Fingal O'Reilly, Irish Doctor (17 page)

“And it come up in a red bump and you said that meant I was immune til TB.”

It did, so one obvious cause was excluded. O’Reilly never saw a patient with chest troubles without remembering the high rate of TB in the tenements in the 1930s. Many people were infected as children, were unaware and shook off the disease, leaving them immune for life. Her red lump had been a positive immune response to the Mantoux test. Other causes? She was far too young for lung cancer. “You’ve no pains in your legs?”

“No, sir. If I didn’t have this pain in my chest, I’d be going round like a liltie.”

Not long ago Barry had been worried about Aggie Arbuthnot’s deep venous phlebothrombosis, but it didn’t sound as if Brenda could have had a pulmonary embolism from such a source. He was narrowing his suspicions. “And you were perfectly all right up until this morning?”

“Fit as a flea, sir.”

Heart failure, nephrotic syndrome, a severe kidney disease, and cirrhosis of the liver could all cause fluid to enter the pleural cavities, but such patients would all have been very ill for a long time and both sides of the chest would be affected.

“Do you feel hot or are you having chills?”

She pursed her lips, grimaced, and shook her head.

She certainly looked pale and sweaty. He leant forward and put the back of his hand on her forehead. A bit damp, but he was confident she wasn’t running a fever. “Have you a bad cough?”

“No, sir.”

It didn’t look as if she had pneumonia, either viral or bacterial. O’Reilly blew out his breath through semi-closed lips. He was coming to the end of the possibilities he knew. “Better have a look at you, love,” he said, rose from the swivel chair, and helped her onto the examining couch.

By the time he had finished a thorough examination, the only unusual thing he had been able to find was a small area of dullness to percussion over the base of her right lung in the same place that she was feeling the pain. He’d been unable to pick up any sounds with his stethoscope of breath entering the lung there, but immediately above the dull part of the lung he had noted a strange phenomenon. When he’d asked Brenda to whisper “Ninety-nine,” he’d heard the words through his earpieces as if she was speaking directly into his ear. The effect—with the musical name of whispering pectoriloquy—was often heard over a lung that was badly inflamed. It could also appear immediately above a collection of fluid in the pleural cavity.

He stuffed the stethoscope back in his jacket pocket. “Put your clothes on, Brenda,” he said, stepping outside the screens, “then I’ll try to explain.” If he could.

O’Reilly was frowning and scratching his head when she called, “I’m all dressed now, Doctor.”

When he went back she was lying down, doing up the last button of her amber blouse.

“You have a small collection of fluid round the bottom of your right lung,” he said. “It’s a kind of pleurisy.” Most folks knew what that was.

“Pleurisy?” she said. Her eyes widened. “Is it serious, like?” Her voice trembled. “When I was wee, my auntie Norma died of pneumonia and you was our new doctor then, sir, after Doctor Flanagan passed away. You told my da that his sister had pleurisy as well.”

O’Reilly nodded. He could picture the woman even now, twenty years later. And despite all he’d seen in his younger days in Dublin, regardless of having had to deal for six years with the carnage of naval warfare, he’d been saddened by her death. Norma McCausland had been a bright and high-spirited young woman—and much too young to die. No wonder Brenda was frightened now. “I remember Norma well, Brenda. It was 1946, and I’d only been here a few months. We knew about penicillin, but it was just after the war and I couldn’t get my hands on any.”

“She was awful nice, so she was.”

“I know, but what happened to her isn’t going to happen to you. In the first place, I can promise you you don’t have pneumonia.”

“Are you sure?”

“Positive.”

She smiled. “Thank God for that.”

Even after thirty-four years in medicine O’Reilly still marvelled at the absolute faith of most of his patients in his pronouncements. “And in the second place, if you do develop a fever and it starts to look like pneumonia, we’ve antibiotics galore. Fix you in no time flat.” Not quite true if the cause was a virus, but there was no need to worry her. “But we will have to get to the bottom of it,” he said. “You’ll need a chest X-ray.”

“Now? Like today?”

“I’ll send you to Bangor Hospital. They can do it there. Could Ian run you down?”

She sat up and took a breath. He could see how she was trying not to show that it hurt. “Doctor O’Reilly, could it maybe wait for a few days? Please?”

O’Reilly was sure he knew why she was asking. She was a farmer’s wife and it was September. “Harvest?”

