Did Harry mean to the patients or to him? Probably the latter. They’d been working in the hospital long enough now to recognise that disease was inherently unfair to the victim, but the constant demand for perfection made of students and junior doctors, very often by themselves, could be upsetting if they failed to achieve it. Barry wondered how he’d be feeling now if he’d got to know this Robbie Martin as Harry must have.
Harry came back from wherever his reverie had taken him. “I thought,” he inhaled, “mebbe, because I never saw anyone die when we were students, I thought being a doctor was about making people better. You always feel good when you get a winner, but losing them?” Harry shook his head. “It’s getting to me.”
Barry said, “At least we had to spend a year and a half dissecting a corpse early on and attending six postmortems last year. It’s not as if we haven’t seen dead bodies.”
“That’s true,” Harry said, “but we hadn’t known any of them when they were still alive. Your man there was a butcher and he ran greyhounds. His best one was a bitch called Molly.”
Barry smiled. Here perhaps was an opportunity to try to get his friend out of his personal Slough of Despond. “Knowing a patient’s occupation is part of the routine history, but, holy Moses, when did it become medically important to know about their hobbies?” Even though Barry had just learned of Rusky’s marquetry, he thought his own interest, because he knew Rusky’s daughter, Jan, was different from Harry finding out this kind of detail from a relative stranger.
Harry pulled out a packet of Gallaher’s De Luxe Greens, tapped a cigarette on the packet to tamp the tobacco more firmly, and lit up. “Robbie’s been in longer than any other patient on the ward. He didn’t have many visitors. He’s not married—”
Barry noticed that Harry was still using the present tense.
“I got into the habit of chatting with him before I went off the ward in the evenings. Nyeh, the poor man was terrified. He begged me not to let him die.” Harry took another drag, then blew out smoke. “You know, Barry, I’m not sure I’m cut out for this.”
“Come on, man. You’re tired. Upset. Come on. We’ll have our tea. You get an early night. You’ll feel better after a good night’s sleep.”
Harry sighed.
“Come on, Harry.”
But Harry Sloan shook his head. “I’m not hungry, Barry. And don’t get all worried about me. I’m just dog-tired. I’m going for a bath and a lie-down.”
“You sure?”
Harry managed a small smile. “I’ll be fine.” He turned to leave.
“All right, Harry. You’ve just had a rough session. Off to bed. You’ll be fine.” And as his friend walked slowly away, Barry hoped sleep would be all that was needed to get Harry back on his usual humorous even keel.
9
The Heavy Burden of Responsibility
April 19, 1969
“Ba ba pom diddily pom.” O’Reilly puffed his pipe and hummed along as Herbert von Karajan conducted Beethoven’s Sixth Symphony in F Major. O’Reilly and Emer were on call for the weekend. So far, at ten fifteen, no one had needed them.
Emer had come down from Belfast last night and slept in Barry’s old quarters. O’Reilly, always an early riser since his days in the navy, had let the lass have a bit of a lie-in. She was downstairs finishing the breakfast he had prepared for her. He was no cook, but years ago Kinky had taught him a few simple things, like grilling kippers. “Da da da da da diddly dada…” The last “dada” was punctuated with stabs with his pipe stem.
Kitty, with a sketch pad on her lap, sat in an armchair looking out the window. “There’s a storm coming, Fingal,” she said, “and I’m trying to get the feel of the leading edges of the clouds rolling in against the blue sky.”
He stood and looked over her shoulder to see how, with charcoal, she had run an irregular line from one side of the paper, about a third of the way up, descending at a shallow angle across to the other side. She’d smudged the charcoal with her thumb to indicate the clouds’ menacing darkness. The steeple of the Presbyterian church opposite was rendered in a few deft strokes.
She stared at the sketch and put down the piece of charcoal. “After we’d all talked about having events at the sporting club last Saturday I started thinking. You know I love to paint. I thought I might have a few new ones of local County Down scenes for sale hanging in the main hall of the clubhouse, and donate the proceeds to the fund.”
