Chapter 17

Nate's experiences during his first week with Dr. Ellingham convinced him that he had been right to take the job. Before he had left his last post, one of the doctors, Peter Griffin, at his clinic had mentioned that two of his old medical school colleagues, Chris Parsons and Martin Ellingham were working in North Cornwall. Nate was likely to meet Parsons during his job search because he was head of the North Cornwall PCT. He then regaled him with tales about Ellingham, and told Nate that he should look him up if he had the chance. According to Dr. Griffin, Ellingham was a brilliant surgeon who had left surgery at the height of his career and had moved to a small village in North Cornwall. He described Ellingham as a difficult man, a loner, anti-social and devoted to medicine to the exclusion of all else, something of a walking medical encyclopaedia. Despite his brusque personality, Ellingham would be worth knowing, if Nate had the opportunity. In his interview with the man who was now his boss, Nate had found Ellingham to be focused on the work, describing with precision the type of medical cases that walked into his surgery, and which of these he expected Nate to handle. Based on Dr. Griffin's description, he had expected no less from Dr. Ellingham, but when Dr. Ellingham introduced him to his beautiful and charming wife, he knew that there was more to the man than medicine. And he mentioned a son who was just a little older than his own twins, Bobby and Mike. That was when he knew that Ellingham would definitely be worth knowing.

He checked in with Dr. Griffin before he accepted the job, describing his interview and asking his former boss if he thought he should take the job, or if he should take the hospital A&E job. His former mentor didn't make a recommendation; he merely pointed out that he might not see much of interest in a small village surgery, whereas he would likely see quite an assortment of cases in the Truro A&E department. Nate had to agree, but he wasn't looking for a high-stress work environment like that he would find in A&E. He had enjoyed his work in the clinic in Bath where he saw many different types of conditions, and he suspected that he would see the same in a single doctor surgery. Dr. Parsons had told him that he was to assist Dr. Ellingham if he were to experience any problems with his haemophobia, but Dr. Ellingham's outline of his job description made him think that he might have more responsibilities and autonomy in the surgery than he had ever encountered in his previous clinic.

He also thought the small village setting might be just what he needed at the moment, generally calm and sedate with regular hours. It was likely that his wife Emily would be working long hours most weeks of the year. He was proud of her accomplishments, but a headmistress' job was demanding, and their two children needed a parent who had the flexibility to care for them whenever they needed him. Emily's mother was a godsend; if it weren't for her, he might not have been able to start as soon as Ellingham wanted him. Even so, they couldn't depend on her forever, and he had made an appointment to visit Portwenn Tots during Friday lunch his first week and put their names on the waiting list.

He arrived at the surgery a little before 8:00 on his first day to meet with Ellingham for a half hour or so before the surgery opened in order to review the physical set up, and insure he was familiar with the location of supplies and other equipment he would need that first week. He knew that he would be assisting Dr. Ellingham in his surgery, and he had been warned about the man's blood phobia and he was prepared to step in if Dr. Ellingham should need assistance. The surgery had been closed for a month, and it seemed that every single villager had waited for it to reopen and had showed up on the doorstep as soon as Morwenna had opened the door, they were that busy. As he expected, most of the patients who visited the surgery that morning had routine issues, blood pressure checks, sore throats, several mystery rashes, two case of diarrhoea, and a severe case of allergic rhinitis, nothing to test Ellingham's blood sensitivity.

Two cases presented the second day that were unusual. A fisherman had nearly severed a finger on his trawler as he was hoisting his catch into a dingy to take it to the fish sellers and Nate assisted Ellingham in reattaching it. As soon as he saw the man's hand, he thought for sure that he would be required to step in and make the patient stable until an ambulance could take him to hospital. Dr. Parsons had described Martin's disability as severe. Ellingham did gag briefly as he worked on the man, but he certainly didn't vomit or pass out. Perhaps Parsons' assessment of Ellingham's condition was overstated.

The second was a young woman who was concerned about a thyroid condition. She had been gaining weight rapidly and claimed that she just couldn't shift it. After Nate took her vitals, all of which seemed normal, the Doc started to examine her and immediately asked her about her menstrual periods. When she couldn't tell him when she last had one, he gave her a small bottle and asked her to go into the lavatory and give him a urine sample. While she was out, he told Nate that he suspected that she was pregnant, "It's not uncommon for women in this area to fall pregnant without realising it. Many have an irregular cycle and are haphazard about the use of contraceptives. I could feel a mass just above her pelvic bone which I assume is her growing uterus. If the test proves negative, she may have a tumour, and we will send her to Truro for imaging and further testing." She brought the now full bottle into the surgery and the Doc put a few drops on the test strip and within a few minutes announced, "Miss Trevalian, you do not have a thyroid condition. You are pregnant."

