A Dublin Student Doctor

by Patrick Taylor

  “Finish your drink,” said Lars, “and we’ll go back to the car. They’ll be heading inland soon. We’ll nip up a side road. There’s a hill with a great view.”

  Fingal took the last swallow, found a wall to put his glass where Davy’d find it, and set off with his brother. Fingal’s mind returned to that evening studying leukaemia with Bob Beresford. “It wasn’t until she’d married an army captain that I realised I’d let a gem go.” That gem was now Lady Laura MacNeill and if looks were anything to go by she was a corker. He thought of Lars and Jean Neely, and of Kitty O’Hallorhan with her soft grey eyes and soft laugh, who had been willing to wait because she understood how important his studies were. Who’d told him she loved him. Fingal inhaled. It seemed all the best people let gems go. Certainly Bob had called Kitty a jewel.

  Fingal got into the car and sat quietly as Lars turned right, climbed a long hill, then parked. “Out.”

  They crunched through a shallow drift and stood in front of a dry stone wall. Fingal looked down. In the distance the Mourne Mountains seemed to hold up a porcelain sky so delicate it looked as if it might crack if left unsupported. High clouds drifted to the south. A skein of grey-lag geese, tiny marks against Strangford Lough, moved in a ragged vee over the wishbone-shaped Long Island. It lay beside the neighbouring Round Island. The two were white moonstones in the blue enamel of the still waters. They were owned by a wildfowling syndicate of four physicians led by a Doctor Jimmy Taylor from Bangor.

  Inland the little fields were wrapped in a snowy eiderdown that rose and fell over the drumlins, the round hills of County Down. Their bordering hedges and dry stone walls were limned with white. Patches of brown bracken and dark green whin bushes were all the colour to be seen.

  He heard the huntsman’s horn, the belling of the pack, and in the valley not far below saw a russet blur, a fox racing across a field of unbroken snow. Fingal knew the creatures’ numbers must be controlled, they ate chickens and game birds, but his heart went out to the animal running in what must be mortal terror. It vanished under a blackthorn hedge.

  The hounds had the scent and tore along, noses to the ground, tails in the air, an untidy string of twelve couples, twenty-four dogs spread out over a field.

  A hoarse cry of, “View Halloo.” Someone had spotted the quarry in the open.

  The horses, brown and chestnut, black and grey, thundered across the field hard on the hounds’ heels. He could hear the drumming, see earth and snow thrown up from the hooves. As they came nearer, the riders and steaming animals took clear shape. He had no difficulty recognising the army officer and his wife galloping side by side, Lady Laura MacNeill’s ponytail a chestnut battle ensign streaming in the wind of her passage. Clearly her ankle was troubling her not one whit.

  A man’s black peaked hunt cap blew off. “Tally-ho.” He’d seen the quarry too. Headgear forgotten, he urged his horse on.

  In small groups and singly, horses and riders leapt at the hedge where Fingal had last seen the fox. Up. Seem to hang. Over. Land. But not all. Two horses wandered, reins dangling as foxhunters picked themselves up. One remounted. The other limped as he led a grey away from the hedge and clearly was heading for home. The stragglers were still attempting the hedge and now the last horse baulked and unseated its rider, who quite unaccompanied cleared the hedge and landed with an audible thump. Fingal was happy when the unfortunate picked herself up and walked to a gate.

  Three up to Brer Fox. Fair play to the creature.

  The sounds of the hunt died in the distance until barely audible, drifting on the still air came the cry, “Gone awaaay. Gone awaaaay.”

  He smiled. The hounds had lost the scent, and the fox, probably in its lair by now, was safe.

  “That’s it, Fingal,” Lars said. “Unless you want to go and welcome them back.”

  Fingal shook his head. “It was quite the sight. Thanks for bringing me.”

  Lars smiled. “I’m glad we got a fine day for it.”

  Fingal laughed. “‘Half a league, half a league, half a league onward, into the valley of death rode the six hundred.’ Stirring stuff this fox hunting, but my cheeks are like blocks of ice and I’m foundered. Home, James, for a hot half-un.” He piled into the car.