“That’s a splendid idea,” he said, “and I think Bertie Bishop will—”
The telephone extension in the lounge of Number One rang.
He rose and switched off the new Bose stereo system he’d bought last year to replace his ancient Black Box. “Hello? Doctor O’Reilly.”
“I’m sorry til bother you, Doctor”—he recognised Barbara Devine’s voice—“but Norman’s taken a turn. He was still a bit sore, but pretty much all right yesterday when that nice Doctor Stevens popped in. But about half an hour ago, he took a headache and he’s thrown off too.”
“We’ll be right out.”
“Thank you, sir.” The line went dead.
“Gotta go,” he said.
“Take your coat, pet. It’s going to pour.” She bent to her sketch again and picked up the charcoal.
O’Reilly trotted downstairs and into the dining room, where Emer sat eating toast and Kinky’s homemade marmalade. A plate with the wreckage of a brace of kippers sat on the table. “What’s up?”
“I’m sorry to have to tell you that Norman Devine is having a setback.”
“Oh-oh.” She wiped her mouth on a napkin, stood, and said, “What are we waiting for?”
O’Reilly smiled. Good lass. “Only to get our hats and coats, because Kitty’s been studying the clouds, and she says it’s going to bucket down out there.”
To underline his remark, the first wave of driven rain, sounding like the efforts of a drunken snare drummer, rattled off the windows.
Together they dashed across the back garden, and Kenny didn’t even bother to look out of his doghouse.
Sensible animal, O’Reilly thought as he dragged the car’s door open and waited until Emer was settled beside him before driving off into the downpour.
Main Street was deserted. Rain drummed off the car’s roof, the windscreen wipers danced a frenetic two-step, and water was thrown up by the tyres like spray hurled aside by a motor torpedo boat.
Emer’s voice was matter-of-fact when she asked, “What are Norman’s symptoms?”
“Headache and vomiting.”
“All right. Could be a couple of things, but we’ll not know until we’ve—”
“You. Until you’ve examined him. He’s your patient.”
“Right. Until I’ve examined him. Thank you.” She settled in her seat.
O’Reilly knew from lab tests on the cerebrospinal fluid of studied patients that the mumps virus frequently invaded the central nervous system, but symptoms only appeared in 10 percent of victims. Depending on what part of the system was involved, most patients recovered, but in the remaining few in whom the brain itself was affected by encephalitis, the mortality was a terrifying 50 percent, with many of the survivors suffering serious residual damage. His hands grasped the wheel more firmly as his concern for Norman Devine increased.
He glanced over at Emer, who sat upright, her hands held stiffly in her lap, staring out at the rain. Was she concerned about not warning Barbara Devine of the possible complications? It had taken a couple of months for her to get over blaming herself when another child had developed a rare complication after scarlet fever.
The firmament was rent by a sizzling thunderbolt that lit up the inside of the car, and O’Reilly did what he’d been doing since childhood, counting the seconds before the celestial howitzers growled. “Eight miles away,” he said as he parked outside the cottage and a single diesel-powered railway carriage, known to the locals as “the covered wagon,” rattled past on its way to Bangor from Belfast. Although often full of c
ommuters on weekdays, it was half empty today.
Even before they had climbed out of the car carrying their bags, Barbara had opened the front door. “Come on in out of that,” she yelled over the gale. “It’s coming down in stair rods.” She closed the door. “Thanks for coming so quick. I’ll take your coats. You’re drenched, so you are, and after only a few seconds. Normie was getting along rightly, Doctors. He even had a visitor this morning. Colin Brown and his wee dog Murphy called in to talk to Normie about a puppy Colin knows about. Normie’s been wanting a dog for months now and he’s daft about that dog of Colin’s. The boy’s had the mumps so I let him in.”
“Colin Brown’s here now?” said O’Reilly.
