Treatment
Martin stared at Pauline. "He's gone?"
Pauline nodded. "Mr. Dinkins up and left. Said he had things to do and couldn't faff around waitin' for you." She smiled up at him sweetly. "Said he was going home." She tipped her head. "And how is Louisa?"
Her words drew a snicker from the teen girls sitting all in row.
Martin glared at them where five girls were clustered on the waiting chairs. "Why are you here?"
One of them glared right back. "Ooh, like I'm gonna discuss my female problem in public!"
Martin turned away from the snarky teenager and fixed Pauline with a look. Then he told her quietly, "Call Mrs. Tishell and inform her I shall need a two-week dose of ciprofloxacin tablets plus a refill of Mr. D's asthma inhaler. I'll be at her shop in thirty minutes. Um, and write out his address. And… Louisa… is fine." He inclined his head towards the gaggle of girls. "Which one?"
"Moira Sweeny!" Pauline announced in the loud voice of a festival barker. She handed Martin the note packet. In a whisper she added, "It's just I was worried, Louisa being pregnant and all – carrying your baby. And she looked sooo upset."
Martin took a deep breath and turned toward his patient. "Go through."
The tallest girl stood up and sourly preceded him towards surgery. Martin stopped. "Oh, and Pauline I need to see to a patient, so cancel the rest of the afternoon patients."
Pauline grinned. "Moira's the last one."
"Good."
"Can I leave early?" Pauline asked him as he closed the surgery door.
Martin stripped off his exam gloves and binned them. "You can sit up," he told Moira, who was nineteen and tall with piercing blue eyes and jet-black hair. "I don't see anything…" Martin washed and dried his hands, thoroughly.
"But I hurt," the girl protested. She slowly sat up, pulling the exam gown down over her legs.
"Yes. You said you have pains below your umbilicus, the… belly button."
"Yah."
"And these are how often?"
"Told you," Moira said sullenly.
Martin sighed. "Tell me again."
Moira squirmed under his intense gaze. "Well, couple weeks before I get my… my… you know. My…"
"Two weeks. And you said your periods are regular."
"Yep," she replied. "Every 28 days."
Martin nodded. "Then it's mittelschmerz."
"Wha?" she said puzzled. "I don't speak Welsh, Doc."
"It's a German word. It means middle pain. Is the pain always on one side?"
She shook her head. "No."
"So, the pain varies, first on your right-side and next month on the left. Then it repeats like that, month after month."
Moira nodded her head. "Yeah. Like that; just like you said. Just for a day or two."
He took an information pamphlet from a cabinet; actually two. He handed her one. "This booklet will help you understand. The pain is caused when one of your ovaries releases an egg; called ovulation."
"Oh," the girl said. "But I thought they, uhm my ovaries, both did their thing at the same time."
Martin sighed as he opened the pamphlet and began to teach this child about her reproductive system. The child sat up straighter as he instructed her. "Also," he went on, after taking a deep and cautious breath, "are you sexually active?"
"Doc! You can't just ask…"
He held up his hands. "Look. I am your doctor, and it is my job to try and keep you healthy, in all ways."
The girl heaved a nervous sigh. "Uhm, I do have a boyfriend, and we… uh, we…" her lips quivered. "Mess… around a little, maybe." She looked away embarrassed.
Martin pressed on with a brief explanation about the birds and the bees, plus reproductive health and safety. He groaned inside; not what he had trained as a surgeon to be doing – teaching a young woman how to avoid STDs and pregnancy through the effective use of condoms. "If you have other questions this pamphlet may help, or you can ask me. Now you can get behind the screen and get dressed."
Mrs. Tishell was flipping through a glossy TV magazine when Martin entered the chemist shop. She looked up, broke into a huge into a huge smile, her whole face lighting up, as she dropped the offending magazine to the floor, it's beautiful young people safely out of sight. "Oh, Doctor Ellingham! How can I help you?"
He replied, "Yes, Mrs. Tishell. I am here to pick up prescriptions for Mr. Dinkins."
"Got it right here. Just let me write his name on the Cipro bottle label. Right. Antibiotics."