  He still carried a mental picture of Lady Laura’s dancing ponytail, her refusal to let a sprained ankle stop her from revelling in the chase. It would be better not to mention to Bob that Fingal had met her. No need to open old wounds.

  Fingal swayed as the car turned a tight corner. Twigs scraped along his side and he looked out to see a blackthorn hedge like the one the fox had first taken cover under. Fingal was pleased that the animal had outwitted its pursuers. He glanced at his brother. The fox had got away from the pursuing hunt just as Jean Neely had from Lars. Just as Bob had let Laura go. And just as the fox was now safe and getting on with its life, so was Jean Neely, so was Laura MacNeill. Both women had moved on, fallen in love again.

  Fingal O’Reilly stared through the windscreen and felt a great unease at the thought of Kitty O’Hallorhan marrying someone else. Did he really have to let her get away too? He’d chased her off and wished to God he hadn’t. To hell with the colleague she was reportedly seeing. Fingal had told Charlie he’d ask her for a second chance after the exam results were in. They were. He’d passed. So what was holding him back?

  41

  From His Mother’s Womb Untimely Ripp’d

  “Come on, Bob.” Fingal shot to his feet. He’d been startled by the jangling of an electric bell in the Rotunda gentlemen’s mess. It and other strategic sites in the hospital, like the women’s common room, had bells. They were the summons for all medical students to drop everything and hurry to the labour ward. Something unusual was about to take place and they were to observe.

  Cromie and Charlie were on labour ward duty so they’d be there. Hilda and Fitzpatrick would be trotting over from the antenatal clinic.

  They were in the first of eight weeks of structured practical instruction in midwifery and gynaecology, the introduction to a course that would consume five months. They’d already attended the ten introductory lectures given at Sir Patrick’s by the King’s Professor of Midwifery, O’Donel Browne.

  “What do you reckon?” Bob asked as he closed the door behind them.

  Fingal shook his head. “Dunno. Could be anything. Forceps, breech—” He’d seen one breech delivery and had been impressed by the skill of the accoucheur, a skill no doubt that had taken time and experience to attain. Fingal had observed three normal confinements. All students had to watch five then conduct deliveries themselves under supervision, some in the hospital, some in the patients’ homes.

  He was liking midder. The women weren’t sick. Well, some with complications of the pregnancy were, but on the whole this speciality was a lot more cheerful than the ones where watching the likes of Kevin Doherty die was an integral part of the work. Every woman he’d observed was happy once the baby was born. As he heard it said, “Och sure, but doesn’t a babby bring its own welcome?”

  And in midwifery there were techniques that could turn difficulties around and lead to excellent outcomes. Fingal lengthened his stride, pushed open the door to the labour ward, and entered a rectangular room. Beneath three large windows in the far wall was a row of enamel sinks. Electric lights hung on long flexes from a high ceiling. Even in midwifery the cornerstones of good care were light and airiness. Of the five cast-iron-framed beds in the room, one was vacant and three were occupied by labouring women.

  The fourth was surrounded by the resident house officer, here called the clinical clerk; two midwives; the rest of Fingal’s group of six; and ten other medical students. Some were from Trinity, but others were from the undergraduate school at the Royal College of Surgeons in Ireland and there was one Scottish chap from the University of St. Andrews. A senior obstetrician, Doctor E. Hastings Tweedy, stood at the head of the bed speaking to the group.

  At regular intervals one of the three women in the
other beds moaned, cried out, begged the Holy Mother for relief. One kept wanting her own mammy. Midwives and midwives in training listened to the babies’ heart rates and examined each patient to determine her progress. At the appropriate time she would be delivered either by a medical student or a student midwife. Consultants like Doctor Tweedy were summoned only for complicated cases. Their private fee-paying patients who had normal deliveries were confined in nursing homes or their own beds, and not subjected to the ministrations of students.

  “It stinks in here,” Bob said.

  There certainly was an astringent aroma. Fingal wrinkled his bent nose. “It’s Dettol, a new antiseptic. Have you read the Davidson report?” he asked. “I did last night.”

