All of which, Barry thought, was also typical of narcolepsy. Now what should he do? Was he completely sure of his diagnosis? To his knowledge there were no special tests that would confirm or refute his idea, nor any cut-and-dried physical findings, so really no point in doing a thorough physical examination, because he’d have no idea what he was looking for. It was a job for a specialist and one he had no qualms about turning over. And Nonie wasn’t an ordinary patient. How would she as a doctor respond if he told her what he was thinking? Had she not suspected something like this herself, or was she like so many physicians who believed that disease was what happened to other people and that doctors were somehow immune? He pursed his lips. What would he want if the positions were reversed? No question. He’d want to know. “Nonie,” he said, keeping his voice level, “do you know what I think about what just happened, your broken nights, your always being sleepy?”
“Tell me.”
He inhaled, then said, “I’ve never seen a case, but I think you may have narcolepsy.”
“Narcolepsy?” She frowned. “Narcolepsy? Do you really think so?” She took a deep breath and shook her head. “I suppose I’ve always wondered about it myself. The sleepiness, the vivid dreams.” Her laugh was brittle. “But narcolepsy?” She frowned. “I’ve always thought that was kind of a joke. Like something you see in slapstick comedies. People falling asleep in the middle of conversations. But this is no joke. Barry, I think I’ve been avoiding the whole thing, hoping it would go away. Do you really think that’s what I’ve got?”
He nodded, grateful for her willingness to consider the diagnosis. Many people—and doctors, contrary to the beliefs of many members of the profession, were just that, people—denied bad news. Refused even to consider it. Now she clearly recognised that. “I do,” he said.
“Are you sure?”
“Pretty sure,” he said, “but if I were in your shoes I’d not take the word of a country GP, and that’s not false modesty. I’d want to have a word with a specialist neurologist.”
“Me too. I’ve got to get to the bottom of this. I know sweet Fanny Adams about narcolepsy, but I remember that passing out like that might be due to some kind of epilepsy or,” she shuddered, “perish the thought, a brain tumour. I think I should see Doctor Millar at the Royal.”
“I agree,” he said. “But it’s not exactly an emergency. You didn’t pass out, precisely, according to Willie. You quite deliberately put your head down and fell asleep. But you should be seen as soon as possible. Would you like me to make an appointment for you?”
“Yes, please,” she said in a low voice. “I wasn’t very good at neurology. Can they do anything about it?”
“I’m not sure. I believe so, but Doctor Millar can advise you better. I have a hazy memory of reading an article several years ago that said small doses of amphetamine are used, but I’ve never had to prescribe them.”
“It’s scary,” she said. “Unless he can do something, I don’t see how I can manage. God, what if I fell asleep behind the wheel while driving?”
Barry hesitated. The answer was obvious, but he was in no rush to blurt it out. Instead he said, “I’ve seen you in the middle of an episode twice, but never at the very start. How quickly does it happen?”
She shook her head. “Usually I get warning. I know I’m going to have to sleep very soon, but once in a while I go out like a light, just as if I was lying in bed.”
He remembered Willie’s description. She’d had no warning this morning. “I told you I’m no expert, but I reckon for the time being you shouldn’t be driving, until Doctor Millar gives you the go-ahead.”
“God, that’s awful.” She took a deep breath, managed a weak smile, and said, “But of course I shouldn’t.” She sat back in her chair. “Barry Laverty, you are a good man. Thank you. I needed someone to make me face up to what was going on. Thank you.”
Barry shrugged.
“And,” she said, “I’m sorry I came on to you, but you are a most attractive man…”
He blushed, looked at his dressing gown and slippers, hardly the attire in which to be discussing these kinds of things. He smoothed his tuft.
“I apologise. I’m sorry I’ve been a bitch about not swapping call. Fingal was right to tick me off. If I have got narcolepsy, it may explain some of that, but even if it doesn’t, I do enjoy my work here. I’ll try to improve. I promise.”
“I know you will, Nonie,” Barry said, “and the first step is for me to ring ward 22, the neurology unit. Get you seen.”
“You are a pet, you know,” she said, “and a fine physician. Thank you.”