"No, I can't be. I broke up with my boyfriend months ago."

The Doc's eyebrow went up. Nate had already learned that the Doc wasn't particularly forthcoming verbally with his patients, but he had several different facial mannerisms that he used, and Nate had noticed the raised eyebrow the first day, "Hmm … hop up on this table and we will do a quick scan to confirm the test result."

The woman sat on the table as instructed.

"Lie down and pull down the top of your pants, please."

The woman did as she was told and Ellingham rolled his ultrasound machine over, pulled on gloves before squirting some gel on her abdomen, and then placed the transducer on her belly. An image appeared on the screen. Ellingham took his stylus and pointed to an image on the screen, "This is an image of the foetus, the head, the arms and legs. You are most definitely pregnant. I am not an OB, but I would guess you are in your fifth, maybe sixth month."

He paused for a moment to give the young woman time to process the information. The girl stared at the image on the screen, stunned, "That's a baby, my baby? What am I going to do with a baby?"

He printed out a copy of the image and handed it to the girl, "I will have Ms. Newcross book you an appointment with the antenatal clinic at Truro. They will perform a more thorough scan and will be able to give you a more exact due date."

"No. You can't tell Morwenna; she's one of my best friends. I don't want everyone to know."

"Ms. Trevalian. I understand your concern, but all aspects of your health are treated with the utmost confidentiality in this surgery. I do not discuss my patients with my wife, Ms. Newcross does not discuss our patients with her husband, and Mr. Marshall here is also legally required to maintain patient confidentiality. I assure you that Ms. Newcross will not mention anything about your condition to anyone outside of the surgery staff."

He walked over to his desk where he sat down, motioning to the young woman to follow him, and she sat down in the chair opposite his. Up to now, Nate would describe Dr. Ellingham's bedside manner as brusque, coolly professional, but he soon learned that he had a compassionate side. He looked at the young woman and spoke to her in a gentle comforting voice, "I realise that this has come as a shock. When you visit the antenatal clinic, you might want to ask for a referral to a social worker. They can help you sort out plans for after the birth. In the meantime, I will give you a prescription for pre-natal vitamins which you should fill as soon as possible."

He handed the prescription to her along with a sheet that he pulled out of a file in his desk. "Here is a list of guidelines you should follow to insure a healthy baby and a safe delivery. Do you understand?"

The girl nodded her head dumbly, still in shock from the news Ellingham had given her.

"Good. The clinic will send me the results of your scan and your estimated due date. Call the office and make an appointment after your visit to Truro. I will be responsible for monitoring your pregnancy until delivery. We will set up a schedule of appointment then."

He opened the door and shouted, "Morwenna."

Morwenna jumped up and hopped over to the door, "Yeah Doc?"

"Close the door. Will you book an appointment for Ms. Trevalian with the antenatal clinic at Truro hospital before she leaves, please?"

"Sure Doc. Is that all?"

"Yes."

Morwenna opened the door and indicated to the young woman that she should follow her to the desk.

"NEXT PATIENT." Nate still found Ellingham's bellow unsettling. He supposed that it was part of his unique temperament that Dr. Griffin had warned him about. Still …

The next patient walked in and closed the door as Ellingham instructed. "Take a seat. This is Mr. Marshall. He will be assisting in your examination. Now, how can we help you."

Before describing his medical condition, he declared, as so many of the patients did that week, "Glad to have you back Doc." Ellingham responded, with a curt nod and a grunt, "Mmm. And what at seems to be the problem."

When Nate mentioned that his patients seemed to appreciate his reopening the surgery, Ellingham said it was because they were too lazy to go to Wadebridge, but Nate sensed that most were truly grateful to have him back, not just any doctor.

The rest of the day proceeded with the usual complaints as did the next day, but there was some excitement on Thursday.

They were halfway through a patient consultation when Morwenna knocked on the door and opened it. The Doc barked at her, "Morwenna, I've told you to never interrupt me when I'm with a patient."

"Yeah, yeah, I know, but there's an emergency down on the Platt. Some tourist fell off a boat and hit her head. She's unconscious and bleeding."

"Right. Have they called an ambulance?"

"Don't know."

"Find out and call one if they haven't. I'll be right down."

Ellingham rushed over to his desk and scribbled a prescription and handed it to the patient. "Take these twice a day for two weeks. Be sure to finish the course. We're done here."

As he headed out the door with his bag in hand he shouted to Nate, "Come with me."

The patient followed whining, "But Doc I still have some questions."

"Alright. Stay there until I come back."

Nate followed Ellingham out the door and down the hill to the Platt where an elderly woman lay on a mat with a crowd gathered around her. "Out of the way, out of the way. Who can tell me what happened?" To Nate he shouted, "Get these people out of here."

