An Irish Doctor in Love and at Sea

  “I’ll give you a call.” And Sir Donald Cromie disappeared through a door leading to the operating theatres.

  How different, O’Reilly thought, the nonstop, all-go business of the great teaching hospital that never slept, from the comparative amble through the medical day and occasional night of rural general practice. They had busy days at Number One Main, of course, but nothing like this. And he had no doubt which one he preferred.

  He arrived on 21 and went straight to Kitty’s office, where she was sitting alone behind her desk, writing on a chart. She looked up and smiled. “Hello, love,” she said. “Come to find out about Ronald?”

  “Uh-huh. Is Charlie about the place? I’d like to know what the form is before I go and see Ronald.”

  “Charlie should be back in a couple of ticks.” She lowered her voice. “He’s just gone to shed a tear for the old country.” Her voice regained its usual level. “I’ll let him explain what the tests have shown.” She stood up and stretched. “Would you like a cup of tea?”

  He shook his head. “No thanks. Listen,” he said, “I just ran into Cromie. Asked him and his missus if they’d like to come down. He’s going to ring. All right by you?”

  She sat again. “I’d love to see them,” she said. “Just tell me when.”

  “Hello, Fingal,” Charlie said as he walked in. “Come for the results?”

  O’Reilly nodded.

  Charlie smiled. “They could be better, but they could be a damn sight worse. A damn sight.”

  That sounded promising.

  “First off,” Charlie said, “he’s not anaemic, so that excludes vitamin B12 deficiency degeneration of the spinal cord, and his Wasserman’s negative, so we can forget about syphilis.”

  “I don’t think we ever really considered it,” O’Reilly said.

  “Right,” said Charlie, “and his chest X-ray’s clear, so no lung cancer. I did the lumbar puncture for the myelogram myself.”

  O’Reilly flinched at the thought of the wide-bore needle being inserted between the fourth and fifth lumbar vertebrae until it had entered the fluid-filled space between the membranes that surrounded the spinal cord and the cord itself. He remembered that Americans called a lumbar puncture a spinal tap.

  “Then I attached the needle to a manometer and did a Queckenstedt test.”

  Kitty nodded. This would all be old hat to her as a specialist nurse, but to O’Reilly it was unfamiliar. “I didn’t learn that one at Sir Patrick Dun’s.”

  “It hinges on detecting rises and falls of the fluid in the manometer when pressure is exerted on the jugular vein and abdomen. I’m afraid that pressure on the vein did nothing, but pressure on the belly did move the fluid. We know that confirms that something is pressing on the subarachnoid space between the membranes and the cord, causing a blockage to cerebrospinal fluid flow.”

  “And that something could be?” O’Reilly asked.

  “Pretty much what I said yesterday, syringomyelia or a space-occupying lesion either inside or outside the cord.”

  O’Reilly pursed his lips. “Not good. Sounds to me that we’re between the divil and the deep blue sea.”

  “Not quite, you old sailor man,” Charlie said. “We did the myelogram and I am pleased to be able to tell you that Ronald does not have syringomyelia, nor a tumour inside the cord. They tend to be gliomas and haemangioblastomas, both of which are not good.”

  A polite euphemism for usually lethal. O’Reilly knew that much.

  “Whatever’s causing the compression is extramedullary,” Charlie said.

  “So there’s a chance you can do something, Charlie?”

  Charlie nodded. “Depends on what it is. The ordinary X-ray wasn’t much help. We’re stuck with his having either a primary or secondary tumour, an abscess, some blood and bone marrow disorders, or some degenerative bone diseases, but my and Teddy McIlrath’s best reading of the myelogram is that there is a tumour.”

  O’Reilly sucked in his breath.

  “And,” Charlie said, “I’ll not know for certain until we’ve done a few more blood tests, so we’re sure there aren’t any blood or marrow diseases, to be on the safe side. But I’m convinced that there is a growth and it’s operable.”

  “That’s a step forward,” O’Reilly said, “isn’t it?”

  Charlie nodded. “The best bet if it is a tumour is that it’s either a neurofibroma, and those are benign, or a meningioma, and it’s pretty rare for those to be malignant.”

