The Parting Glass (58 page)

Peggy held her breath and sat still as Finn listened. He sat back on his heels and pulled out the earpieces. “No crackles, but he’s having trouble getting air.”

“Aren’t you going to check his throat?” She started to tilt his head back so that Finn could look inside.

“Absolutely do not do that.”

She dropped her hand, surprised at his tone. “Why not?”

“Has he been immunized for Hemophilus influenza? Type B?”

“He got the first shot, but he had a pretty severe reaction, and I decided not to continue. My doctor was ambivalent, but I thought he was probably allergic to something in the vaccine. I—”

“Peggy, listen to me.” He spoke calmly and smiled gently at Kieran. “The most important thing right now is not to upset Kieran. Do you understand? We’re going to move slowly, and you’re going to be very reassuring with him. We don’t want to do anything to make it harder to breathe. If he’s upset, it could cause laryngospasms.”

“What’s wrong with him?”

He glanced at her. “I’m not sure, but probably epiglottitis. We have to get him to the hospital stat.”

She’d only had one year of med school, but she knew that epiglottitis had nearly been wiped out by the Hemophilus influenza vaccine. The same vaccine she had chosen not to continue with. “Then this is
my
fault.”

“Don’t think about that now. More important is that you realized this was something more than a cold and set out to do something about it.”

It was not the time for recriminations, but she was devastated. How much better to have been wrong, to have Finn tell her that this was only a nuisance virus, that her son’s lungs were clear and once the fever broke he would be on the road to recovery.

“Peggy, can you manage him? He’s better off with you. He trusts you.” Finn grabbed the diaper bag off the floor and took the other bag that Irene handed him.

“Yes.” She pulled her son’s shirt back over his head, then got carefully to her feet and started after him, holding Kieran gently against her.

“I called Nora,” Finn said. “She’s coming to stay with you.” He addressed this to Irene as he headed for the door ahead of Peggy.

“You’ll call? The moment you know something?”

“We’ll call. Beck’s going to meet us there.”

Peggy knew better than to upset Kieran further. She kept her voice low. “I don’t want him anywhere near my son.”

“He’s a good doctor, Peggy, and for that matter, he was probably right. This may well have started as a virus that’s unrelated to the epiglottitis. Unfortunately, he should have listened to you when you called back today.”

She was too angry and too worried to reply.

He had the car door open and the engine running by the time she and Kieran got there. She slid in and waited while he reached across her to fasten her seat belt. “He doesn’t sound good,” Finn said. “I don’t want to lie to you. I’d call EMS if I thought they would get here quickly enough, but out here in the country, sometimes the wait’s too long. At this point our worry is additional respiratory distress. Your job is to keep him breathing while I drive. As long as he’s conscious, he’ll be all right. But if he passes out, we have to worry about his airway. Help him sit forward with his chin extended.” He demonstrated. “Like this.”

She nodded, and Finn pulled the car into the lane leading to the main road. She listened as Kieran struggled to breathe. He began to flail weakly, fighting the lethargy of fever and the panic of not getting sufficient air. She spoke soothingly but knew better than to try to comfort him by smoothing his hair as most mothers would have. Kieran’s world was so different and mysterious, and the fact that he was allowing her to hold him at all was miracle enough.

They were out on the main road, close to Shanmullin, when he flailed once, twice, then jerked and fell forward. Panicked, she listened for breath sounds.

“Finn, I don’t think he’s breathing.”

He didn’t question her. “Push him farther forward and extend his chin gently.”

She jostled him a little as she did, but she still couldn’t hear the gasps that had characterized each breath. “He’s not breathing! And he’s unconscious. Oh God.”

Finn didn’t stop. He pressed down on the accelerator and sped toward the village. “Just hold on,” he said. “Hold on.”

“But he won’t make it to the hospital.”

“No.” He drove even faster and made a turn onto a side street. She knew then where they were going. Finn’s office.

The moment he could get his keys out of the ignition, he was out and running for her door. It flew open, and he helped her out; then he left her to make the short journey with the unconscious Kieran and ran ahead to unlock the door and turn on the lights.

“In here.”

