“I’m afraid not. Doctor Fullerton is a meticulous man. He made several smears of the marrow. They show immature lymphocytes. He sent two slides over.” He pointed to the brass barrel of a microscope on a nearby bench. “Would it help if you were to examine one?”
Fingal shook his head. “No thank you, sir.” Fingal knew that at high magnification the malignant cells would appear as dark blue irregular circles. Wanting to peer at the harbingers of his own father’s death struck him as being morbidly curious.
Doctor Micks touched Fingal’s shoulder. “My boy, we can take some comfort. The lymphocytes make up less than five percent of all the bone marrow cells.”
Fingal felt his hands relax. It wasn’t much, but there was a glimmer. “Does that mean the disease is in remission, sir?”
“Not exactly. We’ll have to be sure there’s no involvement of other systems.”
Fingal understood. Father had cancer of the bone marrow, but at present it was not pouring out vast numbers of cells. If the rest of the body was not affected the process was said to be in remission. It was quiescent, but only as trustworthy as a cask of powder on a burning fuse.
He wanted to ask, “How long has my father got,” but that was a question for a character in a bad film. No honest doctor could ever answer that question. “You said we’d go and give them the news.” Fingal stood. “Thank you for telling me first.”
Doctor Micks said, “I need you, Fingal. Now that you understand, you’ll show no surprise, no anger when I explain to your parents. They’ll be comforted by your response if you are not visibly upset.”
Moments ago, Fingal had wanted to yell, rage against the fates. Now he could at least show a façade of calmness.
The senior man continued, “I will not be prevaricating as I did at the first consultation when there was a possibility of something else. I shall be telling them the facts now. It will be hard for your parents.”
Fingal bowed his head. Nine months ago he had been scornful of how Doctor Micks distanced himself from his patients, insisting that the students do the same. Yet here he was taking Fingal’s feelings into consideration, asking him if he’d like to examine one of the slides, doing what he could to ease things for Father and Ma. His concern was hard to reconcile with the apparent attitude of a man who had seemed to regard human beings as mere “cases.” Fingal was beginning to understand that in his teaching, Doctor Micks was trying to protect his students. He himself was a humane man.
“Now come along. I’ll explain in the car what needs to be done,” he said, and added, “I’ve already spoken to Mister Kinnear. He understands why you won’t be at his rounds this morning. You will be expected this afternoon to meet Doctor Ellerker, the house surgeon, here and be instructed in your duties.”
* * *
“Thank you for visiting again.” Ma managed a smile when Bridgit showed Doctor Micks and Fingal into the drawing room. Ma’d had her hair done and wore her favourite cardigan and a tweed skirt. She held a lace hanky in one hand. The sun’s light made her pearls shine.
“Much better day than the first time you called,” Father said. “Please forgive me if I don’t get up.” He indicated two vacant chairs.
Fingal took one and noticed that Father had a pillow between his hip and the chair arm. His bone, the iliac crest, where the device had been thrust into the marrow cavity on Friday, would still ache.
“So, Doctor,” Father said, “what have you to tell us?” His voice was flat, expression deadpan. “The blood test made it clear it wasn’t a simple infection. The last two weeks have been hard on Mary.” He smiled at her. “Fingal did explain why we had to wait, but I’m glad you’re finally here—” He cleared his throat. “—to put us out of our misery.”
Fingal glanced at Father. He was still smiling. Once more, the dark sense of humour that Father used so sparingly had caught Fingal completely off guard.
Doctor Micks smiled. “You could say that, I suppose, but you’re not a horse with a broken leg and I’d make a very poor vet.”
Father said, “It was, perhaps, an unfortunate choice of words, I agree, but I understand you do have a diagnosis.”
Doctor Micks’s smile faded, his voice became level. “I wish the news were better—”
Ma made a small sound.
“Professor O’Reilly, I am so very sorry, but you are suffering from acute leukaemia.”
“I see. And that is bad, isn’t it?” Father’s smile had gone.
“I’m afraid so.”
Doctor Micks had meant it when he’d said he wasn’t going to prevaricate. Fingal wanted to get up, go to his parents, hold them, but instead he sat on the edge of his chair.
