Disclaimer: The story and characters of Doc Martin belong to Buffalo Pictures. This work of fan fiction is for personal amusement only and no infringement of any legal rights is intended.
Thank you to my beta, robspace54, for his thoughtful suggestions and thorough editing. All errors are my own.
The Consultation
Chapter 11
Martin steers the Lexus through the narrow village streets and passes the scene of yesterday's lorry accident on his way to the main road leading to Truro. There isn't much traffic on this early Sunday morning, and he hopes to arrive at hospital in time for rounds.
He switches on BBC 2 and the opening strain of Bach's Brandenburg concertos fill the car, one of his favorites. Last night, he had one of his recurrent nightmares and padded downstairs to listen to the concertos on the DVD player. This helped chase the demons back to where they came from and he fell asleep, but woke up stiff and sore on the lounge sofa at the break of dawn. There were nightmares when Louisa shared a bed with him; but instead of turning to Bach or Mozart for solace he would place his hand on the soft curve of her waist and feel the rise and fall of her breath, soothing him ways that no piece of music ever could.
Martin stifles a yawn as the car accelerates up a short rise. At the top, he is startled by a small flock of sheep huddled in the middle of the dirt road and he hits the brakes. The tires skid on the wet gravel and he comes to a stop, narrowly missing the beasts. "Bloody hell", he exclaims and gets out of the car. The sheep run up the foot path and stare at him vacuously with their beady eyes. He looks around for the farmer, primed to give him a good upbraiding.
"Martin!" His Aunt Ruth walks quickly up the road from the farmhouse. "Glad you found them."
"They found me," he answers angrily. "You can't have these animals wandering around the road. Someone's going to get hurt."
"Thanks for stating the obvious, Martin." It starts to rain and she wraps her coat tightly around her thin frame. "I could use some help getting them back into their pen."
Martin frowns. "Where's Al? Isn't he supposed to be helping you?"
Ruth shrugs. "Not today." Al had made himself scarce after he admitted using the fence money to pay off his father's debt and she had muddled on her own, unsure of the feeding schedule for the animals or how to tend to the early winter crops. It was a relief when Al called and said he wanted to talk; they agreed to meet in the village early in the week. She is ready for him come back, tired of tending the chickens and chasing the sheep around. And she does miss their chats and chess matches, even though he wins most of the time.
"I warned you not to rely on anyone from the village." He briskly walks up the foot path, careful to skirt around the mud puddles and sheep droppings.
Ruth is about to reply that he's being unreasonable when Buddy comes bounding up the hill and starts to bark furiously at the sheep.
"He thinks he's a sheep dog," says Ruth. Martin sniggers but then watches in amazement as Buddy weaves around the sheep's spindly legs, and herds them into the pen. The little dog runs to Ruth and sits down next to her with a look of smug satisfaction on his sweet doggy face.
"Good boy, Buddy." She secures the gate and promises him a special treat with his breakfast.She turns to Martin, "Would you like to stay for breakfast?"
"No, I've already eaten. I was on my way to Truro Hospital when your livestock jumped in front of my car." He wipes his hands with a handkerchief and looks at his watch.
"Oh yes. I heard about the accident yesterday." Ruth walks Martin to his car and Buddy trails behind her. She faces Martin and asks, "How are your preparations coming along? You are leaving for London in less than two weeks."
He sighs. Is it that soon? The solicitor had called to go over the financial arrangements for Louisa and James and there's the matter of returning Dawson's call at Imperial. He turns away from his aunt's piercing gaze, and looks at the moor, cloaked in autumn's dusky colors. As if in a nightmare, he sees himself stranded on an out of control train, trying desperately to find a way to stop it, but can't.
Ruth sees that something is amiss, but decides to keep quiet. She and the little dog watch him drive away and, after the car disappeared on the horizon, they walk down the hill to the farmhouse.
