This bed was inside an oxygen tent like the one that had helped the long discharged Kevin Doherty. This patient was a man of thirty-four. He was skinny as a rake, his upper front two teeth missing, his Old Bill moustache nicotine-stained, and his right arm ending in a stump below the elbow. Fingal had admitted him so it was his job to keep up the daily progress notes and present the case, when required. Fingal had spent quite a bit of time with the little man. “Good afternoon, Sergeant Paddy Keogh,” he said. As many male patients did, the man was wearing a tweed duncher. “How are you today?”
“I’m not altogether at myself, Mister O’Reilly, sir,” he coughed and winced, “but I’m mending, t’anks.”
Dubliners, Fingal thought, could never manage the th sound. In the north, folks had trouble with thr so instead of “three” they’d say “thee.”
“Always glad to see yourself, sir.” Paddy Keogh tried to smile. His breathing was laboured, his lips and cheeks cyanosed. Even without a stethoscope, Fingal could hear the wheezing of the little sergeant’s lungs. Fingal had admitted the patient at one A.M. four nights ago. One disadvantage of living in students’ quarters was that they were easily called at night. Still, it increased the number of patients they saw and so their experience grew.
On that night it had taken Fingal a moment to recognise the beggar he’d given two shillings to last March. Sergeant Pádraig, “Paddy,” Keogh—febrile, sweating, suffering violent pain with every breath, coughing, wheezing, and shivering as he was—had no difficulty recognising Fingal. “Jasus,” he’d gasped, “it’s yourself, sir, w’at gave me a whole feh—” He must have seen the nurse and corrected himself in time, “sorry, a whole two shillings, sir.”
“Och,” Fingal had said, “sure and amn’t I only an eccentric millionaire? Now let’s get you seen to.”
Fingal had busied himself with the admission history and physical examination. Address, 27 Francis Street; age thirty-five; religion, Roman Catholic. He’d recorded the symptoms and signs. The diagnosis was simple, particularly as it wasn’t the man’s first bout of pneumonia. Fingal cursed the Dublin tenements.
With Geoff’s advice, tests had been ordered. A chest X-ray confirmed that the man had left lobar pneumonia and pleurisy: inflammation and infection of his left lung and the membrane surrounding it. Treatment was prescribed; oxygen, sponge baths to try to relieve his temperature, and the drug that had been in vogue since the late 1800s to reduce temperature, acetylsalicylic acid—or aspirin. It might help the pain a little, but morphine was out of the question because of its known suppressant effects on respiratory function. He was going to be in pain for a while.
Fingal had already heard that one of Hilda’s patients, a young woman, had died of pneumonia. Some days after the onset of the disease, the crisis had come heralded by a dramatic rise in temperature. They’d all hoped for an equally dramatic fall in her temperature, followed by a gradual recovery. But at the height of the crisis the woman had died. Victorian novelists like the Brönte sisters and Wilkie Collins had loved to use pneumonic crises for dramatic effect. The course of the disease and its treatment weren’t much different in 1934. What was needed was a medication that killed bacteria, but according to Doctor Micks, in 1930 a Doctor Fleming had abandoned attempts to use a derivative of a fungus called Penicillium notatum for such a purpose. The substance was known to stop bacterial growth in the lab but couldn’t be collected and purified well enough for human use. Patients had to rely on their own resistance to fight off the infection.
Fingal lifted the notes and scanned the temperature chart. The graph covered the eighty-four hours since admission. Thirty-three hours ago the spidery, black line had ripped upward to an acute spike then plummeted to where it wandered along rising above and falling to the normal level of 98.4 degrees Farenheit before rising again. Even though he’d not been on duty, Fingal had taken it upon himself to sit with the sergeant that night until the crisis passed.
Fingal could still hear Fitzpatrick’s nasal whining. “You’re not on duty, O’Reilly. I want this case. I’ve never seen a pneumonic crisis.”
“You’ll get your chance.”
“I don’t care. I want this one. It’s my turn.”
“For God’s sake, Fitzpatrick,” little Hilda Manwell said, “Fingal’s particularly interested in the man. You met him before he got sick, didn’t you, Fingal?”
“I did.”
“Suit yourself.” Fitzpatrick stormed off muttering, “Serve you right, O’Reilly, if he snuffs it.”
