Louisa’s Difficulties and Martin’s Hand Wounds

After Santa and a few others mentioned the last scene in S6E3 where the camera recedes (a dolly-out shot) as M continues to treat the cut on the palm of his hand, I went back to look at it. Their comments had to do with the camera work accentuating M’s isolation, which I think they are right about. Then I started thinking about how that episode has always bothered me, beginning to end. I have been a staunch defender of Louisa, but if I were to find a time when I think Louisa is depicted as lacking sympathy or sufficient concern for M, it would be in this episode. I want to discuss that and then move on to another pet peeve of mine-whether DM is medically accurate.

The episode begins with loud knocking at the front door before 6:30 a.m. L is annoyed at being awakened so early and stays in bed while M goes downstairs to see who’s at the door. It isn’t long before her alarm rings and the baby starts crying. She didn’t get much more time in bed and I would have expected her to get up with M like she does in S5 when Morwenna shows up too early for work. (I think that time it was only 6 a.m.) When L comes down to see what’s going on, M asks her if she can identify the man who has been dropped off after being found unconscious on the beach. She has never seen the man before and is in a hurry to get James dressed. We can hear James crying upstairs. She, therefore, doesn’t want to get M water for the pt. The look he gives her makes her change her mind. I would have expected her to be willing to help with the water without objection. The next time we see her, she is ready to head out to school and finds many things to express concern about to Michael before she hands him James. Here we have a mother’s difficulty with leaving her baby, while she overlooks her husband’s needs. We know M has gone upstairs to get dressed, but we don’t know what, if anything, was discussed while they were both getting ready for the day.

By the time L is ready to walk out the door, M has confronted his blood phobia’s return. L notices something is up with M, but ignores it and leaves for work. (This may not be surprising since he looks like he’s deep in thought and he isn’t much for affectionate goodbyes.) They’re really both on edge, for different reasons.

As the day continues, L is distracted by mixed feelings about leaving JH and doesn’t read Becky’s article for the newspaper. The next day she gets angry with Becky over publishing it without her permission. She’s still bothered by leaving JH with Michael. Thus, work is stressful at the same time as L is stressed by her dual roles and M can only say “I told you so.” We should give her some space for dealing with so many stresses.

The following day begins with Ruth visiting and finding M rocking JH because they had a bad night. Of course, lack of sleep puts additional stress on both parents. The day turns out to be trying in many ways with L dealing with Bert’s anger over Becky’s article and M dealing with the recurrence of his hemophobia and then rescuing Ruth from her stalker and getting his hand cut.

By the last scene, L has learned of M’s scuffle with the stalker at R’s house and says, “what a day!” She sees him cleaning his wound, and asks how his hand is. She’s not satisfied and asks again if he’s all right. He covers up by asking her about her day and putting some gauze over his wound, keeping it covered from L. L tells him about how she’s handled the Becky matter. It would be a nice exchange between them if it weren’t for the hand issue. L tells him he looks pale, but reads Becky’s article about him anyway, asks if he’s really ok, then leaves him. Of course, he says he’s fine; he says that every time. But I had to wonder why L would read an article to him that criticizes him just when he’s dealing with a wound after a long, tedious day? They first agree that Becky has a right to free speech, but it’s rather harsh to read a critical article about M at that moment. If it’s meant to be funny, the joke falls flat, including L’s judgment that Becky’s only ten and has written this piece well.

Louisa at least has a mixture of concern and lack of concern. She always meets with his resistance to tell her very much, and that can’t be easy. So I give her a less than satisfactory assessment during this episode even though she can’t be faulted entirely.

Then I started thinking about all the times M has wounded a hand and how difficult that would be for a surgeon. Their hands are exceptionally important to them.
S2: Martin gets his wrist caught in a trap while looking for Mark in the woods
S4: falls and hurts hand on broken glass
S6: hurts wrist falling down a hill in E1
gets his palm sliced by large knife during scuffle in E3

Hand wounds are often quite painful and this last one should have been. I also think it should have been looked at in the ER and L should have insisted on taking him there. Most doctors think they can take care of their own medical problems only to find out they need help. (I know because I’m married to one of those! Don’t bother a colleague-it’s embarrassing.)

