Chapter 11

There is medical information in this chapter; I am not a doctor or claim to be one. I gathered all my information on WebMD. Explanations are at the end of the chapter.

Decisions to be Made

DM/LE

"And that haunted past will follow you like a lost dog on the beach. Nipping at you trail until you've drifted out of reach." – Josh Woodard, 'Fight the Sea'

DM/LE

It is a quiet ride back to the hotel; Phillip is sound asleep in his seat with Joan is in her own world looking out her side window. I feel myself brooding knowing Louisa is less than five miles away and I can't be with her. We arrive at the hotel almost twenty minutes later, as Joan gathers Phillip's bag, I unbuckle his car seat and carry it all into the lift Joan has waiting for us. She swipes her key card and I take Phillip directly to my room to change his nappy and clothes for the night. Phillip must be very tired as he didn't wake during any of it and soon he is lying in his cot with his purple dinosaur.

Joan has settled on the sofa with a cup of tea and bids me sit and enjoy one also. I can tell she wishes to discuss her time with her brother before I will be allowed to sleep. I sit down next to her with my evening tea and wait for her to start asking her questions; finally, she starts, her voice gives away how she feels right now.

"Martin, I went to visit your father, he looks so ill; he reminded me of my father just before he passed."

"We will know more when and if he wakes from his comatose state. I read his notes, he is improving but the brain is a fragile organ. It controls memory, motor skills, vision, breathing, temperature, hunger, and every process that regulates our body. If just a small area is damaged, the body is not the same. Christopher hit his head on the right hemisphere of the cerebrum, depending on the damage from the bleed and pressure, the functions that control his movements, judgment along with his vision and hearing can all be affected. In some cases, a person's emotions, reasoning, and learning are diminished. We won't know anything until he wakes up."

I look over to Joan and she seems to understand so I continue, "I noticed he has lost a lot of muscle mass; did you notice his arms? He could have other medical issues besides the current one."

"Don't older people lose muscle as they get older," she asks.

"Yes and no, everyone over thirty has muscle loss, it depends on their activity level. You work hard each day lifting, cleaning the house, scrubbing the floors, wrestling with sheep; you have good muscle tone even for your age. Christopher plays golf all the time or used to, his arms, back and chest muscles should not have shrunk in mass that much. He is only seventy."

"I believe he has a severe case of sarcopenia. He could have a reduction in nerve cells responsible for sending signals from the brain to the muscles to start the movement. There is another possibility of lower concentrations of some hormones, including growth hormone, testosterone, and insulin-like growth factor where a decrease in the ability to turn protein into energy for the muscle. There are ways of treating this disease, but the brain injury is only going to make it worse."

"Martin, what happens if he doesn't wake up?"

"His solicitor will need to be contacted; I haven't had contact with him for almost four years, I don't believe I am in his will. He divorced mum, I don't have any idea who would make the medical decisions for him. Maybe you should call Ruth and tell her the circumstances regarding his health."

"Good, yes…I forgot about Ruth. She should visit him tomorrow. I'll call her now unless you want to."

"No, I cut him out of my life when he was last in Portwenn and I sold my flat to settle his debts. I'll let you or Ruth handle any of his needs."

I finish my tea and start to get up, "Joan, I plan to be at the hospital for rounds tomorrow and find out when Louisa can be released. I plan on bringing her here and leave for Portwenn the following morning."

I stand and take my teacup to the tray and walk toward my bedroom, checking on Phillip, then gather my night clothes to do my ablutions but my mind has disturbed thoughts. As I said to Joan, I have no idea the state of my father's estate. I wonder if he has the same solicitor. I'll call tomorrow. One thing settled, as I brush my teeth as the next thought comes forward; how to get Louisa to Portwenn. The car ride is over four hours, the train not much better, a flight to Newquay but who would monitor her on the flight and drive her to Portwenn. I can't bear to be away from her so the best option has to be we travel back by car together. My mind continues processing the needed requirements for the drive, I will need to make some purchases for the extended trip. I pull my mobile out and start searching for my required items and set up a tentative delivery. When I am satisfied with my plans I call St. Mary's ICU and inquire about my father's condition before turning out the light for an agitated night sleep without Louisa lying beside me. I miss her.

