An Irish Country Cottage

by Patrick Taylor

  “I am,” she said. “I’m sorry. I’m trying not to, but I can’t stop thinking I should have referred him to a specialist sooner. I know why you’ve invited me tonight.” She glanced at Barry, who had opened his mouth to speak. “No, it’s fine, Barry, I’m touched you want to help, but I’m not sure much can be done.”

  “Emer, you’re among friends,” Connor Nelson said. “You know that. B-Barry and I are your colleagues. You, Sue, by being Barry’s wife, are an honorary colleague too. Whatever you say, Emer, it will go no farther. Would it help you to talk about it?”

  Emer hesitated, looking from face to face. “I suppose it can’t hurt, but I feel I just have to pull myself together and somehow live through this next week before we get the results.” She drew in a deep breath. “I’m just not sure I’ve got what it takes to be a doctor. I thought I’d made a mistake with that little boy with strep throat and scarlet fever.” She managed a weak grin in Barry’s direction. “Both Fingal and Barry—thank you, Barry—managed to persuade me to try to stop blaming myself. It helped. A lot, but then this patient who seemed to me to have a simple alcoholic gastritis…”

  Barry bit back the urge to interrupt again and tell her he’d thought so too, but no need to plough that furrow twice. Better to let her talk.

  “Then it looked more like a gastric ulcer, and I didn’t get an X-ray until treatment at home failed.

  “Now he’s had a polyp removed—and it could be cancerous.” She sat stiffly and stared into the fire, a posture Barry interpreted as being one of self-control. By the way her voice had cracked, he thought she might be close to tears.

  “And you think it’s your f-fault, Emer?” Connor asked.

  She nodded.

  Barry glanced at Sue. She too was nodding in agreement. He smiled. She was such a soft-hearted woman. Another thought struck and his smile vanished. Was she identifying with Emer’s “failure,” applying it to herself because she hadn’t conceived yet? Sue had even less reason to blame herself than Emer did, but blaming ourselves seemed to be a human trait. Perhaps this evening wasn’t such a good idea.

  Connor had waited before saying, “And no amount of us telling you is going to help, is it?”

  Emer shook her head. “Barry’s already done that.”

  Connor said, “When will you get the p-path report?”

  “Sometime next week. The waiting’s killing me.”

  Again, Sue nodded. They weren’t seeing Graham Harley until next Wednesday.

  “I was at the gastroscopy,” Barry said. He’d broken the news of the polyp to Emer last Wednesday and at that time she’d not wanted to hear a detailed discussion. Nor had she raised the subject again, until now. “Jack Mills explained to me about gastric polyps. They’re not all malignant, you know.”

  “Maybe not. But I just can’t get it out of my head that Bertie Bishop’s probably will be,” Emer said.

  “Look, all three of us d-doctors know that the most difficult thing for p-patients to deal with is uncertainty.”

  “Without going into detail,” said Sue, “I can tell you I understand too. And the waiting.” She sipped her wine.

  Barry crossed the room and sat close beside her on the sofa. He’d learned how important physical contact was if someone needed comforting.

  “It’s hard for doctors as well. Emer, do you think if Barry told us some of the information Jack Mills has told him, that might help to remove a bit of the uncertainty? As physicians, we solve most of our patients’ problems by looking at the facts.”

  “I doubt it. I’m not sure hard data are going to straighten out what’s going on in here.” She pointed to her heart, then straightened her shoulders. “And that’s not self-pity either. I know I should have got Bertie Bishop seen to a week earlier, that’s all, but I’ll listen, Barry. It may help.” She took a sip.

  “Alright. Here goes.” Barry took a pull of his ale. “Jack said basically there are three types of gastric polyps. One is the hyperplastic kind, quite benign—often related to inflammation, and Bertie Bishop had had gastritis, Jack confirmed that at the gastroscopy.”

  “That’s true, I suppose,” Emer said.

  “Jack also said that most polyps don’t cause much in the way of symptoms. They’re picked up all the time during gastroscopies for anaemia, and you checked Bertie Bishop’s conjunctivae, Emer, remember? No anaemia.”

  She nodded.

  “And the investigation of bleeding. We did ask for specialist help and an X-ray as soon as Bertie had bloodstained vomiting.”