"Yes."
"And an inhaler."
"Right." Martin held out his hand. "May I?"
Sally plied her pen, then affixed the sticky label to the pill bottle. "Standard instructions?"
"Yes."
She put the inhaler, pill bottle and the antibiotic information and warning instructions with it into a white paper sack. She folded over the top of the sack, then held it out to Martin, who grasped it, and Sally felt a tingle when their hands touched. "Doc… if there is anything I can do for you…" she was batting her eyes.
"No!" Martin recoiled. As he tried to take the sack from her hand she resisted, pulling back on it. With a tug he got the paper sack away from her.
Sally stood frozen for a second, staring at her hand. "And…" suddenly she felt flushed, "and… how is Louisa, your pregnant wife?" she asked at his retreating back.
Martin stopped at the door. "Louisa is fine. Thank you for asking," he said over his shoulder.
Sally sighed after the door closed. Such a fine man, she thought. So tall, big hands, fleshy lips and ears. She still felt the tingle from where their fingers had touched. "Martin…" she said. "Oh Martin…" she moaned.
Martin made his way on foot a few blocks uphill to a stone house with sagging shutters, battered paint-peeled front door and rusted house numbers. He checked the scribbled note from Pauline. Yes, this was the place, so he rapped on the dor. "Mr. Dinkins! It's Dr. Ellingham," he announced.
In a few moments shuffled footsteps and a cough announced the resident's arrival. The door opened a crack. "Oh, Doc Martin. It's you."
"I have medications which you need." Martin pushed the door open wider to see aged furniture piled high with clutter, papers and bottles plus there was a fusty smell in the air. It was a combination of dirt, an overflowing trash bin, sweaty old man and something else. Martin wrinkled his nose as he saw a large orange cat slink past, followed by a brown tabby. "And you have cats," he observed.
Mr. Dinkins chuckled. "Well, they keep me company."
Martin looked into a gloomy room beyond the front one and he could see a black and white cat lying inside a carboard carton nursing kittens. "Plus kittens." Yep, it all fits.
The old man wiped his eyes. "Especially since I'm on my own."
Martin shook his head. The place needed a good sorting out and scrubbing and he resolved to get the local care aides on the way to get this mess cleaned up. "You have a bacterial infection. Likely caused by a cat scratch; also known as cat scratch fever. It was due to the bacterium Bartonella henselae which is usually carried by young cats and kittens."
The man coughed.
"And that cough," Martin added, "is asthma aggravated by cat dander; whish is dried cat saliva which often causes an inflammatory response, in this case in your lung tissue."
"What?" Dinkins asked. "Don't understand all that."
One of the cats, the orange one, returned to the room, stood by the man's leg, and then sat down and began to bite at what he was certain were fleas on it's flank. God. He hated fleas. He needed to get out of this house! "Look. Take the tablets three times a day which will clear up your infection, but I want to have you come see me in one week. Got that? And go back to using your inhaler twice a day."
The man bent down, picked up the cat and cuddled it. "Okay."
Martin backed away. "And someone will be coming in to help you with clearing up… this…"
Dinkins looked around. "Sorry Doc. I guess it got away from me."
"And," Martin watched as a flea jumped onto the man's threadbare white shirt. "I'll also have the local vet contact you so these cats can be treated." And spayed he thought.
"Angela Sim? The vetnary? Old Doc Sim's girl? Treated? Fer what?"
"Fleas, Mr. Dinkins. That's how the bacteria got into the cats and into you." Martin was slowly backing away from the man, the cat, and the fleas. "I'll have Pauline Lamb call you tomorrow with that follow up appointment. Now you must take all the tablets. Two weeks' worth. Don't skip a dose. And take a bath and wash all your clothing and linens."
The old man sighed. "Right, Doc."
Martin escaped to the street, and as he closed the door behind him he got a last glimpse of the man scratching his neck.
"Fleas! Gawd!" he shuddered as he walked back to surgery, resolving to thoroughly scrub the soles of his shoes and to have his suit drycleaned. "Fleas, lice and other vermin," he muttered. "Oh my heavens." Perhaps he'd throw away his socks as well.
