A Dublin Student Doctor (8 page)

Fingal peered up and read,
Nosocomium Patr. Dun. Eq. Aurat. MDCCCXIV.
In full he knew it would be
“Nosocomium Patricii Dun Equitis Aurati”
and the date.

To Fingal’s delight, Doctor Micks avoided Fitzpatrick and pointed at Charlie, who manfully translated, “The Hospital of Sir Patrick Dun, Knight, 1814.”

“Well done, young Greer. That’s the year this part of the building was completed, before it was opened, two years later.” He removed his spectacles, polished, and replaced them. “But we must not dwell on the past,” he said, “I want to bring you up to date with more recent developments.”

Fingal leant forward.

“Since the original two wings on each side of this arch were built, one for men and one for women, Sir Patrick’s has expanded. The upper floor of the east wing to my left became, and still is, a fever ward with twenty-six beds and a separate entrance. New operating rooms were built in 1898 and replaced in 1916.”

The year of the Easter Rising, Fingal thought, and he knew that wounded rebels and British soldiers were treated here during the battle at the nearby Mount Street Bridge, which spanned the Grand Canal. One of the leaders had eventually come to Sir Patrick’s and asked to be taken to British headquarters to arrange the surrender of the rebels.

Doctor Micks continued, “Those operating rooms were replaced again in 1924, this time in the rear of the building. There are student rooms when you are living in the hospital for the required periods of residence.”

Fingal was looking forward to that. Every month spent practically
gratis
in the hospital was a saving of rent money.

Doctor Micks continued, “That structure in front of the east wing is the outpatients’ department.” He smiled. “It was opened last year. Thirty thousand patients a year are seen there, so you’ll have plenty of opportunities to learn. And there is a home for student nurses on Lower Mount Street.”

Fingal saw Charlie’s grin. Perhaps Doctor Micks had seen it too. He continued, “The lady superintendent, Miss Northey, keeps a very close eye on her young ladies, so be warned.”

Charlie’s eyes narrowed. Fingal could almost hear him plotting how to bamboozle the redoubtable Miss Northey. Trust Charlie.

“The X-ray department is getting overstretched so the Board of Governors is applying for money from the Irish Hospitals Sweepstakes Fund for a new one. The massage department is next door to the lecture theatre, in which I’m sure, Mister Greer, you’ll enjoy the weekly compulsory lectures delivered in Latin.”

Charlie groaned.

“Now,” said Doctor Micks, “that’s enough about the place, unless there are questions?”

Fitzpatrick held up his hand.

“Yes, Mister Fitzpatrick?”

“Is it true, sir, that there’s a memorial in the front hall, a brass table engraved with the names of the thirty staff and students of Sir Patrick’s who fell in the Great War?”

“It is,” Doctor Micks said.

Fingal shook his head. And it’s true about you, Fitzpatrick. You’re one of those people who only ever ask a question if they already know the answer.

“So,” said Doctor Micks. “No more questions?”

Silence.

“Right. Follow me and we’ll go and make ward rounds. Doctor Pilkington, the house physician, will be joining us.”

Fingal trooped after the rest, through the front doors, past the War Memorial, and to the right of the splendidly named Grand Staircase.

“This,” said Doctor Micks, holding open a door, “is Saint Patrick’s Ward.”

Fingal’s nose was assailed by hospital smells. A low continuous moaning came from behind screens around a bed halfway up. Elsewhere someone was snoring, deeply and rhythmically. Nurses, their voices low and soothing, went about their duties.

Inside the door, a young man in a long white coat waited. Two student nurses, a staff nurse, and the ward sister accompanied him. She wore a neck-to-ankle white apron over a floor-length blue dress. A white starched fall, a headdress that was bound across her forehead below the hairline, drooped in folds at the back and sides like the head adornments of a pharaoh.

“Good morning, Doctor Pilkington, Sister Daly, ladies,” Doctor Micks said.

The nurses bobbed, Doctor Pilkington said, “Good morning, sir,” as did Sister Daly. Her accent was pure County Cork. She smiled, then her green-eyed gaze fell for a moment on the six students. She might, Fingal thought, be inspecting something she’d found on the sole of her shoe that wasn’t to her liking. “Everything’s ready. Shall we start?” she asked.

“Please.”

