A Dublin Student Doctor

  “Not at all. Ronald Hercules snaffled the patient. He only wants the exotic ones.”

  “I did not ‘snaffle,’ as you put it, Miss Manwell.” Fitzpatrick appeared from behind screens around a bed. “You and I agreed to see new admissions turn and turn about.”

  “Indeed we did,” she said. “Pity I was looking in on Mister KD when the syphilis arrived and you happened to be free and didn’t want to interrupt me even if it was my turn.”

  Fingal did not want to be embroiled in a dispute. “Is Mister Doherty any better?”

  Hilda sucked on clenched teeth. “No, Fingal. I’m sorry. He’s not responding to digitalis, quinidine, and hydroclorothiazide and he’s been on the quinidine for a lot more than three hours.”

  “Huh,” said Fitzpatrick, “his ticker’s so badly wrecked the sooner he’s out of his misery the better if you ask me.”

  Fingal stiffened. He took two paces forward. “We didn’t bloody well ask you, you gobshite. For once in your life have some pity.”

  Fitzpatrick sniffed. His Adam’s apple bobbed. He snatched off his pince-nez and took a pace to the rear. “I’ve listened to his heart, examined his ankle oedema. I’m glad I did. I’ve never seen such swelling. The man’s finished.”

  “That,” said Fingal, very levelly, “that’s as may be, but he’ll be scared. He’s drowning himself in his own fluids. He shouldn’t be written off like a spavined old horse.”

  “Well put, Fingal,” Hilda said. “You really are a heartless bastard, Fitzpatrick.”

  “Rubbish,” Fitzpatrick said. “Anyway, I’ve no time to be standing round. You can admit the next case, Hilda.” He strode off.

  “Dear God,” said Hilda, “and that man’s got his sights set on the prize for medicine? He should be a pathologist. Examine tissue specimens. Look after the dead. Those patients don’t need sympathy. Or in basic research—no patients at all.”

  “And,” said Fingal quietly, “he doesn’t need a prize either.” He saw how Hilda was looking at him, her head tipped to one side like a thrush looking for a worm. “Aye,” he said, “we’ll need to see about that later, but not now. Now I’m going to see Kevin.”

  “You go ahead, Fingal. There’s yet another case of tuberculosis over on the women’s side. I need to reexamine her. It’s pitiful. All we can offer them is fresh air, bed rest and a good diet, and gold injections. Ye gods. Gold injections. What the hell are they supposed to do?”

  Fingal sighed. “Things haven’t changed much for hundreds of years,” he said. “A sixteenth-century French surgeon, a man called Ambroise Paré, did battlefield amputations. He was famous for saying ‘I dressed the wound, but God healed the patient.’” Fingal shook his head. “Pretty much the same for TB patients today.” He remembered the bet he’d offered Bob about a germ-killing drug. If ever one was needed, it was for TB.

  “You go and visit your patient,” she said softly, “everything that can be done has been.” He heard the sympathy in her voice.

  “Thanks, Hilda.” Fingal headed off to the bed where, behind screens, Kevin Doherty struggled to breathe. “Kevin,” Fingal said.

  Kevin lifted one bony, blue-veined hand. Inside the oxygen tent his eyelids drooped, his nostrils flared. His legs were on top of the bedclothes. Fingal could see that Fitzpatrick was right. From toes to knees the legs were massive. Serum had collected in the tissues despite the fact that Kevin’s legs were elevated on pillows to assist their drainage. In Biblical times swelling like that was called “dropsy.”

  Fingal could visualise the page of the textbook. “In desperate cases of congestive failure, as a last resort, multiple punctures of the lower limbs can be essayed. The oedematous legs are flexed and made dependent. Multiple small stab wounds are made in the oedematous tissue and the resulting effluent allowed to drain. In some cases, there will be amelioration of the patient’s pulmonary congestion.” Fingal slipped a hand inside the tent and squeezed Kevin’s. “Back in a minute,” Fingal said, forced himself to ignore the pleading in the man’s eyes, and left. Hilda thought everything had been done? Not yet it hadn’t.

  Sister Daly was at her desk. “Mister O’Reilly?”

  “Sister, where can I phone Doctor Pilkington? About Mister Doherty.”

  “He’s very sick. I’d be surprised if he’s with us in the morning, the poor lamb, so.”

