A Dublin Student Doctor

  The man shook his head. “Nah. ’Bout as much use as a lighthouse in a peat bog. Me lump’s bigger than ever.”

  He was an ideal examination “case” with a clear history and obvious clinical findings. The thyroid disorder and his war wound would give a well-prepared candidate plenty to impress the examiners with.

  This was a gift. Fingal knew everything about the patient, but it wasn’t right. Presenting this case would be the same as answering a written question with the textbook open on your knee. “Excuse me,” he said, “I have to talk to Sister.”

  He fled back to her desk. “Sister Daly, I need your help.”

  “My help?” She drew herself up and said, “You know perfectly well I’m not allowed to give hints to any candidate, Mister O’Reilly. I’m shocked you of all people would ask, so.”

  He shook his head rapidly. “No, Sister. No. Not that kind of help. It’s Mister Gourley. I know the man. I saw him at outpatients. I know exactly what’s wrong with him. Exactly what treatment he’s had.”

  “Did you indeed, bye?” Her glare disappeared and she smiled. “You’re an honest man, Fingal O’Reilly.” She consulted the list. “The next candidate’ll be here any minute, but go you to bed 52. I’ll give Mister Fitzpatrick your case when he arrives. You can have his.”

  That, thought Fingal, would really give Bob Beresford’s odds-calling abilities a run for their money. Fitzpatrick was going to see yet another case of thyroid disease. The gold medal was his. No question about it. Damnation. Fingal had been speculating about coming up with a way to upset Fitzpatrick’s applecart. Instead he was handing him the prize on a plate. It couldn’t be helped, and Fingal needed to get a move on. He’d already wasted five of his precious twenty minutes. “Thanks, Sister.” He spun to go.

  “Take your time, Fingal,” she said. “We always tell the student nurses, only ever run in a hospital for a fire,” she winked, “or a really good-looking man.”

  Fingal stopped and stared at her. Sister Daly had said that, and winked?

  “I’ll explain to the examiners why you’re held up. Ask them to test Fitzpatrick first. Give you a bit of extra time.”

  “Bless you, Sister Daly,” he said.

  “Go on, Fingal. I always thought you were a sound man. Now I know it. From now on, except in front of the patients or Doctor Micks, it’s not Sister. It’s Mary.”

  “Thanks.” Fingal grinned at her, and feeling a confidence he hadn’t earlier, set off for bed 52.

  * * *

  “Mister McLoughlin, you’ve been wonderful.” Fingal pulled his stethoscope from his ears and started to put it in his pocket.

  The ginger-haired man with the high forehead and the dusky-hued cheeks said, “Ah, sure I hope yiz does well, young fellah. It’ll be scary for yiz. All dem highheejins askin’ questions. I’d be feckin’ brickin’ it if I was youse.”

  “I’m nervous all right,” said Fingal, missing his pocket and dropping his stethoscope. He bent to pick it up and straightened. “But I’ll be fine, I’m sure. You gave me your history perfectly. I’ve heard your murmurs. I know what’s wrong. You have mitral stenosis.”

  Back in ’35, Ronald Hercules Fitzpatrick had been asked to report on a similar case the day the Pilgrims had visited here at Sir Patrick’s to, among other things, give their blessing to the latest crop of fourth-year medical students. He’d been unable to hear the murmurs because Fingal and the lads had stuffed cotton wool in his stethoscope.

  Hilda had stepped into the breach and described the symptoms perfectly. Funny, Fingal thought, how such an inconsequential event as a practical joke could fix a piece of information in a student’s mind. Ronald Hercules, the butt of the joke, would certainly have remembered the nature of the murmurs he should have heard. If he had been given this case as originally intended, he’d probably have aced it too and won the bloody medal just as easily.

  Fingal glanced at his watch. He’d taken only fifteen minutes, but he was confident he had made the correct diagnosis. He knew about the treatment for valvular disease, had done ever since he’d first met Kevin Doherty. Some patients, some diagnoses, would be indelibly inscribed in his memory. In five minutes the examiners would come in from outside the screens and grill him, asking him to demonstrate the clinical findings. The high cheek colour, the classic cardiac murmurs. They’d ask about treatment and what to do if heart failure supervened. Fingal could take them through that like a skilled navigating officer through charted seas, right up to the use of multiple punctures for severe leg swelling and the future hope for Red Prontosil as a curative of the original infection.