In the above episode there are several medical and logical instances that are not very accurately presented. Not only does Martin seem to have a clean gauze bandage handy in his pocket to wrap around his bleeding hand immediately after it is cut, the knife isn’t dripping from blood after the event. Martin seems to have a high pain threshold throughout the series, and in this case he would have to because palms of hands have a lot of nerve endings. Following the altercation, he offers to make Ruth a cup of tea to calm her, which means he must feel good enough to not deal with his hand immediately. We also have to assume the cut wasn’t very deep because he can move his fingers and the wound stops bleeding pretty fast. Also, Martin had to have held his hand so perfectly following the cut, and the cut must have been rather shallow, or the skin would not have been aligned as well as it looks in the final scene, nor would the edges have adhered to each other so well. Furthermore, all surgeons are very alarmed by any injury to their hands. Surgeons sometimes joke that they are all cerebellum, brainstem and hands. At the beginning of S6E4, Martin no longer has a bandage on his left hand and he can hold the baby without a problem. We don’t know exactly how much time has elapsed between these two episodes, but unless it’s at least a week later, it would be surprising for him to not have it bandaged anymore. In S4, his phobia kept him from even looking at his wound and he kept the bandage on for quite a while.

In addition, Ruth gives Robert an injection of either Largactil or Benzodiazepine. She suggests either to Martin, and we’re not sure which one he has in his bag. Both of these meds are used to treat all sorts of psychiatric disorders related to psychosis, anxiety, schizophrenia, etc. Neither would be likely to work so fast that the patient would collapse on the floor immediately following an intramuscular injection of it. It would be more likely to take a minimum of 5 minutes rather than 10 seconds to take effect. For the purposes of the show, the medicine has to work fast, but it’s not accurate.

There is always a spectrum of plausible to possible to likely in every medical condition. Naturally there are individual differences for everything too. But I think the accuracy of the medical cases in this show is very much along the lines of what Philippa says in one interview: they ask the medical consultant if something they’ve come up with is possible and if he says it is, they leave it in. The medical accuracy in this show is better than most yet still not really that stringent.

Originally posted 2014-05-22 17:23:25.

17 thoughts on “Louisa’s Difficulties and Martin’s Hand Wounds

  1. Santa Traugott

    I really don’t know much about medical practice or medications in general, but I do think that whoever is advising them on psychotropic meds is not a practicing psychiatrist. At least, I hope not. To add to your list, Dr. Dibbs has a supply of fluoxetine (prozac) on hand for when she is experiencing anxiety. Prozac — and SSRIs in general — needs time to build up (and wear off) and unless something’s changed drastically in the last few years, it is never prescribed on an “as needed” basis. So easily checked too — I always wondered why they made that blatant error.

    The word “isolation” in your first sentence made me stop and think. It has a different connotation than “claustrophobic” which is how I had thought of it. Maybe it is even more appropriate. Perhaps both are at work. I do think Martin feels shut-in, and to a degree, trapped in a living situation that is far less comfortable than he must have imagined. But Martin is certainly isolated in dealing with what is happening to him — that is largely self-imposed. But as you point out, Louisa in this episode in particular is pretty cranky, preoccupied, tense and in general seems anything but affectionate and supportive. Her withdrawal from him — b/c that’s what it seems like — must contribute to a sense of isolation.

    Would you go further and suggest that perhaps it is this sense of growing distance between him and Louisa that actually contributes to bringing on the return of the phobia? I don’t know how I feel about that, but now I am wondering if his sense that things are not quite working out is so anxiety-provoking that the phobia comes back as a way of binding up that anxiety. Interesting to think about anyway.

    CADMFAN remarked on DS that the very first sign of the phobia’s return came in this episode when the rescued man asked him about his family. I think that is very significant and ties in with the idea expressed above.

    It is hard to feel that Louisa comes off well in this episode. I don’t think the groundwork was adequately laid for what seems like a change in character. Fiery, “spiky” – often. But never before so, well, unpleasant. I think this episode is the peak of it, isn’t it?

  2. kjacobson@mindspring.com Post author

    Now that you mention it, the idea that the return of the phobia is related to being asked about his family is an astute observation. I’m not sure whether they meant it to be triggered by that, but possibly more connected to the fact that the stranger is intruding on his home life in a very personal way. The fact that he works in his home, or he lives where he works, has to be difficult, especially for someone as private as he is. Campbell also asks him whether there are a lot of Ellinghams in town. He’s looking for Ruth, but that could be a reminder that now there are quite a few Ellinghams. Could be kind of weird for M to think of being surrounded by other Ellinghams.

    I think you’re so right about him being both isolated and hemmed in. When the shot pulls out, M is framed by the doorway as if he’s in a box.

    The stuff about the anti-psychotics and SSRIs is definitely something they should have done a better job with. I think it’s a mistake to claim accuracy in medical shows because it’s so hard to really sustain that.

  3. Mary

    Don’t you think that Dr. Dibbs was self-prescribing and since she turned out to be a rather inept doctor, would it not be possible that she messed up her own prescriptions?
    I agree it would be just about impossible to have a medically accurate show all the time. A little artistic license is sometimes necessary as well as a little suspension of the audience’s disbelief.