  Fingal remembered Geoff remarking that it was “A braver man than me who will disregard the advice of a nursing sister.” He hoped she was wrong. “You’re probably right, Sister,” he said, “but I want to ask Doctor Pilkington if he thinks multiple punctures might help.”

  “Do you now?” she asked. Fingal heard respect in her voice. “Do you now? I’ve only ever seen it done twice. It might just.” She pointed to the phone. “Go ahead. He’s in the clinic.”

  * * *

  “Sure you want to do this, Fingal?” Geoff Pilkington asked.

  Fingal nodded.

  He did not, but he must. He knew if he hadn’t done everything in his power and Kevin died Fingal would have to go through the same self-inflicted persecution he’d suffered six years ago because he thought he’d been too slow getting a boat away in the Red Sea.

  “You all right, Fingal?” Geoff asked. “You look pale. I’ll do it if you like.”

  “I’m fine.”

  “I don’t mind you going ahead, even if it is our team’s turn to learn procedures,” Hilda said. She’d come back ten minutes earlier from the female ward. “I know this patient is important to you.” She glanced at the door from the ward. “Pity Fitzpatrick’s not here. He’ll be livid when he finds out he’s missed seeing this.” There was the hint of a smile on her lips. It faded. “May I watch?” she asked. “I may never get to see another one.”

  Fingal looked at Geoff, who nodded and said, “Of course, Hilda.” He turned to Fingal. “You scrub. Put on gloves. I’ll get the gear organised, and, Fingal?”

  “Yes?”

  “I know it sounds pretty brutal what you’re going to do, but because the oedema has stretched the skin so much, it’ll’ve disrupted nerve transmission. The patient will feel practically nothing.”

  “Thanks, Geoff.” I hope so, Fingal thought, as he headed for the sluice, I certainly hope so. He put on a full-length rubber apron, the kind butchers wore, and started to scrub.

  Bloody sharks, he thought. He’d been on the poop deck of a freighter that morning in 1928, smoking his pipe and sheltering under a canvas awning. The heat was palpable. He was sweating and could see the air shimmering as it rose above the hot iron deck. As officer of the deck he’d granted permission to swim in groups of four and a companionway had been lowered. He could hear laughter, splashing, and a cry that made the hairs of his neck stand upright.

  “Sharks.”

  “Shite.” Fingal hadn’t wasted time looking. He bellowed, “Boat’s crew,” and tore down to the boat deck. They were well drilled and already the lashings had been cast off and the davits were swinging outboard. As soon as the lifeboat’s gunwales were level with the deck he piled aboard, accompanied by four lascar seamen. His commands to the men on the davits came smoothly, “Marry the falls.” The men handling the ropes that lowered the boat brought the lines together so each would be paid out at exactly the same rate and neither the bow nor the stern would hit the water first.

  “Lower away.”

  The falls rushed through the blocks. These men understood the urgency.

  “Handsomely,” Fingal roared. He wanted the men lowering the boat to slow down. It would be no help to anybody if in their haste it was capsized. “Handsomely, for Christ’s sake.”

  A shriek. Silence save for the splashing of men in the water and his calling the stroke of the oars.

  He hauled two terrifed seamen onboard. The water round the boat was pink. A grey reef shark swam near the surface and in its eye he saw the mindless stare of death.

  Maybe if he’d let the davit men carry on lowering the boat at breakneck speed. Maybe if he’d statio
ned a lookout with a rifle or lowered a guard boat? He’d not make the same mistake twice.

  When he returned and went behind the screens, Geoff, Hilda, and a staff nurse were ready. Kevin sat sideways on the bed propped up on pillows and supported by Hilda and the nurse. His head was slumped forward on his chest and his swollen legs hung over the bed’s edge on top of a red rubber sheet. Its free edge was folded into a bucket.

  “Ready, Fingal?” Geoff asked.

  “As I’ll ever be.” Fingal took a deep breath.

  “Right. The disinfectant’s in the gallipot.”

  Fingal picked up sponge holders, loaded them with cotton wool balls, soaked them, and said, “I’m going to wash your legs, Kevin.”

