Chapter 11: See Chapter 1 Disclaimer

"Doc Martin just called. He hired me back and we'll do the GP assistant thing!" Morwenna told Al, excitedly.

"That's great, Mor! That's exactly what you wanted. First rate news, that. Proper job! When do you start?"

"He wants me there NOW. Better ditch these jim jams for some real clothes quick and head over. No shower for me this morning."

Al took a sniff of Morwenna and said, "No worries. You'll pass muster. And I always think you look great."

Morwenna beamed. "Thanks, Al. Better crack on, then," and with that she ran off to the loo. She gave herself a quick face cloth wash, grabbed some colourful clothing and earrings from the bedroom, and ran out, giving a quick, "Cheers!" as she cleared the door.

"'Bye!" Al said to an empty room. Right, that's good. They could use the type of money the job at the surgery brought in, especially with the baby coming and the food truck business being light during the winter. The pub needed him on and off, but business there was lighter when the tourists weren't around. Frankly, it was his favourite time at the pub when all the faces were familiar.

"Well, that's me at loose ends, which is good actually!" Ruth had agreed to give him a chess game, and a chat with Ruth couldn't come soon enough, but he waited until after 09:00 to give her a call. "Ruth, it's me. Say, did you have any time today to play that game of chess? The Doc rehired Morwenna and she's already back at the surgery."

"Really," Ruth drawled. "Martin hadn't mentioned that he'd made any decisions about that, but I haven't spoken with him much in the last couple of days. That's good news, right? I know it will be very good for Martin."

"Absolutely! Morwenna has been in a tizzy since she told me we were expectin'. She's worried about stuff and, well, we can talk when we see each other. What time works for you?"

"How about 14:00, Al? That will give us a few hours before the surgery closes."

"Perfect, Ruth. And thanks."

Al decided to head into the village and pick up an egg and bacon bap for himself and Morwenna, as he was pretty sure she didn't eat anything before heading to the surgery. The last thing he needed for her to do was to get hangry, which she had a tendency to do these days. Dealing with the Doc and his patients was trying enough.

At 14:00, Al tapped on Ruth's door and she opened right up. She wore a wool skirt and a turtleneck and what looked to Al like a cashmere cardie. "Hello, Al. Come on in. Give me your coat." Ruth stepped aside and Al walked in, handing over his blue puffer coat. Joan's old chess set was already set up on the kitchen table.

"You're all ready then. I hope you're prepared to lose," smirked Al.

"Well, it can always go either way when we play, but I think I'm going to hand it to you today, as I've been refreshing my knowledge of strategies. Still, a younger brain gives you the advantage. Time will tell whether it's youth or experience today. But first, let me pour some tea."

"Thanks, Ruth. Really, this young brain might be a bit distracted today. I'm sure you've already sussed out that I'm hoping to talk about some, well, things too, whilst we play."

"Yes, I've learned how to read you pretty well, having seen you in some stressful times. You've been displaying a nice combination of happiness and anxiety if you don't mind my saying. Most of the times I've seen that combination, it's been whilst discussing a prior conquest with a serial killer or some such. Getting to chat with an expectant parent is far more pleasant, although both are gratifying, if I'm being honest." She poured two cups of tea, put a few biscuits onto a plate, and encouraged Al to take a seat.

"Right, well, glad I can give you a superior experience." He sat down, took a contemplative sip, and launched in, "The thing is, Ruth, Morwenna has been moody for about a month, and so weird about Toby the Turkey and all. Of course, now that I know she's preggers, I understand why. But before she'd told me, I had been researching on the internet and…"

"Now, that's your problem right there, Al. Doctor Internet is far more likely to panic than inform. But you've never struck me as an alarmist. What in particular caught your attention?"

"Well, she sort of bounces between happy and crying and it seems to take nothing to make the switch. She's having a tough time staying asleep and then she's tired during the day and sometimes just stares off. And I read this thing from the NHS on psychosis during pregnancy and it just seemed like things were matching up."

"Oh Al, you're a levelheaded man. I know you love Morwenna very much. When you really care about someone, like your father or Morwenna or an ethical dilemma, you worry, you worry a lot. But you also tend to know what to do if you think it through. So, first off, what you are saying about Morwenna is likely quite normal for a mother experiencing her first pregnancy. I mean, it hasn't been my focus in psychiatry, but mood swings in pregnant women were a known symptom even in the dark ages when I was studying. Of course, they weren't called that. So, knowing that, and approaching it objectively, what do you think is the best thing to do?"

Al paused and scratched at his neck. "Well, I guess it would make sense first to talk to Morwenna and ask her how she's doing."

"Good start. Keep going."

"And I can also try to think through some things that might be worryin' her. Like money and the size of our place and her career plans and all. And I could be ready with some suggestions."

"There you go, Al. You got it in one. "

"You make it sound simple. Do you think I should talk to the Doc?"

