An Irish Doctor in Love and at Sea (17 page)

Jenny said, “It was way before our time; I was only one.”

“And I was born that year,” Barry said.

“But I know about Lansteiner and Stetson,” said Jenny, glancing at Barry. “In 1940, they discovered that 83 percent of the human race shared proteins on their red blood cells with the Rhesus monkey, but that 17 percent did not. The first ones were said to be Rhesus positive and the others Rhesus negative. Now we know that a baby's blood cells can get into the mother's circulation, usually in a first pregnancy. Then in 1941—is that right, Barry? Was it just a year later…”

O'Reilly watched the two young people comparing notes and thought about 1941 and how even now, twenty-five years later, the memory of that year still clutched at his heart.

“Another doctor, Doctor Levine, found out that if a mother was Rhesus negative and the baby was Rhesus positive, there could be trouble,” Jenny continued. “The mother's immune system would recognise the proteins on the baby's red cells as foreign—just like a virus or bacteria—and set about producing antibodies that could cross back into the baby and attack its red cells.”

“But usually not in a first pregnancy,” Barry said. “It's the later ones you have to worry about. The antibodies raised in the first are at a low level. It's not until the mother is exposed to more foetal red cells in a subsequent pregnancy that she starts cranking out high levels of antibodies. Effectively, the mother is trying to kill the baby's red blood cells as if they were a dangerous invader. That causes what is now called haemolytic disease of the newborn, in all of its manifestations that you knew by highfalutin' names like
hydrops
and
kernicterus.
Fifteen of every hundred affected babies are stillborn.”

O'Reilly frowned and said, “So that's 15 percent, if they do have the incompatibility, right? But the condition itself is still pretty rare, isn't it?”

“It is,” said Barry. “They taught me that immunological differences between a mother's blood group and the baby's only occur in six of every one thousand babies born. Not surprising you've not seen a case here. It would be rare as hen's teeth in a wee place like Ballybucklebo. But in all of Ulster at least today, when it's discovered, things can be done.”

“Doctor Charley Whitfield has a major research project running at Royal Maternity,” Jenny said. “If Lorna Kearney needs to be seen there, Fingal, I can have a word with Doctor Harley, my old boss. Speed things up.”

“Grand,” said O'Reilly. “I knew I'd come to the right folks for advice.” He picked up an antenatal history form. “It's Lorna's second baby. The first, Reggie Jr., was perfectly normal a year ago, but it does say here her blood group is O Rhesus negative. She's been a bit naughty. Didn't come in for a first visit before the third month as pregnant women are supposed to. Typical busy farmer's wife. Sees her sow farrow, cows drop calves, cats have litters, and reckons there's nothing to pregnancy.”

“How far on is she?” Barry asked.

“She told Kinky she was about four and a half months.”

“Not the end of the world,” Barry said. “You'll have all her baseline information from her last pregnancy.”

O'Reilly consulted the chart. “Everything was pretty much normal. She's a young woman. Only twenty-four. Had her appendix out ten years ago. Nothing else to worry about.”

“So at this visit, Fingal, you should arrange to have Rhesus antibody levels checked, although they don't usually develop until after the end of the fifth month. That's why seeing her a bit late's not critical. The husband's blood group and details about it are important and—” Barry hesitated. “Would you like me to see her? It might be simpler.”

O'Reilly thought how turning Lorna's care over to Barry would be simpler. But damn it all, O'Reilly, you might be getting a bit older, but you're not senile yet. He sat up in his chair and looked at Barry. Some old dogs still could learn new tricks. “I'd like you to see her with me today if you've time, but no, I'd like to manage the case. I need to learn about it.”

“And,” said Jenny, “as I don't think I can offer much help now and I've a stack of paperwork to do, will you excuse me? If you need me to pull any strings, Fingal, just let me know. I'll be in the upstairs lounge.” She rose and left.

“Nothing urgent about my home visits,” Barry said.

“So be a good la—”

“And nip along to the waiting room and get her?” Barry laughed. “You said that to me the very first day I started working here.” He shook his head. “I seem to remember something about leopards and spots.”

“And Ethiopians and skin,” said O'Reilly. “Jeremiah 13:23. And isn't there a comfort to the tried and true?” His smile was beatific. “Now do please nip along—like a good lad.”

