Chapter 10: See Chapter 1 Disclaimer
Given how active Christmas week had been, it was surprising how quiet New Year's Eve and Day were. The brutal weather on New Year's Eve had kept many people home, and the usual alcohol-induced trips and falls had been proportionally reduced. As was typical, people didn't seem to imbibe as much in their homes as they did when they were clustered together like a school of fish, all swimming in synch and trying to outpace each other.
Barbie, Martin's current so-called receptionist from the temp agency, was not at her desk when he was ready to open the surgery promptly at 08:30. "Oh, god," he thought, "So predictable." The phone started ringing immediately, and there were already two people outside the surgery when he unlocked the door, Bert Large and an older man who looked vaguely familiar and more cheerless than Bert. Martin let the calls go to voicemail, intending to fire the receptionist at his first opportunity. "Have a seat, Bert," he said, assuming Bert was there to waste his time. He uttered, "Go through," to the man he now recognized as an old sheep farmer whom he'd treated for Type 1 diabetes. He pulled Mr. Hughson's records from the filing cabinet and followed him into the consulting room.
"Ah, Mr. Hughson, why are you here?" Mr. Hughson was a well-kempt man who was 68 years old but continued to work a few sheep, more for something to do than for an income. His daughter and her children lived with him now and did some sort of work from the house.
"It's me feet, Doc. They're all tingly and such, and I keep tripping over them. And it doesn't help that I'm tired all the time."
"Right, remove your shoes and socks."
Mr. Hughson removed his shoes, exposing navy socks with small Christmas wreaths on them. "A gift from the little ones, Doc, had to humour them by wearing them. They know I like to wear dark coloured socks and…"
"Shush. Take them off so I can see your feet. Do both feet feel equal or is one more affected than the other?"
"They're pretty much the same, Doc." He proceeded to remove his socks.
Martin inspected his feet, finding a seeping wound on the pad of the small toe of his left foot. "How long have you had that sore?"
"First time I'm seeing it. It doesn't hurt or anything. Not sure how I did that, how do you get a sore on the bottom of a toe? I didn't stub it or nothing."
"Mr. Hughson, you are diabetic, and I have instructed you about what that can mean to your overall health. Have you been monitoring your sugar levels regularly and taking your medicine?"
"Well, you know, Doc, it's Christmas and all. Everybody cheats a bit at Christmas, right? I haven't been as good as I should have been."
Martin pulled out a test kit. "I'm going to test your sugar. "
Mr. Hughson cringed, knowing his numbers were unlikely to be good. The Doc was going to go berserk when he saw them. Indeed, when Martin tested the sample, it read in at 219 mg/dL. "Nooo, no, this is completely unacceptable! No wonder you're having diabetic complications. Mr. Hughson, do you want to lose your feet? Or your vision?"
"Of COURSE not, Doc, but it's Christmas. There were biscuits and cake and I just can't resist when it's homemade. Plus the grandkids make special ones, my wife's family recipe.."
"Stop TALKING. Your sugar is dangerously high, and you're already showing evidence of poor healing. I'll put a plaster on your toe now, which you need to replace daily and any time it gets wet. Starting now, no more sweets, resume the diet I already recommended and make sure you are taking your medicine. Keep an eye on that sore and come back in five days if it's not visibly better. Have your daughter take a photo of it when you get home and compare it each day to that photo. Really, I don't know why I bother if people just ignore sound medical recommendations." Mr. Hughson put his socks and shoes back on and followed Martin back out to the waiting room.
Martin put Mr. Hughson's notes away and pulled out Bert's, but also checked the messages on the answerphone. Nothing was emergent. There were two new arrivals in the waiting room, and he decided to ask Bert in private who had entered first, to avoid the usual arguments over who was next. "Bert, go through, I'll be in shortly."
Martin went out to the front terrace and called the temp agency. Upon their greeting, he launched in with zero ceremony. "This is Doctor Ellingham of Portwenn. Your employee was supposed to be at the surgery 20 minutes ago and you'd been warned that one more late arrival would cost you the position. I will forward her last paycheck." At least there should be no blowback for firing a temporary worker. Still, that left the Doc without a receptionist. Again. Although he hadn't thought through all the implications of Morwenna's proposal, he was desperate for good help, admired Morwenna's initiative and intestinal fortitude in making the proposal, and felt it could work out well for all involved. He placed a call to her and was relieved when she answered right away with a chirpy hello.
Martin launched in, "Yes, Morwenna, it's Doctor Ellingham. Uh, I've given your proposal some thought and, yes, I believe we can come to a mutually satisfactory arrangement, assuming you are effective at managing your time."
"Brilliant, Doc, that sounds good. When would you like me to start?"
"Now."
