A Dublin Student Doctor (39 page)

Fingal crouched and changed his direction of attack. Some bastard was seeing Kitty. He’d not kiss her when he had a split lip. Fingal unleashed a rapid flurry of punches all hitting home. Somehow all his anger, all his hurt were driving his fists.

He felt someone wrapping him in a tight hug, pinioning his arms. They waltzed like a pair of drunken bears.

“Fingal,” Charlie gasped, and said, “we’re sparring.” Gasp. “It’s not a title bout.”

Fingal felt the referee pulling the clinch apart and dropped his left shoulder. Not a title bout? That penetrated Fingal’s rage. Charlie was right. Fingal should ease up. His next couple of jabs lacked steam and Charlie’s next punch, like his words, got through Fingal’s guard. Once.

Damn it. Damn it. He crouched, tightened his defensive stance. Rage boiled in him. His fists clenched so tightly his gloved fingers tingled. He let his hatred focus solely on the target of all his hurt, whoever the faceless man opposite was.

Fingal let go another series of punches, stamping forward as his opponent backed against the ropes. Fingal was sure the man could be fooled with a feint to his right. He always weaved to his left and the next time, Fingal hoped, the fighter would dodge straight into a punishing right glove. That would be sweet.

Fingal feinted with his left, opened his shoulders to deliver a bone-crushing right hook, not to his friend Charlie Greer, but to all that hurt Fingal O’Reilly; the hidden, but never absent worry about Father, the constant anxiety about the exams he must pass, and—he saw the faceless man, the Baggot Street bastard kissing Kitty. His muscles knotted and his right arm became a swinging demolition ball that was going to smash—

Bone crunched as a pile-driver slammed into Fingal’s nose. He tasted the copper of blood, spat, staggered, held his gloves in front of his face, and tried to backpedal. His vision was blurred, but he was aware of the referee between him and Charlie.

“Put down your gloves, sir.” The referee peered at Fingal’s face. “Jasus. You’ve a face on you like a smacked arse and your nose? It’s fecked.” He raised his voice. “I’m stopping the fight.”

Fingal was aware of Charlie moving off the ropes. “Fingal, I’m sorry.” He bent and looked. “I really am. I think I’ve bust your nose, but you didn’t give me much choice. I had to stop you. I’ve never seen you like that. You went berserk.”

“I t’ought youse was trying to kill Mister Greer, sir,” the referee said from where he stood between them.

The jolting pain had brought Fingal to his senses. He felt his mouth fill with blood and spat. Christ, but his face was sore. And Charlie was right. Fingal was the one who should apologise. Charlie Greer had been defending himself. Fingal rocked on his heels, laid a gloved hand on his friend’s shoulder. “You’re right, Charlie. I got carried away. Sorry. I completely lost the bap. I’m ashamed of myself.”

“It’s all right,” Charlie said. “No need to be. Anyone can snap in the ring.” He tipped his head to one side. “Fingal?”

“Yes?”

“We’re friends. All right, so you got carried away; I belted you one. That’s all there is to it. Let the hare sit.”

Fingal tried a lopsided smile. “Thanks, Charlie.”

“Will yiz come to your corner, sir?” the trainer asked, led Fingal there, and sat him on his stool. Charlie followed.

“Dis,” the trainer said, “will hurt,” and without giving Fingal a moment to reflect, grabbed his nose, pulled down, and hauled the tip to the right.

“Jasus bloody Murphy,” Fingal roared as what seemed like liquid fire ran over both cheeks and he heard the grating of bone on bone. Tears ran unheeded and dripped mingled with blood to the canvas below. “You’ve marmalised me.”

“I’m sorry, sir, but when he taught me first aid the Saint John’s man was insistent. Fix a broken nose at once, or you’ll never get it back after it’s swelled up.”

Fingal blinked away the tears. The violent pain had been replaced with a constant throbbing. He nearly managed a smile. It was odd being a patient and on the receiving end. “Thank you,” Fingal said, “I’m very grateful. I know how it has to be done—” Fingal managed to stop himself trying to caress his wounded nose with his gloved hand. “And I’ll remember how much this hurts next time I go to treat a patient with a broken nose.”

“It’s the best I can do,” the trainer said. “You’re going to have a couple of right shiners for a week or two, and I t’ink when it heals, when the bones mend, you’ll have a tilt to the left. Sorry.” He turned to Charlie. “Hold out yer hands, Mister Greer. I’ll get your gloves unlaced.”

