“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.
“I know. Can I help?”
“Not in theatre. Drilling a hole in the skull is a one-man job, but would you please phone Mister Greer? Sister will give you the number. Ask him to come in. Burr holes are first aid. Your patient needs a craniotomy.” Gupta left.
The nurse showed O’Reilly the phone number. He had trouble focusing his eyes. Damn. Damn. Damn. Poor Donal. O’Reilly wondered if he should be phoning Barry too. Ask him to tell Julie. No, best to let the hare sit until he had more news to report. He’d first learned in 1935 not to worry relatives unneccessarily until you knew all the facts.
“Dial nine to get an outside line,” she said.
A well-remembered voice answered. “Greer.”
“Charlie, Fingal. This patient of mine that’s here with an extradural. Mister Gupta’s gone to theatre to do burr holes—”
“I’ll be straight in.”
“I’d like to observe.”
“Meet me in the surgeons’ changing room in twenty-five minutes.”
* * *
O’Reilly let himself into a brightly lit room. A row of metal lockers stood along one wall. Some had nameplates, Misters Alex Taylor, Colin Gleadhill, Derek Gordon. And there was Mister Charles Greer’s. Several doors were ajar, the shelves inside piled neatly with white surgical trousers and short-sleeved shirts. He took a set from the LARGE pile and changed.
Donal was in there past double doors at the far end of this room. O’Reilly gnawed the inside of his cheek and recalled that the outcome for patients with Donal’s kind of intracranial bleeding was dependent on how soon the pressure could be released. Mister Gupta could not have moved more quickly. There was still hope. There was.
He tightened the drawstring of his pants and selected a pair of white rubber boots. Knowing the man as he did, O’Reilly expected him to be here when he said he would be and sure enough Charlie Greer barged into the surgeons’ changing room at the appointed time and went straight to his locker. “Fingal, you old fart. How the hell are you?”
“Good to see you, Charlie,” O’Reilly said, and stood. “I just wish it was under different circumstances.”
Charlie stripped off his overcoat and jacket as one and shoved them into his locker. “You worried about your patient?” He continued undressing.
“I am.”
“You always were like that, O’Reilly,” Charlie said. “Probably what makes you, by all reports, a damn good GP.” He slipped into a theatre shirt. “Extradural haemorrhages can be tricky. No need to tell you that, but we’ll do everything we can. You know that too.”
“I do. I appreciate it.” They’d be going into theatre soon and he didn’t want Charlie to think that he, O’Reilly, was overly concerned. He’d noticed Charlie’s pot belly. It was no longer flat and muscled the way O’Reilly had seen it in so many rugby changing rooms all those years ago. “I see you’re putting on a bit, Charlie,” O’Reilly said, and grinned.
Off came Charlie’s shoes, and his trousers. “I’d say that was the pot—pun definitely intended—calling the kettle black.” Charlie laughed.
“My housekeeper, Mrs. Kincaid, agrees. She keeps feeding me salads.”
“How is old Kinky? I haven’t seen her for months.” Charlie tied his waist drawstring.
“And that, Charlie Greer, has not been for want of a standing invitation to visit. Particularly after what you offered to do for Barry last August.”
Charlie shrugged. “The young man wasn’t at fault. Of course I’d have testified on his behalf. Damn it all, I did the surgery on your Major Fotheringham.”
“Your offer was appreciated.”
“Fine, now, come on. It’s time to go and see what Gupta’s up to.”
As Charlie scrubbed and discussed the case with the gloved and gowned Gupta, a nurse stood nearby. She was the quaintly titled “dirty nurse.” That meant she was there to attend to nonsterile tasks like fetching bottles of blood or mopping a sweating surgeon’s brow.
The senior registrar briefed the consultant. O’Reilly thought they might as well have been chatting about laying courses of bricks, but on the table, beneath green sheets, lay Donal Donnelly.
“I did the burr hole,” Gupta said. “He’s still bleeding from it so at least the pressure’s not building inside the skull.”
O’Reilly could see Donal’s head. His ginger hair had been shaved on one side and a small incision made in the scalp. A trickle of blood ran onto the towel, which appeared damply black under the brilliant overhead lights. The stain was slowly spreading.
“I’m sure the middle meningeal artery has gone,” the senior registrar said, “that’s why we’re set up for a craniotomy, sir, and we have the patient anaesthetised for you.”
“Two pints of blood cross-matched and ready, Charlie,” the anaes
thetist said from where he sat at the head of the table. His back was turned, but O’Reilly recognised the voice. The doctor was flanked by his Boyle’s anaesthetic machine with its colour-coded cylinders of oxygen, cyclopropane, and nitrous oxide. Changed days, O’Reilly thought, since patients had been put under by chloroform dripped on gauze and held in place by a Schimmelbusch mask, a contrivance of metal bars that looked like something used in the old Bedlam lunatic asylum to muzzle dangerous inmates.