He had not walked far when his mobile rang. He scooped it from his pocket and answered without looking to see who the caller was. "Ellingham," he answered.
At first he heard dead air, perhaps the rustle of paper, and then a closing door. "Hello?" he prompted. "Who is this?
"Martin?" a female asked.
"Yes? Who is calling?"
"Ellingham. Martin, it's me, Edith, Edith Montgomery."
Martin took a deep breath while he pondered what to say, for he wanted it to be direct and effective; stamp out the harm Edith had caused; erase her contamination.
"I do apologize," Edith told him. "I don't know what came over me."
Those was no help for it, so he just started in on her. "Edith. Dr. Montgomery, I have no interest in you nor in rehashing or reliving the twisted and dysfunctional events of our past. Furthermore…"
"Ellingham, I don't think I like your tone," she answered in a hurtful vice.
"Just shut up and listen! You have not only lied about the facts of our relationship and our parting, but you have done so to MY WIFE! A woman that I love and who is also carrying my child – a child that was conceived in tenderness and love. So if you EVER have any contact with Louisa in any way whatsoever, I shall lodge a complaint with the General Medical Board. The GMC will take a VERY dim view of what you have done." He had to pause for air. "How could you for heaven's sake?"
Edith answered, "But Martin… alright, look, I am sorry."
"Sorry? SORRY?"
"Yes… I… uhm, I apologize. I won't do it again."
"It? It? You have badgered my wife! A pregnant woman who is also a patient at the OB-GYN practice in which you are attending! I doubt, very much, Edith that a simple apology will suffice."
Edith drew a deep breath. "Look, Ellingham, what do you want me to do?"
Oh, well, he thought, tie a millstone around your neck and leap into the sea? No, he thought. "I want you to…"
Suddenly the police rover pulled up next to Martin, and Joe asked through the open window. "Doc? You okay? I could hear you screaming from a half-block away?"
Martin shook his head at the constable. Then he cupped his hand around the instrument and told Edith, "I have just come from an old man's house who had cat scratch fever. He is living in a filthy hovel infected by his cats."
She replied, "Oh that sounds like a lovely home visit. Not nearly as good as surgery, is it? I heard you had to leave surgery. Couldn't carry on anymore, that it? Edith said accusingly. "Haemophobia. Tsk, tsk. Poor you. Poor Martin Ellingham."
There it was; Edith was an abuser, always had been always will be. "Fine. Considering the facts of the matter I shall report you to the GMC and on this very day, Edith. They will receive a very clear and direct message from me. A formal complaint."
"Oh come on now," she protested. "It was just words."
"Words Edith? Words cut and hurt, they create pain and agony, and even murder and wars." He paused for breath. "And scars Edith; scars which will not fade quickly."
"Now wait a minute Ellingham."
Penhale got out of his rover and was peeking at Martin with a concerned expression, but Martin held up a hand to warn him to stand back. Joe could not quite hear what the Doc was saying on his mobile, but he could see the Doc was very angry.
"It is called abuse, Edith. You are an abuser and a liar," Martin told her. "I suspect that there have been other incidents in your medical files which this one will only add to."
"Now you are just being nasty," she told him.
"Oh, no, Edith; not nasty. Just factual. You were – factually speaking – a user and abuser of me in medical college. The older Dr. Edith Montgomery, seems to me, is just as abusive if not more so, especially to a patient in your medical practice. Poor ethics all around."
She took a deep breath. "What do you want me to do Ellingham? I said I was sorry."
Martin answered, "If you were a bacterial infection I would prescribe a strong antibiotic treatment to eliminate you from the patient's system. Well… in this case, the system is the medical system. Can you understand what I am saying?"
Suddenly Martin was listening to dead air.
"Doc?" Joe asked him. "You okay?"
Martin put his mobile away and gave the constable a little grin of satisfaction. "Yes, Joe. I am quite well."
Author's note:
A reader sent me a message and asked if I was alright, I suppose because I had not posted a new chapter for a while. I am doing okay. Just have a few things on my plate. Thank you for asking.
