Chapter 33

Saturday morning saw Louisa doing the usual chores. Martin had opened the surgery at the normal time but was somewhat surprised when no-one showed up. "Pauline, who is my first patient?"

Pauline checked through the appointment book, "Mrs Godfrey-Carstairs" she yelled back.

"Who's next?"

"Bert Large, Doc."

"Well, where is he? He doesn't miss the chance of a sicknote, usually."

As Pauline lodged with Bert and Al she should know where the errant plumber was.

"He left with Al, Doc, early this morning. Said he was going to help someone in trouble."

"That sounds like a recipe for disaster if ever I heard one," Martin muttered.

"You what, Doc?"

"Nothing – send in the next patient when they arrive!"

The next patient, Alan Dexter, just needed a prescription renewal while the next three needed medical certificates for new jobs.

He took time for a coffee and was just sitting down again when the phone rang.

Penhale's nasal twang was very loud in his ear. "Got a car crash for you Doc. Out on B3267 road, near the Cornish Arms Pub. Two vehicles, one belonging to Bert Large and the other one to a Mrs Godfrey-Carstairs. Bert's car is in a ditch and he's trapped in it. The other one has been righted but the lady driver, she doesn't look too good."

"Right Penhale, I'll be out there as soon as I can."

"Pauline! It looks like Bert's had an accident; I'm going out there now."

"Doc, can I come, pleeease?

Martin thought for a moment, ordinarily he wouldn't have allowed it, but seeing as it was likely that Al was involved as well, he thought he might need someone with medical training.

"Just a minute, Pauline." Martin went into the lounge where Louisa was reading. "Louisa, can you man the phone please? Bert's had a car accident and Pauline wants to come with me. Just tell the callers to make an appointment for next week. If it's an emergency tell them to phone for an ambulance. Can you do that?"

Louisa nodded and shooed him out. She then walked into the waiting room and asked the two people there to make an appointment for next week, as the surgery was now closed.

Martin and Pauline arrived at the scene in time to see the firemen begin to right Bert's van. Al was stood at the side of the road looking very anguished. Martin went quickly to the lead fireman and asked about Bert. "Not looking good, Doc. He's complained of chest pains, but has been slipping in and out of consciousness. We managed to get a collar on him before we started lifting the car. The lady over there has a broken arm, but I'm not sure if there's anything else."

Martin nodded his thanks and went across to Mrs Godfrey-Carstairs. "Mrs Carstairs does anywhere else hurt other than your arm?"

She said yes "Head." Then began to collapse. Martin managed to catch her enough to ease her to the ground. "Pauline, come here," he shouted. When she appeared, he told her to unloosen the coat and blouse of the patient. Martin then used his stethoscope to assess any heart/lung damage. There didn't appear to be any so he looked at Mrs Carstairs' head. A bruise was forming at the top of her hairline. Touching it gently he didn't think there was any fracture, but he'd have to recommend an X-ray. Finally, he put a sling on her broken arm and her groans told him she was returning to consciousness. "Pauline, wrap her in a blanket and get her in the ambulance, when it arrives. Keep her quiet, nothing to drink."

"Doc, Al doesn't think he's hurt, but he's holding his midriff." Pauline reported Al's condition.

Martin went across to Al. "Al, where does it hurt?"

"It's nothing, Doc. Dad's more important."

"Look at me Al," commanded Martin. Al complied and Martin did a quick assessment for a head injury. He then began to palpate Al's ribs. He got nearly to the spare rib on the left side and Al yelped. "X-ray for you to query broken rib. Are you sure you don't have pain anywhere else?"

Al just shook his head while he continued to watch the van being righted

Finally, the van was back on four wheels. Martin went to the driver's door as the firemen got it open. He looked at Bert and could see him sweating and very pale-faced. The pulse at Bert's neck was very hard to read, so Martin picked up the right wrist, only to hear a loud groan from Bert. There was blood oozing down from the bottom of the sleeve. Martin took one look and turned to vomit into the ditch. When he'd recovered sufficiently, he went on with his examination. There seemed to be an open cut, if not a broken arm. "Bert, Bert! Can you hear me? Where do you hurt?"

Martin was struggling to find a pulse and reached across to the left wrist. The pulse there was slow. "Can you get his spine supported before you take him out?" he asked the firemen.

"Won't be easy Doc. He's a big bloke."

"Try, please."

The firemen used the "Jaws of Life" (hydraulic spreader/cutters) to cut the side panel back on the van. Then they dismantled the door support, giving them access to the seat. One man climbed inside and began to lower the seat backwards slowly to get a spinal board in behind Bert, who must weigh almost 20 stones. Eventually they got him on the board and out of the vehicle onto ground. Martin knelt by him and monitored him for other injuries. As he did so the ambulance arrived and three paramedics got out. They brought a trolley over and quickly raised Bert onto it. They picked Bert up and put him in the back of the ambulance. Mrs Carstairs also got in the back as well.

Martin detailed the injuries he could see and mentioned X-rays as well as heart monitoring for Bert. "As quickly as you can, without excessive jarring, please."

The paramedics acknowledged Martin's instructions and they began to prepare Bert for transport."

