Fingal O'Reilly, Irish Doctor

by Patrick Taylor

  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.

  In this case, O’Reilly heard a low rumbling that was continuous across both systole and diastole. That was the classic “machinery murmur” he’d been sure he’d detect. He nodded and moved the bell of his stethoscope to the side of Hall’s neck. He could hear the murmur over the carotid artery. More confirmation.

  He straightened, took the earpieces out, and said to Jenny and Hall, “You did well, Doctor Bradley. Lots of busy G.P.s would have taken a quick history and not bothered to examine Mister Campbell. You are a lucky man, sir—in more ways than one.”

  Hall was sitting up and listening intently.

  “Put on your shirt,” O’Reilly said, “and I’ll explain.” He waited until Hall was dressed. “When you’re a baby in your mammy’s womb,” O’Reilly said, “getting your oxygen from the afterbirth—”

  “Excuse me, sir, isn’t it oxygen we get from the air when we breathe?”

  “It is, Hall, and if we don’t get it, as if—” Use an analogy a fisherman would understand, he thought. “Well, like if we’re underwater too long, our lungs can’t take in any oxygen and we die.”

  “I know all about that, sir. I was thirteen when the Princess Victoria, the Larne-to-Stranraer ferry, went down near the Copeland Islands. One hundred and thirteen people drowned. My daddy was one of the Donaghadee lifeboat crew, so he was.”

  “Was he, by God?” O’Reilly whistled. “That’s very interesting. All volunteers too. Brave men.” O’Reilly pursed his lips. “Terrible day,” he said. “The folks of North Down will never forget it.”

  “I know,” Jenny said. “My daddy had a friend who was lost.”

  “Just about everybody here knew of someone on board her,” O’Reilly said, and let a few respectful moments of silence pass. He remembered old Victoria. He sailed on her when he’d got leave from the battleship HMS Warspite when she’d been based at Greenock in Scotland early in the war. Long ago now. He said, “To get back to your problem, Hall, when we’re babies inside our mammy, we’re surrounded by fluid. But we don’t drown because the afterbirth gives us oxygen. And in order for it to go directly to our bodies, there’s a special short blood vessel between the two great arteries of the heart.” He saw Jenny nodding. Now she knew what the problem was. “One supplies the body with blood, the other the lungs, but the lungs don’t need much blood until we are born and start to breathe. Until then, this short vessel, it’s called the ductus arteriosus, lets the blood bypass the lungs. Once we’re born, it closes.” He looked at Hall, who was listening intently. “Except in some people, it doesn’t close.”

  “Is that bad, sir? I’ve never noticed nothing wrong, so I’ve not.” Hall frowned.

  “It could be a damn sight worse,” O’Reilly said. “Some folks with it get a heart infection, called bacterial endocarditis, but you’ve been spared that. It can lead to heart failure by the time you’re getting close to thirty, but thanks to Doctor Bradley, who took the trouble to examine you, we know about it and can take steps to fix it.”

  “Honest?” Hall grinned. “That’s great, so it is. Thanks a lot, Doctors.”

  “It’s going to mean an operation. I remember,” said O’Reilly, “the very first time the operation was done. Back in 1938, a Doctor Gross in Boston fixed the condition for an eight-year-old girl. It was a sensation, operating on the heart—then. Now?” He shrugged. “It’s routine. We’ll get you up to the Royal to see Mister Bingham, the heart surgeon. He’ll have you back on your feet and out fishing again in no time.”

  “I’ll make the arrangements, Doctor O’Reilly,” Jenny said.

  “I’d be grateful. Good to meet you, Hall.” He’d compliment Jenny later. O’Reilly turned to go. As he was closing the door, he overheard Hall Campbell say, “Jimmy Scott told me there was a lady doctor working here”—O’Reilly stopped to hear the rest—“and that there was no need to worry. She was very good.” O’Reilly heard a laugh. “Bejizziz, ould Jimmy was right.”

