A look of horror crossed Roisín Kilmartin’s face. Damn you, Fitzpatrick, Fingal thought, you’ve scared her silly. He was relieved when Doctor Micks turned to the patient and said, “Please do not concern yourself, my dear. I’ve had a look at your tests. You do not have TB, I promise you.”
She managed a weak smile. “Ah sure, dat’s all right den, sir.”
“For those of you who do not know, TB terrifies the working class of Dublin. So much so that I’ve had more than one woman tell me her husband was in gaol rather than admit he was in hospital with tuberculosis. Furthermore,” he stared through his wire-framed spectacles at Fitzpatrick, “there are certain diseases we simply do not mention in front of patients. Am—I—clear?”
Fitzpatrick whipped off his pince-nez and polished them.
“Now,” said Doctor Micks, “let us continue. Mister Cromie, how would you investigate this patient?”
“Lord Jasus,” said Roisín Kilmartin, “investigate? I dun nuttin’ wrong. Is your man a Peeler?”
“No, Mrs. Kilmartin,” Fingal said, “Mister Cromie is not a policeman. By ‘investigate’ we mean what tests does he think should be done? Remember when we took your blood yesterday?”
“Blood tests? Ah sure—”
Dat’s all right, Fingal thought.
Cromie made a good reply and included a differential white cell count, “In case of neoplasia of the blood system.”
“Well done, Cromie,” said Doctor Micks. “Neoplasia. Absolutely right.” He glanced at Fitzpatrick.
Fingal knew that neoplasia, taken from the Greek and meaning “new growth,” was a euphemism for cancer, which, like TB, was another disease that should not be mentioned in front of patients. In Fitzpatrick’s case, Doctor Micks was rubbing the message home. “Now, Mister O’Reilly, please tell us what the tests showed.”
“The haemoglobin level is low, the red blood cell count is down, and mean corpuscular volume and diameter are elevated. The cells are oversized or macrocytic.” He added, “White and platelet counts are low so I don’t think we need worry about neoplasia.” Or leukaemia, he thought. “Many of the enlarged red cells are immature or megaloblasts.”
Doctor Micks asked, “And that degree of megaloblastic activity means? Mister Beresford.”
“I’m sorry, sir.”
It wasn’t the first time Bob had been unable to answer a straightforward question.
“Mister O’Reilly?”
“Pernicious anaemia, sir. And after eight gravidities,” Fingal wasn’t going to risk saying “pregnancies” in front of the consultant, “I’d be pretty sure there will be iron deficiency as well.”
“Correct.”
“And the treatment? Miss Manwell?”
“For pernicious anemia, sir, either intramuscular injections of liver extract containing antianaemic substance—”
“The equivalent of half a pound of raw liver daily that until recently the unfortunate patients had to consume orally,” Doctor Micks added.
Fingal shuddered. The thought of having to eat raw liver every day. Revolting. A cure from the Stone Age, but little by little the science of biochemistry was making advances. They hadn’t identified the factor in liver, but he was confident they would. The outlook for people with sugar diabetes had been powerfully advanced since insulin had been discovered in 1921 by those Canadian doctors Banting, Best, and Macleod. Trinity had appointed the first professor of biochemistry last year, Robert Fearon, a man Fingal admired enormously, a polymath who introduced literary quotes into his lectures, had written a play about the Irish patriot and martyr Parnell, and who played the organ. Research certainly suited some folks. It, nor any other branch of medicine, wouldn’t suit Bob if he didn’t pull his socks up and study more.
“And you were going to say, Miss Manwell?” Doctor Micks asked.
“Or desiccated hog’s stomach or gastric juice from a healthy subject—although the latter is hard to come by.”
“Good. The anaemia is caused by the body’s inability to absorb a substance found in liver because a factor in normal gastric juice is absent from the patient’s stomach.” He turned to Bob. “Beresford? How do we treat iron deficiency?”
Bob shook his head.
Fingal sighed. Fingal wanted his friend to pass Finals Part I, and the examinations were only three months away. Time to have a word in his delicate shell-like ear.
