The phone in the hall rang and was answered.
Barry cocked his head and listened.
Kinky appeared. “Doctor Laverty, it does be that nice Mister Mills from the Royal. He says he’d like a word.”
“Right. Thanks, Kinky.” Barry rose. Jack had phoned last Friday after Bertie Bishop had been admitted to the Royal. A barium meal was scheduled for Monday, and Jack, a fully qualified surgeon, was sure the diagnosis of gastric ulcer was correct. He had gone on to say Helen couldn’t get free on Saturday so there’d be no night out for the four of them.
Barry took the receiver. “Jack? What’s up?”
No pleasantries. “Barry, I’ve some bad news. Your gastric ulcer.”
Bertie Bishop. Barry was always irritated how surgeons thought of their cases as diseases, not the humans who suffered from them. “What’s wrong?”
“He’s just come back from X-ray. No ulcer crater, I’m afraid, but there is a filling defect on the greater curvature.”
“God.” Barry flinched. Bertie would have been asked to swallow fluid containing barium, which was radio-opaque. If the man hadn’t liked taking all that milk and bicarbonate, he had undoubtedly not been thrilled with the barium. Still, it allowed an enhanced X-ray in which the stomach would appear as a completely white area because no rays would have penetrated. If a dark patch appeared, the barium had not travelled there because something was filling the space already. The most common lesion was gastric carcinoma, and according to Barry’s textbooks, the prognosis was among the worst for all kinds of carcinomas. “You sure?”
“Aye. There’s a defect alright, but we’ll not know for certain what it is for about a week or so, after we have some more data. I’m doing the gastroscopy tomorrow.”
“May I observe?”
“Sure. Tell you what. I’ll do him last. It won’t delay us getting the path report. I’ll explain that to your patient. Try to reassure him. Maybe the pair of us could nip out for a jar and a bite after? Gotta run now.” He hung up before Barry could say thanks or get more details about what Jack thought the defect might be.
That had been decent of Jack to say he’d have a word with Bertie. Lots of surgeons wouldn’t have bothered. Specialists like his friend dealt with so many more life-threatening diseases than GPs, the former perforce must develop thick skins. Under O’Reilly’s tutelage, Barry, even after four years in general practice, never would. If he did join Jack later, Barry reckoned he’d not have much appetite if things looked ominous.
“Hi, Barry. Long time.” The familiar voice pierced Barry’s memory of yesterday morning. A white-coated Harry Sloan, friend, classmate, and now a fully qualified pathologist senior registrar, was standing at the bottom of the stairs. “What brings you here?”
“Harry. Good to see you. A patient—who I hope won’t be one of yours for a very long time.”
“Suits me,” Harry said. “Mine don’t have anything to say anyway.” He grimaced. “But you seem a bit…” Harry rocked his right hand, palm down, from side to side. “Nyeh…”
For as long as Barry’d known Harry Sloan, he had punctuated his sentences with that peculiar nasal sound.
“No, I’m none too sanguine about the outcome.” Barry knew he sounded down.
“While the sick man has life, there’s hope,” said Harry. “Some ancient Roman said that about two thousand years ago and it’s still true. Have you time to talk about it?”
Barry looked at his watch. “Yeah. About fifteen minutes.”
“Come on. I’ll buy you a cup of coffee.”
Barry turned and the two men walked back to the canteen. While Harry joined a short queue at the cashier, Barry took a seat at a table in an alcove under the yellow arches that supported the floor above. The place was full of nurses, medical students, junior doctors, physios, radiographers. He wondered how many late-night snacks he’d taken here during his student and houseman years.
“Here you are, mate.” Harry handed Barry a cup and saucer, sat, and lit a cigarette. He coughed. “Time I quit,” he said.
Barry said nothing. He knew from personal experience how difficult that was.
“Right,” said Harry, blowing a perfect smoke ring, “what’s getting you down?”
Barry shrugged. “One of my patients had stomach trouble. Sounded like a gastric ulcer and we treated him at home. He’s late middle age. It got worse, vomit bloodstained. To cut a long story short, his X-ray looks ominous.”
“Haematemesis? Fifty plus? Cancer ’til proved otherwise. I’m sorry, Barry.” Harry frowned. “I know how you worry about your patients, man, but come on, you’ll never save them all.”