  No response. Fingal painted the discoloured skin. He discarded the sponge holders and stared at the trolley. The only instrument there was a stainless steel scalpel. Its blade was triangular and pointed. He looked at Geoff, who said, “Start above the ankle and work half-round each leg. Go about a quarter of an inch deep. Space your incisions two inches apart. Once you’ve done a row at the front of both legs, move up a couple of inches and do the same thing over again. We don’t need to stab over the calf muscles.”

  Fingal lifted the scalpel. It was cold. He faced Kevin and squatted. “This may sting a bit,” he said, hoping to God Geoff was right about the nerves being stretched and insensitive. Fingal put his left hand behind Kevin Doherty’s right ankle to steady the leg. The skin was warm and the flesh doughy. Fingal shuddered.

  He took a deep breath, held the scalpel as he had been taught months ago when for the first time he’d lanced a carbuncle. “Sorry, Kevin,” he said, closed his eyes, gathered all his resolve, opened his eyes and made the first wound.

  Fingal had no sense of the passage of time. Kevin had tried to writhe away twice, but had been restrained. Still holding the bloody scalpel, Fingal stood. “I’m finished, I think.”

  “Well done,” Geoff said.

  Fingal gave him a weak smile. Hilda and the nurse were pale. He could feel sweat trickling down his brow. He dropped the scalpel onto the instrument trolley, bent, and put his mouth close to Kevin’s ear. “All done, Kevin.” There was no reply, only laboured breathing and the sounds of rasping and wheezing in the man’s chest.

  Fingal glanced down at the row of cuts, each draining blood-tinged straw-coloured serum onto the rubber sheet and into the bucket. Work, he thought, please work. Give Kevin Doherty back his breath.

  “Nurse, please get him into his oxygen tent,” Geoff said. “Stay with him until we come back. We’ll take the trolley.”

  “Yes, Doctor Pilkington.”

  “Come on, Fingal, you need to get those gloves off and wash your hands.” Geoff set off pushing the trolley.

  Fingal put his mouth beside Kevin’s ear again. “I’ll be back in a minute.”

  “You,” said Hilda, “‘are a better man than I am, Gunga Din.’” She shuddered.

  Although Fingal’s hands had been steady while he worked, they now shook and his breathing was shallow and rapid. Reaction, he supposed. It wasn’t every day that he went round stabbing people. “I was scared silly,” he said. “I hope it helps.”

  “You’re a soft-hearted man, Fingal O’Reilly, for all your bluff and your acting the lig with your friends,” Hilda said. “Us girls heard about the skeleton in her undies last year and who dressed her. The fearsome four.”

  “Och, that was just a bit of fun. We all took life lightly,” said Fingal. “It’s getting serious now. Maybe I was soft when I started, but doing all the things to people we’ve had to since we came to the hospital, I think it’s built in as part of the training. Not just learning the techniques, but having to do them over and over. You learn, but it hardens you too. I think it’s meant to.”

  She gave him a knowing look. “I’m not convinced it’s working with you, Fingal O’Reilly. Now hang on,” she said. “Your gloves are bloody. Let me open the door.”

  Fingal went in, crossed to the sink, stripped off his gloves, and washed his hands. He knew there was truth to what he’d said, but Hilda was right too and he hoped, no, he resolved that he would not let himself become too hard. Ever.

  “We should send for the Catholic chaplain,” Geoff said.

  Fingal rounded on the houseman. “For the last rites? Extreme unction? You’ve given up, haven’t you? Damn it, I haven’t. Not yet.”

  Geoff shrugged, but said, “I don’t think KD’s going to make it and he is a Catholic. It is the proper thing to do.”

  Fingal lowered his head. “You’re right,” he said. “Of course you are.” He dried his hands and turned only to see the staff nurse standing there, the glint of tears in her eyes.

  “Come quick,” she said. “I think he’s got ventricular fibrillation.”

  “Christ.” Irregular contractions of the ventricles would stop the heart. Fingal barged through the door and pounded down the ward, pursued by Geoff and Hilda. He tore one of the screens from its rail as he ripped it back. The oxygen tent was open.

  Kevin lay limply, tilted to one side on his pillow. His jaw hung open, there was no rise and fall of his chest, and his eyes stared. To Fingal they looked exactly as had those long-ago shark’s eyes.

