Chapter 31
Martin met Chris Parsons a few minutes before their meeting with the board on Thursday. He had been in to check on Bert the previous day before his meeting with Charles and again just that morning. Bert was still sedated but breathing normally. All his vitals seemed to be within the normal ranges. All was going as well as possible. He had also checked in with Westmore, who had spent the night after Bert's surgery checking on him every hour or so. At least the man took responsibility for his patient. A registrar could have handled caring for Bert, but Westmore had taken Martin's directive seriously. And Martin was pleased to see that the Truro hospital hadn't eliminated "on-call" rooms like so many other NHS hospitals had in the past decade.
Chris had heard how Martin had brought in one of his villagers for a complex surgery, and he wanted to know how it went and if Westmore had been up to the job. "It was a difficult procedure, and I did have to guide him once or twice, but otherwise his work was satisfactory. I need you to be straight with me Chris. Your vascular unit is nearly non-existent and your cardiothoracic unit is woefully understaffed. Alan O'Neill, your new thoracic man was unavailable when we brought our patient in, although he did check in as we were closing up. What is going on here? I haven't looked into the other departments, but I have to wonder. How have you let your consultancy staff drop so precipitously?"
Chris ran his fingers through what remained of his hair, and then clasped his hands together on his desk and looked up at Martin, "Our other departments are fully staffed with highly competent practitioners, now that you ask." Chris responded defensively. "But you must know how financially strained the NHS is Mart. They have cut back on both staffing and training, and there is a shortage of qualified consultants all across the country. That is one reason the GMC was so motivated to let you continue to work as a GP in Portwenn."
"Mmm … "Martin grunted in reply. He had been aware that finding a new GP was going to be difficult for Chris, but he hadn't realised that things were so dire.
"I'm sure you are aware that many of our new medical staff comes from abroad, but we haven't been able to tempt many of them to relocate to Cornwall. You've met Kirkham, chief of surgery, I believe?"
Martin nodded in the affirmative.
Chris continued, "Kirkham works hard and has been successful in recruiting highly competent surgeons for all of our departments, but, for some reason, vascular has been a problem. To be honest, we are hoping that your reputation will help entice several candidates to give us a look see, and maybe relocate."
"Hmm … I did talk with two young consultants who seem to be competent and who expressed interested in joining us. We can talk more about it later and determine what is likely to encourage them to move here. I briefly mentioned it to Louisa and she would be more than happy to meet with these two and their partners over dinner or take them on a tour of the area."
"Yes, yes. That would be perfect. Maybe she could tempt them with the natural beauty of the area, discuss the other attractions and the high quality of life we can offer."
"But I don't want her to overdo it."
Chris nodded his head in agreement, "No, no, I understand. Let's discuss it after our meeting with the board." Chris looked at his watch and rose from his seat. "Time to face the board."
As they stood up and made their way to the boardroom, Martin quickly reviewed the advice that Charles his therapist had given him when they met the day before. It had been a useful session. When Martin first walked into Charles' office, he had briefly summarised the job on offer, and Charles had extended his congratulations at the opportunity. They both sat down and Charles dropped the small talk, "So Martin, tell me how you are feeling about this opportunity."
Martin mentally rolled his eyes at the question about his 'feelings'; he still had reservations about practitioners who specialised in such an ephemeral subject as feelings; it wasn't like real medicine that dealt with actual physical ailments; however, his experience with Dr. Timoney had tempered his opinion on therapy because it did seem to have some benefits. Ignoring his current 'feelings', he sat up straight and looked Charles in the eye, "I won't deny that I find the opportunity both exciting and challenging."
"Challenging?"
"Yes. The current department is in disarray and will require a strong hand to bring it up to snuff. I believe I am up to the task, and I am looking forward to the challenge. Martin spoke forcefully, but then trailed off and turned his attention to the storm brewing outside the window … "But …"
"But what?"
"I am also apprehensive."
"Can you elaborate?"
"So many reasons." Sighing, he leaned back in the chair and stared at the ceiling, "It will be challenging and stressful. I am concerned that the haemophobia will return."
Charles interrupted, "We discussed this and I believe that should not cause you a problem. Intrinsically, you are in a much stronger emotional place than you were when the haemophobia initially struck. I do not believe you will be susceptible to such a reaction again. If you sense it returning, we can meet and go over your situation."