It had been all Fingal could do to restrain himself from charging after Fitzpatrick and belting him. Instead he’d sat by the bedside willing the sergeant to pull through. That had been a day and a half ago.
Geoff had abandoned his attempts to make Fingal treat patients dispassionately. The house officer didn’t even shrug when Fingal said, “Your fever’s getting better, Paddy.”
Perhaps because of the old soldier’s dogged refusal to give in to the pain, to try to get a laugh if possible, Fingal felt so protective of the man, so unwilling to do the procedure and hurt him. “You are on the mend,” Fingal said.
He was rewarded with a weak smile and a hoarse, “I hope so, sir. I was sick two days at home now four days in here. I’m gasping for a fag.”
Fingal shook his head. “You light a cigarette next to that oxygen and you’ll be giving an impression of a flammenwerfer.”
“A German flame thrower? Jasus.”
“Oxygen is very flammable.”
“I’d not want dat, but sure how could I anyway? Didn’t the nurses take me gaspers away?” He sounded aggrieved.
“Paddy, you eejit, you’re not well enough to smoke.”
The sergeant grunted.
He was recovering, but not fast enough. A repeat X-ray this morning had shown a dark shadow, a collection of fluid at the base of the left lung between the twin layers of the pleura. This morning at rounds Doctor Micks had instructed Geoff to drain the fluid to reduce the patient’s suffering and shortness of breath.
Fingal saw the trolley being wheeled along the ward and smiled. Sister had sent Kitty. He winked at her. Her eyes smiled at him from over her mask. Turning to the patient, he said, “All right, Paddy. You’ve a spot of fluid on your lung—”
“Jasus, sir, I was never gassed.” He held up his stump. “Losing me arm was bad enough, but I saw chlorine gas in the trenches and w’at it did to a man’s lungs.”
Fingal put a hand on the man’s bony shoulder. “We know you weren’t gassed, Paddy. The bug that felled you has made your lungs raw and your body’s tried to soothe it by making fluid. That fluid’s squashing your lung. Making it harder for you to breathe.”
“Aye, and sore.”
“So,” said Fingal, “Doctor Pilkington and Mister Greer are going to remove the fluid.”
“You mean they’re going to stick a feckin’ great needle into me back?”
“I do.”
He coughed and held the left lower side of his chest. “I had that done once before. It stings like bejizzis.” His bony hand sought Fingal’s and the sergeant looked up into his eyes. “Would you do me a favour, sir?”
“If I can.”
“Would you do it yourself, like?”
“Me?” Fingal recoiled. “I’ve never done one before.” And I don’t want to do this one, he thought.
“Ah, but—” He coughed again. “I know you’ll be gentle, sir.”
Fingal looked at Charlie, who said, “Fine by me.” He’d be disappointed to be deprived of the opportunity to add to his growing armoury of skills, but he’d have another chance.
“I’ll help you,” Geoff said. “Come on, we’ll go and wash our hands.” He turned to Kitty, who stood at the bedside with her instrument trolley. “Can you and Mister Greer get the patient sitting up?”
“We can, Doctor.”
“We’ll only be a minute, Paddy,” Fingal said.
He and Geoff soon returned, gloved and masked, and stood by the instrum
ent trolley. While they’d been away, the screens had been closed.
Charlie and Kitty had the sergeant sitting on the far side of the bed. His skinny legs dangled over the side. Charlie stood facing him with a hand on each shoulder to support him. Kitty moved to Fingal’s side.
He glanced at the instruments. Big syringe, he shuddered, little syringe, stainless steel kidney dish, small gallipot with antiseptic solution, cotton wool balls, sponge holder. He loaded several cotton wool balls into the jaws of the holder. “Just going to wash your back, Paddy. It’ll be a bit cold.” Fingal couldn’t understand why when the antiseptic was diluted they didn’t use warm water. A little thing, but important to the customers.
Fingal daubed the left side of the man’s back over the spot where the X-ray had shown the fluid.
“There.” Doctor Pilkington pointed to a space between two of the lower ribs, halfway between the chest’s edge and the spine.
Fingal nodded and picked up the smaller syringe. “Local please, Nurse.”
Kitty lifted the bottle of procaine. Fingal filled the syringe’s barrel. As he withdrew the needle from the bottle, his glance caught hers over her mask.