  O’Reilly’s grin was huge as he closed the door behind him.

  33

  To Comfort and Relieve Them

  “How old are ye, son?” Doctor Corrigan asked.

  “Twelve, coming on turteen.” The boy’s fair hair was cut in a fringe of equal length all round his head. He looked the doctor straight in the eye.

  “And do you go to school?”

  “Nah. I’m a working fellah. I sell readers. I make ten shillings a week and dat’s good money.”

  When rent for a room like this would be from three to six shillings a week, and a fourteen-year-old girl working in a shirt factory made five shillings a week—and that was reckoned to be not a bad wage—ten shillings from selling newspapers, “readers” in the local argot, would be quite a help to a family’s budget.

  “And when did you hurt your foot, Dermot?” Doctor Corrigan asked.

  “T’ree days ago I was scuttin’ on a cart…”

  “That’s, ahem, ‘borrowing’ a ride by hanging on a tailboard,” Doctor Corrigan translated.

  Fingal knew all about it. You couldn’t walk down a Dublin thoroughfare but some urchin would go by you illegally clinging on to a vehicle.

  “When I jumped off, I landed on a feckin’ nail and now I’ve got this ruddy great stone bruise.”

  “Can we have a look?”

  “Go ahead.”

  “I wonder, Mrs. Finucane, if we could get young Dermot sitting in a chair, and maybe a chair for me?” Doctor Corrigan said. “Doctor O’Reilly will give ye a hand.”

  Fingal helped rearrange the furniture, and soon Doctor Corrigan was sitting in one chair facing Dermot. “Shove your bad hoof onto my lap, son. Doctor O’Reilly, can ye bring over the lamp, please?”

  Fingal did, and peered at the left foot. What looked like a white blister stretched from the ball beneath the big toe to halfway along the sole. A black point stood in its middle, presumably the scab of the nail wound.

  “And if I push on it?” Doctor Corrigan asked as he laid two fingers on the lesion.

  “You’ll hear the gulders of me all the way to Saint Stephen’s feckin’ Green
. Please don’t, Doctor.”

  “I won’t, but I’ll tell the young doctor it’s hot as Hades. Full of pus. Can you twist your foot to the side?”

  “Like this?” Dermot rolled his ankle sideways.

  “Good lad.” Doctor Corrigan scrutinised the calf. “No lymphatic involvement so we can be thankful for small mercies.”

  Fingal noted with relief the absence of thin red lines under the skin running up the leg. Their presence, indicating lymphangitis, inflammation of the lymphatic channels, would be a sure sign of spreading infection—and the absolute need for amputation.

  “So,” said Doctor Corrigan. “What we have is a plantar abscess, better known as a stone bruise.” He slowly lifted the boy’s foot, stood, and set it gently on his chair. “We’ll fix you up in no time, Dermot. Now.” He looked over to Mrs. Finucane. “Mother?” He nodded his head to the far side of the room.

  While he and Mrs. Finucane talked, Fingal set the lamp back on the mantel beside a plaster statue of the Blessèd Virgin in a blue shawl and rummaged in his pocket. Ever since he’d started seeing young patients he’d carried a halfpenny bag of sweeties. “Dermot,” he said, “what would you say to a piece of clove rock?”

  “I’d say, ‘True on you, sir.’” Dermot, despite his obvious discomfort, managed to grin.

  “Here.”

  The boy popped it in his mouth. “T’anks.”

  “And if you’re a brave soldier while Doctor Corrigan fixes your foot, I’ll give you two more later.” Fingal knew that because the skin over the abscess was so tightly stretched there would be no sensation when the pus was released. But if Doctor Corrigan followed up with the second step of treatment—

  And he was going to. Mrs. Finucane was filling a saucepan with water from a bucket. It would have been brought in from a pump in the yard.

  “Give me the bag there, please, Doctor O’Reilly.” There was just the slightest hint of emphasis on the “please” and Phelim gave Fingal a wicked little grin.

