It wasn’t the first time Barry had heard the expression, and he knew some overworked physicians in the poorer parts of Belfast only had time to take a brief history, decide the complaint was medically simple, and prescribe accordingly, or simply refer the patient on for specialist care. “Don’t worry, Mister Peters. I am.” And always will be, Barry thought. “Tell me how and when you ‘took real bad.’” A simple rule he’d learnt in the Royal. Don’t talk down to patients, but always use language they can understand.
“I usually get up at six thirty, but this here headache woke me at quarter past. Tried til get up for a drink of water and a couple of Panadol—And damn it, didn’t I take a dizzy turn and fall down? That woke Dora, the missus—and by the time she was full awake, so was I. And now here I am. Only other thing I noticed was that my toe was a funny blue-black colour. It’s numb, but there’s no pain.”
“And that’s it?”
“Aye.”
“Give me a minute, please, to make some notes?”
“Aye, certainly.”
Uncontrolled diabetes could cause a patient to faint and develop discolouration of the extremities, but once in coma they did not recover until treated. Disorders of the nervous system could cause headaches and fainting, but not discolouration. Atherosclerosis, hardening of the arteries, could cause both, but rarely in a man of fifty-six. And so could … what? Damn it, Barry knew there was another condition, but like a naughty boy who had been called for tea and doesn’t want to come, the answer refused to be coaxed out.
“I just need to ask a few more questions before I take a look,” Barry said.
“Go ahead, sir.”
As he took the man’s pulse, which was normal, Barry led Ivan Peters through the standard questions to establish that he was orientated in person, place, and time.
“It’s dead polite of you, young Doctor Laverty, to keep calling me Mister Peters, but I’m only a docker, so I am. Everybody calls me Rusky.”
Barry was warming to this man. He smiled. “Why Rusky?”
“It’s slang for ‘Russian.’ Ivan’s a Russian name.”
“I see. All right, Rusky. It’s time to examine you, but before I do, is there anything else you’d like to tell me? Anything different happen to you in the last couple of months?” Barry had no idea what kind of answer he was hoping to hear, but sometimes, sometimes a fly cast over seemingly deserted water would produce a rise.
Rusky frowned. “Only thing I can think of is I had a tooth pulled three weeks ago. I had til go back to have the socket packed twice, like. Thought it would never stop bleeding.”
Uh-huh. The bad boy had come out from behind his bush, but not far enough to be recognisable. But Barry did have a nearly formulated idea. A single physical finding would clinch matters—and the disease Barry was now considering could be confirmed by some simple blood work after admission. “Thank you,” he said, “now, let’s have a look.” He turned the blanket back.
Both pupils were equal and reacting to light, and Rusky had suffered no loss of motor or sensory function, because with veiled good humour he could move his limbs and respond to pinpricks on them. His elbow, knee, and ankle jerks were active and equal and his Babinski reflex, named for Doctor Joseph Babinski in 1869, was normal. When Barry stroked a blunt instrument along the sole of Rusky’s foot from heel to big toe, it curled down. Had it curled up it would have been a sign of subtle but serious damage to the central nervous system. “Soon be finished,” Barry said, “but you can stop worrying about having had a stroke.”
“Dead on, sir. Thanks for telling me. It’s great til get your mind set at rest, so it is. And I don’t think my headache’s near so bad neither.”
“Mind set at rest.” A lesson well learned, Barry thought. There’s always a very worried human being inside the symptoms and signs. “Can you slip off your left shoe and sock?”
Rusky’s left great toe was blue-black, cold to the touch, and the man could feel nothing, nor move it. Gangrene. Not good, but dry gangrene due to poor blood supply of oxygen, not the more dangerous wet kind associated with infection. Barry was 99 percent certain now of what was wrong. “One last thing,” he said. “I need to examine—”
As he spoke, Barry became aware of a raised, pleading, female voice he recognised as Virginia’s coming from the next cubicle. “Look, Mister Shaw, sir, I only asked if you’ve been drinking. The doctor will want to know.”
A slurred male voice yelled, “None of your bloody business, you stupid wee bitch. I’ve my rights, so I have. I’ll not be asked questions like that. Not by nobody.”
