A Dublin Student Doctor (48 page)

“A Mister Fitzpatrick.” She curled her lip. “Here I was, just like I am with you, sir, and he told me I was a thick, stupid, bog-trotting woman. Just because I still have my Cork accent, so even if I have lived in the Liberties for the last thirty years. He told me to get a bloody move on. He hadn’t all day to waste on an eejit. A very important and grumpy young man was Mister Fitzpatrick, bye.”

Fingal could sympathise with Fitzpatrick, but there had been no need to be rude, not to an apparently simple woman who was doing her best. Fingal looked down at Eithne Flynn and then to the incomplete chart that he should have half-filled in by now. Hold on. Hadn’t Bob said Fitzpatrick’s midder case was one of thyroid disease? Some patients were used more than once in the exams and students didn’t think it cheating to discuss what they had seen as long as they didn’t identify the specific patient. Was this a bit of divine intervention? An unexpected clue to a working diagnosis?

She patted his hand and said, “And what’s funny is that I was teasing him. I was
teasing
him. I’ve been a ‘case’ for exams before. I know you youngsters only have twenty minutes. He’d have got it all from me in jig time if he’d been nice like you. He still got the answers, but I made the
amadán
work for them and I thought if all you students were as bad as him, bye, I’d have a bit of fun with the next one too. And that’s yourself. I reckoned I’d put the heart sideways into you and I did, didn’t I?”

“I was terrified,” Fingal said. “Really planking it.”

“Well, don’t you worry your head. First off. I’ve had twenty pregnancies, twenty-one if you count this one, but,” and she smiled, “the Lord above was good to me. I’d one, then He took fourteen to Him before I was three months gone.”

Fourteen miscarriages. And the Irish Free State had outlawed contraception in 1935? Fingal shook his head. Why the hell should any woman be treated like a brood mare?

“It was a clever doctor at Sir Patrick Dun’s found out my thyroid was out of kilter and treated me. I’d five more after that. I can tell you about all my six babbies in a flash and about all else like the thyroid that ails me.”

And she did. She was a walking textbook when it came to her condition. Fingal finished with five minutes to spare.

“Mrs. Eithne Flynn,” Fingal said, as he made a final note, “if I wasn’t in love already and you weren’t wed, I’d fall for you, head over heels. Thank you.”

“Go way out of that,” she said, and grinned. “Now you tell the professor what you know about me and you’ll be bound to pass, so.”

47

Vaulting Ambition, Which O’erleaps Itself

Fingal waited on the footpath, collar turned to a persistent morning drizzle. A lorry with
O’CONNOR AND SONS. FISHMONGERS TO THE QUALITY
painted on its canvas sides turned off Grand Canal Street. Its solid rubber tyres rattled through the gateway of Sir Patrick Dun’s. Abstaining from red meat on Fridays had been demanded by Saint Paul in his Epistle to the Corinthians. Failing to do so had been decreed to be a mortal sin by Pope Nicholas I in the ninth century. The hospital’s kitchen would need fresh supplies today to prepare meals for Catholic patients.

Fingal followed the vehicle into the courtyard, skirted the outpatients building, then stopped and looked up at the inscription beneath the clock over the entrance.
Nosocomium Patr. Dun. Eq. MDCCCXIV.
It didn’t seem nearly two years since Charlie had been asked to translate the Latin by Doctor Micks.

Fingal climbed the front steps. As ever, like the ones to Dublin’s churches, the heavy double doors were wide open to admit those in need. He passed the brass war memorial table and skirted the Grand Staircase. Old friends now.

He headed to the ward. He had one last patient to examine there, then he’d be grilled by two examiners. The medicine oral was this afternoon and that was it. The results would be anounced sometime after five o’clock. He’d know his fate and that of his friends within ten hours. Six hundred minutes. Fingal took a deep breath. The last lap of five years’ study, he hoped. Tonight he would be Doctor O’Reilly. He corrected himself. Could be. It wasn’t a sure thing. In two more weeks he could be attending convocation for the conferring of his degree, watched, he prayed, by Father and Ma.

Five weeks ago the old man had said, “Fingal, I was in error. Utterly and completely,” and had hugged his son, an act Fingal could but barely remember from nursery days. Thank you, Father. Thank you. It had been at that moment that Fingal had realised his father had not been the only stiff-necked one. He smiled. Perhaps, like blood groups, stubbornness ran in families?