My alarm wakes me from my restless sleep, as quietly as I can I make my way to the lavatory for a quick shower, but before I reach the doorway Phillip calls to me, "Dada". Disappointed for allowing the alarm to wake him, I turn to pick him up.

"Dadda. Wve you. Baff," he says as he points to the loo. I look at the doorway leading to my shower and back to Phillip,

"Phillip do you mean you want to shower?" He and I have only showered together once, yesterday morning so I can't understand. I carry him into the lavatory and he points to the shower stall, "Baff", he repeats and giggles as he wraps his hands on my face, "Dadda baff". I feel uneasy, yesterday was a necessity to have Phillip in the shower with me, today he wants to be with me instead of the tub in Joan's room. My thoughts wander back to school days, the requirement of sharing the shower room with others; I hated it. I always endured teasing but for some reason, Phillip needs to share his time with me; I don't understand. Do other fathers do this? Phillip points once again to the shower stall and repeats his request for a third time. Would Louisa say this is a bonding time for us, I will ask her when I see her?

I return us to my bed and lay Phillip on it as I pull off his pajamas and wet nappy, removing my pajama top and pick him up, and return to the lavatory. I turn the tap on; as the water warms to the correct temperature. I set Phillip on the shower mat and pull my pajama bottoms off, Phillip takes the opportunity to show his walking skill and walk towards the stall, I quickly grab him; I check the water temperature for the suitability, satisfied we step in as I explain to Phillip,

"Phillip, your mum and I always need to check the water temperature before you touch, it could be too hot and burn you."

He squirms to feel the water spray over his head and down his body; I set him down standing next to my leg as I take my soap and rub it over a wet flannel to wipe over my body, I look down at Phillip holding onto my leg and notice his natural response to the warm water cascading over his body, reminding myself to leave a note for the chambermaid that the shower will require a thorough cleaning for human urine. Phillip brings me back from my thoughts with his giggles; I quickly rub the flannel over his body ensuring the shower rinses the soap remnants from our bodies. I turn the water off and grab the heated towel and wrap Phillip in it; rubbing him dry. Once again I find I need to place him on the floor mat so I can dry myself, and quickly perform this task before wrapping the towel around my waist. I pick up the towel-wrapped Phillip and walk toward the cabinet containing his clothes and nappies; I find the suitable clothing to dress him and proceed to place the clean nappy and clothes on a now clean Phillip. I place him in his cot with his purple dinosaur,

"Phillip, allow me a moment to dress and we will find your breakfast."

He sits and babbles to his dinosaur about a baff and Dadda and points towards the lavatory; I can only assume he's relating his story of urinating in the shower on his daddy. I finish tying my tie and slip my jacket on as I walk back in the lavatory to wet a clean flannel in preparation for Phillips breakfast. Ensuring myself I am finished, I walk over to Phillip and lift him out of the confines of his cot and place him onto the carpet. He quickly crawls out of the room, heading straight to Joan's door. Quickly intercepting him, picking him up, I shush him quietly and place him in his chair so I can prepare his banana and bottle. With his bib on him and a bowl of cut-up banana in front of him, I prepare his bottle. He quickly consumes the mashed-up banana and I use the flannel to clean his hands and face of the remnants of what didn't make it into his mouth. I put the dirty flannel and bib onto the tray and lift Phillip out of his chair and settle us on the sofa with his bottle. As he feeds, I settle into my latest BMJ and soon I find Phillip pulling the magazine towards him to see the pictures on the page I am engrossed in; he points to the page, "eed" he says. I read the rest of the article to Phillip on the concerns of the higher failure rate of NHS-issued contraceptive condoms.

Just as we finish the article Joan emerges from her room, greeting us with a pointed stare. "Martin, are you sure you want to discuss that particular medical information with your son? As a result of said failure, aren't you swaying upon him that he came about due to a medical failure?"

"He doesn't understand what is read to him at this age. Don't be ridiculous and now you will say that my second and third children are also a contraceptive failure…and…medically yes they were, but not unwanted as I was," I sputter as my temper rises. If I wasn't holding Phillip at that moment, I would have stumped out of the room like a spoiled child amid a tantrum; the feel of Phillip in my lap calms me as usual.