  He’d been hearing conversation coming from the screened bed next door, number 51, for some time but had paid no attention. Now he was free to listen. Fingal didn’t recognise two of the voices. They must be examiners, doctors he didn’t know, but Fitzpatrick’s high-pitched rasp was unmistakable.

  “A very straightforward case. Simple goitre, treated correctly with thyroid extract and sodium iodide. The goitre is easy to see and as I am demonstrating, by deep palpation—”

  Fingal heard the patient’s voice. “Jasus, sir, go easy. That hurts.”

  “Be quiet. Strong palpation is required to delineate the regularity of the margins.”

  “A little more gently, please,” an examiner said, “but otherwise carry on. You’re doing well.”

  Even through the screens, Fingal could hear the smugness of Fitzpatrick’s tones.

  “Because the treatment has failed, the next step will be to transfer the patient to the care of a surgeon for a subtotal thyroidectomy despite its attendant risks of damage to the parathyroid glands and the recurrent laryngeal nerve.”

  Fingal shook his head. Would the man never learn tact? He clearly had to show the examiners what a genius he was.

  “You seem to know a very great deal about the thyroid, Mister Fitzpatrick.”

  “I try, sir. I know you have a special interest in the disease. I read your paper in The Lancet last year. I thought your suggestion extremely cogent that we should stop using local anesthesia for surgery if the gland is well prepared preoperatively.”

  You oily bastard.

  “One last question, Mister Fitzpatrick, before we let you go, and you have done extremely well—”

  I hope, Fingal thought, you’ll enjoy polishing your medal. Will you sleep with it pinned to your pyjamas?

  “You did examine the patient thoroughly, didn’t you? It is very important.”

  “Naturally, sir.”

  “You didn’t just focus on the obvious thyroid disorder?”

  “No, sir. Apart from it and the facial scar the patient is absolutely healthy. Absolutely. I am positive.”

  Fingal leant over closer to the screens. He’d seen the man six months ago and didn’t want to miss what he hoped was coming next.

  “Will you please turn down the bedclothes?”

  Fingal held his breath and heard a rustling from next door followed by a sharp indrawing of breath and a muttered, “Oh my God.”

  “So if the patient is, I believe you said, ‘absolutely healthy,’ how do you account for the fact that his left leg has been amputated below the knee? He got the obvious facial scar then too. I’m sure if you’d not neglected to take the history of how he got it, you would have been alerted to his other war wounds. After a Somme battle in ’16, I believe.”

  “Leuze Wood, September fifth, Royal Dublin Fusiliers, sir,” Mister Gourley said.

  Fitzpatrick, I could feel sorry even for you.

  “Mister Fitzpatrick, I must conclude that in your desire to amaze us with your erudition about the thyroid you neglected to take a comprehensive history of his other conditions or examine the man thoroughly. Ambition, wanting to shine is natural. Trying to bluff is not, particularly when you get caught out in,” he coughed, “a terminal inexactitude.”

  “I’m very sorry, sir.”

  Fingal could imagine Fitzpatrick bowing his head and wringing his hands. It was impossibl
e to know exactly how the man must be feeling having just, euphemistically or not, been called a liar, but Fingal cringed for him.

  “You should be. Now, Doctor Lyndon, do you have any more questions?”

  “None.”

  “In that case you may go, young man.”

  Fingal heard the screens being pulled back, hurried footsteps growing fainter.

  One voice said, “Pity about that chap,” and the second voice said, “I don’t think we’ll have that kind of trouble with the next candidate, O’Reilly. He made Sister swap cases because he’d seen the thyroid in outpatients and didn’t want an unfair advantage.”

  “Admirable. And if he hadn’t, Fitzpatrick would have had a different case to examine and we might not have found out about him.”

  “Ah,” said the second voice, “the Lord moves in a mysterious way. Now let’s go and find out what O’Reilly has for us. He had to turn down a trial for Ireland last year, you know.”

  48

  If You Can Meet with Success and Failure

  “No thanks, Bob,” Fingal shouted. “One pint’s enough for me until after the results.” The four friends were in Davy Byrnes and could barely hear each other over the other loud voices. Nearly every student who had taken Finals, along with two or three supporters for some of them, were crammed into the pub. Tobacco clouds blued the air. The smell of Guinness was overpowering.

