A Dublin Student Doctor (34 page)

Fingal was well aware of the pain caued by a bone marrow biopsy. “Perhaps,” he said, “Mother and I could leave and you could examine my father here, sir?”

“Rubbish,” said Father. “I am perfectly capable.” He limped to the door.

When he and Doctor Micks had left, Ma turned to Fingal and held up a hand before he could speak. “It’s all right, son. Your father and I do understand the seriousness of his condition. He trusts your Doctor Micks implicitly, but Father has always believed that one should be as knowledgeable as possible about anything that affects one directly. We had our friend Doctor Synge round for dinner on Saturday.”

“I see.”

“He explained a lot about what a bone marrow biopsy—that is the correct term?”

Fingal nodded.

“What the biopsy might show so Father and I have had time to think about things, to prepare ourselves for the worst. I did have a little weep, but Father has been a tower of strength.”

Fingal wondered. Certainly Father had always insisted on his boys keeping stiff upper lips. Was he practising what he preached, or had reality not sunk in?

Ma leant forward. “I’d like you to explain why your chief wants to examine Father again and what tests might have to be done.”

Fingal swallowed and recalled Doctor Micks’s conversation on the way here. “At the moment the leukaemia cells are in small numbers,” Fingal said. “If they are only inside the bones, it is fair to say the disease is in remission.”

“And that’s good?”

“It is. Doctor Micks is examining Father for signs of other parts of the body being affected, particularly the nervous system and lungs. He’ll then ask for some X-rays and, possibly, just possibly, the collection of some of the fluid around the brain and spinal cord.”

It was the only way to detect cancerous cells in the nervous system. It was how tuberculous meningitis was diagnosed too. Fingal had become well practised in the art of lumbar puncture, slipping a wide-bore needle between two vertebrae and beneath the membranes that surrounded the spinal cord. Unless Ma asked, he’d keep that information to himself. Father had been pierced enough.

“More waiting,” Ma said, and sighed. She patted his knee. “You are such a comfort to us, Fingal.” She frowned. “I know we decided not to upset Lars, but I do think it’s time he was told.”

“I’ll phone him after Doctor Micks has finished, let him know exactly what is happening, and see if he could come down for the weekend.”

“Thank you. I’m sure Father would appreciate seeing both his boys. We must hope for the best, but this uncertainty is very trying,” she said.

Fingal looked around the big room he’d known since he was fourteen. He’d felt safe here, protected, but he must leave this sanctuary soon and cope alone with another uncertainty, one that would only be resolved when the results of Finals Part I were posted at five o’clock.

32

Examinations Are Formidable, Even to the Best Prepared

“Everything all right at home?” Cromie asked when Fingal arrived at the students’ mess at Sir Patrick Dun’s. He’d explained his first morning’s absence from the surgical dressership to the lads by pleading family business and arranged to meet them before lunch.

He shrugged, avoided Bob Beresford’s eye, and said, “My father’s been a bit under the weather. Doctor Micks is sending him for a chest X-ray. The old man’s been feeling a bit off-colour and my mother wanted him seen by a senior specialist. Our chief has visited a few times.”

“Nothing serious I hope, Fingal?” Cromie asked.

“I’m sure Fingal will tell us in his own good time,” Bob said, and looked straight at Fingal.

“Sorry. Of course. Just worried.” Cromie clearly recognised he’d overstepped the mark. A family member’s illness was nobody’s business until they or those close to them chose to reveal matters.

“It’s all right, Cromie,” Fingal said. “I appreciate your concern.” He wanted to get his mind off his family. “How did it go this morning?” he asked. “What did I miss?”

“Not much,” Bob said. “Working in this discipline’s going to be pretty much like our six months of medicine. Assistant professor Mister Kinnear—”

“What I’d like to know,” interrupted Cromie, “is why it’s called a surgical dressership?”

“Because years ago it was the students’ job to change the patients’ dressings,” said Charlie. “The nurses do that nowadays.”

“As I was saying,” Bob said, fixing Cromie with a glare, “Mister Kinnear greeted us. Told us something about the history of surgery at Sir Patrick Dun’s. Fitzpatrick tried to correct him—remember our first day here?”

Fingal smiled.

“‘Flashing Fingers’ Kinnear they call him because he once took out an appendix in six minutes flat. He looked at Fitz, remarked, ‘Young man, when I want your opinion, I’ll tell you precisely what it is,’ and carried right on.”

