Barry said, “I’m sorry, Emer.”
“Don’t worry. These things happen. I’ll get over it.”
“I know. They’ve happened to me too, and you do.”
She smiled. “I’ve always enjoyed seeing the new year in, but not all alone. Fingal and Kitty have a terrific knack for making folks feel part of the family, and everyone seemed to be into the spirit of things.”
Barry laughed. “Including another patient on today’s rounds, Bertie Bishop. Heart and soul of the party last night. He might be a bit under the weather too today.”
Emer cocked her head. “Somebody else feeling it?”
“Just a tad.”
“Self-inflicted injury.” She laughed and said, “The drink didn’t seem to affect Fingal much.”
“Fingal? Iron constitution, that man. He and Kitty are tramping around Ballybucklebo Estate this morning at a pheasant shoot.”
The light changed and he drove off, slowly because the tractor was trundling along ahead of him.
“I’d better fill you in on our first patient, Willie Lindsay, and his family. Seven years ago, Eileen Lindsay’s husband left her with three chisslers to raise. Her oldest, Sammy, had Henoch-Schönlein purpura in ’64.” He smiled. “That was the year her kids managed to lose all the money she’d saved for their Christmas presents.”
“Good God. What did they do?”
“I’ll tell you the story sometime. But for now, I’ll just say O’Reilly and Donal Donnelly managed to get the money back for her. I seem to recall she also got a turkey into the bargain. We all thought she was going to marry the poulterer, but…” He shrugged. “As if being a single mum wasn’t enough, I gave her acute porphyria in ’67.”
“Reaction to barbiturates?”
That was sharp. “Mmm.”
“Hardly your fault. Could happen to a bishop—if bishops prescribed medicines rather than prayers.” Her chuckle was deep and throaty. “That condition is rare.”
“I know,” he said, turning onto the housing estate. “And luckily she’s not had any recurrences.”
“Glad to hear it.” Emer looked around and said, “It’s not the first time I’ve been here, but golly, it’s a pretty dismal place.”
“Thrown up as council subsidised housing immediately after the war.”
Even though today was sunny, the Ballybucklebo Hills blocked the light from entering the narrow streets. Discarded cigarette packets and fish-and-chip wrappers clogged the gutters. Barry had to park down the street from the Lindsays’ front door because a strange car, a white Ford Anglia, was already there, which was unusual in the estate. Few residents owned cars. He got out, noticing the cigarette butts and the chewing gum wads like so many leprous sores sticking to the pavement. Two little lads tore past on scooters, each boy frantically pumping one foot onto the ground to propel his little two-wheeler along.
“Happy New Year, Doctor Laverty,” one yelled in a high-pitched voice.
“Happy New Year, Micky, Sean,” Barry said to the lads’ departing backs. “And be careful.”
The Bolton twins lived one street over. Their dad was an iron worker at Mackie’s Foundry in Belfast.
Emer joined him, and as they walked to 31, Eileen Lindsay appeared at the front door.
“Saw you from the window. Come on in,” she called. “Thanks for coming so quick.”
“Eileen, this is Doctor Emer McCarthy.”
“Pleased til meet yiz, Doctor. You’d be the new trainee?”
“I am. I hope you don’t mind me—”
“Mind? Doctor, dear, sure we all have til learn our trade.” She ushered them into the cramped hallway. “Come on on in. I’ve Willie teed up on the sofa in the parlour. I sent Mary and Sammy til Bangor. Sammy’s sixteen now, all grown up. He’s taking his wee sister til the Tonic Cinema til see Chitty Chitty Bang Bang. It’s a special kiddies’ new year morning matinée, so it is. And I told him straight off that he and his sister was not to eat too many sweeties.” She opened a door to the right of the hall.
Barry winced when he thought about his last encounter with Sammy Lindsay, but he quickly directed his attention to a tow-haired boy, lying on a sofa under a red woollen rug. His back was to Barry and the lad seemed to be asleep.
A clean-cut man in his early thirties, brown hair neatly combed and parted, necktie carefully knotted, trousers creased, and black shoes highly polished, stood up from where he’d been sitting by the coal fire.
