GI
"And your mother refused to come see me?" Martin asked judgmentally.
"Oh my God, yes. Said it wouldn't make any difference." Louisa's face looked pale. "I mean, not like me and mum are close, but still…" she wiped a teary eye. "She is my mother." Despite all of their history, or lack of, Louisa still longed for – wished for – a sincere emotional connection. "I was a teenager, and…" she sniffled. "It was your Aunt Joan who took me into Truro for new clothes."
"Yes," Martin replied, not actually paying attention, but he did turn away from the dinner prep when he heard Louisa openly crying. "Louisa?"
"I'm… alright… it's just there were so many things my mum should have been here for, my first period, to have 'the talk,' my first bra." She paused and used a tissue on her eyes and nose.
Martin handed her the box of facial tissues, which she tugged some extra from.
"It was Joan, you know, who bought me my first bra. She... Aunt Joan and a couple other ladies... filled the gap as they could." She frowned. "Not like having a real live mum, but…"
Martin sat down at the table to be near Louisa, who took his arm. "I see," he muttered.
"Different for boys," she sighed.
Martin knew what it was like to have an absent, at least emotional, mum, plus Martin recalled a terse explanation from his dad about the birds and bees, ending with his father exclaiming, "Just don't get any sweeties up the duff out of wedlock!" Then he had whacked him on the cranium, whether to harm him or to drive home the point was never clear. He did remember his mother was in the front room drinking a cocktail at that moment, chatting with one of her la-dee-da friends on the telephone. She had called out, "Can't you two be quiet in there?" His father had uttered a low curse then wandered away to leave his son to ponder romantic relationships, let alone the wonders and scariness of sex. He was only twelve at the time.
Martin rubbed the back of her hand which rested on his arm. "All part of the same… ahem… equation."
Louisa blew her nose. "Sorry." She stood up. "Loo."
Martin watched as she stood up with a little grunt. Her belly, at this point had wiped out her waist as a body joint. Her rounded belly was matched by her full breasts, proclaiming to all the world that a pregnancy was well under way. "Different for girls," he mused.
"What's that?"
"Nothing. Just…." He shrugged. There were times that he was both amazed and frightened by the thought of parenthood. Of course, he knew how sperm and egg combined, how a resulting embryo was implanted, hormonal changes caused by the blastocyst grew the placenta and sent hormones to brain and body to suppress further ovulation and to change the chemical landscape fit for a growing fetus and pregnancy. Then there was parenting.
Louisa had turned to face him, then she put a hand on her belly. "Martin, come here!"
Suddenly his brain and body were on full alert. "What?!"
"Just come here! now!"
He jumped up, inspecting her face as he went to her. She did not look to be in distress but all the same. Louisa grabbed one of his hands and pressed it against her belly bump.
"Feel that?" she asked.
"Wha…? He started to say, then he felt it; a thump, a push of some sort. "It's moving!"
Louisa was now smiling and crying once more. "That's our baby, Martin." She pulled him close, pressing against him. "Oh, Martin… if you could just feel… this like I can."
Different for girls, he reminded himself. "Uh, twenty-three weeks, fairly common to feel foetal movements."
Louisa shook her head. "I have been feeling little thumps, but they were fleeting, just flickers but this…" Her fingers held his hand pressing his fingers into her bump. "You feel that?"
"It's faint. Likely a kick or punch."
Louisa was pulling him even closer to kiss his mouth, when they heard a banging on the front door.
Opening the door, Martin saw Joan supporting Eleanor whose face was pale and ashen with staring eyes.
Joan gave a sigh. "Need your help, Marty. I found Eleanor on a bench on the Platt, and she was spewing." Joan's strong arms were holding Eleanor under the arms, and the woman was sweating, her mouth rimmed with a faint green tinge.
"Oh, mum!" Louisa exclaimed. "What's wrong?"
Martin reached out to help. "What did you spew up?"
Eleanor managed to say, "I don't know, but it looked green. Bile I think. And my lunch."
Martin could see the woman was in distress, shaking under his hands and as he held her up, she screamed.
"God! Don't touch my stomach! It really, really hurts!"
Louisa drew them inside. "Martin?" She managed to close the door, for it was now pouring with rain.
"To my exam room; quickly now!"
Martin, helped by his aunt, and Louisa taking her lower legs, got Eleanor onto the exam couch. "Now, what's happened?" he asked.
"After Louisa left I ate some crisps and drank coffee, but went down strange," Eleanor said. "And then… I'm gonna be sick!"
Martin got a basin under her chin, and she spewed up only bile, and as the woman writhed, she was keening with pain. He turned his attention to her abdomen. "Has this happened before?" he asked, pulling up her shirt and above her trousers saw the problem. Her umbilicus was protruding in an obvious herniation. "Is this new or preexisting? Your hernia?" He carefully touched the surrounding area, which was a lump about three centimeters across sticking out the same amount.
