A Dublin Student Doctor (30 page)

“We appreciate that. Don’t let me hold you up.” Father closed the door behind him.

“This is irregular, O’Reilly,” Doctor Micks said, “but your mother is right. You are practically a doctor.”

“Thank you, sir.”

“I’ll not beat about the bush.” Doctor Micks pursed his lips. “Your father is not well. He is anaemic, and I noticed bruises on his wrist and left shin although he cannot recollect having injured himself.”

“I see.” Doctor Micks was implying that there was not only a lack of red blood corpuscles, but some defect in the clotting process. Not good.

“I found enlarged lymph nodes in his left anterior triangle.”

Fingal’s trained mind said, “The space bounded by the neck, the shoulder, and the outer edge of the trapezius muscle that runs from the base of the skull to the shoulder tip.” He thought, I don’t like the sound of this.

“The spleen is also enlarged. There are no other clinical findings.” He smiled but there was sadness in his look. “Please understand, I am not using your father as a teaching case, O’Reilly, but would you care to offer a differential diagnosis?”

Fingal swallowed. “It’s got to be one of the blood diseases, but I’m not sure”—or I’d rather not face the possibility of—“which one.” While he had a vague notion of those disorders, he wished to hell he’d not cut those classes to play rugby.

Doctor Micks nodded. “Or it could be a virus infection. Glandular fever, the Americans call it ‘mono,’ short for infectious mononucleosis. It was first described in 1887 by Doctor Nil Filatov. It can be associated with your father’s findings, anaemia, bruising, and enlarged lymph nodes.”

“I hadn’t thought of that, sir.”

“Of course, usually in infections the patient is febrile.” Doctor Micks frowned. “Your father’s temperature is normal.”

The patient, Fingal thought. Somehow it was less personal to think of Father as “the patient.”

Doctor Micks smiled. “It’ll be easy enough to sort out. We’ll arrange a complete blood analysis. If the number of lymphocytes is massively increased we’ll have a diagnosis of glandular fever.”

“Because their function is to fight viruses,” Fingal said, although he realised that his senior colleague was trying to sidestep the critical question. He took a deep breath and looked Doctor Micks in the eye. “Sir, could my father have leukaemia?”

“I’m sorry. It is a definite possibility. If so, and we won’t know until we have the results, we must pray it is one of the chronic varieties.”

“Why, sir?”

Doctor Micks frowned. “I should have thought you’d know that by now.”

“Sorry, sir.”

“Their prognosis is very good. Remember that.”

“I will.” Fingal wanted to ask Doctor Micks to explain about the other kinds of leukaemia, the ones with the not-so-good prognoses. He knew vaguely about them, every fourth-year student did by now, but not only had he missed the lectures on the subject, but disorders of the blood was a topic he’d not yet read up. He asked, “How long will it take to get the results, sir?”

“The blood for tests will be taken tomorrow. I’ll arrange to have the slides read first thing Monday morning. Come to the ward at eleven after rounds. We’ll have an answer by then. I’ll set aside time on Monday afternoon to talk to your family. I assume you’ll want to be there?”

“Thank you, sir.” Fingal glanced down, then back at his teacher. “I do appreciate all you’re doing. May I ask another question?”

Doctor Micks inclined his head.

Fingal said, “Doctor Pilkington taught us that patients should be told why tests were being ordered and what results might be expected.” Earlier Fingal had been convinced patients should always be told the truth. They were the ones with most at stake. “What will you say to my folks, sir?”

“There’s no point giving them reason for concern until there are clear answers,” he said, “and as an old teacher of mine used to say, ‘some questions are better left unanswered.’ In this case if your parents don’t accept my explanation of a probable virus infection, I’ll prevaricate—until I know for sure, and I will expect you as a junior colleague to support me.” That wasn’t what Geoff Pilkington had taught, but Doctor Micks was the senior.

“You don’t think they’ll be more worried by uncertainty? Could they blame you, sir, if the diagnosis isn’t glandular fever?” Fingal asked.

“They could, of course,” Doctor Micks said, “but that is a risk every doctor must accept. We try to cure, but we can’t always, so we must spare our patients as much suffering, and I include mental anguish, as possible. If we become less than loved by a disappointed patient, but have spared them grief, it’s a small price to pay.”

“I see.” Fingal did see the kindness of the approach. It also answered his own question of what to tell Lars. Fingal would phone, tell his brother that Doctor Micks wasn’t worried, but was doing tests next week.

“Good,” Doctor Micks said. “Shall we go and talk to them?”