  4. kjacobson@mindspring.com Post author

    Mary, I agree that Dibbs is not very capable as a doctor and was shown to be quite slipshod in writing prescriptions. I think that what Santa is getting at, however, is that fluoxetine (or Prozac) just doesn’t work like they show it. You have to take it for several days if you expect it to help your anxiety. You can’t just pop a pill in your mouth and have a sense of relief in a few minutes because it has to build up in your system over time. They show her using it as though she takes it whenever she feels anxious and not as a daily regimen. I imagine they do that because it’s more dramatic to see her grab the pills while feeling under pressure, but it’s not an accurate demonstration of how this medicine works.

  5. Mary

    I really am quite ignorant of how these medicines work, so the fact that this was a blatant error went right over my head. As it quite possibly did for most people. Like when Mrs. Tishell pops a few extra “intelligence” pills when Clive annoys her….she does it in such a way that her frustration is quite palpable….and funny!

  6. kjacobson@mindspring.com Post author

    It is absolutely funny, and in Mrs. T’s case, the meds she’s taking can be taken on demand. She takes too much and combines meds that would cause her to react dramatically. What I’m responding to, and what Santa was agreeing with, is the constant refrain that this show is required to be medically accurate while American medical shows are not. This show is not always so medically accurate either and they would be better off not accentuating that aspect of the show as so important.

  7. egwrd

    I don’t think that DM’s blood phobia ever went away totally. Remember, he vomited after Louisa had the baby, and he was literally on his way to his surgery job. I am so curious to see how all of these issues are resolved in S7. I found watching S6 very painful and heartbreaking. It wasn’t until I watched the series a couple of times that I was able to appreciate the episodes. I think the last episode was brilliant, but I would have loved just a little bit more indication that things will turn out alright for the Doc and Louisa.

    PS. Just reading this blog for the first time and LOVE it!

  8. kjacobson@mindspring.com Post author

    It’s nice to have a new reader! Thanks for your comments.

  9. Amy

    I just watched this episode today, and I guess compared to how cold Louisa seemed at times in S7, this didn’t seem quite as surprising or disturbing. A lot of people are grumpy in the morning (I am!), and having an intruder come in and your husband then ask you to help while you’re not even dressed and your baby is upstairs would certainly have made me testy. But I didn’t marry a doctor. Probably a good thing for me and for him!

    I did find her reading of Becky’s article rather odd. Was she trying to let M know how he was perceived by his patients? Certainly doing so while he was already stressed and injured was rather thoughtless. Of course, he wasn’t at all upset about Becky’s article–more about his own issues.

    As for the return of the hemophobia, it still seems to come out of nowhere. Only a few weeks earlier he performed surgery on the caravan owner, had blood spurting everywhere, covering both Louisa and him. He was undisturbed. He presumably was living with JH and L between the castle scene and the wedding and had lived with them through most of S5. What had changed? The dinner with Dennis and Karen? Louisa being annoyed about his treatment of Mel, the nanny? M liked Mike and his orderliness so it wasn’t that.

    So maybe it was Louisa’s testiness—both that morning and in the prior episode. Maybe he saw he wasn’t making her happy and feared losing her. The hemophobia was initially triggered by his recognition of the humanity of his patients; maybe this time it was triggered by recognizing his own. And then he just shuts down.

  10. Santa Traugott

    First I think that the phobia never really was extinguished — it was in a kind of remission. And I like the idea that it was the fear that he wasn’t making Louisa happy that brought it back.

    If we look at the original incident in that light, maybe it makes even more sense. That is, what if the original fear was that these were actual people that he might disappoint and fail, in his treatment of their loved one, and that is what he cannot bear. Another iteration of being an unsatisfactory and deeply disappointing person. So, rather than face that, he develops a phobia so crippling that he can’t even attempt to do something at which he might fail or injure someone.

    Now, perhaps he’s in the same situation with Louisa. He may always have felt that he didn’t deserve her, was bound to disappoint and hurt her, and the phobia cropped again to give him something else to focus on, instead of the fear of losing her, which would be (and was) devastating. And by withdrawing, he wasn’t doing things that might actually hurt or disappoint her. Of course, he failed to recognize that exactly that withdrawal was a major part of the problem.

  11. Amy

    That all makes sense to me, Santa, and helps me put the bigger picture together of how the hemophobia fits with Martin’s overall psychological state and his relationship with Louisa and with his patients. He is haunted by a fear of disappointing people, having always felt like a failure with his parents. He can succeed at surgery because he has withdrawn into a shell that allows him to see the patients as no more than bodies, not people he can disappoint. Once he sees that in fact they are people, that fear of being a failure reappears in the form of a fear of blood.