  “Sounds to me,” Connor said, “that you did all the right things.”

  “But too late,” Emer said. “I should have asked for help a week sooner.”

  Connor raised his shoulders. “I honestly don’t think a week is a matter of life and death, Emer, and if it’s alright with you, I’d like to learn a bit more from B-Barry.”

  “Fine by me.” She recrossed her legs.

  “There’s a second kind called fundic polyps. The patient grows a crop of them in the fundus at the stomach’s top end, but Bertie’s was in the lower curve of the body so Jack ruled them out.” Barry drank. “Finally, a single polyp like Bertie’s could be an adenoma, a growth from one of the glands in the stomach. They can be benign and stay harmless, but can go nasty or even start out like that.”

  “By nasty, you mean cancerous.”

  Barry nodded.

  “I’m convinced Mister Bishop’s has, and it’s my fa—”

  “No,” said Connor Nelson with great firmness. “No, it is not,” he emphasised the not, “your fault, Emer McCarthy. And I think if you want to survive as a doctor, you’re going to need to interrupt those kinds of thoughts the same way I just interrupted you. Your mind will take you down all kinds of unhelpful pathways—but only if you let it.”

  She looked at him long and hard before saying, “But how do I stop it? You make it sound as if I’ve a choice in the matter.”

  “You do have a choice, Emer. It doesn’t feel like it, I know, but you do have a choice. It takes practice, but you can replace that destructive thought with something more constructive.”

  “I know I take things to myself,” Emer said. “I know you’re both technically right. I do know it. Maybe I’m being too self-centred. Of course, I’m worried about Mister Bishop, but I’m also worried something I’ve done could cause someone—” She stopped abruptly and her voice dropped to almost a whisper. “—cause someone to die. It feels like such a huge responsibility, and those feelings aren’t always things you can control with logic.”

  “If we could use cold facts to sort out emotional upsets,” said Sue, “an awful lot of psychiatrists would be out of work.”

  Connor and Barry smiled and Emer managed a small laugh. “You’re right, Sue,” she said, “and while I appreciate that, I guess the facts do help relieve some of the uncertainty…”

  “I have heard that,” Sue said, and looked at Barry.

  Emer sighed.

  “Are you sleeping alright, Emer?” Barry wondered if low-dose barbiturates might help if she wasn’t.

  “Not too badly, and if you’re thinking about sleeping pills, I’d rather not.” She looked at the faces surrounding her. “What has helped me most tonight is how much you, my friends, care and are trying to help. Thank you very much.”

  Harry Sloan had had a point, Barry thought.

  “We do care,” Sue said. “Very much. We are all delighted if the talk has helped, even if only a bit, Emer. You’ll have the results by next week and we all pray the news is good and you can start to forgive yourself—even if, as I understand the medicine of it, you don’t need any forgiveness at all.”

  Barry could see his wife swallowing her own worries for the sake of another. I do love you so much, Sue Laverty. My poor darling. The next week is going to be hard for you, but you could try to follow the same advice Connor had given Emer to help you get through it. And if you’re not pregnant? At least they were seeing Graham Harley soon. There
would still be hope. He had to hold on to that too.

  Perhaps having Emer here hadn’t been such a bad idea after all.

  24

  That Bringeth Good Tidings

  “No,” Barry said to Emer as he parked outside the Bishops’ bungalow. “He’s your patient. You explain to him.”

  “Alright, Barry.”

  Flo Bishop answered the door, her face crumpling when she saw the two doctors on her doorstep. Her mouth sagged open as she clutched one hand with the other. “Is the news bad? They discharged him yesterday, they needed the bed, and Bertie said youse’ve to get his report soon. Is it bad? Tell me quick.”

  “No, Mrs. Bishop,” Emer said, “the news is very good.”

  “Oh, my God. My knees is weak.” Flo clutched the doorpost for support. Tears coursed down her cheeks and she gulped in a deep breath. “Honest to God?”

  “Cross my heart,” Emer said, and did. In Ulster, there was no more solemn assurance of something being the absolute truth.

  “Come on in,” Flo said. “I’ve got him all comfy in the lounge on the sofa.” Flo led the way, honking into a linen hanky that she replaced in the pocket of her blue-and-white gingham pinafore.

