“Thank you. Anyway, you know Norma Cochrane.”
“Twenty-six. Lives on the Shore Road. Husband’s an avionics expert at Short’s aircraft factory. He has a face not even the tide would take out, but they seem very happy together. It’s her third pregnancy. Last normal menstrual period…” He frowned, then said, “March fifth, so she’s—thirty-six weeks today. Oh yes, and she plays the balalaika and the penny whistle.”
Jenny shook her head. “Doctor Fingal Flahertie O’Reilly, walking department of medical records. Balalaika and penny whistle? I’ll bet you know her granny’s name too.”
“Paternal is Susan, maternal is Joyce.” He lit his briar.
She chortled. “I despair. I’d need her chart to remember the half of that.”
He bowed his head in acknowledgement. “Jenny, I’ve been here for nineteen years. When you’ve been in one practice for as long you’ll remember your customers too. And before you say anything, we’ll have Barry’s answer in three and a half weeks.” And God knows, he thought, it’s getting to be a toss-up who I’d rather have stay. “Tell me about Norma.”
“I wish she’d sent for one of us,” Jenny said. “She’d have been much better seen at home and then packed off by ambulance to the Royal Maternity Hospital. She had an antepartum bleed, but it stopped so she came to the surgery.”
“It wasn’t painful?”
She shook her head.
“Sounds like a placenta praevia to me,” he said. “She should be in hospital.”
“She is. I kept her here until the ambulance came. She’ll be in RMH now.”
“Good,” O’Reilly said. “I’m sure she and her baby will be all right. It’s not good when the placenta comes before the baby, but it’s not as bad today as it was. Prof MacAfee, here in Ulster, did the early work on treating the condition conservatively. He got the maternal mortality down to half a percent and the fetal mortality down to ten percent. Have you any idea what those figures were in my day?”
“Not the foggiest, but I’ll bet they were much higher.”
“Much higher. Maternal seven percent, fetal more than fifty percent. Seven women out of every hundred with the condition died. And half the babies.”
“That’s appalling.”
“I know. I was a trainee obstetrician for a year. I saw it all. And that’s only thirty-odd years ago. People forget what a bloody risky business childbirth was and how the work of a few dedicated physicians like Davidson, MacAfee, Stallworthy, Lewis, Whitfield, have made it seem routine today. Sometimes,” he frowned, “sometimes I get a bit tired of some of the evangelical ‘natural childbirth’ brigade. I’m all for as little interference as possible,” he puffed out a cloud of smoke, “but I saw what that was like back then and I know what my colleagues did to improve things out of all proportion and I’d never want to turn the clock back.” He shuddered.
“I’m very glad I’m living today,” said Jenny, glancing down, then back up at him. “I love medicine, but one day I do want to get married, start a family. It’s good to know that’s not so dangerous for me as it would have been in your younger days, Fingal.”
“At least we did have blood transfusions, reasonably effective anaesthetics, fairly safe Caesarean sections. Can you imagine what it was like prior to that? And we were on the brink of the antibiotic era then too.”
“Penicillin, tetracyline, streptomycin, chloramphenicol. I don’t know what we’d do without them.”
“I do,” said Fingal quietly. “We had to watch a lot of people die.” He brightened. “But we did have the sulphonamides, the antibacterial drugs that preceded the true antibiotics. The first was called red prontosil. I’ll tell you a story about it one day, but you said you’d to be on your way. I’d not want you to keep Terry waiting.”
She rose. “Nor would I. He’s a lovely lad.” She paused at the door. “’Night, Fingal. I hope you’re not going to be too busy.”
O’Reilly blew out a blue cloud and sipped his whiskey. He heard Jenny greeting Kitty, and in a moment she had stuck her head into the lounge. “I’m home.”
“I’ve missed you,” he said, standing. “Drink?”
She crossed the room, pulled off her headscarf, and shook her hair free. “Not just now, thanks.”
He waited until she was seated and took his own chair.
“I came in through the kitchen. Kinky was able to tear herself away from a conversation with Archie long enough to tell me she’s made us lobster thermidor tonight. I thought a bottle of wine would be called for?” She cocked her head and pursed her lips.