One of the local fishermen stepped up, "We was just coming in from a special fishing tour and the guests were climbing down off the boat and she slipped, lost her balance and hit her head on some of the rocks in the sand under the water."

Ellingham quickly scanned her for obvious signs of trauma, confirming that she had a pulse and was breathing. He gently examining the woman's arm and shoulder, "Looks like she broke her arm as well. What's her name?"

"Mrs. Rogers, I think."

Another elderly woman peeked around the fisherman and confirmed, "Yeah, she's my friend, Carol Rogers. She's from St. Louisa – that's in the states." Martin spoke to the woman, 'Mrs. Rogers! Mrs. Rogers."

"She's not responding."

He broke out some smelling salts and waved them under her nose, which revived her. "Mrs. Rogers, you have had a bad fall. I need to clean up the cut to your head and set your broken arm."

The woman looked confused as Ellingham started to clean the abrasion on her head. Nate observed that he did have to turn away once or twice as he cleared the blood from her head and applied a bandage. As he was finishing up, she started to squirm as if she were trying to sit up. "Stay still." Ellingham commanded in a loud voice. "Here look at my finger … keep your head still and follow my finger with your eyes."

Ellingham looked up at Nate and commented, "She's definitely concussed. She'll need a CT scan when she arrives in hospital. Mr. Marshall, can you stabilize her arm for transport. They can set it in hospital."

He stood up to allow Nate to take over and then turned toward the woman who identified herself as Mrs. Roger's friend. "Your friend needs to go to hospital. It's possible they will want to keep her overnight because of her concussion. You may go with her in the ambulance if you wish."

The woman appeared confused as well. "Do you think I should?"

"It's up to you." The ambulance drove down to the Platt and Ellingham turned to speak to the attendants as they loaded her in, then signalled to Nate that they could leave and head back to the surgery.

Friday was a repeat of Monday with routine cases, nothing to test Dr. Ellingham's blood phobia. As he was readying to leave the surgery that evening, Dr. Ellingham called him into his office. It had been a busy first week and he was ready to go home and enjoy the weekend. He and his wife were planning to take their boys to one of the local beaches where they had been told the water was gentle enough for children to enjoy safely.

The Doc indicated that he should close the door behind him and take the seat opposite his, and then returned his attention to his laptop where he was making a few last notes on the day's patients.

Nate took the seat dropping his bag on the floor next to him and waited on the Doc as he finished up his notes. Two minutes more, and he gently closed the laptop and looked up. "Um …. I though it prudent that we discuss your first week. How are you finding the practice?"

Nate had a thousand thoughts racing through his head, but decided to keep it simple, "Good."

Martin tilted his head and looked at him with that raised eyebrow that he so often used against recalcitrant patients, "Good … that's good. Any other thoughts?"

Nate took that as an invitation to make a few observations. "Your surgery is much busier than I thought it would be, sleepy little fishing village. Has this week been typical or was it just busier than usual given that the surgery had been closed for the prior month?"

Ellingham stared at him for a few moments and replied, "pretty standard."

"I just never expected to see such a range of medical problems."

"Is that a problem?"

"No, no. It's good to keep busy and I have learned a few things just this week working with you. And it's nice to get out of the office and treat patients 'in the field' so to speak."

"Umm … Yes, that happens frequently here, the fishermen and farmers seem to be quite accident prone."

"I hope that you have found my work satisfactory."

"Yes. Satisfactory. Do you think you are ready to take on more responsibility?"

Nate leaned forward in his chair eagerly, "That would be great. What do you have in mind?"

"I believe that Dr. Parsons explained that the primary reason you were hired was to help with the patients should I have an adverse reaction to blood whilst treating them."

"Yes, he did. I have noticed you to have an occasional very slight reaction when a patient presents with a bloody wound, but not so much that it has hindered treatment."

Martin took a deep breath and blew it out forcefully, "No. I told the GMC that my haemophobia didn't affect my work as a GP. As you probably heard, the one and only time that I did faint whilst treating a patient, the patient was a solicitor who brought charges, which ultimately led to you sitting here."

He stared down at his pen which he was twirling nervously in his hands, "There were several other developments resulting from that entire episode, one of which is that I have taken a role in the creation of a surgical training tool, a virtual tool, which will require two or more days of my time each week starting soon. The software team is located in London and they will be sending me preliminary application software to test out the week after next."

Martin continued to explain the tool and his role, becoming more animated than Nate had seen him in his entire first week. "The upshot is that I will expect you to handle the patients on your own for the days that I will be working on the training tool. I know that this level of responsibility was not what you were expecting, but I have observed you with the patients this week and feel you have the knowledge to handle the work. Do you think you are up to this change in your role in the surgery?"

