Begin Reading
Table of Contents
About the Author
Copyright Page
Thank you for buying this
Tom Doherty Associates ebook.
To receive special offers, bonus content,
and info on new releases and other great reads,
sign up for our newsletters.
Or visit us online at
us.macmillan.com/newslettersignup
For email updates on the author, click here.
The author and publisher have provided this e-book to you without Digital Rights Management software (DRM) applied so that you can enjoy reading it on your personal devices. This e-book is for your personal use only. You may not print or post this e-book, or make this e-book publicly available in any way. You may not copy, reproduce, or upload this e-book, other than to read it on one of your personal devices.
Copyright infringement is against the law. If you believe the copy of this e-book you are reading infringes on the author’s copyright, please notify the publisher at: us.macmillanusa.com/piracy.
To Dorothy
ACKNOWLEDGMENTS
I would like to thank a large number of people, some of whom have worked with me from the beginning and without whose unstinting help and encouragement, I could not have written this series. They are:
In North America
Simon Hally, Carolyn Bateman, Tom Doherty, Paul Stevens, Kristin Sevick, Irene Gallo, Gregory Manchess, Patty Garcia, Alexis Saarela, Fleur Mathewson, Jamie Broadhurst, and Christina MacDonald, all of whom have contributed enormously to the literary and technical aspects of bringing this work from rough draft to bookshelf.
Natalia Aponte and Victoria Lea, my literary agents.
Don Kalancha and Joe Maier, who keep me right on contractual matters.
In the United Kingdom
Jessica and Rosie Buchman, my foreign rights agents.
To you all, Doctor Fingal Flahertie O’Reilly and I tender our most heartfelt gratitude and thanks.
AUTHOR’S NOTE
Once again it’s time to welcome back old friends and bid new readers céad míle fáilte, a hundred thousand welcomes. Once again, because some aspects of this work require explanation, it is necessary for me to write another author’s note.
In five of the preceding Irish Country Doctor novels I have told stories involving central characters in different time frames. Developments affecting a full cast of familiar players in the village of Ballybucklebo in the nineteen sixties have been presented in tandem with a story of one of the central characters at an earlier stage in life. Kinky Kincaid in the twenties, and Doctor O’Reilly in the early thirties, and during the start of the Second World War.
In this work in the hospital year of 1963–64, just-qualified-in-June ’63 Doctor Barry Laverty and his friends are experiencing their houseman’s (medical intern’s) year, beginning in August ’63 in the Royal Victoria Hospital Belfast before becoming fully licensed medical practitioners. A major teaching hospital is a very different place from a rural general practice and the young doctors must deal, under supervision, with a wide range of technically more difficult cases, and at a young age, on average about twenty-four, confront their own feelings about life and death, and with being, albeit in a junior capacity, at the cutting edge of medical progress.
I wish first to deal with that cutting edge, cardio-pulmonary resuscitation (CPR) and correction of ventricular fibrillation, and to thank everyone whose advice on these subjects has been invaluable.
Today we take for granted CPR and the availability of the ubiquitous Automated External Defibrillators (AEDs). While CPR had been devised in 1960–61, prior to 1963 there was no such thing as a portable cardiac defibrillator. In mid-1966 the first successful defibrillation of a patient at home was carried out by Doctor John Geddes and his Cardiac Ambulance team.
That triumph, which led to today’s AEDs, was the brainchild of two remarkable men, Doctor Frank Pantridge and Doctor John S. Geddes, and their technical staff, Mister Alfred Mawhinney and Mister John Anderson. They were all on the staff of Belfast’s Royal Victoria Hospital. I have firsthand knowledge because I was Doctor Frank Pantridge’s houseman on wards 5 and 6 from November ’64 to February ’65, and at that time Doctor John Geddes, a trainee cardiologist, was my immediate superior. I have always wanted to tell the story of the pioneers, but in a fictional setting. For dramatic purposes I have had to compress the time line, but I wanted the events as I describe them to be technically accurate. To that end my friend John Geddes, now retired, has read and corrected those chapters. John Geddes was a houseman on 5 and 6 in 1963–64 and the senior house officer there in ’64–’65. I was privileged to work under his guidance in ’64 and as a colleague at the University of Manitoba in 1989. He has graciously agreed to my condensing three years’ progress into three months—but only on receipt of my solemn promise that in this note I will provide the entirely accurate history. Thank you, John.