He smiled. “You have a rest,” he said. “I’ll see to Willie. Send him home. Then I’ll call the ward.” He laughed. “And then I’d better get washed, shaved, and dressed.”
“Thank you, Barry. At least Willie was my last patient. He needs forms filled in so we can check his uric acid levels. I’m going upstairs to lie down for a while.”
“I’ll look after the forms. You stay there until I’m ready, then I’ll run you home to Belfast. Will you be okay taking the bus to see the specialist?” he asked, and saw her nod.
“All right, then once you’ve seen Doctor Millar, we’ll have to talk to Fingal about how this will affect your work in the practice.”
She took a deep breath. “I understand. Thanks, Barry. Thanks for everything.”
He wrote up Willie’s lab requisition, then headed for the door, feeling a sense of pride at his diagnostic achievement and a little ashamed for having misjudged her. But now they had a dilemma. Certainly it was a kind of relief to know that Nonie’s difficulties probably stemmed from a physical disorder, but if it could not be treated, should she be allowed to work with patients? Or even drive a car? That was certainly something to discuss with Fingal.
The scent of toasted barmbrack was mouth-watering when Barry entered the kitchen, and he realised he hadn’t eaten since last night. Kinky said nothing. She’d understand the need for confidentiality.
“Everything okay, Doc?” Willie wanted to know.
“Fine,” said Barry. “Doctor Stevenson just had a wee faint. No need to worry.”
“Right enough,” Willie said, “it could happen to a lady bishop—except there are no lady bishops. I don’t mind telling you it scared the living daylights out of me. I hope she’ll be all right, so I do. She’s a very nice wee lady.”
“I’m sure everything will be fine. Here,” Barry handed over the requisition, “and do me a favour, Willie. Mum’s the word.”
Willie chuckled. “Doc, if I told you all the things a barman hears they’d blister the paint off the walls. Of course I’ll keep my trap shut.”
“You are a sound man, Willie Dunleavy,” Kinky said.
“And I’ll be running along,” Willie said, rising. “I’ll see myself out.”
“Thanks for seeing to Willie,” Barry said. “Things were a bit fraught for a while there.”
Kinky tutted. “And did the doctor have a fit?”
“Not exactly,” Barry said, “but Doctor Stevenson’s not well.”
“The poor wee dote.”
“I’m a bit worried about her. I think she’s got a thing called narcolepsy.” Kinky was a trusted member of the practice with a mouth like a steel trap. Anything Barry told Kinky would stay with Kinky.
“I never did hear of that.”
“It’s pretty rare, but I hope we’re going to get it sorted out.” He half turned. “And if we are, I’ve a phone call to make.”
“You trot along, Doctor, dear,” Kinky said.
Barry went to the hall phone. As he waited during the inevitable delays of getting through to the switchboard and then being connected to Doctor Millar’s secretary, he noticed a buff envelope from the laboratory on the hall table. It was addressed to him.
A voice on the other end said, “Doctor Laverty?”
It took only a few moments to arrange an appointment for Nonie, and as a doctor she was paid the professi
onal courtesy of a ten o’clock appointment the following day.
“Thank you very much,” Barry said, and replaced the receiver. He opened the envelope and grinned. Sonny’s results. And they were what Barry had been hoping for.
Right. He’d take care of his ablutions, get a quick bite to eat, ask Kinky to tell Nonie he’d had to nip out to the Houstons’, but that he’d not be too long and then he’d take her to Belfast.
22
Thou Migh’s’t Him Yet Recover
Once in a while, an early February day in Ulster can feel like spring. Barry parked outside the Houstons’ house, grabbed his bag, and left the car. He needed no overcoat as the early afternoon sun beamed down from a blue sky. The roadside elms were still bare, but each twig had the beginnings of a bud. From somewhere high in one of the trees came the loud, clear trilling of a song thrush, each phrase repeated thrice. To Barry’s delight he heard an accurate imitation of a telephone’s ring. The birds were noted for their mimicry.