“That’s right. Ian and Peter are at it from dawn ’til dusk. They should have it in in another few days, but they need me too, so they do.” She pointed at the window. “Now the rain’s stopped Ian’ll be reaping the barley and Peter’ll be driving the lorry that catches the grain that’s been threshed out.” She smiled. “Ian reckons it’ll be a wheeker crop, so it will—if he can get it in time. And there’s no time to waste.” O’Reilly heard the urgency in her voice. “He rented a new CLAAS Herkule combine harvester, one with a self-cleaning rotary screen.”

“A rotary screen?”

“Aye. It’s a new whigmaleery, you know. Stops grain dust from clogging the radiator so the engines never overheat like they used to and you can keep reaping nonstop. It’s hard, dry, dusty work, so it is, with all that chaff in the air, and they need me for to feed them, make cups of tea because they eat on the run, bring them plenty of water. And the cows need milking.” He saw the pleading in her deep brown eyes. “Please, sir. I always wrap a hanky round my face when I’m near the combine. Keeps the dust out.”

“Give me a minute,” he said. He couldn’t understand why she had this small pleural effusion and an X-ray might give some answers. But the truth was, it probably wouldn’t help him decide on any different treatment than he could offer today. “Brenda,” he said, “I’d like to get an X-ray—”

“But—”

He held up a hand. “I’m pretty sure one of two things will happen. Either the accumulation of fluid will get absorbed and you’ll start feeling better soon, or it might just get bigger, in which case, it’s the Royal Victoria for you.” To have the fluid removed, he thought, but kept the thought to himself. “You have a phone?”

“Aye.”

“If you can stick the pain and promise, and I mean promise, to call me the minute the pain gets worse or you’re having more trouble breathing—” He made a rapid calculation. “—I can be at your farm in fifteen minutes.”

“Oh, thank you, sir,” she said. “I promise. Honest to God. Cross my heart.”

“And,” he helped her down, “go on using the painkillers I gave you even after your monthlies are over. They’ll help the pain in your chest a bit. Have you enough?”

“Aye. I bought a clatter last month to do me for six months.”

“Good,” he said. “Now, try not to overdo it.” And take a short trip to the moon while you’re at it, he thought, knowing from experience how tough and hardworking Ulster farmers’ wives were. “Get as much rest as possible, and try to keep warm. Lots of fluids.”

“Yes, Doctor.”

“Sit down for a minute,” he said as he helped her to a chair. “How are you getting home?”

“Mister and Mrs. Houston live not far away. Sonny’s a real gentleman. He give me a lift in his motorcar, you know, and he’s waiting for me, so he is, in the waiting room.”

As she spoke, he sat at his desk and filled in an X-ray requisition form. “If you get worse,” he said, rising and giving it to her, “you’ll not need this. The hospital doctors will see to it. But if you’re getting better, and I’m fairly sure you will, the minute the harvest’s over I want you in Bangor Hospital for a chest X-ray, then come in and see me the next day.” O’Reilly wasn’t quite sure what it might show if the fluid had gone, but it was better to be safe than sorry. “Right,” he said, rising. He offered his arm.

“I can manage, sir,” she said, and he knew she was trying to prove to him, and probably to herself, that she could cope unaided.

In the waiting room, all eyes turned toward him. He nodded a greeting to the other patients and as always admired the roses on the wallpaper. He wondered why Kitty thought they were gaudy. That’s what she’d said the day Colin Brown had an infected foot.

Cissie Sloan grinned back. She’d be in to get her thyroid pills and, he sighed, a good blether. Sonny Houston stood.

“Morning, Sonny,” O’Reilly said, “how’s Maggie?”

“Right as rain,” Sonny said. “She’s home making a plum cake for Brenda and Ian, and seeing to the dogs. We’ve six now. We couldn’t find a home for the last of Missy’s pups, but I saw Colin Brown yesterday. He’s making a good fist of his dog Murphy.”

“Good for Colin,” O’Reilly said, wondering how Donal and the boy were getting on with Bluebird and when Donal was going to race the animal. “And it was kind of you to bring Brenda in.”

“It was really no trouble.” He looked expectantly at her. “If she needs to go to the—”

“Doctor O’Reilly’s for letting me go home,” she said.

“Wonderful. I’m delighted to hear it.” Sonny offered his arm, which she took.

“And don’t forget, Brenda, if you’re worried at all,
at all,
phone. Either myself or Doctor Bradley”—That provoked a few subdued mutterings among the other patients—“will be out in a flash.”

He barely heard her “Yes, Doctor,” as he said, “Right. Who’s next?”

