Arrivals

As I approached the Portwenn surgery my heart rose into my throat. Would I find Ian and Martin screaming at each other? Would they be staring one another down like two American cowboys in the center of a dusty Western town, hands twitching above six-shooters? Or conversely, be sitting there calmly discussing the latest methods of intra-aural lavage for removal of impacted earwax?

This was Portwenn after all, where we had man-sized invisible squirrels, a precocious schoolboy who played doctor and was usually right, a plumber - philosopher, and a former GP/surgeon who was afraid of blood. Anything was possible. We even had a head mistress who didn't know her own heart very well.

As I climbed the steps from the street, I expected to hear screaming and shouting, the crashing of crockery or the thumping of bodies as two men pummeled one another. The front door was closed and locked but the side door into the kitchen was propped open. I did not expect to see what I saw as I came around the corner and my sight fell into the green painted kitchen.

Ian Exley drooped at the table with a stricken look on his face, hands over mouth. The kitchen was filthy with a stack of food crusted pots in the sink and the bin was overflowing, with a stench of rotten food. Hard to equate this mess with the confident and well dressed doctor of just three weeks ago.

Martin stood and didn't look much happier than Ian, who looked up when I stopped in the doorway. "Ah, Louisa. Come in. Is that alright, Ian?"

"Yes," a muffled voice came from the younger doctor. "Doesn't matter anyway."

"It might." Martin waved me inside. "Close the door."

I did and turned from one doc to the other. "Ian?" I crossed to the table and sat opposite him. "What can we do for you? What's happened?" I asked quietly. Somehow my teacher-self exerted itself and I went into head-mistress mode.

Ian looked up at me with red rimmed eyes and huge pupils. "Don't know." He rubbed his face. "Don't know what I should do, let alone that I should tell anyone what to do."

"Did Pauline quit today? Sorry about that." I asked.

"Yes. She gave notice this afternoon! And as for what I said… at the pub… please…" he started.

"Ian, just let that go! I'm not upset," I said soothingly. "Forgotten."

"Well you should be upset! What I said, was inexcusable. And I've made a total balls-up of this whole Portwenn post." He sighed. "Martin, maybe you should…."

Martin looked sharply at me then began to speak. "Ian. I noticed over the last three weeks your behavior seemed to be inconsistent. At times well adjusted and other times you seemed quite depressed and erratic. Do you agree with my assessment?"

The younger doc rubbed his eyes and yawned. "Yes. I think you've hit it spot on. Can't get much past you. I didn't exactly want to come out here."

"Oh, really?" started Martin sarcastically. "Pretty damn obvious, that although your credentials, and I have checked them, seemed quite good, your performance here was less than par. Even accounting for the uhm…" Martin gave me a quick glance, "adjustments necessary for a doctor from London to adapt to Portwenn. You were off."

"Yes off," Ian agreed. "Bodmin as they say?"

"Bodmin. Quite Bodmin. But the question is why, Ian? Twice I've seen you at close quarters – at Louisa's cottage and again at the pub. Each time the most striking feature was extremely dilated pupils. I assumed that you'd not be foolish enough to be playing about with mood enhancing drugs, at least not on purpose. But there was something else…"

"Oh? Going to psychoanalyze me now, Ellingham? Haven't you done enough to ruin me?" Ian snarled.

"No," Martin answered stiffly.

"No? You bastard!"

"No, Exley. Not psychoanalyze you. But I will diagnose you. Another finding was that each time I detected an organic, almost weedy smell on your breath." Martin rubbed his jaw. "Now what could be causing that?"

Ian looked at Martin with half hate and half admiration on his face. "You're so smart. You figure it out."

"Louisa, didn't you mention to me that when you spoke to Pauline, she said that there was some sort of odd phone calls to the surgery? Calls that Ian would not take?"

"Yes, I did say that. Pauline said it was a woman that knew Ian." I recalled.

"Yes," said Martin. "Ian, you yourself mentioned there was someone, behind you. A patient… uhm, a friend?"

Ian lifted his eyes from staring at the floor. "Yes, both."

"So! Here is what I believe has happened. You took this GP job for a number of reasons. One, likely the primary one, was that you were leaving this someone behind. You were escaping from them."

"Escape," whispered Ian. "Yes that is a good word. The correct word."

Martin continued. "Then you arrive at the small and insular village of Portwenn, hard on the heels of the former doctor; one with… a bit more… uhm, experience… than you."