  “Not yet. Not in detail, but I know it’s about last year’s outbreak of puerperal fever, postpartum infection, here. There were five maternal deaths. It’s on my list.” Bob grinned at Fingal. “Honestly. It is. I will read it. I promise. I know it’s important. Postpartum infection is serious stuff.”

  “You’d bloody well better. It could be a step to the greatest advance in years. The infection’s caused by the haemolytic Streptococcus. Doctor Davidson has three recommendations to combat it. One is using this new antiseptic, the second is wearing masks, because Davidson cultured the bacterium from throats and noses of doctors and nurses and reckons they were the source.” Fingal lifted a couple of masks from a box on a table near the door, handed one to Bob and started to tie his own. “And, the third is a drug that prevents the development of streptococcal blood poisoning in mice. They’ll be running a trial here.”

  “Honestly? I didn’t think any medicine could do that.”

  “This stuff called Red Prontosil just might. It’s a sulphonamide. Jesus, Bob, if it works for postpartum infections—remember Kevin Doherty?”

  Bob nodded.

  “We might finally have something to treat rheumatic fever with too, before Streptococcus damages the heart valves.” But too late for you, Kevin, he thought. Fingal gritted his teeth, finished tying on the mask, and said through the material, “Now, let’s go and see why we were summoned.”

  Doctor Tweedy looked over his mask at the new arrivals. “Let me briefly recap for you two. Mrs. EL is a twenty-year-old primigravida.”

  So it was her first pregnancy, Fingal thought, looking at a short, thin woman. She was pale, the bags under her eyes dark and deep. There was blood on her lower lip, probably because she had bitten it. Her gaze never left Doctor Tweedy’s face.

  “Her estimated date of delivery was December twenty-eighth so today, January eighth, she is eleven days overdue. She went into labour at home some thirty-eight hours before she was admitted.”

  Mrs. EL moaned and clutched her bulging belly.

  Fingal marvelled at the endurance of women. Nearly two days in labour.

  “The district midwife was summoned to the patient’s home on Railway Street early this morning, examined the patient, and concluded that the baby was lying longitudinally, vertex presentation, right occipito anterior.”

  The child’s spine was aligned with its mother’s, it was coming headfirst, with the back of its head turned slightly to the right and facing the front of the mother’s abdomen. This was the normal lie and presentation.

  “It was not engaged.”

  So the widest part of its head hadn’t passed the pelvic brim.

  “On rectal examination, the cervix was five shillings dilated and the vertex two knuckles.”

  It was believed there was less risk of infection if the rectal route was used for examinations to assess the progress of labour. Using coin sizes to assess how far the cervix was dilated was routine, as was the use of “knuckles.” The midwife had described a cervix that had only completed half its necessary dilatation and the leading edge of the baby’s head was the distance between the second knuckle of her index finger from its tip and the tip from the pelvic floor. Both indicated poor progress.

  “The midwife sensibly suggested the patient be brought here. Mrs. EL applied at the Porter’s Lodge for admission. The assistant master, Doctor Edmond Solomons, as is the custom, agreed. He put her under my care. It was determined that because of her social circumstances, the six-shillings-a-day hospital fee and my own would be waived.”

  Fingal knew that all patients, except in these kinds of circumstances, were expected to contribute to the cost of their care. Rightly so, but money should not stand between a patient and proper help, and here, like in the twenty-five percent of beds set aside in Sir Patrick’s, it clearly wasn’t.

  “It has taken us some time to assess her progress and have tests done. So altogether she has been in labour for forty-one hours. The adage is a true one, ‘Never, never let the sun set twice on the same labour.’ She has had a gruelling two days and has suffered many examinations,” said Doctor Tweedy, “so I will not invite any of you to repeat anything. Instead I will tell you, there has been no change in any of her physical findings. Labour has not progressed and her contractions are becoming less frequent and less powerful. She is clearly distressed. What does all that suggest?”

  “Obstructed labour, sir,” Fitzpatrick called from where he stood at the front of the group, “due to a fault in one of the ‘Three Ps.’”