“Me, sir,” said Cissie, lumbering to her feet. “I need more of them wee thingys Doctor Laverty prescribed. They’re doing me a power of good, so they are. I’m brisk as a bee—” She was still talking on the intake of breath as he closed the surgery door behind her.

16

Skill in Surgery

“Jasus, Doctor, I hope it works. The back’s still feckin’ killin’ me.” Lorcan O’Lunney, the Dublin tugger, shook his head. “I’m like a toad with a broken leg dragging meself and the cart about. Last time I was here some pregnant woman told me to try her granny’s bog onion poultice. And she gave me her granny’s prayer too.” He made a derisive snort. “About as much use as a fart in a high wind.”

He was clearly aggrieved but held out his callused hand to take the prescription. He was the last patient of the Monday morning surgery as Fingal began his fourth week working at the Dublin dispensary. He’d enjoyed the rest of his Saturday after he’d left John-Joe Finnegan at Sir Patrick Dun’s. Thanks to Phelim Corrigan’s flexibility with the on-call schedules, he and Charlie were now bona fide members of the Wanderers Football Club and would have their chances to earn their places on the first fifteen this season, the first step toward that much-longed-for Irish cap. Turned out Phelim had played Gaelic football at the county level in his youth, and despite the prohibition by the Gaelic Athletic Association of its members attending “Garrison” or “English” games like rugby and cricket, he took a keen interest in the fortunes of the Irish Rugby team.

And the evening spent with lovely Kitty? He told himself to stop grinning and concentrate on Lorcan O’Lunney’s aching back. He had to show the sympathy he felt for the man. Fingal took a deep breath, pursed his lips, and said, “It can be miserable, I know.”

What Lorcan needed was a long rest, but Fingal might as well suggest the man take a Mediterranean cruise. Pulling that cart hour after hour, day after day was all that kept a roof over Lorcan’s and his family’s head and put stale bread on their table. “Here,” Fingal said, handing over a scrip’, “Take that to Mister Corcoran, the apothecary. He’ll make you up a strong linament with oil of wintergreen”—it contained a salicylate, as did aspirin—“and he’ll also compound these tablets.” Although Fingal had never seen it used for backache, the Atophan he was prescribing was effective for another joint disease, gout. It was worth a try. “Break one up, mix it with water and baking soda, take the same dose three times a day, and come and see me next week.”

“All right.” Lorcan shrugged, took the paper, clapped a duncher on his balding head, and headed for the door. “I’ll give her a go, but I’m not expectin’ to be yellin’, ‘whoa, hold the fecking’ lights because I’ve had a miracle cure.’ You’d need to go to Lourdes for dat and where’d a man like me get the money for the fare?” He shrugged. “But t’anks anyway, sir, for doin’ yer best.”

He’d barely closed the door when Phelim and Charlie came in.

“Great,” said O’Reilly, rising and lifting a small picnic hamper that Cook filled every morning. “Lunch.” He was aching for today’s cold poached salmon and mayonnaise sandwiches and hard-boiled eggs with a big slice of her Bramley apple pie to follow.

“Will ye wait a minute?” Phelim held up one hand like a policeman on traffic duty then adjusted his toupee. “Charlie’s agreed to do the afternoon visits, Fingal. One of my few paying patients seems to have twisted or ruptured an ovarian cyst. She’s in a lot of pain.”

“And you sent her to hospital? Don’t see why that should hold up lunch,” Fingal said as he opened the hamper and lifted out a sandwich wrapped in greaseproof paper. A woman as sick as that needed surgery.

“I did not.” Phelim reached over, removed the sandwich from Fingal’s hand, and returned it to the hamper. “I asked Doctor Andrew Davidson, a gynaecologist from the Rotunda, to make a domiciliary visit. He came straight out and agreed with my diagnosis. He’s sent for his team and they’re setting up her bedroom as an operating theatre. It’ll take an hour to sterilize everything, longer to set up the portable operating table and get everything ready. He’s going to operate as soon as it is. I’ll give the anaesthetic. I’ve come back to get my gear. You’ll assist Doctor Davidson. Clear?”

“Yes, yes, of course.” Fingal looked longingly at the sandwich but had to admit it would be an interesting way to spend the afternoon. He knew that surgery was often carried out in wealthy patients’ own homes, but he’d never seen it done. He felt a momentary twinge of nerves and then relaxed. Surgical assisting had been part of the routine of his student days and he’d discovered that he had a talent for it.