Chapter 12: See Chapter 1 disclaimer

Louisa rose on Friday morning feeling better than she had in days. The low-grade headache she'd been dealing with had vanished and even the soreness at the site of the bruise was nearly gone. Martin had already gotten up and she could hear the water running in the shower. After her nap and dinner yesterday, and putting the children down for the night, she had taken a soaking bath, so this was not a morning to shower. She put on a solid navy-blue dress with a lighter blue cardigan in a Fair Isle pattern, then walked softly to Mary's room.

Mary was awake, on her back, smiling broadly, and looking completely adorable, in stark contrast to how she smelled. "Hoo, Mary Elizabeth, you look pretty happy, and I can smell why. Let's get you cleaned up and changed." Louisa took care of everything necessary and dressed Mary in a warm long-legged orange velour outfit with matching top and bottom. She chose socks with gripper soles so that Mary's little feet could be warm, but she could still keep her balance when walking.

James continued to sleep in, so Louisa tapped on the door to the loo and asked Martin if he'd wake James and get him going before coming down. She then headed down to the kitchen to make some breakfast.

"It's porridge and fruit for us today, little one, yeah? A good stick to the ribs brekkers to get us going." She seated Mary in the highchair and gave her a few pieces of cut up banana to keep her occupied while making the porridge.

It didn't take long for Martin and James to come down. Martin wore one of his grey suits with a white shirt and a grey green tie. It was a colour combination she hadn't seen on him before, as he normally wore that tie with a navy suit. It looked quite good, really. "Martin, that's a nice combination, the outfit you have on. I see you're branching out a bit."

"James chose the tie."

"Oh, well done, James. You have a good sense of style."

James replied, "The colour reminded me of the harbor. I like the water and the waves."

"I do too. We all do, don't we, Martin?" agreed Louisa.

"Yes, although Mary is probably too young to have an opinion."

"Right. Well, alright, everyone, eat your breakfast. I need to get you up to school, James, then I have a client coming in at 09:30. Bella Woodley is coming, Pippa's sister-in-law, with her daughter Joy. Bella has agreed to keep an eye on Mary during our consultation, which is quite nice, actually. I have another appointment at 16:00 and I've asked Ruth to come help, then stay for dinner."

"Right, good. Um, Louisa, we may have an issue with child minders for the foreseeable future. Janice will not be available for a while, so we'll have to make some other arrangements. Is Portwenn Tots an option for Mary? James seemed to survive it, despite the inanity of some activities. I think we can rely on James to do schoolwork and play on his own during your consultations."

James asked, "Why can't Janice stay with us? I like Janice. She tells fun stories."

"Ah, James, well, um, Louisa?" Martin gave Louisa a wide-eyed look, unusually flummoxed at how to explain the medical information privacy laws to a child, when he didn't even want James to know there was a medical issue with Janice. He had of course not informed Louisa of any of the latest developments, but she was aware that Janice had been ill on Christmas Day.

"What, Martin, you want me to explain? Um, okay. James, Janice is feeling poorly and until she feels better, she's going to stay home and rest, and that way we don't catch whatever she has."

Martin exhaled, not having realized he'd been holding his breath. In his head, it had been far more complicated than that.

Louisa continued, "Alright, what were we discussing? Oh, yeah, childcare. Yes, I can check in with Portwenn Tots. And I think you're right, James can occupy himself often, but I also think we should encourage some after-school play dates. James, did you enjoy playing with Pete and Mickey on Boxing Day up at the village hall?"

"Yes, Mummy, but it was really loud there. I didn't like all the noise, but Pete and Mickey are fun."

"So if I could possibly arrange things so that you could maybe play more quietly with them, you'd think that was fun?"

"Yes."

"Okay, then if it's okay with you, Martin, I'll ask Maureen Fenn if she and Roger would be willing to have James come over a couple of days after school each week. Maureen told me she had been feeling a bit claustrophobic these days, with Roger being home most of the time, so we could plan to have the boys over for a sleepover once a month to give them a night out. Sound okay?"

"Mmm. I have no experience with sleepovers. What are the requirements?", he said, a bit nervously. It was clear he was not charmed by this idea.

"No experience?"

"I was in boarding school at age six, Louisa. In a way, every night was a supposed sleepover, if you think living with dozens of neander.."

