A Dublin Student Doctor (37 page)

And as she left, Kitty O’Hallorhan never looked back.

35

You Can Cut That Right Out

An acrid smell of antiseptics and chloroform assailed Fingal’s nostrils.

“Ready?” Harry Ellerker said, peering over his mask from where he waited on the patient’s left.

Fingal stood on the patient’s right and had been staring at the skylight above the operating table. As I’ll ever be, he thought, and looked down. The theatre sister was beside Harry with her table of instruments. Doctor Callaghan, the GP anaesthetist, twiddled the knobs on his flowmeters, directing a gas mixture of nitrous oxide, oxygen, and carbon dioxide over chloroform and on to the patient. “Ready when you are,” he said.

Fingal daren’t speak. His voice might quaver.

On the operating table, Seamus Farrelly was covered in sterile white towels. Three months had elapsed since Fingal had admitted the butcher with an appendix mass that had responded to conservative treatment. He’d been readmitted last night for his appendicectomy, the operation Mister Kinnear had promised Fingal he could do. It was the last case of the afternoon list.

He took a deep breath and glanced across the room. A large window took up most of the north wall and the rest was surrounded by five tiers of steps with room for seventy-five students to stand and lean on rails observing. The gallery was deserted but for the front row. Bob, Cromie, and Charlie had turned out to offer Fingal moral support. Each had seen and assisted at several appedicectomies, but Fingal was the first who would operate.

“It’s time,” Harry said, handing Fingal a scalpel. “Make a gridiron incision, there to there.” He indicated an area of skin that had been left exposed when the patient had been draped.

Fingal took the knife, hard through his gloves. As he had suspected when he’d first seen the very sick man, he was someone with a sense of humour. He’d told Fingal, upon hearing he had a “mass” in his belly, that it was bad enough “getting dragged to church by me devout wife wit’out having a mass in me belly too. Must be feckin’ small priests and altar boys in dere.” He’d been a butcher for seventeen years, was married, but childless, and had been a keen hurler in his youth. The man was asleep now and his face was hidden, but there was more than a lump of diseased flesh under the sheets.

“Fingal,” Harry said.

“Sorry.” Fingal swallowed and drew the blade firmly along the line Harry had indicated. Blood welled and the skin gaped, the fat beneath parted. Two lips garishly painted with scarlet.

Fingal paused and glanced at Doctor Callaghan. “I didn’t feel a thing,” said the anaesthetist with a grin. He must have seen the look in Fingal’s eyes. “It’s all right, neither did the patient.”

Harry swabbed. Fingal set aside the scalpel and clamped small blood vessels. Sister handed him a spool of ligature. As Fingal tied off the vessels, Harry removed the clamps and cut the ties close to the knot. There was a glistening sheet of tissue at the bottom of the wound. Now those hours of anatomy dissection were bearing fruit. Fingal recognised the fibrous tissue, the external oblique muscle’s aponeurosis that attached the muscle in the midline and to the hip bone. Beneath lay the internal oblique and tranversalis, the two deeper muscles of the lateral abdominal wall.

“Slice the aponeurosis,” Harry said, and Fingal did. Clamps on each side of the incision peeled the fibrous tissue back to expose maroon muscle.

“Use the handle of the scalpel. Shove it through the muscles, Fingal.”

He did.

“Now put your index fingers in that hole and pull sideways.”

Fingal started to sweat. He was surprised by how easily the muscle fibres separated. Blunt dissection opened far fewer blood vessels than cutting and shock from blood loss was one of the hazards of surgery to be avoided at all costs.

“Mister O’Reilly.”

He half turned. Sister offered him forceps. He slid their tip into the hole in the muscles. Open. Advance. Shut. Gently pull. As he withdrew the instrument, it was followed by a pyramid of glistening peritoneum, the membrane that lines the abdominal cavity. He felt the peritoneum between finger and thumb to assure himself that no bowel had been included. It would be serious if he sliced into gut and spilled its contents into the abdomen. No bowel was palpable so a second forceps was applied and he incised the membrane between them.

“I’m in,” he said, and was gratified by the firmness of his voice. “Retractor, please.” Slipping the flat blade of the right-angled instrument into the incision, he pulled toward the patient’s middle to give himself more room to work. “Here.” He gave the handle to Harry Ellerker. “Pull on that.”