Joan realizes her comment was a below-the-belt blow to my fragile self-confidence, changing the subject quickly, "I spoke to Ruth last night. She will be at the hospital at nine and wishes for your company concerning Christopher, and then she will come here for lunch. I assume you will stay at the hospital with Louisa, so Phillip and I will have a quiet lunch with Ruth."

"I thought I would call my solicitor this morning, more than likely Dad hasn't changed to a different firm and he will know the legal matters we spoke of last night. I will give him your number here to discuss the strategy going forward. I'll order our breakfast and then I need to leave for the hospital."

"Thank you Martin that will be very helpful. Ruth had no idea about his medical decisions or the contents of his will; she assumed you were the executor."

"No, I wouldn't believe the man held me in such low regard would make me his executor."

DM/LE

"Auntie Joan, I am leaving for the hospital now. Please ask the chambermaid to thoroughly clean my shower…Phillip released bodily fluids in it this morning."

Phillip hearing his name looks up from the ground and giggles and points towards me. Joan thinks the whole situation is as funny as Phillip's and smirks at me, "Yes Martin, I'll make sure she cleans it."

Ten minutes later I find myself in a taxi on my way to the hospital to meet with Aunt Ruth. I call Alistair Cummings, my solicitor at his home, and leave a message on his answering machine explaining my reason for bothering him on a Sunday and request he returns my call. I arrive earlier than anticipated at the hospital, so I text Aunt Ruth enquiring about her location and if she has not arrived at the hospital to please meet me in the canteen. As I walk into the room I find a table near the entrance by the side-wall, we will need some privacy to discuss my father, her brother's medical condition. A few minutes pass and I see my aunt entering the seating area looking around for a familiar face. It's been a few years since we last saw one another, I stand up so she can see all one hundred ninety and a half centimeters of me; she waves acknowledgment and walks over to the table, and sits down.

"Martin, tell me what happened to Christopher," she asks as she takes her seat.

"He was involved in a lift accident Friday evening. The hotel lost power and the lift stopped suddenly and he slammed his head into the railing and again when he hit the floor causing brain swelling and bleeding. He was taken by ambulance here and surgery to relieve the pressure was performed by Mr. Pettyjohn. The specialists hoped the medication would stop the bleed, it did not and Mr. Shaw performed an endovascular embolization yesterday afternoon. Medically he has improved but he has not regained consciousness. You know as well as I do the longer he is in a coma, more troubling the recovery if there is a recovery."

"I understand there is another issue; you don't know his wishes for medical intervention. I believe his solicitor is the son of Neville Cummings…but I don't know his name."

"Alistair Cummings is his name; good he is my solicitor, which will make things easier. I called him this morning and left him a message to call me today."

My mobile buzzes just I finish talking, pulling it out, and answer, "Ellingham."

"Martin, Alistair here, how may I help?"

"Alistair, my father had an accident and is in a coma with possible brain damage. He is in St. Mary's ICU under the specialist care of Pettyjohn and Shaw. We need to know what level of medical care is stated in his medical directive."

"I need to call my associate; he and I will come to the hospital shortly. Martin, do anything necessary until I arrive. You do know that you are the executor for your father?"

"I will see you soon." I end the call and replace my phone in my pocket. "Aunt Ruth his solicitor and associate will come here and will take care of the medical directive and I was informed I am the executor of my father's will. What a bloody bother, it would have been nice to know that beforehand."

Aunt Ruth gives me her lopsided smirk, "You know now and that is all that matters. Let's go upstairs and see if there is any change to his condition." She stands up and walks towards the lifts, I quickly catch up to my elderly aunt just as the lift doors open. Like a true Ellingham time waits for no one, "I understand from Joan Louisa was injured in the same lift as your father, and he made an objectionable request of your wife. Did he know Louisa is your wife?"

"No, they never met when he and mum tried to steal Joan's farm a few years ago. Louisa thought his eyes looked familiar but didn't put it together until we spoke yesterday about the accident. A…mmm…there might be another issue we should talk about before we enter ICU," I state.

