Chapter 30

"Mummy … Daddy", James called out to his parents. He wasn't entirely awake, and he was confused. It was the first night in their new home, none of them was completely settled, and James especially was disoriented. Martin rose and went into his room to reassure him that he wasn't alone, and James wrapped his arms around his father's shoulders and held on tight. It was early, only 5:30 and Martin wanted to go back to sleep in his own bed. "James, it's too early to get up. You need to go back to sleep."

"Nooo …" James wailed. "It's scary in here."

Realising that he wasn't likely to return to his own bed anytime soon, Martin settled down on James' bed and gently rocked him, patting his back. James burrowed his head into Martin's shoulder and his wails gradually softened to whimpers. Martin lifted James' head and whispered into his ear, "Shush … shush … can you tell me what's scary?"

With a hiccup, James nodded his head and gestured toward the corner where packing boxes filled with his toys were haphazardly stacked.

Martin glanced at the boxes, "The boxes are scary?"

James nodded his head in agreement.

"Would it help if I straightened the boxes, put them all in a row against the wall? We can unpack your toys after breakfast and put them on your shelves."

"'kay," James responded with a slight catch in his voice.

Martin laid James back on his bed and pulled up his duvet, tucking it around his shoulders and gently brushing his fingers across his forehead. Over the weekend, Martin and Louisa done some of the light packing and preparing the new house for their household goods. Louisa had lined the kitchen shelves to be ready to store the dishes and she had started organising the linen cupboard. They had let James play in his new room while they were working, and they had hoped he would become familiar with it. But an unfurnished room wasn't the same as the room with his bed and dresser and boxes stacked haphazardly around the room, hence his fear upon awaking in what was now an unfamiliar room.

Martin went to work on the boxes, making them all straight and tidy. When he had finished, he turned around to ask James if it was better, only to see that James had fallen back asleep. He smiled to himself and crept to the door, returning to his bed and curling up against his wife with his hand resting gently on her belly. All was quiet in her womb and he was soon fast asleep himself.

Breakfast was a simple affair, a few boiled eggs, some toast and juice. They had managed to unpack some of their dishes the night before, but most of the kitchen cookware was still in boxes scattered around the house and Martin had to rummage through them before he found, in the lounge, the toaster and a pot in which to boil the eggs. After breakfast, Louisa ushered James up the stairs to dress for school and Martin prepared his lunch. Louisa walked James to school and bought a fish for dinner on her way back, whilst Martin cleaned and started ordering the kitchen.

The removal men had set up all their furniture where they wanted it, had unpacked the heavier boxes and had installed the lamps and other electricals, but there were still many boxes to unpack. Martin volunteered to manage the kitchen before checking in at the surgery, and Louisa agreed to put James' room in order. They would bring him home a bit early so that he could play in his room and, hopefully become comfortable in it. They didn't want him waking early again the next morning.

Martin had just finished putting away their cookware and was starting on the remaining dishes when his mobile rang. "Ellingham", he bellowed into the phone.

"Hey Doc, it's Nate. We've a bit of a problem down here and need you to come and help out."

Martin huffed. He had hoped to complete the unpacking before lunch when he planned to start his work day. He didn't want to be distracted, and he grumbled into the phone. "What is it?"

"It's Mr Large. He's complaining of dizziness and back pain, upper and lower. I see from his notes that these are common problems for him. What has me concerned is that his blood pressure is 85/50, and his pulse is irregular."

Martin was suddenly alert, "Yes, that is concerning. I'll be right there."

He rushed out the door, shouting up the stairs to Louisa that he had to attend an emergency at the surgery before he ran down the hill where he found Bert lying on the surgery examination couch, "Doc, my back and hip are killin' me."

Martin acknowledged Bert with a nod of his head, "So Mr. Marshall has told me."

As he made some initial checks, he barked, "Have you done an ECG*?"

"Not yet. Should I set that up?"

"Yes. He may be having an MI*. I'll have Morwenna call an ambulance. We'll do the ECG and a quick scan before they arrive."