She saw him in the doorway of an examining room off the reception area. The office was spotless. He might have abandoned it, but she knew in that moment that despite everything he’d told himself, he had never abandoned hope that one day he would come back.

“Put him on the table, face up.” Finn was rummaging through boxes.

“What are you going to do?”

“We have to establish an airway, and we have to do it now. We can’t wait for Castlebar.”

She laid Kieran on the table. He was no longer flushed with fever. She recognized cyanosis. Her son was turning blue.

She had worked in an emergency room during college, and the doctors had taken her under their respective wings, explaining, demonstrating. And she had been a med student for one incredible year.

Her son was going to die.

“He’s going to go into cardiac arrest!” She bent over Kieran, slapping his cheeks and calling his name.

“Not if I can help it.” He pushed her aside and stood over Kieran. She recognized the oropharyngeal airway in his hand, but she’d never seen one so small. “I’ve done this before, Peggy. We practice emergency medicine out in the country, more than we’d like. We’ll get an airway, then oxygen.”

“You have oxygen?”

“We’ll bag him.” Finn was tight-lipped, concentrating. “Use the phone in the front and call EMS. The number’s on the wall above the phone. Call now.”

She was torn. Finn had turned Kieran to his side and was beginning to work the plastic tubing into his mouth.

He didn’t look up. “Go, Peggy.”

She ran into reception, and found the telephone and the number where Finn had said they would be. Once someone answered, she explained what she could. The man on the other end told her someone would be at Finn’s office as soon as possible.

“They’re coming.” She stopped short of the table. Finn was removing the tube. “What’s happening? Why are you—”

“The epiglottis is too swollen. There’s no way around that obstruction. We’re going to have to do a tracheostomy.”

“Here?” She knew that a tracheostomy, which involved making an incision in the throat and inserting an endotracheal tube, was not a simple matter. She had seen it done more than once. Each time an anaesthesiologist had performed the surgery, and an endoscopist had been on call in case of difficulties. The procedure had been done under sterile conditions, with anaesthesia.

“We have no choice, Peggy. Give me your permission.”

She was sobbing now.
She
had done this to her son. She had not continued the vaccinations, and, more recently, she had not followed her own instincts and insisted that someone see Kieran again. If Kieran died, she would be responsible.

“Say yes,” Finn demanded. “Damn it, Peggy, this is not the time to falter. Say yes!”

“It’s different with children. I remember that. You’ve done this with a child?”

“Yes, Peggy. Just say yes.”

A child’s physiology was different. A child’s needs were different. How could he possibly have the right equipment here?

Somehow, though, he did. She saw him pick up Kieran’s hand and measure her son’s pinky against several tubes he had already placed beside him.

She didn’t know what to say or do. She was faint with anxiety. “Yes,” she croaked. “Go ahead.” It seemed like the wrong choice, but it was the only choice Kieran had. Without oxygen, his heart would fail. Her son would die right here.

He made the incision with lightning speed, and in what seemed like a moment he was threading the tube between her son’s vocal cords. “Got it,” he said. “In the top drawer over there you should find tape. Bring it now.”

She couldn’t move. She was so frightened that her body had shut down.

“Peggy!”

She put one foot in front of the other, sobbing again. She found the tape and brought it to him. He was holding the corner of Kieran’s mouth and the tube together. She tore off pieces and he taped it quickly so that the tube was stable and could not be moved, then he stepped one pace back, examining Kieran’s chest. “He’s breathing. But we’ll bag him for the trip.”

“He’s breathing?”

“Now that he can, yes.”

She leaned over and saw that Finn was correct. Kieran’s skin was still tinged with blue, but even during the moments that she watched, his color seemed to improve.

She stifled another sob. “What will they do at the hospital?”

“We’ll run an IV and start a drip in the ambulance. We’ll do blood work in hospital, X rays. We’ll probably ventilate him temporarily, definitely start antibiotics. Most likely the edema will resolve itself in the next forty-eight hours. If it’s Hemophilus, we might do a lumbar puncture to be sure there’s no meningitis.”

“Meningitis?”

“It’s the same organism.”