XXXXX
Martin walks through the empty corridors of Truro hospital and listens to the sound of his footsteps bounce sharply off the gleaming white walls. The stillness may seem eerie to some, but to Martin it's like an old friend. As a registrar and later as chief of vascular, he took surgical call on most weekends. He won't be expected to take weekend call at Imperial but he might as well. There won't be much for him to do in London other than work, and he can't be expected to travel the five hours to Portwenn every weekend to see James Henry.
Aunt Ruth's words keep repeating like an endless loop in his head- leaving in less than two weeks. He stops outside the High Dependency Unit and looks out the window at the spires of Truro Cathedral stretching up to the overcast sky. Not in a million years had he ever imagined being a father. But now that he is a father, the thought of not being be on hand to hear his son's first words or watch him take his first steps brings on a sense of loss that takes his breath away.
From the reception, Lisa watches the tall, impeccably dressed man standing by the window. She sees lots of people come through the unit; some sit sad and depressed and others pace worried and upset. This man has a stern look about him, but she can see the sadness in his eyes and in the slump of his shoulders, as if he's carrying a burden of which he can't speak. He must have sensed her looking at him, for he turns and walks up to her desk.
"Dr. Ellingham. I'm here to see Ben Tulley."
Lisa points to the visitors register "Sign here."
Martin shows his hospital identification, and stops at the nurse's station for Ben's record. The nurse points to the second bed from the station and he sees Morwenna sitting by Ben's side. There are dark circles under her eyes and her clothes look untidy and slept in. She turns her head and smiles when she sees it's him. "Doc! It's nice to see a familiar face."
He stands on the other side of the bed, and flips through Ben's record. "Has he woken up at all?"
"He did about ten minutes ago and twice during the night." Morwenna had snuck back in after Ben's horrid mother had left to spend the night at a hotel. Alphia hadn't seen the point in staying and left her mobile number with the staff in case something happened. Even though it was against the rules, Kathy had settled Morwenna on a cot next to Ben and hoped she wouldn't get into too much trouble with matron.
Kathy bustles in carrying a syringe and stops at the foot of the bed. Morwenna smiles and says "Doc, this is Kathy, Ben's nurse." Her expression freezes when she sees what Kathy is holding. She jumps up and says, "I don't like needles." She gives Ben's hand a squeeze and quickly leaves.
Martin looks at Kathy and thinks she looks familiar but he can't recall where or when he'd seen her. He shrugs and asks, "Has he complained of abdominal pain, right about here?" He points to the left side of Ben's abdomen, below the rib cage.
"Yes, he did the last time he woke up. I have some pain medication for him." She holds up the syringe.
"Don't give it to him." As Martin gingerly press down on Ben's abdomen, he feels the soft contour of the spleen along with a worrisome fullness. He pulls the hospital gown to one side and frowns at the series of red striated marks extending to both flanks.
Martin pulls the gown over Ben as Adrian Pitts enters followed by Philip Adler and a young female registrar. The surgical consultant stops short when he sees Martin but recovers quickly and says, "Dr. Ellingham! To what do we owe the pleasure?" He smiles but eyes Martin coldly.
"Have you looked at this patient's scan and lab work?" Martin asks quietly. He stares at Pitts impassively, but a knot of anger tightens in his chest. Pitts had taken a malicious pleasure in telling the denizens of Portwenn all about their new GP's little problem with blood and the village idiots had used this as an opportunity to ridicule him. This happened five years ago, but Martin could hold a grudge and had not forgiven his former pupil.
"Of course. I'm the surgical consultant on this case."
"You didn't see anything unusual?" Martin hands Pitts the reports.
He ignores the papers in his hand. "A faint blush on the CT, and a small drop in the hematocrit but nothing else to indicate a worsening of the patient's condition, Dr. Ellingham," he answers lightly, but squirms under Martin's unrelenting gaze.
"A two point drop in the patient's hematocrit and signs of bleed on CT don't concern you?" Pitts recognizes the ominous tone in his former chief's voice and quickly glances at the report. He turns to Adler and snaps, "why didn't you tell me about the change in his blood count?"
