly, and can move about inside you. I've read about rare cases where a patient's heart moves lower in their chest when they stretch, causing sudden loss of blood pressure. And similar conditions that can kink arteries, causing an apparent decline in liver function when a patient lies on one side. Those cases could only be diagnosed correctly by comparing vital signs when the patient's posture changes. I've not come across a case study for the bladder shifting out of place, but I believe it could be possible. I'd like to test... hmm... I think it could be informative to get ultrasound images when you are sitting, standing, and lying down. Any differences there would give us a big clue what could be wrong. But barring that, I do think that this is most likely to signify a psychological problem. Being in hospital with a friend might have put your life on hold, in a way, pushing other problems out of your mind. Do you think that could be the case?"
"It could be," Tess admitted. "But it's hard to imagine, though. I really don't feel stressed. About the only anxiety I have is because of this problem."
Dr Lutwa asked some more questions. She was surprised to hear that Spike had moved in with Tess, but she didn't give any judgement. Tess realised that a good proportion of the clinic's patients were kids younger than her who had sex-related problems or questions; so a platonic housemate was probably nothing shocking to her.
The ultrasound didn't show anything. Dr Lutwa also requested Tess to go through some imaging machine to get pictures of her abdomen. She'd done it before, when they slid her inside the machine on a tray, but this time they had things arranged so that she could be pushed into a similar machine on a wheelchair. She couldn't do standing, because that particular machine wasn't large enough. But Dr Lutwa said she thought they had enough evidence to check for any obvious problems.
"I'll have a look at those pictures, and see if I can identify anything out of place. But it may be worth making an appointment to see a counsellor. Would you be willing to speak to someone with more relevant expertise to advise on your mental and emotional state?"
"I will," Tess said, making a little promise to herself. If she was talking to anybody about that, it would have to be Ffrances. And that was sure to be easier than explaining to someone else how she'd suddenly started wetting the bed again. "I don't think it can be stress now. But I promise, if there's nothing on those tests, I'll make an appointment with Ffrances. She... She already knows a lot of the details. I've been trying to keep this secret so I don't worry her, but she already knows a little bit about the problems I've been having, and she's probably the most qualified. Or she can recommend one of her colleagues."
"Okay. If I find anything on these scans, I'll let you know this week. So if you don't hear from me, you should speak to your psychiatrist friend. And I hope that she can help you with this."
"Thank you, Doctor."