  O’Reilly realised he was crossing his fingers so tightly his hands were cramping. He took a deep breath and relaxed them.

  “But we’ll not know until I’ve got the thing out and off to the pathology department.”

  Kitty said, “When will you operate, sir?” A student nurse had come into the office and formality was demanded in front of juniors. “Yes, nurse?”

  “Mister Gupta needs a chart, Sister. May I?” She gestured to the chart trolley.

  O’Reilly remembered the young Indian trainee who had saved Donal Donnelly’s life after a head injury.

  “Of course. Sorry, Mister Greer?”

  “We’ll have the rest of the blood work back on Monday. I’ll look at it then, and if it’s all right, please put him first on my Wednesday list. And don’t look so worried, Doctor O’Reilly. They are both very slow-growing types of lesions. He’ll not be at any risk by waiting for a few days, and I have some patients with much more urgent conditions.”

  “It sounds promising,” said O’Reilly. “Now, if it’s all right, I’d like to visit him. May I tell him what you’ve told me,”—the student nurse, chart in hand, was leaving—“Charlie?”

  “Fire away, but I’ve already had a blether with him. I think he understands.” Charlie glanced at his watch. “I’ve got to dash. Bloody management committee.”

  “I’ll take you to the patient,” Kitty said, and rose. “Charlie’s done everything he can to reduce the risk of post–lumbar puncture headache, but it can affect one in three patients so we nurse them in dimly lit, quiet rooms and keep them lying flat.”

  It was a whole new field to him.

  She led O’Reilly to a single-bed room. The curtains of the windows looking out to the corridor were closed. Quinn House, where Ward 21 was situated, was an octagonal structure. On its inside were a number of single rooms separated by a corridor from a series of peripheral, four-bed units. Each looked out over the hospital grounds to the redbrick Royal Maternity Hospital and past a static water tank that had been put in for firefighting during the war and in summer served as a swimming pool. Today the pool was empty, drained for the winter and littered with dead leaves. The red bricks of the maternity hospital were darkened by the rain. She held a finger to her lips and opened the door. In the half-light he could see Ronald lying on his back. His eyes, weak-looking without his pince-nez, stared up at the ceiling. “Fingal’s come to see you,” Kitty said.

  “Thank you, Fingal.” Fitzpatrick’s voice was low and quavery. “It’s very kind of you.”

  “How are you?” O’Reilly asked.

  “I’ll live,” Ronald said, “at least in the short term. Everybody’s been very kind, but I did not like that myelogram.”

  “I hear it can be pretty tough,” O’Reilly said, “but Charlie seems pleased with the results.”

  “He came and told me,” Ronald said. “Most considerate of him. He’s probably going to have to operate. I don’t mind telling you, as my friend, I’m scared.”

  O’Reilly heard the pleading in the man’s voice. “I reckon I’d be pretty frightened myself,” O’Reilly said. “It’s the waiting, the not knowing, that really gets to you.”

  “Charlie has been most honest. I appreciate that. He says the chances are very good that once the tumour has been removed, I stand an excellent chance of making a good recovery.”

  O’Reilly sat on a chair at the bedside, debating with himself for a moment. Men in Ulster typically shrank from physical contact other than handshakes. He reached
out and took Ronald’s hand. “You couldn’t be in better hands,” he said, instantly recognising the double entendre. “Charlie Greer is one of the top brain surgeons in Ulster, probably the world.”

  Ronald did not, as could easily have happened, pull his hand away. Perhaps, as O’Reilly hoped, he was deriving some comfort from the personal contact.

  “I know, but he is also a very honest man. He didn’t beat about the bush, and anyway, I am a doctor so I do know that people can die from operations on their spinal cords, or end up paralysed.” He rolled and looked at O’Reilly’s face. “I think I’d rather die than have that happen.”

  “I know there’s a risk,” O’Reilly said, “but I’m convinced you’ll pull through.” Then, to get Ronald’s mind off that honest but morbid line of thought, he said, “And you’ll not need to worry about your patients. I promised I’d make arrangements, and we have. Young Barry and Jennifer and I will share the load. I’ll not bore you with the details, but there is one thing…”

  “Oh?”