I grew up in Bangor, he thought, looking up into the sky. A small place where he’d learned to love sailing and the countryside. I’ve never been one much for huntin’ and shootin’, but I do enjoy a day’s fishing. He was sure John MacNeill would give permission for a day on the Bucklebo River soon. No matter what cares might bedevil Barry’s everyday life, the quiet of the riverbank, broken only by the chuckling of the waters over rocks or the splashing of moorhens in the shallows, was balm for the soul. It was so easy to become lost in the fluid actions of cast and retrieve, cast and retrieve, until satisfied by its position, he let the fly drift onto the water upstream from the rings left by a rising trout. No matter that on that try the fish ignored the bait. Just repeat, cast and retrieve, cast and retrieve in harmony with the rhythm of the rippling river.
But that, of course, was to come.
Sonny Houston was sitting reading at a white wrought-iron table in his garden. As Barry approached the gate, the dogs, Jasper included, came bounding across the lawn, yipping, barking, tails thrashing, jostling each other. “Can I come in, Sonny?”
“Doctor, of course. Give me a minute.” Sonny rose and walked to the gate, his steps even and assured. “Come to me, dogs,” he said. “To me.”
They clustered round him.
Sonny opened the gate. “They’ll not bother you.”
Barry let himself in. Each dog in turn came to him, sniffed him, and bounded off.
Sonny grabbed Jasper by the collar. “Here’s old Jasper. He’s put on a bit of beef in the last ten days. We’re very grateful to you, and especially to Colin Brown.”
“Everyone’s delighted,” Barry said, running a hand over the dog’s soft, sun-warmed head. “Off you trot, Jasper. Go and play with your pals.” Sonny let the dog go.
Barry walked with Sonny along the path, noticing that the man’s complexion had returned to normal and that he was breathing without difficulty.
“Isn’t it a wonderful day?” Sonny said. “I just couldn’t bear being cooped up, so the dogs and I came and sat outside.” He pointed to one of the chairs. “Please have a seat.”
Barry did. The metal of the chair was warm under his backside. He put his bag on the tabletop.
“Maggie’ll be sorry she missed you,” Sonny said as he sat. “She was so excited by the prospect of spring she decided she had to go into Ballybucklebo and buy a new hat. Alice Moloney will be thrilled. She’s been tempting my dear wife with new hats for at least a year now.”
“Give Maggie my regards.” Sonny had been reading what must be an ancient tome. The fading brown leather covers were scuffed and a lengthy title was picked out in gold leaf.
“It’s by Heinrich Schliemann,” Sonny said. “He published it in 1881. It’s all about his excavation of Troy.”
“Have you been there?”
“Oh, yes, many times. The site was in Hisarlik in northwestern Turkey. Schliemann’s methods were, shall we say, a tad unorthodox. He used dynamite instead of proper dig methods to excavate the early levels.” Sonny shook his head with an indulgent smile. “Some feel the man was little more than a treasure hunter. But it’s interesting reading all the same.”
“Sue’s fascinated by all that,” Barry said. Only six more days.
“She would be welcome to borrow it when she’s home again,” Sonny said.
“Thank you.” Barry opened his bag. “I’ve got some welcome news for you.” He produced the forms and smiled. “I’ve brought your test results and I’ll come right to the point. You do have pernicious anaemia, and the treatment is working.”
“Thank you, Doctor. I am very relieved. Very relieved,” Sonny said. “And I’m not surprised. I’ve been feeling much better every day since we started the injections.”
Jasper wandered over, thrusting his head onto Sonny’s knee, demanding Sonny pet him.
“You’re forgiven, you know,” Sonny said, and stroked the dog’s flank.
Jasper head-butted Sonny like a cat demanding attention.
Barry watched the old man and his dog, each happily at home with the other.
He’d been right not to insist on a bone marrow biopsy or a gastric fluid analysis. Sonny’s reticulocyte count was now 50 percent and his haemoglobin was on the rise. Barry allowed the feeling of satisfaction at taking a chance and being right to sink in, along with the warmth of the sun. What was even more important, though, was the satisfaction of having been able to spare a delightful and scared old man pain and discomfort. And what’s more, in general practice, when you made a diagnosis, you had to follow up, and Barry would have been pretending if he didn’t admit it was gratifying when a patient said thanks.