Tubing ran from the vapouriser on the machine to the breathing circuit where a concertina-like bellows inside a glass cylinder moved up and down feeding oxygen and the soporific gas mixture through a pair of black corrugated rubber tubes to a thinner tube in Donal’s trachea. The whole apparatus was breathing for Donal while keeping him insensitive to pain.
“Fingal, if you stand beside Maurice, you’ll be able to see better,” Charlie said.
O’Reilly moved to the head of the table. No wonder he had recognised the voice. Doctor Maurice Brown, like O’Reilly, had served in the navy in the Mediterranean. Maurice’s ship had been torpedoed, but he had survived. The man spun on his stainless-steel stool and said, “Fingal O’Reilly.” He held out his hand. “How are things in County Down these days?”
O’Reilly shook the offered hand. “Maurice. Good to see you. County Down? Pretty quiet. It usually is.”
Doctor Brown nodded his head to the table. “One of yours?”
“Donal Donnelly. He had a motorbike accident in Downpatrick.”
“How did you know?”
“We were both at the races. I was first on the spot. Beat the ambulance to it.”
“And I suppose you came up here in the ambulance with him?” Doctor Brown’s eyes smiled over his mask. “Haven’t changed, Fingal, have you? I remember when my ship was in Alexandria harbour. I was visiting a colleague at the base hospital and you arrived with one of your charges, a chief petty officer with a ruptured amoebic liver abscess.” He chuckled. “Some Woman’s Royal Navy nursing sister told you he’d have to wait like everyone else. Hang on,” Maurice read a gauge and adjusted a knurled wheel. “Can’t have him going too deep,” he said, then continued, “I wondered did they use you on Warspite if they ran out of ammunition? I’d never heard an explosion like it. You wouldn’t leave until you’d seen the man admitted and a senior surgeon commander hauled out of the mess to treat your patient. Pretty gutsy for a lowly surgeon-lieutenant.”
O’Reilly grinned. “I shouldn’t have yelled at a Wren sister, but my patient was a damn sight sicker than some of the malingerers there and a dose of the clap’s not life-threatening. A ruptured liver abscess is. She should have known better.”
Charlie Greer was speaking. “Ordinarily, Rajat, I’d let you operate, and I’d assist. You’re here to be trained after all, but you do understand?”
“Of course,” the senior registrar said.
“Thanks, Charlie,” O’Reilly said quietly, “and thank you too, Mister Gupta. I remember how eager I was to do things when I was young.”
“There’ll be plenty more,” Gupta said. “I’ve another year to go and Mister Greer’s very generous in letting us trainees operate.”
He would be, O’Reilly thought. Charlie Greer had always been a generous man when it came to letting others have opportunities to learn new techniques.
“Right, let’s do it,” Charlie said.
O’Reilly watched as his friend made an incision shaped like a reversed question mark in the skin in front of Donal’s ear. He turned the skin flaps back to expose a muscle, which he incised. Gupta lifted a set of forceps with curved pieces at the end of each limb, which, when inserted, slipped under the muscle. He squeezed the handles and the limbs parted widely, pulling the severed edges of the muscle apart to expose a blood clot.
He swabbed the superficial clot away to reveal the bone beneath.
“That’s a good burr hole, Rajat,” Charlie said. “Right where it should be. Suction, please.” He held out his left hand and the sister slapped a suction catheter into the palm. He slipped the soft tip of the tube through the hole in the skull.
The rhythmic sound of the anaesthetist’s bellows now had to compete with a gurgling. O’Reilly could see dark blood from inside Donal’s skull flowing through the plastic tube.
“Better an empty house,” said Charlie as the blood flowed, “than a bad tenant.”
Surgeons were adept at black humour. It was the nature of their calling. It took a special breed, O’Reilly recognised, to slice into a fellow human being. And in brain surgery, a mistake, a momentary lapse of concentration, could lead to permanent brain damage or death, and Charlie had already operated for seven hours today.
“See, Fingal?” He pointed to a dark line running along the white parietal bone. “That’s the fracture and Rajat put the burr hole spot-on beside its edge. Bone nibblers please, Sister.”
She handed him an instrument that looked like pliers but with sharp-edged circular steel cups inside the tips of the blades. “Gotta make room to get at the artery,” Charlie said, and began to work.
O’Reilly heard the steady crunch, crunch as the blades of the nibblers bit out chunks of skull. Finally Charlie said, “There it is.”
