The first thing I noticed as I rushed into the kitchen was a pile of lettuce, tomatoes, cucumbers and other chopped vegetables littered across the floor near an upturned wooden bowl. I stepped around the mess and hurried over to Parsons, who was slouched awkwardly in one of the kitchen chairs. Emily, who'd been standing over him, quickly moved aside.

"What's wrong?" I asked, steadying his head in my hands and peering into his eyes, which were unfocused and terrified.

He grabbed at the sleeve of my suit with his left hand. "Mwwtt," he garbled, only the left side of his mouth moving.

Trouble speaking. Aphasia, he'd told me was one of his previous symptoms. Or was it paralysis? Either had appeared virtually instantaneously as Parsons' speech had been perfectly normal not a few minutes before. I turned to Emily. "What happened?"

She was clearly flustered. "I don't know! I asked Chris to take the salad into the dining room and, the next thing I knew, the salad was on the floor and he couldn't stand up. I only just managed to get him into the chair." She was twisting one hand on the other, eyes fresh with worry. "Martin, what's wrong with him?"

"I don't know yet," I replied, unable to keep the sharpness out of my tone. How was I supposed to diagnose him within thirty seconds without any medical equipment? I again looked at Parsons, focusing my full attention on his symptoms. A neurological problem was the most likely explanation, but others came to mind as part of my mental differential.

I grabbed his shoulders. "Chris, can you hear me?"

He opened his mouth and once again only gibberish came out.

"Don't try to speak for now." I reached into the pocket of my suit jacket for my penlight. Blast! Of course I hadn't bothered to bring it on a social visit. I glanced around for Louisa, who hovered in the doorway, staring at us with an expression that indicated she was clearly vexed at the turn of events.

I pulled my car keys out of my trousers pocket and handed them to her. "Get my medical bag."

"Should I call an ambulance?" Emily asked.

"Not yet," I replied absently, turning my attention back to Parsons. A check of his pulse found it elevated, but not dangerously so and his breathing was normal. "Are you having pain anywhere?"

"Carry drop salad."

I frowned at the response. "Are you in any pain?" I repeated.

"Move not arm."

Broca's aphasia, I told myself, mentally reviewing the potential causes of the condition. I was beginning to consider whether Parsons was having a CVA. His age mitigated against it, as did the lack of severity of his symptoms. Still, it was a possibility I'd have to rule out.

"What's wrong with my dad?" came a child's voice from the kitchen doorway. Parsons' son was now standing there, staring at his father, horror etched on his features. At the same moment, Louisa appeared beside him, medical bag in hand.

"It's all right, Danny," she said, touching a hand to his shoulder. "Your dad's going to be fine."

"You don't know that," I snapped, impatiently reaching for my bag.

"Martin!" She handed me the case, then put her arm protectively around the boy. "Dr. Ellingham's going to take good care of your father, aren't you Martin?"

"Yes," I replied impatiently.

"Come on, Danny, let's leave him to do his job."

"I want to stay with my dad."

And I wanted to get the whole lot out of the kitchen so I could examine Parsons without an audience. I'd no doubt that the sight of his wife and child gawking at him wasn't improving his condition.

"Come on Danny," Louisa repeated, gently pulling him away from the scene. "Emily, why don't you join us?" It was as if she'd read my mind and, when she glanced back at me, I realized she essentially had.

I threw Louisa a grateful look as she left the room and, pulling up a chair next to Parsons, checked his pupils, which were equal and reactive. His BP at 156/92 was on the high side. I took each of his hands in my own.

"Chris, squeeze my hands." Nothing. "Come on. I need you to squeeze my hands." After a few seconds, I felt a slight pressure from his left hand being held in my right. "Harder!" The pressure increased slightly on the left side. Parsons' right hand rested limply in mine, and his eyes remained filled with fear.

"It's all right. Rest a moment."

I leaned back in the chair and assessed what I knew. Parsons was in no immediate danger but equally obviously had experienced an attack of some sort that had left him with aphasia, confusion, and right side muscle weakness. The problem could be neurological, vascular or even viral, and multiple differential diagnoses came to mind. To confirm any of them would require an investigation and testing beyond what I could perform here. In the meantime, there was little I could do for Parsons medically other than monitor his condition. If it didn't improve, I'd have to call for an ambulance and admit him to hospital.

I repacked my bag and considered whether I could leave him alone long enough to update Emily on his condition.

"Mart?" He blinked rapidly then looked down at his hands, trying to wiggle his fingers.

I let loose a tight breath. The fact he recognized me and had spoken a clear word was a good sign. "Chris?"

His eyes focused on mine. "What happened?" he asked.

I gazed steadily at him. "You tell me."

"Carry salad and hand . . . not feel. Not stand up. Emily . . ." His eyes looked around wildly. "Where's Emily?"

"Sitting room."

Parsons was still experiencing some aphasia. I again grabbed his hands. "Squeeze my hands as tightly as you can." This time, he responded immediately to my command, and I was pleased that his strength was almost equal bilaterally. I watched carefully as he took some deep breaths and tested his right arm and leg. A check of my watch showed that less than twenty minutes had elapsed since I'd been summoned to the kitchen.

"Mart?" Parsons asked me quizzically. "What . . .?"

There were quite a few possibilities. The rapidity of onset and short-term resolution of symptoms narrowed the potential options. Although a CVA was off the list, there were still quite a few serious conditions that could present with the symptoms Parsons had experienced – brain tumor, Guillain-Barre, and MS among them. Based on my experience, another possibility seemed more likely.

"I think you may have just suffered at TIA," I said.