Fingal accepted a large moistened swab from Sister and slipped it into the wound beneath the retractor’s blade to pack loose bowel away from the field. Now came the tricky bit. He had to fish out the caecum, that bit of bowel that was the junction between the small and large intestine and from which the appendix hung, a long narrow tube. The ancient anatomists had named the organ well. Vermiform—wormlike.

“Pack.” He took another gauze square and used it to grip the caecum. The smooth rubber of his gloves would have slid off the slippery bowel, but the rough gauze gave added traction. Slowly the organ emerged, and there it was. The appendix.

Fingal blew out his breath. He hadn’t realised he’d been holding it and felt the dirty nurse swabbing his forehead. How did he feel inside? Certainly not as scared as he had at the start. Relief? There was that all right. He’d felt the same way when for the first time as a young deck officer he’d anchored the ship unsupervised.

Sister had given Harry a Morrant Baker forceps and was offering one to Fingal. The instrument was designed to encircle the appendix without damaging it while it was still within the abdominal cavity. Harry applied his to one end while Fingal placed his where the organ joined the caecum. He then handed his to Harry who, by pulling on both, lifted the appendix and exposed its mesentery, a thin membrane through which the blood vessels ran. It took but a moment to clamp it and the vessels firmly and divide them. The appendix was free and ready to be removed.

Fingal took a different set of forceps with ridged blades and, to facilitate its ligation and division, deliberately crushed the appendix close to the caecum, removed the forceps, and reapplied it above the crushed area to seal part of the organ that would be removed. Those days of suture duty and learning to tie knots paid off as he ligated the appendix at the crushed area then took a scalpel and divided it between the ligature and the clamp.

Harry lifted the diseased organ and dumped it and the attached forceps into a stainless steel dish.

Fingal heard the clatter of metal on metal. His feelings of triumph were pulled up short when Doctor Callaghan asked, “Going to be much longer? Mister Kinnear would be halfway through his third case by now.”

“Not long,” Harry said. “Just have to suture the mesentery to secure the blood vessels, and bury the stump in the caecum.”

“Let me know when you have. He’s been under for a fair while—”

Fingal pursed his lips. He’d completely forgotten that a person called Seamus Farrelly lay under the towels. A childless married butcher who had been a keen hurler.

“I’d like to start lightening the dose of chloroform.”

“I’ll finish,” Harry said. “I’m quicker.”

“Fine.” Fingal was happy for the houseman to speed things up and cheerfully assisted as Harry sutured the mesentery, put a purse string suture in the caecum around the base of the appendix, pushed the stump in, and tightened the loop before tying the knot.

“Closing,” Harry said, pulling out the moistened swab Fingal had inserted into the belly to keep loose bowel out of the way.

“Thanks,” the anaesthetist said.

Fingal was happy to cut the stitches as Harry closed the wound.

“Done,” Harry said, helping Sister put on the dressing. As she tied the last knot in the bandage the patient moaned.

“That,” said Doctor Callaghan, “is close to the perfect anaesthetic. As the surgeon finishes, the patient is wide enough awake to be told the fee.”

Fingal laughed in relief that the surgery was over. He was startled to hear a round of applause coming from the stands, looked over and saw his three friends clapping.

Charlie Greer said, “Well done, Fingal.”

Cromie added, “And we don’t give a hoot about your self-imposed monastic life of study. Tonight, boyo, Hilda and Fitzpatrick are on duty so we’re going to Davy Byrnes and the first pints are on you.”

“I’m sorry to disappoint you lads,” Fingal said, “but go away on your own. I’ve work to do. I’ve got those Part I exams in December, remember?”

“And you’ll destroy them,” Cromie said. “Utterly.”

Fingal shook his head. “It’s all right for you lot. You’ve only all the clinical subjects to master for Finals Part Two in June. I have them on top of repeating Part One. And I’m not going to fail this time around.”

“Fingal,” Charlie said. “One evening’s break won’t kill you. We’ve got our certificates of good standing in all the other clinical disciplines except the final three, midwifery, opthalmic surgery, and anaesthetics.”

“That’s right,” Bob said. “And Mister Kinnear’s bound to issue our certificates for surgery in December.”

“Three months away, but that certificate will be bugger all use to me if I fail Part One. I’m studying tonight.”

“I think, gentlemen,” said Charlie, “we have run up against the immovable object.”

“Pity,” said Bob.

“Fraid so,” said Fingal. “I’m going to change, have my tea, and then work. See you lot at rounds tomorrow.” He strode into the surgeons’ dressing room. Eejits. But he smiled. They were good lads. They meant well.