“He is, sir. Colin was for going, seeing Normie’s head had got so sore. He’s boked twice, and the light hurts his eyes. But having Murphy beside him seemed to soothe Normie, and then the rain started coming down, so I asked Colin to stay. I have Normie teed up in there ’cause it’s warm and I can keep an eye til him, and I have the curtains shut.” She pointed to where Norman, today in blue pyjamas, lay in the dimly lit living room on a couch with what must be a cold wet towel on his forehead, a ceramic baking bowl on the floor beside him. “I done what you said, Doctor Emer, I give him an aspirin, but he boked it up, and then I called. I hope you don’t mind on a Saturday, like.”
Emer said, “You did exactly the right thing, Barbara.”
Dear God, the consideration of rural patients for their physicians, O’Reilly thought.
“Hiya, Doctors,” Colin Brown said from where he sat on a chair near Norman. Murphy, Colin’s mongrel, lay on the rug at Norman’s side. “Mrs. Devine said that seeing it was so bad out, I could stay and she wouldn’t mind if I watched you work, if that’s all right with you, Doctor O’Reilly? If I pass my exams in June I’ll be well on my way to being a vet, and sure don’t doctors do more or less what vets do? I could learn something.”
O’Reilly smiled. A couple of years ago, Colin had said when O’Reilly was examining a sick dog, “Sure isn’t a doctor the next best thing to a vet?” Clearly his opinion hadn’t changed.
“You sure, Barbara?” said O’Reilly. “You don’t mind?”
Another thunderclap.
“Och aye. I think Normie’s more comfy with Colin and Murphy here. He loves Murphy, so he does.”
“Would you like Colin and Murphy to stay, Norman?” said O’Reilly. “You don’t mind?”
Another thunderclap.
“I don’t mind, Doctor. Murphy’s all comfy here on the bed.” The boy reached out to lay a hand on the dog’s flank.
O’Reilly recalled with great clarity how two years ago, when Kenny had been a pup, how much his presence had cheered up Anne Galvin. Why not let them stay?
“We’ll be good, Doctors. Honest to God,” Colin said.
“All right. Just don’t get in the way.”
Norman’s face and neck were still swollen. He looked flushed and he’d been crying.
Emer squatted in front of him. “Feeling poorly, Norman?”
“Yes, Doctor Emer. My neck’s awful stiff, so it is.”
The central nervous system is involved, all right, O’Reilly thought. Now let’s see how badly. He crossed his fingers behind his back.
“I’m sorry to hear that. Do you know where you are?”
“At home.”
“Good. What’s your name?”
Norman frowned. “Sure you know it’s Norman Devine.”
She turned to Barbara. “Has Norman been hard to wake up?”
“Och, no, Doctor.”
Making sure the child has not had any episodes of unconsciousness. Coma was frequent in encephalitis patients. “Have you anything here in your kitchen with a strong scent, Barbara?”
“I’ll get something.”
Emer turned back to the boy. “I have to ask you a few more questions and then examine you. Don’t be scared.”
“Here y’are, Doctor.” Barbara handed Emer a bottle.
Emer held the open jar under Norman’s nose. “What can you smell?”
“Cloves. I like clove rock, so I do.”
“Me too,” Colin said. “I wonder how you’d ask a dog what it could smell? They’ve terrific senses of smell. English springers and Labradors are likely the best sniffers.”
“Wheest, Colin,” Barbara said. “You promised to be good.”
“Good lad, Norman.” Emer returned the bottle of cloves to Barbara. “Now, Norman, what colours do you see me wearing?”
“You’ve a green sweater on, miss.”
“Can you sit up for a wee minute?”
“I’ll help,” Barbara said, did, and took away the cold compress.
That’s two of the twelve cranial nerves tested, the ones that carried their messages directly to and from the brain. If all were unaffected, the outlook would be getting better.
Another low rumbling, but less loud. The storm was moving away.
“Norman, I want you to cover your left eye with your hand and look into my left eye with your right one. I’m going to wiggle my fingers, and I want you to point as soon as you see them appear, but keep staring into my eye all the time.” She stretched out her left arm and began wiggling. Colin was covering his eye too, and the boy’s serious expression made O’Reilly smile, despite his concern for Norman.
It took two minutes to complete the test of the boy’s visual fields. He had no defects.
“Now before we get you lying down again, a couple more things.” She held up three fingers. “How many?”
