Barry went to the desk, aware that he had seen Doctor O'Reilly perform minor surgery with all the skill of one of the senior surgeons at the Royal. And somehow he had let Councillor Bishop know that while patients might have certain expectations of their physician, courtesy was a two-way street. Get the upper hand? Barry thought Councillor Bishop hadn't, in local parlance, come within a beagle's gowl.
By the Dawn's Early Light
A telephone rang. Barry fumbled for the receiver. The night sister must want him up on one of the wards. His hand, the one he had cut on Mr. Kennedy's gate, smacked into an unfamiliar bedside table. "Ow." The pain brought him to full wakefulness, and he remembered he wasn't in his room in the junior staff quarters of the Royal. He was in the attic in O'Reilly's home. The door opened and a beam of light from the landing spilled into his room. A large figure stood in the doorway.
"Up," said O'Reilly, "and be quiet. Don't disturb Kinky."
"Right." Barry knuckled his eyes, got out of bed, dressed, and crept downstairs to find O'Reilly, black bag in hand, waiting in the hall. "Come on." He headed for the kitchen. Barry followed out through the back garden, which was illuminated only by the dim lays of a distant streetlight. Arthur Guinness stuck his head out of his doghouse. "I'm not going shooting," O'Reilly said.
'Umph," said Arthur, eyeing Barry's trouser leg. The dog must have decided that love at this hour was too much trouble. He retreated into his kennel, muttering something in Labradorese.
Barry climbed into the Rover. "What time is it?"
"Half one," said O'Reilly, backing into the lane.
Barry yawned.
"Mrs. Fotheringham called. Says her husband's sick, but I doubt it." He headed for the road. "Major Basil Fotheringham's had every illness known to man, and a few that only the Martians have dreamed of. He always takes a turn for the worse after midnight, and as far as I can tell, he's fit as a bloody flea. It's all in his mind." He turned left at the traffic light.
"So why are we going out into the Ballybucklebo Hills at this hour of the morning?"
"Do you know about the houseman and the surgeon?" O'Reilly asked, turning the car's lights to full beam.
"No."
"Surgeon comes in to make rounds in the morning. 'How is every one?' says he. 'Grand,' says the houseman, 'except the one you were certain was neurotic, sir.' 'Oh,' says the great man, 'gone home has he?' 'Not exactly, sir. He died last night.' Once in a while even the worst bloody malingerer does actually get sick."
"Point taken."
"Good. Now be quiet. It's not far, but I've to remember how to get there."
Barry sat back and watched the yellow headlights probe the blackness ahead. Now that Ballybucklebo lay behind, the dark enveloped them as tightly as a shroud. He peered up and saw the Summer Triangle: Altair, Vega, and Deneb high in the northwest, each star set in a jet sky, backlit by the silver smudge of the Milky Way. His dad had been a keen amateur astronomer, probably because he'd been a navigating officer in the war. He'd taught Barry about the constellations.
Barry's dad and mum would be seeing different stars now, he thought. The Southern Cross would sparkle over their heads. Their last letter from Melbourne, where his dad was on a two-year contract as a consulting engineer, had been full of their enthusiasm for Australia, and had hinted that there were all kinds of opportunities for doctors there. Barry watched a meteor blaze through Orion, and knew he was quite at home with the northern stars. The car braked in a driveway, and Barry came back to earth. "When we get in there I want you to agree with everything I say, understand?" said O'Reilly.
Barry hesitated. "But doctors don't always agree. Sometimes a second opinion--"
"Humour me, son."
"Humour you?"
"Just open the gate."
Barry climbed out and opened a gate, waited for O'Reilly to drive through, closed the gate, and crunched along a gravel driveway to a two-storey house. An imitation coach lamp burned in the redbrick porch. "Agree with everything I say. Humour me." What if O'Reilly made a mistake? Barry looked ahead. There O'Reilly stood, dark against the light from an open door, talking to a woman wearing a dressing gown.
"Mrs. Fotheringham, my assistant, Doctor Laverty," he said when Barry arrived.
