A Dublin Student Doctor

  9

  There Shall Be Weeping and Gnashing of Teeth

  “That’s the last teaching patient for today,” said Doctor Micks as the entourage left the final bed. “You’ve seen a valvular congestive heart failure, a recent heart attack, an epilepsy, tuberculosis, and a diabetes. A good sampling of what our work entails in general medicine.”

  Fingal recognised it was usual for doctors to refer to their work impersonally as cases, but now he’d got over his initial reaction to the young nurse with the beautiful grey eyes, he remembered the fear in the eyes of the first patient, Mister KD. He was a man, a scared human being with heart failure. “If you cut him, did he not bleed?” Fingal wondered if the man was single, married, had kiddies depending on him? Had he played Gaelic football before the bacteria had crippled him? Did he have a job or was he like the many unemployed men from the tenements consigned to hang out on street corners, grateful for the few shillings their working wives might allow them for a pint or two of porter. Come on, Fingal, he told himself, you shouldn’t be getting too involved and you should be listening to Doctor Micks.

  Doctor Micks continued, “This afternoon, four of you will be at outpatients, or any other classes you’re scheduled to attend, and two will be working on the wards. Doctor Pilkington here will explain your duties as clerks before you leave this morning.” He strode off, pursued by the ward sister, the staff nurse, and, to Fingal’s disappointment, the student nurses.

  “This is the first time for all of you at Sir Patrick’s?” Doctor Pilkington asked.

  “I think so, sir,” Fingal said. Four years of maritime discipline, and Pilkington’s thick head of grey hair, had led Fingal to mark the man’s superior rank.

  The doctor laughed as he took off a pair of tortoiseshell spectacles and pinched the bridge of his nose. “First of all I’m not ‘sir.’ I qualified this June. I’m only two years ahead of you. I want to be a specialist so I took this job as resident house physician. As a courtesy in front of patients, please call me Doctor, but otherwise I’m Geoff.” He replaced his glasses.

  “Right, Geoff,” Fingal said, and saw the others nodding. One point to Geoff Pilkington. O’Reilly knew too many people who were overly conscious of their titles.

  “As regards your work on the wards,” Geoff said, “you will take the history from all admissions and examine them. You’ll be expected to make a provisional diagnosis, or at least give a reasonable list of potential illnesses, what is called a differential diagnosis.” Fingal was paying close attention until he noticed the grey-eyed nurse walk onto the ward carrying a basin. Even under her ankle-length dress that young lady had a delicious sway to her hips.

  “You’ll suggest any necessary tests or procedures and recommended treatment. Then you’ll check with me or one of the consultants to see how accurate you’ve been. If procedures need to be done, like setting up an intravenous drip or taking blood samples, you’ll learn how, and—”

  “Who gets to see the first patient?” Fitzpatrick demanded.

  Geoff Pilkington laughed. “You’ll all get your fill, and more, of doing routine admissions. There are six of you so I suggest you team up in pairs.”

  Fingal and Charlie had already paired off, as had Bob and Cromie, just as they’d planned it in Davey Byrnes pub on that spring day in March.

  “A different couple every day will come to the ward first thing in the morning to take any bloods and then to see admissions, day or night. All six will attend rounds in the morning. The rest attend outpatients or classes until it’s your turn here. Off you go. Get your lunch and I want the first pair back here by one.”

  “That’s us, Hilda,” Fitzpatrick announced. He lowered his head and peered down over his pince-nez at her. “I don’t mind working with a woman.”

  Hilda pulled herself up to her full five foot two and looked up at Fitzpatrick’s six-foot frame. “Decent of you, Fitzpatrick,” she said.

  Fingal saw her roll her eyes. “Do you think a woman will mind working with Fitzpatrick?” he said to Charlie. “That’s more like the question to me.”

  Hilda’s smile was gratifying.

  Damn you, Fitzpatrick, Fingal thought. I wanted to get back here this afternoon. I would have had a good chance to have a word with Grey Eyes. Now it’ll probably have to wait until Thursday. He and Charlie were scheduled to receive instruction in the techniques of vaccination tomorrow afternoon. Each would pay a tuition fee of one pound one shilling, an archaic sum known as a guinea. Pity, Fingal thought. That much money would have bought twenty-five pints of Guinness. Still, it was in the good cause of increasing his skills. “Come on, lads,” he said, “lunch,” and headed for the door.

