Chapter Twenty-Eight

Next morning, Clyde and Clifton showed up at the surgery a little after 9:00 am. Finding out which one was Clyde, Doc Martin ushered him in to his consulting room, but Clifton snuck in as well. Both sat in chairs across from Martin at his desk.

"Is Clifton staying?" Martin asked Clyde.

"Yeah. We do everything together."

Martin filled out the basic paperwork for a new patient, and then spent some time getting the history of Clyde's constipation problem. Always had it, even as child. Never got better no matter what he ate, or what he eliminated from his diet. Fiber was bosh for him, same with prunes and all the rest. No imaging or colonoscopy.

"I just don't go. Got Irritable Bowel, they say. Due to nerves."

"He can get nervous about things," Clifton added. "Girls, and studying, and whether Chelsea'll win."

"They tried all kind of drugs, anti-anxiety, anti-depressants."

Martin put Clyde on the examining couch and did an abdominal exam. Pain was mostly elicited in the lower left quadrant of his intestines.

"Go back to your chair," Martin said, returning to his.

"So, Doc, what do you say? IBS? Keep on the laxatives?"

Martin put down his notes and looked at Clyde. "I'm scheduling you for a barium study, colonoscopy and biopsy of your rectal lining."

Clyde looked aghast. "I don't think so."

"Shut up. You'll drive to Truro Hospital this afternoon. I'll have the results by tomorrow."

Martin handed them imaging orders and Clyde reluctantly took them. "Do you know what I have?" he asked.

Martin looked up. "Probably Hirshsprung's Disease."

"What's that?"

"A genetic disorder of the colon where a section, usually in the rectum, does not have ganglion nerve fibers."

"I don't know what that means."

"There are no nerve signals allowing stool to move through that section."

"So, it just sits there all the time?"

"Yes."

"And I have to use laxatives to blow it out?"

"Yes."

"Why didn't anyone else look into this?"

"90% of patients are diagnosed as newborns. It's rare to be diagnosed your age."

"But, I've had it my whole life."

"Apparently in a milder form with no history of colonic obstruction." He paused and then added, "And, your previous physicians may have been incompetent."

He continued writing in his chart notes and when the twins still sat there, Martin looked up, and motioned with his pen to the door. "Go away."

After the twins left, Martin called Truro Hospital and relayed his information and asked them to send the test results as soon as possible.

He was not surprised when the test results came back two days later and the diagnosis was confirmed. He saw the twins and Garvey this time, explaining that a specific type of surgery would be indicated, and that the best surgeon for the procedure was in London. He had set up a consulting appointment with the surgeon in a month's time. Until then, he advised Clyde to maintain his laxative use.

"You're a good man and a better physician, Doctor Ellingham. Thanks for caring to examine him and helping to make the diagnosis," Garvey said as they all strode into the waiting room. It was full and since most folks usually fled Martin's office as quickly as possible, having been yelled at, intimidated or insulted by Martin, it was unique to hear someone praise the doctor so effusively.

Martin grunted in response, though he could not deny a certain satisfaction at helping Garvey's nephew.

"Oy, how much did you pay him to say that, Doc?" someone joked.

Martin turned and shrunk him down to the size of a midget with a look of absolute scorn and then went back into his consulting room.

"You're an ass, Wally," Garvey said. Everyone felt relieved hearing that. Someone had called a patient an "Ass" in the waiting room. Things were back to normal.