Most patients seeing me for post-surgical follow up were required to visit my surgery if they were at all physically able. Chris Parsons wasn't most patients, and it made no sense to have Emily make the long drive only days after her husband had returned home from hospital.

For this reason I was spending my morning making a house call to check on his progress. Emily greeted me at the door with haggard features and a strained smile.

"I'm so glad to see you, Martin."

I frowned slightly. "Is something wrong?"

"No," she quickly reassured me. "It's just that . . . well, Chris hasn't seen a doctor since he came home from hospital and I'll feel better once you've checked him over. I'm just a worrier," she added.

"Hmm," I grunted trying to decipher the comment as I followed her into the living room. Parsons sat in overstuffed chair with his feet propped up on an ottoman. The fact he was resting was a good sign. He wore a loose T-shirt, probably because it was one garment that didn't irritate his wound.

"Mart," he greeted me, careful not to twist his neck too far or too quickly. "About time you showed up to take out these damn sutures; I was ready to do it myself."

I rolled my eyes at the comment as I strode across the room and set my bag on the floor next to his chair. Facial and neck sutures needed to stay in for five days, as Parsons well knew. He looked good for being less than a week out of surgery, although still a bit pale. There was significant edema and a large hematoma on the left side of his neck, both of which were to be expected at this stage.

"Let me see." I snapped on a pair of gloves, pulled up a chair and, carefully tilting Parsons' head to the side, scrutinized the wound closely, gently pressing along its edges.

"It's looks so horrible," Emily said from behind me. "Is it infected?"

To a layman, it probably did look somewhat gruesome but, to my experienced eye, it was healing quite nicely. Leahy had done excellent work. I glanced around at Emily. "It's normal for there to be swelling and bruising in the first few weeks after surgery. There's no sign of infection."

"Told you," Parsons said pointedly to his wife.

"I wanted confirmation from the expert," she replied, giving me an appreciative look.

"Any numbness?" I asked, as I set about removing the sutures. The carotid lay beside sensitive facial nerves and even the best surgeon could leave some impairment. Thankfully, it was almost always temporary.

He started to shrug and nod. "A little."

"Keep your head still," I snapped.

"Sorry," he replied with an apologetic grimace.

"As you know, it's common to experience some numbness. It should resolve within a month or two." Using forceps, I picked up the knot of the next suture and then cut it with surgical scissors before pulling it from the skin.

"Yeah. No complaints here."

"Are you still having pain?" I asked as I worked.

"Only if I move my head too quickly."

"Then don't move your head too quickly."

"Right."

"I'm sure Leahy told you that some pain and stiffness is to be expected for at least a fortnight."

"Yes, he did."

"Is the paracetamol adequate for analgesia or should I prescribe something stronger?"

"It's fine."

"And you're continuing aspirin therapy?" Aspirin served as a mild blood thinner and would be necessary for months, and perhaps forever.

"One a day."

Having removed the last of the sutures, I glanced away from my work. "Any trouble sleeping?"

"Not really," Parsons replied, a touch of annoyance creeping into his tone.

I ignored it. My questions were important in terms of his post-operative recovery. "And that means?"

He sighed. "I'm fine, Mart. Really. Thankful to be alive."

I let that go, put aside my instruments and retrieved the stethoscope from my bag. "Lift up your shirt."

"Why?"

"Why do you think?" I replied smartly then, in a slightly softer tone, added, "I need to make sure you aren't developing a respiratory infection." It was a not uncommon post-operative complication of endarterectomy. I had Parsons breathe in and out until I was satisfied his chest and lungs were clear.

"So," he asked, as I packed up my bag and stood up, "can I go back to work tomorrow?"

"Of course you can't! In case you hadn't noticed, you've just had major surgery. You need to rest."

"Oh, come on, Mart. I have a sedentary job. I'll get as much rest in the office as I will here."

"Are you stupid? No driving and no working for at least three weeks."

Parsons waved him arm in an arc. "I'll go stir crazy sitting around here all day, not to mention I'll drive Emily nuts."

"I don't care."

"Martin, you . . ." He started to shake his head, then thought better of it and rolled his eyes. "Oh, never mind."

"Hmmf," I replied, satisfied with my victory.

Emily approached with a tray of water and tea. "Would you like something to drink?"

