After Sebastian had left, O’Reilly said, “Do you remember an article about Ulster by Alan Coren?”
“Didn’t he become deputy editor of Punch this year?”
“Correct, and he wrote a satirical piece about the favourite occupation in our pubs.”
“That of being hospitable to strangers—and making them the immediate topic of conversation the moment they’d left.” Barry finished his pint. “So, what do you make of Doctor Sebastian Carson?”
O’Reilly waited. It was a naval custom at a court-martial to make the most junior officer speak first so he could not be influenced by his seniors’ opinions. “You first.”
“All right. I’m not sure. At first, I thought he was just a toffee-nosed snob, but then I thought, an upper-class background and coming from a first-class public school helps, but you need brains to be accepted at Cambridge. He’s not afraid of authority. Initially, I wasn’t impressed with his reasons for choosing GP and thought he sounded a bit work-shy. And yet—” Barry shrugged.
“And yet—Barry, we both enjoy our free time because of the bigger on-call rota.”
“True, and I nearly bust when he said—” Barry cleared his throat. “Now, I know my upper-class accent isn’t a patch on Jack Mills’s, but I’ve give it a try, ‘I’ve not the remotest intention of being celibate. None whatsoever.’”
O’Reilly laughed. “A sense of humour is critical in our work, and he has one.”
“So, you’d accept him?”
“I’d like to sleep on it. I’m not sure how our patients would take to him.” O’Reilly frowned. “I think he’d be a better fit in practice on London’s Harley Street, home of the physicians to the very upper crust. I didn’t like the way he spoke to the waitress when she asked if he’d like a drink, and if he condescends like that to some of our rough diamonds, we might start losing customers. And then there is the matter of his lateness. I won’t tolerate that.” He nodded to himself. “It’s silly, but did you notice how he spoke of his tortoise?”
“I did. I think he still misses the creature. I wonder if he had many friends when he was little?”
O’Reilly nodded. “My thoughts exactly. All right, we’ll both think on it. Under the crust there may be a decent chap, but I do worry about how he’d fit in in Ballybucklebo. I’ll maybe drop in on George Irwin, see what he can tell me, but for now, I’ll settle up and,” he bent, “come out, you great lummox…”
Kenny emerged, shaking his head.
“We’ll give the long-suffering hound his walk.”
6
Who Knows If the Moon’s a Balloon?
“There’s the little devil.” Charlie Greer pointed to a spot on the X-ray film that was slotted into the illuminated viewing box.
O’Reilly leant forward and saw what looked like a gnarled tree of a lighter colour than the black background. Its trunk, coming from the bottom of the angiogram, ran straight up, curved ninety degrees to the right, then left, then right again, narrowing all the while. Branches, all of lesser diameter, spread out upward like the ribs of a fan.
“See, after the second right bend, that bump inside the loop of the right middle cerebral artery?”
O’Reilly did. It jutted directly from the main vessel, had a body like a tiny hot-air balloon, and was attached to the vessel by a narrow neck.
“We’ll soon sort that out.” Charlie picked up a cloth face mask, put it on, and knotted the ties.
As O’Reilly pulled a white theatre shirt over his unruly dark mop, he thought how calm Charlie sounded, just as he had on Wednesday evening on the phone after confirming he and Pixie could join the O’Reillys and Cromies on Sunday for dinner. “Fingal, your patient Frew’s improving, I’m pleased to say.
“The angiogram shows a middle cerebral aneurysm. I’ll be operating on Friday. The ward sister will be asking his friend, Mister Donal Donnelly, to stop visiting until Saturday. We like to keep the patient as calm as possible for twenty-four hours preop.”
Charlie had asked Fingal if he’d like to observe and he had said yes. And, still unsure about Sebastian Carson, O’Reilly had made an appointment to see Professor George Irwin after the surgery to find out more about the young doctor.
Now here he was on Friday morning, dressed in surgical whites, masked, wearing a white tube-gauze hat, and ready to accompany Charlie into the operating theatre to see exactly what was going to happen to Dapper.
