Fingal O'Reilly, Irish Doctor (33 page)

Fingal peered through the windscreen that the wiper struggled to keep clear. To his left was Saint Patrick’s, a medieval Anglican cathedral built between 1200 and 1270. To Fingal the great architecturally ornate house of God, with its precious communion plate, lavish candelabra, lecterns, altar screens, rich vestments, and easy living for the clergy, stood like some rich dowager while the tenements of the Liberties clung round her skirts like so many begging children.

Phelim pulled over and parked at the kerb. “Out.” He reached for his bag from the back.

Fingal dismounted and, with his collar turned to the rain, followed, off the street and into a passageway between houses. Their redbrick façades were crumbling. Window sashes needed painting, but on every sill bright flowers grew in window boxes. Inside a half-open window, a linnet in a cage trilled despite the downpour, its red, feathered breast swelling as it sang. Underfoot, dark water overflowed from a single shallow gutter running along one side of the cobbles. It was dammed by the corpse of a cat.

The stink was overpowering but did not come as a shock to Fingal. Three months of working here had inured him to the worst smells the slums could offer, if not to the living conditions of the folks who had no choice but to exist here.

Doctor Corrigan entered a hall and knocked on a shabby door.

The place reeked of human and cats’ piss, damp, and stale cigarette smoke. The acrid fumes of the disinfectant Jeyes Fluid, known locally as “Jasus’s fluid” hung over all. Someone had tried to hide the permanent stench by sprinkling the stuff in the hall and on the staircase.

The door was opened by a short, grey-haired woman in an ankle-length skirt. She hugged a shawl around her upper body. “Doctor Corrigan, sir. T’ank you for coming. It was the Big Fellah there I spoke to this morning.” She looked to Fingal and then back to Corrigan and frowned. “Do you think Dermot needs two doctors to attend to him? Is he dat sick?”

“Not at all,” Fingal said. “I’m new at this, and I’ve never seen a stone bruise. Doctor Corrigan’s come to teach me so I’ll know what to do with the next one.”

She smiled at him, put a hand on her hip. “I’ll tell you a t’ing, Big Fellah, you’re as honest as a feckin’ priest admitting you’ve more to learn. I like it.”

He bowed his head.

“Come in. I have Dermot ready for youse til see.” She led them into a single room lit only by light from a cracked but spotlessly clean window, the rays of a paraffin lamp on a mantel, and the guttering flames of a turf fire burning in an open grate. Turf, at two pence for a dozen sods, was cheaper than coal. Fingal had to wait for his eyes to adjust. Plain wooden table, two chairs, one end curtained off with a blanket, from behind which came loud snoring.

Fingal wondered who was sleeping there but knew it wasn’t the patient. He was lying on an old overcoat in front of a fire where cabbage leaves and potato skins burned at the back of the grate. The people of the tenements believed that burning them helped keep diseases away. He wished it did, but clean drinking water and proper sewage would keep them away a hell of a lot more effectively.

“Now Dermot,” Mrs. Finucane said, “dese are nice doctor men come til look at your foot.”

Doctor Corrigan crouched on his hunkers and Fingal followed suit.

“Hello, Dermot,” said Doctor Corrigan. “How are ye?”

The lad, who looked to Fingal to be about fourteen, sniffed, wiping his nose with his shirt sleeve. “Me foot’s feckin’ killing me. It hurts like bedamned. I’ve a stone bruise the size of County Wicklow.”

“I’m sorry,” Doctor Corrigan said, clearly paying no attention to the child’s language.

“Not as sorry as me. It’s not your feckin’ foot.”

“Dermot.” Mrs. Finucane stood over her son. “Be polite to the nice doctor men. They’re only here til help.”

“My da was going to let it go last night.”

“That means drain it,” Doctor Corrigan said to Fingal.

“But,” said Mrs. Finucane, “he’d won money at pitch and toss and he came home mouldy maggotty drunk. Eejit. It’s not like my ‘Minty.’” She must have seen Fingal’s quizzical look. “Jasus,” she said, “we’re great ones for the nicknames in the Liberties. There’s a ‘Rashers’ upstairs and ‘Duckegg’ Brennan across the hall’s married to ‘Skylark,’ her w’at works wi’t me at Clery’s. My oul wan was christened Cathal, but if you asked for Cathal Finucane round here nobody’d know who the blazes you were talking about. He got ‘Minty’ because when he was a chissler he was always feckin’ peppermints from sweetie shops. The name stuck.”

“I see,” Fingal said.