  “Here you are.” Fingal handed it over—and smiled back.

  Doctor Corrigan took out a square of cloth, a sling, and half a loaf of what looked to be stale bread. He took them to the table, crumbled the bread into the cloth square, folded it over, and rolled it in the sling. “Let me know when the water’s boiling,” he said to Mrs. Finucane.

  “Yes, Doctor.” She stirred the fire and set the saucepan on top.

  “Right,” said Doctor Corrigan. “We’ll drain the thing now.” From his bag, he brought out a bottle of Dettol, the newest antiseptic, and swabs. “I’ll need a bit of help,” he said. “Doctor O’Reilly, come with me and we’ll wash our hands.” They did so over a galvanised tub.

  When Fingal returned, he bent to the boy. “How’s the rock?”

  Dermot mumbled past a still half-full mouth of hard-boiled sweetie, “Grand.”

  “We’ll get through this the pair of us, won’t we?” Fingal said.

  Dermot looked up to Fingal towering above him. “Aye, because I want d’em other two sweeties.”

  Fingal squatted so he was at the boy’s level, trying to keep him occupied. Waiting for a procedure was often worse than the thing itself. Fingal was relieved to hear Dermot’s mother say, “Water’s ready.”

  The boy’s gaze left Fingal’s face and he stared as Doctor Corrigan set the bread poultice in the saucepan with the two dry ends sticking up above the water.

  “Have ye a towel?” Doctor Corrigan said.

  Doctor Corrigan lifted the boy’s foot, took his seat, and when Mrs. Finucane appeared with a threadbare but well-laundered towel, he spread it over his knees and put Dermot’s foot on it.

  “Now, Doctor, bring that lamp over here again, and open the bottle of Dettol and pour some onto a swab. This will be cold, Dermot, but it won’t hurt,” he said, taking the swab from Fingal.

  “Promise?”

  “I do.” Doctor Corrigan swabbed the sole of the foot over the abscess.

  Dermot sucked in a swift breath. “It’s colder than a witch’s tit,” he said, but didn’t move.

  “Now, Doctor, in the side pocket of the bag you’ll find a wide-bore hypodermic and a box of matches. Flame the tip of the—” He mouthed the word “needle.”

  Fingal did. “Here.” He handed it to Doctor Corrigan then stood behind the boy, a hand on each of his shoulders. Fingal felt Dermot stiffen. “Youse isn’t sticking that feckin’ great t’ing in—” The boy’s shoulders relaxed. Fingal saw the yellow stream flowing onto the towel and Doctor Corrigan mopping more away with swabs that, as they became saturated, he chucked on the fire.

  “Jasus,” said Dermot, “it’s a miracle. The pain’s gettin’ better already.”

  “Doctor O’Reilly, can you fix the poultice?”

  “I can.”

  “Mrs. Finucane, I want you to watch what Doctor O’Reilly does, then when this one’s cold you can heat up another one and put it on.”

  Fingal took the saucepan from Mrs. Finucane, setting it on the table. He was wreathed in steam as he lifted the two ends of the sling and began twisting them in opposite directions. Hot water dripped from the middle as the water-soaked bread was compressed. He kept working until no more drips appeared. “It’s ready,” he said.

  “Could you do that, Mrs. Finucane?”

  “I could, sir.”

  Fingal frowned. More than one poulticing? It was believed that the application of the poultice when the wet bread was almost at the boiling point would sterilise the abscess. He didn’t understand why Doctor Corrigan wanted the mother to learn how to do it. Perhaps Phelim used a different approach?

  “Doctor O’Reilly,” Doctor Corrigan said sharply, “take yer time and only bring it here when ye can stand to put it against yer own elbow.”

  So it wasn’t to be applied at boiling point? Interesting. “It’s not quite the way we did it at Sir Patrick Dun’s, Doctor Corrigan.”