Barry inhaled. “It’s not that. I can cope with it, but do you know a Doctor Emer McCarthy?”
“Class of ’67. Petite blonde. She trained at the Mater, but came here to attend the six mandatory postmortems. I did them all. Nyeh. Nice girl. Bit unsure of herself, though.”
“That’s the problem. She’ll be with us as a trainee for a year. Blames herself because it wasn’t until the patient was seen for the third time that a course of action was pursued that led to the present working diagnosis. You should have seen her face after Jack called me yesterday to tell me and I explained to her and O’Reilly what our man’s problem looked like being.”
Emer McCarthy had gone as white as Kinky’s starched tablecloth and said, “It’s all my fault. Damn it,” chucked her napkin on the table, and fled. And nothing O’Reilly or Barry had said to her later seemed to comfort her.
“Her confidence is rattled.” Barry remembered a patient of his in 1964 in whom he had missed the diagnosis of a serious disorder. It had taken Barry quite a while to recover his own faith.
“Aye. We’ve all done it, Barry. We all had to grow out of it.” Harry chuckled. “No, that’s not entirely true. I don’t think I ever did, and that’s why I’m a pathologist. We don’t have to know the customers as real people.”
“I’m worried we’re not going to have Emer as a GP, and she’s terrific with patients, especially kiddies.” Barry finished his coffee, feeling its acid in his stomach.
Harry blew out his breath through pursed lips. “I’m not very sure how to advise you, pal.” He stubbed out his cigarette. “Once when we were students I made a mess of an obstetric patient. Didn’t recognise that she had a piece of retained placenta. She had a nasty postpartum haemorrhage. Wondered if I should quit medicine. You remember Buster Holland?”
“Senior tutor, Royal Maternity.”
“That’s him. Anyway, he got her transfused, stopped the bleeding. She recovered, but I was pretty low. Buster tried to cheer me up, even had me round for dinner with him and the missus. Just having a senior give a damn helped.”
“There’s a thought,” Barry said, finishing his coffee and rising. “I’ll see what Sue and I can do.” He rose. “Now I’d better run along to the theatre.”
* * *
Barry stood behind Jack Mills. The theatre sister stood at the opposite side of the operating table with an instrument trolley. All were in white rubber ankle boots, scrub suits, masked and gloved but not gowned. Full aseptic technique was not needed for a gastroscopy.
Bertie Bishop lay on his left side beneath a blanket. At his head the anaesthetic senior registrar, Dennis Coppel, tended his machine that with regular hissing sounds was breathing for Bertie and delivering a mixture of oxygen and the gases through a tube in his trachea.
“You can go ahead, Jack,” Dennis said.
Barry watched as the sister handed his friend a narrow steel tube. A cable ran from it to a box on a trolley near the table.
“That’s the great advance,” Jack said, pointing at the box. “In the Stone Age we got illumination from a tiny bulb at the far end of the scope. Bloody things kept burning out just when you were seeing what you wanted to see. Now there’s a more powerful light source in that box and the light is transmitted along fibreoptic cables. Much better. The gynae boys are way ahead of us in endoscopic techniques, but
we are catching up.” He said to Sister, “Alright. Here we go.”
Barry kept out of the way as Jack manoeuvered the scope into Bertie’s mouth and advanced the thing along the oesophagus.
“I’m in the stomach,” Jack said. He bobbed and twisted, clearly searching. “Mucosa’s a bit inflamed. Probably has had a touch of gastritis.”
Emer will be pleased to hear that, Barry thought. I am, if only from professional pride.
“Aha. Aha. Barry.” Jack held the telescope steady, but stood aside. “Take a keek.”
Barry bent and put his eye to the eyepiece. He was peering down a shiny tube, and in the field at its end he could see a circle of red stomach lining. A structure with an expanded tip was attached by a stalk to the lining. Was that cancer?
“You’re looking at a polyp, and it’s the only one as far as I can tell,” Jack said. “Now, let this dog see the rabbit.” He took control. “Biopsy forceps please, Sister.”
Jack inserted a long flexible tool with cupped jaws at its far end and scissor grips at the near end into a port on the gastroscope’s side. He threaded it in, manipulated it until satisfied, then closed the scissor handle. “Got it,” he said. “The whole polyp at its base.” He removed the forceps and the enclosed specimen.