Oysters weren’t the only denizens of the deep that reputedly got a fellah’s juices flowing, and Kitty knew that very well. “Bloody good idea,” he said, and by God, Jenny was out tonight. O’Reilly inhaled and cleared his throat.
“I thought so,” she said demurely, “so I popped a couple of bottles of Pouilly-Fuissé in the fridge.” She raised a wicked eyebrow.
“Wonderful,” he said, and knew his voice was husky. “Why don’t we eat up here? It’s horrid out”—The wind rattled the panes and moaned—“but the fire’s lovely and cosy and we can put on a lump of turf. I’d not mind a bit of music to dine to, say Mendelssohn’s Violin Concerto?” He stood, bent, and kissed her very firmly. “That,” he said, “is because I love you very much, Mrs. O’Reilly.” He felt her tongue tip on his, stepped back, and took a deep breath.
She crossed her legs demurely with a mere whisper of nylon. “It’s our four-months-and-two-days wedding anniversary.” Her smile was feral. “I’m sure we can find some way of celebrating after a lobster dinner.” Up went her right eyebrow.
O’Reilly choked on his whiskey, then laughed until he cried. “Kitty, my love,” he said, “as usual I’m sure you’re right.” But after dinner. Calm down, boy. He took a very deep breath, swallowed, and said, “It’s always important to have something to celebrate. We made it a rule that we couldn’t have a ta-ta-ta-ra in the students’ mess at Sir Patrick Dun’s unless there was a reason. Last one I remember was Monday, June 18, 1935.”
“And the reason was?”
“The birthday of the late—as far as we knew—Anastasia Nikolaevna Romanova.”
“Who?”
“The last tsar’s daughter. Don’t you remember, they made a film about her with Yul Brynner and Ingrid Bergman years ago? When I was a student, people were still talking about whether or not she’d survived the Russian Revolution. So we celebrated her birthday, June 18, 1901, it was. Our 1935 do was a grand celebration, fit for a grand duchess, I can tell you.” He laughed.
“Eejit,” she said. “I love to see you laugh, you old bear.” She used a hand to rearrange her hair, twisting it into a knot at the back of her neck. “Do you know, I think I might have a small G and T after all.”
“Right.” He rose and busied himself making her drink, singing sotto voce,
from city or country, a girl is a jewel
And well made for grippin’ the most of the while …
“And how was your day, my dear?” he asked to give himself a further chance to calm down.
“Pretty much the usual, but I saw Cromie. I’d spoken to him about Helen. He’s had a word with Walter Braidwood in Newtownards and sight unseen Walter’s recommended Helen for a ward orderly job next summer. The management committee will decide later this month.”
“Wonderful,” he said, and gave her her drink. “Sláinte.”
She took it, letting her hand brush lightly on his. “Cheers.” She sipped. “What have you been up to?”
He grinned. “‘The daily round the common task—’”
“‘—Will furnish all we ought to ask.’ I used to sing that hymn when I was a little girl.”
“Don’t you start finishing my quotes. It was one thing with Barry, now Jenny’s at it.” He smiled at her. “Jenny’s fitting in nicely, but she said something today that I’d simply not considered.”
“Oh?”
“She’ll want to start a family one day.” He frowned, scr
atched his head, and set his pipe in an ashtray.
“That’s hardly unusual, Fingal,” Kitty said.
“Yes, but how can she do that and work full time? I’ve got very used to having a lot of time to spend with you, love.” Alone with you, love, he thought, and smiled.
Kitty pursed her lips and cocked her head to one side. “I’ve no idea how we’d manage, but we don’t know Barry’s plans yet. And if he’s not coming back and you want to keep Jenny on, as I know you will do, then, as a certain Fingal Flahertie O’Reilly of my acquaintance is wont to remark, ‘We’ll cross the bridge when we come to it.’”
He smiled. “Practical as ever, Kitty O’Reilly née O’Hallorhan. And that bridge might come sooner than later. She’s out with Terry Baird again tonight.”
“Now, Fingal…” She raised an eyebrow. “I don’t think you meant it exactly like that.”
He frowned, and then the double entendre struck him. “Eejit. I didn’t—I mean, I wasn’t suggesting—”
Kitty raised the other eyebrow, then, slipping off her shoes, tucked her feet beneath her in one graceful movement and settled back into the chair.