  “Don’t believe everything your seniors in the hospitals tell you, son,” Doctor Corrigan said with a smile. “It’s bad enough to have an abscess without getting your foot scalded as well. I believe that a hot poultice, not a boiling one, works by increasing the blood flow to the site and promoting healing. There’s no need to roast the poor wee divil, but I think poulticing the way I do it needs to be done more often than only once. If Mrs. Finucane can learn, it saves the nurses from coming round.”

  “Are youse goin’ to boil me foot, sir?” Dermot asked. His voice was quavery.

  “No, son, I’m not, but I am going to make it warm.” Doctor Corrigan tousled the boy’s hair. “We want a foot that’s better, not a human cruibín.”

  Dermot managed a smile. “Mind youse,” he said, “I’d go a boiled and pickled pig’s trotter right now. Dey beat the boiled pig’s cheeks we’d for our tea last night. Da bought dem for a treat wit’ some of his toss money before he went down the boozer.”

  “I’m sure they would.” Doctor Corrigan turned and asked Fingal, “How’s it coming?”

  “I think it’s about right.”

  “Bring it here.” He looked the boy right in the eye. “Now, Dermot, I’m going to put a hot poultice on your foot.”

  Fingal stood behind the boy and put his hands on his shoulders, for comfort and to restrain him if he jumped.

  Doctor Corrigan laid the middle of the sling containing the hot bread against the abscess.

  Dermot whimpered and tensed before saying, “It’s feckin’ hot.”

  Fingal said, “Can you thole it, Dermot?”

  The little lad looked up. “I could for another couple a bits of clove rock.”

  Fingal smiled, and as Doctor Corrigan knotted the ends of the sling to keep the poultice in place, he put another hard candy into Dermot’s open mouth, just the way a mother bird would pop a worm into a chick’s beak. “Good lad,” he said. “Now that wasn’t too bad, was it?”

  “One last thing,” Doctor Corrigan said. “Toxoid, please, Doctor O’Reilly.”

  Fingal rummaged in t
he bag, found a stainless steel box and a glass ampoule. He went to the table, turned his back to Dermot, and started to draw tetanus toxoid into the syringe.

  Fingal ignored Dermot’s cries of, “Lie across yer knee wit’ me pants down? The feck I will,” and didn’t even turn to see what was going on.

  Fingal held the syringe vertically and pressed on the plunger to expel any air. A few drops of toxoid dribbled from the needle’s end.

  “Come on now, Dermot,” Mrs. Finucane said, “be a good boy.”

  Fingal concentrated on his own task, not wanting to hurt the child but realising that there was a real risk of tetanus, which could happen anywhere from eight days to several months after an infection began from bacteria in animal faeces. The toxoid had been available since 1924 and its use as a vaccine had reduced the number of cases and was steadily bringing the death rate down. Even if a child had been immunized, it was wise to give a booster dose after an infection when it was possible that the spores of the causative organism had entered the body. It might not prevent the disease, but it could reduce its severity.

  He turned to discover that Doctor Corrigan had Dermot over his knee with his pants half pulled down. Mrs. Finucane was holding Dermot’s head between her hands. Fingal took a deep breath. It was the work of moments to give the toxoid by intramuscular injection.

  Dermot yelled, “Yeeeaagh, youse poxy bollixes. Stop it. Dat feckin’ hurts.”

  Fingal flinched. He knew it did. He finished and withdrew the needle.

  Not even Dermot’s screeching had any effect on the snores coming from the far end of the room.

  Mrs. Finucane said, “Less of your language, Dermot, or you’ll get a warm ear.”

  “It’s all right,” Doctor Corrigan said, pulling up Dermot’s pants and explaining to Mrs. Finucane, “It’s to prevent lockjaw.”

  “You say you’re sorry to the nice doctor for that mout’ful of rubbish or I’ll wash your mout’ out wit’ black soap.” She was standing hand on hip, lower jaw set.

  “Sorry, Doctor O’Reilly,” Dermot muttered, rubbing his backside before he sat down.