"Yes, but I have other concerns. As you are aware, my wife and I had a difficult start to our marriage. I am fearful that we may grow apart once again if I am away from home for the long days that my hospital work will require."
"Hmmm … have you discussed your fears with your wife?"
"Yes, and she tells me that I have her full support." Martin raised his head and looked directly at Charles, "I pressed her and she admitted that she would prefer that I stay in Portwenn as the GP, but she knows how much I have wanted to return to surgery and she says she doesn't want to hold me back."
"Yet you are still concerned."
"Yes. We came to an agreement that I would spend three days a week in Truro and the rest in Portwenn, but I know how these things work. An emergency will arise or a meeting will be called and I will have to attend on one of my Portwenn days. It will be difficult to confine my time in Truro to just the three days."
Martin stood and walked to the window, "And I will be responsible for my patients and their follow-up care, actually all patients cared for in the vascular unit whether I have performed the procedure or not. Ideally, I will conduct rounds every day to assess their recovery. I can delegate that to registrars, but they may miss an important development due to lack of experience. I will also be responsible for training new surgeons, supervising their work and attending rounds with them. To be truly effective, I will need to be on site daily."
"Yes, I see." Charles made a note in his tablet, paused for a moment; and then holding up his tablet for Martin to consider, he looked up. "Have you thought about video conferencing on those days you aren't in hospital?"
Martin shook his head, "Mmm … No, I hadn't considered that approach. A nurse or registrar could focus their tablet on the patient and I could direct an examination; not ideal, but close to being on the wards myself. Most carry a tablet with them during the day to record their patient notes anyway. Yes, something to think about."
"Still, I am concerned that I am taking on too much especially with the IT project to which I have committed. Will I have any time left to attend to my family?"
"Have you considered moving the family to Truro?"
"We just moved to a new home in Portwenn, and Louisa is pregnant. I don't want to upset the family by making another move."
"But perhaps at a later date?"
"Perhaps."
"I understand your concern about giving your family the attention and love they deserve, but …. have you heard the theory that it's not the quantity of time you spend with your loved ones, but the quality?"
"What the …. does that mean?
"You can sit in the same room with your wife every day, but be engrossed in something else, not interacting with her – that is quantity, time spent in each other's presence, but not actually being present to each other. Or it may be that you are only able to actually be in the same room with her for an hour a day; but, during that hour, you interact with her the entire time, talking, cuddling, perhaps sharing an activity … that sort of thing – we call that quality time."
"Gestures of affection." Martin remembered Dr. Timoney's hugging assignment and giving each other a compliment. "Yes, that might help."
With those thoughts at the forefront of his mind, Martin followed Chris into the conference room where coffee, tea and assorted snacks were on offer on a side table. He grabbed a bottle of water as he greeted the various board members, trying to remember some of their names before the meeting started. All the while, armed with the information Chris had just given him, he knew he was in a position of strength in these negotiations. They really needed him, his expertise, and his reputation.
Money wasn't his primary motivation, the toll on his time was the sticking point. If Louisa were willing to move to Truro, things would be easier, but he had promised her they could make their home in Portwenn, and to that end, they had just purchased their new home. But additional compensation could make things easier, perhaps an expense allowance, funds to enable him to hire a taxi to drive him to and from hospital each day. Or possibly, if he decided to continue with the job after the next few months, an allowance to rent or purchase a flat to stay in during the week, perhaps large enough for the whole family to occupy during the week. He put a squash on those thoughts. There was time enough later for that, and he moved toward the seat offered him as the candidate to be interviewed.
From Martin's point of view, the meeting had gone well. Chris' instincts were spot on; they were willing to do almost anything to bring him in as the head of an almost non-existent department, in the hope that he would develop it into a vibrant and fully functioning asset to the north Cornwall community once again. There were a few tense moments when the discussion turned to his need for family leave in January, but he was able to assuage their concerns by assuring them that he had already approached several potential vascular specialists to come down to interview next week.
