Chapter 91
Martin was awakened by the buzzing of his phone. "Ellingham."
"Doc, our Clemo is in a bad way. He's got a fever and he's complaining about his arm. There's an awfully big blister on it and he says the pain is getting worse. Can you come?"
Martin was about to dismiss this as parent paranoia when the symptoms suddenly presented a possibly serious condition. "Where are you?"
"Mayfield Close, no 7. I'm Alan Curnow."
"I'll be there as soon as I can."
Dressing quickly he was about to leave the room when Louisa sat up in bed. "Are you going out?"
"Yes, but it's not too far away. I could be quite a while though. Go back to sleep." He crossed to her side of the bed and kissed her.
Having grabbed his bag, he went to his car and drove swiftly to the address he'd been given.
Knocking on the door he was greeted by Mr Curnow. "Clemo's up in his bedroom, Doc. First on the left."
Martin quickly strode upstairs and entered the room. A teenage boy was laid on the bed, a bucket of vomit next to him on the floor. He looked sweaty and there was a half-finished glass of water on his bedside cabinet. He was moaning and clutching his arm.
"How long's he been like this?"
"He complained about his arm at tea-time. Said it was painful. I had a look and could only see a red blotch. I thought perhaps a midge bite. As the evening went on the blotch seemed to get bigger. I gave him some paracetamol and suggested he went to bed. I thought it would have cleared up, by morning. When we came to bed he was moaning with the pain. He shouted he wanted to be sick and so I got the bucket for him. He's been sick at least three times. I got him up to go to the bathroom, but he was dizzy. What do you think it is, Doc?"
"Clemo? Clemo how do you feel?"
"Awful. My head's aching and I'm hot. The pain in my arm is getting worse."
Martin pulled out his aural thermometer and took the boy's temperature. It was high. Before touching the boy, Martin donned his rubber gloves, and then taking hold of the injured arm Martin inspected it, closely. He could see a blister forming from underneath skin which was now darkening. The surrounding area was red.
As the boy was overweight, Martin asked "Does your son have diabetes?"
"Not that we know Doc. He's always been healthy as far as we could see." Mrs Curnow looked suddenly frightened.
"Is he allergic to penicillin?"
"No. He's been fine with it in the past."
Martin rummaged in his bag and pulled out some amoxicillin. "I'm going to inject this, and then he'll have to go straight to the hospital in Truro. Do either of you drive?"
"I do, Doc." Mr Curnow now looked worried. "Is it bad?"
"I think he has a bad skin infection, but I won't know for certain, until he's been tested." He went to the bathroom and washed his hands, thoroughly.
"I'll take Clemo in my car, with Mrs Curnow. He'll need the bucket as well. Mr Curnow would you help your wife bring him out to the car? I'll get the doors open." Martin turned and gathered his bag before heading for the Lexus. Outside he pulled his phone out and called the A&E department of the Royal Cornwall.
"This is Dr Ellingham, GP for Portwenn. I'm bringing in a teenage boy who will need an immediate skin biopsy done. If my diagnosis is correct, he will need further antibiotics and a possible skin operation."
"I've already administered amoxicillin. He's complaining of severe pain in his arm, which has not responded to paracetamol. He's feverish, dizzy and nauseous. No, I don't have time to wait for an ambulance. This is serious."
Clemo came out of the house with the support of his dad. Martin indicated the back seat and Clemo got in slowly. Mrs Curnow went around the other side and got in. She put the now cleaner bucket next to the boy, and reached across for his seatbelt. She fastened it securely before doing her own up.
Martin closed the door and turned to speak to Mr Curnow. "Do you know the way to the hospital, because I will be driving quickly?"
Alan Curnow nodded. "We've been there a few times, Doc."
"Right, we'll meet you there. Go to A&E and park up."
Martin climbed into the driving seat and set off. He was circumspect when going through the town, but once on the main road, drove as quickly as he could.
As he went along a flashing blue light caught his attention and then he was signalled to pull over. Groaning he waited for the officer to come alongside the car.
"Going a bit fast there, Doc. I'll have to caution you…" Penhale's nasal twang irritated Martin.
"No you won't Penhale. I've got a seriously ill boy here who needs to get to hospital rapidly. You can escort me, on blues. OK?"