“Can anything be done?” Father asked. “We need to know.”
“Very little, I’m afraid, but as I explained to your son, the results seem to show that at the moment the disease is in remission.”
“I don’t understand,” Ma said, “I’m sorry.”
“It means that while the leukaemia is not going away, it is not progressing either,” Doctor Micks said.
“So I’m not getting any worse?”
“I hope not, but I will have to reexamine you and perhaps ask for some more tests before I can be sure.”
“Not,” Father glanced at his hip and grimaced, “not another bone marrow biopsy, I hope.”
“No, but could I examine you now, Professor?”
“Certainly.” Father rose awkwardly.
Fingal was well aware of the pain caued by a bone marrow biopsy. “Perhaps,” he said, “Mother and I could leave and you could examine my father here, sir?”
“Rubbish,” said Father. “I am perfectly capable.” He limped to the door.
When he and Doctor Micks had left, Ma turned to Fingal and held up a hand before he could speak. “It’s all right, son. Your father and I do understand the seriousness of his condition. He trusts your Doctor Micks implicitly, but Father has always believed that one should be as knowledgeable as possible about anything that affects one directly. We had our friend Doctor Synge round for dinner on Saturday.”
“I see.”
“He explained a lot about what a bone marrow biopsy—that is the correct term?”
Fingal nodded.
“What the biopsy might show so Father and I have had time to think about things, to prepare ourselves for the worst. I did have a little weep, but Father has been a tower of strength.”
Fingal wondered. Certainly Father had always insisted on his boys keeping stiff upper lips. Was he practising what he preached, or had reality not sunk in?
Ma leant forward. “I’d like you to explain why your chief wants to examine Father again and what tests might have to be done.”
Fingal swallowed and recalled Doctor Micks’s conversation on the way here. “At the moment the leukaemia cells are in small numbers,” Fingal said. “If they are only inside the bones, it is fair to say the disease is in remission.”
“And that’s good?”
“It is. Doctor Micks is examining Father for signs of other parts of the body being affected, particularly the nervous system and lungs. He’ll then ask for some X-rays and, possibly, just possibly, the collection of some of the fluid around the brain and spinal cord.”
It was the only way to detect cancerous cells in the nervous system. It was how tuberculous meningitis was diagnosed too. Fingal had become well practised in the art of lumbar puncture, slipping a wide-bore needle between two vertebrae and beneath the membranes that surrounded the spinal cord. Unless Ma asked, he’d keep that information to himself. Father had been pierced enough.
“More waiting,” Ma said, and sighed. She patted his knee. “You are such a comfort to us, Fingal.” She frowned. “I know we decided not to upset Lars, but I do think it’s time he was told.”
“I’ll phone him after Doctor Micks has finished, let him know exactly what is happening, and see if he could come down for the weekend.”
“Thank you. I’m sure Father would appr
eciate seeing both his boys. We must hope for the best, but this uncertainty is very trying,” she said.
Fingal looked around the big room he’d known since he was fourteen. He’d felt safe here, protected, but he must leave this sanctuary soon and cope alone with another uncertainty, one that would only be resolved when the results of Finals Part I were posted at five o’clock.
32
Examinations Are Formidable, Even to the Best Prepared
“Everything all right at home?” Cromie asked when Fingal arrived at the students’ mess at Sir Patrick Dun’s. He’d explained his first morning’s absence from the surgical dressership to the lads by pleading family business and arranged to meet them before lunch.
He shrugged, avoided Bob Beresford’s eye, and said, “My father’s been a bit under the weather. Doctor Micks is sending him for a chest X-ray. The old man’s been feeling a bit off-colour and my mother wanted him seen by a senior specialist. Our chief has visited a few times.”
“Nothing serious I hope, Fingal?” Cromie asked.
“I’m sure Fingal will tell us in his own good time,” Bob said, and looked straight at Fingal.
“Sorry. Of course. Just worried.” Cromie clearly recognised he’d overstepped the mark. A family member’s illness was nobody’s business until they or those close to them chose to reveal matters.