    It stays with him as long as he can either disassociate from his patients, which perhaps he does in S4 because he has withdrawn from Louisa as well, or he feels somewhat secure, which perhaps he did in S5 for the most part until Louisa moved out. But it reappears in S6 when he is suddenly once again afraid of disappointing someone he loves and losing her. Imagine how he must have felt operating on Louisa—the double whammy of not only failing a patient but also losing his wife.

  12. kjacobson@mindspring.com Post author

    Well, I see you and Santa are back to wondering what sort of psychological circumstances could have led to the return of ME’s hemaphobia in S6. All of this thinking seems to come from the gaps that have been used throughout S6 and that create these spaces that beg to be filled in. We can suspect intentional use of lacunae to allow viewers to arrive at their own conclusions, or we can think there was no need for them to find a reason…all they had to do was decide to bring back the hemaphobia knowing that there could be many explanations.

    They wanted to switch things up for S6, and take these two from a wedding that actually materializes to a marriage that is on the rocks. How to get there?…hmmm…someone has to fall apart and ME is a good candidate because he has the most difficulties to draw from. As I believe I argued in a previous post, they loaded the early weeks of their marriage with a plethora of stresses and then added more with a second visit from Martin’s mother and the news that his father has died. Then they put Louisa through many hurdles as well as physical injuries. The outcome was two adults who are both psychologically damaged under tremendous strain. Another outcome was a much more serious show, and I was not a fan of that decision.

    Anyway, I guess what I’m saying is that they left the door open for many explanations, either deliberately or for expedience sake, and your ideas are as valid as any. Thanks for the ongoing discussion.

  13. Santa Traugott

    I think that insofar as they had any particular explanation in mind for the plot device of bringing back the hemaphobia. it was probably that after the honeymoon is over, marriage can be hard, particularly if you carry a lot of baggage. And the return of blood phobia signals that he’s having trouble coping. You’re right — everybody is free to interpret it as makes sense to them. But I would bet that’s all they had in mind.

    Personally, I think the simplest explanation is that he was unprepared for the fact that he would find some aspects of marriage not to his liking, and rather than deal with that (which would probably mean confronting Louisa with uncertain results) his handy symptom reappeared to give him something else to think about.

  14. kjacobson@mindspring.com Post author

    Your last judgement does a good job of simplifying what they probably used as their manner of proceeding. They went to his typical means of reducing stress, his clocks, withdrawing, not sharing anything with Louisa, etc. Among those defenses we have to include the recurrence of his hemaphobia.

  15. Marie

    I agree with Santa that Martin’s blood phobia never really extinguished.

    Personally, I was never puzzled by its return in season 6, and here is why.

    We first see it reappear at the beginning of episode 3. A man is brought to the surgery at dawn by two fishermen who found him unconscious on the beach. Martin was in bed, sleeping, with Louisa by his side. We see him next in his pyjamas, in his consulting room. He is met by a dishevelled Louisa, concerned both by the situation (“Is everything all right?”) and their crying son upstairs. Needless to say, Martin was not at all in his clinical doctor mode when all this took place.

    Martin then leaves the man to get dressed, as if he cannot assess a patient without wearing a suit and tie. He is conducting a proper examination, probably minutes later, when the man, Robert Campbell, invades his privacy again.
    —RC: Do you live here with our family?
    —ME: That’s not your concern.
    —RC: But there are a few of you round here. Ellinghams.
    —ME: I’m going to take some blood now.

    Martin confidently sticks the needle in Robert’s vein, blood starts filling the syringe, and BOOM. There it is. Hemophobia creeps back in Martin’s life as we see him show surprise a millisecond before averting his gaze, look back at the syringe filing with more blood, then suppress a gag reflex (good acting from MC!).

    For me, as when it first manifested itself, this happens because the barrier between Martin’s clinical, emotionless, safe world of medicine and the unsafe and fearsome world of everything related to emotions, more so his family, was shattered. He took time to change his clothes, but not enough to change his mode from personal/private (emotions) to professional (emotionless).

    French being my mother tongue, I hope I didn’t do too much harm to Shakespeare’s one and that I managed to get my thoughts though.

    Marie, from Montréal

  16. kjacobson@mindspring.com Post author

    Thank you for joining the conversation. I really like your argument and your contrast of ME’s public v. private persona. This is a very convincing position to me and amplifies how hard it must be for him to both live and work out of the same residence. His private life is constantly being invaded by his professional life and that is very intrusive. The emotions it arouses must be extremely disruptive for him. Bravo!

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