Nate sat back somewhat stunned, but his mind was a whirl, "It is a bit daunting, but yes. I would love to have the chance to be of further use."

Martin continued, "I will of course be available to consult if a patient presents with a condition that you feel is outside your area of expertise. And I will expect you to be conservative in making that determination; if you have any doubts, you are to call on me immediately. Do you understand?"

"Completely."

"I have ordered a desk to put in the phlebotomy room, and the GMC will be sending the hardware I will need to use the IT tool. Next week, we will continue to work together as we have this week, but I will expect you to take the lead in diagnosing and making recommendations to patients. I will monitor your performance to reassure myself that you are up to the task."

"Right." Nate was close to speechless.

"Good. You may go."

'Um, Dr. Ellingham, I do have a question."

"Yes?"

"Umm… what can you tell me about Pauline Lamb?"

Martin took another deep breath, raised his head and exhaled, "Why do you ask?"

"I've been accosted more than once on the street by villagers calling me a tosser, and cursing me for taking Pauline's job. Morwenna tells me that she used to be your receptionist, but left to earn her nursing degree and that she expected you to hire her."

"Have you met Pauline?"

Nate edged closer to the Doc's desk and leaned in, "No."

The Doc folded his hands on his desk and explained, "Morwenna is correct that Pauline once worked in the surgery and that she has recently completed her nursing training. She is a villager and so many feel I should have hired her, but she has no additional experience and I need someone who has the experience to care for my patients without doing something stupid. Pauline was not qualified."

"It's just been unnerving to have villagers hate me before they actually know me."

"I wouldn't worry about it. Once they get to know you, they will come around." Martin paused, "although I am still called a tosser to my face at least once or twice a day … just on principal, I believe."

"They call you a tosser?"

"Yes. It's just the way with the villagers. Ignore them."

"Right."

Martin cleared his throat and leaned back in a casual manner, "Umm … I heard my wife give one of her students some advice when I first came to the village. Uh … she wasn't my wife then. She said that you have to let them tease you, see the funny side, and soon enough they will accept you. They will say to themselves, 'Oh he's all right. He's one of us'."

Doc looked at him and added, "Give them time."

Nate nodded his head in understanding and rose to leave, but Martin called him back. "I'd appreciate it if you didn't mention your expanded role in the surgery until we have actually implemented the change. It may be that no one will notice."

"Sure."

He picked up his bag and headed to the door just as Morwenna was saying good-night to the Doc. They left the surgery and walked down the hill together.

"Why don't you join me at the pub for a few minutes, say hi to Al, before you go home?"

"Maybe just a few minutes. I have to get home and help with the boys."

"You should bring them round this weekend. Let them get to know the village."

"I might do that. We were going to take them to the beach at Daymer Bay tomorrow, but we don't have any plans for Sunday …. that I know of."

After a quick visit to the pub with Morwenna to say hello to her husband Al and meet a few of the other villagers, he had made his way to his car, anxious to go home. He opened the car door and looked out at the ocean from his spot in the village car park where he had been parking this first week. Dr. Ellingham had secured a space next to one of the cottages in the centre of the village where, starting next Monday, he wouldn't have to vie for space with all the tourists that seemed to arrive early every morning anxious to secure a parking space. He was pleased that he wouldn't have to queue up every morning for a place, but he would miss the view out to sea. Of course, there was a view of the sea from almost any vantage point in the village. It was a beautiful place, and he thought that he and Emily might consider making a home here if they decided to stay in Cornwall.

Nate pulled out of the car park and turned away from the village to the main road. On the drive back to his home, Nate reviewed the week's work. This first week was to have been a probationary period, and Ellingham was demanding, expecting perfection in his every move. Nate was to take each patients vitals with Ellingham observing. It was a bit intimidating at first when Ellingham offered what could be called constructive criticisms to his techniques, but the comments were minor and he found that Ellingham's refinements did make the work flow more smoothly, and he soon found a good working rhythm with the Doc, as most patients called him, who patiently explained his treatment for each patient.

Nate had been expecting a quiet, coastal environment, fishermen and farmers; however, Doctor Ellingham's surgery was anything but. The workload was more varied than he had expected, and Ellingham was a natural teacher. He was likely to learn more about medicine than he had ever learned in nursing school. Yes, accepting Doctor Ellingham's offer was the right decision.

Author's Note: Happy Thanksgiving to those of you who will be celebrating tomorrow. I know that this has been a particularly difficult year for many all over the world, but I hope you find some good things to be thankful for. Among my many blessings, and I do have many, I am thankful for this fan fiction community which has helped me weather the ups and downs of 2020, for my readers and for the other writers who have provided many, many hours of enjoyable distractions when things are looking bleak. Take care everyone.