An Irish Country Practice

  Barry held his breath.

  “There’s the little devil, Barry. Take a gander.”

  Barry exhaled and moved to beside Alan, who held the telescope steady. Barry bent and peered in. He could see two oval tubes, one going up into the upper right lobe of the lung. The tubes’ walls were nacreous with a tingeing of pale pink. Little bubbles formed in the natural secretions and moved back and forth with the in-and-out flow of the anaesthetic mixture. A dark red craggy mass stood above the surface of the wall of the bronchus supplying the upper right lobe. “What do you reckon, Alan?”

  “Sorry, Barry, but I don’t like the look of it,” Alan said. “We’ll know in about twenty minutes once the biopsy has been done. Move over in the bed.”

  Barry stepped aside. Surgeons, he thought. All the same. Masking serious concerns with flippant remarks.

  Sister gave Alan long biopsy forceps with jaws at one end and scissor grips at the handle. He slid them down the bronchoscope, manoeuvred his right hand, closed the grip, and withdrew the scope. “Here, Sister.” He deposited the specimen in a specimen bottle Sister held for him. He stared down the scope. “Very little bleeding. Mission accomplished, I’d say.”

  “If you like, I’ll take it across to pathology,” Barry said. “I’d like to see Harry, and I’m anxious to hear his opinion.”

  “We’d be grateful,” Alan said as he withdrew the bronchoscope and Richard Clarke slipped in an endotracheal tube. Anne would be kept under a light anaesthetic. Mister Bingham, the consultant thoracic surgeon, had been happy enough for the trainee to do the bronchoscopy, but he was waiting in the surgeons’ lounge so if the results were bad, an immediate removal of the entire right lung and all the lymph nodes in the centre of the chest could be performed. Cancer cells often spread by way of the lymphatic system. Barry shuddered. It was the kind of macabre figure that stuck in his mind: One in ten such patients did not survive the procedure. He accepted the specimen jar from Sister. “Thanks again, everybody,” he said, heading for the changing room. He sighed as he took off his theatre clothes. Not long now until he had the answer, and he was sure he wasn’t going to like it.

  * * *

  “Nyeh, how are you, Barry?” Harry Sloan, Barry’s old classmate, now almost fully qualified as a pathologist, prefaced many of his sentences with that peculiar nasal noise. He looked up from a binocular microscope.

  His room, third on the left in the department of pathology, always stank of stale cigarette smoke, which stifled the usual smells here of floor polish and formalin. A half-smoked fag smouldered in an ashtray. “I’m fine, Harry.” Barry handed over the requisition form and specimen. “But I’m worried sick about the patient this came from.”

  Harry took the specimen. “Bronchial biopsy? Needs a frozen section. No problem. Alan Strachan told me about it.” Harry stubbed out his smoke. “Make yourself at home. I’ll only be a minute. I just need to pop this in the cryostat.” Harry left.

  Cryostat? Barry guessed it was the device that froze the specimen. He sat down. Looked around. Two tomes, each of a thousand-plus pages—Boyd’s Pathology and Muir’s Pathology—sat on a bookshelf surrounded by monographs and pathology journals. Harry’s desk was cluttered with papers—and an ashtray full of butts. The last time Barry’d been in this office, he’d been trying desperately to get the results of the postmortem of a patient whom he’d misdiagnosed. The man had died and his widow had been threatening to sue. Harry, bless him, had speeded things up and Barry had been exonerated by the medical evidence.

  Harry came back. “The technician will bring them in as soon as they’re done. I’ll read them.” He took his seat and pulled out a packet of Capstan Full Strength cigarettes, looked at Barry, smiled, left the packet on the desktop, and said, “Given what we’re hoping not to find, I think smoking might be a bit tactless.”

  Barry sighed. “The poor woman was on her way to having quit when she bled. I’m no preacher, Harry, but…” He let the sentence hang.

  “Nyeh, you’re dead on, Barry. And I will. One day. Honest.”

  Barry shook his head. Addicts were all the same. For a moment, he wondered how Ronald Fitzpatrick was doing. Certainly there had been no complaints on the two occasions in the last ten days when he’d been on call.