"Now? As in, now now? Today, come-right-away kind of now?"
Trying to keep the frustration out of his voice, Martin replied, "Yes" so tersely it was if the word only had two letters.
"Well, alright, Doc, I'll be there in 30 minutes. Cheers, and thanks!"
Martin rang off, relieved. He knew the practice would be in good hands with Morwenna and they could work through the details of her GP assistant program after the post New Year's rush. She certainly showed past interest in and willingness to dive into assisting him, but there could be an issue with hypodermics. Perhaps it won't be a problem if the pointy end is targeted at someone other than her. Now he just had to survive the next half hour. With that problem soon to be sorted, he entered the surgery and walked back to the consulting room to see Bert, who was sitting on the patient chair, with his chin on his chest, nearly asleep.
Martin sat down behind his desk, steepled his fingers, and prepared for his time to be wasted. "What do you need, Bert?"
"Well, Doc, it's like this. Al and Morwenna are going to be parents, so that'll make me a grandfather. I never thought I'd be a grandfather and…"
"Get to the point, Bert, please. I have people waiting." Yes, time wasting again.
"Right-O, I guess 'Be More Pleasant' didn't make your New Year's Resolution list, eh, Doc. Well, what I mean to say is this. I want to be healthier! I want to watch this little baby grow up and go to school and, well, you know." The man had a shine to his eyes.
Martin sat back, surprised but also quietly pleased. Part of his frustration with Bert had always been that the man was at such a high risk for any number of medical crises, yet never seemed to want to discuss anything that might be of help to himself. "Ah, well, good. That is good, Bert. Mm, for starters, surprise, you need to shift a significant amount of weight. I think that should be the focus, as many other health conditions are caused by morbid obesity. I can recommend a nutritionist who can set up a calorie allotment to elicit a gradual but permanent weight loss. You might find support groups to be helpful. We can also add some light exercise. I would recommend pool aerobics at the leisure center, as the water can provide some buoyancy to help protect your joints." Martin looked at the man with a tiny bit of compassion. "It's not going to be fast, Bert, but I think you have the proper motivation to keep you on track."
"Thanks, Doc. Just saying it out loud helped. I want to be healthier," he said, emphasizing each word of that sentiment. "Well, you know, you've got little ones. You don't want to miss a thing whilst they are growing up, learnin', becoming little people."
Martin thought about that and realized that, for once, he agreed with something Bert had to say. "Right, Bert. Now, give me a day to research available nutritionists and I will call you. Who was the next patient after you?"
"That would be Chippy Miller, Doc. He was limping with the left leg, just in case you want to know ahead of time." Chippy's reputation as a malingerer was well known in Portwenn.
Martin followed Bert out of the consulting room to see that there were a few additional patients as well as Morwenna, who must have gotten ready in record time. "Ah, Morwenna, good. Chippy Miller is next followed by that woman," he pointed, "and I'll let you sort out everyone else. Mr. Miller, come through."
After that, the day went more smoothly, as Martin and Morwenna settled into a familiar rhythm. Morwenna fielded phone calls, retrieved and refiled patient notes, and handled the phone calls with lab results. About ninety minutes after lunch, there was even a break in the patient influx.
"OK, Doc, I think I have things put back pretty much the way I had things running before. You got some results back from the labs, there's some for Janice Bone, Leonard Maitland, and you are copied on the results at the hospital for Ellie Sanders."
"Right, thank you." Martin took the labs back into the consulting room for analysis. As he expected, Leonard's showed the markers for coeliac disease. Janice's were a bit more interesting. Her bloodwork and urine showed the presence of Pseudomonas aeruginosa, a bacterium most often associated with moist areas. There were also other markers in the urine that could contribute to her symptoms. Pseudomonas aeruginosa was not typically an issue in a healthy person but could cause serious problems as it was antibiotic resistant. A follow-up call with Janice was warranted.
He retrieved her records from the waiting room file cabinet and then dialed her number. She didn't answer, so Martin tried calling the Police Station. "Portwenn Police Station, PC Joseph Penhale 3021," boomed out of the earpiece.
"Penhale, this is Doctor Ellingham, ah, I'm calling for Janice. Is she there?"
"Oh, hi, Doc. How're things today? I'd love to have you and Janice chat, but this is the station line and the regulations state that no personal business may be…"
"Alright, Penhale, can you please give her an immediate message to call me then."
"Well, Doc, taking a message is still basically personal business, but given we're a team, I'll let this slide. She'll call you presently." Click. Joe hung up. "Idiot," Martin thought, but he had to admit that Penhale did know his regulations.
The surgery phone rang within a minute and Martin shouted, "I'll take it in here, Morwenna!" He picked up the phone and it was Janice returning his call.