"How do you do?" she said, in a poor imitation of the accent of an English landed lady. "So good of you both to come. Poor Basil's not well. Not well at all. Not at all." Barry heard the harsh tones of Ulster beneath her affected gentility. That, he thought, is what I'd call the buttermilk coming through the cream. He followed as she led them through a hall, expensively wallpapered and hung with framed prints of hunting scenes, up a deeply carpeted staircase, and into a large bedroom. Prawn pink velvet curtains covered the window and clashed with the pale orange tulle drapings of a four-poster bed. 'The doctors have come, dear," Mrs. Fotheringham said, as she stepped up to the bed and smoothed the brow of the man who lay there.
Major Fotheringham sagged against his pillows and made a mewling noise. Barry looked for any obvious evidence of fever or distress, but no sweat was visible on the patient's high forehead; there was nothing hectic about his watery blue eyes, nor any drip from a narrow nose that hooked over a clipped military moustache. "Right," said O'Reilly, "what seems to be the trouble this time?"
"He is very poorly, Doctor," Mrs. Fotheringham said. "Surely you can see that?"
"Oh, indeed," said O'Reilly, making space among the ranks of salves and unguents on the glass top of an ornate dressing table and setting his bag among the bottles. "But it would help if Major Fotheringham could describe his symptoms."
"Poor dear," she said, "he can hardly speak, but I think it's his kidneys."
"Indeed," said O'Reilly, pulling his stethoscope from his bag.
"Kidneys, is it?"
"Oh, yes," she said, twitching at the front of her silk dressing gown. "Definitely. I think he needs a thorough examination."
"I'd better take a look then," said O'Reilly. He stepped to the bed. "Put out your tongue, Basil."
Here we go again, Barry thought. O'Reilly had not made the remotest attempt to elicit any kind of history, and here he was barrelling ahead with the physical examination. Agree with everything I say. Well, we'll see.
"Mmm," said O'Reilly, pulling down the patient's lower eyelid and peering at the inside of the lid. "Mmm-mmm." He grasped one wrist and made a great show of consulting his watch. "Mmm." Barry watched Mrs. Fotheringham's narrow face as she stared intently at every move O'Reilly made, heard her little inhalations each time he muttered, "Mmm."
"Open your pyjamas please." O'Reilly laid his left hand palm down on the patient's hairless chest and thumped the back of his hand with the first two fingers of his right. "Mmm." He stuffed the earpieces of his stethoscope in his cauliflower ears and clapped the bell to the front of the chest. "Big breaths." Major Fotheringham gasped, in out, in out.
"Sit up, please."
Major Fotheringham obeyed. More thumpings; more stethoscope applications, this time to the back; more huffing and puffing; more mmms.
Mrs. Fotheringham's little eyes widened. "Is it serious, Doctor?" O'Reilly pulled his stethoscope from his ears and turned to her. "I beg your pardon?"
"Is it serious?"
"We'll see," said O'Reilly, turning back to Major Fotheringham. "Lie down." O'Reilly quickly and expertly completed a full examination of the belly. "Mmm, huh. I see."
"What is it, Doctor?" Mrs. Fotheringham's voice had the same expectancy that Barry had heard in children's voices when they wanted to be given a treat.
"You're right," O'Reilly said. "It could be his kidneys." And how in the world had he arrived at that diagnosis? Barry thought. No one had said anything about fever, chills, or difficulties or pain urinating, and nothing O'Reilly had done had come close to examining the organs in question.
"Told you so, dear," said Mrs. Fotheringham smugly, as she fluffed her husband's pillows. The major lay languidly, unspeaking as ever in the four-poster bed.
"Then again, it might not be," said O'Reilly, grabbing his bag. "I think a test's in order, don't you, Doctor Laverty?" Barry met O'Reilly's gaze, swallowed, and said, "I don't quite see--"
"Course you do." O'Reilly's eyes narrowed, his tone hardened.
"But-"
"In a case like this we can't be too careful. You'd agree, Mrs. Fotheringham?"
"Oh, indeed, Doctor." She smiled at O'Reilly. "Yes, indeed."
"That's settled then." O'Reilly glared at Barry, who looked away. O'Reilly rummaged in his bag and produced a bottle that Barry recognized immediately. It would contain thin cardboard strips used to detect sugar or protein in a urine sample. What the hell was O'Reilly up to?
"I'll need your help, Mrs. Fotheringham." O'Reilly handed her several of the dipsticks.