Sister held out a specimen jar and Jack dropped the sample in. “Cautery.”
Sister took the biopsy forceps and handed Jack another instrument connected by wires to a diathermy box. He inserted the probe, and when satisfied stood on a foot pedal.
Barry heard the buzzing as Jack passed current to cauterise the site of the biopsy and thus stop any bleeding.
“That’s her,” Jack said, withdrawing the scope and its contained cautery. “One bleeder grilled to well done. Thanks, everybody. All finished. You can wake him up, Dennis.”
Jack walked to a pedal bin and stripped off his gloves, motioning for Barry to do the same. Barry followed his friend to the changing room. “So? What do you reckon?”
“You remember the story about the four doctors who went wildfowling?” He took off his theatre shirt and slipped into his regular one. “When a bird appeared, the physician said, ‘Flies, quacks, and looks like a duck.’ By the time he’d finished describing it, the bird was out of range.”
Barry dropped his theatre pants into a laundry basket and stepped into his trousers. “The radiologist described how the next bird appeared from the various views an X-ray specialist would take. Same outcome. Bird got away.” Jack sat to tie his shoelaces. “Then it was the surgeon’s turn. ‘Blam.’ He picks up the dead bird, hands it to the pathologist, and says, ‘Tell me, have I just shot a duck?’”
Barry laughed as he finished knotting his tie. “You mean we have to wait for the path report.” He already had reckoned as much, but had hoped Jack, who would have been doing gastric biopsies week in, week out, might have a favourable answer.
“Exactly,” Jack said. “I’d like to keep him in until then. See if we can keep him comfortable. Sometimes removing a polyp does the trick. Makes the patient pain free.”
“I hope it does.”
“Anyway,” said Jack, “talking about ducks has given me an urge for some Chinese duck with taro. Fancy some? Helen and I go to the Peacock a lot.”
“Fair enough. Lead on.”
Jack opened the door to the surgeons’ lounge. The hum of conversation was loud. Barry recognised some of his teachers and exchanged pleasantries with Sir Ian Fraser, Mister Willoughby Wilson, and Mister Ernie Morrison. Their junior assistants were strangers to him. Lord, he thought, I’m starting to feel older than these fresh-faced, enthusiastic kids.
He couldn’t help but hear Sir Ian say to Mister Wilson, “You mean this new Cameron Commission, the one that’s being struck to investigate the Burntollet business, is going to include the dean of the medical faculty, our own Sir John Henry Biggart?”
“They announced it last Wednesday.”
Barry wondered what good an inquiry would do, but perhaps it was still better than doing nothing.
“Come on,” Jack said as they left the theatre suite. “It’s not far to the restaurant. I’ll explain about gastric polyps on the way.”
“I’ll drive,” Barry said, “then run you back up here to get your car when we’re done.” He sighed. “At least when you get your Chinese duck with taro you’ll not have to wait for more than a week for a pathologist to tell you what it is.”
21
We Returned to Our Places
“That’s probably Alice Moloney with your trousers, Fingal,” Kitty said as the front doorbell rang. “Didn’t she say she’d be happy to drop them off today when she takes her walk after closing the shop?” Fingal looked up from Forfeit by Dick Francis. It took him a moment to disentangle himself from the world of murder and horse racing scandals in London to arrive back in the upstairs lounge of Number One Main, Ballybucklebo. “Right,” he said, rising from his chair. “I’ll go.”
He trotted downstairs, whistling a snatch of the “Flower Duet” from Lakmé. Emer was on call and out seeing a child with what sounded like croup. Barry was up in Belfast. And when O’Reilly had thanked Alice, he’d happily go back upstairs for his and Kitty’s preprandials. Kinky’s beef cobbler was warming in the oven and the house was filled with the smells of beef, bay leaf, and red wine.
He opened the door. “Good evening, Doctor O’Reilly.” Alice Maloney’s powder blue woollen knitted hat sat at a jaunty angle and matched her full-length overcoat. The high, frilly collar of a white blouse showed at her throat. His trousers were folded over her left arm. “I’ve brought your trousers.”