As he turned onto Saint Patrick’s Ward, he tried to close his mind to everything other than the task ahead.

“Morning, Sister Daly,” he said, craning past her to read a list of this morning’s candidates on her desk. He was first, Fitzpatrick was to be shortly after. Hilda would be examined here at ten.

“Bed 51, Fingal,” Sister Daly said. “Mister OG. And good luck, bye.” She smiled and touched his arm lightly. A change from the stern woman who eighteen months ago had held his certificate of good standing in the palm of her hand.

“Thanks, Sister.”

The black-painted walls were as familiar as the flocked wallpaper in his bedroom on Lansdowne Road. In the picture over the fireplace, Saint Patrick preached on to Ossian. The floor creaked as it had always done when he passed bed 79, “The OTC Commemoration Bed,” where the condition of a young man with rheumatic valvular disease, a man called Kevin Doherty, had deteriorated badly and Fingal at the start of his clinical training had overstepped his authority and prescribed quinidine to stop Kevin’s atrial fibrillation. The drug had worked. That time. If there is a Heaven, Fingal thought, I hope you’re there, Kevin Doherty.

Bed 51, named for Colonel Tench Gascoigne, had its memories too. Of a one-armed, ex-REME sergeant. “You mean they’re going to stick a feckin’ great needle into me back?” the feisty little man had said before Fingal had tapped his first pleural effusion. Paddy Keogh, now out of the Liberties tenements and living in a decent flat and working as foreman on a building site. Well done, Paddy.

This place is full of ghosts, Fingal thought, of Doctor Micks, the deputy professor of materia medica and therapeutics saying, “I won’t put you on probation—this time, but one more lapse.” And Geoff Pilkington, the houseman, saying, “Don’t take it personally. We can’t save them all.” True, Geoff. We can’t.

Fingal knew he had to stifle the memories and concentrate on the case. It and the oral this afternoon were the final hurdles. Bob had described them last night like fences thirteen and fourteen in the famous British Grand National horse race. A lot of tired horses fell at number fourteen every year.

He opened the screens, glanced at the bedside table, and remembered one more ghost. A grey-eyed nurse named Caitlin O’Hallorhan who’d washed all the old men’s false teeth at once and had told him he’d a quare brass neck for singing “Kitty My Love Will You Marry Me?” as he’d helped her wash the dentures.

“Good morning.” The man who lay on the bed was in his midthirties with thinning sandy hair and had a scar running from the corner of his left eye to his chin. The swelling at the base of his throat was obvious, and had been when Fingal had last seen the patient at medical outpatients. Not once, but twice.

Mister? Mister OG. Fingal had to dig into his memory. Oliver Gourley. “Good morning, Mr. Gourley.” The man from Boyle, far from the sea, had a colloid goitre, an enlargement of the thyroid caused by iodine deficiency. It was often seen in people from the midlands of Ireland who ate pike or trout, but rarely bothered with sea fish, the prime source of iodine. “How are
ye,
sir—” The emphasis on the “ye” gave away his County Roscommon origin. “Nice to see ye again. Here for your exam?”

“Supposed to be.” After Fingal had last examined the man, treatment had been started with thyroid extract and small doses of sodium iodide. “Did the treatment we gave you work?” Fingal asked.

The man shook his head. “Nah. ’Bout as much use as a lighthouse in a peat bog. Me lump’s bigger than ever.”

He was an ideal examination “case” with a clear history and obvious clinical findings. The thyroid disorder and his war wound would give a well-prepared candidate plenty to impress the examiners with.

This was a gift. Fingal knew everything about the patient, but it wasn’t right. Presenting this case would be the same as answering a written question with the textbook open on your knee. “Excuse me,” he said, “I have to talk to Sister.”

He fled back to her desk. “Sister Daly, I need your help.”

“My help?” She drew herself up and said, “You know perfectly well I’m not allowed to give hints to any candidate, Mister O’Reilly. I’m shocked you of all people would ask, so.”

He shook his head rapidly. “No, Sister. No. Not that kind of help. It’s Mister Gourley. I know the man. I saw him at outpatients. I know exactly what’s wrong with him. Exactly what treatment he’s had.”

“Did you indeed, bye?” Her glare disappeared and she smiled. “You’re an honest man, Fingal O’Reilly.” She consulted the list. “The next candidate’ll be here any minute, but go you to bed 52. I’ll give Mister Fitzpatrick your case when he arrives. You can have his.”