"Yes, Doctor." Her eyes were bright, her smile barely concealed. "I want you to . . ." He looked at his watch. "It's two fifteen now . . . so start the test at three. Make Basil drink one pint of water."
"A pint?" she echoed.
"The whole pint. At four give him another pint, but not until he's passed a specimen."
"Specimen?"
"Of urine."
"Oh."
"Dip one of those dipsticks in it, and put the stick on the dressing table."
Mrs. Fotheringham looked dubiously at her handful of cardboard, sniffed, and said, "Very well." She sounded, thought Barry, like an English memsahib who'd been asked to clean up a heap of elephant manure from the streets of colonial Bombay--and who would do so, but only for the sake of the empire. "And," O'Reilly bored on, "I want you to repeat the test every hour on the hour until Doctor Laverty and I come back to read the results."
"Every hour? But--"
"It's a terrible imposition, Mrs. Fotheringham, but. . ." --O'Reilly put one large hand on her shoulder--"I know I can rely on you." She sighed.
"Should give us the answer, don't you think, Doctor Laverty?" Barry nodded, knowing his earlier attempts to stand up to O'Reilly had been ineffective, sure that any protest he might make would be rolled over with the force of a juggernaut, and despising himself for his lack of courage. "Good," said O'Reilly to Barry. He turned to Mrs. Fotheringham, who was sorting out the little pile of cardboard. "Get started at three, and remember, this test will sort out once and for all just how sick your husband is. Mind you, I'm pretty sure I know what's wrong with him." She nodded meekly.
"Don't bother to see us out," said O'Reilly, striding to the door. "You're going to have a busy night."
Barry sat stiffly in the Rover. He was angry about O'Reilly's hocus-pocus and angrier at his own inability to intervene. He watched as streaks of yellow made pastel shadings in the grey of the false dawn, and fidgeted in the seat. "Go on," said O'Reilly, "spit it out."
"Doctor O'Reilly, I-"
"Think your history taking stinks, and you're up to no good with all that buggering about with the dipsticks."
"Well, I-"
O'Reilly chuckled. "Son, I've known the Fotheringhams for years. The man's never had a day's real illness in his life."
"Then why didn't you just tell them to wait until the morning?"
"Would you have?"
"If I knew the patient as well as you obviously do, I might."
O'Reilly shook his head. "It's another little rule of mine. If they're worried enough to call at night, even if I'm damn sure it's nothing, I go."
"Always?"
"Lord, aye."
Nothing in O'Reilly's tone suggested pride to Barry. There was no hint of smugness, simply a matter-of-fact statement of how things were in the big doctor's particular universe. "I see," Barry acknowledged grudgingly, "but what was all that nonsense with the test? I've never heard of any such procedure."
"Ah," said O'Reilly, turning into the lane at the back of his house. "'There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy.'"
"You'll not put me off by quoting Hamlet, Doctor O'Reilly."
"No," said O'Reilly, as he braked, "I didn't think I would, but you'll have to wait until we go back to the Fotheringhams' if you want to find out the answer. Now be a good lad, hop out, and open the garage door."
While O'Reilly parked the car, Barry waited in the lane. He looked past the lopsided steeple of the church to where the clouds were being lit by the rising sun.
"Begod," said O'Reilly, standing by Barry's shoulder and staring up. "Red sky in the morning, sailor, take warning. I wonder what the rest of today's going to have in store for us?"
Water, Water, Everywhere
Never mind sailors taking warning; anyone caught out in the summer gale that had blown up in the early hours would be getting drenched. Barry listened to the rain clattering off the surgery's bow windows. He glanced at his watch. Even at almost noon the lights were still needed in the room. Barry stretched and ran a hand over the back of his neck. He was feeling the effects of a broken night. He watched O'Reilly usher an older man with arthritis to the door. The morning had been busy, and yet O'Reilly showed no signs of fatigue. A fresh gust shook the panes.
"Jesus," said O'Reilly, "I wonder if there's an old lad wearing a long gown and a beard running round the Ballybucklebo Hills looking for gopher wood and trying to keep all the animals together two by two?"
"He'd not be doing that. He'd have Shem, Ham, and Japheth to do all the running around for him," Barry muttered.
"Sensible man, Noah," said O'Reilly with a grin. "Trot along and see who's next."
