Chapter 21

Real life has been very demanding lately and has prevented me from visiting my keyboard as often as I would like, just a few sentences here and a few sentences there. I can't promise to be more regular in the next few months, but I will try. In the meantime, thank you for reading; and, if you have time, please leave a review. Like all FF writers, I love to hear your thoughts.

It had been a full month since Martin and Louisa had started their search for a property suitable for a new surgery or a new home. It had been a full month since the news that the Ellingham family was expecting an addition had swept the village by surprise. It had been a full month plus some since Nathaniel had joined the surgery as Doctor Ellingham's assistant. And the entire month had passed successfully. Martin and Louisa had made a decision about their housing arrangements; Louisa's pregnancy was progressing well; and Nathaniel was proving to be a satisfactory addition to the surgery. In addition, Martin was making progress in his therapy; and James had celebrated his third birthday. Yes, it had been a very full month and a good one.

For Louisa, the nausea that comes with early pregnancy had finally abated and she was feeling well. At their most recent visit Dr. Mitchell confirmed that all was proceeding on schedule. Like Martin, she didn't believe in performing unnecessary procedures, therefore she didn't do a scan, but she did let the two of them listen to the baby's heartbeat which thrilled Louisa. True she and Martin had been able to use his doppler to listen to the heartbeat just two weeks prior, but still, it was always a thrill to connect with their newest child. It made the baby seem more real to her.

After that weekend when they had looked at potential surgery sites, when Louisa had admitted to the estate agent that she was expecting, the news of her pregnancy had spread like wildfire throughout the village. Unfortunately, Morwenna heard about it at the pub that night and gave Martin an earful as soon as she walked through the surgery door the following Monday morning. She was highly incensed that neither Louisa nor Martin had told her first. For reasons that eluded Martin, she felt entitled to know about his personal life before the rest of the village. Louisa overheard their conversation and slipped into Martin's office and closed the door before the first patient had arrived, while Nate was in reception examining the list of that morning's patient;, and she tried to explain to him Morwenna's reaction. He looked at her in bewilderment and exclaimed that it wasn't as though he was her father or even an uncle. "No, you're not, but she looks up to you as if you were," Louisa tried to explain. "You gave her a job when no one else would, and she's worked in the surgery with you for three years. She even asked you to be in her wedding, to walk her down the aisle, 'in loco parentis' so to speak. She looks up to you Martin, and I believe she is very fond of you."

He replied with his usual raised eyebrow and a perfunctory grunt, "Right." There was a knock on the door, and he looked up clearing his throat, "Louisa, are we through here? I have a full list this morning."

Exasperated, Louisa shook her head and left him to his patients. As she heard him bellow, "Come through," she could only hope that her words had made some kind of impression on him. Later that morning, she apologised to Morwenna, explaining that they had been planning to wait another month before telling anyone, but that Mrs. Trappett had noticed her bump and guessed about the baby. Morwenna took a closer look at Louisa and understood, "Yeah, when is the baby due?"

Louisa laughed, "Not until late January, but Martin says it's normal to start showing a little earlier in a second pregnancy."

"Didn't know that. You sure you're not having twins?"

"Very sure."

Nate had been at the door when Louisa left the office; and, when he heard the 'come through', he opened it to help Mr. Cleary and his guide dog go through. "I believe Mr. Cleary's gout is acting up again, Doctor Ellingham".

"That's right Doc. It's been very painful these past two days. I'm taking that medicine you prescribe and I've been careful about what I eat, and it got better, but now it's worse than ever before."

Martin stood up and walked toward Mr. Cleary to take his arm to guide him to the examination couch, but he was stopped cold by Mr. Cleary's dog who delivered a deep warning growl. "Ray, quiet. Sorry, Ray gets a bit protective."

"Yes, I remember." Martin looked up at Nate, who immediately understood and knelt down to comfort the dog, which enabled Martin to start his examination. As had been the case in his first week on the job, Nate had proven to be a capable assistant.

Overall Martin had been quite pleased with Nate's work. He had stood by observing while Nathaniel examined each patient who came into the surgery that second week, and it was obvious that Nathaniel was able to handle many of the commonplace patient visits with no follow up from Martin, routine vaccinations, minor injuries, even common colds and ear infections. Martin's chief concern was whether Nathaniel would recognise a more serious issue when it presented and have the sense to call in Martin for a consultation. He had proved up to the task, requesting Martin's opinion several times over the week when something didn't seem quite right. Mr. Cleary's condition was a case in point. Cleary's gout required more intervention than the usual treatment with anti-inflammatories and advice on diet changes, and Nathaniel knew to ask Martin's advice. That second week, Martin's expertise was needed four out of the six times Nathaniel requested help, and the other two times were merely anomalies that required no additional treatment; nevertheless, Martin was satisfied that Nathaniel's judgement was sufficient to the task he had given him.