O’Reilly peered into the hole. A few feet before his eyes lay the membranes surrounding Donal Donnelly’s brain, three pounds of tissue the consistency of porridge. It was the organ that made Donal who he was, moved his muscles, controlled his breathing, his heart rate, dreamed up his crooked schemes, and held his hopes and his fears, his love for Julie MacAteer and their unborn child. If, and O’Reilly’s personal jury was out on the subject, if human beings truly did have a soul, it was here in the brain that it must reside.
He hoped with all his might that bruised and squashed as Donal’s brain might be, it had suffered no irreparable damage. “You come back to us, Donal,” he whispered, “that’s an order.” As if Donal could hear or obey, but O’Reilly had felt deeply the need to offer up what in an earlier generation would have been a prayer of supplication.
He noticed how the shiny dura mater at the bottom of the wound was crisscrossed by dark pulsating blood vessels. Little gouts of blood spurted from one of the arteries.
“Suture.” Charlie took a needle driver loaded with a curved needle, passed it under the bleeding point, and expertly knotted a stitch. The bleeding stopped as if a tap had been turned off. There was oozing from veins, but the real threat to Donal had been dealt with. Charlie placed a second stitch. “Our old friend Cromie, the sailor, would call that second stitch an arrester backstay. For the less nautically inclined, I prefer the expression belt and braces, but I don’t want any chance that a stitch could slip without a backup in place.” He handed the needle driver back to Sister. “Now,” he said, “no sign of any other arterial bleeding, so we can conclude that the posterior branch of the artery is intact. All we have to do is stop that venous oozing. A bit of fibrin foam’ll do the trick. Thanks, Sister.” He used forceps to pack the blood-clotting sponge in place. “I think,” he said, “it’ll be safer to drain.” Sister handed him a length of soft rubber tubing, which he laid on top of the dura. “That comes out in twenty-four hours,” he said. He straightened. “Rajat, I’m banjaxed after today’s surgery. Would you close?”
O’Reilly knew that it was customary for a senior surgeon to delegate the routine work of closing an incision. There were no doubts that Gupta would do a fine job.
“Come on, Fingal,” Charlie said, stepping back from the table and pulling off his rubber gloves. “Thank you, Sister. Nurse. Well done, Rajat. See you tomorrow, Maurice. We’ve a meningioma to do at nine, or rather Rajat has. The intracranial pressure’s going up. We can wait until tomorrow, but not until Monday. I’ll assist.”
O’Reilly was vaguely aware of the replies. He took one last look at Gupta working steadily away and at the object of his attention, Donal Donnelly. Good luck to you, Donal, O’Reilly thought. I’ll see you when you get back to the ward.
�
�Come on, O’Reilly,” said Charlie, turning his back so the dirty nurse could untie the strings of his gown. “Let’s get changed. I’m sure you want to get home.”
“I do,” said O’Reilly, “eventually. But tonight I’d like to stay at the hospital. Barry had to drive my car home from Downpatrick and the last train’ll have gone—”
“Good excuses. You’d fill your knickers if you believed for one moment that I thought you might want to stay because you’re worried about Donnelly. Come on, Fingal, how long have we been friends?”
“Thirty-four years,” O’Reilly said, “give or take.”
Charlie grinned. “It wouldn’t be the first time I’ve told you giving a damn for your patients is not a sign of weakness as long as you don’t let it take control. If it’s important to you and you want to stay here let me make a call before I go up to the ward. I want to take a look at this morning’s case before I go home.”
Ten minutes later, O’Reilly was sitting on a single, iron-framed bed. The room was spartan. Painted plasterboard walls, cheap bedside table, plywood wardrobe in one corner, an armchair and a sink with exposed pipes on one wall. Lighting was provided by a single sixty-watt bulb.
The rooms, housed in a small one-storey wooden building at the back of the hospital, were used by students or housemen. They were known as “the Huts” or, because they were situated between the tennis courts and the morgue, “Mortuary Mansions.” Ordinarily O’Reilly would have found that funny, but tonight the morgue was a very tangible reminder that “Man that is born of woman hath but a short time to live.” Still, Charlie had been adamant that Donal’s prognosis was good because of the rapidity with which Mister Gupta had reacted.
O’Reilly moved to the tattered armchair and lit his pipe. He hoped Charlie was right about Donal. He certainly was about something else. You could get too involved with patients. It had happened to him, and with the first patient for whom he’d become responsible. Certainly there had been plenty of forgettable customers over the years, but the young man with the initials KD and the valvular congestive heart failure was indelibly marked on O’Reilly’s memory.
A Dublin Student Doctor Page 7