Chapter 43 – Another Last Patient

Saturday – six AM. The alarm rang, not that I needed it, as I'd not got much sleep. I lay in the bed wondering what tomorrow would bring. Sunday I'd be back in London and that afternoon the removal vans would arrive at the flat I'd rented on the Internet. The rental agent apologized at the age of the building it was in, but I told him not to worry. After three years in Portwenn, I was quite used to ancient residences, creaking doors, and questionable plumbing.

The contents of my cottage were nearly entirely packed away. I was leaving the office equipment as I was sure the new GP would need it, and it was so much better than the trash that Doc Sim had left for me. That was my real introduction to the backwater of Portwenn. The tubing of the late and not great Sim's sphygmomanometer had totally hardened into a brittle form and it snapped as I touched at, while the pump bulb cracked in my hand. There was not a thing in the office that looked usable, but for the sink. I found that it too was a mass of corrosion and leaks.

Thusly I met Bert and Al Large – plumbers extraordinary, local handymen, and impromptu guides to the village. I sighed at the memory. All the while that dolt Elaine stood there in the background chewing her gum with a tiny gleam in her eye at the mayhem as the office flooded.

I tried to shake off the memory. But as I stood in the shower more came back - more of the odd cases, insane conditions, weird excuses and even more abnormal patients. But I had triumphs as well. Clamping a splenic artery in the back of an ambulance, cranial trepanation with a portable drill at the bottom of a cliff, restarting the heart of a woman would had fallen on glass and in my rush to ease her pain had nearly killed her with morphine.

There were other memories as well, and as those that some might call pleasant rushed into my head, I flipped the hot water tap to OFF and doused them away with a gush of cold water. "Arghhh!"I shouted as frigid water did the job and those thoughts fled away like ghosts before the sunlight.

But one stuck – Louisa. There was no help for it. But with all that happened between us… I had to leave. I rolled the dice and they had fallen such that I was again a surgeon – now Head of Vascular Surgery at Imperial College, London. That was the buoy that I clung to like a drowning man in the ocean – an ocean of my own making.

I dried myself, shaved (avoiding my eyes in the mirror – knowing I'd not like what I saw there) then my suit and tie fell into place as if they knew the route themselves.

Breakfast followed – an egg, toast and jam, juice - then coffee. I'd eaten the food quickly and took my coffee onto the terrace and gazed on a Portwenn morning one final time. True, Ellingham? One final time?

"We shall see," I answered that niggling internal voice.

Down in the Platt at the base of the harbor figures were preparing stalls, the portable merry-go-round was being tested, and faint voices wafted up to the cottage. Harbor Day – Portwenn's annual bacchanalia to celebrate - just what exactly? No one actually remembered. If it had any real significance at one time it had been forgotten long ago. Local legend said that even in wartime they'd held it, although the old people still argued whether or not the precious ration points should have been used for a party. I suspected there was plenty of moonshine then just as now, although it had been a while since I had to treat victims of the local brew.

I stopped that thought as I downed the last of the coffee. Not my problem anymore. They can bloody well go to Wadebridge or wait until Monday! I was done. Doc Martin was finished.

I washed my dishes and the pot I'd boiled the egg in and packed them. I disinfected the table and was reminded of Al and Pauline snogging away on this table. God, they acted like teenagers! But Ellingham, didn't you snogg Louisa right here too!

"Yeah. And suffered a horrible hangover for my trouble."

I heard the front door open and someone walked into the waiting room. I was flabbergasted to see Pauline. "Pauline, what are you doing here?"

She stood straight and tall and looked me square in the eye. "I came to get things squared away – organized! Have to do things properly for the new GP. Don't want 'em to think we're tossers, that is that you were one… or me."

I held up my hands. "Stop! I see." I got out of her way.

Shortly the removal vans arrived and two men came barging in and sized up the boxes, the furniture and me. I was uncomfortable under their gaze. They were both short – one thin and the other gone to fat.

"You're the doc?" asked the thinner one with hair.

"Well yes. No, that is…erh, I was…"

Pauline butted in. "This is Doctor Ellingham and he was the GP here. The new doc starts on Monday, so don't you be messing up any floors, walls, or doors for 'em. Hear?"

I nodded to Pauline. This was a side of her I'd not seen often.

"Doc, you just have to know how to handle people." She then smiled and patted my arm.

That stopped the men so they traded looks and got to shifting the downstairs furniture. As they were taking my desk from the examination room, I upbraided them to have a care with it going through doorways as they had already made numerous collisions between my belongings and door frames.

The one carrying the fore end gave me a hard look. "Doc, when you have a patient with headache and sore throat, do you ask us for advice? Do we stand around and tell you how to do your job? Let us get on and do what we do best!"

Suitably reprimanded, I turned my attention to Pauline. "What are you doing?"

"I am organizing the files and building up a profile; so we get a decent level of feedback patient to doctor."

"Well, is that needed?"

"Where's your desk?" she asked.

"In the removal van." Why was she asking about furniture?

"And where's my desk?"

"Right here." Too obvious. What was she playing at?

"Exactly, so shush." With that she dismissed her former employer.

The movers worked on until the building was nearly bare. One of the movers, the fat bald one, came back inside. "Almost done. Something I wanted to talk to you about, before we left."

"What?" I said, irritated. I wanted to have these two finish packing the vans, while I went to the village and paid off outstanding accounts.

"It's uhm… medical."

Pauline helped me. "He's finished. Come back Monday or head over to Wadebridge."

I squared my shoulders. Perhaps this was the last patient and I'd not let Pauline boss me about the way Edith had. I motioned to the man. "Fine, come through."

He shuffled into the examining room ahead of me.

"What's the problem?" I asked.

The man jabbered on about how he was married, his wife was pregnant, and he really wanted to see the child grow up, and he knew it was bad, and he was a young man… Then he held out his left arm, where a three centimeter raised bump with a glossy and red surface was visible on the dorsal aspect of his wrist, at the junction of the radius and scaphoid bones. I took his hand and prodded the lump. It was soft, almost mobile, and clearly fluid filled.

My attention set him off some more. "It's bad isn't it? I know it has to be cancer!" he blubbered in a rising panic.

I bent down and raised a thick medical textbook from an open box. It was Kroegman's "Treatment of Musculo-Skeletal System Disorders.

The man started to shout. "Oh, bloody hell! You know it's bad when even the doctor has to look it up!"

I rendered my diagnosis. "It's a ganglion – a cyst of the joint." I hefted the book I held in my right hand. The man likely needed surgery but the old method should work – the so-called bible treatment. "Hold your hand up," I commanded.

The man did as he was told. I swung the book from overhead aiming for the bump. I was rewarded by a yell after impact.

"Owww!" The man bent over in pain cradling the arm after I struck his wrist.

"Let me see." He raised it and I palpated the wrist, where the lump was now magically gone. The impact had ruptured the walls of the cyst and dramatically drained the contents into the synovial vaults.

The man's eyes bugged out at as he saw the lump was now gone.

I nodded my head and dropped the book back into the open box. "There are two more boxes in this room." I turned on my heel and walked out. That was my last patient.