Handy

Martin threw on a robe and tore downstairs while I pulled on jeans and a jumper. Philip was peacefully sleeping, in spite of the uproar upstairs and the tumult below. As I dressed I could hear frantic voices with Martin's deep tones interspersed.

I hurried down to see Kendra Gwinnel slumped at the kitchen table, her frantic husband Edwin by her side. They were a couple in their late fifties, who'd moved to Portwenn to run a gift shop ten years ago. I hadn't seen them since I returned to Portwenn and they were usually such cheery people. But Kendra was writhing in pain as Martin touched her right hand. They were in their night clothes; Kendra wearing a long, flowery dressing gown with Edwin in boxers and a shirt.

"How long has this hand been like this?" barked out Martin.

"It started two days ago!" Kendra answered. "I was carrying boxes into the back room, just as Edwin was coming through, and he swung open the door just as I got there!"

"Gave her a hell of a whack on the hand! Sorry, sweetie!" filled in Edwin. His face was drawn with concern as he looked at Kendra who had tears running.

Kendra looked at him from under long gray bangs. "Not your fault. Got me just here." She pointed to the back of her hand which was greatly swollen and sported a blackish mark. "God, Doc it hurts so bad!" she yelled. Her hand looked like a balloon with sausage-like fingers. "My fingers are all tingly too!"

Martin looked at the huge hand on the table, examining it from all sides. "How long's it been like this?"

Edwin said, "Since about seven tonight Doc! Kendra went to see Doc Exley yesterday morning and he wiggled it around. Told her to keep it wrapped, put ice on it and take paracetamol too. Did that all yesterday and today then this ugly thing just sort of popped up."

"Did he say anything else? Exley, I mean?" Martin had picked up her arm was rotating it. "This hand is enormous!"

"Exley said it was just a sprain. Take a few days to get better." Edwin went on. "And seein' as we couldn't reach him…"

"What?" Martin roared.

"Exley won't answer his mobile! Called him a few times, but with Kendra hurtin' so badly, thought we'd better come to you!" Edwin answered.

"Why not hospital in Wadebridge?" Martin asked.

"Our car's got a flat tyre," answered Kendra. "One's had a slow leak for weeks. Edwin keeps pumping it up every day or so."

"We had to come to you Doc!" Edwin threw in. "When Kendra started vomiting from the pain, we had to do something, right?"

"Right," Martin said resignedly. Then he looked over at me. "Louisa! Get my bag, and bring that bottle of rubbing alcohol from the bathroom as well."

I ran upstairs and brought back the things. "Martin, what's going on?"

He drew out a blunt pin from his case. "Mrs. Gwinnel! Tell me if you feel this – sharp or dull? Look over at your husband, not at me!" He poked and stroked her fingers one by one.

"Ok, Doc. Anytime," she said.

Martin looked up at me. "No sensation. None!" His eyes were huge.

Kendra's eyes grew wide too. "Maybe it's the pain? Blocking the nerves?"

"No, that's not it!" He touched her hand again where the fingers were white and blanched. "Your hand is like ice!"

"Yeah, Doc, we been putting ice on it, doesn't seem to help much, though," Edwin answered.

"You idiot!" exploded Martin. "This is frostbite! You've frozen the back of her hand! She'll likely need a skin graft now! Mrs. Gwinnel, do you smoke? Are you on blood thinners or anti-cholesterol medications?"

"No meds. But I do smoke - down to two packs a day now. Been trying to cut down."

Martin grimaced. "Smoking can cause vasoconstriction of the blood vessels of the extremities, which would aggravate the action of ice applied for a long time."

Husband turned to wife. "Oh, Kendra, I'm so sorry!"

"You can apologize later!" yelled Martin.

"Edwin… I ... oh Doc can you help me?" Her head fell towards her lap, cradling her arm. "Feels like my arm is being cut off!"

"Louisa!" barked Martin. "Quick! Hot water, soap, and a scrubbing brush! Get scrubbing this table!"

"Martin, what are you going to do?" I asked.

"Have to operate! She's got compartment syndrome. The impact of the door must have given her a sprain of the hand. Muscles and other tissues are encased in a membranous sheath. If there is leakage of blood or other fluid inside the sheath, the pressure builds, and the increased pressure must be compressing her medial nerve! If I don't release the pressure the nerve and other tissues may die!"

"Die Doc? You mean like no hand?" asked Edwin. "You'll operate here? In the cottage?"

