A Dublin Student Doctor (31 page)

“Idle arse,” Bob said, as he sat opposite. “Not exactly an elegant expression. You still think you’re at sea, O’Reilly. Do you miss it?” He offered Fingal a cigarette, smiled when it was refused, and lit one himself.

“Not really, although I enjoyed my time on HMS
Tiger.
Did a bit of boxing.” He’d won the fleet championship for his weight division, but was not going to boast.

“Did you, by God.” Bob looked sideways at O’Reilly. “I’d not like to go three rounds with you, you big lump. Did you ever think of boxing for Trinity? I think our friend Charlie goes to the gym.”

“He does,” Fingal said, “he likes to spar, but rugby, Kitty, and studying fill enough of my time, and studying is what we came to do. Here.” Fingal opened the text and slid it across the table. “You read. I’ll make notes.”

“Jasus,” said Bob as he picked up the book, “was it a cargo ship or a slave galley you were on?” He took a deep pull on his smoke. “Before we start, tell me a thing, Fingal. Nothing to do with pathology.”

“You’re hopeless, Beresford,” Fingal said. “I’m surprised the thought of working doesn’t bring you out in a rash.” Fingal was sure that the more Bob learned the less scared he became of the subjects and the more he seemed to want to pass after all. “What do you want to know?”

“You mentioned Kitty. How are things going with you and her?”

Fingal hesitated. He didn’t like discussing his private life, but this was Bob Beresford. “Things, as you put it, are fine. She’s a great girl. I’d like to see more of her, but you understand, her schedules, mine, work.”

“Are you in love with her?”

Fingal sat back. “God, Bob,” he said, “a policeman wouldn’t ask you that.”

“I’m not a Peeler, Fingal, and we’ve been friends for a while now. I’m only asking because I don’t want to see you hurt.”

Fingal frowned. “Hurt? How the hell could I get hurt?” He thought of Lars. If he’d not let himself fall for that Jean Neely girl he’d not have been wounded. Kitty was fun, beautiful, but Fingal wasn’t ready to buy her a ring. Not quite yet.

Bob crushed out his smoke. “Three years ago, before I met you and the boys, I walked out with a girl from Cultra.” His voice softened. “It wasn’t until she’d married an army captain, Lord John MacNeill, next in line to be the Marquis of Ballybucklebo, that I realised I’d let a gem go. Your Kitty’s a jewel. She cares for you and it shows. Don’t make my mistake if you feel for her. Don’t lose her.”

Fingal sat back. “Thanks, Bob,” he said quietly. “I appreciate the advice. I didn’t know about the girl from Cultra. I’m sorry for your troubles. Thank you for telling me.”

Bob shrugged. “Water under the bridge.”

Look in your heart, Fingal told himself. Bob’s giving you good advice. You are in love with Kitty O’Hallorhan. “I’ll tell her—after the exam.”

Bob inclined his head. “Good man. I don’t think you’ll regret it.”

“You’re right.” Fingal took out his fountain pen. “Now. Read the bloody book.”

Bob began,
“The leukaemias are a family of blood cancers
—
”
Fingal’s fingers tightened on the pen,
“first described by Rudolph Virchow in 1885 who reported a large number of white blood cells in a smear of a sample taken from a recently deceased patient. He coined the term from the Greek
leukos
, white and
aima
, blood. Ten years later Franz Neuman noted that instead of being red the bone marrow of a leukaemia patient was ‘dirty-green-yellow—’
”

“So medicine’s only recognised the disease for fifty years,” Fingal said.

“Looks like it.” Bob read on—and on until he closed the book and announced, “Here endeth the lesson.”

“Right,” Fingal said. “Let’s see what you’ve learnt.”

Bob sighed. “I love the way you can switch from slave driver to grand inquisitor, O’Reilly. You’re sure you’re not Torquemada reincarnated? Haven’t we done enough for one day?”

“Divil the bit,” Fingal said. He’d remember every word. He had a pressing reason to, but if Bob was faced with an exam question on these disorders, it was important he remember what he’d been reading. “Classify the leukaemias.”

Bob lit a cigarette, pushed back his chair, and said, “Leukaemia is an abnormal increase in white blood cells which are produced in the bone marrow, but appear in the bloodstream—”

“I didn’t ask for a definition. I asked—”

“For a classification. I know. Steady on, old man. The leukaemias are classified by the type of cell involved and the speed of onset and progression of the clinical course. Two types of cells may be involved: Lymphocytes, which are infection fighters, and myelogenous cells, which are immature forerunners of many blood components, including red cells, white cells, and platelets.”