  A clock above the bar said five o’clock. At this precise moment the dean would be calling the examiners’ meeting to order. Fingal shivered. He could imagine how an accused felon must feel as the “twelve good men and true” headed for the jury room to reach their verdict.

  He’d arrived at Byrnes at four thirty after his last oral exam to find that Bob, Charlie, and Cromie had been there for an hour. As promised, Diarmud had set aside a corner table for four of his favoured regulars. Just as well, because it was standing room only and Cromie was swaying in his chair. “Don’t give Cromie any more,” Fingal said into Bob’s ear as he headed for the bar.

  “Tapeworms,” Cromie said, “bloody tapeworms. How do you treat tapeworms? Last question on my medical oral. I’m as sunk as the Lusitania.” He swallowed a mouthful of stout. “Who the hell would bother to read about tapeworms? Nasty bloody parasites. And where’s Virginia? She said she’d be here at quarter to five. Jesus, how do you treat bloody tapeworms?” Cromie shook his head.

  Extract of male fern, Fingal thought, eight millilitres by mouth or, because it tastes so foul, fifteen millilitres given by duodenal tube. But he refrained from telling his friend.

  Fingal’s own concern was whether his answers in the oral about the diagnosis of diabetes had been good enough. The oral counted for sixteen percent of the marks in medicine. He tried to comfort himself that the clinical part of the exam—and he was sure he’d been all right with the case of mitral stenosis—counted for fifty percent.

  All around him faces were creased in forced gaiety, worry lines round every eye. A man with a pint in one hand gnawed on a fingernail of the other.

  Snatches heard above the tumult.

  “Don’t worry, Alfie. You’ll be fine.”

  “I’m scuppered, so to hell with it, give me two gins. Both for me.”

  Fingal glanced at the door. No sign of Virginia or Kitty. Maybe she’d changed her mind and wasn’t coming. He stuck his pipe in his mouth but couldn’t be bothered to light it. He didn’t want a drink, or a smoke. He wanted the waiting to be over.

  Bob came back with a whiskey for himself and a pint for Charlie. “The condemned man had a hearty last jar,” he said. “Sláinte.”

  “Cheers.” Charlie lifted his new pint and sipped. “I dunno,” he said, “but it tastes bitter today.”

  “Mine doesn’t,” Cromie said, “because you didn’t get me one.”

  “Later, Cromie,” Bob said. “After the results. Diarmud has a magnum of champagne on ice for us.”

  “People who don’t know about bloody tapeworms don’t get to drink champagne,” Cromie said.

  “Pity,” said Bob, “it’s a Dom Pérignon and probably the last I’ll be able to afford if I’ve passed. Auntie’s two hundred quid a year goes by the board once I stop being, and I quote, ‘a student of medicine.’”

  Fingal frowned. “Bob, exactly what does the bequest say?”

  “‘As long as he remains a student of medicine,’ and damn you three. You’ve got me nearly as worried as you. I want to qualify and when I do, it’s”—He sang off-key—“Lost and gone forever…”

  Cromie and Charlie, heads together like a couple of music hall song-and-dance men, added in close harmony, “Dreadful sorry, Clementine.”

  Fingal paused and looked at the clock. “I can’t sit here any longer.” He finished his pint and stood. “Come on, drink up.”

  “But Virginia’s not here,” Cromie moaned.

  “She’ll know where to find you. Come on, you bowsey.” He helped Cromie to his feet.

  “I am not a drunkard,” Cromie said primly. He swayed, righted himself like a yacht coming out of a stiff blow, and blinked. “I enjoy a jar or two, I just don’t seem to have much of a—” He staggered and flopped onto a chair. “—head for alcohol.”

  Cromie did know his limit and it wasn’t much, thought Fingal, but he would let his hair down on special occasions like New Year’s Eve or, Lord help us, if he’s passed the exam tonight.

  Bob and Charlie stood and put empty glasses on the table. “God,” said Bob, “all we need is some subaltern blowing a whistle.”

  “What are you on about, Beresford?” Charlie asked.

