Barry lowered his trousers and underpants so that Graham could carry out a thorough genital examination.
It was a reminder of how vulnerable patients must feel, Barry thought, to have another man’s hands on your testicles.
Graham said, “Pull up your pants.”
Barry did.
“You’ve got a matched set, normal size, no failure to descend, no varicose veins, and no tumours. We’ll need to get a couple of sperm counts, but all clinical indicators suggest that you are probably fine so I don’t think there’s an obvious male cause.”
Barry’s ego was relieved, but his heart was not. If his sperm counts were normal, and they probably would be, either Graham was going to find something wrong with Sue, for which, like all women having difficulty conceiving, she would blame herself, or no cause would be found and the diagnosis would be unexplained infertility with all the horrid uncertainty that would bring. He buckled his belt. “Thanks, Graham.”
“Ask Sue to come in, please.”
Barry left the screened-off area. “Your turn,” he said.
After ten minutes Sue reappeared, followed by Graham, who this time did go behind his desk. “It’s easier to write up the charts sitting here,” he said, scribbling. He looked up. “Right,” he said, “what have we got to go on? And feel free to interrupt if you have any questions or something to add.” He steepled his fingers. “We have a healthy young couple. Barry, you’re twenty-eight, Sue twenty-six…”
They both nodded.
“… you stopped the pill thirteen months ago, Sue. You make love often enough. Neither one of you has had or seems to be suffering from any seriously debilitating diseases. Sue, your cycle is regular and you get first day or two cramps. That sounds ovulatory to me.”
“Barry has me taking my temperature every morning, Doctor, I mean Graham. We didn’t think we’d be seeing you so soon, so I’m afraid I’ve only got results for four days and I didn’t bother bringing the graph.”
“That’s alright. Please do keep taking it. I’d like to see it after a month.”
“Alright.”
“I’ve examined both your reproductive systems and there’s nothing glaringly obvious that I can find. So, we’ll need to run a few tests.”
Sue sat forward and her hands reached up to grip the arms of the chair.
Graham reached into a drawer under the table and produced two wide-necked, squat glass bottles. He handed them to Barry. “You know what to do?”
Barry nodded. “Two days’ abstinence, produce a specimen, and bring it to the lab here a week before our next appointment. Repeat as before in two more days so you’re sure to have the results when you see us.”
“Right. Here.” He handed Barry the lab requisition forms. “And, Sue, I want you to keep that graph for a month. I’d like to see it soon after your next period, and that’s when we’ll talk about Barry’s sperm count too. You’ll be due?”
Sue frowned and said, “Thirty-first of January.”
Graham consulted his calendar. “Which is a Friday.” He flipped over to February. “Can you come here at four on Wednesday, the fifth?”
Sue looked at Barry, who said, “School will be over for the day. I’ll work it out with Fingal and the others so I can be free.” He looked at Graham. “And I’ll get my specimens here the week before.”
“Good. Now, at the moment there’s nothing much to guide me, and let me reassure you again, statistically the odds of a spontaneous pregnancy within the next eleven months are very good, Sue.”
“Thank you for saying that. It is a comfort,” she said, but she was frowning.
“I’m not going to be trite and pat you on the head and say, ‘There, there, my dear, don’t worry.’ You will worry, Sue, so the sooner I can get you answers the better. But it will take time. Possibly a few months, so please try to be patient.”
“I will,” Sue said, “but it’s—it’s hard.”
Barry ached for her. Yes, it is going to be hard for her. Harder than for him, even though he was having his own nagging worry. Inability to or difficulty in conceiving was widely believed to be the woman’s “fault,” a horrible word, and dealing with uncertainty was one of the most gruelling of human experiences. He must be there to help her.
Graham Harley stretched, rubbed his chin, and said, “Unless you have any more questions?”
Barry shook his head.
Sue said, “I’m happy that we are trying to get things sorted out, and,” she rose, “and we’ll see you next month.”
Barry followed. “Thanks, Graham,” he said. “Thanks a million. Next month it is.”
Together they walked along the covered walkway, the tails of Barry’s raincoat flapping in the wind.