  “Which are?” Doctor Tweedy asked.

  “The powers, the passenger, or the passages.”

  “Very good. You,” Doctor Tweedy pointed at Charlie, “what could be wrong with the powers?”

  “Either the uterine contractions simply aren’t strong enough, primary inertia, or more likely in this case, something else is delaying progress and the uterine muscles are exhausted trying to overcome it and are giving up. Secondary inertia.”

  “Assuming there is a difficulty with Mister Fitzpatrick’s second P, the passenger, what might it be?”

  Hilda Manwell said, “If the midwife is right, it is unlikely that a malpresentation could be responsible.”

  “You, sir,” Doctor Tweedy nodded at Fingal. “Malpresentation?”

  “When any part of the baby other than the head with the occiput anterior is trying to get into the pelvis. That would include—” Fingal had read up on the subject immediately after Professor Browne’s lecture. How much had he remembered? “Occipito-posterior, occipito-transverse, breech, face, brow, shoulder, and transverse lie.” Got ’em, he thought.

  Doctor Tweedy smiled. “Been studying, I see.” He turned back to the other students. “Anything else that might be wrong with the passenger?”

  “Yes, sir,” Fitzpatrick rushed in. “Abnormal size, malformations, double monsters—”

  The patient screamed, high, piercingly, then yelled, “Jesus, Mary, and Joseph, my babby’s not a monster. It’s not.” She burst into tears.

  You are an insensitive bastard, Fitzpatrick, thought Fingal. Could you not have said teratology for malformations, conjoined twins for double monsters? We’d have understood. She wouldn’t. Fingal now believed that keeping the patient in the dark often was a kindness, at least until the final diagnosis was in. That medical jargon wasn’t all hocus-pocus. Sometimes it was kindly meant.

  Doctor Tweedy bent to her. “It’s all right, Mrs. Lannigan. I can promise you your baby’s absolutely normal and it’s going to be perfectly all right. I promise.” He took and held her hand. “Tactless, Mister Fitzpatrick,” he said levelly. “Very tactless.”

  Fitzpatrick stepped back from his place in the front row. Fingal saw the submissive crouch the man often assumed when chastised. Would that eejit never learn?

  “As you all can see, Mrs. Lannigan is upset, so I’ll come to the point. She has secondary uterine inertia, not because there is anything remotely wrong with the baby.” He patted her hand and was rewarded with a smile. “But because there is something in the passages holding things up. We have carried out some investigations and decided on a course of action before you all were summoned.” He turned to the resident houseman. “Doctor Milliken, please.”

  The junior doctor, a san
dy-haired, short man tending toward chubby, stepped forward and produced an X-ray. He held it up to the light.

  Fingal craned forward. The baby’s skeleton was perfectly normal, as was its head.

  “Please note,” said Doctor Tweedy, “the distortion of the pelvic brim into a figure-of-eight shape when it should be like a fat heart. The waist of the eight is too narrow.”

  Fingal could see that clearly.

  Doctor Tweedy bent to the patient. “It means that things are a bit tight and baby is having trouble getting through.”

  She nodded, her little old woman’s eyes following his.

  “So while I and the young doctors here have been discussing your case, the nurses have been getting things ready and we’re going to do a Caesarean section. Doctor Milliken and I will operate and the young doctors will observe. And you and your baby will be fine. I promise.”

  So time hadn’t been wasted simply to teach, Fingal thought. Good. After six months of surgery, Fingal was not squeamish about the prospect of watching a Caesarean section.

  He heard footsteps and the quiet rumbling of wheels. Two masked orderlies were bringing a trolley. “We’re going to take you to theatre now, Mrs. Lannigan.” Doctor Tweedy let go of her hand. “You’ll be fine.”

  Fingal waited with the rest as she was moved to the trolley and trundled out of the ward.

  “Now, before we go and get ready,” Doctor Tweedy said, “why do you think her pelvis is flat and contracted?”

  “Rickets, sir,” Fingal said. “There’s never much sunlight in the tenement districts even on a good day. Pretty poor nutrition. Half the kiddies there have bow legs, twisted spines.”