  A copy of the Belfast Telegraph was open on his lap, but Bertie Bishop was staring out across the dappled lough. A pilot boat was pulling away from an outward-bound freighter. The watery blue sky seemed to balance on the point of the Knockagh War Memorial high on Knockagh Hill above the little town of Greenisland.

  “Bertie?” said Flo.

  Barry watched the man’s face change from pensive to pale in a moment. But before Barry or Emer could speak, Flo had rushed to her husband, knelt, flung her arms round him, and kissed him soundly. “It’s good news, Bertie.” She released him and with some effort hauled her bulk upright. “Please, Doctors, sit youse down.”

  Barry took an armchair. Emer sat beside Bertie and turned to him. “Mister Bishop. You don’t have stomach cancer.”

  Bertie inhaled deeply then exhaled through half-closed lips. Colour returned to his cheeks. “Thanks very much, Doctor McCarthy,” he said. “Thank God for that. I was worried sick, so I was. I’m no doctor, but when a surgeon tells you he’s taken a growth out of you, you’d have til be thick as two short planks not til fret about cancer, even if the surgeon tells you not til worry.”

  Emer smiled. “You had, and I mean ‘had,’ because Mister Mills removed it completely, a condition called carcinoid.”

  Bertie and Flo both frowned.

  “And what’s that when it’s at home, then?” Bertie said.

  “You know that the human body is made up of different kinds of cells?”

  “Aye,” Bertie said, “just like a house is made up of different materials like bricks and slates and wood.”

  “Yes, just like that. As well as cells for making acid, there are other specialised cells in the lining of the gut that produce chemicals called hormones. Hormones are messengers in the body, sending signals to other cells, telling them to start or stop doing their jobs. And it’s those specialised cells that had started to turn into something that looks like cancer under the microscope. But I said looks like. That’s why it’s called carcinoid, not carcinoma.”

  Bertie sat up straighter. “Looks like, but isn’t?”

  “That’s right,” Emer said. “Some can and do go on to be, but many carcinoid tumours are found when they’re still benign and something else was being investigated. We all thought you had an ulcer until your X-ray. Mister Mills had to take a look at your insides to understand exactly what those findings meant, and that’s when the carcinoid turned up. They can cause tummy pains too.” Then she surprised Barry by saying, “I’m sorry.”

  Bertie frowned and said, “Pardon me? What are you sorry about?”

  “I think I should have sent you for that X-ray sooner.”

  Barry thought it took guts to tell a patient you might have been wrong.

  Bertie Bishop put a fist on his hip and thrust his face toward Emer. “Excuse me…?”

  It had been a while since Bertie Bishop had shown his cantankerous side, and Emer had never seen it.

  Barry watched her stiffen her shoulders. Tighten her jaw. Emer McCarthy might be insecure in her feelings about her abilities. She was no shrinking violet if she thought she was going to be attacked.

  Bertie Bishop said, “No harm til you, Doctor McCarthy, but you’re still an apprentice. You done your very best and I can’t see a week making much difference, even if the news had been bad. Isn’t that right, Doctor Laverty?”

  Emer relaxed and beamed and Barry exhaled slowly before answering. “Indeed, it is. Even Mister Mills agreed. The X-ray came as a complete surprise to all of us.”

  “There, you see. So, thank you very much, Doctor McCarthy. You can look after me and Flo any time you like. Now, is there anything more I need to know about this here carcinoid thingy?”

  Emer nodded. “The likelihood of its recurrence is nil, but if you’ve had one you might develop another—”

  “Aye?” Bertie asked, and frowned.

  “Mister Bishop,” Emer said, “I don’t want to scare you, but I do need to tell you what to look out for, and if anything does show up—pain, swelling of your ankles, diarrhoea, flushing—get in touch at once.”

  “It’ll be them hormones, Bertie Bishop, and you’ll be going through the change of life just like I done.” Flo giggled. “I’m so relieved I feel quite giddy.”

  “Mrs. Bishop is right. The effects would be produced by hormones, but not a lack of the ones causing menopause. It’s because you hadn’t had any of those other symptoms that we didn’t suspect carcinoid in the first place and are now as certain as we can be that nothing has spread into the rest of your body. And you can put your husband back on a normal diet next week, Mrs. Bishop.”