“It’s all right, Cromie,” Fingal said. “I appreciate your concern.” He wanted to get his mind off his family. “How did it go this morning?” he asked. “What did I miss?”
“Not much,” Bob said. “Working in this discipline’s going to be pretty much like our six months of medicine. Assistant professor Mister Kinnear—”
“What I’d like to know,” interrupted Cromie, “is why it’s called a surgical dressership?”
“Because years ago it was the students’ job to change the patients’ dressings,” said Charlie. “The nurses do that nowadays.”
“As I was saying,” Bob said, fixing Cromie with a glare, “Mister Kinnear greeted us. Told us something about the history of surgery at Sir Patrick Dun’s. Fitzpatrick tried to correct him—remember our first day here?”
Fingal smiled.
“‘Flashing Fingers’ Kinnear they call him because he once took out an appendix in six minutes flat. He looked at Fitz, remarked, ‘Young man, when I want your opinion, I’ll tell you precisely what it is,’ and carried right on.”
Charlie said, “It seems our new chief’s a pretty easygoing skin, but he doesn’t like to be corrected in public. Anyway,” he said, “the chief dragged Sister Daly; her nurses; Harry Ellerker, the house surgeon; and us students on rounds. We saw half a dozen cases, two preoperative and four recovering. I think,” he said, “I’m going to enjoy surgery better than medicine.” He held up a pair of hands with fingers the size of sausages. “We’re going to get a chance to assist in theatre on our days and nights on call. Might even get to do some of the simpler procedures under supervision.”
“I’m looking forward to that too,” Cromie said. “I’ve always enjoyed the carpentry on the yacht.”
Fingal wondered if he could be as sanguine about cutting into human flesh as Cromie seemed. People were not made of wood. Fingal shivered and glanced at Bob. His poor ham-fisted friend would not leave the six months with a burning desire to specialise, Fingal was sure. “What happened after rounds?” he asked.
Bob said, “We were briefed by Harry Ellerker. He just graduated last week. Seems like a sound man. Geoff Pilkington’s moved on to Doctor Steevens’ Hospital for more training.”
“It’ll be the same system as the medical clerkship. One day in three with responsibilities only to the ward, see admissions, assist. Attend ward rounds every morning then two days out of three go to outpatients for the subjects like radiology and orthopaedics that we haven’t covered yet.”
“We’ll pair off. Hilda’ll be stuck with Fitzpatrick again,” Charlie said, and rolled his eyes.
“Bob and I’ll work together like we have done for the last three months,” Fingal said, “if you and Cromie make a team, Charlie.”
“Fine by me,” Charlie said, and Cromie nodded.
Fingal said, “Can Bob and I have Saturday free? I’ve to see my brother. It’s important.”
Bob raised an eyebrow. He must have put two and two together and guessed things had turned out worse than the suspected glandular fever. Maybe Fingal would tell Bob his troubles. It would be a comfort not to have to be alone as the tower of strength needed by his folks. Friends were important. And they might all need each other later this afternoon. Fingal said, “Can the four of us reconvene here at quarter to five? It’s only a short walk to Trinity for our results.” They had to be faced.
“I’ll run us over,” Bob said, “and we can get away quickly afterwards. I have no doubt drink will be taken.”
But will it be celebratory or to offer condolences? Fingal wondered.
* * *
Fingal, Bob, and Cromie stood at the back of a scrum of students huddled round a notice board on a wall of the Trinity Library. Charlie Greer had shouldered his way to the front. A County Kerry man called to his friend, “Arragh, Jasus, Liam, you’ve ploughed it again. The whole shebang. All six subjects.”
“What about you, Alfie?”
“Full house too.”
“How many times is that now, altogether?”
“Four. Come on for a pint,” Liam Doak said with a grin. “Next year, I’ll be ten years here if I can keep this up.”
“And won’t your patients think you the learnèd doctor?” another student said. “I can hear them now. ‘Our doctor isn’t like one of those half-baked five-year ones. He spent ten years getting the learning.’”
Fingal tried to ignore the two chronics and concentrate on what Charlie was calling out as he read his way down a list of names arranged alphabetically. “Beresford, pass all six subjects.”