Barry well knew from his experiences here as a student how unpredictable drunks could be. How a seemingly simple question could in some trigger a violent outburst.
“Sir, I’m a student nurse trying to do my job.”
“Well, feck off and do it somewhere else.” The words were accompanied by something, probably a fist, banging on the plasterboard partition. “I just want something for my fecking head. Some bugger’s hitting it with a hammer.”
“Excuse me, Mr. Peters,” Barry said.
The barrage of verbal abuse rose in volume, and Barry tried to tune out the words as he parted the curtains and went into the adjacent cubicle. Virginia Clarke was backed into the far corner, her eyes wide, her hands in front of her in what would be a futile endeavour to give herself some protection. A large, dishevelled man sat on the trolley, swinging his booted feet. His hair was uncombed, chin dark with stubble, puke stains on his darned jumper. Saliva trickled from one corner of his mouth. The place stank of stale drink. This was not a medical case.
The man slid off the trolley and began raising his fist to Virginia. Barry stepped forward and grabbed the patient’s forearm with one hand and hauled, unbalancing and half-turning him so he now had his back to Virginia and was facing Barry. The brute was much stronger than Barry and ripped his arm free, throwing Barry against the wall, but at least the action had deflected the punch from Virginia. The drunk now stretched out a paw, making a grab for Barry, who retreated, but got stopped by the curtain. He steeled himself for a blow. He was vaguely aware of someone coming into the cubicle.
The torrent of insults dried up like a water intake when the Kingston valve is slammed shut, and Barry saw bravado being replaced by fear in the man’s bloodshot eyes. Barry turned.
The cause of the sea change stood with her legs apart, feet firmly planted, arms tightly crossed in front. Norma Fitch’s never-wavering gaze was fixed on her victim. Barry imagined the glare of Balor, the mythical one-eyed Fomorian, a gaze that could turn men to stone. Her voice was low, measured, and as cutting as aqua regia, a mixture of nitric and hydrochloric acids that can dissolve gold and silver. “No. You will not, I repeat, not threaten Nurse Clarke.”
Frantic head-nodding. “No, miss. I will not. Honest to God.”
“It’s Doctor to you.”
Head still nodding. “Yes, Doctor. Sorry, Doctor.”
“You will apologise to Nurse Clarke.”
“I’m dead sorry, so I am, Nurse. Cross my heart.”
“You will give me your details, all of your details. Now.”
The words poured forth. “Sammy Shaw, ma’am, I mean Doctor. Twenty-three. Occupation? Huh. Unemployed riveter. The bloody shipyard lost a contract and give a bunch of us our cards. Ten Balkan Street, ma’am. And miss, I mean Nurse, yes, I was on a bender.” Virginia nodded to the man and Barry stepped to her side. “You all right?”
“Yes, thanks.”
“Thank God for that, and thank you, Doctor Fitch.”
Norma Fitch shrugged. “Doctor Laverty. I’d just come back from room B. Heard this horrible excuse for a man and thought I should do something. I didn’t know you were in here.”
“I’m very glad you came.” For a moment Barry had been convinced he was a dead man. “I think Mister Shaw has discovered his manners now, thanks to you, and Nurse Clarke’s safe too.”
Norma looked back at the patient. “I can understa
nd why you got drunk. I can understand you’re angry, but it is no excuse for taking it out on Nurse.” She smiled at Nurse Clarke. “Mister Shaw understands that the RUC Police Station is a very short walk from here”—her volume increased as she fixed Shaw with her stare—“and he’s promised to be a good boy.”
Shaw flinched. “Yes, Doctor. That’s right, Doctor.”
“Abject” was the word that occurred to Barry.
Norma said, “I’ll take care of this one, Doctor Laverty. I know you’ve a case next door.”
He turned to go. It seemed any concerns about Norma Fitch were quite unfounded. Barry had the courtesy to feel embarrassed that he and his friends had doubted her abilities, and resolved to spread the word about what had just transpired. He glanced over at Virginia Clarke, who said, “Thank you, Doctor Laverty. My God, that was terrible. And thank you, Doctor Fitch.” Then, to his surprise, as Norma began examining Sammy Shaw, Virginia Clarke moved closer to Barry and lowered her voice. “That was brave, Barry. Thank you.”