"I'm all right," Parsons said after a moment, making as if to get up. "Tell Emily okay. Scary."

I pushed him back into the chair. Until the aphasia fully passed, his talking to Emily would only frighten her more than she already was. "Rest here awhile longer. I'll go speak to her."

After quickly assuring Emily that her husband was stable for the moment and was starting to recover, I returned to my supervisor, friend, colleague, and – for the moment – patient. He looked better, stronger, and more confident than when I'd left the room only a few minutes before. In fact, had I not witnessed his attack, I would have never have believed that, less than a half hour ago, he could barely speak or move.

"I should admit you to hospital tonight," I said, more to gauge Parsons' reaction than because I had any real intention of doing so.

Parsons shook his head. "No."

It was the reply I'd expected and, in fairness, there was nothing that the hospital could do this evening that his GP couldn't do equally well the next day. "You need to see your GP straight away."

He again shook his head and pointed his finger at me. "You."

"What about me?"

"I want you to examine me."

My eyes narrowed. "Me? Why?"

He gave me a slight smile. "You're the best GP I know."

"Chris, I don't think—" It was a nice compliment and probably true. But Parsons must have a regular GP, and it made more sense for him to consult a physician familiar with his medical history.

"I don't need the entire PCT gossiping about me," Parsons added, and I recalled the words of Mark Mylow so long ago – "I'm known there." It was true of Parsons as well.

I noted that, in the short time I'd been out of the room talking to Emily, Parsons' aphasia had disappeared almost as quickly as it had come on.

"Will you help me?" Parsons asked.

"Of course I'm going to help you. I'm going to refer you to Nigel Leahy or Brent Meadows who can get you on the damned table where you probably belong." I was furious. Furious that he'd ignored what were potentially serious symptoms and furious that, rather than visit an actual vascular surgeon or even his GP straight away he'd instead come to me weeks after the initial episode.

"Martin, we don't even know what's wrong with me. I'm no vascular specialist. Maybe it's a neurological problem. Which is why I'm asking you as a colleague and a friend to figure out what's wrong with me. That's all."

I rubbed the bridge of my nose. What Parsons was asking wasn't technically difficult. I could still do a vascular workup in my sleep. It was the patient who was the problem. The reason I was here as a GP rather than in an operating theatre in London, was that I couldn't deal with the fact that my patient was a real human being and not just a vein or artery that needed repair.

I shook my head to clear the memories and sat up straight. I was the one being an idiot. Maybe Parsons was wrong about his symptoms. He was an endocrinologist who'd spent the past few years doing mostly administrative work – he wasn't a vascular surgeon, neurologist, or even a GP. Maybe he didn't have vascular disease or, in any event, didn't need surgery. It wouldn't kill me to work him up and it might well kill him if I sent him elsewhere where some incompetent might well misdiagnose him. After all that Parsons had done for me over the years, I could spare an hour helping him.

"All right. Be in my surgery first thing in the morning."

"It's Sunday."

"I know what day it is. Just be there."

Before I left, I rechecked Parsons, whose symptoms appeared to have completely resolved. It was as if the attack earlier in the evening had never occurred. I arranged for him to meet me in the surgery early the next morning and extracted a promise from Emily to drive him there, as I wouldn't risk a return of his symptoms while he was behind the wheel of a car.

"If he has another attack tonight, call 9-9-9 immediately," I ordered. Parsons gave me a foul look but Emily nodded her agreement.

Shortly thereafter Louisa and I took our leave, dinner sitting cold in the kitchen. The incident with Parsons had destroyed our appetites and I was more interested in him getting to bed than continuing to host a dinner that none of us now wanted to eat.

"What happened to Chris?" Louisa asked me in the car on the way home. "It was so frightening when he couldn't move or speak. And then he seemed fine when we left."

I considered how much to tell her. Patient confidentiality had to be balanced against the fact that Louisa had observed the entire incident and was naturally concerned about Parsons' health. And, now that we were living together, she was bound to become privy to some of my patients' medical problems.

"I think he may have suffered a transient ischemic attack," I finally replied. "It's somewhat like a small stroke." Technically, it was no such thing but it was the easiest way to describe the condition to a layperson.

"It's serious then?" she asked.

"Could be."

"Oh dear. Can you help him?"

"Probably, but first, I need to figure out what's wrong. A TIA – what I think happened to him tonight – is only a symptom. An underlying condition is the cause."

"Well, it's good that he has you to diagnose him. I know Emily was thankful you were there tonight."

"It was good of you to get her out of the room while I examined him."

My comment was met with a brief smile from Louisa. "Emily handled the whole episode quite well, didn't she?"

"Ah, yes, I suppose so." It was true that the woman hadn't become hysterical and, more importantly, had agreed to do what I'd asked. Even so, my mind wasn't on this conversation. I was already considering the examination I would perform, the tests I would order, and – with a heavy heart – what I might find.

Medical Glossary

Aphasia – impairment of language ability; trouble speaking normally

Broca's aphasia – a specific type of aphasia where speech is difficult to initiate, non-fluent, labored and halting. Language is reduced to disjointed words and sentence construction is poor, omitting words and inflections.

CVA – cerebral vascular accident – a stroke

Differential/differential diagnosis – the way doctors arrive at a diagnosis by eliminating potential causes until the most likely cause(s) remains

Endocrinologist – doctor who specializes in parts of the body related to hormones, and the endocrine glands and tissues that secrete them. Endocrinologists often deal with diabetes, for example.

Guillain-Barre Syndrome – an acute neurological disorder affecting the peripheral nervous system

MS – Multiple sclerosis