"A bit? Yes a whole hell of a lot more. Why you… can just smell a patient… and tell…"

"So you are a new doctor, younger, from the city, with your own ways. You reorganize the records, do all the blood work yourself, just as Pauline Lamb is considering leaving anyway. All this giving her further dissatisfaction."

"High marks, Ellingham! What else can you deduce?" Ian now had some fire in him, but it was not pretty. "Go ahead, you can figure the whole thing out."

"Yes. I shall. This slovenly kitchen is just one example of what's happened here. Alone, in this new place, no friends, the patients staying away…"

"I tried, really I tried! I did! Drank with the fisher folk, talked to the grocer, even that paranoid PC Penhale, sat right in that surgery and listened to that plumber discourse about all sorts of things; did all that. Just could not get inside people. They stayed away in droves." Ian banged the table. "What was I to do? Then the hand thing made it all worse!"

Martin looked down at the younger doc. "New place and you got depressed. Not sleeping well. You said tonight you weren't sleeping at all. All symptoms of depression. So you started to do something about it, didn't you?"

Ian shot to his feet. "The lady in the herb shop in Wadebridge said it was all natural! Really!"

Martin started scanning the counter top, strode to the sink and grabbed a small bottle. "These?"

"Yes, those!"

"What are they Martin?" I asked.

"Griffonia seed extract!" he shouted. "Trying to get your serotonin levels up?" Martin slammed the bottle onto the table top. "Ian! For God's sake you are a doctor. A man of science and medicine! I can't believe you would try these… these…"

"It's a supplement, Ellingham. It's to help me sleep!" Ian said defensively.

Martin towered over Ian. "Does it work? Well?" He sneered and looked around the filthy room. "Doesn't help the depression either, does it?" Martin scooped up the bottle and made to fling it towards to the bin.

Ian grabbed Martin's bottle filled hand. "Ellingham! I need those!"

"Why! So you can damage your eyesight further! Stupid fool! This stuff in high doses can decrease the serotonin levels in your brain and damage your eyes, due to the constant mydriasis!" He pulled his hand free and shook the bottle in Ian's face, who flinched with every shake.

"Martin, the my-what-sis?" I asked. "What are you talking about?"

"Mydriasis – dilation of the pupils – in this case chemically caused. It's like this Louisa, and this is something that Ian should know very well. Depression can cause insomnia. One of the causative factors of sleeplessness can be a decrease of a chemical called serotonin. This chemical is both created naturally in the brain and can also come from drug treatment. A common drug would be 5-HTP or L-tryptophan, which is then converted in the body into serotonin, and may help. Herbal supplements, such as an extract from these seeds from West Africa, may help as well. But in high dosages, such as Ian's, it makes the pupils dilate unnaturally and can also lead to more insomnia!"

Ian stood there stunned. "I suppose, I might have been over doing it." He slumped back onto a chair. "I'm done then. I can't do anything right, can I?"

"No!" I said, "You're not done! Look Ian, how much of your lack of self esteem might be due to insomnia and depression?"

Martin answered for him. "Some; lots likely."

I put my hands on my hips and looked hard at him. "Look here, Ian Exley!" the head-mistress was now in full mode, "don't you think I got down when I was in London, pregnant besides? Didn't I weep my share of tears? Every day? I got over it. You will too, with treatment if necessary!"

Martin started in surprise. "Louisa? You wept?"

I sighed. "Yes, Martin, I did. More days than I can remember."

"Ah," Martin wrinkled his brow. "And now?"

"Not so much."

We stood there; he looking at me and me looking at him. Martin's eyes were wide with tenderness, with the pathetic figure of Ian Exley slumped in a chair between us. Martin stretched out his hand and I extended mine.

"Louisa, I… didn't know…" he started.

"Now you do." I rubbed his fingers, which shifted into a firm grip on mine. "Looks like truth arrived at last for us, Martin."

"Yes," he started to say, just as there was a knock at the kitchen door.

The three of us looked towards it, and I could see a figure through the frosted glass.

Ian stumbled up and took the door knob in hand. He twisted and pulled the door open and a young blonde woman around my height stood there. She was very pretty with deep blue eyes, and was dressed in a blue flowered print dress with a white sweater across her shoulders. She was wearing open toed sandals and there was a wheeled case at her side.

"Sandy?" Ian shouted.

"Ian!" the woman shrieked and took hold of Ian, pulling him into an impassioned embrace.

"Martin?" I whispered. "She's uh…"

"Yes," he answered me softly, "looks to me to be about six months pregnant."