And Barry was too pleased and too reticent to do anything but nod his thanks.
“You’re back, Doc?” Rusky said when Barry arrived. “You got that bollix next door calmed down? My wee girl Jan? We’re dead proud of her. She’s a staff nurse here at the Royal. She’s told us about some of the shites that comes til casualty. No wee girl should be spoke til like that.”
Barry shook his head. “I didn’t sort him out. One of our lady doctors did.”
Rusky whistled. “Tough lady.”
“Actually,” Barry said, “she’s not, normally. But it is a mistake to rile her. Quite the woman.” He pointed to Rusky’s shirt. “Could you hoist that, so I can examine your tummy, and then we’re done.”
“Aye, certainly.”
It took Barry moments to feel under Rusky’s left ribs and no time to identify an abnormally enlarged spleen. He straightened. “Rusky,” he said, “this is my second week on the job, so I’m still learning my trade, but the teachers here at the Royal trained us well. I can’t give you a proper diagnosis here because you’ll need some lab tests to confirm what I think ails you.” Rusky Peters was staring into Barry’s face. Hanging on every word. And why shouldn’t he? Barry might still feel unsure of himself, but this fifty-six-year-old docker nicknamed Rusky, with a daughter Jan, a staff nurse in this hospital, was a human being with real concerns who needed answers. And Barry Laverty, Doctor Barry Laverty, had an answer. “I think,” he said, “you have polycythaemia.”
“Boys-a-boys. That’s a quare mouthful.”
“That’s the short version. Its full name is polycythaemia rubra vera.”
“I’ll be damned.” Rusky sat up.
“Your body is producing far too many red blood cells.”
Rusky frowned.
“Did you ever try to wash boiled rice down a plug hole?”
“Aye. I always help Dora with washing up. If there’s a lot of rice, the water can’t get through and the grains stick. Everything gets clogged up.”
“That’s what happens with polycythaemia. And the body needs those cells to carry oxygen to nourish the tissues. If too many can’t get through—” Barry shrugged and thought, Which is why you have gangrene in your toe, which will have to be amputated. But that was a bridge to cross later. No need to worry the man any more at this moment.
“Am I for admission?”
Barry nodded. “’Fraid so.”
“So, it’s serious like?”
Barry took his time before answering. He’d learned as a student that questions like that could actually mean, “Am I going to die?” “Rusky, I told you I’m no specialist, but I was taught that you’re stuck with polycythaemia once you get it, but that while it’s not curable, it can be kept under control for years.”
Rusky nodded. “You mean like sugar diabetes? I have a cousin with it.”
“A little bit.”
“He can’t be cured, but as long as he takes his insulin he’s okay.”
“Very true.” This was not the time to discuss the long-term risks of either condition.
“Thanks, Doc. You’ve taken a right load off my mind, so you have, so, admit away.”
“I’ll see to it, and if the senior staff there agree with me—”
“And why would they not?”
“You’re very kind.” Barry glowed. “They’ll order blood work, and if it shows what I think it will, they’ll either arrange treatment there and then or ask Doctor Gerry Nelson, who specialises in blood diseases, to consult. You’ll be in good hands, I promise.”
“Thank you, Doctor Laverty,” Rusky Peters said. He hesitated, then asked, “Could I ask you for a wee favour?”
Barry smiled. “You can ask.”
“You’ve been dead kind, so you have. I feel kinda safe here with you—”
Barry shrugged and felt the blush start.
“I don’t know how long I’ll be in for, but the missus and our daughter Jan’ll visit me.” His eyes misted. “I know all the staff here’s dead good, and all, but when my da, God love him, passed eighteen months ago, I know he was properly taken care of, but nobody would answer my questions about him. Only young doctors like you might be around during visiting hours. The highheejins only came in in the mornings. Nurses were not allowed to go into details in case they disagreed with a doctor. One cleaning lady did her best til help with my questions, but—och. She tried, but…” He shrugged. “Doctor Laverty, would you consider popping in til see me once in a while?”
Barry didn’t hesitate. “Of course,” he said. “My pleasure.”