Additional support came from my classmate and old friend Doctor Tom Baskett, who was also a houseman on 5 and 6, and who has provided me not only with his personal memories there but also critical information about the layout of other parts of the Royal, our duty hours, and pay scale. The excerpts from the Houseman’s Concert of ’65, heavily disguised as the Concert of ’64, require my apologies to that class. Thanks again, Tom, for sending me the programme and some of the original script.
The other source is an excellent work, The Evolution of Pre-Hospital Emergency Care, by John S. Geddes, Ronald D. Stewart, and Thomas F. Baskett, Clinical Press, 2017, from which Doctor Geddes’s words are provided verbatim below.
From those sources then, here are the accurate time lines.
The Lown defibrillator, which was portable but ran off the main electricity supply, was installed on the side ward of ward 6 in October ’63.
The coronary care unit opened in December 1963 on ward 6.
The resuscitation by Doctor Geddes of the man on the pavement and subsequent defibrillation using a portable defibrillator by Doctor Pantridge was in late April 1964. In Doctor Geddes own words, “Brian Pitt and I were both housemen on ward 21. A hospital worker stuck his head in and told us a man was lying on the ground outside the building. Brian and I yelled for help and ran outside. A pulseless middle-aged man lay on the pavement. I started CPR. Dennis Coppel, an anaesthetist registrar, charged up pushing an anaesthetic trolley. He intubated the man and connected him to oxygen. Anand Garg, a neurosurgical registrar, helped us load the man onto a trolley and we got the patient to a side ward and took an ECG. Ventricular fibrillation.” Copyright permission to use this has been granted by doctors Geddes and Baskett.
Doctor Pantridge and Doctor Peter Halmos brought the defibrillator from 5 and 6 and after two shocks had reversed the fibrillation.
In August 1964, Doctor Geddes began teaching CPR and defibrillation to the new housemen in batches of 1–3. The sessions took thirty minutes. I attended one, and in that month the in-hospital resuscitation programme was organised.
The specially equipped and committed to the programme ambulance and driver were ready by October 1965.
The first outing for the Cardiac Ambulance carrying the team led by Doctor Geddes was on January 6, 1966. A female patient who had suffered a myocardial infarction was successfully treated, brought to the hospital, and survived.
The rest is history, but I must make one other correction: Sister Crawford was the ward sister on 5 and 6. Sister Kearney, like Sister O’Byrne in Casualty, is a figment of my imagination.
In the other story set in 1969, Ballybucklebo general practitioners Doct
or Fingal O’Reilly, a maturing Doctor Barry Laverty, and their associates tend to the ills of their patients and their community, both of whom the doctors regard as part of their family. Sixty-nine was a time of drastic political change in the wider community of Northern Ireland. This cannot be ignored and I will refer to it later.
My descriptions of places in North Down and the Royal Victoria are drawn largely from memory, mine and my wife Dorothy’s. We grew up in north County Down and I was a medical student and houseman in the Royal from mid-1961 to August 1965. I am also indebted to The Royal Victoria Hospital Belfast, A History 1797–1997. Richard Clarke. Blackstaff Press, 1997.
As in my previous works, I next wish to acknowledge the actual people and real places that appear on these pages and make a comment on certain social habits.
When it comes to real people I have, where possible, named my contemporaries both nonmedical and medical.
All of the political figures did hold the offices I describe, for example, Harold Wilson MP for Bromley was Prime Minister. I mention Joe Togneri with deep affection. His Italian family ran the Coronation Cafe in Bangor. As a child, he had developed kyphoscoliosis, a hunchback. His main delight in life was sailing his national fourteen dinghy. He taught a very young Pat Taylor to sail. RIP, old friend.