  Before he could open it, the student nurse returned, now carrying two rubber basins. One was empty, but in the other several sets of dentures drifted in clear water like pink-and-white jellyfish in a calm sea. He looked round. No sign of Sister. “Excuse me, Nurse,” he said. “Excuse me.”

  She stopped. “Yes?”

  “It’s a silly question, but what are you doing with those teeth?”

  She laughed, a throaty chuckle. “Paying for my sins.” Her nose was a little too large, her lips a mite full. Her hair could be any colour, hidden as it was under her headdress.

  “Sins?”

  “You coming, Fingal?” Cromie called.

  “In a minute. You three go on.” He asked, “Sins?”

  “Yes,” she said, “and when I tell you, you’re not to laugh.”

  “I promise.”

  “Before ward rounds, Sister sent me to wash some of the men’s false teeth.”

  “I noticed quite a few gummy old boys.”

  “Fourteen,” she said, “and I’ve thirteen to go.”

  “But there’s more than one set in that bowl.”

  She laughed again and he knew, he just knew she was laughing at herself, a trait he admired. “That was my sin. I didn’t think,” she said.

  Fingal looked again at the basin full of dentures and realised what had happened. He grinned.

  “You promised,” she said, and her eyes flashed.

  “Sorry.”

  “I collected them all up at once to wash them. I thought it would be faster. It would have been if these things were interchangeable, but of course they’re not. Now I have to go to each man in turn and have him try every bloody set of dentures until he finds his. I put the dirty ones in this empty bowl and go back to the sink and rewash them. It’ll get progressively easier as I get the right teeth matched up to the right patient, but it’s still going to take all my lunch break.”

  “No it’s not,” said O’Reilly. “Not if you’ll let me help you.”

  “Sister would kill me. We’re not supposed to mix with medical students.”

  “Where is Sister?”

  “At lunch.”

  “Och,” said O’Reilly, “what the eye doesn’t see the heart doesn’t grieve over. Go on,” he said, “try the next old boy and when you come back to the sink I’ll wash with you.”

  She gave him a grateful look. “Thanks.”

  He turned into a room known as the sluice. In it was a device for flushing and washing bedpans, a steam autoclave for sterilizing instruments. It hissed and fizzled. Two stainless steel sinks had taps equipped with long handles that ended in flat expansions so they could be, if necessary, manipulated without using the hands. There was a distinct odour of faeces that a powerfully smelling disinfectant was trying to strangle.

  Fingal took off his jacket and was rolling up his sleeves as she reappeared with a smile on her face. “I was lucky that time. Mr. Shaughnessy, a postop hernia, only needed to try three sets before he found his own.” She handed him four pink, teeth-bearing dental plates. “Can you wash these?”

  Fingal filled one sink. “Pop ’em in.” He scrubbed. “Now, Nurse,” he said, “I’m not much for formal introductions. I’m Fingal Flahertie O’Reilly.”

  “And by your voice I’d say you’re from the Wee North.”
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  “Holywood originally, but I’ve lived in Dublin since I was fourteen.” He put the clean dentures in the bowl with water and the others.

  “I’ll be back,” she said.

  Fingal had trouble containing his impatience until she returned.

  “Seven sets to do this time.”

  “Right.” He scrubbed and waited until he could wait no longer. “You have me at a disadvantage, Nurse. You know my name—”

  “And you want to know mine?”

  And a damn sight more about you, he thought.

  “Caitlin O’Hallorhan. My friends call me Kitty. I’m a first-year nursing student. My home is in Tallaght, South Dublin—”

  “Tallaght means ‘plague grave,’” O’Reilly said.

  “Why yes, it does.” She smiled. “The place is still a midden. I’m not sorry to be living in the Nurses’ Home. They do let us out now and then and Dublin’s quite the city.”

  “It is that. Here.” He handed her the newly washed dentures. “Off you go.”

  Kitty. Kitty O’Hallorhan. That name had a ring to it, she could laugh at herself, and, those eyes. Fingal O’Reilly smiled. When she came back he was going to ask her for a date. He sang the old Irish air in a tuneful baritone,

  Kitty, me love will you marry me?

