An Irish Country Practice

by Patrick Taylor

  Kinky had been in better form at breakfast than she had been yesterday, when O’Reilly and Connor Nelson had shown up late for her special Beltane lunch. But she was now clearly concerned and said, “I do have Mrs. Anne Galvin on the phone. Will you speak with her please, sir? She does sound very agitated, so, and the other doctors are busy.”

  “Of course.” Barry went to the telephone extension on his bedside table, usually only activated when he was on night call, pushed a button, and lifted the receiver. “Doctor Laverty.”

  “Doctor, it’s Anne again. Guffer’s at work and I’m coughing up more blood. Great dollops. Please come quick.”

  Blood? Not good. “Hang on, Anne. I’m coming right over. I’ll be there in ten minutes.”

  He had driven through the village, struggling to understand why she would be bleeding again. Three weeks ago he’d been confident in his diagnosis of acute bronchitis, and she had recovered in jig time, confirming his confidence. O’Reilly and Kenny had seen her nine days ago for some bloodstaining of her sputum, but it had not recurred and her X-ray had been clear apart from some emphysema and that old healed TB scar. Only last Monday, Barry and Kenny had brought her the good news and yesterday she’d popped in to tell him she hadn’t had a smoke for a week. And now this? What the hell was going on? To him, “great dollops” sounded ominous. What had he and O’Reilly missed? He hit the steering wheel with his fist.

  And now here he was parking outside the familiar grey-stuccoed, two-up two-down terrace house with the brown peeling paint on the door. He turned his coat collar up in a half-hearted attempt to shield himself from the downpour, strode through the gloom of the estate to the Galvins’ front door, and knocked.

  Anne opened it, clutching a bloodstained hanky. The harness for the bellows from a set of uilleann pipes was strapped around her waist and right arm. “Come on in out of that, sir.” She stood aside, closed the door behind Barry, and took his wet Burberry and paddy hat. “We’ll go into the parlour.”

  Barry crossed the linoleum-floored hall after her.

  She sat on the sofa of the old maroon three-piece suite and coughed. It was a dry, hacking sound that Barry could almost feel in his own chest.

  “Poor Anne,” Barry said. “I’m so sorry you’re not so good.” He crossed the floor to stand by her side. He noticed the rest of her uilleann pipes—bag, regulators, and chanter—on the sofa beside her. “Can you tell me what happened?”

  She coughed again, holding the hanky to her mouth. “I had the house til myself. The housework was done and I was having a wee practice. I was in the middle of a reel, ‘Rakish Paddy,’ when I had til cough. I’ve been doing more of it since I quit the smokes.” She looked up at him and he saw the fear in her pale blue eyes as she offered him her hanky. “I brung up this.”

  The linen was soaked with what must have been scarlet blood. It was now turning brown. This was no bronchitis, not the simple irritation O’Reilly had suspected. Anne Galvin had bled into her lung, and her recent X-ray had ruled out one probable cause, active pulmonary TB. In Barry’s mind, there was only one other possible diagnosis.

  “Is it bad?” Anne said.

  “I honestly don’t know,” Barry said, realizing that while it was the truth, he lacked the facilities to get the answers he so badly wanted in that moment. “I can’t do much here and I’d only be going through the motions examining you, Anne. Honestly. I want to get you specialist help. The consultant will want to examine you himself.”

  “If you say so. I trust you, sir.”

  Barry wondered why she still did after he had clearly missed her diagnosis. “I’m going to phone Kinky. Let her know I’m taking you to the Royal so Doctor Stevenson can take over in Ballybucklebo for me this afternoon. I’ll get Kinky to talk to the chest doctor’s secretary. It can take a while to get through, so we can get going straightaway. Can you pack a wee bag? Toothbrush, hair brush, nightie. You know the sort of things you’ll need.”

  She stood and took off the pipes’ bellows. “So I’m going til have to stay in?” She sighed. “But surely it can’t be that serious?”