Fitzpatrick butted in, “Inorganic salts of iron, either a ferric one, but they can cause gastrointestinal disturbances, or ferrous ones, although they are hard to keep and tend to oxidize to ferric ones.” He smiled.
Oily bugger, Fingal thought. He’s practically quoting verbatim from Doctor Micks’s textbook.
“Correct.” Doctor Micks turned to the patient. “You’re a lucky woman,” he said, “and these young doctors have done a fine job of finding out what ails you. Thin blood, and we’ll treat it, and have you home in no time.”
“T’anks very much, sir, and t’anks to you too, Mister O’Reilly, sir.”
Fingal shrugged, but inside he glowed. Eeyore was right. It was “nice to be noticed.” And it wasn’t only the thanks. Knowing he’d been part of helping a patient, a patient called Roisín, recover, gave an intense sense of satisfaction. Even if getting to know the patients could cause great pain, as it had with Kevin Doherty, it was worth it. Hadn’t seeing Paddy Keogh being taken on by Willy Duggan yesterday been worth, as Ma would have said, all the tea in China? And that sort of thing only happened if you continued to think of the customers as people, not sterile “cases.” “My pleasure, Roisín,” he said.
“Excuse me, Professor, sir, can I ask a question of Mister O’Reilly?”
“Certainly.”
“Yiz knows how much it rains in Dublin?”
“I do.”
She frowned and ran a reddened hand through her chestnut hair. With her head cocked she asked, “If I’ve to take all d’at iron can I go out in the rain?”
“Now why on earth shouldn’t you?” Fingal asked.
“Have you seen w’at water does to iron? It feckin’ well rusts.”
Fingal smiled. “It’s all right,” he said, “your skin’s waterproof. It’s like having iron galvanised to prevent rusting.”
She laughed. “Wait until Brendan hears his oul’ one’s galvanised. He’ll shit a feckin’ brick.”
Everyone chuckled. Even Sister Henry managed a smile.
“All right,” said Doctor Micks. “One more patient to see. We’ll start your treatment today and I’ll see you in six days after we’ve repeated your blood tests, Mrs. Kilmartin.”
“Ah sure,” she said with a smile at Fingal, “dat’s all right.”
“O’Reilly, a word.”
Fingal moved beside Doctor Micks.
“You did well with that patient.”
“Thank you, sir.”
“But there are good reasons for maintaining a certain professional distance. You will not call my patients, indeed anybody’s patients, by their Christian names. Names may be used, but surnames only. Your calling her Roisín was patronising in the extreme. Is that clear?”
“Yes, sir.”
“Excuse me, your honour.” Mrs. Kilmartin looked at Doctor Micks. “Don’t be too hard on young Mister O’Reilly,” she said. “Didn’t I ask him to use me Christian name?”
Doctor Micks cleared his throat. “Indeed. Thank you, Mrs. Kilmartin.” He turned to the entourage. “Next patient please, Sister.”
They moved down the ward until Doctor Micks stopped, bringing his entire party to a standstill. “I want to draw an important matter to your attention,” he said. “In the last week of March a group will be visiting Sir Patrick Dun’s. They are called the Pilgrims because they travel to different centres, even to the Continent. The travel club is made up of professors, of whom Professor Victor Millington Synge, the playwright J. M. Synge’s nephew, is one.”
Was he indeed? Fingal thought. He’d seen Playboy of the Western World at the Abbey Theat
re and thoroughly enjoyed it. And Professor Synge was an acquaintance of Father and Ma.
“I want you to make a good impression. To that end I will be presenting a patient with valvular heart disease. That much I will tell you. The specifics of the diagnosis, which valve or valves are affected and in what way, I leave up to you to discover.”
Fingal swallowed. Not another one.
“To let you see him in advance would be cheating, but I intend to ask one of you to examine him in front of the visitors. I hope the individual I ask will make an accurate diagnosis and bring kudos for the standards of teaching in this institution.”
Fingal’s eyes narrowed. He remembered on their first day here how knowledgeable Fitzpatrick had been about the murmurs of valvular heart disease. An idea began to germinate. He’d need to talk it over with the lads. If they accepted the notion, he was certain Hilda, who had no great affection for the man, would come onside. If it worked it would take the wind from the sails of that bloody know-it-all.