  “Can we get your records?” O’Reilly waited to see how Ronald would respond. He fully expected resistance. Many doctors regarded medical records as belonging to them alone. They were part of the way a physician could maintain the loyalty of his patients, who were, after all, his bread and butter. Very few country folk could pluck up the courage to demand their files and transfer to another physician’s care.

  “In my locker there is a key to my surgery. There’s a green filing cabinet beside my desk. I think you and young Laverty could manage to carry it to your Rover. Please take it.”

  “Thank you, Ronald,” O’Reilly said. “Thank you for trusting us.” He was deeply moved, and more deeply yet when Ronald said, “You know I lost my parents to the Japanese before the war? I’d had very few friends all my life in Japan. And ever since, I’ve thought my parents had let me down by not joining me in Dublin in 1931. That’s how it felt, even though it was nonsense. It wasn’t their fault, I know, but I’ve found it very hard to befriend anyone, trust anyone. But Fingal, I’d trust you and Kitty with my life. Thank you.”

  O’Reilly could not speak.

  “There’s a letter in the locker too that I’d like you to read. Please get it and the keys now.”

  O’Reilly stood, let go of Ronald’s hand, opened the locker and removed the keys and letter. He pocketed both.

  “I’m very tired,” Ronald said. “I think I’d like to sleep now.”

  “Of course,” O’Reilly said, “I’ll go. Kitty’ll be here for you nearly every day, Ronald. She’ll keep me posted on your progress, and if you need to see me about anything, let her know and I’ll be straight up.”

  “Thank you.”

  He headed for the door and, looking back at the man in the hospital bed, searched for something to say that might let him leave on a lighter note. “And when you’re all better we’ll have you down for dinner again. I think you’ll really enjoy Kinky’s créme brûlées.” He opened the door and didn’t wait for a reply but made his way back to Kitty’s office. Only then did he realise he’d forgotten to give Cromie’s regards to Ronald. Next time. “I’ll be off,” he said, popping into the office. “I’ll see you back home, but before I go, Ronald left me a letter. I’d like to read it.”

  “Go right ahead.”

  He tore it open, read, and, unable to speak, handed it to Kitty.

  She scanned the letter. “Good God. If he doesn’t get better he wants us to have his netsuke collection?” There was a catch in her voice, a gleam in her eyes. “Oh, but look. It’s dated the twelfth of October. He must have written it after he stormed out that night when we were trying to help him. The poor man must have been scared out of his wits by what was happening to him, had a pretty good idea where it was leading, and was embarrassed at refusing our help as well.”

  And Doctor Fingal O’Reilly, gruff and hard as nails, yet shaken to his core, could only say to hide how touched he was by Ronald’s offer, “When you see Charlie again, Kitty, you tell him from me that I expect him to send Ronald Fitzpatrick home in one piece and in good working order.”

  26

  The Shot of Accident

  “You’re late, O’Reilly.” Surgeon Commander Fraser stood beside Sister Blenkinsop at the entrance to Admiral Collingwood Ward. “I suppose it was difficult dragging yourself away from wedded bliss and your glamorous little Irish colleen.” These last words were uttered in an execrable stage Irish accent that made Fingal cringe.

  He stifled an urge to thump the stroppy bastard, not that Fingal objected to being berated for tardiness—that was fair game. But a slur made by any man on Deirdre was risking retribution. “I’m sorry, sir.” He would give no explanation, and there was some truth to what the commander had said. Their wonderful honeymoon in the New Forest had ended four days ago, and it was hard leaving the flat in the Crescent in the mornings. Deirdre went to her Land Army work, he to Haslar.

  “I don’t want to be late for the service of remembrance,” said Fraser. “So let’s get going.”

  Neville Chamberlain had died yesterday and today was November the eleventh, and except for staff performing critical duties, everyone was expected to attend the service in the Garden of Remembrance near the Paddock, a vast burial ground behind the hospital and its outbuildings.

  Fingal followed the surgeon, Sister, and a VAD note-taker pushing a chart trolley onto the ward. As usual, the patients lay at attention in their navy-grey-painted iron beds, or sat rigidly with arms folded. The first man was on a chair, his left arm in a sling. Fingal took the chart Sister proffered. “Leading Seaman Jackson, Colles wrist fracture reduced and set yesterday, sir.”