Martin stepped out of the room to ask Morwenna to call for an ambulance, "Tell them it's a possible MI." He returned and picked up Bert's medical notes, scanning them to see if there was any underlying condition that he may have forgotten. Satisfied that there was nothing he could have missed, he slid over to watch the results of the ECG print out. Bert looked over to see the scowl on Martin's face deepen, "What do you think the problem is Doc?"

"I think you may be having a heart attack, and the results of your ECG are problematical."

"Don't sugar … ouch … coat it Doc … oof," Bert said, squawking each time Nate removed the leads. Martin rolled his ultrasound machine over to Bert's side, as he explained to Bert and Nate, "I'm also concerned that you may have developed an aortic dissection. Ultrasound isn't ideal for examining your heart, but it will do for the moment."

He pulled up Bert's shirt and squirted some gel on his chest and applied the responder. He saw what he feared on the screen, an aortic flap indicative of an aortic dissection. He turned to Nate, "Check with Morwenna about that ambulance."

Before he could reach the door, Morwenna appeared with bad news, "Doc. The ambulance won't be here for another hour. There was a traffic accident and they are all backed up with the victims."

"Great. Bert is going to require emergency surgery."

Martin made a quick decision. "I'll drive him. I'll need you to help me get him into my car. Call Al and have him meet me at the Platt. I will need him to monitor Bert on the way."

At that very moment, Al ran into the surgery, "Morwenna called me. What's wrong with Dad?"

Without looking up, Martin reached in his pocket and handed his car keys to Nate. "My car is up at the new house. Bring it down and be quick about it." At the same time, he called Louisa to advise her of the emergency and that he was going to drive Bert to hospital because, as was so often the case in Portwenn, an ambulance wasn't available.

He then grabbed his medical bag and gave it to Morwenna, "Place this on the front seat of the car as soon as Nathaniel brings it down."

Then he turned to Al, "I'll need your help to carry your Dad out to the car." The two men lifted Bert, each with a hand tucked under one of his arms, and they walked him to the door and out to the terrace. "Gently now" Martin cautioned. Bert's breathing had become ragged and Martin was concerned that his lungs might be affected.

Nate had run out the door and was parked at the front of the surgery within two minutes. With Bert stretched out on the back seat and Al sitting gingerly next to him, Martin flew down the hill through the village and out to the main road. Martin's mind was racing as he remembered the state of the vascular surgery unit at Truro. Mr. Westmore was only one of two vascular surgeons on site. The other consultant specialised in the treatment of varicose veins, an important specialty, but not helpful in other areas of vascular care. They had lost the department head to the hospital in Plymouth and two other excellent specialists just that year to hospitals in Scotland, of all places. Lately, they had been sending their more complex cases to Bristol and Exeter. The general surgeons on staff had managed most of the rest. Parsons had assured Martin that Westmore's skills had improved since Louisa's accident, but Martin had not had the opportunity to evaluate the man himself. Even so, with the traffic accident victims arriving at hospital at the same time, it was likely there would be a shortage of surgeons of any kind available to help.

What Bert really needed was a cardiothoracic surgeon, and Truro had just hired a young specialist from Ireland, but Martin wasn't familiar with his ability. He made a quick call to the surgical unit to request a theatre and staff to be prepared for an arterial repair, and then he made a call to Westmore's office to notify him of Bert's condition and to request that he meet them in the surgical suite. He also requested any information Westmore had on the new thoracic surgeon, and asked that he check on his availability.

Bert's condition was an uncommon presentation and Martin had made, maybe, a handful of these repairs over his surgical career, the last just eight months before his haemophobia crippled him. There was no time to prepare for this surgery or to research whether there were any new protocols. He had to rely on his memory and he began to tick off the steps needed to make this repair as he drove across the countryside and into the emergency entrance to hospital. The staff there unloaded Bert and immediately rolled him to theatre.