Charlie was singing, “Hi ho, hi ho. It’s off to work we go,” as if he hadn’t a care in the world, although he was going to be taking a man’s life, quite literally, in his hands. More than 40 percent of such patients did not leave hospital alive. O’Reilly himself felt more than anxious. He knew that Dapper, if he survived, could in the short term suffer a stroke or epilepsy or brain damage. If Charlie were inaccurate, he could accidentally place the clip on a normal artery, causing more destruction. O’Reilly shuddered. He looked at Charlie’s fingers and wondered how those fat digits could perform such delicate work, and he also noticed that the brain surgeon’s hands had a noticeable tremor. Was the man quite as relaxed as he seemed?
“Your friend’s already under anaesthetic, Fingal. Kitty and my registrar, Mister Wilson, will have started by shaving the area of the incision and painting it with antiseptic. Then they’ll make scalp flaps over the place where I’m going to crack his nut.” He pushed open the theatre doors.
That last remark may have sounded callous, but O’Reilly understood it was merely part of a surgeon’s self-defence. He followed his friend into theatre. It had been four years since he’d last been in here, to observe Donal Donnelly’s operation. Then he’d been concerned but not overly so. The mortality rate for Donal’s type of surgery was less than 4 percent and Donal had, as expected, survived with no residual damage. He smiled. Donal’s tendency to mix up certain words was something he’d had ever since Fingal had known him.
As an observer O’Reilly had no need to scrub up or wear a gown and gloves. His eyes narrowed as he approached the operation table. Nothing, it seemed, had changed physically in the theatre in four years. Same disinfectant smells, same brilliant overhead operating light flooding the table, patient, anaesthetist, and scrub sister (Kitty) in a brilliant circle of illumination. A circulating nurse who was not scrubbed and gowned waited near a trolley bearing sterile gowns and gloves.
Charlie began to scrub. “For those of you who don’t know, this is my old classmate Doctor Fingal O’Reilly, who’s come to observe us fix his patient. Fingal, this is our neurosurgical anaesthetist, Doctor ‘Minty’ Bereen, and my registrar, Mister John Wilson. Nurse Jean McKittrick, and I believe you know Mrs. O’Reilly.”
“Just a little,” O’Reilly said, and winked at her.
O’Reilly acknowledged the greetings but let his gaze linger on the grey-flecked-with-amber eyes of his wife, who stood with her instrument trolley to Dapper’s left beside Mister Wilson. O’Reilly thought she looked perfectly relaxed, but then why not after more than twenty years as scrub sister?
The only sounds were the rhythmic pulsing of the anaesthetic machine’s bellows as they breathed for Dapper, the running of water suddenly being cut off as Charlie finished scrubbing, and his “Thanks, Nurse,” as he was helped into his sterile gown. As soon as he had gloved himself, he moved to the right side of the table. “Fingal, come and stand beside me.”
O’Reilly did.
“Can you see?”
“Perfectly.” Only the right front side of Dapper’s skull was visible. It could be anybody under the green towels, but O’Reilly was very aware that it was a young estate agent who loved racing greyhounds, had an eye for pretty women, had given Donal Donnelly a roof over his head when the Donnellys’ cottage had burned down, and who would have been terrified until the anesthetic made him unconscious.
Mister Wilson and Kitty had already opened the skull. He returned an instrument to Kitty, who dropped it on the floor where it bounced, clanging twice.
O’Reilly flinched and looked o
ver to his wife. “Sorry,” she said. “Nurse McKittrick, please pick it up and take it away.” She sounded tense.
Charlie said, “Don’t worry about it, Kitty. Accidents happen.”
Kitty, with all her experience, making a mistake? Hard to believe. Although she had looked relaxed, perhaps the stress was affecting her. He had been trying for a couple of years to get her to slow down. She looked at O’Reilly, narrowed her eyes, and shook her head.
“Thank you, Nurse.” Her tones were clipped. Kitty gave a set of forceps to John. “Sorry to hold up the procedure.”
“Never worry. It was only for a couple of minutes and we’re not in a race,” Charlie said. “Anyway, Fingal, you see how John and Kitty have created a bone flap, wrapped it in a warm cloth, and laid it down on Dapper’s cheek.”
Fingal nodded.
Charlie said, “Go ahead, John. Open the dura.”
Using the forceps, he lifted the membrane, then used scissors to incise it.
“Ordinarily I’d supervise John as he carried out the entire procedure, and he is a damn fine surgeon, but seeing the patient’s your friend…”
“Thank you, Charlie. I appreciate that professional courtesy. And, so would my friend, Dapper. No offence intended, Mister Wilson.”