  “Feeling well today, Jackson?” the senior surgeon asked.

  “Yes, sir.” The man stared fixedly ahead, his face expressionless.

  “Discharge today back to—?”

  Fingal got the information from the chart. “HMS Vernon, sir.” Rather him than me, Fingal thought. The stone frigate carried out the work of defusing German mines, many of which were booby-trapped. It was also where Scott of the Antarctic had trained as a torpedo specialist.

  “Excused duties today and tomorrow. Light duties after that. Back here in six weeks to have the cast off, and return to full duty.”

  “Aye aye, sir.” The man sounded disappointed. No wonder. In civvy life, he’d have been off work for six weeks, but in wartime, it was a physician’s duty to get men back to work as quickly as possible.

  “Just wait until the rounds are over, Jackson,” Sister said, “and we’ll get you seen by the medical officer in charge so he can complete your discharge papers, and then you can go.”

  “Come on,” said Commander Fraser. “We haven’t got all day.”

  “Chief Petty Officer Brandon,” Fingal said at the next bed, where an ashen-faced man lay. “Perforated duodenal ulcer repaired two days ago.” A red rubber tube was taped to the side of his face. Its far end was in the patient’s stomach so the gastric contents could be removed to give the repaired bowel a better chance to heal. Fluid from a bottle of saline was dripping into an arm vein. Fingal read from the chart: “Temperature, blood pressure, pulse, and respirations all normal. Blood electrolyte values all in the normal range. Output-input—” He scanned the chart, where the amount of saline administered was compared to the man’s fluid loss through the naso-gastric tube as well as through urine, sweating, breathing, and through the skin. “—balanced, sir.”

  Fraser grunted then said, “Let’s see his belly.”

  Sister drew back the bedclothes, took a pair of scissors from her apron pocket, and deftly snipped the adhesive tape that held a bulky dressing in place over the man’s upper abdomen. The incision, closed with black silk sutures that ran from the top of the V between the ribs to the umbilicus, was now a dark red scab. Commander Fraser bent his head and sniffed. “Good. No infection.” He palpated the upper abdomen. “That hurt?”

  “Not much, sir.”

  Of course it bloody well hu
rt, Fingal thought. Fraser was palpating around a recent incision. It was necessary—one of the first signs of peritonitis was severe tenderness—but the examiner could choose to be gentle. Fraser did not.

  The surgeon manoeuvred his stethoscope in his ears and moved the bell over the abdomen, listening intently. “No bowel sounds. Early yet, of course. Keep on the fluid and analgesics as before.” Without a word to the patient, he moved on to the next bed. The VAD left for a moment to get a sister to redress the wound and tuck the patient in.

  Fingal bent, touched the man’s shoulder, and said, “You’re doing very well. We’ll have you back to HMS Victory in no time.” It was the Portsmouth Dockyard headquarters, where the man would spend the rest of the war—or another shore establishment like it. The navy did not want anyone on seagoing duty with an ulcer that might burst again.

  The CPO smiled. “Thank you, sir.”

  “Lieutenant O’Reilly.” The commander’s voice was hard. Imperative.

  Fingal trotted to the next bed. Words from his old senior Phelim Corrigan in Dublin rang in his head. “Never let the patients get the upper hand.” He was sure Phelim would extend his motto to imperious senior surgeons in this case. Fraser may outrank him, but Fingal was not going to be pushed around simply for doing his job. He held up his arm and pointed at the two broad gold rings with the narrow half ring between. “It’s lieutenant-commander now, sir.” He heard Sister Blenkinsop’s rapid indrawing of breath.

  “So it is,” Fraser said. “I’ll do my best not to forget in future. Now what about this patient?”

  Fingal took the chart and was about to start his presentation when a VAD whispered something to Sister, who said, “Excuse me, Commander Fraser, a leading seaman is in the receiving room. There’s been an accident.”

  “You go, Lieutenant-Commander,” Fraser said, with emphasis on the “commander.” “I’ll finish rounds. Do try to be on time for the service.” He turned his back. “And this man, Sister?”

  Fingal, still smarting, left the ward and headed for the receiving room.