"You have a urinary tract infection, Mrs. Trammel," I said wearily a few hours later. The condition was one of the more common reasons patients – especially female patients – came to see me. Annoying for the patient, but easily treated.

"It's Miss Trammel," the prim woman corrected me.

I favored her with a hard stare and scribbled out a prescription. "Antibiotics." I ripped the sheet off the pad with a flourish. "Be sure to take the full course. If you're not feeling better in a week, come back and see me."

"See you? Really?" she said in surprise. "I thought you were going back to London and we were getting a locum."

"My departure has been . . . delayed . . . a bit."

"Of course. Joan." The woman clucked her tongue in sympathy. "It was such a shock, her passing so suddenly like that." Her expression morphed into a smile. "And of course, there's your baby."

There was no benefit in discussing my personal life with my patients. "Next patient!" I called out, and headed toward the doorway, using the opportunity to usher my patient toward the waiting room, which at this late hour, I found to be empty.

"All done for the day, Doc," Morwenna informed me.

A glance at my watch showed that it was already past her normal working hours. "You can go," I said, turning around and heading back into the consulting room, remembering to dip my head so as not to bang it into the doorframe – something I often did when my mind was elsewhere. I still had patient notes to finish up and, in the meantime, I could figure out what I was going to say to Louisa. That was, of course, assuming she'd see me given my behavior of a few hours ago.

I also needed to decide what to do about Chris Parsons and his surgery, which I was scheduled to perform in only a few days. The flashback earlier today had frightened me – and had seriously dented my newly found confidence. I dare not have that happen with Parsons on the table. At best, I'd look like an incompetent fool. At worst, my jitters might occur in the middle of surgery when a mistake could actually kill the man.

I carefully wrote out my notes for the last patient, wondering not for the first time whether I should consider moving to a computer-based system. The act of writing by hand was strangely cathartic and seeing the progression of penmanship from one year to another, one doctor to another . . . I didn't know why I was having this mental debate. In less than a month, I'd be in London where all surgical notes were dictated and left for a medical transcriptionist.

I glanced up at the sound of a soft knock at the door.

"Surgery's closed, unless it's an actual emergency," I barked out, emphasizing the last two words in the hope that whoever had come to bother me would leave. And also hoping that I wasn't inadvertently shouting again at Louisa, although odds were that, after my earlier tirade, she was wasn't likely to return to my consulting room.

"It's only me, Martin," Aunt Ruth said, pushing open the door.

I frowned at her unexpected presence. "Are you ill?" She looked fine, if a bit drawn, dressed as always in a proper navy suit with a crisp white blouse.

She favored me with a half-smile. "I'm not here as a patient."

Well then, this wasn't hard to figure out. Argue with Louisa at lunch, receive visit from Aunt Ruth at the end of the day.

"Louisa called you." It was more an accusation than a question.

"I called her," she corrected me. "Needed to find somewhere to get my hair done. When I asked after you, she mentioned you'd been a bit out of sorts." Her voice remained quiet and her eyes searched mine.

"I can handle my own problems, thank you," I said, standing up and, for the second time in a few minutes, tried to usher a woman out of my surgery.

To her credit, my aunt stood her ground. "Martin, may I ask you something?"

"Do I have a choice?" I asked in a tone meant to discourage further questioning.

"Are you looking forward to returning to London?"

"Of course," I replied automatically.

"And Louisa?"

"She's coming with me."

"I know that. But is she happy about it?"

I shrugged. "I suppose so." I hadn't given it much thought.

"Haven't you asked her?"

"No need."

Her eyebrows arched and she gave me a feigned expression of surprise. "Really? You're asking Louisa to quit her job and move away from the town where she's spent her entire life because you decided you want to work in London. Don't her views count?"

"I considered her views," I replied defensively.

"And dismissed them, I'm sure." She swallowed hard and cleared her throat. "In London, you'll be working incredibly long hours. Have you thought about what life will be like for Louisa alone all day with a baby in a small flat?"

"It was her decision. I'm sure she'll manage."

"I'm sure you're sure."

What she'd said was true. My decision to return to surgery and London had been made while Louisa was away so there'd been no need to consult her. By the time she'd returned to Portwenn, everything seemed so . . . settled. And, when she'd told me that she didn't want me involved in the baby's life – James Henry's life, I reminded myself – there seemed no reason to change my plans or even to involve her in them.