“This here’s my…” Eileen hesitated. “… friend…”
Barry heard endearment in her voice. Could some good things be happening in Eileen Lindsay’s life?
“My friend Mister Gordon McNab from Cultra, and these folks is two of our doctors, so they are, Gordy.”
“Dead pleased til meet youse both,” Mister McNab said.
Barry inclined his head. “How do you do, Mister McNab.” So this must be the owner of the car outside. Barry unbuttoned his coat. The small room was warm. Cards filled the mantelpiece over a coal fire and a tinsel-decked tree occupied one corner of the room.
“Would youse not like me to make myself scarce so youse can do your jobs?” the man said.
Barry shook his head. “No need if Eileen doesn’t mind…” He saw her shake her head. “And Doctor McCarthy will be doing the work.” He stepped aside. “Sit you down, both of you. I’m sure my colleague would like to ask you some questions, Eileen, before she examines Willie.”
Eileen sat on the edge of an armchair. Her knees were together and one hand grasped the other in the lap of her calico pinafore.
Emer pulled over a plain wooden chair and sat in front of Eileen. “When did you notice something wrong with Willie, Mrs. Lindsay?”
“He was off-colour yesterday, so he was.”
“In what way?”
“Said he’d a sore throat, and he shivered a bit, threw off once.” She glanced at Gordon McNab. “Me and Gordy reckoned it was too much holiday grub. We give him aspirin and waited a wee bit.”
I wonder if Mister McNab stayed overnight? Barry thought. I hope so. I’d be delighted to see Eileen in love with a new father for her children.
“But when he was no better this morning, we reckoned we’d better send for you.”
“And you were right, Mrs. Lindsay,” Emer said. “Did you notice anything else?”
“Aye. His tongue was all,” she frowned, “I don’t know if it’s the right word, but it looked sort of furry this morning.”
Kids were very susceptible to thrush infection with the fungus Candida albicans, and to stomatitis, which could be a result of infections, nutritional deficiencies, and allergic reactions. Some of the childhood fevers could have that effect too. Barry wasn’t ready to make a firm diagnosis yet.
“Anything else?” Emer said. “No more vomiting? No tummy aches? No skitters?”
Barry smiled. It had taken O’Reilly to teach Barry to talk to patients in a language they’d understand. Emer already knew that, and was using “skitters” instead of “diarrhoea.”
Eileen shook her head. “No, Doctor.”
Emer rose. “Better take a look.”
Barry hesitated, not wishing to embarrass Emer but recognising it was his job to teach, and the information was important. “Eileen, has Willie had any other fevers?”
“Aye. He’d the red measles in ’62. Doctor O’Reilly looked after him. That’s all. He’s never had the mumps nor them German measles.”
And measles is one condition we can probably take off the list of possible diagnoses, Barry thought. Emer should have asked that. Hardly a killing matter, and she is a trainee. He noticed that she was blushing.
Eileen stood, went to the sofa, knelt, and gently shook Willie’s shoulder.
The boy stirred, rubbed his eyes, and sat up. The blanket dropped off his shoulders to reveal a red-and-white-striped pyjama jacket—and a red rash on his ears and the sides of his neck.
Getting warmer, Barry thought. Closer to an answer.
“M
ammy,” Willie said in a hoarse voice. “My throat’s awful sore, so it is, and I’m foundered.” He shivered.
It was a paradox. Patients with high fevers often felt cold.
“Nice Doctor Laverty and this here lady doctor has come til make you all better, so they have.”
Willie sniffed.
Emer squatted in front of the boy. “Hello, Willie,” she said, “I’m Doctor Emer. I’d like to help you.”
Barry liked that. Using your title was important to establish your bona fides. Only using her Christian name was setting aside some of the formality, which could be daunting to a child.
Willie nodded.
“How old are you, Willie?”
“I’m twelve, so I am.” There was pride in the boy’s voice. Emer quickly established that Willie still had the symptoms Eileen had described.
Well done, Barry thought. Twelve-year-olds should be allowed to tell their own story.
“Let’s have a look at you,” Emer said. “Open wide and stick out your tongue, please.” She looked at it closely. For Barry’s benefit, she said, “White fur, starting to peel off at the edges.” She fished out a pencil torch and tongue depressor. “Open wide and say, ‘Aaah,’ please.”