"Joan mentioned your shorter look alike. We'll deal with that later when we know more. Your Alistair might have information relating to that young man's heritage."

The doors open and we proceed to the double doors of the ICU, I push the auto-release and the doors open.

"Open sesame," my aunt mumbles under her breath and again shows me her lopsided smirk.

Aunt Ruth and I have not seen each other for over five years and I am wondering if she is dementing with her under-the-breath comments and the far-off looks she gives me, other than those she seems healthy. I try to remember what Auntie Joan calls Ruth sometimes…a…feisty bulldog in sheep's clothing and discount my earlier thought on her dementing. Her mind is fine and outwitting mine, always analyzing her opponents no matter who they are.

"Doctor Ellingham, can I see you for a moment," Mr. Shaw calls from the nurse's station. "In here if you would."

"Mr. Shaw, this is my aunt, Doctor Ruth Ellingham, whatever you have to say please include her."

We walk into a side room and he closes the door. "Your father's condition has not improved over the last twelve hours. The latest CT angiography shows several small leaks, I have sent your father down to radiology for an MRI angiography for further clarification."

"We are waiting for the arrival of his solicitor with Christopher's medical directive, would further surgery help my brother at this time?" Aunt Ruth asks.

"The endovascular embolization is holding the bleed sustained with his injury that was located in the precentral artery. The new bleeds are further along in the central artery. The CT didn't clearly identify the leak that is why I ordered the MRI. We won't do surgery until the bleed is known."

The nurse rushes in informing Mr. Shaw of a code blue in Radiology. He quickly excuses himself and leaves running.

"This new medical information doesn't sound encouraging," Ruth states.

I grunt and walk and open the door, "Excuse me the code blue is it regarding the patient, Christopher Ellingham?

"I do not have any information on the patient; only that Mr. Shaw was needed."

I walk back into the room informing Ruth of what I've learned. We don't know how long he will be or when dad is returning, I suggest you go to the canteen or come with me to see Louisa. I'll inform the nurse of our whereabouts and provide our mobile numbers. I'll send Alistair a text to ring me when he arrives and we can meet with him."

"I would like to meet your Louisa," she says.

I instantly regret my offer to my aunt; I completely forgot that Louisa and Ruth have never met. I know Joan and Ruth talk all the time but have no idea what Joan has said regarding my marriage to Louisa.

"Aunt Ruth, maybe now isn't the time for introductions; Louisa is in pain and may not want to be interrogated."

"What do you mean, I have never interrogated anyone…oh you mean…you think I'm going to use psychology on your wife. Delve into her psyche on why she chose you, put the screws to her for the real reason she is with you? Really Martin, relax; Joan has told me everything concerning your life since the non-wedding, the unknown pregnancy, and your questionable choices in birth control including your recent failure. I just want to meet your lovely wife and see for myself what you two have in common," she says with that lopsided smirk again.

I stand there in utter defeat; how my relatives can put my wife through the proverbial wringer when she is laid up in the hospital. I give her a perturb grunt and walk over to the nurse, explain where in the hospital Mr. Shaw can find us, and provide her with my mobile number. When I finish, I push the automatic door button and stride out the doors, down the corridor to the lifts hoping I lose my aunt before we get to Louisa's room. As usual, my luck doesn't hold, just as the doors open my aunt walks in and gives me the Ellingham look I would receive when Joan couldn't understand why the tub was full of my current collection of water plants from the lake with eggs attached, tadpoles clinging to the leaves, with more tadpoles in different stages – some with legs and some that had developed into frogs. I knew when she gave me that look I was in trouble. So I don't understand why Ruth is looking at me in that manner. I step on and push Louisa's floor.

The doors open and we step out, I see Louisa walking with a nurse and hurry towards them; Aunt Ruth hangs back watching the scene with her professional eyes.

"Louisa, how are you this morning?" I ask as I stride up to her.

She smiles, "Good, the pain isn't as bad today and I was able to sleep almost eight full hours." She leans towards me and kisses my cheek; I blush knowing we are under scrutiny in every action we do by a professional.

I turn and notice Aunt Ruth walking up to us. "A…Louisa may I introduce my aunt…my other aunt...Aunt Ruth."

