The Vasectomy Doctor

by Dr. Andrew Rynne

  But the human spirit is strong. Gradually things settled down and some of the more truculent doctors resigned or otherwise drifted off with themselves and we brought in a new and more ‘neutral’ chairman, Jim Canning, who also brought along a few very welcome new investors. But most importantly of all more consultants were now beginning to take an interest in the place and my replacement CEO, Seán Leyden, along with his wife, Gladys, who was and still is, director of nursing, steadied the ship and we were beginning to head for calmer waters. In fact within five years of opening the hospital we were at least solvent and in a position to start building our phase two development. This consisted of an additional twenty-five-bed wing of private and semi-private rooms, a new and expanded x-ray and ultrasound department, a new physiotherapy and sports-injury department and a suite of seven additional consulting-rooms. We were getting there.

  * * *

  Dawn comes slowly over the South Slobs in Wexford. My good dog Jet is beside me in my hide shivering slightly and looking out over the brackish water. She is there to retrieve shot ducks. We are lucky to have been drawn for the Tongue Gate where hundreds of teal are stirring themselves. There is a decent wind up with spits of rain mixed into it. This is good wildfowling weather. Teal, when they have a tail wind behind them, can travel at speeds in excess of fifty miles an hour. Shooting does not get any more challenging than this. I can hear their wings cut through the air, as they turn high overhead. But I can’t see them properly yet; Jet and I must wait for more light.

  It is 6.45 on this mid-December Sunday morning. Soon the winter sun staggers along the horizon like a drunken man reluctant to make a proper appearance. Now I can just about make out my surroundings. The tall reeds on each side of the channel are copper and gold. The water is shimmering silver. I can see the blinds 300 metres across the channel from me in the reeds of the Pill of Ray. A gun, Jack-in-the-box fashion, mans each hide. The fellows over there all work in the AIB. We call them the A team. All is still. A coot calls from somewhere and a reed warbler warbles.

  Now I catch a glimpse of three teal heading my way and about to cross high right to left twenty-five yards out from our blind. I bend low in the hide and press the safety catch forwards with my thumb. The dog is looking at the birds and back at me. She is deeply suspicious of the outcome for she has seen me miss so many times. In two seconds I am up and onto them. I pick out the leading duck. To kill a bird going this fast you have to catch up with him first, them get ahead of him by a good ten feet and then, and this is the bit we all forget, you do not stop the gun but keep it sweeping forwards of your target all the time. For a change I seem to have done all the right things this time because when I squeeze the trigger the teal tumbles in the air feet up and comes crashing into the reeds thirty yards off to my left.

  The dog is away. There were no whistles, no hand-signals, and no ‘good dog, fetch up’. She dives in and is away of her own volition. She has seen where the bird has fallen and it is all down to herself from here on. Deep inside the tall reeds I can hear her splashing about. The tops of the reeds shimmy to her movements below and then suddenly there is silence and stillness. Every wildfowler knows this moment.

  The black Labrador has stopped moving inside the reeds. But has she stopped because she has lost interest or has she stopped to pick up the small bird? In two minutes she is swimming towards me with the teal held in her soft mouth in the water in front of her. This is the miracle and the wonder of wildfowling. Not that a man can shoot a bird but that a dog can then go and find it. No human being can do that. And best of all the bankers across the channel have seen all this and I feel so proud, not for myself at shooting a difficult teal but for my good dog Jet for finding it.

  CHAPTER 11

  The End of a Marriage

  At this stage I have been relegated to the bedroom haunted by Alice Aylmer, the jilted wife of the last Bury of Downings. I had been in there for the last three months and was to stay there for another two years until I eventually came to terms with my broken marriage and quit the house altogether. I have only three bits of advice for you if your marriage runs into difficulty, advice that I spectacularly ignored, of course, in my own case. Firstly, do not ask yourself ‘what will people think of me?’ because the question is totally irrelevant. What people think of you and your marital breakdown is neither here nor there and utterly unimportant. Your first duty is, as always, towards yourself.

  When I was first trying to come to terms with marital breakdown I was in denial. And when considering moving out and into, for example, an apartment, I wondered what my patients would think of me and would my practice suffer. In actual fact my patients could not care less if I was living at home or on the far side of the moon but that is not the point. The point is that I was very stupid to be asking the question in the first place.

  The second piece of advice is to either end it or mend it but do not just ignore it because it will most certainly not go away. Nor will it ‘come right in time’. Again in this department I was quite pathetic. When I look back at it now I wonder just what was I thinking about when sleeping in that spare bedroom for almost two and a half years. Did I really think that that was normal or that one day things would, as it were, right themselves?

  And lastly of course talk your problems over with a trusted friend or confidante and share the problem with your offspring in a non-threatening way. I never told a sinner that my marriage was foundering nor did I let any of my children, then in their late teens and early twenties, in on the true situation. Now I think that was a mistake.