“Aaah.”
Emer depressed the young lad’s tongue and shone the light inside. “Tonsils red and swollen, some yellowish exudate…”
That was certainly narrowing things. Barry was 90 percent certain.
“No Köplik’s spots, so no red measles.” She removed the depressor. “You can close it now, Willie. Doing okay?”
“Yes, miss.”
That was thoroughness. Eileen’s memory of red measles might have been wrong or, perish the thought, so could O’Reilly’s diagnosis in ’62.
Emer took out a thermometer and shook the mercury down. “Pop that under your tongue please, Willie.” She took his pulse. “One hundred and forty.”
Barry nodded. That was very rapid.
Emer removed and examined the thermometer. “One hundred and three.”
Those two figures taken together practically clinched the diagnosis for Barry.
Emer said, “Now, let’s get a look at your chest.”
Eileen unbuttoned her son’s pyjama jacket. The skin over his ears, neck, chest, and shoulders was bright scarlet.
Emer leaned closer. “He’s covered in tiny red spots and—” She pushed her right index finger against his right shoulder. “—they blanch on pressure.”
“That rash wasn’t there this morning, I swear,” Eileen said.
“And he first got ill yesterday, right, Mrs. Lindsay?” Emer said.
The woman nodded. She looked as if she was trying to swallow down tears.
“A rash like this typically appears on day two of this type of illness, Mrs. Lindsay, so you wouldn’t have seen anything yesterday, or even this morning.”
Emer quickly finished the physical examination. Barry knew she was looking for enlarged lymph glands in the neck that might indicate complications such as bronchitis or pneumonia.
Emer straightened up, put her stethoscope away. “Button up your jacket, Willie.”
“Yes, miss.”
Emer said, “Mrs. Lindsay, Willie has got scarlet fever. It’s caused by a germ called haemolytic streptococcus, which is infecting his throat. The little beast produces a special substance…”
Good lass. “Toxin” or “poison” would have scared Eileen.
“… that produces the red rash.”
“And is it serious, Doctor?” Eileen asked.
Tough question, Barry thought. It could be. Let’s see how Emer handles this.
She looked Eileen straight in the eye. “Mrs. Lindsay, all diseases can be, but,” she turned to Willie, who was staring at her with his mouth open, “you are a lucky boy, Willie Lindsay. You’ve only got a mild case and we’ll have you better in no time.” She smiled.
I think you’re right, Emer, Barry thought, and no point scaring the hell out of them listing all the rare, but potentially crippling or lethal complications. O’Reilly preached that one part of any good doctor’s job was to spare the patient as much emotional suffering as possible, even if it meant putting your own reputation at risk if it turned out you were wrong.
Willie’s mouth relaxed closed and his mother smiled for the first time since they’d arrived. “That’s great, Willie. Only a mild case. Isn’t that great, Gordy?”
“I’m dead pleased for youse both,” Gordon McNab said. “Couldn’t be more pleased if you were my own wee boy, Willie Lindsay.” He spoke to Barry. “I’m a bachelor man.”
Barry hid his smile. He could practically hear the unspoken words: “But I hope I won’t be for much longer.”
Emer was scribbling on her prescription pad. Treatment options were either oral phenoxy-methyl penicillin 250 mg or benzyl penicillin 250,000 to 100,000 units intramuscularly for severe cases. Those injections were painful.
“Here.” Emer handed Eileen the scrip. “Penicillin. Willie’s to take one tablet four times a day for a week. I want you to put him to bed, keep everybody away until the rash is gone.”
Gordy said, “I had it when I was a wee lad. We didn’t have no antibiotics then, but I got over it just fine.”
“I never did,” Eileen said. “Have it, I mean.”
“And I’d not be worried that you’ll get it from Willie,” Emer said. “Fortunately, it isn’t very contagious. Most kids, about eighty percent, are naturally immune by the time they’re ten. Even so, if your other two do show any symptoms, let us know, and to be on the safe side, don’t let anybody use anything Willie’s used. Wash those things in hot water at once. And keep warm water, soap, and a towel in his room so you can wash your hands after every time you see him. You’ll need to top it up with a kettle to keep it warm.”