“None taken, Doctor O’Reilly.” Mister Wilson used a retractor to pull his part of the now-open dura aside. “Can you see that, Doctor?”
“Take a look, Fingal,” Charlie said, and stepped back.
O’Reilly peered into the cavity at a piece of a living brain. Not any brain. Dapper’s. In it lived his personality, his hopes, his prejudices, his beliefs, and his fears.
“That valley between those two pieces of grey matter,” said Charlie, “is the sylvian fissure. If you look at the junction of the middle cerebral artery that runs up diagonally from left to right and the smaller vessel running down from the main trunk, you’ll see the little devil I showed you on the X-ray. That’s what’s causing all of your patient’s troubles.”
Nestled between the main trunk and the descending branch was the aneurysm, exactly the shape he’d seen on the X-ray. A narrow neck and a balloon-shaped body.
“And,” said Charlie, the laugh lines at the corners of his eyes suddenly evident, “a spring-loaded clip across the base of that neck stops any more blood getting into the aneurysm. It also stops it bursting or leaking through its thin wall. Yet it won’t prevent blood flowing along the main vessel.”
How could he smile? The next few minutes were critical. O’Reilly felt his breathing and his pulse rate speeding up.
“Sorry, Fingal, I need to get closer to make sure the aneurysm isn’t held down by connective tissue and that placing the clip won’t endanger any small arteries, called perforators.”
O’Reilly stepped back.
“This is the tricky bit. If I’m not careful, I could burst the aneurysm.”
Although not a religious man, O’Reilly mouthed, Please, God.
“It’s free and there are no perforators. Come back and see.”
O’Reilly moved forward.
“Clip.”
Kitty handed Charlie an instrument with scissor grips at the near end. A spring-loaded steel clip was held open by jaws at the far end.
O’Reilly watched as Charlie slipped the jaws across the neck of the aneurysm—one in front, one behind. He squeezed the scissor grips, then opened them and withdrew the clip holder. “Got it.”
O’Reilly exhaled the breath he’d not known he’d been holding.
“Syringe.” Kitty gave Charlie a syringe.
“Just have to check the clip to be certain it’s not nipping the main artery, then stick this needle into the dome of the aneurysm to be sure there’s no blood flow into it.” He paused. “Dry as a bone. Have a look.”
O’Reilly peered in and saw the clip’s bright jaws firmly in place. It would have been inappropriate to have cheered, but he felt like doing just that.
“Thank you, Minty, John, Kitty, and Jean. I’m going to pull my ‘rank has its privileges’ number. Fingal has another appointment and I’d like to have a cup of coffee with him, so close, please.” He was already stripping off his gloves as he turned from the table and, followed by Fingal, headed for the door.
“Thank you, Charlie,” O’Reilly started, pulling off his theatre whites. “Now what?”
“He’ll stay in for ten days. There may be some residual effects and we’ll be monitoring those closely. Minor epilepsy’s quite common, but it usually goes away with time. His major preop difficulties were paresis in his left limbs. That’s all gone and he’s no longer dysphasic. I think he’ll do fine.” Charlie knotted his tie. “I had a patient with a history just like your patient’s. He was an accounting student. Had epilepsy postop, which settled. He graduated top of his class. Twenty years later he became president of the accounting society.”
Fully dressed, O’Reilly dragged a comb through his thatch. “I don’t see Dapper becoming head of the estate agents’ board. He’s not the type to go in for committee meetings and intra-professional politics, but if he gets back to his old self, I’ll be delighted—and so will Donal Donnelly. I’ll let him know when I get home. Boy, am I glad that’s over and you think things look promising. I hate to admit it, but I was pretty scared when you started to put on the clip.”
Charlie shrugged. “I’ve been doing it for a lot of years. You have to get a bit hardened, but you do get used to it.”
“Thanks anyway, old friend.” O’Reilly grinned. “Now coffee. I’ve plenty of time before I see George Irwin.”
* * *
“Fingal.” Professor Irwin’s silver hair was parted to the left, short sideburns coming halfway down beside his large ears. The man rose from behind a Formica-topped table that served as his desk. The tabletop was overflowing with books and manuscripts, an in-and-out tray, and a telephone. “How are you?”