Once James was born, it had suddenly and unexpectedly become important to have him and Louisa in my life. And that's how I'd thought about it . . . how they would fit into my life, not how I could fit into theirs. Louisa could quit her job – or find herself a new job in London. Louisa could move to the flat I'd rented. Louisa could take care of the baby while I worked. My future involved a lot of concessions by Louisa and, I had to admit, not too many by me. Perhaps it was because, until now, I'd never had to consider the effects of my decisions on anyone but myself.

"So then, what happened at lunch?" she asked, taking a seat in front of my desk. My aunt was looking at me curiously, and it didn't escape my notice that she'd suddenly switched subjects on me.

I tried to deflect the question. "Nothing important."

"I don't believe that for a moment."

"Aunt Ruth, I don't need yet another psychiatrist trying to psychoanalzye me."

Her eyebrows again flicked upward. "Another?

Damn. "It's none of your business."

"Oh for God's sake, Martin. I don't need to be a psychiatrist to know that you're upset about something. You've been tense since I arrived in Portwenn and, in the last couple of days, you've been almost impossible to be around." She coughed and cleared her throat. "Louisa's convinced it's her fault – that she's done something wrong."

"It has nothing to do with her."

"Then what is it?"

My eyes narrowed as she coughed again, harder this time, and pulled out a tissue from her bag.

"Are you having more problems with the Sjogren's," I asked. "Are you drinking plenty of water?"

"It's fine."

"No, it's not fine." I grabbed a tongue depressor and stepped around the desk, clicking on my pocket light. "Let me see your throat."

"Oh, for goodness sake," she complained, but nonetheless opened her mouth. To my surprise, it was less dry than the last time I'd examined her, although somewhat inflamed. I let my hands slide down the sides of her neck and found her lymph glands slightly swollen.

"Hmm." I nodded toward the examination table. "Have a seat on the couch and loosen your blouse."

"Whatever for?"

"You're coughing and short of breath; I want to examine you." The coughing was probably nothing more than a virus, but pneumonia was always a possibility and, if left unchecked, could be quite serious in someone Ruth's age.

She gave me an exasperated look. "Oh, Martin."

"Just do it."

I grabbed my stethoscope from the desk and, when she was ready, listened carefully to her lungs. It took only a few breaths to hear the telltale crackles. "It's acute bronchitis," I said, pulling the stethoscope from my ears. "Most likely viral. You should be fine with over-the-counter NSAIDs and cough suppressants from the chemist."

She started tucking in her blouse. "I could have told you that."

"Right." I again sat down behind my desk.

"Martin, why are you so anxious to go back to surgery?"

That was easy. "I spent half my life training to be a surgeon. And I happen to be very good at it."

"You're also an excellent GP – at least from what I've heard and seen since I've been here." Aunt Ruth slid off the couch and leaned against it, folding her arms across her chest. "You have a home here, and a successful practice. Louisa and your son are here. Why are you leaving everything you've built over these past years to go back to London?" She coughed into her hand, and grabbed another tissue from her handbag.

I took a deep breath. "Oh, I don't know. Could it be that the town is an abysmal backwater, the medicine isn't the least bit intellectually stimulating, and my patients are, for the most part, ungrateful and non-compliant fools?"

"And that's why you're leaving?"

I raised my eyebrows. "I think that's more than enough, don't you?"

"Perhaps. And yet it seems you're doing almost everything you can to stay here."

"No I'm not," I replied indignantly. "I'm only staying because Aunt Joan died and then my replacement at Imperial refused to come for—"

She waved off my excuses. "You're not going to tell me, are you?"

"Tell you what?"

"What's really bothering you. A few weeks ago you accused me of hiding something. Well, at the moment, Martin Ellingham, you're the one doing the hiding."

Damn her. For a moment, I wished for Auntie Joan, who'd give me a good talking to but, in the end, would leave me to stew in my morass. Aunt Ruth wouldn't quit. Hard to say whether it was her personality or her profession – probably both.

"It might help to talk about it," she added.

"No it won't," I snapped. "Besides, there's nothing you can do to help."

She coughed again, then took a seat even as her eyes appraised me. Finally, she said, "I can listen."

Medical Glossary

NSAIDs – non-steroidal anti-inflammatory drugs, such as ibuprofen and aspirin.