“What a nice man, your Graham.”
“Yes, he is.”
“And I’m sure he’s going to help us.” She smiled at Barry and said, “I really am.”
But he heard her lack of conviction, and her smile had gone.
15
His Potion and His Pill
Barry sat on the edge of the examining couch, legs dangling. He pictured himself five years younger, sitting here while a much senior Doctor O’Reilly, half-moon spectacles perched on his pugilist’s nose, questioned a patient. Then Barry had been learning. Now he was teaching, and it was Emer, his student, who sat at the rolltop desk consulting with this morning’s last patient.
“So, Julie,” she said to Julie Donnelly, perched on the slightly angled seat of one of the patients’ chairs, “welcome back to Ballybucklebo.”
“Thank you, Doctor,” Julie said. “We come up on the bus from Rasharkin this morning. Dapper Frew borrowed Donal his motorcar and he met us at the Belfast bus station and brung me and the weans to Cissie Sloan’s. The four of us is staying with her tonight.”
“Because,” Barry said, “I’m told you’re moving into the marquis’s cottage tomorrow morning?”
“That’s right,” Julie said. “And hasn’t the whole village just been terrific. Once they got the roof fixed last Sunday and the living room and kitchen redd up, whenever volunteers showed up this week they brung furniture and stuff, stored it in the big room, and moved it in as each room was ready. I don’t know what we’d have done without all these good people.” She smiled. “Me and the kiddies are very grateful and all to my folks, and I love them dearly, but it’s time Donal and me had a wee bit of time til ourselves, if you know what I mean.” She blushed.
“Of course. It will be a relief to be living as a family again.” Emer waited. “Sooo, is there something we can do for you, Julie?”
“Well, I … That is…” Julie nodded, stared at her feet, took a series of short, shallow breaths, and looked at Emer. “I mean, Doctor,” she said, “me and Donal are finding it a bit tight. I’ve lost my hair modelling job, and even if Donal has been upped til foreman, getting our lives back together with five mouths to feed on a carpenter’s wages…” Her eyes held a look of supplication.
Aha, Barry thought. Might this be something he had met before? A woman seeking advice on terminating an early pregnancy? That had become legal in the rest of the United Kingdom since the passage of the Abortion Act in 1967. But it was not under Northern Ireland law. Opposition in the Stormont Parliament in Belfast had been led by an influential member, a Protestant gynaecologist named Mister Ian McClure.
By her immediate response, Barry’s young colleague must have thought she was going to get a similar request. This wasn’t the first time Barry had seen how good Emer was at picking up signals. But he hoped to God they were wrong.
“Julie,” Emer said, letting her sympathy show, “you don’t think you’re pregnant, do you?”
Julie started. Shook her head. “Not at all. Not me. I let myself get in the family way once before I was wed. Doctor Laverty knows all about that. I’m taking no chances now, at least I think I’m not, but an old friend from the linen mill was doing like me—using a Dutch cap—but it let her down. So, I’m not so sure now abou
t mine.”
“The diaphragm does fail from time to time,” Emer said. “No question. Have you considered the new pill? It’s as close to foolproof as anything.”
“I’ve heard, and I’d like to try it, but Donal’s dead scared of them hormones.”
“Right. Well, Donal’s in the waiting room. Should we perhaps bring him in? Give him a chance to understand?”
Barry nodded. After all, if Graham Harley thought it right to have both partners present when they were having difficulty conceiving, there was logic in using the same approach for a couple trying to prevent conception. Barry glanced at his watch and thought about Sue in her classroom surrounded by kiddies.
“Okay, Doctor.”
“I’ll get him,” Emer said, and left.
“For you two, Julie, the pill is a great option, but if you’re sure your family’s complete, you or Donal could also consider sterilization, you know.”
She shook her head. “I’m not ready for that. We might just want one more once we have our feet back under us, and for God’s sake don’t mention it to Donal. He thinks any operation on him,” she blushed, “down there, you know, would take away his manhood, so he does.”
Barry nodded. It was an attitude prevalent among Ulstermen. Women had the babies. It was up to women to take care of not having them. Nor should a man’s sexual prowess be put in jeopardy.