  * * *

  The man smoking the pipe is a psychiatrist and a marriage counsellor. He is a small neat man in his mid-forties. We are in this big room in this old hospital called St Pat’s. At the first hour-long session he speaks to both of us together and tries to come to some understanding as to why it is that we are not getting along and why are we making ourselves generally miserable. The next two sessions are individual ones, one for Ann, followed by one for me. The last hour-long session is for both of us. This was a fairly standard couple-counselling format.

  It is tempting to say that the marriage counselling was no use and a waste of time or that our therapist was inept and unhelpful. The fact of the matter was that our relationship was as dead as a duck and there was little point in expecting miracles. What these sessions did do was make us focus in on our relationship problem and to respect the legitimacy of the other’s point of view. While this didn’t save the marriage it did nonetheless take a lot of the heat out of the situation and rows and arguments became practically a thing of the past. After about another year both of us were ready to move on to the next step, to mediation and separation. The gig was up and the die cast.

  * * *

  I was driving home from work and listening to a man being interviewed on the radio. The man was a retired Irish army officer who had served some time out in Namibia and was now organising groups of Irish to take two weeks travelling on safaris in that strange and very beautiful land. The way the retired officer was describing the place made it seem so interesting and attractive. They gave out his phone number after the programme and I took careful note of it. I wanted to have a look at Namibia.

  Actually there was another reason for my wanting to travel other than to look at the giraffes and baboons of southwest Africa. With total marital breakdown finally acknowledged and mediation counselling entered into I was, as it were, on the market or at least certainly did not cherish the prospect of living out the rest of my life alone. Perhaps then I might meet someone interesting among this group of forty Irish thrill-seekers. But if that’s what I thought then a quick look around the departure lounge where we mustered before takeoff very quickly quenched any vague notions I may have been harbouring about Africa, romance and safari. They were a lovely diverse bunch of people, many indeed with problems of their own but future partner potential? I hardly thought so.

  A few days after returning from Namibia I was having a pint with B
illy Byrne in O’Brien’s of Leeson Street, a famous old Dublin pub with wooden floors and old-fashioned layout. In the pub at the same time were Joan Morrissey and her friend, Dee Ryan. Billy knew both of these ladies to see and we got chatting to them. The upshot of the whole thing anyway was that I stayed up more or less all night talking to the two women. Within a few weeks of this chance encounter I packed my things, moved out of Downings and started to live with Joan in Ballsbridge. After my separation a few years later I bought back Ann’s share in Downings House and returned to live there with Joan who I married a few years later and everyone lived more or less happily ever after. It is funny how things have a way of working themselves out, painful and all as it may have been for all involved at the time.

  * * *

  I caught my first salmon on the Moy river when I had just turned sixty-two years of age. The Moy river rises high in the Ox mountains, swings down through Foxford before heading due north through Ballina and on out to the sea in Killala Bay. The Moy is not an enormous river but it just so happens to be one of the finest salmon fishing rivers in Europe, if not in fact the finest one. It is fished for nearly all of its length but the most popular places are in the town of Ballina itself. As you cross the bridge leaving the town the Ridge pool is on your right-hand side and the Cathedral pool is on your left. The Ridge pool is an icon in the world of salmon fishing. Since I am very new to this sport and my friends want me to catch my first salmon before I die they very wisely take me to the place where my chances of doing so are at their greatest. At my age there is little point in wasting time.

  We pull in and get out of the car to take a look. This place is pure street theatre. All along the length of the river on both sides people lean over the wall and watch the anglers down below as they strut their stuff. They have for the most part waded out into the middle of the river up to their waists and higher in the water. Every ten or fifteen seconds a salmon leaps clear. These are all big fish. Most impressive of all are those who use the long double-handled fly rods. These are used to ‘spay cast’ which is a sideward action as distinct from the more usual overhead casting technique. In one smooth movement they haul their long floating line out of the water and bring it back up beside them in a loop before casting it out once more across the flow of the river. As the long line turns before making its outwards journey it emits a loud ‘swish’ and a whip-crack sound. It then follows a dead straight and tight journey to gently drop the sinking fly thirty yards away. I do not know how they do this but I could watch them all day. This is all art and drama tied up in one.

  Over dinner I complained to my friends that this stuff is way beyond my new-found skills as a fly-fisherman and that perhaps it was a mistake for me to have come here. First of all I hate wading in strong currents and always feel that I am going to fall over at any second. Then there is the matter of not owning or knowing how to use a two-handed rod. And thirdly I did not relish the thoughts of having a large audience leaning over the bridge watching me flounder around in the river below them. But my friends just ignored me and said I’d be fine, that my single-handed rod would do grand and the current wasn’t that strong and there would be nobody looking at me and would I ever shut up and drink my wine.