  Bertie’s “Dead on” came at once.

  “Finally,” she said, “Mister Mills wants to see you in three weeks and it is recommended that you come into the surgery for an examination once a year.” She tightened her lips. “I’ll not be here by then and I shall miss Ballybucklebo very much.”

  “And we’ll miss you, Doctor McCarthy,” Bertie said and, offering his hand, continued, “I’d like for to shake your hand and say thanks again for all you done, and the best of luck wherever your career takes you.”

  They shook and Emer said, “I appreciate that—Bertie. Very much.”

  Her broad smile warmed Barry’s heart.

  “Now is there anything else we can do for you?”

  “Not you, Doctor McCarthy, but I wonder, Doctor Laverty, if you could ask Doctor O’Reilly to do me a favour? I know you don’t like to talk about these things, Flo, so I’m sorry, pet, but that’s twice in three and a half years I’ve had a close call. That there week in hospital got me til thinking and I’d like to get an opinion from Doctor O’Reilly’s brother, the solicitor, about my will.”

  “Of course, I’ll ask Doctor O’Reilly,” Barry said at once. “Now, we should be running along.”

  “I’ll see youse out,” Flo said. “And I have til say, youse two has taken a load off my mind as heavy as thon Goliath crane they’re building at the shipyard can lift, and that’s going til be eight hundred tons. Bertie’s all I’ve got. I wish he’d not talk about wills, but och, it has til be done. Bless him for it. Now run off with you, and thanks again.”

  As they walked back to the car, Barry said, “Feeling better?”

  “Yes,” said Emer. “Much. I think I’m starting to understand that as long as I do my very best, it’s alright.”

  “I seem to recall Bertie Bishop saying exactly the same thing.”

  Barry held open the Imp’s door and waited for her to climb in, closed it, and walked round to climb in beside her. “You surprised me by telling them you thought you should have got an X-ray sooner. It was preached at medical school, in my day, that you never confessed your sins to the customers.”

  Emer laughed, a happy, tinkling sound like gl
ass wind chimes in a breeze. “Ah, but you’re a Protestant. Us Catholics believe full confession is good for the soul.”

  * * *

  Fingal O’Reilly set aside his after-breakfast cup of tea and lowered the morning’s Belfast Newsletter. “So,” he said, showing the front-page headline to Kinky. “What do you think about the big announcement yesterday? Is Ulster ready for an election in twenty days?”

  Kinky peered at the paper. “Stormont Parliament Dissolved. General Election February 24th.” Kinky would have described her sniff as being strong enough to draw a small cat up a chimney. “Being a Southerner, I find it polite not to offer my opinions here in the North, so, but seeing it is yourself, sir, and you being like a priest after confession when it comes to keeping your mouth shut—”

  O’Reilly smiled. “I am.”

  “Then I will tell you.”

  “Please do.”

  “I believe our prime minister is losing control of his Unionist Party. First it was his deputy, Mister Faulkner. He said he was quitting to protest against a ‘lack of strong government.’ Then the minister of health quit too, for the same reason. They don’t think Captain O’Neill is cracking down hard enough on the Republican troublemakers.” She sniffed. “I think Captain O’Neill wants to bring in reforms and end discrimination, but too many of his MPs are staunch Loyalists. ‘Not an inch, no surrender’ I’ve heard them say on the television. They want to give up nothing nor lose none of their side’s privileges.”

  “I agree with you, Kinky,” O’Reilly said. “O’Neill seems caught between peaceful but insistent demands for civil rights, violence by extremists on both sides, and now these calls from the Loyalists for law and order. I’d not want to be in the prime minister’s place. I suspect he’s going to the people to try to get a stronger mandate so he and his supporters can implement reforms they hope will quieten things down.”

  “And do you think he’ll get it, sir?”

  O’Reilly shook his shaggy head. “I hope to God he does, but I doubt it.”

  Kinky inhaled. “I did grow up not far from Béal na Bláth in County Cork, where Michael Collins was assassinated in 1922 during the South’s civil war. I was a girl of twelve then. There does be a disease of us Irish. I still remember me late da splitting up my two brothers, Tiernan and Art, who were scrapping, and Da saying, ‘Agree now, lads.’ Then he winked and said, ‘But fighting’s more fun.’”