  Barry and Harry passed the time in catching up. Harry was still single. His profession, he said, was not to every woman’s tastes, and he lived in hope of meeting someone unfazed by the way he spent his days. He thought Jack Mills was probably in love at last, pronounced Helen Hewitt a right corker, and congratulated Barry on his engagement. Barry kept his present difficulties to himself but wished Monday would hurry up and come. When Harry asked about Sue, he answered briefly and then steered the conversation back to the biopsy. “I was never the world’s greatest student of pathology. You read Boyd. I used the much shorter Lecture Notes on Pathology. I don’t know much about frozen sections.”

  Harry sat back in his chair. “Nyeh, they’re pretty useful for a case like yours, to help the surgeon decide to carry out more surgery under the same anaesthetic, particularly in an open case like an ovarian tumour. Spares the patient being closed up and then reoperated on. Takes about ten minutes to prepare the slides for examination. The regular method is much more accurate, of course, but takes sixteen hours. We only make a final diagnosis from the specimen from the excised organ. But if the frozen section is clearly malignant or clearly benign, that’s practically always confirmed by the second examination. Borderline cases are more tricky. They’re quite often wrong.”

  “I hope Anne’s is clearly benign.” Barry sat forward and, despite his concern, was interested in what his friend was saying. “I used frozen sections once in a while for ovarian tumour cases during my year in the Waveney Hospital in Ballymena. But I guess like most clinicians I’m not well up in the technical details. How long has it been around?”

  “A Doctor Lois Wilson at the Mayo Clinic developed the technique in 1905. The key is the cryostat. We put the biopsy in the machine, freeze it to between minus twenty and thirty Celsius, embed it in a special gel, then a built-in microtome automatically cuts the tissue and gel into wafer-thin slices. Mount them on a microscope slide. Stain them, then the pathologist—that’s me today—takes a look-see.”

  Barry smiled. “Takes me back to those pathology classes with John Henry Biggart. He’d project those blue-and-red microscope slides onto a screen. They all looked the same to me.”

  Harry laughed. “Nyeh, we’re still using that haematoxylin and eosin dye.”

  There was a knock on the door.

  “Come in.”

  A technician wearing a white coat entered. “Your slides, Doctor Sloan.”

  Harry took the box. “Thank you, Kearney.” He pulled out a slide, set it on the stage of his microscope, and fiddled with the focussing wheel, muttering to himself.

  Kearney left.

  Barry reckoned he was feeling like the accused when the foreman of the jury stands to give his verdict. He held his breath.

  Harry stood. He pursed his lips, shook his head. “I’m sorry, Barry. It’s not good. Want to take a look?”

  Barry exhaled and shook his head. Despite all his training, he couldn’t bring himself to look at a piece of the thing that was putting Anne’s life in jeopardy. “Just tell me, Harry.”

  “I’m afraid it’s an undifferentiated oat cell tumour.”

  Barry’s screwed his eyes shut. Inwardly he was screaming “No.” He opened his eyes and looked at Harry. “I see. I thought they often secreted hormones, but Anne has no sign of any endocrine disorders.”

  “The ones with well-developed cells usually do, but this one has tiny, completely undeveloped cells.”

  “And as I remember they are the worst?” He could hear one of his teachers saying, “Do not get emotionally involved with your patients,” but this on top of Lewis Miller’s demise only nine days ago wrung his heart.

  “’Fraid so.”

  “I know it’s only on TV that
the doctor says, ‘I’m sorry, you’ve only got six months to live.’ That we can’t be as accurate in real life, but—?” He took a very deep breath.

  Harry put a hand on Barry’s shoulder. “But we can guess. I’d say with one like this, she’s got eight to eleven months. I’m sorry, Barry, I really am.”

  Barry’s head drooped. Poor Anne, poor Guffer, and poor Pat and Seamus.

  Harry said, “I need to get word to the theatre.” He picked up the phone and dialled. “Theatre? Doctor Sloan. Please tell Mister Strachan it’s an undifferentiated oat cell lung cancer. Thank you.” He put the phone down. “I am sorry, Barry. We can’t win them all. Don’t blame yourself.”

  “Thanks, Harry. I’d best be running along.”

  “Good to see you, pal. If you’d like my advice, I’d pop into my local on the way home. Have a stiffener.”

  “Thanks, Harry. I might just do that.” And as Barry left he decided he would take his old friend’s advice.