  We are on the Moy the next morning at six o’clock. When you are booked onto the Ridge pool there is no messing. Starting times are all to do with tides and I have exactly seven hours to catch my first salmon. They are jumping out of the water all over the place but the question is will they be interested in my poorly presented offerings. There are five rods on this stretch. You wade out into the middle of the river starting at the top beside the weir. After three or four casts you move down a few yards and proceed like this until you are down under the bridge at which stage you get out of the river, walk up to the top and start all over again. My friends were right – wading is not too bad. The riverbed is smooth and I can get a good grip on it, the current is manageable. I forget about falling in and my single-handed casting, while failing to draw a thunderous round of applause from the crowd up on the bridge, is nonetheless adequate. I am lost in what I am doing, too lost to care about extraneous matters like audience or style. Then suddenly BANG!

  When you have a decent salmon on a single-handed rod you must make sure not to horse him but to let him run while always keeping in touch, never let your line slack but do not haul on it either. All my fishing companions on this stretch of the Moy are seasoned anglers and are well aware that I am only a doffer. But they kindly take me in. Soon a man is by my side with a landing net at the ready wanting to know if I have ever done this before. When I tell him that this is my first he is full of gratuitous advice and help. Anglers, like all proper sports people, help each other out. After about six minutes, during which time my salmon runs three times but never all that far, the fish flounders and I can lift his head out of the water. At this stage my helper slips the landing net under my catch and we have him on the bank, all five and a half pounds of him. This is a great country and thank you Mayo for my first real decent wild fish.

  * * *

  During my time living with Joan in Ballsbridge I became involved in a strange way with what was referred to then as the ‘right to die’ case. This was during the long hot summer of 1995. But I need to go back to the beginning.

  Sometime during the spring of 1972 a bright and pretty young Dublin woman, well-educated and in the prime of her life, was suffering from painful periods or dysmenorrhoea as we call it in this profession. She was twenty-two years of age. About eighty per cent of all young women suffer from painful periods at some stage or other of their lives. Most of these women manage to keep going by taking something like Paracetamol for the first few days of their periods. In about ten per cent of young women however the degree of menstrual cramping can be so severe and incapacitating as to make it impossible for them to keep going and they may have to take to the bed or otherwise rest themselves holding a hot water bottle to their tummies. Thus they may have to miss out on school or work for a few days each month. Such young women therefore may need stronger treatment than simple over-the-counter analgesics. This young Dublin woman was such a case. She went to see her GP and he referred her to a conservative obstetrician gynaecologist. This was a bad mistake on behalf of the GP. Some GPs are in the habit of always playing it safe and referring anything more serious than the common head cold to specialists. Our young woman going to see a gynaecologist in April 1972 to treat her dys-menorrhoea was unwittingly heading towards catastrophe. The GP should have been able to treat her himself. This is not rocket science. The standard treatment for severe dysmenorrhoea back in 1972 was then, as it remains to this day, the oral contraceptive pill. By blocking ovulation you can stop painful periods in their tracks. You might think that this kind of treatment was ‘too severe’ but remember, if someone has menstrual cramps so severe as to render them incapable of going to school or work for two or three days a month, then treatments like the oral contraceptive pill are absolutely justifiable in the eyes of most reasonable doctors.

  Unfortunately her GP did not take this view. Even as late as 1972 there was tremendous resistance among many Irish doctors to prescribing ‘the pill’ to unmarried women, particularly to sexually inactive unmarried young women. There was this ridiculous notion abroad that such prescribing could promote promiscuous behaviour. Whether it would or wouldn’t is not the point and in fact is none of the doctor’s business. The doctor’s business is to treat the painful periods in the safest and most effective way possible. And prescribing the oral contraceptive pill is in most cases just such an approach. But our GP in this disastrous case flunked it and took the easy way out and kicked for touch. He decided to refer the young woman to a gynaecologist – a decision that was to have catastrophic consequences.

  Gynaecologists operate. That is their stock-in-trade if you like, it is what they do. So the gynaecologist decided to perform a D&C on her. A D&C, or dilatation and curettage, is an operation on the womb where the cervix is
dilated to allow an instrument inside to scrape away the womb’s lining or endometrium. As a treatment for dysmenorrhoea, even back in 1972, it was already long outmoded, dangerous, ineffectual and totally inappropriate. But in this case it was to be much more than any of these things: death or, worse still, near death. She never recovered from the anaesthetic. During the operation she suffered from three cardiac arrests or heart stoppages. Each of these resulted in her brain being starved of oxygen for prolonged periods of time.

  When the anaesthetic gases were eventually removed and efforts were made to bring her around she did not respond. Instead she lapsed into a deep coma or what is usually referred to as the ‘persistent vegetative state’ or PVS. To be strictly accurate about it in fact she was in a near-persistent vegetative state. Because she seemed to have glimmers of cognition in being able to perhaps recognise some of her long-term carers her condition was thought to be something slightly less than PVS. You might think that this was somehow good news. But it wasn’t, quite the reverse in fact. It raised the possibility of her being vaguely aware of her predicament, which of course would have made her life intolerable. But things were to get even worse than that.