Pains

Martin had just seen his last morning patient when his mobile rang. "Ellingham," he answered, not looking at the screen.

"Martin? It's Louisa."

Martin heard urgency in her voice. "What's wrong? Are you okay?"

"I'm fine, but there's something wrong with Mr. Strain," Louisa answered.

"You said he was odd."

"Right. There is that, but…" her voice dropped to a whisper. "He's not well – not at all."

"Physically?"

Louisa replied, "Mr. Colley found him moaning on the floor in the men's washroom. Says his stomach is killing him."

"Well…" Martin immediately thought about ulcers. "Can you send him up here?'

"Yeah. I am, will. Mr. Colley will bring his car around and take him up to surgery. He's all pale in the face and sweating."

Martin next thought of a heart attack. "Is his breathing alright?"

"Seems to be. But I'm… worried about him. He is odd, but this is something else, I think."

Martin looked at his watch. Pauline was gone and he'd written notes on the last patient, and lunch was next on his schedule. "Fine. Quick as you can."

"Sure. Bye. Bye-bye."

Martin went to the door of the house and prepared to admit his next patient.

"Awfully good of you to see me like this," Mr. Strain said as Martin levered him onto the exam table, with Mr. Colley helping. Martin wrinkled his nose for the school worker smelled of varnish.

"You good now, Doc?" Mr. Colley asked.

"Yes. " Martin told him, if only to get his stink out him of his exam room.

Colley nodded. "Now, Mr. Strain, Miss Glasson, I mean, Mrs. Ellingham, said I should stick around, iffen you need a ride back to yer hotel."

Strain brightened. "That would be marvelous, my good man!" he said happily.

Martin nodded to the school custodian. "Wait out in reception."

Colley nodded. "Sure, Doc."

Martin took a good look at Mr. Strain as he got the man to take his suit coat off. He was in his late forties he supposed, thinning hair, clothing was good but a bit smudged from lying on a floor. His tie had been loosened, and now the man wiped his brow which was pouring sweat, along with his armpits.

"Sorry to intrude like this, Doctor. I understand you are married to the Portwenn school Headmistress," Strain began.

"Right." Irrelevant Martin thought. "You felt pain in the stomach area?"

Strain sighed. "Yes, but lower. Doubled me right over. Couldn't move for a bit."

Martin stared at him. "No pain in the back or shoulder? Either side?"

"Uhm, no."

Martin took his pulse and blood pressure which were both elevated. He listened to breath sounds but heard nothing untoward and the heart had no audible murmur or clicking of a bad valve. Next Martin had the man recline on the table. "Did you faint?"

"No."

"A history of epilepsy? Any other seizure disorders?"

Strain shook his head. "Not that I am aware. No."

"Now loosen your belt so I can examine you further. Do you have any underlying health issues?"

Strain thought for a minute then said, "My cholesterol is elevated, and I am now on statins. My doctor says I should exercise more."

Martin figured as much given his fleshy figure with a rotund tummy, full face and neck, and, he noted, his hands appeared to be swollen.

Strain loosened his belt. "Sore just down there," he said pointing to his right lower quadrant.

Martin grunted. "Just on the right side?"

Strain frowned. "No. Sometimes I get these… attacks call them… just like this one… but could be on left or right."

Martin first checked for pulses at wrist and ankles, and they were normal, then he began to palpate the man's abdomen. "You were found on the school floor, in pain, apparently."

"Yes," the man gasped when Martin pushed on a tender spot over the appendix.

"That hurts there?"

"Little bit. Yeah."

Martin pushed more gently but elicited no other painful response. "Do you still have your appendix?" Martin asked.

Strain laughed. "Oh… oh, yes. No surgeries, ever. Been lucky like that. Broke my wrist playing footie years back. In school, you know. Got run over by a big brute while playing left wing." Strain winced again as Martin podded his belly. "I was thirteen and was that close to scoring a goal." Strain grimaced. "We lost by a point. Oh well. Never much for sports actually. More the academic type, you see."

Martin could not feel anything remarkable in his belly. No masses that he could feel on the liver or lower intestines. "Toileting?"

Strain grimaced. "I do get constipated."

"And?"

"And what?"

"What do you do for it and how frequently does it happen?"

Strain laughed. "Over the counter laxatives and then try to eat more vegetables and fruit. That ties in with the diet my doctor has me on."

"How frequently do you have constipation?" Martin asked through clenched teeth for he wanted a factual answer.

