A Dublin Student Doctor (11 page)

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—”

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.

He lowered the patient to his pillows and took his hand again. A feeble grip was returned.

“Was that digitalis or quinidine?” Doctor Pilkington asked.

Fingal had not noticed his arrival on the opposite side of the bed.

Pilkington, without waiting for an answer, took Doherty’s pulse. “Atrial fib. All right.” He released the man’s wrist. “Taking the pulse is all you need to make the diagnosis. Sorry, I asked you—”

“Quinidine.”

“I’ll confirm that order,” he said to Sister. “Well done.”

So it would not need to be reported that Fingal had acted without authority. “I can’t take credit for the prescription. I asked Sister what she would suggest and she thought quinidine would be best,” he said.

“And she’s rarely wrong.” Fingal heard the respect in the young doctor’s voice. “It’s a braver man than me who’ll ignore the advice of a nursing sister and a fool who doesn’t recognise that early.”

“I believe,” Sister Daly said quietly, “Mister O’Reilly is no
amadán,
so.” She smiled at Fingal, who was relieved to learn that the ward sister believed he wasn’t an idiot.

“Although his language could use some attention,” she said.

Fingal remembered his intemperate “bugger” and “be damned.” “Sorry, Sister.”

“Och,” she said, “it is not unusual for a body to forget his manners when he’s under the gun. It’s more important he not lose his wits, and panic, so.” She glanced at Nurse O’Hallorhan. “Perhaps it’s not such a bad thing Mister O’Reilly was delayed going to his lunch.”

Fingal swallowed. It sounded to him that Sister Daly was offering her forgiveness. “Thank you, Sister,” he said. He noticed Geoff Pilkington inclining his head to one side and moving off, a signal he wanted to talk away from the patient. Fingal tried to remove his hand, but the grip tightened. He bent. “It’s all right, Kevin. I’ll be back in a minute.” He looked at Sister. “He’s scared skinny. Could maybe you or the nurse stay with him until I get back?”

“Nurse,” was all Sister needed to say for Nurse O’Hallorhan to take the patient’s other hand.

Sister turned to leave. “I have to deal with other matters. Please don’t keep my nurse too long.” She smiled and said quietly, “You did well.”

Fingal inclined his head. He took a last glance at the patient, who was still struggling for every breath, then joined Geoff. “Yes, Geoff?”

Geoff’s face was solemn, and he spoke quietly. “I’ll not beat about the bush, O’Reilly. Have you had a patient of yours die yet?”

“No.” Fingal shook his head then looked the houseman right in the eye. “But I did see two men who’d gone swimming taken by sharks when we were at anchor in the Red Sea while I was officer of the deck.”

“Good Lord.”

“Not pretty.” Fingal could remember the screams, the blood in the water, his attempts to lower a boat. His self-recrimination that if only he’d got the boat away more quickly. He’d had nightmares for weeks.

“It never is. Look here, I heard you call the man ‘Kevin.’”

Fingal narrowed his eyes and kept his counsel.

“I’m not recommending callousness, but patients do die.”

“Will Kevin Doherty?”

“We all will.”

“Jesus, Geoff, don’t patronise me. I’m older than you, for Christ’s sake.” Fingal felt his nose tip start to blanch.

“All right. Calm down. It’s going to take three hours for the quinidine to work fully. It might kick in earlier, but his ticker could pack up at any time before the medicine takes effect—or after for that matter.”

“I see.” Fingal looked back to where Nurse O’Hallorhan stood by the bedside. She was needed elsewhere. “Are family allowed in?”

“Sorry, no family allowed, and before you ask, I don’t think things are bad enough to send for a priest—yet.”

“But he shouldn’t be left alone,” Fingal said. “May I sit with him?”

“You should be getting your lunch then going to outpatients. I’ll ask one of your group who’ll be on the ward this afternoon to sit with him.”

That would be Hilda Manwell or Ronald Fitzpatrick. Hilda would be sympathetic, but leaving Kevin Doherty in Fitzpatrick’s care didn’t bear thinking about. “I’ll do without lunch,” he said.

“All right, but Fingal?” There was sadness in the houseman’s eyes. “Don’t take it personally if he goes. We’ve done our best. We can’t save them all.”

“I understand, but we can offer a bit of comfort.”

“Go ahead.” Geoff cocked his head. “I think, O’Reilly,” he said, “you’re big enough and ugly enough to take care of yourself.”

“Balls,” said Fingal gruffly, and blushed. “Go on, Geoff, and finish your lunch. I’m not hungry.” Liar, Fingal thought, I’m always hungry. He felt the houseman’s hand lightly on his shoulder, before Geoff repeated, “Do not, I mean it, do not take it personally if we lose him.”

“I won’t,” said Fingal. He nipped out past the screens and brought in the cane-backed chair. “Off you go, Nurse O’Hallorhan. Sister needs you.”