Joe Penhale came across to Al "What happened, Al?" he wanted to know.

"Woman came around that bend on our side of the road. Dad swerved but couldn't help hitting her. The van spun left and right, finishing in the ditch." Al's version was succinct. Joe nodded and said he'd need a full statement later.

"I'll stay here to measure up as best I can and clear the debris with the help of the fire brigade."

"Come on Al, I'll take you to the hospital, myself." Pauline got in the back seat as Al got into the passenger side.

Martin followed the ambulance but at a more sedate pace.

Arriving at the hospital they parked up and made for the A&E department. Al and Pauline had to wait while Martin checked up on his two patients. Mrs Godfrey-Carstairs and Bert.

They were both in X-ray awaiting their turn. Martin asked for Al to be looked at as well.

As usual the waiting seemed interminable for both Martin and Pauline. The casualty doctor looked over Bert's pictures noting his right collar bone fracture and recommended a CT scan to check the heart and spleen.

As expected, Mrs Godfrey-Carstairs had suffered a broken arm, but her head injury was not deemed to be serious. She was taken to the plaster clinic where a cast was put on her arm. She named her husband as next of kin and he was called to come and collect her.

When Al was X-rayed, he was found to have fractured several ribs, but all they could do for him was to give him analgesics for the pain. There was no indication that his lung had been pierced.

Al and Pauline sat down and waited for the results of Bert's CT scan. Meanwhile Martin took the opportunity to go and phone Louisa.

"Louisa, I'm sorry but it will be some time yet before I can get home. Did you manage to rearrange any appointments? Did the waiting patients have any emergency symptoms and require emergency treatment?"

He rattled the questions off so quickly that she struggled to get them in a coherent manner. She told him that none of the patients had requested emergency treatment. There was the usual moaning about having to wait until next week, but she'd filled in the remaining appointments for Monday morning for them.

"Thank you, Louisa. I'll be able to tell you a little bit more when I get home." A quick look around assured him there was no-one nearby, "Love you."

"I love you too, Martin. I'll expect you when I see you," she told him. She heard him disconnect.

It was more than an hour later when the A&E consultant came to talk to them. "Mr Large's CT scan showed a small laceration to the spleen, no accidental damage other than to his collar bone, but it did show some COPD. They've taken him down to the operating theatre to see whether they can repair the spleen or whether they'll have to remove it. They will also make sure his collar bone is situated correctly. The cut to his arm was sutured and will heal quite quickly.

He continued "The operation will take several hours and Mr Large will remain unconscious for a while after that. I would advise you to go home yourselves and get some sleep. Mr Large is in the best possible place at the moment."

Al gulped and took the plunge, "Will he make a full recovery? What is COPD and can it be treated?"

The consultant said, "The fracture to his collar bone will heal in time. The best we can do there is to put him in a sling to stop unnecessary pain. If the tear in the spleen wall is small the surgeon can repair it, but if it is found to be too big, the spleen will be removed. It is the job of the spleen to remove infections. A person can live without a spleen but they remain susceptible to illnesses for the rest of their lives. As for the COPD, that is a constriction of the airways so making it difficult for the patient to breathe and remove lung infections. It is not currently curable and will worsen with old age. Do you need any more information?"

Al had paled at all these descriptions. He turned to Martin, "Is he gonna be OK, Doc?"

Martin stood up and introduced himself to Dr Cuthbertson. "Martin Ellingham, their GP."

Cuthbertson looked more attentively at Martin, who was renowned throughout the medical world as a top surgeon, and here in Truro, as a first-class GP, who was not slow to share his medical opinions with anyone not meeting his very high standards.

"Yes Al, all being well, he will make as good a recovery as he can be expected to. This is provided he follows the directions of the doctors and sticks to them, religiously."

Al nodded, "Thanks Doc."

Martin held out his hand to Cuthbertson, "Thank you. I'll be in touch tomorrow to check on the progress."

Turning to Al and Pauline he suggested they return home. Al at first was reluctant, wanting to stay near his father, but Pauline persuaded him by telling him that there was nothing he could do, today.

"You need to rest those ribs as well. Come on, I'll even make tea."

Al smiled at this attempt at humour, and agreed to go back home.

As Martin went into the kitchen at the surgery, he heard Joan talking to Louisa. Damn! He'd forgotten he'd invited Joan for a meal. He'd not had a chance to go to Wadebridge for the other ingredients, and to be honest didn't feel up to cooking tonight, anyway.

Looking at the table he saw that they'd already eaten. "What have you had? Do you want anything else?"

"Well, I know you said no fish, but Joan and I opted for fish and chips from Mrs Cronk. I left yours in the microwave if you want to reheat them?"

Martin wrinkled his nose in disgust, and almost started to remind Louisa of the need to watch her consumption of empty calories and fat from the meal. Just in time he thought better of it and said meekly, "no, I don't feel like eating those. I'll do myself some scrambled eggs when I come down from the shower."

"Martin, how are Bert and Al?"

"Al's got a few fractured ribs but will manage with painkillers. Bert is having an operation, and that is all I can say."

Even that was almost an oration, from the normally reticent GP. "OK Martin, give me a call when you get out of the shower and I'll put the kettle on," Louisa ordered him.