The front door opened, and two men arrived. “Lucky for you,” the first man said, “we were just on our way back from another call.”

“And lucky for the boy that the doctor didn’t wait,” said the other, grimacing with sympathy at the limp little body. “Good job, there. That’s more than we could have done for him.”

While one man draped a blanket around Peggy’s trembling shoulders, Finn had a terse conversation with them. Then, with Finn carefully carrying the still unconscious Kieran, they started toward the ambulance.

chapter 38

T
he sight of her tiny son on a ventilator in intensive care should have been the saddest sight of Peggy’s life. But a far sadder sight would have been her child at his wake. She had come so close to that, within minutes or even less, perhaps.

If Finn had not acted decisively, she knew that Kieran would have died of respiratory failure because of decisions that
she
had made.

“A closer call and he’d be with the angels,” said the nurse who was monitoring Kieran’s vital signs. “And what have you done in this life, Miss Donaghue, to entitle you to a miracle?”

Peggy tried to smile. Alice, the nurse, a matronly woman with a steel wool perm and startlingly bushy eyebrows, had tried for the past half hour to help her put Kieran’s condition in perspective. She needn’t have bothered. Peggy knew a miracle when she saw one, and she was not unacquainted with Irish angels. She had witnessed one in action little more than an hour ago.

She reached for another tissue. “Finn saved his life.”

“It’s good to have the doctor back, you know. Dr. O’Malley was a favorite. Never impulsive or condescending, and his decisions were never questioned by the staff. As they say in your country, you’ve the luck of the Irish to have him at your side.”

“Kieran still looks so sick.” But even Peggy, with a mother’s natural fear and doubt, could see that Kieran was improving. He was getting oxygen, fluids and antibiotics. He had been sedated enough to keep him comfortable and, so far, asleep. And as soon as the swelling in his epiglottis dissipated, the doctors would surely extubate him. With more luck, she and her son would be home in a matter of days.

“Well, he is ill, poor little lad, but he’ll pull through. And here’s the doctor to tell you so.”

The room wasn’t private, and people had streamed in and out since their arrival, but not Finn. Now Peggy turned expectantly, but Finn wasn’t behind her. Dr. Beck stared back at her. Blond, with regular features, he might normally pass for good-looking, but tonight he was rumpled, and the eyes behind his glasses were red-rimmed, as if he had pulled himself from a sound sleep to make the hospital trip.

His voice was a careful monotone. “I’ve gone over the work-up. Everything that should have been done has been. Your son had a close call, but he’ll recover.”

She waited for an apology, for a statement, even a hint that he had been negligent, but he shrugged as he spoke. “Epiglottitis is known for its sudden onset. It’s rare these days, and of course there’s no way to predict it. There was certainly no swelling of any magnitude when I examined him. You were clever to get him to the hospital at the first real symptoms.”

“No, I brought him to
you
at the first real symptoms, and that wasn’t clever at all.”

“I sincerely doubt the two infections are related.” He overrode her attempt at reply. “But most likely we will be able to tell once the test results are in.”

“Even if the lab tests come back with neon arrows pointing right at you, I’ll be astounded if you admit you could have done more for my son.”

“That’s uncalled for.”

“No, it’s part of my education. You’ve gone a long way toward teaching me what kind of doctor I don’t want to be.” She turned away from him and moved closer to Kieran’s bedside. A nurse and lab technician passed by on their way to another bed.

Beck lowered his voice. “I welcome you to put yourself in my shoes, Miss Donaghue. Try treating fifty percent more patients than you ought to and see how endearing they find you. I try to settle for quality and speed. It’s not what I went to medical school for, but it gets the job done.”

“Except tonight. Tonight my son got caught in your speed trap.”

“That remains to be seen.” He picked up Kieran’s chart and scribbled something on it, handing it to Alice, who had bustled around the bed during Peggy and Beck’s exchange as if she was too busy to notice any of it.

“Why are
you
writing on my son’s chart?” Peggy demanded.

“I’m his doctor.”

“No, Finn O’Malley’s his doctor. Kieran wouldn’t much need a doctor right now if it weren’t for Finn.”