An Irish Country Practice

by Patrick Taylor

  “Right,” Barry said.

  “Twelve brown pennies or one shiny shilling buys you t’ree balls. That’ll be all a fellah like you’ll need, sir.” He didn’t bother to rebuild the fallen pyramid.

  Barry paid, picked up one ball, sighted, threw side-arm—and missed. He did that twice more.

  “Good try, Barry,” Sue said.

  He frowned, passed over another shilling—and failed again. “Right. Hold this, please.” He took off his sports jacket and handed it to Sue.

  After eight more shillings, twenty-four more balls, a lot of sweat, two hits, but no luck dislodging the whole pile, he confessed defeat. “Sorry about that,” he said to Sue, accepting his coat and carrying it folded over his arm.

  “You’re still my hero,” she said, then whispered, “and I’d rather have you beside me than a stuffed bear anyway.” She blew him a kiss just as Willie and Mary returned on their donkeys, were helped down, and ran over to Barry and Sue.

  “Thank you very much, sir,” Willie and Mary said together.

  Barry sighed. “My pleasure. Come on, then,” he said. “Time we met Mister Houston and Sammy.” He could see them standing at the nearby stall that purveyed sweeties, ice-cream cones and sliders, toffee apples, and candy floss.

  In no time each little Lindsay had been handed a quarter of an ounce of clove rock, a toffee apple, and a whirl of pink spun sugar on a stick.

  “I think he’s spoiling them rotten,” Barry whispered to Sue, but she said, “Let him. Their mum’s been in hospital, Barry, and the poor old boy never had kids of his own.” The look she gave Barry held a great deal of meaning.

  “I think we should be heading back to the big top,” Sonny said. “The show will start soon.” He beamed at his charges. “And if we all go together we can sit together. Won’t that be nice?”

  The answers of the children were muffled by mouthfuls of candy floss.

  Barry’s enthusiasm for such an arrangement was hardly overpowering, but he was spared the need to answer by the appearance of Donal and Julie Donnelly. Donal was carrying a teddy bear like the one Barry had wanted to win for Sue. “How’s about youse, all?” Donal said. “Tori’s at her granny’s. She’s too wee yet for circuses.”

  “I see you won a teddy for her,” Barry said. Clearly other people had been successful.

  “Away off and chase yourself, Doctor. I used til work on one of them throw-a-ball-at-the-bottles stalls. No one ever wins. Two of the bottles is glued til the shelf, so they are.”

  “You’re kidding.”

  “I never kid about such things, Doc. Conning is serious business.”

  “Well, no wonder I didn’t win. So did you win the bear at that booth where you aim the air rifles at Ping-Pong balls bouncing up and down on jets of water?”

  “Not at all. There’s a fellah with a barrow over there”—Donal pointed with his bear—“selling them for twelve and six.”

  15

  Examine Well Your Blood

  “Well, thank you.” O’Reilly accepted the damp teddy bear from Kenny, who had appeared from the doghouse bearing the offering as soon as O’Reilly closed the kitchen door behind him. The pup had trotted straight to his master, sat, and presented his “retrieve.” O’Reilly patted the pup’s head. “Good.”

  Arthur stood nearby, supervising as usual, head cocked at an angle, tail lazily swinging from side to side.

  In the two weeks since Kenny had moved into Number One, he had already mastered “sit” and “heel,” and was improving on “stay,” but with the natural impatience of the young still had a habit of running to O’Reilly before being given permission.

  “Heel. You’ll both get your run after I’ve finished seeing my patient.” O’Reilly set the toy on the grass and headed for the Rover. Both dogs tucked in as directed. He opened the car door. “In.”

  Arthur went first. Even though he had grown, it was a scramble for Kenny, but Arthur took him by the scruff and helped him up.

  Anne Galvin’s husband, Guffer, had phoned earlier to request a home visit. Fingal drove off, his eyes on the road but his thoughts on Anne—how Barry had seen her two weeks ago for acute bronchitis, a cut-and-dried case. From what Guffer had said, it seemed Anne was having a recurrence. That was quite common and not very serious.

