This show began with the premise that a highly respected vascular surgeon in London became hemophobic and could no longer perform surgery. He,therefore, made the decision to move to Portwenn in Cornwall where his aunt lived and practice as a GP. Since that opening rationale, the hemophobia has been the one thing about Martin Ellingham that continues to bedevil him.
At first the notion that a vascular surgeon would become phobic of blood seemed ironic and amusing. What a funny thing to have happen to someone who is defined by working with the veins and arteries that carry blood to every part of the body. Although we could, and some viewers do, think of this as being tragic, I am quite sure it was meant to be humorous.
It meant he had to live in a small village where he was very different from the townspeople; he had to become a GP and treat all sorts of medical conditions, sometimes of minor significance and sometimes life threatening, and often due to foolish mistakes made by the patients. He went from a doctor’s doctor, a medical specialist who was referred patients who had serious vascular problems, to a primary care physician who saw anyone who walked in the door. He also lived near a family member for the first time in his life and fell in love with a local woman.
The symptoms of the blood phobia tended to be nausea and/or vomiting and he did his best to hide these from the town. Unfortunately, his secret was discovered and he became a figure of ridicule for a while. (All of this was in the service of adding to the humor of the show to a great extent, although we were given some background information about his childhood that could have contributed.) He had his first signs of this disorder supposedly when he associated surgery with some feelings for a patient and her family. This was, as far as we can tell, the only time when he could not complete his duty as a medical professional.
Each series saw him trying to deal with his hemophobia and having a variety of problems coping with it. Most of the time he has managed to suppress his immediate sense of nausea and recover sufficiently to successfully treat any problem no matter how bloody. However, some series have used the blood phobia as a major theme. In S4 we saw him try to desensitize himself so he could return to doing surgery; in S6 he became depressed and suffered from insomnia; and now, in S8, we have him being told to suspend his medical practice because a patient has accused him of malpractice due to his phobia. Otherwise there has never been a time when his hemophobia has led to him being unable to complete a task, even one involving lots of blood. Several scenes have included blood spraying onto him and during those he has neither fainted nor been unable to continue. One in S8 is a femoral artery that has been cut. Since the femoral artery is below the heart it tends to bleed profusely, as happens in the scene. When he arrives, Penhale is already covered in blood as a result of trying to put pressure on the wound. ME immediately gets sprayed with blood on his face and upper body, yet he suffers no symptoms of his phobia.
It has only made him faint 2-3 times: with Edith in S4; almost on the jetty in S8; and while treating a patient in S8. The time on the wall never really materialized, the other times he fell to the floor. When it caused him to be depressed in S6, he searched for physiological causes. At that time he took his blood pressure and EKG but could not find anything of consequence. In S8E7 he once again takes his blood pressure and pulse rate. Considering that this phobia is often associated with a drop in blood pressure and heart rate, those symptoms would not necessarily indicate anything significant about the health of his heart. At the end of S8E7 he is shown deliberately cutting his finger and looking at it. That, too, does not cause him to feel faint or become nauseous. If we are about to be given a reason to believe that his heart is having problems, that would have to be a separate issue from the hemophobia, IMO. It would be a new development.
On the other hand, it is well accepted that blood phobia is often caused by direct or vicarious trauma in childhood or adolescence. We can easily suppose that childhood trauma might be the basis for his developing hemophobia as much as any event during his surgical career. Or, the surgery he had trouble performing after meeting the family was actually more a reaction to his childhood trauma and was then associated with blood.
Maybe dealing with his childhood, and its obvious deleterious effects on him, through therapy would be the best way to reduce the hemophobia, which isn’t keeping him from functioning anyway. The solicitor who is now accusing him of being unable to treat patients due to his phobia is clearly wrong and I would expect the whole town of Portwenn to be willing to defend him since losing him would mean they would be without their excellent GP.