*   *   *

Fingal had just settled at his desk in his bedsit at Sir Patrick Dun’s students’ quarters and opened his pathology textbook when he heard a knock at the door. Now who the hell was that? “Come in,” he roared. They’d better be quick, whoever it was. He didn’t need interruptions. He had twenty-six pages to read about the pathology of cancer of the lung.

Bob Beresford stuck his head into the room. “And how is the great Lawson Tait tonight?”

“Lawson Tait? What the hell are you on about, Beresford?” Fingal scowled. “I’m busy.”

“Scottish surgeon,” Cromie said, pushing Bob inside and following, “who did the first appendicectomy in 1880. Clever lot, us Scots.”

“I wonder,” said Fingal grimly, “if he was related to the Butcher of Grand Canal Street?”

“Wasn’t your patient a butcher?” Charlie asked as he brought up the rear.

“He is, but I am referring to myself,” Fingal said, “the student who killed his classmates because they wouldn’t let him study.” But he couldn’t really be angry with his friends.

“We need your help,” Bob said. “And you’d never refuse to give your friends a hand. We know that.” The two large brown paper bags he set on Fingal’s desk clinked. “We’ve just come from Davy Byrnes.” Bob fished out a bottle of Guinness. “You couldn’t expect the three of us to put away another wheen of Mister Arthur Guinness’s best by ourselves, could you? And it’s not every day of the week that a pal does his first appendix.”

“You lot are hopeless. Utterly bloody hopeless.” Fingal laughed. “All right. All right, come in. There’re glasses in the communal kitchen.”

“No there’s not,” said Charlie, producing the tumblers. “Fill ’em up, Bob.”

Bob rummaged in his pocket for a corkscrew.

Cromie and Charlie squashed onto a two-seater settee.

Bob opened the bottle with a distinct
pop
and poured. “We,” he said, “are here to toast you, Fingal, aren’t we, lads?”

“Indeed,” said Charlie. “Pity it takes so long to pour stout.” He stood, moved to the fireplace, and stared at a row of picture postcards. “Mind if I take a look, Fingal?”

“Go right ahead.”

Charlie squinted then said, “That’s the Parthenon in the Athenian Acropolis, and those are the great pyramids, Cheops, Khefren—and buggered if I can remember the third, and that’s the Sphinx at Giza. Napoleon’s gunners made an awful mess of the poor old thing’s nose in 1798. So you’ve friends in Greece and Egypt?”

“My folks,” Fingal said. “They decided to take an extended holiday this year. They send postcards to me and my brother. Keep us posted.” And Lars and I talk on the telephone once a month, he thought. It’s about time I gave him a ring.

Charlie whistled. “Lucky them.”

Fingal saw the sympathy in Bob’s look. He was the only one of the friends who knew the truth about Father’s illness. Bob had never mentioned it again since the night Fingal had told him, but always listened sympathetically if Fingal needed to talk.

Fingal said, “They left in August on their grand tour. They had hoped to take the Arlberg Orient Express from Zurich to Budapest and on to Athens, but my father felt crossing Nazi Germany would be dangerous. They went to Marseilles instead and took passage from there. They’ve decided to winter somewhere warm too.”

“I think,” said Bob, passing a full glass to Fingal, “your dad was right to keep out of—what does Adolf call it? The Third Reich? In September he banned all Jews from public life. The maniac has just announced a program to build submarines—U-boats he called them. It’s got Winston Churchill’s knickers in a real twist. He’s been screaming in the British parliament that England must rearm.”

“I wonder who the subs’ll be used against?” Fingal asked, thinking of his commitment to serve in the navy.

“England,” said Cromie. “There could be a war. Churchill has a point.”

“I sincerely hope,” said Bob, handing a glass to Charlie, “that you are both wrong.”

“Your people had better not winter in Italy,” Cromie said. “Mussolini’s poised to invade Ethiopia. He’s a fascist and he has dreams of Empire too.”

“And,” said Bob, “I had dreams of having a few quiet bevvies with our good friend Fingal O’Reilly tonight and for once not letting him worry about exams he’s bound to pass—”

“I hope,” Fingal said.

“Here.” Bob gave Cromie a Guinness. “And that’s enought blether too about the miserable state of the world. We can’t do much about it.” He pulled a silver flask from an inside pocket and opened its top. “Now,” he said, “who’ll propose a toast?”