  O’Reilly exchanged waves with half a dozen people before turning left to climb the hill to the council housing estate. He sighed as it came into view. He supposed Bertie Bishop had built the rows of identical, gardenless terrace houses according to the directions of town planners. The place had no heart, no soul, and more so today. Children who would have been outside bringing life to the street with their cries and laughter must have been at the circus. Even an early-afternoon sun just past its zenith barely penetrated the narrow streets. Three little girls, not lucky enough to be at the circus, were skipping a rope and chanting,

  One potato, two potato, three potato, four

  Five potato, six potato, seven potato, more.

  O’Reilly recognised the Harrison twins, Ingrid and Astrid, and their cousin Gillian MacAllister. Their fathers both worked for Bertie Bishop, who still hadn’t started work on the new road. Their two weeks’ paid holiday would soon be over and the men would be going on the “burroo,” local parlance for “the bureau,” the department that paid out weekly unemployment insurance. There was probably no money for circus shows and candy floss.

  He parked in front of the Galvins’ two-storey home and wound down the driver’s window to ensure a good flow of fresh air for the dogs. O’Reilly grabbed his bag and got out. One door down, a woman wearing a calico pinafore sat on the sill of the second-storey window, backside protruding into thin air. The sash was pulled down onto her thighs to anchor her in place. She was washing the panes with soapy water and cleaning them off with a piece of chamois leather. “How are ye, Doc,” she called down. “Great day.”

  “Grand altogether, Myrtle, thanks. You be careful up there.”

  “Way off and chase yourself, Doc. Haven’t I been washing windys like this for forty years.” Before he could knock on the Galvins’ door, the air was rent with a howling so loud Myrtle dropped her shammy, which landed with a splat on the narrow footpath. The sound was coming from the Rover. O’Reilly turned to see Kenny standing on the backseat, paws against the window, head thrown back. It was the first time the pup had been left alone in the car with only Arthur for company. The wee mite must be terrified.

  “I thought it was the banshee, so I did. Don’t worry about the shammy. I’ve got another.”

  “Sorry, Myrtle.” O’Reilly retraced his steps and opened the car’s back door. Kenny immediately shut up, but tried to lick O’Reilly’s face.

  “No. Lie down.”

  The pup obeyed, and Arthur looked at O’Reilly as if to say, “He’s only a kid, boss. Don’t be cross.”

  “Stay,” said O’Reilly, and closed the door.

  The howling began at once and Kenny was once more on his hind legs.

  Before O’Reilly could open the door to admonish Kenny, there was a tap on his shoulder. He turned to see Guffer Galvin.

  “Scuse me, Doc, but the missus sent me out til see what all the row was about. Your pup?”

  “Aye. I thought he’d be all right with Arthur there.”

  “We heard you’d a new one. Anne says—and she knows a brave bit about dogs, her da ran Jack Russells all the time she lived at home—she says very young pups can get upset in strange places if they’re left on their own. She says just bring him in with you.”

  O’Reilly hesitated. A dog at a consultation? It was hardly by the book, but Kenny showed no sign of calming down and doors were opening all along the street as folks rubbernecked, wanting to know the cause of the disturbance. “Right, take my bag, Guffer.” O’Reilly opened the door. “Stay, Arthur.” He grabbed a now-silent Kenny and followed the man indoors.

  “Just set him down, Doc. Here’s your bag. I’m afraid the missus’s brownkitees is back. She’s hacki
ng away again. Has been for a couple of days, and it’s worser than her oul smoker’s cough.”

  O’Reilly nodded and put Kenny on the linoleum.

  The pup sat at once.

  “I’ve her teed up in the parlour. Said she wasn’t sick enough til go til bed. Young Doctor Laverty seen her a fortnight back. He said there was no need for a chest X-ray, give her the black bottle and, right enough, she was well mended in four days.”

  The much-valued black bottle, Mist morph et ipecac. “Fair enough. Let’s go and see her.”

  “In here.” Guffer opened a door to the right of the hall. “I’ll leave you and the wee tyke to do your jobs, sir.” He bent down and stroked Kenny’s head. “I’ll be in the kitchen.”

  O’Reilly nodded. A man may not attend his wife’s examination, but, he smiled, apparently chocolate Labrador puppies did.

  The parlour was tidy. A single sash window looked out onto the narrow street. A white roll-up blind hung above. The floor was carpeted. An unlit fire lay in a small black grate and three ceramic mallard, garishly painted and decreasing in size, flew up at an angle on the whitewashed chimney-breast.