"Had it for a couple years," Eleanor grunted. "Stop touching it!" she yelled.
Martin dropped his hands. "Why in heaven's name didn't you have it repaired?" he asked.
"Never bothered me like this, afore," she said through gritted teeth.
Louisa asked, "Martin?"
Shaking his head, Martin addressed his wife, "Your mother has an umbilical hernia. A loop of intestine had protruded through a tear in one of the abdominal muscles, I suspect…" He was interrupted by another bought of retching. "And it's become strangulated, cutting off the blood flow to the intestine and occluding the small intestine. Hence the spewing since the organ is compressed. Quite painful, obviously."
Eleanor looked at her daughter. "It's this, this is why I'm gonna die!"
"Oh nonsense!" Martin told her. "Who told you this was a fatal condition?"
Eleanor's face blanched. "A doctor; down in Spain."
"Then he was an idiot!" Martin exploded. "Was the MD an actual doctor?"
"It was in a clinic. He took an X-ray, then told me it was cancer. Nothing to be done."
Martin ground his teeth. Then he took a deep breath, trying to control his temper. "There is something to be done; this is a simple repair. Any competent surgeon can fix this in 30 minutes. What is it with you people?" He took out his mobile and dialed 999. When the operator got on the line, he explained the problem and requested an ambulance.
"In Port Wicken?" the man asked him.
"No. Portwenn!"
"Right. Now. Who are you?"
God save us from fools. "Does that matter? Dr. Martin Ellingham in Portwenn. I need an ambulance and quickly. The patient has a strangulated hernia and is likely creating a gangrenous bowel as we speak!"
The emergency operator said, "Hold please."
"Gangrene?" Louisa asked with a start.
"Yes," Martin answered her. "The sooner this is corrected…"
The operator came back on the line. "Doc. Got a problem. The A39 is flooded and closed. All this rain, plus a lorry overturned on the main route to your village. Fire service has responded to that, but…"
"Find another way!" Martin barked.
"Even if there was… I… wait… don't have a unit available. Yes," the man sighed into his ear. "I can get an ambulance there in about two hours, if they get the road open." Another sad sound in his ear. "Maybe three hours?"
Martin shook his head. "Never mind. Cancel the emergency call out." Overheard the storm intensified with driving rain and thunder.
"But you said…."
"Yes," Martin looked at his wife and her mother. Louisa was trying not to cry as her mother writhed in pain. Despite the bad history between them, he'd not stand by and watch this disaster get any worse. "I'm a surgeon as well as a GP. I will tend to this patient. Goodbye." He cancelled the call. "Right. Eleanor, I will operate on you."
Joan, Louisa and Eleanor all said, "WHAT?" at once.
Martin stood straighter. "It's a fairly simple procedure. Open the abdominal wall. Retract the muscle fibers which have trapped the intestine. Confirm that blood flow can be restored, then reinsert the bowel, apply stitches to hold it place, suture the separated muscle, push fatty tissue back into place and then suture the skin. It's only a five-centimeter incision. It is a standard GI, that is, gastrointestinal procedure."
His words struck them like a blow, and they all started talking at once; questioning his ability, his fear of blood, the impracticality of operating in his office, and on and on. He let them rattle on for a minute, then held up his hand. "All the same, if I wait, tissue will die – is dying as we delay – sepsis will result, requiring massive doses of antibiotics and a more complicated surgery. Emergency colostomy and a later repair will be required." He let that sink in. "Shall I wait? Or proceed?" Or summon an undertaker now, he asked himself.
Louisa shook her head, while the baby kicked again. "Mum, Martin is a very good doctor." And I've seen him operate in the back of ambulance and stick his hand inside Peter Cronk to save his life. She took her mother's hand. "And a surgeon – in London." She bit her lip then turned to look at him.
"I can do this," he told her with his eyes. He looked at the woman on the couch. "I'll give you morphine for the pain, then administer a local anesthetic in the surgical area. It will not take very long to repair this injury."
Eleanor took a deep breath. "Go on then. Next time I won't shift all those cases of wine by myself… and see a proper doctor, if this happens again."
"It won't," Martin replied. He looked at Louisa and Joan. "One of you must assist me; hold things, hand me instruments, and so forth."
Louisa shuddered. "Not me."
Joan nodded. "Right. I'm for it, then. No worse than killing a chicken or castrating a pig."
"Joan!" Louisa shouted.
Joan smiled. "My girl, you put the kettle on. I'll want tea when this is over." She looked calmly at her nephew. "Right. What do you need me to do?"
Martin nodded. "First off..." He stopped and looked at his wife, who was weeping once more. "She'll be fine."
Louisa took a deep breath. "Hope so. But I'm worried about you as well."
Martin felt a prick of fear. "I can do this."
"But your blood thing?"
He waved her words and his fear away. "I'll be fine."
She kissed him on the cheek. "Okay," then she left the room, her hands twisting each other in knots.