“Please.”

Fingal thought his parents looked as if they were posing for an old daguerreotype. Father, one arm flexed across his chest and the other hand on Ma’s shoulder, stood behind her chair. She sat erectly, hands clasped in her lap.

“Please have a seat,” Father said.

Ma’s gaze went from Doctor Micks as he took a chair to Fingal who remained standing, and back to Doctor Micks when he said, “You were right asking me to discuss the case with your son. He is going to make a fine physician.”

Father and Ma both smiled.

Nicely done, Fingal thought, starting on a cheerful note.

“He has asked me to explain, and with respect to your wishes, Mrs. O’Reilly, I have given him permission to interrupt if I become too technical.”

“Thank you, Doctor.”

“I have examined the professor thoroughly and can find little obvious. You are anaemic, I am sure, and bruise easily. There are lymph nodes enlarged in your neck.”

Fingal saw his mother frown. “We all have lymph nodes, Mother. They’re part of a system that fights infection. Father’s are swollen and it could be a sign of infection.”

“I see.” Ma smiled up at Father. She covered his hand with her own.

“Precisely, and I suspect we may be dealing with one. All the signs are compatible with a diagnosis of glandular fever,” Doctor Micks said.

She frowned, and said, “Glandular fever? Connan, is that what your nice young colleague had last year?”

“Arthur? Yes, I believe it was.” He smiled. “It took him a while, but he did get over it.”

“Sometimes the patient doesn’t show much of a fever. I’m afraid in older patients it can be slow to resolve, with the nodes staying enlarged for quite some time,” Doctor Micks said.

“And the tiredness?” Father asked.

“Can be slow to resolve, but complete recovery is the usual outcome.”

“I see.”

“I’m sure you’d like to know exactly what is going on,” Doctor Micks said. “So, Professor, if you can attend the outpatients’ laboratory at Sir Patrick Dun’s, they’ll be expecting you at eleven tomorrow. We’ll take some blood and have an answer early next week.” He smiled. “Now, you did mention sherry?”

Neatly done again, Fingal thought. Without saying as much, Doctor Micks has given the impression there wasn’t much to be worried about and by accepting the offer of a drink has signalled that the consultation is over.

“Of course,” Father said, rose and walked to a sideboard where decanters and Waterford glasses sat on a silver tray. “Mary? Fingal?”

“Please,” Ma said. “And if it’s only an infection that’s going to get better I think a little celebration is in order, don’t you, Fingal?”

“I do indeed,” he said, following his senior’s lead and keeping his concerns to himself. “A small one for me, Father. I must be running on soon.” Fingal accepted the glass. He wanted to leave before there were any more questions. “I’d like to phone Lars before I go. Let him know not to worry,” he said. “My brother,” he explained to Doctor Micks.

“The one in Portaferry whose car broke down?” Doctor Micks said.

And Fingal was relieved to see that his senior was smiling.

28

These Things into My Ear

“What did Sir Robert Woods, honorary professor and laryngologist to Sir Patrick Dun’s, say was the golden rule?” Bob Beresford asked, as Fingal and a nurse held the wriggling child of six. Bob was trying to remove something the boy had shoved in his ear. His mother had a girl of four by the hand and a baby of a few months wrapped in the folds of her tartan shawl. Beneath the ragged hem of a long skirt, her bare legs vanished into a pair of mildew-speckled boots.

“Would youse feck off, yuh big fecker,” the child yelled, then spat at Fingal, who smiled back, ignored the spittle on his trousers, and tightened his grip. He could understand how scared the youngster was, and Weaver’s Street where he lived wasn’t a finishing school. “They get their language in their mothers’ milk,” he said quietly to Bob. “Pay no heed, but get a move on.”

Friday morning was oto-rhino-laryngology outpatients, known more understandably as ear, nose, and throat, ENT for short. They had been a regular fixture in Fingal’s and his friends’ calendar for the past three months. They’d seen their share of earaches, deafness, sore throats, nose bleeds, nasal polyps, and several throat cancers.

“Come on, Bob.” Fingal knew his friend wasn’t adroit at procedures but believed the more he practised the better he’d become. “You can do it.” Fingal was now adept at packing bleeding noses, removing foreign bodies from ears and nostrils, and clearing out earwax. He felt a ferocious blow to his shin. “Aarrgh.” Bedamned. The little bugger had landed a kick that would not have ashamed a rugby fullback. Fingal, still with the boy gripped tightly, bent, and making sure the mother couldn’t hear, applied Geoff Pilkington’s advice to speak to patients in language they could understand. “Do that again, you wee gurrier, and I’ll kick your arse from here to the Dodder River. Now hold still.”