"AM I DYIN', DOC? You said I should call YOU if I was worse, but You're Calling ME!"
"Yes, No, Yes, that's what I told you and no you're not dying, at least not yet, but I have your lab results."
"OH MY GAWD, what do they SAY? It must be serious."
"They are simply unusual and unexpected. First, tell me how you are feeling now."
"I'm in a bit of a panic, Doc, what would you expect, with you calling me and saying I'm unusual?"
Martin sighed, took a breath, and replied, "How are your symptoms? Are you still vomiting, is your UTI still controlled?"
"The barfing has slowed down a lot, Doc, but it's burning a little bit when I pee again, and I have a little rattly cough and runny nose now, but Joe had a cold and I just figure I picked that up from him."
"Right, mm, okay. You have a UTI that's returning after an antibiotic, you have been vomiting some although that's improving, and now you have what could be a respiratory issue. I want you to listen to your lungs. Can you come in now?"
"NOW!? IT MUST BE BAD!"
"Calm down, shush. I have an opportunity to see you now and, if it is what I am thinking, I'd like to start you on a different antibiotic as soon as possible."
"Oh, phew, alright, Doc, I'll have Joe drive me down now." Martin called out to Morwenna, "Morwenna, when Janice arrives, have her wait in the waiting room and ask her not to touch anything."
"Alright, Doc." Morwenna dug out antibacterial wipes with which to clean the doorknobs and any surfaces she saw Janice touch. She also moved a couple of chairs a bit away from the others, with the intention of seating Janice and Joe there, to limit what they could touch. Knowing Janice, it might be easier NOT to tell her not to touch things and just prevent it as much as possible.
"Good, thank you." He had a few minutes to wait before Janice arrived, so he looked at Ellie Sander's results. His eyes grew wide, and he had a sinking feeling in his stomach. She also had Pseudomonas aeruginosa in her blood and urine. Martin looked up the contact information for the doctor who had ordered the lab work on Ellie Sanders and placed a call. "This is Doctor Martin Ellingham, GP of Portwenn. I sent a patient, Ellie Sanders, to hospital earlier this week and I need to follow up with Doctor Ruski immediately concerning her lab results."
As luck would have it, Doctor Ruski was available, and the call was connected. "Doctor Ellingham, I guess you read those results. A bit strange, yes? Do you know how she could have come in contact with Pseudomonas aeruginosa?" Doctor Ruski had an Eastern European accent, slightly anglified. Martin assumed she had been born abroad but moved to England as a child or teenager.
"No. But I have a second local patient who is positive for the same bacterial contaminant. Tell me how you've treated Ellie and whether it's working."
"Well, the good news is she is responding. I'm sure you're already aware that this is an antibiotic-resistant bacteria. I started her on Aztreonam and she is doing better. The vomiting has stopped, and we've been able to get her rehydrated. Given she recently had bronchitis, we are monitoring her for pneumonia as a precaution."
"Good. She has not been my patient. I only saw her as an emergency over the holidays. I suspect however that she is somehow immunocompromised, given her small size for her age and the medical history provided by her mother."
"I saw that you had recommended such testing. Her blood volume was low with the dehydration, but we will pull more blood when she is feeling better. Quite an astute call, Doctor."
"Yes."
"Is there anything else I can help you with?"
"No, thank you. Please advise me if there are any changes in her condition or treatment."
"Will do." Ruski heard a click and thought, "A man of few words."
Whilst Martin had been speaking to Ruski, Joe and Janice had arrived. Morwenna had so far been successful keeping Janice away from other surfaces. Martin came out of the consulting room, told Janice to come through, spun right around, and grabbed his stethoscope. She stood waiting for directions, and Martin motioned to the chair.
"Remove your coat." Janice did so. Martin proceeded to listen to various parts of Janice's lungs, asking her to breathe in and out at specific times. whilst taking these breaths, she also hacked a bit, which sounded a bit wet.
"I believe you have the beginnings of pneumonia."
"What!? What's going on, Doc? First the burning pee, then the vomiting, and now pneumonia?"
"Well, I believe at least two of them are caused by the same bacteria and one issue made you more susceptible to getting ill from the bacteria and could be a contributing factor to vomiting. I have another patient who has infections caused by the same bacteria who is being treated with Aztreonam and is responding well, but I hesitate to use that for you. Instead, I'm going to use Ceftazidime."
"Doc, why don't you treat me the same?"
"For the same reason you were susceptible to this infection whilst being otherwise in good health. Your urine test showed you are pregnant."
Author's Note: For those following the story who've read each chapter as they're produced, note that I modified Chapter 7 to remove the lines where Martin reminds Morwenna that the practice is only taking emergencies. Morwenna was not yet working for the Doc at that time. Sorry for the error.