“And he’s not usually much of a one for the gargle, but…” She shrugged and gave a wry smile. “Och, sure, once in a rare while he gets scuttered, and sure wat’s wrong wit dat? He couldn’t have bitten his own finger never mind let Dermot’s bruise out last night. Mind you when Minty went out he didn’t know the lad was afflicted.” She grunted. “Dat’s the snores of himself behind the curtain. The bowsey…” And yet Fingal heard affection. “When dat one wakes up he’ll be in an advanced state of decomposition.” She shrugged. “A bloody great hangover’ll remind him dat once in a while I’ll forgive him, and I will, but not to make a habit of it.” There was a trace of steel in her last sentence.

Fingal hid a smile.

“So ye came for one of us?” Doctor Corrigan said, and stood. Fingal stayed hunkered down.

“Yes, sir. I’m sorry to have to trouble youse, but the poor wee lad’s pain’s been getting worser. It’s not right. He needs help.”

“And that’s why we’re here.” Doctor Corrigan turned back to Dermot. “That’s why we’re here, son.”

32

I Hear It in the Deep Heart’s Core

Jenny stopped in the middle of the hallway, forcing O’Reilly to do likewise, and, in the process, to stop speculating about Kinky’s marital prospects. “It’s not another ‘I won’t see a lady doctor’ difficulty, is it?”

“No.” She shook her head. “Nothing like that. The patient has a heart murmur, and—” She grimaced and said, “My sense of rhythm has always been terrible. I’m never entirely sure what I’m hearing. I’m very lucky my internal medicine case in finals didn’t have a murmur.”

Even twenty-nine years later, O’Reilly could clearly see himself on a ward beside a bed, inwardly trembling, and presenting his findings about a case to two examiners as part of the final hurdle that stood between him and his dream of qualifying as a physician. Being bombed by German Stukas off Crete in 1941 had not been as terrifying as being examined. The same thought had struck him back then as the gull-winged aircraft hurtled down, dive sirens screaming. Taking a direct hit by a bomb was quick and the outcome sure. The finals examination had gone on for three weeks with every nerve screwed up day to day with no guarantee of the outcome whatsoever. He shuddered.

She stood aside, but he indicated that she should precede him into the surgery.

He followed and closed the door behind him. A fair-haired young man, quite unknown to O’Reilly, lay on the examining couch. The patient was stripped to the waist. The room’s central heating was off and it was chilly, but it didn’t seem to faze the patient. He certainly was not shivering. O’Reilly immediately noticed ruddy cheeks, pallid chest, but deeply tanned forearms and the brown sunburned vee at the top of the man’s chest where his shirt would have been left open. Farming? Fishing?

“This is Doctor O’Reilly,” Jenny said.

“Pleased til meet you, sir,” the patient said. “I’m Hall Campbell, I’ve just moved here from Ardglass.”

“Fisherman?” O’Reilly asked.

“That’s right, sir. How did you know?”

O’Reilly chuckled. “What do most men from Ardglass, famous for its herrings, do? And you’ve an open-airman’s tan and,” he said, walking to the radiator and turning a knurled iron wheel to the “on” position to the accompaniment of a series of clangs and gurgles, “you’re not bothered by the cold. And neither, it seems, is my colleague.”

Jenny gave O’Reilly a wry smile and mouthed “thank you.”

“Boys-a-boys,” the man said. “Is your Christian name Sherlock? I love them detective stories, so I do.
The Speckled Band
was wheeker and see that there
Hound of the Baskervilles
? Absolutely dead on, so it was.”

“It’s what they teach you at medical school; to be observant and make deductions,” O’Reilly said. “Conan Doyle was a doctor and patterned the great detective on one of his teachers—”

“Doctor Joseph Bell of Edinburgh,” Jenny said quietly.

“See,” O’Reilly said, giving her a smile, “Doctor Bradley doesn’t only know her stuff as a doctor.”

“She was quare and nice til me, so she was, and dead honest too. Said I’d a heart murmur, but she couldn’t make head nor tail of it and was going to get a second opinion.” He frowned. “Is a murmur bad, sir?”

O’Reilly said, feeling reasonably confident, “Not necessarily. You look pretty fit to me.” Most heart murmurs, caused because the valves were damaged, or the heart or great vessels, the aorta and the pulmonary artery, had been deformed since birth, led to some degree of heart failure. Patients with the condition were, among other signs, usually short of breath and had blue, cyanosed cheeks and lips. “Just let Doctor Bradley tell me your history and then I’ll take a look at you, and try to answer your questions.”

“Fire away,” Hall said.