"Ah, yes, right, that's fine, Martin, you can stop there please."

"What?"

"Well this will be completely different. These will be small affairs with friends of James', carefully supervised by caring parents. Alright? We'll feed them dinner, arrange a couple of activities if they can't manage on their own, police their giggling when they go to bed until they fall asleep, then get them ready for the day then return them to the Fenns."

"Sounds appall.." Martin stopped talking at a look from Louisa. "Um, appealing."

Louisa looked smug. "Then it's settled as long as it's okay with the Fenns," something she was already confident about, having discussed play dates with Maureen on Boxing Day. Louisa felt strongly that socializing would be good for James, and she wanted to build off his enjoyment the other day.

Louisa continued, "So, Martin what is on your agenda?"

"I have a few appointments in the surgery first thing, then I'm heading to Truro to check on a couple of patients. I should be back midafternoon for more appointments."

"Sounds busy. Let's get started then. Get your coat and shoes on, James, it's time to head up to school. Have a good day, Martin."

"Yes."

Louisa used her hand like an invisible hand puppet, "And you too, Louisa."

"Yes, right. You too."

"Thank you, Martin."

—ooOOoo—

Martin proceeded into the surgery, where he treated an ear infection, a supposedly suspicious mole which was just adult acne, as well as a myriad of other uncomplicated medical complaints that posed no challenge to his diagnostic skills. He then proceeded to Truro to check up on Ellie Sanders and Janice. He hoped Ellie was nearing release, as she'd been in hospital a few days and hospitals are full of disease and bacteria. Upon arrival, he sought out Dr. Ruski in paedeatrics.

"Ah, Doctor Ellingham. Good to meet you. Ellie is coming along well. She is fully rehydrated and tests negative for any Pseudomonas aeruginosa as well as is symptom-free from the complications. We completed the immune system testing this morning and should have the results in two days, so I'll call you Monday to discuss. "

"Fine, good, that's good news." Since becoming a father, Martin was a bit more, um, interested in the cases involving children. He had also recognized that the illnesses among the very young could not be their fault, unlike the ridiculous teenagers and adult villagers who routinely took actions counter to their own wellbeing.

Dr. Ruski continued, "I'd like to release her today around 13:00 one injection shy of her full course. Can you administer her last dose at 21:00? I know that's after hours, but if not, I'll have to keep her overnight again."

"No, that's fine. I can make a house call."

"Great. Thanks. By the way, you would make a good Pole. My family comes from Poland. We don't say much and everything we say is relevant. I've never been able to get used to polite chitchat in this country."

"Yes. Same." Martin's short reply simply underlined the point.

After Martin received a copy of the discharge notes for Ellie, including the dosage of the medication, he proceeded to see Janice.

"Ah, hello, Janice. How do you feel?"

"Hiya, Doc. No burning pee anymore, and my cough and the nausea are better. I have to do this super complicated injection thing though, with gloves and needles and everything. I had them teach me while Joe was here. He's good at following instructions. We almost have them convinced we can do it at home, but they want to see me do it by myself."

Martin read through Janice's chart. "Right. It's important to do the procedure correctly to keep the risk of secondary infection down. Staving off another infection while fighting an antibiotic-resistant one is to be avoided at all costs. Ah, what about your pregnancy?"

"Well, Doc, I decided I should tell Joe the whole thing, about the tubes and the baby and the topical thing. He's pretty freaked about the risks. We still have a couple of weeks to think about things, right?"

"EK-TOP-IC. But yes, you have a couple of weeks before we will know whether the foetus is viable. If it is, then you will need to make a decision about carrying to term, a decision that can be revisited up to 24 weeks of gestation. If you choose to terminate, we would need two doctors to concur. I will be referring you to an obstetrician as soon as you are released, who would be your primary for your pregnancy, so I would be the second doctor. Because of your high-risk status, you may have a bit more time than that, but I would hope you could reach a decision prior to that. If it is an ectopic pregnancy, we would need to terminate it immediately."

"Right," Janice said, quietly. She had always thought she did not want children, but two things were preying on her mind. The first was that Joe really wanted children, and she did love Joe and thought they could make their marriage work. The second was that she might ACTUALLY be pregnant now, and the circumstances might be making this decision for her. She didn't like that one bit, that a decision that she'd made earlier on, getting her tubes tied, could actually now complicate this unexpected pregnancy and take away her choice. "We have a lot to talk about."