“So there are only two types of leukaemia?” Fingal asked.

Bob shook his head. “I said the rate of progression was important. Disease of both cell types can be acute or chronic. The chronic ones have a slow onset and can go on for many years with many patients succumbing to some other unrelated cause of death.”

Fingal could hear Doctor Micks. “If it is—we must pray it is one of the chronic varieties.”

“Acute leukaemias, lymphocytic and myelogenous, are swift in onset and rapidly fatal,” Bob said, and grinned. “There, how did I do?”

“Top of the class,” Fingal said quietly. “Absolutely right.” He pulled in a deep breath and sighed.

Bob leant forward. “You all right, Fingal? I thought you were just your usual no-nonsense about work self, but now you sound, I don’t know, you sound a bit low.”

“I’m sorry, Bob,” Fingal said. Like his love life, he didn’t want to discuss family matters, not even with closest friends. Certainly not now when the tests had yet to be done and Father’s diagnosis was speculative. “Just a bit tired, and worried about Part One.” He slipped from his chair and pulled out his pipe. “Tell you what. Let’s have that drink, a smoke, then you take the notes and grill me on the signs, symptoms, investigations, and treatment.”

Fingal lit his pipe while Bob poured two Jamesons.

“Here.” He handed a glass to Fingal. “Fingal,” Bob said. “I’ve already stuck my nose into your business about Kitty. You can tell me to shut up if you like, but you’re
not
yourself today. What’s up?”

Fingal swallowed and felt the smoothness of the Irish whiskey. He rolled the glass between his palms, and looked at Bob. “At eleven o’clock this morning my father had blood samples taken. We’ll have the results on Monday. We hope it’s glandular fever.” He didn’t need to go on. Bob’s whispered “Oh Christ” was enough for Fingal to know his friend had understood what else might be turned up.

29

The Sensation of a Short, Sharp, Shock

Describe the macroscopic and microscopic postmortem findings in a patient who had been suffering from sarcoidosis of the lungs and liver.
Fingal reread the question. It didn’t help. He still knew virtually nothing about the subject. Two hours ago, the invigilator had announced, “It is two o’clock. You may turn over the examination paper and begin.” Moments later, Fingal had recognised his nemesis. The mine lurking in calm waters. Now, having written the other two required essays, he was glaring at the question and realising he was not going to find divine inspiration.

He sat in the back row of the hushed Examination Hall of Trinity College Dublin. Six months earlier he’d squired Kitty here to the New Year’s Ball. Since Monday he’d written two three-hour exam papers each day. One before lunch. One after. The subjects were twinned. Materia medica and therapeutics, medical jurisprudence and hygeine, and pathology and microbiology. They were passed or failed in pairs, a good mark in one could compensate for a poor mark in the other. Two sets of poor marks and the student would be repeating the exam in those two subjects in December.

And the papers weren’t all. Starting tomorrow would be a series of oral and practical exams. Now, on Wednesday afternoon, June 26, 1935, he was staring at the last paper of Finals Part I. Pathology. And he wasn’t happy.

He’d had no trouble with two of the questions, rheumatic fever and cirrhosis of the liver. He’d learnt about the former when he’d looked after Kevin Doherty. Cirrhosis had been one of the subjects he’d missed for rugby practice, but they’d seen a patient of Hilda’s on the women’s ward. The poor woman had died three weeks after admission. He and Bob had spent an evening together reading the pathology. But this? This? He knew sweet Fanny Adams about sarcoidosis. He’d missed the Thursday lecture two weeks ago when Doctor Micks had come to Lansdowne Road. Fingal had never seen a case and had been too preoccupied with the blood disorders since his old chief’s visit to read up on this disease. He wished to the bottom of his soul that he’d spent an hour or two on the rare inflammatory condition.

And he’d not been satisfied with his answers on this morning’s microbiology paper either. A first-class answer to all three questions now should compensate for a poor showing in one question this morning. But to mess up two linked subjects? He’d be joining the chronics in December, would have to reread two vast subjects in detail to be sure of a pass, and that would mean less time to study for the all-important Finals Part II exam next June.

Damn it. He shook his head. Damn it, if he had to go down, he’d go down fighting.