“I don’t believe it,” Bob said, grinning from ear to ear. “I don’t bloody well believe it, but the first two rounds are on me tonight. After I’ve said a couple of novenas.”
“You can’t say novenas, you goat,” Fingal said, “you’re not a Catholic.”
“No matter. It’s still a bloody miracle.”
Fingal slapped his friend on the back. “I knew you’d do it. Our favourite chronic no more. You’ll be Doctor Bob this time next year. I’m delighted for you. Well done.”
“I’d not have done it without you, Fingal. Carrot and stick. Forcing me to read. Going on about doctors making a difference.”
“Rubbish,” Fingal said. “I didn’t answer the questions. You did, and I am delighted.”
Bob danced a little jig. “Begod, O’Reilly, I could get used to this passing.”
“Cromie,” Charlie yelled, “you’ve made it. So have I.”
“Charlie. Charlie Greer.” Fingal heard Hilda Manwell’s voice. “I can’t see over everybody.”
“You don’t need to,” Charlie yelled back, “you’re through, Hilda. Well done.”
Fingal opened his eyes in time to see her clasping her hands above her head like a victorious prize fighter. “Good lass,” he yelled. He noticed Ronald Hercules Fitzpatrick making his way from the front. His grin was oily. No prizes for guessing his results.
Charlie was pushing his way to where Fingal stood. He arrived before Fitzpatrick. Charlie lowered his voice. “I’m sorry, Fingal—”
Dear God, was that all anybody could say today? “I’m sorry.” First Doctor Micks, now Charlie. Fingal stood feet planted firmly, arms hanging loosely. “Go on, Charlie, spit it out.”
“You can keep four subjects—”
Fingal relaxed his still crossed fingers. “But I know I made a right hames of pathology so I’ll have to repeat it and microbiology in December?”
“’fraid so.” Charlie said.
“Aye.” Fingal’s shoulders sagged. “Aye, well. I expected it.”
“So did I, O’Reilly,” Fitzpatrick said. “It’s a mir
acle you passed too, Greer, all the classes you pair skipped for that foolish game.”
“Jesus,” said Charlie, “you’re a ray of sunshine, Fitzpatrick. A regular, ‘ever-present help in times of trouble.’ Why don’t you bugger off?” He turned his back.
Fingal couldn’t be bothered to think of any repartée. He sighed and stared at his boots.
Charlie clapped Fingal’s shoulder. “But you’ll be able to stay with us. Remember what Bob said about being able to take courses? You can still do your six months’ surgery from now until January, and midwifery next year.”
“And a bloody great pile of extra studying now I’ve re-sits ahead, and if I pass them Part Two of Finals to face in June.” Fingal looked up and saw Bob and Cromie watching him. Both looked solemn. Neither spoke.
Fingal took a deep breath. “So,” he said. “I’ve had a setback. It’s not the end of the bloody world—” although how Father and Ma would take it he shuddered to think. He’d not tell them yet, but his failure couldn’t have come at a worse time. “You said the first two rounds were on you, Bob Beresford.” Fingal forced a smile and had a fleeting image of a brokenhearted Lon Chaney in the movie Laugh Clown Laugh. “We’ll go to the Bailey and toast your success,” he said as lightly as he could manage. And I’ll go easy on the drink and try to work out the best way to deal with whatever comes next.
Then he remembered. What came immediately next was a phone call to Kitty. He’d promised to let her know his results the moment he heard.
33
A Disinclination to Inflict Pain
“I admitted Mrs. CD on Monday night, two days ago,” said Ronald Fitzpatrick, the familiar note of self-importance in his voice. He stood at the head of an iron bed and whipped off his pince-nez as he continued to address the assistant professor of surgery, Mister Nigel Kinnear, and the usual entourage of nurses and medical juniors. “She is forty-one and the mother of ten. She presented complaining of severe, spasmodic, right-sided, upper abdominal pain, and pain between her shoulder blades. She had experienced nausea and vomiting. The symptoms began shortly after a meal of colcannon and butter, and fried bacon. She has had previous attacks, but cannot remember exactly how many.”