“You remember that your haemoglobin level was very low?”
“I do. When numbers apply to one’s self, you don’t forget them. It was six and should have been fourteen point eight.”
“It’s nine point five now. Another couple of weeks and it should be back up to that fourteen point eight mark. Then we’ll cut your injections down to once a month.”
Sonny laughed. “I’ll not mind that,” he said, “and do you think you could teach Maggie to give me them? I really have been quite a drain on your resources having a doctor call every day.”
Barry smiled and opened his bag. “It’s our job, Sonny. We don’t mind.”
Sonny needed no bidding. He rolled up his shirtsleeve. In moments, today’s injection was given.
“Thanks,” Sonny said.
“Honestly. It’s no bother,” Barry said, putting his gear away, “and it’ll be Doctor O’Reilly’s turn tomorrow. I’ll have a word. I’m sure he could teach Maggie.”
“Excellent,” Sonny said.
Barry rose, and said, “I’ll be trotting on now. Please don’t get up.”
“Thanks again for everything, Doctor,” Sonny said.
Barry smiled and wandered off down the path, noting the little clumps of snowdrops and crocuses blooming in the sun. He turned as he closed the gate behind him, looking back at one of the most contented men he had ever known. Sonny Houston sat clearly engrossed in the excavation of Troy, surrounded by all his faithful canine friends, well on the mend from a disease that only forty years ago would have killed him.
He waved and Barry waved back and turned to go, but for a moment was distracted by a bleating from the next field. He glanced across. The lambs that had been born before Christmas were growing and one, in the inexplicable way of its kind, was bouncing on stiff legs like some ovine pogo-stick jumper revelling in the weak sunshine. The green field, bounded by dry stone walls, was mottled with white ewes heavy in their winter fleeces. Several lambs, including two black ones, were nuzzling at their mothers’ teats. It wasn’t spring yet, but the year was moving along. The promise was there.
Damn it all, the smartest thing Barry Laverty had done in his twenty-six years had been to decide to go to medical school. He paused. That had been the beginning of the journey that found him here, at the edge of this field at the top of the Ballybucklebo Hills. He’d w
orked bloody hard and qualified, he’d accepted the offer of a crusty old GP named Fingal Flahertie O’Reilly’s to work in his rustic village, and now he was about to marry Sue Nolan.
High above him, the thrush’s notes soared in a sweet, liquid ode to joy.
23
Cries, and Falls into a Cough
“Thank you, Nonie, for coming down early from Belfast on a Monday morning, especially coming by train,” O’Reilly said, wondering whether he should take the last piece of toast.
The kitchen where the three doctors were having breakfast was cosy and filled with the aroma of Kinky’s freshly toasted raisin bread. “Barry here told me about your possible narcolepsy. How did things go with Doctor Millar on Friday?”
Nonie sipped her coffee. “He was very understanding,” she said. “There’s no test that says the diagnosis is certain, but he had me have an electroencephalogram and a skull X-ray. No abnormal brainwaves, no space-occupying lesions, so I don’t seem to have epilepsy or a brain tumour, which,” she smiled, “I must say is a great relief.”
“To all of us,” Barry said.
“He told me that we’d have to work with a probable diagnosis of narcolepsy. I’m taking amphetamine ten milligrams every day when I wake up and we can increase the dose by ten more milligrams up to a maximum of sixty until I have the nodding off under control.”
“Does that mean,” Barry asked, “that you’ll be fit to drive, see patients?”
She shook her head. “I mustn’t drive until I’ve been a month free from uncontrollable napping, he said. He reckons if I take my first pill at eight thirty and start the surgery at nine I should be able to cope. And if I don’t do any procedures, I’d be no risk to patients.”
O’Reilly scratched his chin. “Mmmm,” he said. “So you couldn’t make home visits for a while except maybe the odd one you could walk to. Most home visits are out in the country, of course. If it’s walkable, patients usually come to the surgery. No driving means no night call too.”
An Irish Country Love Story Page 20