"Yes. Um, right." Martin almost told her he was glad she had spoken to Penhale but stopped himself. "Alright, then, I'm going to speak to your doctor and then return to Portwenn. Call Morwenna to make the recommended follow-up appointments after you are released. I'll want to see you within a week of your release, regardless of the instructions."

"OK, Doc. And thanks. Thanks for keeping things private and giving me space."

Martin nodded once, and then went to track down Janice's doctor.

—ooOOoo—

The Royal Cornwall Hospital in Truro did not have an infectious disease specialist, but Dr. Niles had done an internship at one of the regional infectious disease units. Martin found Dr. Niles by having him paged. Dr. Niles had wanted to speak to Martin, because there were not just two but three patients from the Portwenn area in the hospital with the same type of bacterial infection. Plus, there seemed to be additional similar patients from other parts of Cornwall and Devon.

Dr. Niles introduced himself, then said, "Doctor Ellingham, glad to see you. I've been treating the Bone patient as well as Hughson."

"Hughson? Diabetic? Sore on the toe? And who is the Bone patient? I have no patients with orthopaedic problems right now."

"Bone. Janice Bone. And yes regarding Hughson, one and the same. He was brought in by ambulance yesterday when his daughter could not wake him up. He has pneumonia and a blood infection."

"I was not informed. What is his status now?"

"We have him on Aztreonam based on the success Doctor Ruski is having with the Sanders patient. It has also been effective with the patients we have from other practices. So, we feel we are on top of the infection, but we still don't understand why there are so many cases of this and so widely scattered."

"Well, Janice, Hughson, and Sanders are all, I believe, immunocompromised, which would certainly make them a target for what I believe is an opportunistic bacterium. I'll get the results of Sanders' immune system status on Monday, but I have high confidence I'm right. What about the other patients?"

"Immune system disorders are a common contributing factor in many of them. But certainly, there are more immune compromised people who live in the same area, use the same water, etc. I would think we would see either fewer or more cases."

"Agreed. I have many more patients with diabetes and other conditions that could make them vulnerable, if the contamination were more widespread. When I go back to Portwenn, I'll see if I can find something that is common amongst these three but not the rest of my at-risk patients."

"Excellent. Your reputation in diagnostics precedes you, so as strange as it may sound, I'm grateful you have cases in your practice."

"Mmm. Right. Well, I will check in on Mr. Hughson. What's your thinking on releasing, um, Bone?" Martin had a hard time thinking of Janice by her last name, as she had always just been Janice and Louisa always took care of paying her.

"Well, I think it will take a couple more days to feel confident she can administer the medicine on her own. But I agree with your assessment that keeping a fairly healthy person here who already has the complication of the pregnancy is higher risk than sending her home, especially in light of the fact that you are her GP and can monitor things."

"Ok, good. I will keep a close eye on her." He then proceeded to Mr. Hughson's room to read his chart and check on the wound care, in case the toe was forgotten in the priorities of treating the man's emergent pneumonia and blood infection. Things appeared to be properly treated and, after a few words of inquiry, Martin took his leave.

—ooOOoo—

Martin looked at his watch and saw that there was no way he was going to be able to get back in time for his next patient. In fact, he wanted to contact the farmer's daughter to ask her about the situation she'd found her father in. He called Morwenna.

"Portwenn Surgery, how may I help you?"

"Morwenna, I'm not going to make it back for my appointments and I'd like you to reschedule anyone who is non emergent."

"Oh, hiya Doc. Not a bother, we had one walk in with a mildly sprained ankle, but I was able to bandage that up, so you can see him tomorrow. Everyone else is coming in for something sketchy, if you know what I mean. Just my opinion."

Morwenna had good instincts, so Martin felt comfortable allowing her to reschedule everyone. The only appointment he had left in the day was to administer Ellie Sander's final injection at 21:00.

On the way home, he placed a call to Ann Sanders. "Mrs. Sanders, this is Dr. Ellingham. I have just been to hospital to see Ellie. I expect her to be released today and then I will come to your home at 21:00 to administer her last injection."