Fingal shrugged. Black eyes were the inevitable accompaniment of a broken nose because blood seeped into the loose tissue under the eyes. “A tilt? Well,” he said, “I’m not in a competition with Ronald Coleman or Errol Flynn.” He shook his head and scarlet drops flew. “Mind you,” he tried a weak joke, “I could star as Captain Blood.”

“True on you, sir,” the trainer agreed, “but the bleeding should stop soon. I’ll get you ice when we get you back to the changing room.”

“Here.” Fingal lifted his hands to Charlie. “Let me out.”

Charlie, his hands now free, started unlacing. “Showers for us, lad, and I know I said we’d let it drop, but looking at your schnozzle I have to say again I truly am sorry, Fingal.” He took off the left glove.

Fingal nudged his friend. “No need to be. It was a fair punch. And I had it coming. For a minute or two there I’d’ve been happy to destroy you. I was trying to,” he hesitated, “trying to exorcise a ghost.”

Charlie said very quietly, “I think I know her name.”

“You do.” Fingal used his free hand to remove his other glove. He handed them to Charlie.

“And I know you well, Fingal Flahertie O’Reilly. When you compete you always want to win, but there’s no malice to you.” Charlie cocked his head. “Did you lay the ghost?”

“I did not.” Fingal tried to shake his head, but stopped quickly. “The exam’s in a month. Once it’s over I’ll try to effect a resurrection. Go and see her—but not until then.” Fingal lowered his head. “Thank you for telling me about Kitty. Thank you for getting me out tonight.” He looked up at Charlie and offered his hand. “Friends?”

Charlie shook. “Friends.” He laughed. “But you do look a sight.”

Fingal opened the changing room door. “I don’t feel much like studying so I’ll let you buy me a pint.” He managed a smile. “I couldn’t read anyway. I’ll hardly be able to see past this.” He pointed at his nose.

“One night won’t—”

“No, it won’t, and I’ll have all day for the next couple of Saturdays to catch up on pancreatitis and TB. I’ll not be able to play rugby until this settles down.” He indicated his nose.

Charlie said, “What if you’re picked for the rugby trial for Ireland? Will you be able to play then?”

“Wild horses wouldn’t stop me from playing in that game, Charlie Greer, and well you know it. Now come on. I want that ice for my nose, I want my shower, and by God, I want that pint.”

38

I Am Disappointed

November had turned to December. The six-month surgical dressership was drawing to a close. As usual at nine o’clock precisely Fingal was attending rounds conducted by Mister Kinnear, the senior surgeon. He stood at the foot of bed 85,
St. Stephen’s Parish Bed. Supported by annual collection.

Doctor Ellerker, the house surgeon, and the students were to one side, Sister Daly and and her nurses on the other. Charlie Greer had been sent on some errand.

Fingal noted that the patient, a middle-aged balding man with angular cheekbones but a bulbous nose, lay absolutely still. His breath came in shallow gasps. In contrast to the red stripes of his pyjama jacket his face was ashen. His left hand, which lay palm up on the blanket, was rough and calloused.

“Good morning, Mister Lynch,” Mister Kinnear said, “and how are we this morning?”

Fingal could see what an effort it was for the man to speak. “I feel like shite. I’ve got a feckin’ great rat gnawing at me belly.” His eyelids drooped and he took shallow breaths.

“I’m sorry to hear that,” Mister Kinnear said. “Give us a few minutes to talk about you, decide what to do, and we’ll soon have you right.”

“Dat’s w’at dem doctors at Doctor Steevens’ Hospital said. Fat lot of feckin’ good they done me.” He sniffed, swallowed, and burped noisily.

Mister Kinnear didn’t even blink. “Ah but,” he said, “here at Sir Patrick Dun’s we’re different. We will see you right.”

In his five months of surgery Fingal had been impressed by the confident no-nonsense approach of his surgical seniors. One consultant was known as “Fix You Friday Finlayson.” Friday was his usual operating day and his approach was consistently optimistic.

The consultant pointed at Fitzpatrick. “You admitted the patient. Give us a potted history.”

Fingal felt sorry for Ronald Hercules. He looked wretched, pale with dark bags under his eyes. He and Hilda must have had a rough night. There were six new surgical patients on the wards since yesterday.

“Yes, sir.” Fitzpatrick pinched the bridge of his nose. “Mister AL from Gordon Street is a forty-eight-year-old dock worker—”

That accounts for the calloused hands, Fingal thought.

“He was admitted at six this morning having experienced violent mid-upper abdominal pain and collapsed. He had not vomited. On examination he was pale, his temperature was ninety-seven degrees and pulse rate eighty. The most striking physical feature was board-like rigidity of the abdominal wall muscles.” He paused for breath.