Charlie said, “It seems our new chief’s a pretty easygoing skin, but he doesn’t like to be corrected in public. Anyway,” he said, “the chief dragged Sister Daly; her nurses; Harry Ellerker, the house surgeon; and us students on rounds. We saw half a dozen cases, two preoperative and four recovering. I think,” he said, “I’m going to enjoy surgery better than medicine.” He held up a pair of hands with fingers the size of sausages. “We’re going to get a chance to assist in theatre on our days and nights on call. Might even get to do some of the simpler procedures under supervision.”

“I’m looking forward to that too,” Cromie said. “I’ve always enjoyed the carpentry on the yacht.”

Fingal wondered if he could be as sanguine about cutting into human flesh as Cromie seemed. People were not made of wood. Fingal shivered and glanced at Bob. His poor ham-fisted friend would not leave the six months with a burning desire to specialise, Fingal was sure. “What happened after rounds?” he asked.

Bob said, “We were briefed by Harry Ellerker. He just graduated last week. Seems like a sound man. Geoff Pilkington’s moved on to Doctor Steevens’ Hospital for more training.”

“It’ll be the same system as the medical clerkship. One day in three with responsibilities only to the ward, see admissions, assist. Attend ward rounds every morning then two days out of three go to outpatients for the subjects like radiology and orthopaedics that we haven’t covered yet.”

“We’ll pair off. Hilda’ll be stuck with Fitzpatrick again,” Charlie said, and rolled his eyes.

“Bob and I’ll work together like we have done for the last three months,” Fingal said, “if you and Cromie make a team, Charlie.”

“Fine by me,” Charlie said, and Cromie nodded.

Fingal said, “Can Bob and I have Saturday free? I’ve to see my brother. It’s important.”

Bob raised an eyebrow. He must have put two and two together and guessed things had turned out worse than the suspected glandular fever. Maybe Fingal would tell Bob his troubles. It would be a comfort not to have to be alone as the tower of strength needed by his folks. Friends were important. And they might all need each other later this afternoon. Fingal said, “Can the four of us reconvene here at quarter to five? It’s only a short walk to Trinity for our results.” They had to be faced.

“I’ll run us over,” Bob said, “and we can get away quickly afterwards. I have no doubt drink will be taken.”

But will it be celebratory or to offer condolences? Fingal wondered.

*   *   *

Fingal, Bob, and Cromie stood at the back of a scrum of students huddled round a notice board on a wall of the Trinity Library. Charlie Greer had shouldered his way to the front. A County Kerry man called to his friend, “Arragh, Jasus, Liam, you’ve ploughed it again. The whole shebang. All six subjects.”

“What about you, Alfie?”

“Full house too.”

“How many times is that now, altogether?”

“Four. Come on for a pint,” Liam Doak said with a grin. “Next year, I’ll be ten years here if I can keep this up.”

“And won’t your patients think you the learnèd doctor?” another student said. “I can hear them now. ‘Our doctor isn’t like one of those half-baked five-year ones. He spent ten years getting the learning.’”

Fingal tried to ignore the two chronics and concentrate on what Charlie was calling out as he read his way down a list of names arranged alphabetically. “Beresford, pass all six subjects.”

“I don’t believe it,” Bob said, grinning from ear to ear. “I don’t bloody well believe it, but the first two rounds are on me tonight. After I’ve said a couple of novenas.”

“You can’t say novenas, you goat,” Fingal said, “you’re not a Catholic.”

“No matter. It’s still a bloody miracle.”

Fingal slapped his friend on the back. “I knew you’d do it. Our favourite chronic no more. You’ll be Doctor Bob this time next year. I’m delighted for you. Well done.”

“I’d not have done it without you, Fingal. Carrot and stick. Forcing me to read. Going on about doctors making a difference.”

“Rubbish,” Fingal said. “I didn’t answer the questions. You did, and I am delighted.”

Bob danced a little jig. “Begod, O’Reilly, I could get used to this passing.”

“Cromie,” Charlie yelled, “you’ve made it. So have I.”

“Charlie. Charlie Greer.” Fingal heard Hilda Manwell’s voice. “I can’t see over everybody.”

“You don’t need to,” Charlie yelled back, “you’re through, Hilda. Well done.”

Fingal opened his eyes in time to see her clasping her hands above her head like a victorious prize fighter. “Good lass,” he yelled. He noticed Ronald Hercules Fitzpatrick making his way from the front. His grin was oily. No prizes for guessing his results.