She must have left the room while I was attending to her husband. I accepted the water and took a seat in the chair across from Parsons, who allowed Emily to serve him a cup of tea.

"So," he asked, "have you come to any decisions about whether to go to London or stay in Portwenn or . . . do something else?"

"I don't know." I was comfortable talking about post-operative complications; I wasn't all that interested in chatting about my future, even with Parsons. "I need to discuss it with Louisa."

Parsons smiled. "Well, that's a good sign."

My eyebrows lifted even as I frowned a bit. "What?"

"That you're actually consulting her about your decision."

"Yes, well . . . it's not only about where we live. I also have to work there."

Although I'd promised Louisa that I'd stay in Portwenn because Louisa was here, we hadn't actually had the opportunity to sit down and discuss whether that was what we wanted to do. It was odd thinking about what she might want; what was best for the both of us - actually the three of us - rather than solely what was best for me. I'd made that mistake in my aborted attempt to flee to London. As I'd come to realize, I'd been terribly wrong to think that I was better off without Louisa or that I could even be satisfied without her. And that, strange as this new approach was to me, it also made me happier than I ever thought I could be.

Parsons sipped his tea and looked at me over the rim of his cup. "Based on our prior conversation, I assume you're thinking of a GP post."

I sighed. "Yes, I suppose so." I said, as the chimes of his grandfather clock punctuated the finality of my statement. If Aunt Ruth's theory was correct, what choice did I have?

His eyes seemed to smile. "You make it sound like purgatory."

"It's what I must do, not what I choose to do." The events of the past week had brought home the sobering fact that, despite my successful hernia repair on Louisa's mother, I would be forever relegated to the tedium and mediocrity of general practice.

"Don't tell me you never find it rewarding to be a GP." Parsons' tone remained light and I wondered if he understood the depth of my anxiety.

I stood up and walked across the room. "If you call treating URIs, UTIs, arthritis, and migraines rewarding. Oh, and then there's the occasional exciting case of acute bronchitis to spice up my day."

Parsons didn't rise to the bait. "You have to admit that my case was a bit out of the ordinary. Your diagnosis was spot on and in record time. There probably isn't a GP this side of London who could have done what you did. You may well have saved my life."

"Surgery performed by someone else saved your life," I responded bitterly. "I sat in the damn waiting room like some grandmother while Leahy cured you." I stood up. "Blast it, Chris! I spent much of my life training to be a surgeon. And now that I can no longer do it, I'm just supposed to sit back and accept my fate with a smile? No thank you!"

"Mart, if you don't want me to twist my neck trying to follow you around the room, then please sit down."

It was a fair request and I felt a bit chagrined for my impulsiveness. "Chris," I said, resuming my seat. "I'm meant to fix things – people. It's why I became a surgeon."

"I know that," he replied patiently.

"And both of us know that I don't exactly have the . . . temperament to be a GP."

"Your patients in Portwenn have come to accept you as you are."

"They don't exactly like me."

"They don't need to like you. They liked Dibbs and we both know how that turned out."

I remained silent.

"Look Mart, I'm not going to try to convince you that you can save people just as well working as a GP or debate whether or not you should try to continue your career as a surgeon. I'll only say that we often end up where we're meant to be."

"How prosaic," I replied with disgust. How could he know where I was meant to be or what I was meant to do? I knew I was meant to be a surgeon and God only knew why fate had taken that from me.

"Right. Well, for purely selfish reasons, I hope you stay here, in Cornwall at least. You do know there are Cornish towns and villages other than Portwenn if you change your mind about staying here," he added with a smile.

"Of course I do."

"And I hope that you'll remain a GP," he added. "The NHS and the PCT need good men like you."

I wondered if Parsons were being honest or simply trying to convince me to stay so that he didn't have to find my replacement, then quickly banished that thought. Parsons had in fact done everything he could to get me the surgical post at Imperial. And yet, for some reason, he still believed I was better suited to my current role as a GP.

"At this point, I'm not sure what I want."

"I know you don't. You have time to sort it out, and I'm sure you and Louisa will make the right decision. I just want you to consider all of your options."

All my options? At the moment, all of my options seemed like no option at all.

Glossary

Analgesia – pain relief

Edema – swelling

Forceps – hinged instrument used for holding onto things, such as sutures

Hematoma – bruise

URI – upper respiratory infection such as the common cold

UTI – urinary tract infection