The child stiffened, stared at O’Reilly, and burst into tears, but he didn’t move and in a few moments Bob was holding a pea between the tips of his forceps. “Got it,” he said. He grabbed an otoscope. “Keep holding his head please, Nurse.” Bob popped the illuminated instrument’s hollow tip in the ear canal. “Drum’s a bit inflamed,” he said, and turned to the mother. “I’ll give you a note to go to the hospital dispensary and get some drops.”

“Can I come back for dem tomorrow, sir?”

Fingal, still holding the boy, understood. Either she’d not come back or she’d have pawned something to pay for the medicine.

Bob clearly understood too. “Or,” he said, “make up salt in warm water, a tablespoon to a pint, and put a few drops in Enda’s ear three times a day. If he’s not better, still says it’s sore, in five days bring him back.”

“I will, sir.” She managed a small smile.

Fingal turned his attention to the patient. “You can let him go, Nurse.” He gradually lessened his own hold, squatted, and looked at the little lad. Tears ran down his cheeks, snot glistened on his upper lip. “You’re all better now, Enda, so dry your eyes and blow your nose. Here.” Fingal handed him a cloth from Bob’s instrument table. The boy snatched it and did as he was told. O’Reilly produced a paper bag of brandy balls. “Go on,” Fingal said, “take a couple.”

The boy sniffed, looked in the bag, then at Fingal. “Can I have six, mister?”

Fingal laughed. Greedy wee divil, he thought.

“Nah,” Enda said, “only two for meself,” he nodded to where his mother sat, “and two for Emer, me sister dere, and two for Brid w’ats at home minding the dog.”

Fingal swallowed. “Here,” he said, “take the bag.” Replacing the ha’penny’s worth of boiled sweeties he always carried in case he had to deal with children would hardly bankrupt him.

“Honest?” Enda looked suspiciously at Fingal. “Honest?”

“Cross my heart.”

The boy snatched the bag. “T’anks, mister.”

“And,” Fingal said, feeling guilty for his outburst and leaning closer to the boy’s good ear, “I’d not have kicked you. Not really.”

It was the kid’s turn to laugh. “If you had, you’d not have been the first, but,” he looked Fingal over from head to toe, “even if you are a big fecker, you’re not strong enough to kick anyt’ing as far as the Dodder. Dat river’s all the way to Ballsbridge.”

“Take him away, mother,” O’Reilly said. “Take him away.” He was still chuckling after they’d gone, then he turned to Bob. “And to answer your first question, the prof’s golden rule was, ‘Never, never,
never
put anything in your ear smaller than your elbow,’ and by God, he was right.”

*   *   *

Fingal was no stranger to Bob’s flat on Merrion Square on the ground floor of a yellow brick Georgian terrace. Since he’d extracted the promise from Bob that he would study, Fingal had changed partners and instead of Charlie had worked with Bob in outpatients and spent a lot of time here making sure Bob studied too.

The drawing room was carpeted, the walls papered, and on them hung framed prints. Old masters and Van Gogh’s
Starry Night
kept company with several of Stubbs’s horses.

“I’ve always liked your pictures, Bob,” Fingal said, opening his knapsack and taking out a tome. “Particularly the Van Gogh.”

“I’m not that interested,” Bob said, “except in the horses, but I’ve been living here for eight years and bare walls aren’t very cheerful so I borrowed these from home.”

“You and your horses.” Fingal set the textbook on the table and opened it at “Disorders of the Haematopoetic System.” “Blood today, Beresford. I missed the lecture for rugby and you were—”

“At the horses. I won twenty quid that day too.” He opened a sideboard. “I know we’re supposed to be studying, but I could use a drink. Fancy something?”

Fingal shook his head. “After we’ve done a few hours. We need to catch up on these blood disorders.”

“Anaemias, leukaemias—”

Fingal flinched. This morning Father’s blood samples would have been drawn.

“—thrombocytopaenias, polcythaemias, that sort of stuff?”

“Right.” Fingal put a notebook beside the text, set his bag on the floor, and pulled out a chair. “Come on, Beresford, get your idle arse over here.” He was used to working alone, but for three months had developed a system of studying with Bob. This was for Bob’s benefit, Fingal could take in information quickly by reading and making notes by himself, but he did enjoy the man’s company, perhaps because he was more of an age with Fingal than the younger Charlie and Cromie.