  “I’m old enough to remember Pathé newsreels of troops in the trenches going over the top. There was always some poor lieutenant with a whistle. I know how the squaddies must have felt. Waiting, waiting, then H-hour and, ‘Sweet Jesus, this is it.’”

  Soldiers like Paddy Keogh with his amputated arm, and Fitzpatrick’s medical exam case, Oliver Gourey, with his missing leg. “I hear you, Bob,” Fingal said, “but we don’t have to cross no-man’s-land, just walk along Duke and Dawson Streets to Trinity. And try to keep our spirits up.” Fingal hoped the news would not be, for any of them, as brutal as a storm of enemy fire.

  * * *

  Fingal stood in the quadrangle with his friends, part of an expectant crowd in a semicircle in front of a doorway under a mackerel sky. His old shipmates believed those soft clouds foretold a shift in the weather. There certainly was going to be change in a lot of young peoples’ lives tonight.

  He scanned the faces, familiar after five years of classes together. Fitzpatrick was over at the far side, looking, as Fingal had once heard a depressed patient described, like a constipated greyhound. Hilda was in the front row.

  The sounds of conversation were overpowered by the rumbling of traffic on College Street, but Fingal heard running feet, saw two women approaching.

  “I’m sorry we’re late, Cromie,” Virginia Treanor said. She was panting. “We missed a tram, looked for you in the pub, and had to run to get here.”

  “Hello, Fingal,” Kitty said. “We came to bring you four lads luck.”

  Not, “I came to bring you luck, Fingal.” “Hello, Kitty,” he said, “that was very—”

  He got no further because there was a swell of gasps and mutterings of, “He’s here.”

  From a door had appeared, resplendent in his dark red robe with its scarlet facing and matching hood, the professor of bacteriology and preventive medicine and recently appointed Dean of the School of Physic of Trinity College Dublin, Joseph Warwick Bigger. His nose was large for his square face and he wore round-rimmed spectacles. He was a man of medium height and towering academic reputation. He carried a scroll.

  “Ladies and gentlemen,” he barely had to raise his voice, “after due deliberation the board of examiners for the Finals Part Two examinations for June 1936 has instructed me to publish the following list of successful and unsuccessful candidates.” He held the opened scroll at eye level and adjusted his spectacl
es.

  Fingal closed his eyes.

  “Aherne P. F., pass. Beresford R. St. J., pass.”

  It was customary not to applaud, but Fingal opened his eyes and gave his friend a massive thumbs-up. Bob Beresford, the man who had been a “chronic” for seven years before he buckled down, looked as stunned as a cow looking over a whitewashed wall.

  “Brady J. H., fail.”

  There was a communal indrawing of breath. Fingal shook his head. Poor Jim Brady from Carrickaboy, County Cavan, was this year’s “How the hell did he fail?” unlucky one. Or one of this year’s unlucky ones. The list had a long way to go and the Os came so very late.

  “Cromie D., pass with distinction in orthopaedic surgery—”

  Fingal heard Virginia’s delighted cry, saw her giving Cromie a massive hug.

  “Fitzpatrick R. H., pass. Graham W., fail—”

  Pass for Fitzpatrick, but no medal. The dean would have specified as he had with Cromie’s distinction. Fingal could feel relief for Ronald Hercules’s pass and take satisfaction knowing that the man had been deprived, no, had disqualified himself from medal consideration. “Poetic justice, with her lifted scale.” Fingal frowned. He’d have to ask Father who had written that.

  Charlie turned and grinned at Fingal, who returned the smile.

  The dean read on and Fingal nodded with each “pass,” and flinched with every “fail.”

  “Manwell H. A., pass—with gold medal in medicine.”

  There was loud applause, tradition bedamned. Everyone liked Hilda and obviously rejoiced in her success. Fingal looked at her, a good-natured short woman wearing what must be a special dress for the occasion and an out-of-date cloche hat. She was blushing, grinning, accepting handshakes and pats on the back, and probably oblivious to the tears coursing down her cheeks.

  Well done, Hilda. There’s the answer to Fitzpatrick’s haughty, “I don’t mind working with a woman,” on their first day at Sir Patrick Dun’s, Fingal thought, then paid closer attention. There were two Ns, the Nolan twins who both passed, Billy O’Donahue, who didn’t, and finally,