Several hours later, the repair completed and Bert in recovery, Martin and Westmore sat down to review the procedure. Westmore had been jittery when they first arrived admitting that he had not made this particular repair since his early days as a registrar, but he had done some quick research before Martin had arrived and by the time they were scrubbed and gowned and in theatre, he had calmed and was able to make the repair with only a few words of caution from Martin. 'I believe that went as well as we could have hoped," he commended Westmore. "O'Neill seemed to think the results were satisfactory." O'Neill was the thoracic surgeon on staff; he had been in theatre with a complicated bypass surgery, but was able to join them as they were closing up.

"Thank you, Mr. Ellingham. I couldn't have done it without you, though."

"Mmm…" Martin responded with a grunt. "Yes, you have to be prepared for any type of presentation if you want to be competent. I'd suggest more rigorous study in the future. Go write up your notes. I'll check on the patient, and send in my notes this evening. Recovery will be tricky; you should plan to monitor him yourself overnight."

Martin showered and changed and walked down to recovery where Bert was being kept sedated and monitored for any post-operative complications. Martin looked down at his patient and shook his head, contemplating Bert's condition, "That weight," He sighed, "It's going to make his recovery so much more difficult." Martin knew that highly obese patients required longer stays in intensive care, with a higher risk of post-operative infections, and renal and pulmonary complications. He wasn't feeling optimistic despite the success of the surgery.

He checked in with the ICU staff and cautioned them regarding Bert's care and gave them his mobile number to contact him with any non-routine postoperative complications. As he was leaving the surgical unit and walking towards the hospital exit, he heard someone calling "Doc, Doc". It was Al. Of course, Al was still in hospital waiting for some news of his Dad. Martin had forgotten all about him, and chided himself; failure to communicate surgical results with family was a serious lapse in protocol. He would have to be more attuned to this sort of thing when he started working as a surgical consultant here in hospital. Morwenna had joined Al, and the two of them walked over to him as he turned around, "Yes. Al ... Morwenna." He dropped his head, "Sorry. I should have come out sooner. The surgery on your dad was successful. We were able to repair his artery and he is resting comfortably in the recovery area."

"Can we see him?" Al was obviously very upset, not good for his own blood pressure.

Martin rubbed his temple, it had been a long arduous day, and he wanted more than anything to be home, but he motioned for them to take a seat in a bank of chairs to the right of the door. "No. He will be kept under sedation for the next 24 hours or so." He gave them a brief summary of the operation, what they had done and how Bert had fared. "There's no guarantee that his recovery will be simple. His obesity will complicate his recovery, so you should expect his stay in hospital to be lengthy with possible setbacks. He should make a full recovery … eventually."

Al nodded, "Thanks Doc. I guess there's no reason for us to stay here in hospital."

"No. You should go home. The staff will notify me if anything untoward should occur, and I will call you immediately if I hear anything."

All three rose to leave, but Martin stopped them short, "Umm I have a meeting in the area here tomorrow morning. I will check on Bert before then and immediately afterwards and will let you know how he is, and whether he will be allowed visitors."

It was well past rush hour as Martin drove home, but there was a traffic jam of sorts in his head, as thoughts ricocheted one off another, piling up in a tangled heap. On the one hand, he was pleased with the success of the operation on Bert; he was fairly certain that the man, not really a pillar of the community, but a significant character nonetheless, would pull through. He felt the satisfaction he had always felt after the end of a successful surgery, the feeling that this was what he was meant to do. But what if he himself hadn't been there to help with the diagnosis. Would Nathaniel or a new GP have known to call an ambulance; would they have waited for the ambulance to arrive, by which time Bert's condition might have deteriorated to the point of death, or would they have recognised the seriousness of the situation and called on Penhale or someone else to carry him to hospital? He knew he couldn't be all things to all people, but sometimes there was the temptation to try.

By the time he pulled into the parking spot next to his new home, he was exhausted. Was this how it would always be? Surgery was a physically demanding profession, much more so than general practice. Would he have the energy to attend to his family if he were to take on the position full time after the baby's birth? There was no way to know until the time came to make that decision. He put it all out of his mind and walked up to the front door to seek solace in the arms of his family…. and dinner.