I closed the door to the surgery and stepped through the alcove into the kitchen. Out of the corner of my eye, I saw Louisa curled up on the sofa in the sitting room. The baby was nowhere to be seen, which meant that he was upstairs, asleep in his cot.

I steadied myself, determined to do what Aunt Ruth had suggested and explain myself to Louisa. After this afternoon's tirade, I at least owed her that much.

"Louisa," I said softly, not wanting to wake her if she too was taking a nap. She always seemed so tired of late juggling school and the baby. It was as difficult as I'd expected but reminding her of my concerns only put more strain on our already strained relationship.

"Martin." Her eyes opened and she gave me a soft smile. "Everything alright?" If she was angry with me for my actions earlier in the day, she gave no sign of it, for which I was thankful.

"Fine," I lied.

"I saw Aunt Ruth heading down the walk a bit ago," she said. "You should have invited her to stay for supper."

"She, uh, needed to get back to the farm. Before dark, that is."

"Oh."

I sat down next to her on the sofa and she pulled up her feet to give me room.

"Louisa, I was rude this afternoon, when you came to the consulting room. I want you to know. . ." I couldn't quite meet her eyes. "My being upset; it wasn't directed at you." It was my best attempt at an apology.

Her eyes narrowed. "Did something happen with a patient?"

"No."

"With Morwenna then? You didn't let her go her did you?" she asked with some apprehension.

"No. She was fine. Today that is."

She sighed with relief. "Good."

I sat there, stupidly trying to figure out what to say next. It had been relatively easy with Aunt Ruth; why did I always find it so difficult to talk to Louisa? We seemed to talk at angles, with neither of us being able to express our feelings plainly to the other which invariably led to misunderstanding and, frequently, a row.

"Louisa, would it make you unhappy if I – we – didn't go to London?"

She sat up straight and gave me a look of astonishment. "You mean stay here awhile longer?"

I shook my head. "I mean if we didn't go at all." I let the statement rest between us.

"Not go to London?" There was a note of hesitation in her tone. "But it's all settled. I mean that's where your position is, where you're planning to work. Surgery and all that."

Yes, I was well aware of my plans. I tried again. "What if I were . . . not to take the position at Imperial?"

"Not take the position at Imperial? I thought that's what you wanted, what you've been working for all these months."

"It is." I had trouble meeting her eyes. "It was."

"I'm sorry, Martin. I'm don't understand. I thought it was all settled. You're going back to London, to vascular surgery . . ."

"I may not be able to go back to surgery." There, I'd said it. I'd done what Aunt Ruth had suggested and told Louisa the truth. I mentally held my breath to see what she would say or do next.

She was staring at me curiously, eyes wide. "Not go back to surgery? Why not?"

I wet my lips. "Earlier today, before you came to the consulting room, I was mentally reviewing Chris Parsons' surgery, imagining myself performing the operation. Step by step." I left out the part about the pig's liver.

She nodded.

"And . . . I experienced a . . . panic attack. The surgery, the blood, the cautery . . . I couldn't do it."

"That's what had you so upset when I came by, wasn't it?"

I nodded. "Yes."

Louisa's mouth hung open as she seemed to process what I'd just told her. "Oh, Martin."

Please, I silently begged her. Don't pity me. The one thing I could not endure from Louisa of all people was pity.

"And you think it could happen again when you actually operate?" she asked in a quiet voice.

"I'm afraid so, yes."

"On any patient?" Louisa had figured it out quite quickly.

"Well, it's unlikely on just any patient." I cleared my throat. "Aunt Ruth seems to think it's only – mostly – when I operate, or think of operating, on people . . . who are close to me. That I would probably be fine most of the time - with most patients. But, I can't be sure it won't happen againt. I might never be sure."

She took a breath and stared down at her hands, which were clutched together. "Martin, I . . . don't know what to say."

Then don't say anything, I thought. I'd done what Aunt Ruth had suggested in unburdening myself to Louisa. I really didn't want to get into an in-depth discussion of my psychological issues. If Ruth was correct, there was nothing I could do about the situation and definitely nothing Louisa could do about it.

I stood up quickly, hoping to dispel further conversation on the subject. "I'll fix some supper. Maybe we can get in a meal before the baby awakens."

She trailed me into the kitchen. "If you don't take the position at Imperial, what will you do?"

I gave her what I was certain was a dark look. How the hell do I know? Can't you see that my entire world has just been upset like a bloody applecart? My position, my career, my future.

Louisa must have sensed my consternation because she took a step back. "You'll sort out something, I'm sure," she offered lamely.

I, in turn, did my best to force back my teeming anger. This wasn't Louisa's fault and lashing out at her would only push us back to the days when we couldn't seem to have a single conversation without arguing.

"What do you suggest I do?" I asked, trying to keep the sarcasm out of my voice. I was sure Louisa, as always, would have a dozen ideas, things to make things better, ideas to make me better. I couldn't wait to hear them, I thought sarcastically.

"You're asking me?"

"Yes," I reassured myself as much as Louisa. "Yes, I am."

It was almost amusing – almost – to see her so flummoxed. And, it was, I realized with a profound sense of guilt, because this was probably the first time I had actually consulted her on any decision affecting me.

"Well, I don't know, Martin. With your skill, I'm sure you could work anywhere you like."

Not as Chief of Vascular Surgery at Imperial, I thought.

"I know you don't want to stay here in Portwenn," Louisa continued.

It was true that I'd made quite clear to anyone who would listen that I was more than anxious to get out of this village. Permanently. I'd burned quite a few bridges in that regard. There were undoubtedly openings for GPs in other parts of the country – maybe even London, I thought with a sense of irony. And, I could work as a locum for a time, until I sorted things out. At the moment, it all seemed too overwhelming.

I opened the refrigerator to see what I might fix for dinner. "There's no need to decide this evening."

She looked somewhat disappointed that I was ending the conversation. "No, I suppose not. So, what happens next?"

"I need to give my notice at Imperial. But first, I need to tell Chris that I can't perform his surgery," I said with a sense of dread.

She slid a bit closer to me. For a moment, I thought she might touch my shoulder or even take my hand. Instead, she simply gazed up at me, her head slightly tilted. "Would you like me to come with you when you talk to him?" she asked softly, and, I couldn't help be touched.

"No," I said quickly. "I, uh . . . this is something I need to do on my own."