Fingal savoured the idea but then focused his attention on Hilda as she presented a case of cirrhosis of the liver. Even from where he stood he could smell the ketones on the patient’s breath because her failing organ could not process the breakdown products of proteins. Poor woman. Unless somebody found a way to give her a new liver, and that was about as likely as capturing a unicorn, she’d not be long with us. Not long at all. Geoff Pilkington and Lars were right. Not all patients get better.
* * *
“By God, Fingal,” Cromie said as the friends ambled past the Grand Staircase. “If we can pull it off, Fitzpatrick’s going to have a canary. He hates being laughed at.”
Charlie chuckled and said, “He needs to be put in his box. Self-righteous bollix. You’re right—and I see no reason why we can’t set him up to make an ass of himself when those senior profs—what did Doctor Micks call them?”
“The Pilgrims,” Fingal said. “It won’t take much.” He explained exactly what he had in mind.
“Bloody ingenious,” Bob Beresford added. “I can hardly wait.”
“I—” said Fingal, and stopped. Approaching from the nurses’ dining room was Kitty O’Hallorhan. “I’ll catch you up.”
“Right,” Charlie said.
“Kitty,” Fingal said as she drew near, “Kitty, I’m sorry about Saturday. Please let me explain.”
She stopped and faced him. “Go ahead, but I already know,” and she smiled. “Virginia gave me your message. I knew you were stuck in Belfast and I knew you were on call on Sunday. I was disappointed, but I did understand.”
“Thank the Lord. I’d not have wanted you to think I’d run off with someone or got steamboats with the lads.”
She chuckled. “Steamboats? You’re starting to sound like a real Dubliner.” Then she said, “I’d never have thought that of you, Fingal O’Reilly. You’re not the kind of man to be thoughtless. But I would have been worried sick if I hadn’t known where you were. I’d’ve had you dead after a car crash or a train derailment.”
“I’m sorry,” he said, “I wanted to have a morning’s wildfowling. I—” He looked down at his boots then back up at her. “I needed to get away—just for a little while.”
She touched his sleeve. “Mister Doherty?”
He nodded.
“I had a good cry for him,” she said softly. “He was such a nice man.” She looked straight at him. “I love the way you care,” she said.
O’Reilly took a deep breath. “I love the way you care.” That’s what she’d said. “I took it hard. Too hard.” He spoke softly. Inside himself, in quiet moments, he was still mourning. “Portaferry’s on Strangford Lough. Strangford’s always been special to me—a place I could go to if I was hurting.”
“Go on.”
“Lars and I talked things through on Friday then went wildfowling on Saturday morning. We left the shore and set off in his car for Belfast in plenty of time to catch the Dublin train and be with you that evening. His car broke down. I missed the train. Spent the night in Belfast with a friend. I’m sorry.”
She inclined her head. “Fingal, it’s all right. You did let me know, and we’ll be able to get together—”
“Mister O’Reilly. Nurse O’Halloran.” Sister Daly had come round the corner. “You two know the rules. You, Nurse. Back to the ward. At once. You’re late. I’ll speak with you later.”
Kitty fled.
Fingal sought for anything he could say to protect Kitty from the wrath of Sister, but she forestalled him.
“I warned you, Mister O’Reilly. I warned you when you started here. Doctor Micks will not be pleased.”
Was there any point pleading now? He shook his head. All he could do was say, “I am truly sorry.”
There was iron in her voice. “I’ve watched you since you started. You are gentle with your patients and you care—perhaps too much. You are developing good diagnostic skills. I’ve seen generations of students. I know how to judge them. One day, when you’ve grown up, you will make a fine physician.”
Fingal held his peace.
“I will think about you for the next two weeks and I will decide whether or not I believe my suggesting to Doctor Micks that an extra six months repeating this clerkship might help you achieve the maturity that you currently lack.”
“Thank you, Sister.”
“But you will not be seeing Nurse O’Hallorhan during that time. I shall arrange for her to be transferred to the children’s ward and I will be having a word with the lady superintendent to ensure Nurse O’Hallorhan is confined to barracks for the rest of March.”