In the three months since the Wanderers game he’d been seeing her as often as their duties permitted, which wasn’t one hell of a lot. Even a few stolen words and glances on the ward were risky. Sister Daly had her rules about student nurses and medical students.
Even so, after only five dates they had grown closer. He was able to read some of her moods by looking into her eyes, and he sensed she was encouraging him. Bless her. She was quite the girl, but this was not the time for those kinds of thoughts. They’d have to keep until the New Year’s Eve Ball at Trinity unless he could arrange to see her sooner.
He turned to the patient. “You’ll feel a little jag, Paddy.”
“All right, sir.”
Fingal slipped the needle under the skin and began to inject, raising a blanched wheal.
“Now, Mister O’Reilly,” Doctor Pilkington said, “gradually advance the needle tip, injecting as you go to infiltrate the intercostal muscles and the pleura.”
Fingal took a deep breath. The pleura was exquisitively sensitive. He knew when he’d hit it because he heard the patient sucking in air through clenched teeth. “Sorry, Paddy,” he said.
“It’s all right.”
“We’ll give the local time to work,” Doctor Pilkington said as Fingal withdrew the needle and laid the little syringe beside Big Bertha. That was a powerful needle all right. Fingal hoped the local would be very effective.
He stretched out his hand for the larger syringe.
“Give it a minute or two,” Geoff said.
Fingal waited, then, remembering something he’d learnt in outpatients, picked up the small syringe. “What do you feel, Paddy?” He gently pricked the target area with the fine needle.
“Not a t’ing, sir.”
“Right,” Geoff said.
Fingal took a deep breath, picked up Big Bertha, and held it the way he’d seen Charlie being shown.
He heard a very quiet whisper from Kitty, who was standing closer to him, studiously staring into space. “You’ll do a great job, Fingal.”
He exhaled, thought, thank you, girl, thank you. He looked at Doctor Pilkington, who nodded and said, “Go in at a right angle to the skin and advance slowly. Keep pulling with your thumb on the plunger’s ring. As soon as you start to see fluid in the syringe’s barrel, stop advancing. You’re in the cavity and you don’t want to go too far.”
Too bloody true, I don’t, Fingal thought. On the left side of the chest, less than an inch from the needle’s point of entry, was Paddy’s heart. “I’m going to start now, Paddy. All right?”
“Go you right ahead, sir.” He began coughing. Fingal had to wait until the paroxysm had passed. “I suppose,” Paddy managed, “you’d not want to shoot at a moving target. I never did meself unless the Hun was coming over the top.” He collected himself. “I’ve stopped coughing now. You carry on.”
“You’re a tough man, Paddy Keogh,” Fingal said, his confidence increasing. “A tough man.”
He put the needle tip against the red mark where the local anaesthetic had been injected and followed Geoff’s instructions. It took an effort to advance and it was awkward trying to pull back with his thumb. His efforts were rewarded when a dirty brown fluid flowed into the barrel. He immediately stopped advancing and slowly filled the syringe. “Could you hold the kidney dish please, Doctor Pilkington?”
Geoff put the stainless steel receptacle under the out-spout of the syringe.
Fingal turned the two-way tap and thrust on the plunger. A jet of brown blood-tinged fluid spurted into the dish.
He had emptied eight and a half syringefuls before more suction refused to produce any fluid. “Just about all done, Paddy.”
“T’anks, sir.”
“Needle out, and I’ll dress the puncture,” Geoff said.
As Fingal removed the needle, Geoff clapped a dressing over the entry wound. “Well done,” he said.
There was a whispered, “Well done, Fingal,” from Kitty.
“Well done, Paddy,” Fingal said, and realised he was grinning. He wiped sweat from his forehead with the back of his gloved hand. “Come on, Charlie,” he said, “let’s get Paddy here back on his pillows.” Fingal was amazed to see how the man’s colour had already improved. “Are you all right?” he asked.
“I’m sound, sir. Sound—and it doesn’t hurt as much.”
Fingal smiled. “I’m delighted,” he said, and for the life of him he couldn’t be sure whether his pleasure was in the reassurance he’d been given by Kitty, the “well done” from Doctor Pilkington, the fact that he himself had been able to stifle his squeamishness, or the fact that his work had helped to improve Sergeant Paddy Keogh’s condition.