Louisa smiles at Ruth as she extends her hand, "it is so nice to meet you. Joan speaks of you often."

My aunt shakes Louisa's hand as she looks her up and down and then looks at me, my mind trying to analyze what she might be thinking of my wife. "Louisa have you received an update from Doctor Chen on when he is releasing you?"

"Yes, waiting on admissions to send up the paperwork and I can leave. Kevin…a… Doctor Chen came by earlier and is very happy with my progress. He gave me the same information Doctor Thyring gave us the other day and sent his referral to Doctor Gee at the Royal Cornwall. He wants Doctor Gee to follow up on the coccyx in a month. The nurse will give us his instructions I am to follow until I see Doctor Gee." She smiles again and takes my arm as we walk back to her room. "I was wondering…how is your father doing?"

I look over towards Ruth as we walk further down the corridor, "We haven't seen him today. Mr. Shaw had sent him down to Radiology. He had started explaining some information on my father when he was called away. Mr. Pettyjohn wasn't in ICU to provide anything so I thought we would come to see you."

"Did you bring Phillip with you?"

"No, he stayed with Joan at the hotel. I thought it would be difficult getting transportation for the five of us, a car seat, and your luggage." I can see the sadness in Louisa's eyes. "Maybe I should contact admission and see if I can speed up the paperwork," I suggest. "Joy Benedict helped me the first morning; I believe she might be helpful."

We are finally at Louisa's door; I push it open with Louisa and Ruth going through. I help Louisa sit in her lounge chair, "Louisa do you need a cold pack or the heating pad?" I ask.

"The nurse left the heating pad on the bed, if you can grab it and help me place it correctly on my back."

I quickly find the warm pad and adjust it to lay on Louisa's back. "I'll go to the nurse's station and see if they can contact Ms. Benedict," I say. I look over at my aunt, watching us, waiting to pounce. I am hesitant about leaving Louisa alone with Ruth; she has not said a word to either of us since I introduced her; this does not bode well. I fidget with Louisa's medical notes, stalling for time.

"Martin, I thought you were going to the nurse's station to contact someone from admissions so we can go?"

My time has run out, "Humm…yes…I will be back soon." I rush out the door, the faster I contact this Benedict woman the faster I can get back to Louisa.

Ruth pulls up a chair closer to Louisa, "I thought he'd never leave," she says with a calm professional voice.

"Yes he did seem nervous about leaving, didn't he?"

"I understand my brother made unwanted advances towards you the other night. I apologize, he was always a charmer or he thought he was. I understand that is the reason Margaret divorced him; she said something to Martin when they visited a few years ago, about wasting time with him and when he lost all his money, she found someone else."

"I never met them when they visited Portwenn. He and Martin had dinner at the pub and many of the villagers thought Martin should be more like his father, but nobody saw his mum the entire time they were visiting; oh wait Danny did see her on the day of their arrival, but she never said a word. Martin doesn't talk about his parents. He always changes the subject when I ask him. He was upset when I told him what his father said to me in the lift. He stormed out of here. He said he was angry with his father disrespecting his wife and wanted to tell him, but from what I understand his father is in a coma."

"Has Martin ever told you about his childhood?"

"Bits and pieces; Joan has told me some. I know Martin spent his summer holidays in Portwenn with Joan and Phil, and it ended around the age of ten; his father wanted him to study more. Martin has never said what growing up in London was like; just that he attended an awful boarding school. My husband doesn't talk much about himself."

"What was your childhood like?"

"I don't know what Joan or Martin has told you; I grew up in Portwenn, my mum left us when I was eight, my father left just before I went to Uni. After graduation, I taught in London and Manchester for a few years before returning to Portwenn to teach. I was on Martin's GP hiring board and I was the only one that voted against him. I smile at the aunt that seems to be analyzing every bit of information I pass to her. The more time he spent in the village I saw a good man hidden deep inside the rude doctor. After a while, we fell in love, but our communication skills with each other were lacking, so I called off our wedding and left the village only to find out a month later I was pregnant. I came back when I was six months pregnant and Martin offered his extra room till I was settled. One thing leads to another and we learned to talk and listen to each other, fell in love again."