"Well, you don't even know if you need a GP or any other doctor for emotional issues until you have a chance to talk to Morwenna. So, have that conversation first. Get her to feel comfortable talking to you about her pregnancy and her feelings. Listen more than you talk. Let her cry. If Joan were here, she'd probably advise hugging her. If you're still struggling, you are both always welcome to talk to me. You might also suggest she chat with Louisa, although that could put her in a slightly awkward position, talking to her employer's wife. Baby steps, Al, baby steps. Pun intended."

Al looked slightly relieved. "Thanks, Ruth. Dad's not much of a sounding board, although he means well. He's really chuffed about being a granddad. I hope he can live up to the example set by Mor's granddad. She worshipped him. Dad's got his work cut out for him there." A range of emotions played over Al's face as he talked about Bert's upcoming role as a grandfather.

"Well Al, you and Morwenna will never move from the village without taking your child with you, so there's a lot less that Bert will need to do except spoil him or her. I think you will all be just fine."

They finished up their tea, and Al proceeded to mop the chessboard with Ruth.

Back at the surgery, Janice turned even more pale than she had been. Martin could see patches where her makeup started and left off. He cleared his throat and asked, "Are you alright?" He wanted to interrupt the vasovagal syncope he could clearly see pending, as Janice's eyes were unfocussed.

Her eyes refocused on him and she sat up straighter. "What? I'm pregnant? How can I be pregnant?"

"Umm, I would imagine you and Penhale, ah, have, ah."

"Well, yes, but, well, Doc, I had my tubes tied after our failed wedding. This can't be happening."

"Ah! Right, it's rare but it can happen. It could be very early days, you may be only 6-14 days pregnant. You have many options open to you, although should you decide to carry to term, we need to be careful you don't have an ectopic pregnancy."

"Neither of us has been to any islands or anything Doc so I don't think I can have a tropic pregnancy."

"Not tropic, ectopic! That means the fertilized egg implants outside the uterus, usually in a fallopian tube. Those are quite dangerous and would require surgery to remove the pregnancy at the earliest possible time."

With that news, Janice's eyes became unfocussed again, and Martin ran around the desk just in time to prevent her from toppling off the chair. "Morwenna, come in here!" he thundered.

Morwenna charged into the surgery, trailed by Penhale, who said, "Janice, are you okay? What's going on?"

Martin said, "Penhale, OUT! Morwenna, you hold her steady on the chair whilst I see to her." Morwenna held Janice firmly and Martin lightly tapped Janice's cheeks. "Wake up. Janice. Look at me." She stirred and picked her head up, noticing Morwenna and Joe, who was torn between wanting to help Janice and defying a direct order.

Janice blurted, "What's going on? How did you folks get here?"

Martin informed her, "You fainted. Morwenna, get me a glass of water."

Morwenna filled a paper cup at the sink and brought it over to Janice, who sipped it slowly.

"Do you feel as if you're going to faint again?" Martin asked Janice.

"No, Doc, I just need a minute."

Martin turned to Joe, "Penhale, everything is okay. She felt a little faint. Go back out and let me finish here. You too, Morwenna, well done and, um, thank you."

"Call me if you need further assistance," Morwenna said cheerfully. She could see having more tasks like this as she progressed in her GP assistant training. Joe didn't look happy about leaving, but Morwenna helped shepherd him back to the waiting room with an assertive, "Out we go, Joe."

Janice finished her cup of water and looked marginally better. "Doc, I don't know what to do. What about all these things wrong with me? Oh my god! Tell me what I should do, I can't even think."

"Right, well, we need to treat your infection first off. Your prior antibiotic should be finished by now." He looked at her sharply. "You did take every pill as specified, right?"

Janice nodded yes, and Martin sighed with relief. This was going to be tricky, treating a pregnant woman for an antibiotic-resistant infection. He didn't need to start out with someone who didn't take all their prior antibiotic.

"Good. Given you could be contagious, and this antibiotic requires injections three times a day for an extended period, I'm going to send you to hospital. They will install a PICC line and get you started on the treatment."

Janice looked alarmed. "I really don't feel that bad, Doc. I hate hospitals."

Martin sighed. "The last time I checked, everyone hated them. Nonetheless, it's important that the medication is administered at regular intervals until two days after your symptoms have cleared up. It is possible to administer the drug at home but there is a specific procedure. They can teach you at hospital and ensure that you do it correctly, then they will release you."

Martin pondered briefly. He could have Penhale drive Janice to Truro, or he could call a non-emergency ambulance. Before speaking to Penhale though, he needed to discuss more with Janice alone.

"Regarding the pregnancy, do you have any initial thoughts about carrying to term, assuming the foetus is viable and not ectopic?"

Janice was clearly agonizing over this and feeling peaked did not help. "Doc, I don't know what to say. I need time to think. Joe and I are getting married, but we hadn't talked about kids, AGAIN! I'm such an idiot. He doesn't even know I had my tubes tied and he said last time he wanted loads of kids. You don't have to tell him, do you?"

"No, the mother does not need to inform the child's father, and the doctor is neither legally obligated nor allowed to share the medical information." Just thinking about this gave Martin feelings that he couldn't precisely identify. Tension, anger, sadness, fear. Louisa had learned about her pregnancy alone and made this choice alone, although she didn't have the additional complexity of the flawed tubal ligation. She had some random doctor in London whose competence Martin didn't even know. So much could have gone wrong at her age. He returned his attention to Janice. "You have time to think, but I have some additional questions. First, have your periods been regular?"

