A Dublin Student Doctor (21 page)

“Mind you,” the builder said, “I’ve heard it said if a man’s out of work for two straight years he’ll never work again. It breaks him.” He fixed his eye on Fingal. “You’re gentry, probably don’t need a real job.”

Fingal laughed. “Oh, but I do.”

“Well den, you’re a lucky lad to be gettin’ an education.”

“I think so.”

“I wish,” said the builder, “I could even get a half-learned man who could read, and write, and cipher. He could keep track of my inventory, free me up to build, once me feckin’ hand’s better.”

“I’m sorry I can’t help you there,” Fingal said as he dressed the wound. Then he wondered. Paddy Keogh had been a sergeant. Would he have needed some education to rise to that rank? Possibly. In the Royal Navy, petty officers, the nautical equivalents of sergeants, were literate. It was worth bearing in mind. He’d not say anything yet, but if he could find out, he could always contact Duggan by pulling his emergency card and getting his address. “I’m afraid all I can do is tell you to try to keep that clean,” Fingal said.

“I will, sir, and t’anks again. Back in seven days?” He rose.

“Seven.” Fingal stood. That might be the time to mention Paddy Keogh, if Fingal could get a chance to talk to the little man, but for now Fingal had more pressing business with Kevin Doherty. “Any more for us to see, Nurse O’Rourke?” he asked.

“No,” she said. “It’s been one of those odd days where not everyone in Dublin seems bound and determined to slice themselves open.”

“Makes a change.” One which Fingal welcomed. “Right, Charlie,” Fingal said, “if you can hold the fort I’d like to nip over and see how Kevin Doh—” He realised that Willy Duggan was still within earshot. “Mister KD’s getting on.”

“Off you go, Fingal,” Charlie said. “I’m sure your patient will be on the mend by now.”

“I hope so.” He stripped off his gloves. “If you get busy, call the ward and I’ll come back.”

19

The Heart No Longer Stirred

Hilda Manwell gave Fingal a tired smile when he arrived on Saint Patrick’s Ward. She’d come out of the sluice. “Busy day,” she said. “We’ve admitted an epilepsy and a diabetic. Thank God for insulin. Doctor Micks says that up until it became available, diabetes was an automatic death sentence.” She sighed as she pulled a hand through her hair. “At least insulin is specific. The body can’t produce the hormone—replace it. Miracle cure. Not like treating the other admission.”

“Which is?” Fingal asked.

“A case of tertiary syphilis who’s being given neoarsphenamine supplemented with mercury. From what Geoff says, it’s probably doing as much good for the poor divil as rubbing him with vegetable marrow jam.”

Fingal had to laugh, then said, “I know we can’t cure syphilis when it’s so advanced, but perhaps we can slow the progress. It’s worth a try.”

“It amazes me that a drug that’s mostly arsenic is any good for anyone,” Hilda said.

“Seems odd using a couple of poisons to try for a cure,” said Fingal as he moved out of the way of a passing trolley. Two porters were bringing a case back from the operating theatre. “I suppose the causative bugs are more susceptible to them than the patient is. It’s not that long ago that doctors were actually giving patients with syphilis a dose of malaria hoping the high fever would destroy the spirochaetes. It’ll be an interesting patient to follow. Your case, Hilda?”

“Not at all. Ronald Hercules snaffled the patient. He only wants the exotic ones.”

“I did not ‘snaffle,’ as you put it, Miss Manwell.” Fitzpatrick appeared from behind screens around a bed. “You and I agreed to see new admissions turn and turn about.”

“Indeed we did,” she said. “Pity I was looking in on Mister KD when the syphilis arrived and you happened to be free and didn’t want to interrupt me even if it was my turn.”

Fingal did not want to be embroiled in a dispute. “Is Mister Doherty any better?”

Hilda sucked on clenched teeth. “No, Fingal. I’m sorry. He’s not responding to digitalis, quinidine, and hydroclorothiazide and he’s been on the quinidine for a lot more than three hours.”

“Huh,” said Fitzpatrick, “his ticker’s so badly wrecked the sooner he’s out of his misery the better if you ask me.”

Fingal stiffened. He took two paces forward. “We didn’t bloody well ask you, you gobshite. For once in your life have some pity.”

Fitzpatrick sniffed. His Adam’s apple bobbed. He snatched off his pince-nez and took a pace to the rear. “I’ve listened to his heart, examined his ankle oedema. I’m glad I did. I’ve never seen such swelling. The man’s finished.”

“That,” said Fingal, very levelly, “that’s as may be, but he’ll be scared. He’s drowning himself in his own fluids. He shouldn’t be written off like a spavined old horse.”