“You’re a real gent, sir,” Rusky said. “Thank you.”
And Barry Laverty felt humble. Sure, they’d all been warned ever since they’d set foot in the Royal three and a half years ago not to get too close to their patients, but this was the kind of medicine he was becoming even more sure he wanted to practise. And what harm could it possibly do?
“I’d better go and see if anyone else needs me.” And without waiting for an answer he walked out, closing the curtains behind him.
To his surprise, Virginia Clarke stood in the cubicle opposite, one finger to her lips, beckoning with her other hand.
“You all right?”
“Perfectly, but I wanted to say thank you again.”
“You already did. It’s fine.”
“Barry, you were trying to ask me out last Thursday. I said no. I usually do with young doctors because, well, I’ve a career to make, haven’t I, just like you? I’m only twenty-one. I did have a steady boyfriend until about four months ago, but he—well, let’s just say we don’t see each other anymore—”
“I’m sorry,” Barry said, but he wasn’t really. His hopes were up.
“What I’m trying to say is,” she smiled, “if we could find a time that we are both off duty—”
Barry felt as if Sammy Shaw had hit him. “We will,” he said, and to his pure delight she kissed his cheek.
7
With a Sad Swell’d Face
April 16, 1969
O’Reilly leaned on Norman Devine’s bedroom door frame as Emer finished their last morning consultation. The little lad by her side wore red-and-white-striped pyjamas. His face was flushed, sweaty. O’Reilly had seen him for a skinned and swollen knee and once with croup since the family had moved here four years ago.
He glanced at his watch, a Christmas present from Kitty. It told him the date, which he thought an extravagance. But sometimes it came in handy. April 16, the anniversary of the Battle of Culloden. Eleven fifteen. Still time to see how work was progressing at Dun Bwee and be home for lunch. Kinky had been in her element this morning getting the meal ready. Today lunch would be more than soup and a sandwich.
From where O’Reilly stood, he saw the right side of the boy’s face was swollen behind the angle of the jaw. O’Reilly had made his diagnosis, but Emer had asked all the right questions, looked for all the right signs.
“All done,” Emer said. “Button up your
jammy jacket.”
“Thank you, Doctor Emer.” Barbara Devine pushed back her auburn hair and ruffled nine-year-old Norman’s mop. It was the same colour as his mother’s.
“You, Norman, you poor wee lad, have mumps.”
“Aye. There’s a wheen of it about this year, and my Normie’s had his measles jag and polio sugar lumps, so I knew it wasn’t one of them fevers.”
Emer, still talking directly to Norman, said, “A nasty germ has got into your salivary gland.”
O’Reilly saw Norman frown, but Emer explained. “Saliva is what doctors call spit. It’s made in special places called glands. The one where you’re swollen is called the parotid.”
“Parroted? You mean I’m turning into a parrot, like?”
O’Reilly chuckled.
“No, I don’t, son,” Emer said. “It’s doctor talk. You’re going to feel peely-wally for a while. And have to stay in bed.”
“I’m glad mumps is all it is, Doctor. Lots of kiddies get it and they get better,” Barbara said.
“You’re right, Mrs. Devine. They do.”
Not entirely true, O’Reilly thought, but Emer now had the confidence not to mention potential but rare complications, sparing mother and child additional worry.
“I’m sorry we don’t have any vaccine for it. It’s probably better if they get it young—”
Particularly boys who, if they caught it after puberty, risked painful testicular infection that could lead to sterility.
“We’ll have to let the disease run its course. Some of the other salivary glands may swell, but it usually goes down in ten days. Please give Norman lots to drink, keep his mouth clean. A semi-fluid diet will make it easier for him to swallow. Jellies, juice, clear soups, rice puddings.” She turned back to Norman. “You look like a lad who likes rice pudding. You’ll be fine, and if it gets sore, Mammy will give you an aspirin.”
“I will.”
“I’ll drop in in a day or two. See how you’re doing. All right?”
“Yes, Doctor Emer. Thank you. I’ll show youse out,” Barbara said. “I’ll come back and see you in a wee minute, Normie.”
An Irish Country Family--An Irish Country Novel Page 8