“You, Mister Fingal Flahertie O’Reilly, have a quare soft hand under a duck,” Charlie said.
“I’d drink to dat meself—if I could get me hands on a feckin’ gargle,” said Paddy.
Fingal said, “Sister gets one-third-pint bottles of Guinness free from the brewery for tonics for our patients. Do you think, Doctor Pilkington, Sergeant Keogh could benefit from one?”
“Two a day,” said Geoff, “until he’s discharged.”
Fingal grinned. “Och,” he said, “I’d go a celebratory pint myself, but we’re on duty tonight and have outpatients tomorrow afternoon, but after that I’ll be in the snug in Neary’s pub at seven if anyone would care to join me.” He didn’t need to look at Kitty. He just hoped she could find some excuse that would allow her to leave the Nurses’ Home in the middle of the week. Three months ago, when his brother had warned that he might get hooked, he’d replied, “Me? Not likely. I’ve exams to pass, remember?” But, damn it, the New Year’s Eve Ball seemed like an eternity away, and Fingal Flahertie O’Reilly wasn’t a monk who’d taken vows of chastity.
13
We Will Go into a Public House
Fingal stopped on Grafton Street and listened to a ragged man playing “The Irish Washerwoman” on a penny whistle. Oblivious to the busker, well-dressed folks Christmas window-shopped on the brightly lit thoroughfare. The power for the streetlamps and storefronts came from a hydroelectric plant at Ardnacrusha on the Shannon River near the city of Limerick. The generator, Fingal knew, had opened five years ago.
The man switched to “The Wind that Shakes the Barley.” Fingal thought the musician a deal more adept than Cromie on his whistle and chucked a couple of coppers into a cap on the pavement where the man’s mangy dog sat, its tongue lolling, a grin on its face. “Lummox,” Fingal said, and patted its head.
“Lummox, yourself,” a familiar voice remarked.
Fingal turned and saw Bob Beresford, dapper as ever.
Bob lifted his bowler. “Evening.”
“What the hell are you doing here, Bob?”
“Looking for a little Yule gift for Bette.”
“Bette? Not
Freda?”
Bob smiled. “Bette.”
“Don’t tell me you’re dating Bette Davis. I’d not put it past you, Beresford.”
Bob laughed. “Bette Swanson, and no, she’s not related to Gloria. You’ll meet her at the New Year’s Eve Ball,” he said, and winked. “What brings you to the bright lights?”
“I’m hoping Kitty’ll show up in Neary’s snug,” Fingal said.
“Neary’s? On Chatham Street?” Bob grabbed Fingal by the arm. “Brilliant notion. Come on. I’ll buy you a jar. You’re probably broke. I saw you giving that old boy money.”
“Pennies,” Fingal said, and hesitated. He wanted Kitty to himself, but Bob was such a good-natured chap.
“Don’t worry, Fingal,” Bob said. “One drink and I’ll be off. I’ll not play gooseberry.”
Fingal, laughing at the thought of Bob intruding on a friend’s assignation, fell into stride.
In no time he was sitting in the familiar small room. The snug was open to ladies and their escorts. A curtain across the arch leading to the men-only public bar was closed, but he could hear the sounds of conversations, the clink of bottle neck on glass.
Bob came back clutching a Jameson and a pint. “Here you are,” he said. “Cheers.”
“Cheers,” Fingal said, and drank. “Begod, that hits the spot. Thanks, Bob.”
“My pleasure.”
Fingal said, “I hope Sergeant Paddy Keogh’s enjoying his one-third-pint bottles back at Sir Patrick Dun’s.”
“The fellah with one arm and a pleural effusion? You like that wee man, don’t you?” He sipped.
“He’s a terrier.” Fingal savoured the bitterness of the stout. “Never complains. Do you know where he’s from?” Bob shook his head.
“Francis Street.”
“Should I know it?”
It was Fingal’s turn to shake his head. “Not if you can help it. It’s in the Liberties.”
“The tenements? I’ve heard about them.”
“I’ve seen them.” Fingal pursed his lips. “We take all this,” he waved an arm round the brightly lit snug, “for granted. But there’ll be no electric light in Paddy’s place. Just tallow candles or a reeking paraffin lamp.” Don’t get involved with your patients, Geoff Pilkington had said. But why not? Fingal took another pull.