“I meant I’ve a notion things are serious between those two and he might pop the question. Tonight.”
“Better,” she said. “She certainly came down the stairs at a gallop. Seemed in a hurry to get somewhere.”
“I held her up a bit. I was going to tell her some interesting medical stuff about antibiotics, but I didn’t want her to be late so I said I’d tell her some other time.”
“Good for you,” Kitty said. “A girl does not get dressed up in her best black dress and pearls to hear about antibiotics.” She chuckled and took another sip of her drink.
O’Reilly thought of the story he hadn’t told Jenny; a story of how things might have been a lot different back in ’36 if a certain antibiotic hadn’t made Fingal merely late. He’d missed the date altogether. Still—he looked Kitty up and down, perched comfortably in her armchair—it had all turned out for the best.
“Excuse me, sir,” Kinky said.
O’Reilly spun and saw her standing in the doorway. He hadn’t heard her coming. “Yes, Kinky?”
“Would you mind very much having the lobster cold with just mayonnaise, lemon slices, a potato salad, hard-boiled eggs, and a shmall-little tossed salad?”
“Would I mind? You’re offering that feast to a man who could eat the tyres off a truck.”
“I’m asking, sir, because, and I know it is not altogether right to ask, but something has come up and preparing the lobsters that way would be much quicker. I’d have been doing the garnishings anyway.”
“It’s certainly all right by me,” Kitty said.
“You see, sir—and Kitty, Archie’s mother’s visiting from Greenisland across the lough. She’s eighty-seven and Archie would like for me to meet her, so, and she’ll be leaving first thing in the morning, and—”
Oh ho, O’Reilly thought. Meeting Mama. Interesting. “You do the lobsters, stick ’em on two trays, leave them, give us a shout, and take yourself off with Archie.” O’Reilly smiled and looked longingly at Kitty. “And, Kinky? Have a lovely time and don’t feel that you need to rush home.”
39
… Painful Vigils Keep
“Wake up, Big Fellah. Come on wit’ you now. Wake up.”
Fingal was dimly aware that someone was shaking his shoulder. “Go ’way, Charlie.” He tried to roll over, pull the bedclothes round him, but hands were restraining him.
“Wake up, sir, or you’ll fall off the feckin’ chair.” It was a man’s voice, but not Charlie’s.
Where the hell was he? O’Reilly forced his eyes open, shook his head, screwed his eyes shut and opened them. His surroundings, dimly lit by a guttering, smelly paraffin lamp and the glow of a turf fire, came into sharper focus. “Sorry,” he said, sitting upright in the chair. “Must have nodded off. How’s Dermot?”
“He’s asleep, sir,” Minty Finucane said.
Fingal blinked and said, “What time is it?”
“It’s six fifteen in the mornin’, sir, and you said you’d need to examine him before he’d get his next dose at half past six.”
“Right. Let’s have a look at him.” Fingal pulled off a threadbare blanket—someone must have covered him up—got to his feet, and looked at the mattress in front of the fire. No sign of Dermot. “Where—”
“Orla took him into our bed, sir. He was still shivering. You nodded off at about t’ree. I’ve been sittin’ up so I could wake you at the right time.” He yawned.
Fingal looked at the man’s unshaven face, dark circles under his bloodshot eyes, and rubbed his own chin. He felt the rasp of stubble. “Thank you.”
Minty, carrying the paraffin lamp, crossed the room, pulled aside the blanket that did duty as a curtain, and said, “Dere dey are.”
Fingal turned back a faded rug that once upon a time had been a bright tartan. They lay like two spoons; Orla, her long grey hair spread like a fan, wore only her shift and was on her side with her back to the whitewash-peeling brick wall, arms wrapped round a naked Dermot, who was fast asleep, muttering to himself. His breathing was slower, sixteen rather than the eighteen breaths per minute it had been when Fingal had last examined the boy before giving him his third dose of ten grams of Prontosil at two thirty. There’d been no change for the better since he’d had his first dose, and Fingal had had to discipline himself from examining Dermot every ten minutes hoping for a sign. It was a good thing Fingal had slept. This waiting for improvement was driving him daft.