I look at this woman who is easy to talk to and now understand why Martin seems to hesitate in leaving me alone with her. "Ruth is there anything else you need to know; have I passed your examination, am I good enough for your nephew?" I ask a little angry.

She smiles, I can see she is about to answer me when the door opens and Martin bursts into the room. "They are printing your release forms now. I'll just help you with your packing now."

I smile, "Martin, I just finished the third degree with your aunt," I look over to Ruth, "Did I pass?"

"I didn't mean to pry, just a professional hazard," she says. I like this Louisa; she will be good for Martin. I can see Martin is very much in love with her, just as Joan said.

My mobile buzzes and I see Alistair has arrived and directed him to meet Ruth and me in the ICU. "Aunt Ruth the solicitor is here and we need to go to ICU now."

"Martin, go I'll handle my paperwork and call you when I'm done," says Louisa.

Her smile is enticing, I walk over, take her hand, the feel of her soft skin shuts out the world for just a moment, I lean in closer and give her a full kiss on her lips; Ruth be damned, this is my wife and I have missed our time together.

The clearing of my aunt's throat and her movements behind me, cuts into my mind, I pull back looking Louisa in the eyes, and whisper, "I'll be back as soon as I can. Don't do anything strenuous," my eyes lock on hers to reinforce my words.

I turn towards the door holding it open for my aunt, my eyes stay on Louisa, "As soon as possible I will be back."

We take the lift and meet Alistair in the same room we met Mr. Shaw earlier in; my need to finish and return to Louisa is crushing any other thoughts from my mind. Clearing it, I look over the will and medical directive I will use to make any decisions regarding my father. The four of us have spent nearly thirty minutes going over all possible medical scenarios.

A knock at the door stops all discussion, Mr. Shaw and Mr. Pettyjohn enter with expressions I know so well. My father has died and they are bringing us the news. I take Ruth's hand to ease her discomfort when they announce the news; she looks at me with the knowing look as she readies herself.

"Doctor's Ellingham…sorry to say…your father suffered a hemorrhagic stroke during the MRI, the bleed was due to several small aneurysms spaced closely together and it seems each ruptured at the same time; the intracranial pressure increased and there was nothing we could do, he died twenty minutes ago."

I am not sure of the emotions I am feeling. If it is relief that my father isn't suffering or my father no longer has control over my life with his belittling. There is sadness for my aunts. Alistair and the specialists began their discussions and I sat there in my own little world, replaying my life with the man that hated me. It is Ruth that brings me out from my memories with a touch on my arm; I look at her with sad eyes.

"Martin, go to Louisa; I will work with Mr. Cummings and the doctors. You need Louisa right now and she needs you," my aunt says.

As if on auto-pilot, I get up and leave the room, walking down the long corridor ignoring all who pass. How I end up at Louisa's door, I can't say I remember exactly how I got there. I push open the door, my wife turns her head towards me, my emotions burst with tears streaming down my face and my body shakes. She walks as quickly as she can and engulfs me in her arms and I openly cry, not for the man but for the father that never said he loved me.

DM/LE

End of Chapter

Hemorrhagic stroke: Hemorrhage refers to blood leaking from a blood vessel in the brain, intracerebral. Hemorrhagic strokes are the most common type of stroke. They occur when blood vessels in the brain rupture. As blood leaks and the body responds, pressure builds inside the brain.

MRI: is a magnetic resonance imaging test that uses powerful magnets, radio waves, and a computer to make detailed pictures of the inside of the body. An MRI can be done on different parts of the body; it is especially useful for looking at soft tissues and the nervous system. An MRI of the brain and spinal cord can help find damaged blood vessels.

CT: is a computerized tomography scan that combines a series of x-ray images taken from different angles around the body and uses computer processing to create cross-sectional images or slices of the bones, blood vessels, and soft tissues. CT scan images provide more detailed information than plain x-rays do.

Sarcopenia: Muscle loss. Typically muscle loss starts during the '30s. Inactive people can lose as much as 3% to 5% of their muscle mass and function. Sarcopenia typically happens faster around age 75 but it may also speed up as early as 65 or as late as 80. It is a factor in frailty and the likelihood of falls and fractures in older adults.