Fingal looked around as he followed the entourage. He noticed that the walls were painted black. Someone called Nathaniel Hone had been resposible for the colour scheme, apparently believing that walls so coloured were easier to keep clean. High arched windows provided a great deal of light, and on good days were opened to admit fresh air. Light and air, it was believed, were two things critical to patients’ recovery. In the children’s ward, that recovery was helped along with liberal helpings of Bird’s custard.

Along each side, beds were arranged with military precision, heads to the wall, feet to the central walkway. Every bed had a cane-backed chair at its foot and the case notes clipped to the bed-head. The twenty-five beds to each side were all occupied by men, some recovering from operations, others with medical conditions that did not require surgery.

Fingal recognised the painting hanging over a fireplace, a scene depicting Saint Patrick preaching to Oisín, a warrior from Irish mythology.

They arrived at a bed inside an oxygen tent. As the group arranged itself on either side of the foot of the bed, doctors to the right, nurses to the left, Fingal noticed a plaque on the wall.
OTC COMMEMORATION BED
.
Endowed by citizens of Dublin in recognition of the gallant defence of Trinity College. Easter 1916.
Dublin’s history was never far away.

Through a wide celluloid window in the canvas Fingal could make out a man of about thirty propped up on pillows. The inflowing oxygen hissed and a fan whirred extracting carbon dioxide. Sister nodded to a student nurse who opened the zipper that gave access to the bed, and folded the material back. The man’s cheeks were dusky, his breathing jerky and shallow, his head was turned to one side, and his eyes were closed. The jugular vein, running from his collarbone to the angle of his jaw, was distended.

The staff nurse handed Doctor Pilkington a chart. He glanced at it then started to give the patient’s history. “The patient, Mister KD, aged twenty-nine, of Ash Street in the Liberties, was admitted last night complaining of weakness, shortness of breath, coughing and haemoptysis—”

Fingal had begun learning the language of medicine early. Patients were never referred to by name when they were being discussed. Only their initials. If a case were to be talked about in a public place, there could be no breach of confidentiality. Haemoptysis was spitting blood, as opposed to haematemesis, vomiting blood.

“He had no other symptoms. A diagnosis of acute rheumatic fever was made five years ago when he was treated in Doctor Steevens’ Hospital with bed rest, fresh air, and acetylsalycilic acid at a dose of two hundred and forty grains daily—”

“Aspirin,” Doctor Micks added. “First introduced by MacLagan of Edinburgh in 1874 to treat rheumatic fever—”

Fitzpatrick interrupted, “But your book, sir, says it has now been proved that salicylates exercise no specific action in rheumatic heart disease.” His grin was oily. “And you recommend only thirty grains daily for relief of symptoms.”

Fingal looked at Cromie and crossed his eyes.

Doctor Micks inclined his head. “Thank you, Mister Fitzpatrick. Please carry on, Doctor Pilkington.”

“He has been admitted on several occasions with congestive heart failure as a consequence of mitral stenosis and aortic incompetence.”

Doctor Micks turned to Fingal. “Mister O’Reilly, what is rheumatic fever?”

“An infection with the bacterium beta-haemolytic
Streptococcus.
Given where Mister KD lives, a damp, filthy, tenement—”

Doctor Micks sighed. “Mister O’Reilly, we physicians cannot solve the difficulties of the whole world. Just tell me about the disease.”

Fingal looked at the bed. That was a human being lying there, not just a disease, but he swallowed and continued, “The infection damages the heart valves. The mitral valve is narrowed so it’s difficult for blood to get into the left ventricle—”

“Which is?” Micks asked Bob.

“The lower chamber of the left side of the heart that is responsible for pumping blood around the body, sir.”

“Good. And aortic incompetence, Greer?”

“There’s a valve between the aorta and the left ventricle. When the ventricle finishes pumping, the aorta contracts to boost the blood along and the valve shuts to prevent backflow. But—”

“But if the valve is damaged,” Fitzpatrick leapt in, “blood goes back into the ventricle, the blood gets dammed in the system, pools in the lungs, and causes congestive heart failure—”

“Indeed.” Doctor Micks cut him off and spoke again to O’Reilly. “And how is the diagnosis of valvular disease made?”

“From the previous history of rheumatic fever and by hearing the classic murmurs, sir.” O’Reilly tugged out his stethoscope.

“Now,” said Doctor Micks, “you’ve got your stethoscope out, O’Reilly, have a listen to his chest. Tell us what you hear.” He nodded and said, “Sister, please.”

Sister Daly said, “Nurse Kelly. Nurse O’Hallorhan. Please sit the patient forward.”