"Oh, yes, Doctor. I'm surprised we didn't cross paths. I'm at the hospital with her now and I'll bring her home when she is released."

"Right. Do I recall you had mentioned your husband felt a bit nauseous the other day? Is he still experiencing that?" At this point, there was an incoming call on his mobile, which he ignored and allowed to go to voicemail.

"Yes, that's right. Richie still feels a bit punky but not bad enough to come in. He's pretty stubborn. By the way, we've decided to transfer to your practice. We were impressed with how you handled Ellie's situation and the fact that you were available when we needed you, unlike at Camelford."

"Right, please ask them to send your records immediately. In fact, please call them when we finish talking, then I will follow up with them. There are a few things I'd like to know right away. Do you know if your husband has any conditions that would compromise his immune system?"

"Not that I know of, Doc. He always tells me he's fine and not to worry."

"Right. See you tonight."

Martin waited fifteen minutes, then called the Camelford practice. "This is Dr. Martin Ellingham, Portwenn Surgery. You should have heard from Ann Sanders by now about transferring to Portwenn. I need her family's records as soon as possible as I treated her daughter Ellie as an emergency over the holidays. I would like to know right now whether Richard Sanders has any condition that could affect his immune system."

"Yes, we received that call. One moment while I connect you to the doctor."

"Yes, Doctor Ellingham, this is Doctor Roberts. I understand you want to know about Richard Sanders. He does have irritable bowel syndrome. I'll send the family's records down by courier tomorrow, if that is sufficient. Otherwise, you're welcome to pick them up today." He sounded a bit surly, no doubt unhappy to lose patients to Ellingham. This had not been the first case of someone transferring there, based on the positive word of mouth about the man's diagnostic skill. Of course, word of mouth also said he was a first-class arse. I guess people are willing to take the bad with the good.

"How long ago was he diagnosed?"

"Rich has had IBS for years. It's pretty well managed."

"Good, thank you. That's helpful. And tomorrow for the records should be fine." Click.

Dr. Roberts was about to reply when he realized he was speaking to dead air. "Well, he's an abrupt bugger, but he did say thank you." He hung up the phone at his end.

—ooOOoo—

Martin now had additional information. He had three patients with the same opportunistic antibiotic-resistant bacterial infection responding to treatment, all who were immune compromised. He had another one with nausea which could be explained by his irritable bowel symptoms, but the fact that his wife commented on it and didn't know about his condition was suspicious. One would think the nausea must be new, and therefore from some different source. Of course, he could just be off his diet over the holidays. Martin would be able to follow up when he visited tonight to administer Ellie's last dose. The cases weren't just from Portwenn but were all around the Royal Cornwall area. But the numbers weren't a large proportion of the immune compromised.

That left Mr. Hughson, whose infection he had just learned about. He placed a call to Hughson's home in the hopes the daughter would answer. She did not and the call went to voicemail. Martin left a message, asking for a return call.

He continued on until he arrived at the surgery, where Louisa was still finishing up her consultation. Ruth was with James, teaching him what the chess pieces were called and how they moved. Martin was pleased to see this, as it was something he hoped James would become interested in.

"Daddy!" James Henry bounded away from the table and gave his father a hug around the legs. This took Martin by surprise, and he stiffened by reflex, but James had seemed a little happier with his father since the Christmas Eve sleigh ride. Martin crouched down to hug James properly and it only felt a tiny bit strange.

"Hello, James. Have you had a good day?"

"Yes, Daddy. Aunt Ruth is teaching me chess. I like the knight the best. His sword is cool. And he moves in the best way."

"Very good. Yes, I like the knight as well. You'll find out that the Queen is the most powerful piece, though." Nodding to greet his aunt, he said, "Ruth."

"Hello, Martin. I hope you don't mind that we've started on this without you. I assume this is something you were thinking of doing?"

"Ah, yes, but it's fine. Would you say there is interest in the game or just the pieces."

"I think James may have just answered that, with his comment about the knight's movement, don't you think? By the way, you really need to play Al. He absolutely crushed me today, and I had been studying. Truly, I think he can beat you."

"I doubt that."

"Well, there's really only one way to find out now, isn't there. Just be advised that my opinion stands until you prove me wrong."