“Three.”
“Now how many.”
“One.”
“I don’t know what you’re doing, Doctor Emer.” Colin had been paying rapt attention. “But it wouldn’t work with cats. They can’t count, but I seen, I mean I saw, a dog at a circus once that could.”
“Colin.” Barbara held up an admonitory finger.
“It’s all right,” Emer said, and smiled, but she was perfectly serious when she added, “And Norman has no squint. Now, please, Norman, without moving your head, look straight up, down, far left, far right. Good. No loss of eye movements. Sorry I have to do this.” She shone her pencil torch in his eyes.
He jerked his head away. “That hurts.” He sniffed.
Murphy raised his handsome, square head from the sofa and licked Norman’s hand. It seemed to comfort the lad.
“I am sorry,” Emer said, but reported, “Pupils equal and reacting.”
Nerves three, four, and six were intact, but photophobia was a sign of meningeal inflammation.
It took several more minutes for Emer to assess six more nerves. All were unaffected. “You’ve been a good boy, Norman. Now, I want you to stick your tongue out at me.”
Norman looked to his mother for approval. A child sticking out his tongue at an adult was an unforgiveable act of rudeness. She nodded. “Mammy won’t be mad.” As Norman Devine stuck his tongue out at Emer, O’Reilly watched Colin struggling with what must be an urge to stick his out too. He succeeded. The boy was maturing. Emer was testing the twelfth, the hypoglossal nerve. If it were damaged, the tongue would deviate to one side.
O’Reilly uncrossed his fingers. His initial anxiety on behalf of the boy was fading. And he was impressed with Emer’s unruffled professionalism. He chuckled.
“That tongue is as straight as a die,” Emer said. “Now, let’s get Norman lying down again.”
Barbara helped.
Emer assessed the boy’s ability to move his limbs and feel pressure and touch, and tested his reflexes. None were abnormal. “Now, Norman, this is going to tickle.” And Emer tested his Babinski reflex. The toe curled down.
“You could do most of that to a horse,” Colin said. “Thank you, Doctor Emer. Boy, I knew I’d learn something.”
Barbara smiled. “My mammy says you should learn something new every day.”
Emer stood. “Now, let me explain what’s going on.”
Colin hunched forward, his frown indicating his
attention.
“I believe the nasty bug has caused some—”
Norman moaned, hung his head over the bowl, and threw up.
O’Reilly’s nostrils were assailed by the acrid smell, but he’d been exposed to it for thirty-eight years. He didn’t even wrinkle his nose.
“Poor Normie,” Colin said, “but there’d be worse smells in a byre or a pigsty, I reckon.”
Norman Devine might be feeling rotten, but Emer’s thoroughness had removed encephalitis as a diagnostic possibility. The examination was conclusive proof that the boy’s brain itself was not infected, praise be.
Barbara cradled her son’s head, wiped his lips with the towel that had been his cold compress. “’Scuse me. I’ll just go and empty this and get you a glass of water, Normie,” she said, picking up the bowl.
“Don’t worry, Norman,” Emer said, “you’re going to be fine.” She pulled a hanky from her sleeve and dried the boy’s tears.
O’Reilly heard a toilet flushing. Tap water running.
Barbara came back and replaced the bowl. “Sorry about that.” She held a glass to her son’s lips so he could drink.
“Hardly Norman’s fault,” O’Reilly said, inclining his head to Emer to indicate she should carry on. He was going to be interested in her explanation.
“Sometimes the mumps bug can inflame membranes in the head—”
Barbara’s hand flew to her mouth. “Has Norman got the meninjitees?”
O’Reilly knew what Barbara must be thinking. There had been an outbreak of meningococcal meningitis, cerebrospinal fever, here two winters ago. It was a virulent disease and one little boy had died. Emer couldn’t know about that and how it was affecting Barbara.
“Yes,” said O’Reilly quickly, “but it’s a very different kind to the one you’re thinking about, Barbara. No need to worry. None at all. I promise.”
An Irish Country Family--An Irish Country Novel Page 11