  Anne Galvin sat in an armchair, one of a frayed maroon three-piece lounge suite. She had her feet up on a pouffe and was tucked up under a tartan rug. She coughed and said, “Afternoon, Doctor O’Reilly.” She peered at him from pale blue eyes behind her wire-rimmed granny glasses. “And is this the wee one Cissie Sloan told me about? Handsome lad. What’s his name?” She coughed again, a dry, rasping sound.

  “Kenny.”

  “Can I pet him? Please?”

  Kenny was not a lap dog. He’d be a working animal when he grew up, but there was such pleading in Anne’s voice.

  “I love dogs, but wouldn’t be fair to have one here on the estate.”

  “All right,” O’Reilly said. He lifted Kenny and set him in Anne’s lap. How she managed to have a simultaneous coughing fit and keep a huge smile on her face amazed him.

  Kenny seemed unfazed by the coughing and tried to lick her face.

  “No, Kenny,” she said firmly. “No.”

  The pup obeyed.

  “Good,” she said. “Good.”

  O’Reilly nodded. This woman did know about dogs, and if Kenny was a comfort to her, why not let him stay?

  “Thanks for coming, sir. Sorry to drag you out on a Saturday.” Her right hand stroked the top of Kenny’s head.

  “Rubbish. It’s what we’re here for. How are you, Anne?” He set his bag on a table beside her chair and perched himself on its arm.

  “Och,” she said, “I’ve been better. I’m not all shivery like last time.”

  So she probably didn’t have a fever, making pneumonia and acute bronchitis unlikely.

  “I’ve a bit of the rheumaticks, but doesn’t everybody my age?”

  O’Reilly nodded. It was true. Vague muscle and joint aches were prevalent among the denizens of the damp, draughty council houses.

  “And the coughing’s not the same as when young Doctor Laverty was here. Once I’ve had my morning coughing over and a good spit, nothing comes up, I’m still hacking away.” She punctuated her remarks with a dry cough. “See what I mean? I’d still a toty-wee bit of the medicine he give me a couple of weeks back so I took it, but it never done me no good. I’m not wheezing as much, but—” Her gaze held O’Reilly’s eyes. “I’ve been coughing up a taste of blood today. That’s why I asked Guffer til send for you.” She lowered her voice. “I never told him about the blood.” She stroked Kenny a little faster.

  Kenny wriggled but made no other attempt to move.

  O’Reilly heard her anxiety for herself and her concern for her husband and kept his face impassive. What she had just described did not gel with simple acute bronchitis, where the sputum could be blood-tinged but the cough was moist. And what he’d been taught back in his Trinity days had not changed, particularly now when the relationship between smoking and lung cancer had been established. Haemoptysis, coughing up blood by itself, had to be taken very seriously, because it might be a symptom of either pulmonary tuberculosis or lung cancer. There were other causes, but those two must be excluded. “Are you sure you’re coughing it up?” he asked, dropping a hand to take her pulse. Her skin was cool to the touch. Blood was always worrying and could be vomited up in a number of gastrointestinal conditions, as well as coughed up.

  “Aye. Dead sure. It’s bright red. Frothy, like.” She forced a smile. “It’s only a toty-wee taste. Not much.”

  O’Reilly nodded. He did not like the sound of this. Her pulse was a steady eighty beats per minute. “Have you noticed any other things?”

  She shook her head. “I told you I’m a bit creaky, but”—she managed weak smile—“what can’t be cured must be endured. If it was just a bit of a cough, I’d have tholed it because there’s nothing else wrong … except the blood.” She inhaled a jerky breath, pursed her lips, and coughed again.

  “Right,” he said, producing his stethoscope. “Can I pull up your blouse at the back?”

  “Aye, certainly.”

  “And it’s all right if you want to hang on to the pup.”

  “Thank you.” She sat forward.

  “Uh-huh,” O’Reilly said when he’d finished a thorough examination of her chest and found nothing. The rate of breathing was not increased. No dull areas to percussion. No tender spots. Lots of air going in and out as she breathed. No wheezes, whistles, or hirstles of any kind. He straightened up. Put his stethoscope back in his jacket pocket. But still the blood called for an X-ray. And soon. “You can tuck in your blouse now, Anne.”