Her smile before she left was beatific. For the moment he was distracted from his concern for Kevin. He had to get to know this nurse better. He zipped up the tent then sat alone holding the hand of a very sick man.

Fingal lost track of time, only knew that he’d had to change hands twice because he’d got pins and needles, and his backside was growing numb. For most of the time Kevin Doherty was asleep or passed out, but every time Fingal took his pulse it was careering out of control. And there was less than the half of sweet bugger all Fingal could do about it. He felt futile. He wondered if Kevin Doherty even knew he was not alone.

The screens were pulled back and the tent unzipped. He looked up to see Caitlin O’Hallorhan. She carried a small tray bearing a cup of tea and a plate of buttered toast.

“I hardly think your man’s ready for that,” Fingal said, and smiled.

“Silly,” she said. “Sister Daly reckoned a big fellah like you, your belly’d think your throat was cut. She sent me to make this in the ward kitchen.”

“God bless you both,” said Fingal. His stomach rumbled. “Pardon me,” he said, but reached for a slice of toast.

“Sister says I can stay until you’ve finished.” She sat on the bed and took Kevin’s hand.

Teacup in one hand, toast in the other, he wolfed his snack listening to the rasping breathing, his gaze flitting from the face of the patient to the grey, amber-flecked eyes of Caitlin, Kitty to her friends, O’Hallorhan. He finished the tea, swallowed the last morsel of buttered toast, and said, “That was just what the sister ordered. Thanks, and thank her for me too, please.”

The nurse rose and picked up the tray. “I know it’s not the time or place,” she said softly, “but I don’t know if I’ll get another chance to talk to you. I’m going to see my parents in Tallaght this weekend—”

Fingal turned to see her wide smile. The amber highlights sparkled.

“But I’ll be off again in two weeks’ time, on a Saturday, if you like.”

“Jasus,” said Fingal, wondering if he himself had suddenly experienced a bout of atrial fibrillation. “I’ll be playing rugby at two thirty at the Wanderers’ club on Parnell Road that day.”

“I’ll be off at noon. I’ll come and watch. See you after the game.” She slipped out and closed the tent.

Fingal’s grin was from ear to ear when he turned back to Kevin and discovered that the man was staring at him. His breathing was less laboured. He had a glimmering of a smile on his face.

Fingal grabbed for his pulse. It was regular. He clipped in the earpieces. “Just going to listen.”

Lup-dup. Lup-dup.
The assorted clicks and whooshes were still there, but the beat was regular. Fingal concentrated and was convinced he could identify the classic snaps and murmurs that Fitzpatrick had described. More important than Fingal’s having learnt something, the quinidine had worked in jig time. Kevin Doherty’s wounded heart was beating more strongly. He looked at the man in the bed. “I think, Kevin,” he said, “you’re on the mend.”

“T’ank you, Doctor, sir—”

“I’m only a student.”

“Well you should be a doctor, or maybe get yourself made a feckin’ saint. Sitting dere for ages.”

Fingal frowned. “It’s my job, that’s all—”

“Bollix, Doc, wit’ all due respect. I’ll never forget w’at youse did for me. Your bum must be as numb as a feckin’ plum.”

Fingal blushed.

“And I’ve been awake for the last ten minutes. Dat wee mott in the uniform? She’s a corker. Youse two have a good time, all right?”

He felt his face flush again; it must surely be the colour of beetroot. “I’m sure we will, Kevin. I’m sure we will.”

As Fingal Flahertie O’Reilly rose to leave, he made himself a promise. He resolved that when he was in his own practice, he’d never think of patients or refer to them by their initials or as cases of whatever ailed them. And from now on, here at Sir Patrick Dun’s Hospital, by God, he’d get to know his patients’ names.

*   *   *

The iron bedsprings squeaked as O’Reilly rolled on his side. He sat up. He was glad he wasn’t a houseman who had to make this cubicle in the Huts his home for twelve months. He rubbed the back he’d ricked on his way to a recent delivery of twins. Of course, housemen would have the advantage of youth. Perhaps it might be more comfortable in the chair?

He limped over to the armchair. A French epigram ran through his mind,
“Plus ça change, plus c’est la même chose.”
The more things change, the more they stay the same. He’d never forget the day he’d stopped calling Mister KD by his initials. It was the day he’d started thinking of all his patients by their names. Imagine thinking of Donal Donnelly, arch schemer, dog racer, carpenter, husband, and soon-to-be father as DD? O’Reilly felt a familar tug of worry at the thought of Donal. How long would it be until he regained consciousness? Would he recover? O’Reilly’s mind gnawed at the thought. Time would tell, but perhaps Geoff Pilkington had been right all those years ago. Better to stay detached.

And if he had been earlier tonight, he’d be in his own bed in Ballybucklebo. Donal, who had appeared perfectly lucid once he regained consciousness near Downpatrick, would have tried to ride the motorcycle home—and could well be lying in a ditch, far from expert help, under the bike that he’d crashed for a second time because he had continued to bleed into his head.