Martin had noticed a significant increase in consultations as well, which he had found a bit surprising, given that the village population was stable. Many of the villagers had stopped Louisa in the street and in the shops to tell her how impressed they were with the new nurse at the surgery. She had also overheard more than one conversation discussing how much more pleasant visits to the surgery were now that Nathaniel was caring for them. No need to see that tosser Doc Martin unless there was a serious problem. Of course, she didn't share that bit of gossip with Martin, although she was certain that he wouldn't care one way or another. She just told him that villagers were pleased with Nate's work. It was apparent that the surgery would need to expand or even move if the patient load increased much more than it already had.

After their inspection of possible surgery sites, they were able to book a viewing a few days later at Mrs. Nancarrow's home just up the street from the surgery. Samantha was right when she said it needed updating. It needed a thorough cleaning and several new coats of paint, but the structure was sound, the plumbing and electrics were functional and met all current code requirements, and there was plenty of room for their growing family. Despite some renovations done thirty years prior, the kitchen needed a major upgrade. The bathrooms were serviceable, but also needed updating. Louisa was insistent that the worn pink tub in the hall bath had to be replaced which meant that the whole bathroom had to be gutted and redone. The other two bathrooms had a certain antiquated charm, but needed some sprucing up with new grout in the tile, a few coats of paint and new fixtures.

They told Samantha that they were very interested, but wanted to consult with the architects that Louisa had contacted to discuss changes to their current home. The first was scheduled for that Saturday right after morning surgery hours. The second would come by on Sunday. The more Martin thought about it, the more he thought moving the surgery was the ideal solution, despite his uncertain future plans. The village would need the services of a GP whether it was himself or another doctor. A larger building with parking for more than two cars and with several rooms suitable for examinations and consultations as well as reception and phlebotomy would be a practical solution. And Louisa had expressed a preference for keeping their home in their present location, near the heart of the village and close enough to the harbour that they could hear the sea from time to time. He was willing to listen to any ideas that these architects might present; but, in all honesty, he was sceptical that they could manage to build a third bedroom upstairs and carve out a safe play area in the garden for the children to play.

Both architects they consulted were confident that a third bedroom could be added to the first floor just behind the second bathroom and cantilevered over the part of the garden behind the surgery office. One of them even suggested adding a second floor with a large master suite. It was tempting, but they decided against that; with two small children in the house who needed frequent attention during the night, there was too much chance of injury on the stairs. Both architects suggested hiring a landscape architect to devise a way to make the garden more accessible for a children's play area.

With respect to enlarging the surgery, the architects offered several ideas about carving the current lounge area into two additional examination rooms. Those rooms would be quite small, less than optimal. One of them offered an alternate option of making the lounge area into one examination room, using the current kitchen for storage and laboratory work, and using the rooms upstairs for two additional consultation rooms; they could installing an elevator in the phlebotomy room to make those rooms accessible for patients with mobility problems. Martin found that solution appealing, especially if they moved to a new house.

After several evenings discussing the pros and cons of moving house and moving the surgery, they came to an agreement. Despite Louisa's original stated preference for keeping their home in their present location, near the heart of the village, they concluded that moving to a new larger home and adapting the surgery was the best solution to both their home life and Martin's work, and they made an offer on Mrs. Nancarrow's home. After all, it was only a few steps further from the village than their current home, and they would still be able to hear the sea from time to time. After some negotiations with her children and a thorough inspection by a structural engineer as well as a qualified home inspector, they came to an agreement and the sale was to go through the following week near the first of August. Louisa had visited the home several times after they made their offer along with a kitchen designer and she had already made plans to start the renovation as soon as they closed on the property. She was hopeful that the renovations would be complete by the end of October so that they could move in early November before blustery winter weather really arrived.

When he had first hired Nate, Martin had thought to outfit the small phlebotomy room as a second examination room, but its small size made it far from ideal. The purpose for hiring Nate was so that he could assist Martin side by side in case Martin should have a reaction to blood, not as a traditional nurse practitioner. He was certain that the GMC had not thought beyond that limited role for Nate. In fact, he was certain that the GMC had no further thoughts about his situation at all; his case was closed. There was no reason at all that Nathaniel's role should not be expanded, and as such the surgery needed, at a minimum, another examination room, one for Nate to do the preliminary checks and to handle the routine medical cases, and another for Martin to do the more thorough patient examinations. Until they could make the necessary renovations to the house, Martin decided to place a desk and chair in the small phlebotomy room where he could write up patient notes between patients while Nate did the preliminary examinations on the next patient. Again, it wasn't ideal, but it would have to suffice until the family moved to their new house and the current living room could be converted to a second examination room. If the need arose for additional examination rooms in the future, they could install the elevator or, if necessary, move to a larger building. It all fit in with Martin's plan to let the next year play out before making the decision to remain as the village GP or to move on to another phase of his career.