Not a tricky diagnosis, Fingal thought. An ulcer either in the stomach or duodenum had perforated, releasing corrosive stomach or duodenal contents into the peritoneal cavity. That would cause intense irritation. The body’s response was to send the abdominal muscles into violent spasms.

Fitzpatrick continued, “He has a five-year history of recurrent bouts of upper abdominal pain, which comes on two hours after food. He eats biscuits at regular intervals because they relieve the pain.”

“What’s that called, O’Reilly?” Mister Kinnear asked.

“Hunger pain, sir.” When he’d first read this technical term Fingal had been struck by its apparent trviality before he’d realised it was medical shorthand for pain being relieved when hunger was assuaged. It alone was sufficient to differentiate between a gastric or duodenal ulcer. Ulcers in the stomach acted up almost immediately after the patient ate, those of the duodenum two or more hours later and were eased by eating again.

Mister Kinnear nodded, turned to Fitzpatrick. “Any prior admissions?”

“Yes, sir. Mister AL was in Doctor Steevens’ Hospital two years ago—”

“Isn’t dat w’at I’m just after telling yiz? Dey told me to ‘Eat little and often.’ Suck feckin’ chalk tablets.” He coughed and both hands sought his belly. “Shite, that stings.”

“Try not to talk,” Doctor Ellerker said. “Just lie still.”

But the patient shook his head. “Don’t have a fag. No drink. For Christ’s sake, no smoke, no drink?” His lip curled. “I might as well have joined a bunch of feckin’ monks. Doctors? They’re all a load of bollix.”

Fingal had learned that not all patients were undyingly grateful, particularly those in whom treatment had been unsuccessful. Doctors had to understand and shrug off their patients’ anger. The first time the class had encountered a belligerent sufferer they’d asked Doctor Ellerker later what should have been done. The houseman’s reply, though blasphemous, had a ring of truth. “Don’t expect all your patients to love you. The last chap everybody loved had a lousy Easter, and no doctor is Jesus Christ. We’re not God. Our job is to try to understand, and give the rude ones fools’ pardons.”

Fitzpatrick snapped, “Don’t you dare speak to Mister Kinnear like that, my good man.”

The lesson about fools’ pardons had gone unheeded, Fingal thought.

“Your good man? I’m not your man.” A fire came into Mister Lynch’s sunken eyes. “Feck off, you bollix.”

Mister Kinnear bent and said, “We do understand you are in pain, worried, upset, but please try to be polite. The young doctors and I are trying to help you.”

“Ah, Jasus Murphy.” The patient clamped both hands tightly across his belly, gritted his teeth, then said, “I’m sorry, sir, but would youse please get on wit’ it?”

“Soon, I promise,” Mister Kinnear said. “Carry on, Fitzpatrick.”

“Yes, sir. He was treated with six weeks’ bed rest in hospital. A search was made for any factors causing stress which, as we know, is the prime cause of peptic ulcers. Initial treatment was undertaken by nursing him in a quiet room, passing a nasal tube into the duodenum and instilling milk, and giving alkalis in the form of magnesium carbonate.”

“Good.” Mister Kinnear turned to Bob. “And for stress what would you recommend?”

To Fingal’s delight Bob didn’t hesitate. “Either phenobarbitone or tincture of cannabis resin, sir.”

“And cannabis’s other names. Miss Manwell?”

“Hashish or marijuana, sir.”

“We’re just beginning to understand that particular plant. It may hold promise for the future,” Mister Kinnear said, “but clearly conservative treatment has been a failure in this case.” He turned to Cromie. “Diagnosis?”

“Perforated duodenal ulcer, sir.”

“Right.” The consultant turned to the patient. “You’ve got a hole in your guts.”

The pain seemed to have taken the fight out of the man. “Mother of God,” was all he could manage.

“Treatment, Mister Beresford?”

“Surgery, sir. Laparotomy. Close the perforation with interrupted sutures. Patch it if necessary. Wash out the peritoneal cavity. Suprapubic drainage…”

Fingal’s eyes widened. He’d never heard Bob Beresford give such a comprehensive answer. Good for you, Bob.

“Intravenous dextrose/saline, and nurse in the Fowler’s sitting-up position to encourage drainage.”

Mister Kinnear smiled. “Well done, Beresford. Liking surgery, are you?”

Bob smiled. “The theory, sir, but I’m not very dextrous.”

“We can’t all be.” Mister Kinnear turned to the patient. “I’m sure you didn’t understand all that, but what it means is we’re going to operate, close the hole, and make damn sure you recover postoperatively. There is one thing my young colleague forgot to mention—”