After the meeting, he and Chris had a long private lunch with Kirkham, the head of surgery, where they laid out a tentative schedule for his days in Truro, consulting office hours with time for supervising surgical procedures until his credentials were up to date, and most important, the fast-tracking of his revalidation so that he himself could perform surgery once again. Martin had spoken with Kirkham the day before and sent him an outline of the continuing professional development programs in which he had participated during his time as the Portwenn GP. Kirkham planned to assist in several procedures that Martin would perform in the next week or so in order to certify Martin's surgical expertise was still outstanding. He expected the revalidation process shouldn't take more than two to three weeks; he had contacts in the RCS* who reviewed revalidation applications and he was certain that with his recommendation, Martin's revalidation should sail through. They contacted the two individuals Martin had identified and set up meetings with each of them for the following week to tour and discuss their opportunities in Truro.
Martin planned to meet with some of the cardiology consultants later in the afternoon, but he dropped in to see Bert before heading to that department. Bert was awake, but not really alert, although he did recognise Martin, 'Hiya Doc."
"Hello Bert. How are you feeling?"
"How do you think I'm feeling? Best day of my life." Bert mumbled with a bit of sarcasm.
"Good. Glad to hear it." Martin responded without missing a beat as he commenced to check Bert's vital signs. As he finished and made some notes, he looked up at Bert and said, "Everything looks good so far. But you're lucky to be alive Bert."
"Good doctoring that." Bert managed to moan.
"Humph," Martin grunted, and then started to lecture Bert. "But you're not out of the woods yet. We have discussed this many times before, but you have to shift that weight. Your heart and lungs have to work harder than most because of all the weight you are carrying around."
"I know Doc, but I just can't seem to shift it."
"So you have said. You're going to have to try harder. Once we are certain that your heart and arteries are healing, we will place you under the care of a nutritionist and a physical therapist."
Bert groaned and turned his head away.
"Do you think you are up to a visitor? Al would like to come see you."
"Yeah. That would be good." Bert grimaced as he replied, still grousing over the thought of a dietician controlling all his meals and the thought of working with a physical trainer. This recovery wasn't going to be any fun at all.
"I'll let the nursing staff know you are allowed one visitor for fifteen minutes maximum and then I'll call Al, let him know he can come visit for a few minutes later this afternoon."
"Thanks Doc."
'Right." Martin gave him one last quick glance and strode from the room, heading to the cardiology unit to speak with the staff there before heading home.
It was late when he started his journey back to Portwenn, and he was tired. Physically, it had been an easy day, but it was stressful, and that could be exhausting in its own way. He was glad to have negotiated the funds to hire a driver to and from hospital. Now he needed to find someone who was both a safe driver and reliable, and who wasn't inclined to chat or play the radio. He would need quiet in order to read or write up notes whilst in the car. He was planning to spend the next day in Portwenn working on his simulation project and helping Nathaniel if necessary. Perhaps Morwenna or Al knew of a driver who would meet his exacting standards. If nothing else, they could ask around. They knew pretty much everyone in the village and surrounding areas. It would be best if it were someone who lived in or near the village who could pick him up early without encountering traffic, and who would be able to end his day dropping him off at home.
He turned onto the road leading to the village and pulled off at the top of the hill overlooking the village. He stepped out of the car and took a moment to revel in the landscape spread out before him. The sight of the Cornish coast had always soothed his soul; it always had from the time he spent at the farm when he was a child; it was one of the reasons he had taken the GP job in Portwenn. The sun was low in the sky; the sky had cleared from earlier in the day, but there were more clouds on the horizon. The wind had picked up from the southwest and the sea was covered in whitecaps reflecting the restlessness he felt after the intensity of the day's interactions; nonetheless, the rhythm of the sea as it rushed in to break against the rocks and then rushed out again had a calming effect. A storm was likely to come in later that night, the first in their new home. Would the storm awaken James? He could only hope not. James, his son, how could he have known when he first entered this village that he would have a child, a child that meant more to him than he could have ever imagined.
He stood and gazed over the village, scanning the familiar streets and contemplating the turn his life had taken since he had first arrived more than five years ago to restart his medical career as the village GP. So much had changed, and despite his nearly constant annoyance with the villagers, he felt a certain fondness for the place, undoubtedly because of Louisa. She was one of the first villagers he had met and now she was his wife and would soon present him with a second child, a second child he was looking forward to meeting. He was certain that the love he felt from Louisa and James was one of the factors that led to his conquest of the debilitating haemophobia. And now he was moving on from his work as the village GP to his true vocation in surgery. He took a deep breath of the sea air and felt good … yes, good … there was no other word. He opened the door to his car, slid behind the wheel and headed down the hill towards home and his family.
*RCS - Royal College of Surgeons