Joe's eyes lit up. "Gotcha Doc. The Dynamic Duo in action again!" He ran back to his jeep and switched on his flashing lights. Overtaking Martin he went as quickly as he could towards Truro.
There wasn't that much traffic about, but what there was soon pulled over when they saw the police vehicle bearing down on them. With Joe's help, Martin got to the hospital in just over 40 minutes. "Thanks Joe. I'll keep you informed." Martin was grateful for the escort. A porter with a wheelchair came over to the car.
"He needs an immediate skin biopsy on his right arm. You'll see the blisters there."
Mrs Curnow got out and followed her son into the hospital.
When Martin arrived in the cubicle a doctor was taking the sample. "I'll get this off immediately." He jerked his head to the side and Martin followed him out into the corridor.
"What do you think it is Dr Ellingham?"
"If I'm right, it's necrotising fasciitis. I've given him amoxicillin to start with, but you may have a better idea of what other antibiotics to use when you get the test results. The boy isn't allergic to penicillin, nor, as far as I know, diabetic, but that's open to debate as well."
"He may need an operation to cut the dead flesh away, which is why you need to hurry. The longer this goes on the worse the condition of the arm." Martin looked hard at the doctor.
"Right, I'll get this to the lab as priority 1. Thank you." He went away as quickly as he could, not even stopping to delegate the responsibility to anyone else.
The doctor returned and began to question Clemo about his symptoms, and when the pain had started. When he'd gathered all the details, he asked for another dose of amoxicillin to be given, together with a stronger dose of painkiller, and ordered a nurse to sit by the bed to monitor Clemo's condition.
Alan Curnow arrived and Martin stepped outside to speak to him. "Mr Curnow, they've sent a skin sample off to be tested. If I'm right then your son has a serious skin infection which will require surgical intervention."
"What? From that small blister on his arm, Doc?"
"I'm afraid so. There was nothing you could have done to prevent this, so don't go blaming yourself. What was Clemo doing today?"
"He went around to his mate's house and from what I can gather, they were clearing thistles from the back garden. Clemo was helping them do that and also doing some digging."
"Its possible soil got into a cut caused by a thistle. That would explain it. Right, I'll wait over there, while you sit with your son."
He settled into a chair and waited for events to unfold.
A few hours later his diagnosis had been confirmed. The A&E staff gave Clemo stronger antibiotics in the form of a continuous drip, and monitored his pain threshold.
He was taken to theatre and the affected tissue cut away. Instead of sewing the wound back up a pack of special beads which were infused with broad spectrum antibiotics was placed in the wound and securely held with a bandage. Should it prove that all the infected tissue had not been removed more debridement would be necessary. Once the cultures had been grown, a more specific antibiotic would speed up the process.
The surgeon who had performed the operation went to talk to the parents. "Clemo has had the operation now, to take away the infected tissue. We've not sewn it back together as we want to make sure we've removed all the infected tissue. When it is apparent that the wound is clean, he will be taken back into theatre and the wound closed properly. I'm afraid he will have a scar. We will also going to test him for diabetes. Are there any questions?"
Alan reached out and shook the surgeon's hand. "Thank you." Turning to Martin, he also profusely thanked him. He suddenly went white as he realised that had they not got there so quickly his son might have had to have his arm amputated. Such was the speed with which the bacteria spread.
"Go back to your wife, I'm sure she needs some support at the moment. By the way, you should remove all your son's bedding, washing the sheets, pillow cases and quilt cover at very high temperatures. Failing that discard them and buy new. All surfaces he's touched should be disinfected. The same with his clothes. "
Alan accompanied the surgeon, who then went to inform Martin that his diagnosis had been correct. "That was a very good diagnosis, Dr Ellingham. Not many GPs would have spotted the possibilities, so quickly."
"Yes." Was all Martin said, self-deprecating as usual.
Martin told Alan Curnow, "I'm going back to Portwenn, but I'll be in touch with the hospital to check on Clemo's progress."
Martin drove home at a more conservative speed and entered quietly into the surgery. As usual he went and re-packed his bag before getting a glass of water. When he entered the bedroom, Louisa was snoring softly as he quietly got into bed. He lay on his back and waited for sleep to come.