*   *   *

“You can get dressed, Lorna,” O'Reilly said. “So far everything looks great. You said your last period started on April the third. Today's October the tenth so you're twenty-six weeks and five days now, and due on January the tenth. Your blood pressure's good, uterus is the right size for the length of the pregnancy, and there's no ankle swelling.”

“And the urine sample Kinky asked you to bring's clear,” Barry said, from where he had been testing it at the sink.

“Grand,” said O'Reilly. He'd not needed to explain Barry's presence. Lorna had said she'd known all about the young man's extra training.

Lorna Kearney was a thickset young woman with close-cropped fair hair and the same kind of farmers' arms' suntan as a man might have. She had biceps to match, and O'Reilly could picture her, sleeves rolled up, swinging bales of hay with a pitchfork up into a hayloft. She sat up on the examining couch and started to tuck her shirt into the waist of her trousers. She'd taken off her Wellington boots before climbing up on the couch. There was a hole in her right knitted sock near the great toe. “Aye,” she said, fixing her unusual pale blue eyes on Fingal with an intensity that unnerved him. “And didn't I tell Kinky, Lord knows I know she means well, but didn't I tell Kinky she was making a fuss about nothing? I've work to do on the farm and Reggie Jr. to see to. I could've waited for another couple of weeks before I come here, so I could.” She slipped down off the couch.

O'Reilly glanced at Barry before saying, “Sure, all us doctors are nothing but fusspots, but it's always better to be safe than sorry. And your case is a wee bit different, Lorna.”

She finished pulling on her second boot before straightening up and saying, “Different? What way?”

O'Reilly pursed his lips. The trick was to get her to understand the potential severity of her condition without scaring the living bejasus out of her. She could be one of the ones at risk of losing her baby. “We need to make sure that you—” He had been going to say “won't hurt your baby,” but stopped short. Not smart. What expectant mother would? And the offence taken at the suggestion would be vast. He remembered Barry describing thyroid hormones to Cissie Sloan as “little thingys in the blood.” Something like that might work. “Take a pew, Lorna,” he said, indicating one of the chairs as he dropped into the swivel one. “The last time you had a baby, we noticed a thingy in your blood.”

“A thingy?” She leant forward and frowned. “What kind of a thingy?”

O'Reilly hesitated. “It's a bit tricky to explain,” he said, “but did you ever go to the zoo at Bellevue in Belfast?”

“Aye,” she said.

“And did you ever notice how alike the monkeys are to us?”

“Aye,” she said.

The taciturnity of some Ulster patients was legend.

“Well, about four out of five humans share something with monkeys…”

“Aye?” There was an upward inflection.

“And one in five, don't.”

“Aye,” she said, brightening, “and that's me and my big Reggie, so it is. We're good Christians. None of this evolution, Darwin rubbish. We don't believe in that there clap-trap that we come down from the apes.” She chuckled. “Except maybe thon Donal Donnelly. His hair's about the right shade for an orang-ootang.”

O'Reilly let that pass, but his mind was whirling. He'd not meant to open that particular debate, and if he persisted he might suddenly find his patient had gone to the Kinnegar to see Ronald Fitzpatrick for medical advice. The more fundamental Protestants took their book of Genesis very literally. “Quite,” he said, and reflexively fumbled in his jacket pocket for his pipe so he could play for time as he sought a better explanation …

Barry said, “May I, Doctor O'Reilly?”

O'Reilly nodded. He was making a right bollix of this and Barry had more experience in explaining the condition.

“Do you remember getting your vaccination for smallpox, Lorna?” It had been compulsory since 1883 for every child in Ulster.

“Aye.” Her hand rubbed her left shoulder where the vaccination would have been given.

“That was so your body's defences would recognise the germ that causes smallpox and have been prepared to attack the germ and destroy it if it ever tried to infect you again.”

Her eyes widened. “Honest to God? I never thought of it that way.”

“Sometimes,” Barry said, “the body's defences can get muddled. We know that if you are one kind of blood group and your baby is another, your defences, they're called antibodies, could mistake the baby's blood for something like a germ and attack the baby's blood cells.”