Charlie was pushing his way to where Fingal stood. He arrived before Fitzpatrick. Charlie lowered his voice. “I’m sorry, Fingal—”

Dear God, was that all anybody could say today? “I’m sorry.” First Doctor Micks, now Charlie. Fingal stood feet planted firmly, arms hanging loosely. “Go on, Charlie, spit it out.”

“You can keep four subjects—”

Fingal relaxed his still crossed fingers. “But I know I made a right hames of pathology so I’ll have to repeat it and microbiology in December?”

“’fraid so.” Charlie said.

“Aye.” Fingal’s shoulders sagged. “Aye, well. I expected it.”

“So did I, O’Reilly,” Fitzpatrick said. “It’s a miracle you passed too, Greer, all the classes you pair skipped for that foolish game.”

“Jesus,” said Charlie, “you’re a ray of sunshine, Fitzpatrick. A regular, ‘ever-present help in times of trouble.’ Why don’t you bugger off?” He turned his back.

Fingal couldn’t be bothered to think of any repartée. He sighed and stared at his boots.

Charlie clapped Fingal’s shoulder. “But you’ll be able to stay with us. Remember what Bob said about being able to take courses? You can still do your six months’ surgery from now until January, and midwifery next year.”

“And a bloody great pile of extra studying now I’ve re-sits ahead, and if I pass them Part Two of Finals to face in June.” Fingal looked up and saw Bob and Cromie watching him. Both looked solemn. Neither spoke.

Fingal took a deep breath. “So,” he said. “I’ve had a setback. It’s not the end of the bloody world—” although how Father and Ma would take it he shuddered to think. He’d not tell them yet, but his failure couldn’t have come at a worse time. “You said the first two rounds were on you, Bob Beresford.” Fingal forced a smile and had a fleeting image of a brokenhearted Lon Chaney in the movie
Laugh Clown Laugh.
“We’ll go to the Bailey and toast your success,” he said as lightly as he could manage. And I’ll go easy on the drink and try to work out the best way to deal with whatever comes next.

Then he remembered. What came immediately next was a phone call to Kitty. He’d promised to let her know his results the moment he heard.

33

A Disinclination to Inflict Pain

“I admitted Mrs. CD on Monday night, two days ago,” said Ronald Fitzpatrick, the familiar note of self-importance in his voice. He stood at the head of an iron bed and whipped off his pince-nez as he continued to address the assistant professor of surgery, Mister Nigel Kinnear, and the usual entourage of nurses and medical juniors. “She is forty-one and the mother of ten. She presented complaining of severe, spasmodic, right-sided, upper abdominal pain, and pain between her shoulder blades. She had experienced nausea and vomiting. The symptoms began shortly after a meal of colcannon and butter, and fried bacon. She has had previous attacks, but cannot remember exactly how many.”

Fingal had made the diagnosis. The woman in the bed was two stone overweight. Her complexion was dusky yellow. Almost certainly a gallstone had lodged in her common bile duct, which had contracted forcibly trying to expel the obstruction. She was suffering from biliary colic with blockage of the duct that carried the breakdown products of red blood cells from the liver to the gut. One of those components, a yellow pigment called bilirubin, entered the bloodstream and coloured the skin. Colic was often provoked by eating a fatty meal. The condition was recurrent and most common in certain women over the age of forty who had borne many children. There was a way to remember. It was called “the five
F
s,” and Fitzpatrick was spouting them while he smirked at Mister Kinnear.

“This case is fecund, female, fair, forty.” He smirked. “I’ll refrain from mentioning the fifth
F,
but she is that too.”

Fingal nodded. Perhaps Fitzpatrick had learned a modicum of tact. Calling a patient “fat,” the fifth
F,
to her face would have been unconscionable.

She struggled to sit, digging her beefy elbows into her pillows. Redness in her cheeks shone through the jaundice. “I beg your pardon, I beg your pardon, did youse call me a ‘feckin female’? W’at’s wrong wit’ being a woman?”

Fingal could barely hide a smile. Mister Kinnear hadn’t bothered to. “Come now, Mister Fitzgerald—”

“It’s Fitzpatrick, sir.”

“Explain to the patient what you actually said.”

Fitzpatrick blushed. His wattles shook and he took an enormous breath. “I said, dear—”

“Who’s dear? I’m not your dear anyroad. I’m Mrs. Colleen Donovan from Gloucester Street. My friends call me Bluebell, but I’m Mrs. Donovan ’til youse. And youse said I was a feckin’ female, just dere now. Everybody heard.” She looked from face to face. “Didn’t yiz all?”