A second student nurse joined the first. Together they bent over Mister KD and with their arms supporting his shoulders bent the man at his waist. The one on O’Reilly’s side unbuttoned the pyjama jacket.

“Please, only describe the murmurs, O’Reilly,” Doctor Micks said.

O’Reilly looked at the man’s narrow, sallow face, at how he gasped for breath, at the fear in his sunken blue eyes. “You don’t mind if I examine you?” he asked.

The man weakly shook his head.

“Get on with it, O’Reilly,” Fitzpatrick hissed. “Don’t waste time.”

Fingal ignored Fitzpatrick. “Don’t be frightened,” he said to the patient. “I’m not going to hurt you.” He plugged his stethoscope into his ears, placed the bell below the man’s left nipple over the heart, and strained to make sense of what he was hearing. A fifteen-second glance at his watch told Fingal the heart rate was regular and ninety beats per minute. Superimposed on the heart’s
lup-dup, lup-dup
beats was a bewildering series of clicks and whooshes. He knew he was meant to relate them to the lups and dups, but for the life of him could not. He looked up. “I’m not sure, sir.”

“You’re an honest man, O’Reilly. Very few people can at the first attempt. It takes practice. We’ll make sure you get plenty.”

Fitzpatrick, without waiting to be asked, provided a comprehensive description of what should be heard, larding his discussion with terms like opening snaps, diastolic murmurs with presystolic accentuation, and aortic diastolic murmurs.

“Very good, Mister Fitzpatrick. Have you by any chance got your eye on the prize for medicine?”

Fitzpatrick nodded.

Have you, by God? O’Reilly thought, made a mental note and glanced at Charlie, who slowly shook his head. There can be, Fingal thought, many a slip betwixt cup and lip.

“Treatment for congestive heart failure, O’Reilly?”

“Bed rest sitting up, oxygen, no-salt diet, small amounts of aspirin—”

“And the drug of choice is, Beresford?”

Bob shook his head. “Sorry, sir.”

“Digitalis, sir,” Fitzpatrick said. “Its active principle is the glucoside digitoxin, described in your chapter sixteen, sir.”

God, O’Reilly thought, that man could give Dickens’s Uriah Heep advanced classes in obsequiousness.

Doctor Pilkington said, “We gave him a loading dose of six ccs of tincture of digitalis on admission, sir, and he seems to be responding well. We have him on two ccs every six hours.”

“Good,” said Doctor Micks. He turned and for the first time spoke to the patient. “You’re doing fine,” he said.

Mister KD managed a weak smile.

“Now come out of the tent, please, and zip it up.”

Fingal stepped aside and when the student nurse at the far side moved toward him, Fingal Flahertie O’Reilly found himself looking into a pair of grey eyes, eyes which had amber flecks in the irises.

When everyone was back in their place, Fingal closed the zipper of the oxygen tent. He tried to pay attention as Doctor Micks explained the classic murmurs associated with various kinds of heart valve disease, but his gaze kept straying to the face of the grey-eyed nurse. And when she caught him looking at her, she smiled. Fingal knew he should be listening to Doctor Micks, feeling sympathy for the young man in the bed. But those eyes.

There’d been a couple of other girls since Finnoula Branagh back in March. Fingal enjoyed the company of women, but he had no intention of starting anything serious until he was qualified. Nevertheless, come hell, high water, or the protective maternal instincts of the ward sister, he was going to get Grey Eyes’s name.

8

City of the Soul

“Doctor O’Reilly?” Gupta was standing over him, his face grave. “I’m sorry to disturb you, but I knew you’d want to know. Your patient has got a fracture of the temporal bone.”

It took a moment for O’Reilly to realize he was sitting at the ward 21 nurses’ desk of Belfast’s Royal Victoria Hospital, his tea cold, his heart still warmed by the memory of his first glimpse of Nurse O’Hallorhan’s grey eyes.

“Clinically he’s worsened. The bruise over his temporal bone is getting bigger. The ultrasound now shows an obvious shift in the
falx cerebri,
the connective tissue separating the two halves of the brain.”

“Extradural haematoma?” O’Reilly asked, sitting up in his chair and giving himself a shake. There was blood between Donal’s skull and the tough outer membrane, the dura mater, that surrounded his brain. Blast.

“I’m afraid so. I’ve sent Mister Donnelly straight to the operating theatre. I’ll do a burr hole to release the pressure and let the blood out. Time counts,” Gupta said.