"Yep, cramps and all. Nothing unusual."

"Second, how long ago was your last period and was it normal in duration and intensity?"

"It was about three weeks ago, Doc. And yes, it all seemed normal."

"Okay, when did first have intercourse after your period?"

"I don't know, about a week or so? A couple of times since."

"Right. Then it's likely very early days and an ultrasound won't show us anything. I'm afraid I won't be able to tell you whether the embryo has implanted properly in the uterus for at least a month."

"What do I tell Joe?!"

"Um, that's not something I can help you with. Let's focus first on the infection. That is the most time-sensitive priority. It also gives you some time to bring up the topic of children with, uh, Joe." Martin paused and thought for a moment. "Would you like me to ask Penhale in here to inform him just about the infection and the care that is needed? It's possible that it didn't all, ah, get through, given your, um, emotional state."

The relief Janice felt was clearly visible. "Oh, yes, Doc. Please."

Martin walked to the door, opened it, and asked Penhale into the consulting room and proceeded to tell him about Janice's infection, treatment, and the need for hospital admission, omitting any information about the pregnancy.

"Right you are, Doc! It's near enough end of shift. I can drive her over. Glad to be able to partner up on this. It's a little disappointing that it isn't a crime but, still, Ellingham and Penhale on the job, making things safer for Janice at least."

"Right. I'll call the hospital and fully inform them of the situation." Penhale and Janice made their exit and Martin sat back in his chair. There's a lot here to solve, not least of which was how two of the villagers were infected with the same bacteria. He placed a call to the Royal Cornwall Hospital A and E department, explaining Janice's condition. He also tersely explained the need for privacy regarding the pregnancy and that the father would be present, but the mother did not want him to know about the pregnancy. He hung up the phone, took a breath, and shouted, "Next patient!"

When surgery hours were over, Martin was spent. It was atypical of him to take time off between Christmas and New Year's, but it seemed like the right thing to do after his experience treating Leonard Maitland. Because of the gap in local care, many villagers had held off going further afield for treatment and simply waited longer, whilst their illnesses and injuries simply got worse. He went out to the waiting room, where Morwenna was packing up for the day. "Ah, Morwenna, well done today. Thank you for coming in so quickly."

"Sure thing, Doc! It's good to be back. It's surprising to think how much I missed this desk and handling all the hubbub. About the GP assistant…"

"Not right now, ah, please. I had a chance to look at it briefly but need to go over it in more detail."

"The next class starts up in less than a month. It's okay that I sign up for it, right?"

"Yes, yes, go ahead. Give me through the weekend to read up on the program and its requirements."

"Thanks, Doc. That's me off then. See you tomorrow. Oh, will you be having Saturday hours?" Saturday was two days away.

"Yes, just a half day, as usual."

"Alright. See you."

Martin turned off the lights and locked up, then went into the kitchen to see Louisa at the table, looking completely exhausted. She had mostly recovered from her concussion and had rescheduled all her counseling appointments until after the weekend, but this was the first day she'd had Mary without Martin's help. At least James was back at school for part of the day, but he was now home as well. Some of her hair had escaped her ponytail and was trailing down behind her ears.

"Louisa, you are a bit pale and appear drained."

"Why, thank you Martin. You don't look that chipper yourself. Why is it that hols seem more exhausting than restful?"

"Because it's extra work to prepare for them and, during the holiday, the work doesn't cease, it accumulates and…"

"I know, Martin. It was a rhetorical question, yeah?"

"Yes. Why don't you sit on the sofa and put your feet up whilst I cook. I can watch Mary, and James looks well-occupied."

"Oh, Martin, would you? I am just DONE. Mary wanted to try walking constantly and I could barely keep up. I have a little headache too."

Martin swooped over and attempted to take her pulse. Louisa started to pull her wrist away, then realized it wasn't a completely silly thing for Martin to do, given she had recently had a health event. "Your pulse is normal. Let me look at your eyes." Martin looked at her and saw a tired woman with beautiful eyes. "They look fine. I think it's just fatigue. I'll get you a paracetamol. Tomorrow is Friday, do you think you can still manage, or should we try to find someone to help? Janice won't be available." He thought, "And that could be a long-term situation."

"I think I'll be fine, Martin. A good night's sleep and some adjusted expectations from my end should sort it. I can call Ruth if I need a hand. You've been doing so much these past few days I just don't think I was ready mentally for Mary's newfound skills. It is a fun age, though, so much self-satisfaction on such a tiny face." She moved over to the sofa and stretched out, and put a pale-yellow knitted throw over her legs.

"Okay. Just let me know if your head feels worse or you feel anything untoward. In the meantime, I didn't have time to run to the market, so will pasta do? We have the boxed kind that's higher in protein. I'll make a salad to go with it." His question was met with silence.

He looked over at Louisa and she was fast asleep. She looked comfortable enough for a short nap, so he let her be whilst he put the big pot of water on the boil and added a limited amount of salt.