  * * *

  Barry walked through the Duck’s doors into its usual fug of smoke and alcohol fumes, friendly clinking of glasses, and buzz of conversation. Immediately, the tension in his shoulders relaxed a little. Dapper Frew was chatting to Gerry Shanks, but there was no sign of Donal Donnelly and not as many men as usual sat at tables or stood at the bar.

  “Evening, Doc. Bout ye, Doctor Laverty.”

  Barry wasn’t sure who’d spoken, but replied, “Evening, all.”

  “Hello, Barry.” This from O’Reilly, who sat alone at a table near the door. Arthur Guinness and Kenny lay beside an empty dish that would have contained their Smithwick’s, for which Kenny had now developed a taste. “Come and have a pew.” He turned to Willie Dunleavy. “Pint for Doctor Laverty, please.”

  Barry sat. He didn’t speak.

  “Bad?” asked O’Reilly in a low voice.

  Barry nodded and replied, also sotto voce, so as not to be overheard, “Couldn’t be much worse. Undifferentiated oat cell.”

  “Bugger,” said O’Reilly.

  “She’s having her right lung and mediastinal lymph nodes removed as we sit here,” Barry said. “Sometimes I wonder what would be kinder. To slip away under anaesthesia or be granted a few more months of life?”

  “Only twenty-five percent of those surviving the surgery are alive five years later,” O’Reilly said, “and I know the average is much lower for oat cell.”

  “Much,” said Barry. He looked up. “Thank you, Willie.”

  Willie set a pint before Barry.

  O’Reilly paid.

  “I don’t feel much like saying cheers,” Barry said, and stared at his pint.

  “Just sup it, son,” O’Reilly said, and Barry heard the compassion in the big man’s voice. He took a pull and put the glass down. The stout was bitter. “I’ll just have the one,” Barry said. “I’m going to nip round and break the news to her husband. He’s usually home by six so I’ll be late for tea.”

  O’Reilly shook his head. “No need. I know he’s going straight from the shipyard to the Royal during evening visiting hours. Gerry Shanks was in here earlier. He told me. The staff on duty will give Guffer the news.”

  “Well, at least I’ll phone the ward and see how she is. Set my own mind a bit at rest,” Barry said. “Poor Anne. Her big concern is getting her son Seamus home for a visit.”

  O’Reilly took a deep swallow. “It’s a brave way from Palm Desert. It won’t be cheap.”

  Barry was aware that someone was standing by their table. He looked up.

  Bertie Bishop said, “I don’t want til intrude, like, but could I have a wee word?”

  Barry, still preoccupied with Anne, would rather the man would go away, but O’Reilly said, “Have a pew, Bertie.”

  Bertie lowered his bulk into a chair. “I just want til let youse know that the Folk Museum is going til use Bishop Contracting til move them cottages. We’ll start next Monday and I’ve just heard too, that all the permissions will be in place for the road building to start on Tuesday, June the sixth. Earliest the museum can let us in. The lads is going til be very pleased, so they are.” He looked round. “None of them’s in tonight. I’d hoped til pass the word, but my office’ll send out letters in the morning.”

  “I’m pleased too, Bertie,” O’Reilly said.

  Barry forced a smile and nodded. “That,” he said, “is very good news. For everyone. They’ll all be relieved to know the money’s going to be coming in again.”

  “Aye,” said Bertie, “and not just my lads. Willie’s take’ll go up and it’ll be the same for the rest of the shopkeepers.”

  Those words got Barry thinking.

  “This,” said O’Reilly, whose glass was empty, “calls for a pint. You’ll have one, Bertie?”

  “Please, but my shout,” Bertie said. “Doctor Laverty, will I put one in the stable for you?”

  Barry shook his head. “Kind of you to offer, but not tonight, thanks.” He hesitated then said, “May I ask you a question, Mister Bishop?”

  “Aye, certainly.”

  Willie brought the pints and Bertie paid.

  Barry had time to wonder, should I not discuss my idea with Fingal first, but decided no.

  “Cheers,” said O’Reilly, and drank.

  “Good health,” said Bertie. He was still grand master of the local Orange Lodge and saying sláinte in Irish would be anathema to him. “Now, Doctor Laverty, your question?”

  “Nearly the whole village and townland pitched in in February and March, signing the petition.”