“I’ll do that, Doctor,” Eileen said.
“Can you gargle, Willie?”
“Aye, miss.”
“Good. Your mammy will put a tablespoonful of salt into warm water for you. Three times a day during the hours Willie’s awake, Mrs. Lindsay. It’ll make your throat not as sore, young fellah.”
“Thanks a million,” Eileen said. “Now, son, say thank you.”
“Thanks, Doctor Emer.”
“Right,” said Barry. “We’ll be running along. Is there anything you’d like to ask Doctor McCarthy, Eileen?”
“No, Doctor Laverty. We’ll get this filled right away, so we will.”
“Good. We’ll be off then. Someone will pop in tomorrow, and don’t hesitate to call if you’re worried.” He headed for the door. “We’ll let ourselves out.”
As Barry and Emer were leaving, he heard Mister McNab say, “Give us the scrip, love. I’ll go straight round til the chemists. I’ll not be contagious. Like I said. I’ve had it.”
Barry’s heart swelled for Eileen Lindsay, who McNab had called “love.”
As he turned the Imp onto the Belfast to Bangor Road and started heading back to Ballybucklebo, Emer said with a stiffness in her voice, “Doctor Laverty, I’m sorry I neglected to take the previous history, but I’d already noticed the classic rash on the boy’s ears. I don’t think you could see it from where you were. That and the current history were yelling scarlet fever at me. I just wanted to get on and make a diagnosis.”
Barry turned the wheel of the car sharply to avoid a red squirrel that had darted across the road and felt his face heat up with embarrassment. The woman was right. “Emer, first of all, it’s been Barry since you arrived, except in front of patients. Second, your point’s well taken. I apologise for correcting you in front of the customers.”
“No apologies needed, Barry, and if you’re wondering why I didn’t explain that the skin over the rash will all start to peel off in about a week, I thought I’d given them enough information to handle today. I’ll tell Eileen on a follow-up visit to expect the exfoliation.”
“Makes sense. I thought you did very well. I think you’ve learned a lot they don’t teac
h in the big hospitals. You’re going to be a fine GP. One thing though.”
“Yes?”
“You gave Eileen good advice. I’ll just remind you to take it yourself at our next call.”
Emer frowned. “You mean to be sure to wash my hands with soap and warm water? As if we’d not do that after examining an infectious disease patient. I do know that, you know.” She laughed. They were both chuckling when the traffic light turned as red as the rash on Willie Lindsay’s chest.
6
The Whirring Pheasant Springs
“Do you remember the first time I brought you to his lordship’s annual pheasant shoot, in ’65?” O’Reilly said to Kitty as he drove up the twisting gravel drive to Ballybucklebo House. The usually immaculate lawns were overgrown, but the expenses of running the estate had been mounting and Lord John MacNeill, Marquis of Ballybucklebo, was having to cut back.
“Hard to forget,” Kitty said. “Bertie Bishop tried to hit a running pheasant and nearly shot us instead. You, my knight in shining armour, threw me to the ground and lay on top of me.”
“Pure reflex. I’d have done it for anyone,” O’Reilly said, but he tingled when she squeezed his thigh and said, “But you did it for me, old bear, and I loved you for it.”
O’Reilly smiled as the Rover trundled past the creeper-covered gable end of the big house. The mellow reds of its autumnal foliage were gone and now only the filigree of its tendrils clung to the masonry. He passed under a high arch of Mourne granite blocks into the cobbled stable yard and parked.
It had taken him some time on outings like this to get used to the fact that Kenny had not developed old Arthur’s habit of muttering and yipping with barely restrained excitement once the car had left the paved road. O’Reilly looked into the backseat, where Kenny sighed, stretched out, and put his head on his forepaws.
O’Reilly and Kitty got out and O’Reilly opened the boot. The first drive would be starting soon. He handed Kitty a shooting stick. The flat, broad handles could be opened to lie at ninety degrees to the shaft and make a seat. A flat, circular flange, six inches from its sharp metal point, could also be unfolded to prevent the thing from sinking too far into the ground. “Here you are, love. You can get a rest on that during the drives.” He was aware of the scents of horses and the acrid tang of coal smoke drifting from three of the big house’s chimneys.
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