Julie blushed. “I’d not like nothing til happen like that neither.”
Emer reappeared without Donal in tow. “Doctor Laverty, something’s come up. An emergency. And we’re the only doctors here. Julie, I know it’s not fair, but would you mind waiting with Donal? Mister Bishop’s in severe pain. He and Flo are in the waiting room.” Her face was calm and composed, but she was repeatedly clicking the plunger on the ballpoint pen she held in her hand.
Last night, over a pint in the Duck, O’Reilly had told Barry about Emer’s concerns for the way she’d managed Willie Lindsay. Today, he thought, I’ll be right here to help her with Bertie Bishop.
Julie rose. “Of course, we’ll wait.”
“I’ll come with you,” said Barry. “Mister Bishop might need a hand.” As they hurried along they met Kinky in the hall.
“Archie was delivering milk at the butcher’s when Mister Bishop was taken ill. He loaded Bertie and Flo on his float and—”
“Good for him.” Barry didn’t want to waste time.
“Och,” Kinky said to his retreating back, “see to your patient. Your lunch, it does be creamy chicken soup and kipper pâté with wheaten scones, will keep. You just get on with your doctoring.”
In the waiting room, Barry tried to calm a fluttering Flo Bishop while Bertie grunted and held his belly.
“Doctor dear, him and me was getting a nice piece of steak for my tea. The butcher had just wrapped it when Bertie says til me, ‘Flo, someone’s taking a brace and bit til my belly.’ He clutched himself and let a gulder out of him. Scared the bejizzis out of Aggie Arbuthnot. Says he, ‘Flo, I have til sit down.’ And he did, right there on the floor.” She tutted. “His good trousers is all covered in sawdust.”
The man was pale and sweating. Had he had an ulcer all along and had it perforated, releasing stomach contents into the belly? Pain of such severity could indicate that. “Can you stand up, Bertie?” Barry asked.
“I’ll try if you give us a hand.” His voice was shaky.
“I’ll help too, sir,” Donal said.
“Thanks.”
Between Barry and Donal they got Bertie along to the surgery and up onto the examining couch.
“Don’t youse worry, Mister and Mrs. Bishop. Youse are in good hands, and me and Julie can wait.”
“Is he going til be alright, Doctor? Please?”
“Have a seat, Mrs. Bishop.” Emer’s voice was kind but firm. “Now, Mister Bishop, tell me about the pain?”
“It’s much worser than it was.”
Emer looked at Barry, who inclined his head toward Bertie to indicate “he’s still your case.”
“Scared me so much I near took the rickets,” Flo said.
“I’ll keep more questions until later. Right now, I want to take your pulse and blood pressure and have a quick look at your tummy.”
Good lass, Barry thought. If he has perforated, it’s straight up to the Royal for emergency surgery.
As Emer carried out the examination, Flo chuntered on. “Fix him up right this time, please, Doctor Laverty. I’m so worried about him. He’s all I’ve got.” She pulled a hanky from a pocket and twisted it between her hands.
That the request had gone to him and not Emer was not lost on Barry. Nor was the thinning of Emer’s lips.
She said for Barry’s benefit, “Pulse is up a bit. BP’s one twenty over eighty, but Mister Bishop usually runs a bit higher. Most importantly, there’s abdominal tenderness, but it’s not severe, no rigidity, guarding, or rebound tenderness.”
“So,” Barry said to Flo, “Bertie’s belly is sore to touch but not excessively so, the muscles aren’t in spasm, he doesn’t tighten up his muscles when Emer presses, and if she pushes in and lets them go, the muscles springing back doesn’t cause severe pain. All those signs would be present if the peritoneum, the membrane lining the belly cavity, were inflamed.”
Emer said, “I think we can confidently exclude perforation of an ulcer.”
Flo heaved a heavy sigh, presumably of relief.
“I agree.” He realized he’d been holding his breath and let out a quiet sigh.