“Well put, Fingal,” Hilda said. “You really are a heartless bastard, Fitzpatrick.”

“Rubbish,” Fitzpatrick said. “Anyway, I’ve no time to be standing round. You can admit the next case, Hilda.” He strode off.

“Dear God,” said Hilda, “and that man’s got his sights set on the prize for medicine? He should be a pathologist. Examine tissue specimens. Look after the dead. Those patients don’t need sympathy. Or in basic research—no patients at all.”

“And,” said Fingal quietly, “he doesn’t need a prize either.” He saw how Hilda was looking at him, her head tipped to one side like a thrush looking for a worm. “Aye,” he said, “we’ll need to see about that later, but not now. Now I’m going to see Kevin.”

“You go ahead, Fingal. There’s yet another case of tuberculosis over on the women’s side. I need to reexamine her. It’s pitiful. All we can offer them is fresh air, bed rest and a good diet, and gold injections. Ye gods. Gold injections. What the hell are they supposed to do?”

Fingal sighed. “Things haven’t changed much for hundreds of years,” he said. “A sixteenth-century French surgeon, a man called Ambroise Paré, did battlefield amputations. He was famous for saying ‘I dressed the wound, but God healed the patient.’” Fingal shook his head. “Pretty much the same for TB patients today.” He remembered the bet he’d offered Bob about a germ-killing drug. If ever one was needed, it was for TB.

“You go and visit your patient,” she said softly, “everything that can be done has been.” He heard the sympathy in her voice.

“Thanks, Hilda.” Fingal headed off to the bed where, behind screens, Kevin Doherty struggled to breathe. “Kevin,” Fingal said.

Kevin lifted one bony, blue-veined hand. Inside the oxygen tent his eyelids drooped, his nostrils flared. His legs were on top of the bedclothes. Fingal could see that Fitzpatrick was right. From toes to knees the legs were massive. Serum had collected in the tissues despite the fact that Kevin’s legs were elevated on pillows to assist their drainage. In Biblical times swelling like that was called “dropsy.”

Fingal could visualise the page of the textbook.
“In desperate cases of congestive failure, as a last resort, multiple punctures of the lower limbs can be essayed. The oedematous legs are flexed and made dependent. Multiple small stab wounds are made in the oedematous tissue and the resulting effluent allowed to drain. In some cases, there will be amelioration of the patient’s pulmonary congestion.”
Fingal slipped a hand inside the tent and squeezed Kevin’s. “Back in a minute,” Fingal said, forced himself to ignore the pleading in the man’s eyes, and left. Hilda thought everything had been done? Not yet it hadn’t.

Sister Daly was at her desk. “Mister O’Reilly?”

“Sister, where can I phone Doctor Pilkington? About Mister Doherty.”

“He’s very sick. I’d be surprised if he’s with us in the morning, the poor lamb, so.”

Fingal remembered Geoff remarking that it was “A braver man than me who will disregard the advice of a nursing sister.” He hoped she was wrong. “You’re probably right, Sister,” he said, “but I want to ask Doctor Pilkington if he thinks multiple punctures might help.”

“Do you now?” she asked. Fingal heard respect in her voice. “Do you now? I’ve only ever seen it done twice. It might just.” She pointed to the phone. “Go ahead. He’s in the clinic.”

*   *   *

“Sure you want to do this, Fingal?” Geoff Pilkington asked.

Fingal nodded.

He did not, but he must. He knew if he hadn’t done everything in his power and Kevin died Fingal would have to go through the same self-inflicted persecution he’d suffered six years ago because he thought he’d been too slow getting a boat away in the Red Sea.

“You all right, Fingal?” Geoff asked. “You look pale. I’ll do it if you like.”

“I’m fine.”

“I don’t mind you going ahead, even if it is our team’s turn to learn procedures,” Hilda said. She’d come back ten minutes earlier from the female ward. “I know this patient is important to you.” She glanced at the door from the ward. “Pity Fitzpatrick’s not here. He’ll be livid when he finds out he’s missed seeing this.” There was the hint of a smile on her lips. It faded. “May I watch?” she asked. “I may never get to see another one.”

Fingal looked at Geoff, who nodded and said, “Of course, Hilda.” He turned to Fingal. “You scrub. Put on gloves. I’ll get the gear organised, and, Fingal?”

“Yes?”

“I know it sounds pretty brutal what you’re going to do, but because the oedema has stretched the skin so much, it’ll’ve disrupted nerve transmission. The patient will feel practically nothing.”

“Thanks, Geoff.” I hope so, Fingal thought, as he headed for the sluice, I certainly hope so. He put on a full-length rubber apron, the kind butchers wore, and started to scrub.