Barry shook his head and went to the waiting room to discover that only one patient remained, a young woman with long auburn hair that had a sheen like a freshly shelled horse chestnut, and green eyes set in a freckled face. "Good morning," he said. "Will you come through, please, Mrs. er . . . ?"
"Galvin," she said, standing with some difficulty, one hand supporting the small of her back, the other holding her swollen belly.
"I'm a bit slow getting about," she said, giving him a weak smile. "That's all right; take your time." Barry stepped aside as she waddled past.
"Doesn't look as though it'll be long now."
"Just a week more." She went into the surgery. "Morning, Doctor O'Reilly."
"How are you, Maureen?" O'Reilly asked.
"Grand." She rummaged in her handbag and gave him a small plastic urine-sample bottle.
O'Reilly took it and handed it to Barry. "Pop a dipstick into that, would you?"
Barry took the specimen over to the sink and tested the urine. He found nothing wrong. As he worked, he heard O'Reilly say, "Can you get up on the couch, Maureen?"
She turned her back to the table and sat. "Are you sure there's only the one in here, Doctor O'Reilly? I feel like the sidewall of a house."
"It was only a week ago when I examined you," he said, "but if it'll make you happier, we'll get Doctor Laverty to lay on a hand."
"I heard you'd a new assistant," she said.
O'Reilly bent and put one arm under her legs. "There you go," he said as he lifted her legs onto the couch. He reached past her. "Stick that pillow under your head."
She lay down, and Barry watched and listened as O'Reilly asked the routine late antenatal questions, took her blood pressure, and palpated her ankles to make sure there was no swelling. "Right, let's see your bump."
She lifted the skirt of her maternity dress. The blue of the material was bleached, and a small patch was neatly sewn on one side. O'Reilly pulled the top of her underwear down until Barry could just see a wisp of pubic hair at the bottom of her distended abdomen. He noted the silver snail tracks of stretch marks on her flank, her umbilicus turned inside out from the pressure of the uterus that filled the abdominal cavity. He stepped back and waited while O'Reilly examined her. Maureen's green eyes never left O'Reilly's face. Barry saw her concern, watched as O'Reilly's face betrayed no expression. "Doctor Laverty?"
Barry moved to the table. As he did so, he rubbed his palms rapidly together trying to warm them. "This won't take long."
"Take y
our time, Doctor." She flinched as he began his examination. "Sorry."
"Cold hands is the sign of a warm heart." She smiled at him.
He examined the belly, felt a single baby's back on her right side, the hardness of the head just above the pubic symphysis. He grasped the head between the outstretched thumb and finger of his right hand. It refused to budge when he tried to move it from side to side. "Here," said O'Reilly, handing Barry a fetal stethoscope.
He laid the wide end of the aluminium trumpet over the abdominal wall and bent to put his ear to the flattened earpiece. Tup-tup-tup-tup. . . . Barry listened, counted, and looked at his watch. "A hundred and forty." He saw the narrowing of Maureen's eyes and the questioning lines appear in her forehead. "Absolutely normal," he said, pleased to see the little furrows disappear.
"So?" said O'Reilly.
Barry trotted out the formula he had been taught. "There's a singleton, longitudinal lie, vertex presentation, right occipito-anterior, head's engaged, heart rate . . ."
"A hundred and forty," said O'Reilly. "The rest's right too."
Barry felt smug.
"So are you worried now, Maureen?"
Barry looked at the woman's face. The furrows were back and were keeping company with three deeper ones that ran upwards from the bridge of her nose. She glanced from O'Reilly to Barry, then back to O'Reilly. "Not if you say so, Doctor."
"Just like Doctor Laverty said, Maureen, there's one baby, just the one . . ."
Some of the furrows flattened.
". . . Straight up and down, the back of its head is on the right-- that's the most normal way--and the head's dropped. The little divil's halfway out already."
Her forehead became smooth, a twinkle shone in her green eyes, laugh lines appeared at the corners. She gave a contented sigh. "That's great, so it is."
Barry cleared his throat. He saw how he'd baffled the woman with his jargon. She hadn't understood a word of his "singleton, right occipito-anterior" talk, but O'Reilly had gone right to the heart of the matter in plain English.
An Irish Country Doctor Page 6