  Kitty, me love will you go?

  “I heard that,” she said. “You’ve a fine voice, Mister O’Reilly—and a quare brass neck. Marry a big lig like you?” She chuckled. “Not in a month of Sundays.”

  “Well,” said O’Reilly, quite unabashed, “maybe it is a bit quick for a proposal—”

  “Wash these,” she said, handing him three sets.

  He bent to his task. “But I could take you to the Savoy on Saturday night. I Was a Spy is on. Conrad Veidt and Madeleine Carroll.”

  “You’re not a shy one, are you?” she asked.

  “But he’d better start being one on my ward, Nurse O’Hallorhan.”

  Fingal looked round to see Sister Daly, brows knit, fists on hips. Her gaze was steely.

  “I’ll not have any hanky-panky on Saint Patrick’s Ward—my ward. Is that clear?”

  “Yes, Sister,” they both said in unison.

  “Good. Now get about your business, Mister O’Reilly, and leave Nurse to hers.”

  “Yes, Sister,” Fingal said. Doctor Micks might be a consultant here, but the ruler of Saint Patrick’s Ward was Sister Daly. It was not a good idea to have rubbed her up the wrong way on his first day, and it was his fault that Kitty looked as if she was in for it. One of the things Father had always insisted on was, “If you make a mess, you clear it up.”

  “Sister, I think you should know that this is all my fault. I thought Nurse O’Hallorhan was going to miss her lunch and so I offered to help her wash the dentures. She didn’t approach me.”

  “Is that true, Nurse?”

  Kitty nodded.

  “And she’d no notion I was going to ask her out.”

  “I see.” Sister Daly pursed her lips. “In that case, Nurse, I’ll consider the matter closed. Get on with your duty.”

  “Thank you, Sister.” Kitty started scrubbing with the focused concentration of a watchmaker.

  “And you.” She pointed a finger. “You can’t sit for your finals without a certificate of good standing from Doctor Micks, so. Do not in the next six months give me any cause to have a word in his ear, bye. Am I clear?”

  “Yes, Sister Daly. Perfectly. I’ll be going.” Fingal turned and left, not daring to take a backwards glance at Kitty. He could feel Sister Daly’s eyes on him.

  He knew where the lads would be eating and decided he had time for a quick bite. Damn Sister catching him like that. He was bloody sure if he’d been given another few minutes with Nurse O’Hallorhan she’d have accepted his invitation. Och well, at least he knew her name. He’d find a way to have another go. And, he reminded himself, it was all very well paying attention to pretty nurses. The real reason he was here was to learn about patients like the anonymous Mister KD.

  And as for Sister Daly? He’d be at pains to tiptoe round her and mind his p’s and q’s. Because nothing, nothing was going to stop him sitting, and passing, his finals on time.

  10

  For This Relief Much Thanks

  “Me?” Fingal spun on his heel. “Christ Almighty, I’m only a fourth-year student.”

  Nurse O’Hallorhan stood at the door to the ward. “Sister Daly says to come immediately. We’ve sent for Doctor Pilkington, but he’s gone to lunch. The patient with valvular heart failure fainted. He looks awful.” Fingal heard the tremor in her voice. “Sister wants to see if there’s anything you can do until Doctor Pilkington gets back.”

  “What I can do?” Jesus. Fingal trotted to the ward, trying to remember what he’d learned about rheumatic heart disease. Mister KD had passed out. Not enough oxygen was getting to his brain because for some reason even less blood was being pumped by the damaged heart. Why? Why?

  Fingal raced down the ward, pulling out his stethoscope. Perhaps atrial fibrillation had started. It was common in patients who had had rheumatic fever. The heart’s electrical control system broke down and the muscles in the atria, the upper chambers of the heart that collected blood from the body and lungs, started working asynchronously. That meant each individual muscle fibre would contract as often as four hundred times per minute instead of the whole chamber at a rate of eighty beats per minute. That electrical chaos stimulated the ventricles irregularly and their ability to pump blood suffered.

  Screens had been closed round the bed. He pulled one aside. Sister stood at the bedside. The oxygen tent was unzipped. She was taking Mister KD’s pulse and looking at her watch.