She drew back. “I never would. My wean?”

“It wouldn't be your fault, Lorna,” said O'Reilly. “You'd have no control over it.”

“That's what Doctor O'Reilly was talking about. We know your blood group is negative…”

“Negative what?” Her eyebrows knitted.

Barry smiled. “I'm sure you know that guinea pigs are used in research, and white mice.”

“Aye,” she said, “I've heard tell.”

“The doctors who specialise in this use serum from a kind of monkey called Rhesus to help identify blood groups. People are either positive or negative.”

“Boys-a-dear, isn't modern science a wonderful thing?”

“According to your records, you are Rhesus negative, but if your husband Reggie is positive, the baby might be too and—”

She pointed a finger at Barry and said, “And them antibody thingys you were talking about could make my baby sick?”

Not all country folks, O'Reilly thought, to maintain the country idiom, were as green as they were cabbage-looking. Barry's explanation had been lucid, and certainly Lorna had been very quick on the uptake.

“That's right,” Barry said, “but we'll not know for sure. We need to do some blood tests for you.”

“Sure, that's wee buns.”

“And it would help to get your husband's blood group established.”

“I'll see til that, so I will.”

“So,” Barry said, “I'll save Doctor O'Reilly the trouble and fill in the forms, and you and Reggie can get the samples taken in Bangor Hospital.”

Good man, O'Reilly thought, because I'm not entirely sure what tests to ask for.

“You get the tests done tomorrow, and I believe Doctor O'Reilly would like to see you back here in two weeks for your next checkup and to get the results. Now hang on a jiff while I fill these things in.” Barry worked fast, ticking boxes and writing in the patient's name and age. “Here,” he said, handing them over, “your forms.”

She tucked them into her handbag.

O'Reilly said, “So you trot on home, Lorna, do as Doctor Laverty has told you, and come back…” He consulted a calendar. “… on the twenty-fourth to get the results.”

“We will, Doctor, and thank you.” She shook her head at O'Reilly. “You near put my heart in my mouth, sir, saying them things about monkeys. But young Doctor Laverty explained it all right lovely, so he did. I'll be running along and I'll see you in two weeks.” She hesitated on her way to the door and said, “With all that talk about monkeys and yokes in my blood, I near forgot. Reggie telt me til tell you, Doctor O'Reilly, that you know that bit of bottom wet land with all the rushes?”

“I do.”

“The snipe's in something lovely this year and there might be a few pheasants too. Off the marquis's estate, like, so if you'd like for to bring Arthur and your gun? I know you don't shoot, Doctor Laverty.”

Barry laughed and said, “I used to be a sailor. Still am when I can get a bit of time off.” He looked straight at O'Reilly.

“Thank you, Lorna,” said O'Reilly. “That's very kind.” He peered over his half-moons at Barry. Two can play the innuendo game. “If I can get away, I certainly will.” Not only would he enjoy the sport, but if Lorna was willing to let him shoot on their land, he could be assured that no offence had been taken today. Nor would have Barry, who enjoyed a bit of mutual teasing as much as his senior partner.

Barry rose and held the door for her.

“Thank you, Barry,” O'Reilly said after the door had been closed. “That was nice about the snipe shooting. I'll look forward to that, but what a silly girl. Leaving it so late for her first antenatal visit. Still, there's no point yelling at her. What's done is done and it looks like it's so far so good except for the Rhesus business. You saved my bacon on explaining that one.”

Barry laughed. “In darkest County Antrim, the folks of Ballymena are just as much creationists as the County Down people. You soon learn how to skate round it when you have to talk about Rhesus monkeys. More to the point, we have to figure out what to do when her results come back.”

“Go on,” said O'Reilly. “I'm listening.”

“It's all going to depend on her husband's blood group. If he's Rhesus negative then there's nothing to worry about. The baby will be too. But if Reggie's positive then I'll have to work out the likelihood that the baby might be Rhesus positive and affected. It's a bit complicated, so in your own immortal words, ‘We'll cross that bridge when we come to it.' I also asked for an antibody level. It's called a titre. It's unlikely to be up so early. We start looking for them again at about thirty-two weeks if the hubby's group seems to pose a risk. Where we go next, if we have to, will depend on those results.”