Martin had discussed his hesitation about remaining the village GP with his therapist, Charles Payne, at his weekly therapy sessions. The primary purpose of his therapy was to eliminate his haemophobia, but when he mentioned his apprehensions to Charles, he agreed that Martin should use him as a sounding board for elucidating his concerns. It was apparent that it would take more than one session for him to resolve the conflict he felt about his job. During their first session, Martin articulated those aspects of his GP work that he found the most distasteful. It wasn't difficult. He had always found frustration in some of his patients' more ludicrous activities, the school secretary who got a tattoo whilst on vacation, or the farmer who was unable to keep his farm working profitably and comforted himself by eating his hair, the cat lady who refused to buy the new glasses she needed because she thought her money was better spent on feeding stray cats … similar to Paula, Ruth's next door neighbour who was so intent on aiding animals that she kept a seal in her bathtub who then bit her and caused a serious infection. It went on and on. Few of the villagers followed the simplest hygiene practices and too many failed to follow his instructions returning to complain that they hadn't improved. Then there was Bert, a case all on his own, fascinating. Every one of them did something stupid and injured or otherwise made themselves ill.

Just like Dr. Timoney had done, Charles gave him a homework assignment. He was to list all those ways he found his work as a GP rewarding. Surprisingly, this assignment wasn't difficult; as he listed specific cases, he realised that he actually enjoyed much of his job. The routine patient complaints had always been tedious, but he was relieved from most of those now that Nathaniel was handling them. It was the more complicated situations in which his patients found themselves that were rewarding. As he contemplated many of those patients, he realised how their relationships in the community were either the source of their medical problems or the means to their healing. Those were the cases where the patients often expressed their gratitude for his help. He rarely acknowledged their gratitude, preferring to think he was just doing his job, but he did feel some satisfaction in knowing that his work was appreciated.

Before they continued his haemophobia therapy in the next session, they briefly discussed this list and Charles gave him another assignment, to list the reasons he found surgery rewarding. He knew that would be an easy assignment. He loved being a surgeon, but as he started to make the list, he realised that, much as he had loved the work, the rewards were not all that different from the rewards he experienced as a GP. Surgery provided intellectual stimulation, something that was often, but not always missing in his work as a GP. It also provided challenges; he had developed several techniques that were now used to improve surgical outcomes, not only in the UK, but worldwide. He had to admit that he found the resulting accolades satisfying. And there were the patients that he helped; they almost always expressed their gratitude to him for improving their quality of life and often for saving their lives. As much as he hated to admit it, Adrian Pitts was right to ask if Martin missed that, the patient gratitude. He had never admitted it to himself, but that gratitude along with the knowledge that he was doing something worthwhile with his life helped fill the hole in his psyche created by all the disparagement that his parents had heaped upon him as a child.

When he presented his list to Doctor Payne, he didn't feel the sense of loss that he thought he would. He thought it was odd, but Charles didn't seem surprised. He suggested that Martin take his two lists, review them at the end of each day along with the negative aspects of being a GP and being a surgeon and jot down his thoughts, whatever crossed his mind no matter how profound or trivial. As he let his thought wander, he realised that general practice required a broader depth of knowledge than that of a surgeon. True a surgeon had to develop very specialised skills and he had been among the most skilled of them all. As he had told Roger Fenn when he first arrived in Portwenn, he had the Midas touch, couldn't look at a body on the operating table without fixing it. A GP might not need such specialised skills, but he faced intellectual challenges nearly every day. It was imperative that he understand all areas of medicine, gastroenterology, dermatology, cardiology, rheumatology, he could go on and on. He might refer a patient to a specialist for further treatment, but he needed the knowledge and skill to recognise the various presentations of all aspects of medicine in order to make the correct diagnosis, and that was something at which he was very good. He had always thought that surgery was the only thing he was any good at; but, as he sometimes heard Louisa tell others, he was a very good doctor, a very good GP. Wasn't that why he had offered to consult with other GPs on difficult cases? He was a very good doctor.

He continued to think about his role as village GP, and it almost pained him, physically, to realise that he was becoming a student of human nature, how and why people behaved the way they did and how it led to their more complex medical illnesses and conditions. He might never be able to make them change their ways, but he could analyse their motives and come to a better understanding of what motivated each patient and use that knowledge, occasionally, to help them heal themselves, if they would only listen to him. In London, he had become accustomed to the surgical solution, a strictly medical solution to his patients' conditions. He had brought that perspective with him to Portwenn, but as he looked back at his time in Cornwall, he began to realise that there was more to healing his patients than the medications that he usually prescribed. Antibiotics and blood pressure medication and all the other modern medications available to treat patients were important weapons to have in his arsenal against disease, but consideration of the patient's background and personal situation was important in developing a treatment plan as well.

Oh god, he thought, isn't that what Angela Sims preached, holistic medicine? He would never go so far as to offer alternative medicines, no herbs or potions would ever leave his surgery, but he might probe more deeply into his patient's personal lives in future. He was certain that books had been written on the subject, but he thought his own research with his own patients might yield even more insight. He was beginning to feel more excitement about his role as village GP, a bit anyway. He would give himself the year to evaluate his position, but, maybe … it was a lot to think about.