  As she did, he said, “I’ll nip through. Get Guffer so I can explain things to you both.”

  “Doctor,” Anne said, “I know blood’s serious. I’d an uncle who got…” She didn’t say the word aloud but mouthed “cancer.” “Please don’t say nothing til Guffer until you’ve all the answers. Please.”

  O’Reilly nodded. He was not unfamiliar with this present dilemma. Anne deliberately wanted to keep any possible bad news from her husband to spare him worry until either the cloud had passed or there was something to be concerned about. Yet O’Reilly had always believed in being honest with patients. He had never accepted the received wisdom that if a diagnosis of cancer had been made, only the closest relative should be told, not the patient. “Stay, Kenny,” he said, and headed for the Galvins’ kitchen.

  His nose told him there was something cooking involving ginger. “I’m all done, Guffer,” O’Reilly said, sticking his head round the kitchen door. “Come on through.”

  Guffer set down a copy of Reader’s Digest and followed O’Reilly back to the parlour.

  Both men remained standing, with Anne’s gaze shifting from face to face.

  O’Reilly cleared his throat. “I’m not quite sure what’s up. It’s not the bronchitis back.”

  “I’m glad to hear that,” Guffer said. “I’d a notion she should’ve got antibiotics, so I had. I asked Doctor Laverty. He said no, and if it’s not come back, I was probably wrong.”

  O’Reilly shook his head. He should support Barry immediately but chose to be more circumspect. “Guffer,” he said, “no good doctor, and Doctor Laverty is a good one, minds being asked questions.” Just please don’t ask me the wrong one this afternoon, he thought, and directed his gaze to Anne. “I’m stumped this time,” which was nearly true, but he did have two serious conditions in the forefront of his mind, “and I don’t want to go off at half cock. Anne needs an X-ray, and I’ll arrange that for Monday morning. I’ll need to use your phone.”

  “In the hall,” Guffer said.

  “In case you’re wondering why not today, us GPs are expected not to clog up the X-ray department at weekends.” And despite a widely believed notion that cancer must be diagnosed immediately, two days would make not a pick of difference to the final outcome.

  He went to the hall, and after the usual delays was connected with a sympathetic unit clerk, made the arrangements, and le
ft a message asking his friend Teddy MacIlrath, a senior radiologist, to read the plates himself as a favour to Fingal and phone the results through to Number One.

  He returned.

  Guffer was standing beside his wife, holding her left hand while she went on stroking Kenny with her right.

  O’Reilly rummaged in his bag for the necessary form. As he wrote, he said, “All set. Be at the Royal on Monday at ten. Here. Take this form with you. The X-ray won’t take long and I or Doctor Laverty will give you the results as soon as we have them. Probably by Monday afternoon. All right?”

  Before Guffer could speak, Anne looked O’Reilly right in the eye and said, “That’ll be dead on, sir. We’ll bide patiently. Isn’t that right, Guffer?”

  “Aye. I suppose so, but I’d like til know—”

  “Guffer,” Anne said, “let Doctor O’Reilly get on with his job. Please.”

  O’Reilly knew that the worst thing for patients and loved ones was dealing with uncertainty.

  Guffer said, “Aye. Well.” He sounded confused.

  “I’ll get the answers as soon as I can. I promise.”

  Anne coughed. “That would be grand—” Another cough stopped her. When she recovered, she said, “Wouldn’t it, Guffer?”

  “Aye.”

  O’Reilly produced a small bottle from his bag. “This is linctus pholocodeine, Anne. One teaspoon at bedtime might help you get a night’s sleep.”

  “Thanks very much, sir,” Anne said. “For everything.”

  O’Reilly detected a hint of emphasis on that word. “My pleasure,” he said. “And now I’ll be running along.” He closed and picked up his bag.

  “Thanks for letting me pet Kenny,” Anne said. “Can he come and see me again, please?” She inclined her head. “Please?”

  O’Reilly said, “I don’t see why not.” He heard her thanks as he picked the pup up and headed for the door. “If it gets any worse, but I don’t think it will, send for me at once.”

  “I will.” She turned to Guffer. “And we’ll say nothing til our sons until we know exactly what ails me.” She smiled. “I’m a tough oul duck, you know. I’m sure it’ll all blow over soon.”