Bloody sharks, he thought. He’d been on the poop deck of a freighter that morning in 1928, smoking his pipe and sheltering under a canvas awning. The heat was palpable. He was sweating and could see the air shimmering as it rose above the hot iron deck. As officer of the deck he’d granted permission to swim in groups of four and a companionway had been lowered. He could hear laughter, splashing, and a cry that made the hairs of his neck stand upright.

“Sharks.”

“Shite.” Fingal hadn’t wasted time looking. He bellowed, “Boat’s crew,” and tore down to the boat deck. They were well drilled and already the lashings had been cast off and the davits were swinging outboard. As soon as the lifeboat’s gunwales were level with the deck he piled aboard, accompanied by four lascar seamen. His commands to the men on the davits came smoothly, “Marry the falls.” The men handling the ropes that lowered the boat brought the lines together so each would be paid out at exactly the same rate and neither the bow nor the stern would hit the water first.

“Lower away.”

The falls rushed through the blocks. These men understood the urgency.

“Handsomely,” Fingal roared. He wanted the men lowering the boat to slow down. It would be no help to anybody if in their haste it was capsized. “Handsomely, for Christ’s sake.”

A shriek. Silence save for the splashing of men in the water and his calling the stroke of the oars.

He hauled two terrifed seamen onboard. The water round the boat was pink. A grey reef shark swam near the surface and in its eye he saw the mindless stare of death.

Maybe if he’d let the davit men carry on lowering the boat at breakneck speed. Maybe if he’d stationed a lookout with a rifle or lowered a guard boat? He’d not make the same mistake twice.

When he returned and went behind the screens, Geoff, Hilda, and a staff nurse were ready. Kevin sat sideways on the bed propped up on pillows and supported by Hilda and the nurse. His head was slumped forward on his chest and his swollen legs hung over the bed’s edge on top of a red rubber sheet. Its free edge was folded into a bucket.

“Ready, Fingal?” Geoff asked.

“As I’ll ever be.” Fingal took a deep breath.

“Right. The disinfectant’s in the gallipot.”

Fingal picked up sponge holders, loaded them with cotton wool balls, soaked them, and said, “I’m going to wash your legs, Kevin.”

No response. Fingal painted the discoloured skin. He discarded the sponge holders and stared at the trolley. The only instrument there was a stainless steel scalpel. Its blade was triangular and pointed. He looked at Geoff, who said, “Start above the ankle and work half-round each leg. Go about a quarter of an inch deep. Space your incisions two inches apart. Once you’ve done a row at the front of both legs, move up a couple of inches and do the same thing over again. We don’t need to stab over the calf muscles.”

Fingal lifted the scalpel. It was cold. He faced Kevin and squatted. “This may sting a bit,” he said, hoping to God Geoff was right about the nerves being stretched and insensitive. Fingal put his left hand behind Kevin Doherty’s right ankle to steady the leg. The skin was warm and the flesh doughy. Fingal shuddered.

He took a deep breath, held the scalpel as he had been taught months ago when for the first time he’d lanced a carbuncle. “Sorry, Kevin,” he said, closed his eyes, gathered all his resolve, opened his eyes and made the first wound.

Fingal had no sense of the passage of time. Kevin had tried to writhe away twice, but had been restrained. Still holding the bloody scalpel, Fingal stood. “I’m finished, I think.”

“Well done,” Geoff said.

Fingal gave him a weak smile. Hilda and the nurse were pale. He could feel sweat trickling down his brow. He dropped the scalpel onto the instrument trolley, bent, and put his mouth close to Kevin’s ear. “All done, Kevin.” There was no reply, only laboured breathing and the sounds of rasping and wheezing in the man’s chest.

Fingal glanced down at the row of cuts, each draining blood-tinged straw-coloured serum onto the rubber sheet and into the bucket. Work, he thought, please work. Give Kevin Doherty back his breath.

“Nurse, please get him into his oxygen tent,” Geoff said. “Stay with him until we come back. We’ll take the trolley.”

“Yes, Doctor Pilkington.”

“Come on, Fingal, you need to get those gloves off and wash your hands.” Geoff set off pushing the trolley.

Fingal put his mouth beside Kevin’s ear again. “I’ll be back in a minute.”

“You,” said Hilda, “‘are a better man than I am, Gunga Din.’” She shuddered.

Although Fingal’s hands had been steady while he worked, they now shook and his breathing was shallow and rapid. Reaction, he supposed. It wasn’t every day that he went round stabbing people. “I was scared silly,” he said. “I hope it helps.”