He touched the lad’s forehead. It was clammy, but was it less hot? Fingal couldn’t be sure and was not going to be taken in by wishful thinking. “I’ll just be a minute.” Fingal went to where he’d hung his jacket on his chair, removed the thermometer from the breast pocket, and snapped his wrist several times to shake the mercury level down below the normal mark.
Kneeling, he slipped it into Dermot’s armpit, then took his pulse by feeling his carotid artery at the angle of his jaw. Still up, but at ninety-six was down from its earlier one hundred beats a minute. As Fingal waited for the thermometer to register, he said, “Can you hold the light, so I can see his leg?”
He managed to slip two fingers into the crease of the boy’s groin without disturbing him. Their tips moved from the inside of the thigh to its outside near the iliac crest, the hinch bone, and did not encounter what Fingal had been dreading. There was no sign of hard, rubbery, enlarged lymph glands.
One of the glands’ functions was to act as hubs to collect the lymph and direct it into larger ducts that eventually returned the fluid into the general circulation. If the fluid carried attackers like living bacteria, the lymph glands mobilised the immune system and became barricades, last-ditch redoubts that tried to keep the invaders out.
When that happened, the glands became swollen and hard. But Dermot’s weren’t. They were not fighting the Streptococci—at least not yet. Fingal took a deep breath. The microorganisms must still be confined to the wound and the lymphatic channels of the leg. Either Dermot’s own defences were holding their own or, and he hardly dared tempt Providence by wishing it so, the Prontosil was beginning to have an effect.
Fingal moved to Dermot’s foot and took off a soiled dressing. The yellow circle cast by the flame was sufficient for Fingal to make out clearly that the ulcer did not seem to be any bigger. Fingal sniffed. The smell was no worse. He looked at the boy’s calf and Fingal’s left fist clenched. A tiny smile flickered on his lips.
He’d used an indelible pencil at the times of giving the first, second, and third doses to mark the furthest upward extent along Dermot’s leg of the red lines of lymphangitis. Three blue lines crossed the ascending red ones at ninety degrees, each about one inch apart. Since six thirty last evening the progress had been inexorable. It had taken all of Fingal’s willpower not to call a halt at two thirty, admit defeat, arrange for hospital admission and, he took a deep breath, amputation. He’
d calculated that as the rate of progress was about one inch every four hours he could take a chance. If the thing did go higher between then and six thirty, the boy would still only lose his foot, not the whole lower leg and now, glory be, there’d been no more advance. Maybe? Maybe? Added to the noninvolvement of the lymph nodes it was promising. “Hold the light steady,” Fingal said. He removed the thermometer and, holding it up to the light, squinted at the silver mercury column. 99.8. It was hardly plummetting from its earlier 100.2, and body temperature tended to be lower in the morning, but it wasn’t getting any higher. He pulled the rug over the sleeping mother and son, taking care to leave the ulcer uncovered. He’d re-dress it in a minute. “Let them sleep,” he said, stood, and inclined his head to Mister Finucane to indicate that they should move back to the fire.
The warmth was pleasant on the back of Fingal’s legs. The scent of burning turf made an heroic attempt, but failed to counter the overpowering tenement smell.
“Well, sir?”
Fingal managed a smile that he hoped might be reassuring. “Dermot’s not out of the woods yet—but he’s holding his own.”
“Will he lose the foot?” Fingal heard the way Minty’s voice trembled. “I’d rather dat dan have him—” He looked down then back at Fingal. “—die. He won’t die, will he, sir? He’s all we’ve feckin’ got.” The man’s voice cracked.
Orla had mentioned that just before Fingal had rushed off to track down a supply of Prontosil. He’d thought it odd that a Catholic family should still only have one child after fourteen years since the birth of their first, but he’d been so concerned for Dermot that he’d refrained from asking why. And now certainly wasn’t the time.
Amputate or go on hoping? Your decision, Fingal O’Reilly, and ask yourself, look in your heart. If you decide to carry on with this treatment, is it for Dermot’s sake—or is it to prove you are right, gain kudos from your colleagues? He clasped his hands behind his neck, pushed his head back, wrestled with the question, then looked at Minty and said, “I think we should wait a while longer. Give the Prontosil more of a chance. Give Dermot more of a chance,” and hoped to God it was the right choice.
Fingal O'Reilly, Irish Doctor Page 32