“Thank you, Alice. Come in.” O’Reilly moved aside.
She stepped into the hall with, O’Reilly noticed, her usual regal bearing. Alice Moloney was one of the last remnants of the British Raj having grown up in India before the war. O’Reilly closed the door. “How are you?” he said, accepting the trousers and setting them neatly on a chair. “And how much will that be?”
“Bless you, Doctor, but Kinky has paid me already.”
“Of course,” O’Reilly said. Even though Kinky had moved out three and a half years ago when she married Archie Auchinleck, O’Reilly still gave her weekly housekeeping money to pay for necessities at Number One.
“And as to how well I am, ever since your delightful Doctor Laverty cured my anaemia in 1965 I have been perfectly fine, thank you.” She permitted herself a little sigh. “I was upset last November when Billie Budgie, my budgerigar, died, but life must go on. And so must I. I suspect you and Mrs. O’Reilly are relaxing after a long day of work. I’ll be on my way.” She started for the door, but was forestalled by the ringing of its bell.
“Excuse me.” O’Reilly stepped in front of Alice and slowly opened the door. “Good lord.”
Doctor Ronald Hercules Fitzpatrick stood on the doorstep. A tall, gangly man, he wore a grey trilby and a dark worsted overcoat. His gold-framed pince-nez perched on the bridge of his narrow nose, and his prominent Adam’s apple went up and down as he swallowed.
“Ronald. Ronald Fitzpatrick.” O’Reilly offered his hand. “Come in. Come in. How in the hell are you?”
The man took O’Reilly’s hand as he stepped across the threshold. “How do you do, Fingal? I hope this isn’t an inconvenient time. I just got back from Nepal on Saturday. I bought a car yesterday—a little Citroën 2CV—and was driving by and thought I’d pop in to say hello.”
“We were half expecting you, Ronald. We got your Christmas card and letter and—”
Alice Moloney stepped to O’Reilly’s side, smiled, and said, “Good evening, Doctor Fitzpatrick.”
O’Reilly heard the pleasure in her voice and remembered the party after the rebuilding of O’Reilly’s dining room in March 1967, at which Alice and Ronald had been guests. The two had seemed to be enjoying each other’s company that night. But that was before the man had decided to move five thousand miles away.
Both were single. Alice had been shattered by the early
death from leukaemia of a young subaltern in Skinner’s Horse in India. She had never married. O’Reilly had always suspected that when they were students Ronald had harboured a secret longing for Nurse Kitty O’Hallorhan, now O’Reilly. Both Alice and Ronald were interested in matters Oriental.
“Miss Moloney. I didn’t see you there behind Doctor O’Reilly.” Fitzpatrick raised his trilby, as a gentleman would to a lady, and made a little bow. “How very pleasant to meet you. I do hope I find you well.” He replaced his hat and straightened up. The hall light was reflected from his pince-nez.
“Very well, thank you. And thank you for your recent Christmas card and letter. I particularly enjoyed the photographs of Mount Everest.”
Letter, O’Reilly thought. Have they been corresponding? Might Alice Moloney be part of the reason for Ronald missing Ulster?
“Yes. I was very lucky to get them. Many of the monks in the Tengbuche Monastery are of the Sherpa people. A brother of one of them had been part of the British 1953 expedition, the first to climb Chomolungma, ‘Goddess Mother of the World’—that’s what the Sherpas call Everest. He gave me some pictures.”
“Goddess Mother of the World,” Alice said quietly. “I suspect being on top of that mountain would be the closest one could get to heaven.”
Ronald smiled and said, “As long as one had a full oxygen tank.”
Alice looked wise and said, “Indeed. I quite remember how sad I was over the deaths of Mallory and Irvine in 1924. Such young men. The mountain has fascinated me ever since. And you have actually seen it.”
“Every day, unless it was hidden by clouds or it was snowing.”
“How lovely.”
O’Reilly heard the restrained enthusiasm in the woman’s voice and came to a decision. Far be it from him to play matchmaker, but the two seemed so interested in each other that they appeared to have forgotten he was there. He cleared his throat. “How would you both like to come up for—” He hesitated. One of the reasons Ronald had gone away was gambling, the other was his drinking. “A cup of tea?”
An Irish Country Cottage Page 20