24
And Great Was the Fall of It
“Are we certain we want to go ahead?” Charlie asked, sprawled in a chair in the students’ common room. He nodded to where Fitzpatrick had hung his white coat.
“Bloody right I am,” said Fingal. “In twenty minutes we’ve to be in the lecture theatre with Doctor Micks, the patient with valvular disease, and the learnèd professors of the Pilgrims. It’s a brilliant opportunity to prick Ronald Hercules’s balloon.”
“Hear him,” Cromie said, and ran a hand through his thin hair. “Hear him.”
“I know it’s what we’ve planned,” Charlie said, “but, Fingal, so far you’ve been on your best behaviour. It’d be a shame to spoil it just to put one over Fitzpatrick.”
In the last two weeks Fingal had done everything possible to appease Sister Daly and impress Doctor Micks. Today, with a bit of luck, Sister would agree not to report Fingal after all, and in one more week he’d get that certificate of good standing from Doctor Micks.
“I think the risk’s worth it,” Fingal said. “We’ve put up long enough with Fitzpatrick’s arrogance, his disregard for other people’s feelings.”
“But Charlie has a point,” Cromie said. “Our three months in psychiatry starts next month and we want you with us. And for the surgical dressership in July.”
“After Finals Part One,” Fingal said, looking straight at Bob Beresford. “We all have to pass in June.”
“Well, actually, no,” Bob said. “We don’t. As long as we have our certificates we can continue our clinical studies and repeat Part One six months later. The Regulations say so. I should know. God knows how many cracks I took at Intermediate Part Two.”
“And,” Fingal asked, “how many goes at Finals Part One were you thinking of having, Bob?” Fingal had had a heart-to-heart with Bob two weeks ago, but it clearly had been as much use as farting into a force-ten gale.
Bob reddened. “Well I—that is—”
“Haven’t been studying quite as hard as you might?”
Bob looked away, then smiled and said, “You all know I’m in no rush to qualify, which is why I have a suggestion to make about our plan for the downfall of Fitzpatrick.”
“Go on,” Charlie said, glancing at the coat again, “but I reckon if we all confess—if we have to—Micks won’t hold us all up.”
“I’ve a better idea. I know getting qualif
ied as quickly as possible is important to you three.” Bob shrugged. “I’ve all the time in the world.” He lit up.
“What are you suggesting, Bob?”
“I don’t believe Doctor Micks is going to be too enthralled when we pull this off. We’ll embarrass Fitzy all right, but we’ll embarrass Doctor Micks too.”
“Come on,” Fingal said. “Our chief’s not going to treat us like schoolkids. He’ll see the funny side.”
“If he doesn’t?” Bob asked.
Silence.
“I’ll tell you,” Bob said. “We act as planned, but if Micks demands to know the perpetrator, I’ll be happy to own up.”
Fingal said, “A regular Sydney Carton, ‘It is a far, far better thing I do now—’”
“Tale of Two Cities,” Charlie muttered. “Dickens.”
“I’m not so sure I want you going to the guillotine for us, Bob.”
“Facing Doctor Micks is not facing beheading. He might let me off.” He hesitated then continued, “And you’re right, Fingal. I haven’t been working as hard as I should. I’m not sure repeating the medical clerkship would necessarily be a bad thing for me.”
Fingal said deliberately, “All right, but on one condition if the other lads agree.”
“Which is?” Bob asked, and blew a lazy smoke ring.
“Which is, Bob Saint John Beresford, you make a solemn promise here and now—”
“To what?” The smoke ring collapsed.
“To use the next three months to get stuck into the books and bloody well pass Part I with us. We’ll help, won’t we, lads?”
Both grinned and their heads nodded. “Indeed we will,” Charlie said.
Bob’s jaw dropped. “That’s blackmail.”
“Yes,” Fingal said with a grin, “but it’s in a good cause.” He held out his hand and eventually Bob shook it. “It’s a promise, Fingal Flahertie O’Reilly,” he said to the applause of the other two. “But you’re one crafty devil. You’re the Wily O’Reilly, by God.”
“Wily O’Reilly,” Cromie echoed. “I like that.”
A Dublin Student Doctor Page 21