"Hmmph. Well, I'll start preparing dinner. I have a patient to visit later tonight."

—ooOOoo—

After dinner and Ruth's departure, Martin headed over to Port Gaverne to the Sanders home. In his bag, he had Aztreonam and the articles he needed to do the twenty-minute infusion. He thought Dr. Ruski's plan to get Ellie out of hospital a day earlier was wise, given the amount of airborne illnesses in the paediatric department. Dr. Ruski sounded like someone he would be comfortable with, someone not prone to nattering on about nothing.

Out of habit, Martin took Ellie's vital signs, and they were in line with expectations. He washed his hands at the kitchen sink, drying his hands with sheets of kitchen roll, then started the infusion in Ellie's bedroom. Ellie's parents were hovering over her, which was irritating. "The infusion will take twenty minutes, so I suggest you, ah, occupy yourselves." Ann gave Martin a sidewise glance, as if she were thinking, "Really? Does he think I'm going to leave her side?" She instead took a seat to make her intention to stay unmistakable, and said, "That's fine, Doc. I'm going to stay right here and keep Ellie company." Rich was more pragmatic, moving off into the kitchen. Martin said, "Excuse me," and followed him out. This was the exact situation he was hoping for.

"Mr. Sanders, I spoke with your doctor at Camelford. I asked him if you had any condition that could affect your immune system and he said you had IBS, but your wife had answered no when I asked her. Is she unaware of the condition altogether?"

Rich looked uncomfortable. "That's right, Doc. Ann frets and she has enough on her hands with the three kids. I have it sorted, it's not an issue. I told her the types of things I like to eat, and she basically sticks to that. I avoid or eat very little of anything I know will give me a problem."

"So, it's a minor case, then. But you've been a little nauseous lately? I have a sense that's unusual, as Ann mentioned it."

"Just a little bit, but I figured it was just too much Christmas feasting. Is that all, Doc? I have to get the older ones washed up and ready for bed."

"Yes."

Rich headed out, calling, "Paul, Archie, time for bed! Go wash up and then put on your jams." To Martin, "Gotta go supervise, Doc. Boys this age will skip as much washing as they can get away with."

"Mm." Martin thought to himself, "I didn't. James won't." But he also knew he would give James a bit more leeway than he'd been given, and he certainly wouldn't smack James' hands with a cane if they looked dirty.

Martin went back into the bedroom and saw that the infusion was close to finished. He waited until the medication drained completely, then withdrew the needle, cleaned the wound, and put a plaster in place. He packed up his case, then went back out to the kitchen to wash his hands. He found Rich busy at the sink, so he grabbed some sheets of kitchen roll and asked where the loo was. Rich pointed it out. "Down the hall, first door on the left."

Martin entered the room, and noticed there was an unusual smell in the room. It wasn't a good smell, but it also wasn't one he could identify. He thought about Janice and the funny smell she reported. She had also said it was at night and in the morning. He ran the tap, filling his palm with some water, but couldn't smell anything.

He washed his hands thoroughly, dried them, and used the towels to turn off the tap. He then came out and asked Rich, "There's a smell in your loo. It doesn't seem like it's the water."

"I told ya, Doc, it's boy smell. Do you have any kids? Believe me, you'll understand as they get to be 10 or so." Martin had no further information to go on, so he left it there.

—ooOOoo—

When he went out to the Lexus, Martin checked his phone for messages and saw that one had come in earlier in the day that he hadn't noticed. It was from his parents' solicitor, St. Aubyn. "Oh, gawd, I'd completely forgotten about that." He clicked on Play and the man's message came out.

"Dr. Ellingham, Nigel St. Aubyn here. I have taken care of your mother's burial as you had directed. She was cremated and her ashes interred with your father's. There is just the matter of her will and personal effects. Please call me at your earliest opportunity so that we may conclude the disposition of her estate."

Martin sighed. He had the conflicting emotions of not wanting to deal with it but also wanting it to be over. The sooner he could forget about his mother, the better. This should be the last thing, though, so best to just get on with it. As it was late Friday night, it was going to have to wait until Monday, so there wasn't much to be done.

A/N: For those who read as chapters come out, I changed James' age in Chapter 7 from 7 to 4 after rewatching the Last Christmas in Portwenn.