On the principle that a blank sheet would garner nothing, but putting down what little he knew might collect a few critical marks, Fingal wrote,
Sarcoidosis is a rare disease of unknown causation. Collections of inflammatory cells,
but he hadn’t a clue about which specific ones,
can be identified in any organ system and would be particularly numerous in the lungs and liver of the patient in this question. There is no known cure.
Just, he thought, as there is no known cure for not having prepared enough for this exam. He looked down the hall where his entire class bent over their desks scribbling. Several students from more senior years were re-sitting.

He looked up. The clock said there were fifty minutes left before time was up, but what was the point of sitting here? He held up his hand. The invigilator left his desk and walked past the ranks of desks. “Yes, Mister O’Reilly?” he said sotto voce.

“I have finished, sir.” He handed his answer booklet to the lecturer. Perhaps Fingal should have said, “I am finished, sir,” to convey his certainty that he had failed, but he felt an even more appropriate expression would have been, “I am bollixed.”

“Once you leave the hall you will not be readmitted.”

“Yes, sir.”

“Very well. Good luck.” He smiled.

*   *   *

Fingal found a bench under a sycamore tree in the courtyard. The sounds of traffic from nearby College Green were muted. The sky was overcast and he heard a distant rumble of thunder. A grey day to suit his mood. He lit his pipe feeling like a newborn taking comfort from a dummy tit. Lord knows, Fingal O’Reilly needed solace, and being certain he’d failed two subjects was the least of his troubles since Monday nine days ago. He puffed a mighty cloud and remembered.

“O’Reilly,” Doctor Micks had said, “you are on time. Good.” The consultant turned to his entourage. “I shall see you all back here on Saint Patrick’s Ward on Wednesday.”

There was a chorus of, “Thank you, sir,” from the current group of clinical clerks.

He took Fingal by the elbow. “Come with me,” and led him into a small room to the side of the ward. “Please sit down.” He picked up a report and handed it to Fingal. “I imagine you’ve become quite knowledgable about leukaemia. Under the circumstances, I certainly would have read up on the subject.”

“I did, sir.” Fingal looked at the report. “There’s no rise in the lymphocyte count so it’s not glandular fever.” Damn. “The platelet count is low, the red cells are low, and that explains why my father has bruises and is tired and short of breath—” Fingal looked up at his teacher and back down to the form, “but the white count isn’t increased. I don’t understand.” He grinned. “He doesn’t have leukaemia. That’s wonderful.”

Doctor Micks steepled his fingers and looked straight at Fingal. “That’s what I thought, but blood diseases aren’t my field. I asked Doctor Fullerton. He has a special interest in haematology.”

Fingal’s grin faded; his palms were sweating.

“I’m sorry,” Doctor Micks said, “but there is a rare variant called aleukaemic leukaemia.”

“It wasn’t in the book I read, sir.” Aleukaemic meant “without white blood.” “How can anyone be suffering from an excess of white cells without having too many of them? It doesn’t make sense.”

“My thought exactly, but contrary to popular belief, consultants are not omniscient. My colleague explained that in this situation the abnormal cells are produced but never leave the bone marrow so they don’t show up on a blood test. They do, however, interfere with the production of other blood components.”

“Father’s red cells and platelets are low.”

“I’m afraid so.” Doctor Micks leant closer. “Fingal,” he said, surprising him with the familiarity, “Fingal, I very much fear it is what ails your father.” He paused.

He’s giving me time to digest that, Fingal thought, and it’s a tough mouthful to swallow. “Will Father need a bone marrow biopsy?” he asked.

“Yes, he will. It will deny or confirm that there is leukaemia, but more importantly if there is, what cell type and whether it is chronic or acute.” He touched Fingal’s arm, surprising him for the second time in as many minutes. “My boy, things might yet turn out well. The condition may be chronic.”

“How soon can you arrange the biopsy, sir?”

“Doctor Fullerton will do the procedure himself as a courtesy to you and to a fellow Trinity professor.”

“That’s very decent.” It was. Even in skilled hands, driving a wide-bore instrument into the breast or hip bone to get into the marrow cavity was tricky and painful.

“Unfortunately Doctor Fullerton is leaving this afternoon for an extended visit to Saint Bartholomew’s Hospital in London. He can be back on the thirtieth, do the biopsy, and read the slides first thing on Monday, July first.”