  He grabbed for Kevin’s wrist. The skin was clammy. There was no movement in the radial artery at the base of the thumb. Fingal lowered his head and put it immediately in front of Kevin’s mouth, but there was no gentle current of air moving back and forth.

  Fingal stood. “I think he’s gone.” He felt the lump in his throat, but swallowed it. Damn. Damn. “Can we try the Silvester or Holger-Neilson methods of artificial respiration? I learnt them in the navy.” He knew how high-pitched his voice must sound.

  Geoff shook his head. “They’re for drowning victims. If the heart has stopped nothing can restart it.” He shone a pencil torch into each of Kevin’s eyes in turn. “No reaction,” he said. He put his stethoscope on the patient’s chest, listened, and shook his head. “Too late for the priest now,” he said. “This’ll have to do even if I don’t have oil sanctified by the bishop and I’m neither Catholic nor ordained, but I’ve seen it often enough.” He made the sign of the cross over Kevin Doherty’s forehead and intoned slowly, “To this through his most tender mercy may the Lord pardon thee whatever sins thou hast committed. Ego te absolvo.”

  And Fingal O’Reilly, his hands trembling, his own heart bruised, said, “Amen. Requiescat in pace, Kevin Doherty.” He leant over and closed Kevin’s eyelids. “Thank you, Doctor Pilkington,” Fingal said. “I’ll remember those words. At least we can tell the family he didn’t die unshriven, even if it’s not entirely true. It’ll comfort them. And I may need to do it myself in the future.”

  Geoff Pilkington put a hand on Fingal’s arm. “I know you’re upset,” he said, “but if you can think of the relatives and your future patients, you’re going to be all right, Fingal O’Reilly.”

  Fingal himself was not so sure. All the training seemed pointless. By the time he was finished he would have spent five years learning masses of facts, trying to believe he was a learnèd man, but for what reason? Patients still died all the time. Yes, perhaps it was better that he understood the mechanism of the sickness that had killed Kevin Doherty. His forebears, from the Greeks right up to the doctors of the eighteenth century, would have attributed the condition to an incorrect balance of the four “bodily humours.” His immediate seniors had given up leeching, cupping, and bleeding, so less harm was inflicted in the name of healing. But at the heels of the hunt, Kevin Doherty had died because medicine had virtually no truly effective cures. Arsenic and mercury for syphilis? It was little better than witchcraft.

  “I hope you’re right, Geoff,” Fingal said, “I really do,” and wondered if Father could be right? Could a career in basic medical research benefit thousands? Was wanting to see the effects of your efforts in a small community and reap the satisfaction as your reward a high form of selfishness?

  Fingal O’Reilly le
ft Saint Patrick’s Ward and stumbled past the Grand Staircase, out into the daylight. He paused, took in lungsful of fresh air, barely noticing clouds scudding across the sky, raindrops on his cheeks. He looked into his heart and asked, “Are you really cut out for treating patients, Fingal O’Reilly? Are you?”

  20

  The Feathered Race with Pinions Skims the Air

  “Excuse me, Sister Daly?” Fingal hoped she’d be sympathetic. “Would it be possible for me to make an outside phone call?” He knew personal calls were forbidden, but this once Fingal needed someone. He wasn’t going to be able to cope alone.

  She looked up. “Who to, bye?”

  That informal “bye” was promising. Sister usually called him “Mister.” “My brother in the North.”

  She smiled. “I’ll not ask what about, but if you don’t tell, I won’t.” She nodded at the receiver. “Lift the phone and ask the exchange to put you through.” She winked. “Whatever your brother works at, call him ‘Doctor.’ That way it sounds like business. One medical man to another.”

  Fingal lifted the receiver, identified himself to the operator, and gave Doctor Lars O’Reilly’s number, “Portaferry, 57.”

  Fingal heard Annie, one of the operators, say, “I’ve a call for yiz from Mister O’Reilly in Dublin. Would yiz two be related, sir, seeing youse is an O’Reilly too?”

  Pause.

  “Dere’s a t’ing now. A doctor and a goin’-to-be doctor in one family. Lord be praised.”

  Fingal surmised that Lars had understood and had gone along with the deception.

  Despite his sadness over Kevin Doherty, Fingal couldn’t help smile. Was there a more inquisitive breed than telephonists?

  “Here yiz are, Mister O’Reilly, sir.”