  “That’s right. My Flo and Alice Moloney organised it.”

  Barry glanced at O’Reilly, who was sitting with his head cocked to one side. Looking puzzled, Barry thought.

  “I’m not breaching any patient confidentiality, but someone who lives in the village is very ill and needs money. Do you think Flo would be willing to organise a whip-round?”

  “In the Liberties in Dublin,” said O’Reilly, “they used to pass round a sugar sack in pubs to help pay for wakes.”

  Bertie nodded. “I could ask her, let you know, Doctor.” He took a pull on his pint.

  “Thank you,” Barry said. “Thank you very much.” He’d come in here feeling absolutely helpless, defeated, but now his spirits were lifted. He may be powerless to help Anne, but he could at least contribute in a small way to helping the rest of her family. He sat back and took a pull on his pint. The Guinness, it seemed, was somehow tasting less bitter.

  32

  Justice Is Truth in Action

  Connor and O’Reilly watched the two dogs bound away over the springy grass of Hubert Doran’s pasture, then share a companionable leak against a large erratic boulder that sat in the middle of the field. O’Reilly knew rocks such as these were thought by the locals to be the home to the Dubh Sidthe, the Doov Shee, or dark faeries. “I’m in a hurry to get to the Dorans’, Connor, but I wanted to give the animals a chance to cock a leg first.”

  From a nearby beechwood, where the new-burst leaves were the pale lime colour of early spring, came the laughing call of a green woodpecker. Its name in old English was “speight,” which also meant “to despise.” The bird had been the emblem of his ship, HMS Warspite.

  “Come,” he called sharply, and both dogs raced back. “Good,” he said, “now, in you get.” He closed the car door behind them as a movement overhead caught his eye. A huge hooded crow flapped past, giving a series of harsh caws. He had enjoyed the few moments of pastoral peace, but now he and Connor must go and confront a violent man and hope to God he could be stopped.

  Little was said until O’Reilly parked in the Dorans’ farmyard. “He shouldn’t be home for a while. We’ve plenty of time to see Hester on her own first.”

  O’Reilly knocked on the farm door, looked over to see Doran’s golden retriever cowering in a kennel near the house, then back to the door. It was a typical one, split in the middle so the top half could be opened to see who was there without letting the chickens, which had the run of th
e yard, into the house.

  Hester opened the top half and smiled. “Och, it’s yourself, Doctor O’Reilly.” She squinted at Connor. “And Doctor Nelson?” Her smile vanished and the lower half of the door remained shut.

  “Doctor Nelson has come up with a way to maybe help you.” It wasn’t entirely true, but there was no question the young man’s more up-to-date knowledge had been helpful, and O’Reilly saw no reason not to improve Connor’s standing with Hester Doran. “He is a very smart young man.”

  “I’m sure he is. All right,” she sighed as she opened the bottom half of the door. “Come in, the pair of you.”

  She closed the door and they found themselves in a typical Ulster farm kitchen: red-tiled floor, plain wooden table surrounded by six chairs, a great black range against one whitewashed wall, a deep sink beneath a window looking out over the farmyard to the outbuildings, a long sideboard on a third wall, and a door leading to the rest of the house in the fourth.

  “Come and sit down,” she said. “I was expecting you, sir, but not the young gentleman.”

  “Doctor Nelson is fully qualified, bound to keep anything about a patient in strict confidence, and knows a deal more about your kind of trouble than I do. He’s here to help when Hubert comes home.”

  “Hubert?” she said, and her eyes widened. “Dear God, if he catches you here there’s going to be hell to pay. Doctor O’Reilly, I’m all healed up, and my arm’s near better.” She held up her cast and wiggled her fingers to show him. “I think the two of youse should go away. Right now.”

  O’Reilly shook his head. “Hester,” he said, “we really want to help you. Please let us try. Please?”

  She sighed deeply, pulled out a chair from the table, and slumped into it. “I’ll listen til what you have to say, but I think you and the young doctor should be on your way by the time I expect Hubert home at”—she glanced at the clock—“three thirty. That’s twenty minutes from now.”

  “That’s plenty of time. All I need to know is this: Are you still bound and determined to say nothing? The court can order him to stop, you know. Or you can press charges with the police. Doctor Nelson and I would be willing to bear witness to what we saw on Monday.”