"Once a week, maybe, or more often." Strain answered after a long delay while Martin fumed.

"And your stools? Color? Size? Hard or soft?"

"Oh, normal, I suppose. Brownish? Small things, I guess. Hard. Quite hard."

"Once a day?"

"Yes."

Martin shook his head. "And how is your pain now?"

"Gone. With the wind," Strain replied, chuckling.

Martin closed his eyes thinking that his surgery peers would be laughing their heads off if they overheard this conversation. "You can sit up. Fasten your belt. I'll take a blood sample for analysis. Do you think you can produce a stool sample?"

Strain laughed. "I doubt it."

"Then I'll send you off with a kit. Return it soon as you can." Martin sighed inside. "Are you going to be at Portwenn School much longer?"

Strain shrugged. "Another day, perhaps. Then up to Bristol for another bit of work," the man chuckled. "Never a dull moment, right?"

Martin held the syringe and tourniquet for the blood draw. "Roll up your left sleeve." He quickly got the sample then bandaged the puncture spot, managing to avoid looking at the procedure and the red fluid in the syringe. He put the syringe into a dish and covered it with a cloth.

Strain stared at him. "You alright, Doctor Ellingham? You went all white for a moment there."

"I'm fine," Martin told him, as he swallowed a mouthful of saliva. "I'll send this off to the lab and here," he handed Strain a stool sample kit in a white paper sack. "Follow the instructions then return it soon as possible."

Strain nodded happily. "Right-oh!" he shouted happily.

The mercurial behavior of the man concerned, Martin. "I'd like to do a memory test…"

Strain's face fell. "But I came for pain in my gut."

"I will name three objects then I want you to repeat them back to me when I ask you to."

"Ooh, like a parlor game," Strain clapped his hands with glee. "Let's give it a go, shall we?"

Not exactly Martin thought. The man was acting oddly. Not quite on mental task and easily distracted. Martin nodded, thinking both of what Louisa had noticed about the man, as well as his mental ups and downs. ADHD? Anxiety? Bipolar disorder? "All the same, might be best to…"

Suddenly, Martin's surgery door was thrown open and Bert Large stood there, holding his forearm out before him. "Doc! Help! I need help!" Bert shouted.

Martin turned at the intrusion. "What's wrong?" he asked the problem plagued plumber.

"Burned my arm, Doc. Hot kettle. Caught it on the rim."

Martin took a deep and slow breath because he hated burns, then turned to Strain. "Mr. Strain, it seems I have to move on, so if you would…"

"Oh, right!" Strain said, with a happy look on his face. He hopped off the table and pulled his coat on. "Best let you get on. Thank you for the assistance."

Martin handed Mr. Strain the stool sample kit, which he'd left on the exam table. "Return as soon as you are able."

"Doc!" Bert protested. "I'm in a helluva lot of pain here!"

Martin nodded. "Right. Now, Bert, up here on the exam couch. Now, Mr. Strain…" Martin waved a hand at the door.

Mr. Strain headed for the door, practically skipping as he went. "Doctor Ellingham, I am so very glad for this little visit, and I shall…" he waved the paper sack, "See if I can produce what you require." He gave out a tiny chuckle.

"You're staying in town?" Martin asked.

Strain now looked confused. "For tonight and tomorrow, yes, then off to a school in Basel… Beeswax, no, uhm Bristol. That's it." His brow furrowed. "I'm staying here in your village at the Seaman's Rest."

It was a B&B up top of the village. "Yes." Martin had no time for the man, as he turned to Bert who was now crying silently, tears running down his fat cheeks. "Mr. Strain," Martin said over his shoulder, "I'll call your B&B and leave a message when I get your test results, but close the door on the way out."

Strain stood in the hall peering about his head on a swivel. "You know, I do like this shade of green paint that you have used. Very – restful – very, uhm, green."

Martin turned to the door and slammed it in Strain's face. Then, bracing himself, he faced his next patient. "Bert, let me look…" he started to say but he had to swallow hard, for Bert had a second-degree burn in a line across his lower forearm. It was four centimeters long and a few millimeters across. A red border was all around it and it was dripping serum from burst blisters.

"It's bad, ain't it, Doc?" Bert moaned.

Martin shook his head. "Yes."

Bert shook his head. "He's an odd duck. Am I right? He's been flitting about the village. Mrs. Tishell was tellin' me…"

Martin ignored Bert's words as he went to his supply cabinet to get the burn dressings and salve.