On the medical front, Professor John Henry Biggart was the head of pathology and dean of the faculty. Doctor Gerry Nelson was the chief of haematology and coincidentally shared a surname with my Doctor Connor Nelson. They were not related. Mister Willoughby Wilson was a surgical consultant on wards 9 and 10. Mister John A. W. Bingham was a thoracic surgeon. There were three senior neurosurgeons on ward 21, but Mister Charlie Greer was a contemporary of Fingal O’Reilly as undergraduates at Trinity College in Dublin in the thirties and is a figment of my imagination. Professor Graham MacGregor Bull was the senior physician (internist) on wards 3 and 4, and Muz Khan, an outstanding scholar, was a registrar at the time. Doctor Harold Millar was a senior neurologist. Professor Ivo John Carré taught us paediatrics and I still use his book Aids to the Diseases of Children as a trusted source. While much their junior, I knew them all.
Doctor Graham Harley was special. For those of us—myself, Tom Baskett, Brian Ireland, and Gerry MacCarthy—who went into obstetrics and gynaecology, he was our hero, the doctor we all aspired to be. I hope I have captured his skill and humanity in these pages. And Patrick Taylor. I decided it would be fun to give myself a supporting role, because in 1969 my chief, Mister Matt Neely, sent me to Oldham to learn laparoscopy from Mister Patrick Steptoe. I believe Doctor Eddie MacPhedran may have done the first one in Ireland, but I certainly was an active endoscopist then at the Ulster Hospital in Dundonald.
I did not know Rosalind Yarrow personally, but her discovery of radioimmunoassay in 1959 was integral to the research carried out on the hormone prolactin by my old friend Doctor Bernard Corenblum and me. Doctor Yarrow received the Nobel Prize for physiology in 1977, only the second woman to have done so.
I had mentioned social habits. One was smoking. The modern reader may have difficulty believing my references to smoke-filled pubs, restaurants, and even the hospital. Smoking during those years was the norm, despite clear evidence linking the addiction to lung cancer. That notwithstanding, my Christmas present from Doctor Frank Pantridge, senior cardiologist, was a packet of fifty Capstan Full Strength cigarettes, and I can still remember offering one to sister, our both lighting up in the clinical room, and no one thinking anything about it. I’m a slow learner, but I finally quit more than twenty years ago.
The other, which may also come as a surprise, is that a pregnant woman might drink alcohol. Some quit voluntarily because they found alcohol tended to nauseate them. Others thought it perfectly natural because the link with foetal alcohol syndrome was not established until 1973.
When it comes to the story line set in Ballybucklebo in 1969, I wish I could carry on as I had done with Ireland at peace, but alas, such was not the case. I began alluding to the increasing civil unrest in book 13, An Irish Country Cottage. I do not wish to belabour the matter in this work, but I have had to make mention of the critical political and sectarian events in April and May 1969. I have chosen to conclude the Ballybucklebo portion in July 1969, the month in which a man first walked on the moon on the 21st. Our story concludes prior to July 12, 1969. It was then, at the height of the “marching season,” when Loyalist organizations held parades to celebrate the victories of the forces of Protestant Prince William of Orange over the forces of the deposed Catholic King James II of England in the late seventeenth century, that rioting erupted in Belfast, Londonderry, and Dungiven, leading to almost continuous civil strife until the Good Friday Agreement of 1998.
My picturing the tolerance of the two sides in Ballybucklebo one for the other is a reflection of how novelists often use their pages to set down how they would have liked the world to be.
One more thank-you and two apologies will conclude this note.
I had thought I was familiar with a host of Irish and Ulster expressions, but I must thank Brother Henry Gaither for one I had not heard before. “I have a thirst you could photograph.” I’m not sure where he got it, but I think it’s sticking out a mile. Thank you, Brother Henry. And as usual, a glossary defining these and other vagaries of the Queen’s English as it is spoken in Ulster will be found in a glossary starting on page 361.
To my readers, I’m afraid the winner of the talent contest described in the last two chapters must remain a secret. Sorry. And my apology is to my nonmedical friends and classmates. There are a lot of characters in fourteen novels. In order to help me recall them, I have developed a habit of using real people’s surnames although not their character traits. If you think you find yourself in here and are hurt—or worse, don’t find yourself in here—I am truly sorry.