  Fingal saw how much more dusky the man’s face had become. His lips were blue. His breathing was shallow and irregular. The great strap muscles of his neck stood rigidly every time he struggled to inhale through flared nostrils. He did not respond when Fingal spoke to him.

  “He’s fibrillating,” Sister said.

  “Thank you, Sister,” O’Reilly said. “Can I listen to his chest?”

  She opened the man’s pyjamas. Fingal clapped his stethoscope over the heart and tried to count the beats, but the great muscle was wildly out of control, contracting rapidly, irregularly, and with hardly any ability to circulate blood to the lungs and brain. He could hear no air going into the lung bases, and higher up the chest there was clear evidence of fluid. Sister was right. The fibrillation and failure were going to kill the man if they couldn’t be reversed. And quickly. Clearly the dose of digitalis was not enough. Should he be given more? Fingal remembered Doctor Micks’s measured tones. “If any symptoms of overdosage are produced, sudden death is a possibility as the late stages of digitalis poisoning may be passed through very rapidly.”

  “How much digitalis has he had, Sister?” Fingal heard the uncertainty in his tone.

  She lifted the chart. As she did, Fingal noticed that Nurse O’Hallorhan had come behind the screens. Her eyes were wide and a hand covered her mouth. If he was worried, she, as a first-year nurse, must be terrified.

  “A total of twelve ccs since he was admitted last night.” Sister’s voice was calm.

  “And it takes a whole day to get rid of about one cc, so he’ll not have metabolised much,” he said.

  Sister nodded.

  Fingal took a deep breath and looked at the man battling to breathe, listened to his wheezing gasps and the hissing of the oxygen. His eyes were open, pleading.

  Standing here doing nothing, hoping to hell Geoff Pilkington would materialise, wasn’t going to help Mister KD, but giving him more digitalis might kill him. Fingal exhaled and remembered one of Father’s adages, “Never be ashamed to ask advice from an expert.” “Sister Daly,” he said, lowering his voice so the patient couldn’t hear, “I’m very green. You must have seen hundreds of cases. Do you think more digitalis would kill him?”

  “Mister O’Reilly, I don’t know. You can never be sure—”
r />   You’re going to have to decide, Fingal. He could feel his own pulse hammering.

  “—but, I think for a case like this, Doctor Micks would use quinidine sulphate, particularly as this patient has had digitalis already. He’d start with two grains to see how the patient tolerated the medicine.”

  He could have kissed her. “Could you not have given it yourself?” he asked.

  “Only doctors and senior students under supervision can order medicines.”

  Fingal snorted. “That’s ridiculous. With all your experience?”

  She smiled and said, “Och, sure don’t we know it does be ridiculous—but it’s the rules, so.”

  “Can I prescribe it?”

  “Only under supervision.” She looked him directly in the eye.

  “Bugger. We can’t wait. Time matters. If I’m right, Doctor Pilkington will confirm it—when he gets here.” And if I’m wrong, what the hell will Doctor Micks do? he wondered. “The sooner we get started—rules be damned—the better. Get some quinidine. You said two grains?”

  “Come with me, Nurse O’Hallorhan,” Sister said. “You can watch me prepare a quinidine solution.”

  The nurse looked at Fingal and whispered, “Good luck,” before she left.

  He turned back to Mister KD. To hell with rules and to hell with initials. Fingal picked up the chart and read “Kevin Doherty.” The poor man did have a name; he wasn’t merely a case of valvular disease complicated by fibrillation. O’Reilly sat on the bed and took a clammy hand in his own. “It’s all right, Kevin,” he said softly. “It’s all right. We’ll get you fixed,” even though Fingal was not one bit sure they would.

  Kevin Doherty managed to nod. He squeezed Fingal’s hand. When Sister and Nurse O’Hallorhan reappeared, the student nurse held out a small glass of milky-coloured liquid.

  Fingal took it. “Kevin,” he said, “I want you to swallow this. I’ll help you.” He held Doherty by the shoulders, feeling the rise and fall of the man’s chest. “Open wide.” It was like talking to a child. “Wide.” As soon as Doherty had opened his mouth, Fingal held the glass to the man’s lips. He gulped, swallowed, and slumped back against Fingal’s arm.