That, thought Fingal, would really give Bob Beresford’s odds-calling abilities a run for their money. Fitzpatrick was going to see yet another case of thyroid disease. The gold medal was his. No question about it. Damnation. Fingal had been speculating about coming up with a way to upset Fitzpatrick’s applecart. Instead he was handing him the prize on a plate. It couldn’t be helped, and Fingal needed to get a move on. He’d already wasted five of his precious twenty minutes. “Thanks, Sister.” He spun to go.

“Take your time, Fingal,” she said. “We always tell the student nurses, only ever run in a hospital for a fire,” she winked, “or a really good-looking man.”

Fingal stopped and stared at her. Sister Daly had said that, and winked?

“I’ll explain to the examiners why you’re held up. Ask them to test Fitzpatrick first. Give you a bit of extra time.”

“Bless you, Sister Daly,” he said.

“Go on, Fingal. I always thought you were a sound man. Now I know it. From now on, except in front of the patients or Doctor Micks, it’s not Sister. It’s Mary.”

“Thanks.” Fingal grinned at her, and feeling a confidence he hadn’t earlier, set off for bed 52.

*   *   *

“Mister McLoughlin, you’ve been wonderful.” Fingal pulled his stethoscope from his ears and started to put it in his pocket.

The ginger-haired man with the high forehead and the dusky-hued cheeks said, “Ah, sure I hope yiz does well, young fellah. It’ll be scary for yiz. All dem highheejins askin’ questions. I’d be feckin’ brickin’ it if I was youse.”

“I’m nervous all right,” said Fingal, missing his pocket and dropping his stethoscope. He bent to pick it up and straightened. “But I’ll be fine, I’m sure. You gave me your history perfectly. I’ve heard your murmurs. I know what’s wrong. You have mitral stenosis.”

Back in ’35, Ronald Hercules Fitzpatrick had been asked to report on a similar case the day the Pilgrims had visited here at Sir Patrick’s to, among other things, give their blessing to the latest crop of fourth-year medical students. He’d been unable to hear the murmurs because Fingal and the lads had stuffed cotton wool in his stethoscope.

Hilda had stepped into the breach and described the symptoms perfectly. Funny, Fingal thought, how such an inconsequential event as a practical joke could fix a piece of information in a student’s mind. Ronald Hercules, the butt of the joke, would certainly have remembered the nature of the murmurs he should have heard. If he had been given this case as originally intended, he’d probably have aced it too and won the bloody medal just as easily.

Fingal glanced at his watch. He’d taken only fifteen minutes, but he was confident he had made the correct diagnosis. He knew about the treatment for valvular disease, had done ever since he’d first met Kevin Doherty. Some patients, some diagnoses, would be indelibly inscribed in his memory. In five minutes the examiners would come in from outside the screens and grill him, asking him to demonstrate the clinical findings. The high cheek colour, the classic cardiac murmurs. They’d ask about treatment and what to do if heart failure supervened. Fingal could take them through that like a skilled navigating officer through charted seas, right up to the use of multiple punctures for severe leg swelling and the future hope for Red Prontosil as a curative of the original infection.

He’d been hearing conversation coming from the screened bed next door, number 51, for some time but had paid no attention. Now he was free to listen. Fingal didn’t recognise two of the voices. They must be examiners, doctors he didn’t know, but Fitzpatrick’s high-pitched rasp was unmistakable.

“A very straightforward case. Simple goitre, treated correctly with thyroid extract and sodium iodide. The goitre is easy to see and as I am demonstrating, by deep palpation—”

Fingal heard the patient’s voice. “Jasus, sir, go easy. That hurts.”

“Be quiet. Strong palpation is required to delineate the regularity of the margins.”

“A little more gently, please,” an examiner said, “but otherwise carry on. You’re doing well.”

Even through the screens, Fingal could hear the smugness of Fitzpatrick’s tones.

“Because the treatment has failed, the next step will be to transfer the patient to the care of a surgeon for a subtotal thyroidectomy despite its attendant risks of damage to the parathyroid glands and the recurrent laryngeal nerve.”

Fingal shook his head. Would the man never learn tact? He clearly had to show the examiners what a genius he was.

“You seem to know a very great deal about the thyroid, Mister Fitzpatrick.”

“I try, sir. I know you have a special interest in the disease. I read your paper in
The Lancet
last year. I thought your suggestion extremely cogent that we should stop using local anesthesia for surgery if the gland is well prepared preoperatively.”