"Yes! If you hadn't messed about with Exley the new GP or gone to hospital or called me earlier this could have been avoided!" Martin looked at his watch. "Been three and a half hours since the onset of intense pain?"

The man nodded. "Yes, about."

"Right!" he looked at me. "Get scrubbing this table!"

Kendra looked at Martin with consenting eyes. "Anything you need to do, you do it."

Martin looked at her and then over her head to me, as I drew water and got the soap out. I could see the unease on his face. "I'll do my best," he said sadly.

As I scrubbed the table I had to ask him a question. "Martin?" I whispered. "Can't we just drive her to Wadebridge? What about the ambulance?

"No. No time," he whispered back to me. "Almost too late now. She might lose her whole hand, if not use of it if I don't do something and right away! We'll get her to Wadebridge after I decompress that hand. She'll need treatment for the frostbite as well."

The table was scrubbed to within an inch of its life and dried. Martin had Kendra place her arm across it after we liberally doused the table with the rubbing alcohol as a disinfectant.

"Sorry Louisa, I fear this table won't be fit anymore after…"

"Yes, Martin. I understand."

"Now, Mrs. Gwinnel, I'll infiltrate your hand and wrist with local anesthetic. I'll then make an incision on the palm and the back of the hand. These will be small, and should heal well, later. Don't be concerned about scarring. That can be fixed, if needed."

Edwin poked his voice into the discussion. "Don't you worry, Doc, you just do it. You'll be able to do this?"

Kendra looked hard at Martin. "What choice do we have, Edwin? The new GP is out of touch but Doc Martin will fix me, won't you?"

"We're right lucky that Doc Martin is at hand, don't you think?" Edwin said and went on. "Sorry about the joke Doc."

Martin looked up as he was administering the local. "What's that?"

Edwin looked at me with a gleam in his eye. "He don't have much of a sense of humor does he?'

Kendra slapped his arm lightly. "Don't make jokes now for God's sake!"

Edwin looked at his wife. "Sorry luv. Sorry Doc. Sorry Louisa for making fun." He kissed Kendra's face next. "Oh, sweetheart…"

I spoke up. "Edwin, it's alright. Ready Martin?"

Martin looked where he'd laid out a scalpel, and some gauze. "Right. Mrs. Gwinnel, your hand should now be totally numb. I'll make incisions here and here." He pointed to two spots. "Right.'

He slipped on surgical gloves and took a deep breath. "Louisa and Mr. Gwinnel could you please brace the patient just as you are doing. Ready Mrs. Gwinnel?"

Martin glanced up at me as I braced her shoulders. "He'll take good care of you Kendra." I patted the side of her neck.

"I know he will," she said. "But I can't stand the sight of blood."

"Pity," answered Martin grimly. "Neither can I. You may look away. I shall not."

He picked up the scalpel and looked at the edge. "Not as sharp as I'd like. Hm." He laid her now numb hand onto one of my clean tea towels. "Try not to move, please." He made a two centimeter slice along the back of her hand and the tissue gaped open. "Through the layers of the fascia, now here is the, yes, you can see how the membrane is distended…"

With a clunk, Mr. Gwinnel crashed to the floor. Kendra looked down at her husband. "He doesn't like the look of blood either. Hm, I didn't know that."

"Martin, I don't think you need to make it a lecture." I told him and I could see sweat on his face. "Are you ok?"

"I'll get through it." He pierced the yellow white membrane and blood and puss started to spurt out. He taped a gauze square to it then turned her hand over. He gulped loudly and looked away for a few seconds. "Right. Now for the palm. The puss is degraded cells from the freezing, by the way."

He looked up and I could see more tension on his face. Luckily Kendra was staring at the floor. "Almost done," he said while looking at me.

"Martin! You can do this," I said to him.

He breathed deeply. "Yes. You're right," he answered. He laid the knife on the flesh and laid it open in an s-shape. He poked about in the wound as blood squirted out followed by another square of gauze. Martin's eyes bulged and his lips were pressed tightly together. "There." He dropped the scalpel and ran out to the terrace.

"It's alright, Kendra. He's done it." I could hear Martin being violently sick outside.

Kendra slumped back into the chair and my arms. "Doc Martin can really vomit can't he?"

"Yes." I said and smiled at her. "He's not like other doctors."

Kendra made a deep sigh. "I know." She looked at her hand, appearing smaller in size already. "I don't know that anyone else could have done it, do you?"

I could hear more barfing into the bushes. "No, I don't." I said proudly.