The flustered registrar is about to answer when Martin flicks open's Ben's gown and gestures for the consultant to have a look.
"What would you call this, Mr. Pitts?" he asks bluntly.
Pitts swallows hard before answering, "Grey Tuner's sign." He turns to Adler. "Call the theater and tell them were bringing a patient in for an emergency splenectomy." Adler starts to leave but isn't quick enough for now irate Pitts. "Now!" he bellows. Adler scurries off and Pitts turns to Martin. "Good call, chief."
Martin sneers, "You're an incompetent arse."
Pitts takes a step back, knowing full well he has lost this round with Ellingham.
Adler hurries back and says, "Operating Theater one is ready for us."
Pitts turns to the female registrar, "You're scrubbing in." The pretty blond smirks at Adler before disappearing down the corridor after Pitts. "Bloody bitch," he mutters under his breath and shoves past Martin on his way to the nurse's station.
Martin watches him walk away. Edith was always asked to scrub in for the most interesting cases by their chief while her fellow registrars were side lined to the gallbladders and hernia repairs. Later, she'd callously told Martin that sleeping with the chief was a means to an end and that he really shouldn't take it personally. He hadn't trusted her after that, but still had been devastated when she broke off their engagement a few months later.
He's about to leave when Kathy calls out, "Dr. Ellingham! He's dropping his blood pressure."
Martin hurries to Ben's side and looks at the monitors. "He could be bleeding out. We need to get him to theater."
Kathy nods and wonders what's taking the porter so long. She's about run to the nurse's station to ask for assistance when they hear the rattle of a stretcher coming down the corridor. Kathy yells out, "Hurry up! We have to get this one out of here now!"
Martin grabs one side of the bed sheet and helps Kathy place Ben on the stretcher, careful not to jostle his fragile spleen. Kathy quickly transfers the IV bags and they race to the service lift.
Morwenna is on her way back from the cafeteria and sees Ben being taken away by an anxious looking Doc Martin and Kathy. She runs after them and yells, "What's going on?" Kathy stops long enough to tell her, "He needs surgery. I'll be back to talk to you." She enters the lift and the doors shut with a finality that unnerves Morwenna.
She looks wildly around the unit for someone to ask about Ben, and sees Philip Adler at the nurse's station. Her eyes are glassy with tears and worry as she rushes up to him and asks, "Is Ben going to be okay?" Before he can answer, they hear a woman's loud and strident voice coming from the reception area.
"What do you mean he's been taken to theater? Wasn't I supposed to be notified?"
Alphia Tulley marches into the unit and spots Adler standing with Morwenna.
"Are you going to tell me what happened?" She barks at Adler.
Philip sighs and wonders how he got to play nursery maid to these two instead of assisting in theater. "His spleen is bleeding into the abdominal cavity and needs to be removed urgently. He'll be in theater for about an hour and then in recovery for a few hours before being brought back here."
Alphia replies, "That's very well and good, but how long is he going to be in hospital now? I have a business to run and can't possibly be expected to do so from a hospital room."
Morwenna's eyes swim with anger. She turns to Alphia and yells, "Then why don't you leave? I know he doesn't want you here!" She takes a step back. "Ben told me he hates you, and I can see why."
She turns and runs towards the exit, tears streaming down her cheeks.
To be continued….
Medical Glossary
Grey Turners sign- Refers to bruising of the flanks and indicates an accumulation of blood in the space between the abdominal organs. In this chapter, Ben's spleen is leaking blood into this space and causing the flank bruising. This sign is named after British surgeon George Grey Turner. He served in the Royal Army Medical Corps during the World War I and made one of the earliest attempts to remove a bullet from a soldier's heart.
Hematocrit- This is the measure, expressed in percentage, of the number of red blood cells in a sample of blood. A declining percentage is a bad sign in a critically ill patient like Ben.