“All the better for seeing you, George.”
“Have a pew.” George Irwin sat and O’Reilly followed suit on a small sofa with dark linen-covered cushions in front of the desk. “You said you wanted to talk to me about young Doctor Carson.”
“That’s right.”
George Irwin frowned. “I’m a bit surprised. I’ve always tried to send you good prospects. What’s the difficulty?”
“Good prospects? Connor Nelson and Emer McCarthy are both outstanding. It may sound petty, but our man Carson was fifteen minutes late for our interview over lunch.”
George laughed. “I seem to remember so was I a couple of years ago when I asked you to come here and talk about your practice accepting trainees.”
O’Reilly smiled. “True. But you apologised and explained why. He didn’t, and he was patronising to a waitress. Very. That kind of thing will not go down well with our customers. Barry and I are pretty down-to-earth and so are they. Call a spade a spade. Less posh talking. The other thing was that he seemed to be more interested in time off than the nature of our work. Barry said afterward that he’d be willing to take Carson on but he also had similar reservations. I said I’d need to think about it, and when I heard two days ago I’d be coming up to the Royal I thought I’d seek your advice. I’m sorry to have left the poor fellah wondering, but, ‘Buy in haste. Regret at leisure.’”
George steepled his fingers. “I must say I found him—um—cultured, I think would be the word. But you’d expect that given his background. A bit shy and tries to hide behind his upper-class façade.”
Fingal nodded. “Might be, I suppose.”
“You’re not going to like this, Fingal, but could there be a bit of inverted snobbery here?”
O’Reilly sat back on the sofa. “On my part?” What George had just said could be true, and Fingal Flahertie O’Reilly was never a man who’d not face up to his own shortcomings. “You know, George, I don’t like snobs, but perhaps I can go overboard a bit.”
“Perhaps you can, Fingal. Let me tell you what I know about Sebastian Carson, and it’s not a great deal
. I have interviewed him. He tends to be a bit reticent about blowing his own trumpet, but he has an excellent record as a medical student. If you insist I can show you letters of reference from his dean at Cambridge and some senior consultants at Bart’s.”
“Not at all, George. I trust your judgement.”
“Thank you. The chiefs of the four services he worked on at the City Hospital were all perfectly satisfied with his performance. In my opinion he is a well-qualified young man with an upper-class background that you might find grating.”
O’Reilly cleared his throat and said, “Seems I may have misjudged the man.”
“I think you might have, and remember you’re not offering him a partnership. He’ll be with you for only one year as a trainee.”
“True.”
O’Reilly considered his options. “I’ll need to talk to Barry, tell him what you’ve told me, and if he agrees we’ll take young Carson. I’ll ring you as soon as I’ve spoken with Barry. We’ll notify Connor and Emer on Monday if he agrees.” O’Reilly rose and offered a hand. They shook. “Thanks, George. I’m sure Barry will agree. If he does we’ll do our best with Sebastian, might even roughen up some of the smooth corners. Make a sow’s ear out of a silk purse.”
George laughed. “Of that I have no doubt whatsoever.”
O’Reilly rose and offered a hand. They shook. “Thanks, George.”
“Safe home, Fingal, and let me know as soon as you can. If you agree, I’ll have him with you on August the first.”
* * *
Fingal waited for a gap in the traffic and turned right onto the Grosvenor Road, remembering how he’d felt in the operating theatre this morning. It hadn’t been the knee-weakening, hand-trembling, visceral fear he’d had to overcome during the war when his battleship HMS Warspite had been bombed or when, in the face of flames roaring near him and of live ammunition, he had amputated a sailor’s hand. But it had been enough to make his pulse race wildly when Charlie had started examining the aneurysm—and O’Reilly an experienced doctor. The concern bordering on fear had been for his patient, Dapper Frew. Nor had O’Reilly often experienced such a sense of relief at Charlie’s later optimistic prognosis. Since leaving the navy O’Reilly had rarely set foot in an operating theatre, and given the potential for serious long-term complications of Dapper’s condition, he marvelled at how surgeons like Charlie could stand the stress. Come to that, how could theatre sisters like Kitty? She had been flustered after she’d dropped that guide. Was her job starting to tell on her?
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