Emer nodded, her face softening. “Now, Mrs. Bishop, Mister Bishop, we’re sure there’s nothing badly wrong. I was worried you might have had an ulcer and that it had broken through the wall of the stomach, but now I’m certain that’s not the case.”
Flo said, “Are you certain sure, Doctor?”
Barry waited to see how Emer might respond.
“Yes, Mrs. Bishop. I am, and it’s not very often that I am one hundred percent, but the signs of perforation are very clear, and Mister Bishop has none of them.”
That seemed to satisfy Flo, but, “I’m still sore, so I am,” Bertie said.
“I know,” Emer said, “and that’s why I need to ask you some questions.”
“Fire away. Now I know I’m not going to meet my maker here in the surgery, you can ask anything you like.”
“Can you tell me how you’ve been since we saw you last?”
“He’s been coming along rightly, so he has,” Flo said, “but the griping and groaning about having til take all that there milk and soda bic. Huh.”
“Go easy, Flo,” Bertie said. “The doctor wants til know the facts. Aye. I have my appetite back and the heartburn’s gone, just like you said they would be, but for the last three days,” he pointed to his belly where the lower ribs met, “I keep getting this pain.”
Barry thought that what Bertie was describing, even though the duration of the symptoms was short, was the classic presenting complaint of someone with a peptic ulcer, either of the stomach or duodenum. Those conditions occurred more frequently in men and during the winter months. Postmortem studies had suggested that 10 percent of the population had been so afflicted at some time in their lives.
“Does the pain have any relationship to food?” Emer asked.
Bertie Bishop nodded. “Aye. It comes on about half an hour after I’ve had my grub.”
That, Barry knew, was more like a stomach ulcer. Duodenal ones tended to be sore when the stomach was empty, and eating would relieve the pain.
“Has it woken you at night?”
Another symptom of duodenal ulcers.
“Him?” Flo sniffed. “You could set off one of them there atom bombs outside our bedroom and your man would sleep on. And the snores of him? I think his mother was scared by a grampus when she was carrying.”
It was an old Ulster belief that a shock to a pregnant woman could influence her unborn child.
“Pay no mind to Flo,” said Bertie. “And you, woman, can hold your wheest. She’s
just sounding angry like because she’s worried about me.”
“I am worried, and I’ll not be told to hold my tongue, you silly old B.”
“Uh-huh, Mister Bishop,” said Emer, her face working to remain serious. “Have you noticed anything different about your motions?”
If an ulcer bled and the blood ran down the intestines, the stool became a black and tarry substance called melaena.
“No.”
“Good.” She looked him in the eye. “I think we may be looking at an ulcer.”
“We may be?” said Flo. “I like that ‘we.’ It’s my Bertie that’s looking at it, so it is.” She stuffed her hanky back in her pocket. “It’s him that has to suffer the pain of it.”
Barry glanced at Emer. She didn’t seem to be rattled.
“Come on, Flo,” Bertie said, “the wee doctor’s doing her best, and if it is an ulcer, my late da had one. It kept coming back. He had til have half his stomach took out, but it come back.” Bertie Bishop managed a tiny smile. “The ulcer, I mean. Not his stomach.” He grimaced and made a noise in his throat.
“They do run in families.” Emer turned to Barry. “Doctor Laverty?”
“I agree.”
“Mister Bishop, is there anything else bothering you?”
Bertie Bishop shook his head.
“Right,” she said, “now let’s figure out what ails you, Mister Bishop, and try to make you better.”
“Fair enough. I think…” He inhaled and exhaled. “I think it’s a bit easier now.”
“Good. Very good,” Emer said. She moved to him and pulled down his left lower eyelid. “Look up, please. Thank you. The conjunctivae are a lovely red,” she said, “so you’re not clinically anaemic, Mister Bishop.”
Well done, Emer, Barry thought. That excludes any serious amount of occult bleeding.
“I’m pretty sure it’s a stomach ulcer, but I can’t tell by more physical examination.”
Barry saw Bertie stiffen in his chair.
“There’s a much better way to get a correct diagnosis. A special X-ray called a barium meal.”
Bertie beamed.
An Irish Country Cottage--An Irish Country Novel Page 15