PATRICK TAYLOR
Saltspring Island
British Columbia
Canada
July 2018
1
Home and Beauty
April 11, 1969
“Home is the sailor, home from the sea, and the hunter home from the hill.” Fingal Flahertie O’Reilly, Doctor Fingal Flahertie O’Reilly, swept into the upstairs lounge of Number One Main Street, Ballybucklebo, yawned, and rubbed his gritty eyes.
“You look more like the wreck of the Hesperus,” his wife, Kitty, said from where she sat in an armchair in front of a set but unlit fire. Their little white cat, Lady Macbeth, was curled up in Kitty’s lap. She put a Dick Francis mystery on a wine table beside her. “Seriously, Fingal, I know you got your feet up for a while yesterday afternoon, but you were out again at midnight and you didn’t come home until five this morning.”
O’Reilly crossed the room and dropped a kiss on the top of her head, noting fondly that her raven hair was more than just tipped with silver. “Sorry if I disturbed you, my dear.” He leant against the mantel. “Time, tide, and arriving newborns wait for no man. It took a while for me and Miss Hagerty, the midwife, to get everything squared away. You remember Aileen MacCormack, the plumber’s wife?”
“Cheerful redhead? Baby number two?”
“That’s her. She and her child, all nine pounds of baby boy, are doing well.” He yawned.
Kitty shook her head. “I know you enjoy midder, but you’ve a couple of youngsters in the call rota, one of them with extra training in obstetrics. Ever think of giving it up?”
O’Reilly shook his head.
“I’m not complaining,” Kitty said, “but you know very well I hardly sleep when you’re out on a call.” She crossed her legs, trying not to disturb the sleeping cat. “Fortunately, you’re not on call as much now. Even if you still want to deliver babies, one in four nights and weekends isn’t bad. Not like when it was just Barry and you.”
“Gives me more time with my lovely wife, and I’d get even more time with her if she’d think about slowing down too.” He’d been encouraging her for more than a year about this, but she loved her jo
b as senior neurosurgical operating theatre sister at the Royal Victoria Hospital.
Kitty shook her head. “We can talk about it, but not now. Not now. How was your refresher course for GP trainers today?” She looked at her watch. “Five fifteen. You made good time from Belfast.”
“Traffic wasn’t too bad.” The two exchanged a glance. “We both enjoyed the course. Young Laverty’s turning into a first-class teacher. I’m very lucky to have him as a partner.” O’Reilly yawned again. “Had lunch with Professor George Irwin, Department of General Practice. He’s impressed with Barry too. But George isn’t sure he can find an assistantship here in Ulster for Emer McCarthy when she finishes her stint with us.” O’Reilly pursed his lips. “It’s worrying. It’s April the eleventh today and she’ll be leaving us on July thirty-first. She’s a fine lass. I should be able to do something for her. I really should.”
“And knowing you, you probably will, but that’s three months away, Fingal, and getting your knickers in a twist now isn’t going to help her find a job, is it?”
“No. It’s not.” He shook his shaggy head. “You’re right.”
Kitty nodded once. “I am right. You’ll only get her worried too. So instead of fretting about your trainee, what you need now is a good brisk walk in the fresh air, so go on. Give young Kenny a run too. The dog needs his exercise.” She patted O’Reilly’s tummy. “And he’s not the only one.”
O’Reilly grunted, stood up straight, and sucked in his gut. He offered his hand. “Coming?”
Kitty smiled. “No. Thanks, Fingal. Not this evening. We had an astrocytoma today. Brain tumour cases always take a while. I was scrub-sister for Mister Charlie Greer. On my feet six and a half hours. I think a visit to the Duck by yourself would be good for you, but be home for seven. Kinky was here today. Polished all the silver, hoovered every square inch of the place, and made a fresh batch of tomato soup, and beef and dumplings for me to heat up.”
An Irish Country Family--An Irish Country Novel Page 1