“Mister Campbell used to crew on a herring boat out of Ardglass, but he got a better offer from one of our fishermen, a Mister Scott.”

“That would be Jimmy,” Fingal said.

“That’s right, sir. Sound man, Jimmy, so he is. He’s getting on a bit, wants til retire, so he’s letting me buy shares in the boat and one day I’ll own her outright.”

O’Reilly heard the pride in the man’s voice.

“Mister Campbell came in today to see if he could join our practice,” Jenny said.

The “our” wasn’t lost on O’Reilly.

“You’d told me, when I started, to accept any new patients, so I said of course he could. But that even if he felt fit and well, I’d like to take his history, and examine him so we’d know how he’d been when he came here first and could compare that with what we found if he ever did get sick.”

“Just right,” O’Reilly said, “and what did you discover?”

“Mister Campbell, who was originally from Donaghadee before the family moved to Ardglass, is a single man. He was born, the youngest of four brothers, at home, three weeks prematurely in July 1940, so he’s just turned twenty-five.”

O’Reilly noted the prematurity. Babies born early were more likely to suffer from congenital heart defects. Yet the man looked to be in the pink. There was one thing that might be causative … O’Reilly concentrated on what Jenny was saying.

“There is no family history of inheritable diseases. He’s had the usual children’s infections, dropped a weighted lobster pot on his foot two years ago and broke a toe, and doesn’t count the number of times he’s got a fishhook stuck in his finger or thumb.”

“We’ll not count them either,” said O’Reilly, “but did they teach you at medical school how to get a barbed fishhook out?”

She shook her head.

“They didn’t teach me either,” he said, “but doctors working in fishing communities do need to know.” O’Reilly was careful not to say, “But if you’re going to go on working here.” That was not finalised yet.

“If youse don’t mind me interrupting? It’s dead easy,” Hall said. “Because of the barb you can’t pull it out. You go to the other end where there’s an eye for tying the hook on the line. Get a pair of pliers with a wire cutter, cut off the eye, and then use the pliers to shove the hook the whole way through. As the barb breaks the skin on its way out, grab the point of the hook with the pliers, and haul. Bob’s your uncle, out she pops.”

Jenny was frowning. “Doesn’t that hurt?”

“Och, aye,” he said, “but you just have to thole it. If you’re on a boat, you’ve to shove your hand in til the sea to disinfect it.” He grimaced. “That stings like bug—Sorry, miss.”

As if to hide his words and perhaps in sympathy with the man, the radiator rattled and violently shuddered on its cast-iron feet.

“It always does that when it’s getting going,” O’Reily said. “Pay it no heed.” He rubbed his hands. “At least the room’s warming up.” He asked Jenny, “And was there anything else in Hall’s history?”

She shook her head. “That’s it, and, oh yes, his pulse is regular and his blood pressure’s one twenty over sixty. The diastolic pressure’s a bit low.”

O’Reilly had already made a shrewd guess, and the low diastolic blood pressure was another confirmatory clue. Hall had been born at home, as was normal practice for second to fourth pregnancies, which were not considered to be as hazardous as first and fifth and subsequent, which should be confined in hospital. His mother would have been attended by a midwife or busy G.P., either of whom might have missed the murmur of a congenital heart lesion, something more likely to be present in a premature. No serious illnesses in the rest of his life so no real reasons for anything but cursory examinations to confirm conditions like measles or whooping cough. No signs of congestive heart failure, which, if O’Reilly was right about the cause of the murmur, wouldn’t begin to appear until the late twenties—and Hall was only twenty-five. “I’ll take a listen,” he said, and did, but confident that he knew what to listen for, put the bell of his stethoscope higher up the chest in the second space between the ribs to the left.

O’Reilly had learnt very early in his studentship that the heart has four chambers. The upper are the auricles and receive blood from the whole body, and the lungs where it has picked up oxygen. The auricles contract and send the blood to the two lower chambers, the ventricles. When the ventricles contract to drive blood to the body and the lungs, the phase of the heart’s action known as systole, two valves close to prevent blood being forced backward into the smaller auricles above. That makes an audible
lub,
the first heart sound. Once blood had entered the pulmonary artery and the aorta, supplying the lungs and the rest of the body respectively, the ventricles relax in diastole and the aortic and pulmonary valves close to prevent the blood returning to the ventricles. The closure of those valves produced a
dup,
the second heart sound. All murmurs were classified, depending on their relationship to the heart sounds, as being either systolic or diastolic, or a combination of both. A skilled physician could infer from that timing which valves might be damaged.