  We all do it, Barry thought. Try to deny potentially bad news. He inhaled. This was not the time for comforting prevarication.

  She frowned and spoke more softly. “Can it?”

  “Anne,” he said, and looked into her eyes, “I honestly don’t know for sure”—he steeled himself for what must come next—“but I am worried.”

  She caught her breath, took a step back, and tossed the bellows onto the sofa. “I’ll go and get my things, sir, and let Myrtle, her that lives next door, know so she can tell Guffer what’s happening. Poor man, he’ll go spare if he gets home and I’m not here.”

  “What time does he get back from the shipyard?”

  “Six.”

  “I’ll try to be here then to explain.”

  Her tears started. “That’s very kind. He’ll appreciate that.” She coughed and sobbed. Her voice broke as she said, “And if it is bad, how are him and me going til tell our boys? I can phone Pat in Dublin, but Seamus…” another shuddering sob, “Seamus is far, far away.” She looked at Barry with pleading in her eyes. “I thought if I saved up all the money I was not spending on smokes anymore, never mind new curtains, I’d have enough in a few years til help him with a plane ticket, but och…” She wiped her nose on her sleeve. “I may never see him again now. I know it. I just know it.” She was begging to be told she was wrong.

  And Doctor Barry Laverty, for all his training, for all his wish to comfort Anne Galvin, could not in all honesty contradict her. All he could do was hold her as the tears flowed and her body shook.

  * * *

  “That wasn’t too bad, was it, Anne?” Barry asked. He was guiding Anne Galvin along with a hand under her elbow and holding in his other hand an envelope containing her chest X-ray films. They left the department of radiology and walked along the main corridor. Mister Bingham’s secretary earlier had been most helpful when they arrived. Barry had been instructed to take Anne directly for an X-ray, then to ward 16 where she’d be seen by a senior registrar who was training to be a thoracic surgeon.

  “No, sir.” She managed a tiny smile. “But I think they keep the bit of the X-ray machine in the fridge that they put fornenst your skin.”

  Barry thought back to his student days. That had been the complaint then too. And about certain gynaecological instruments. One nurse had put woolly oven mitts over the stainless steel stirrups where women were expected to put their bare feet. He glanced round. The Royal Victoria Hospital seemed ageless. Changeless. Same smells of disinfectant and floor polish. Same bustle of nurses and medical students in their bum-freezer white jackets, their heels clacking on the marble floor. Porters, cleaners, and patients’ relatives filling the long, echoing main corridor where the blue plastic double doors of the twenty wards slapped each time they closed.

  He stuck his head into the nurses’ station. A corridor ran between the paired male and female wards, 15 and 16. A long desk behind a glass partition stretched the entire width of the unit, giving a panoramic view along the length of the ward to high French windows at the far end. More light was admitted by a series of skylights. Twenty-four full beds were lined up in two rows facing each other across a central open area. A single bed was at the end of the ward in front of the French windows. Women, some sitting up in bed jackets, others either sleeping or sedated, filled each bed. Many of the patients had intravenous drips running. Tables bearing vases of cut flowers stood along the central space. Several beds were screened by closed curtains on overhead rails. Staff, student nurses, and medical students went about their duties. Snoring and moaning rose above the muted sounds of the staffs’ voices.

  The ward’s senior sister, recognisable by her dark red dress beneath a white apron, sat at the desk writing in a chart. Unusual. Nurses hardly, if ever, sat down when on duty. She looked up. “Barry,” she said, “we are expecting you. Mister Bingham’s secretary phoned. Is this Mrs. Ga
lvin?”

  Barry nodded. “Hi, Betty.” Betty Adair had been a junior sister three years ago when Barry had been a houseman here. “Anne, this is Sister Adair.”

  “Pleased til meet you, Sister.”

  “Doctor Laverty, will you please take Mrs. Galvin into the side ward?” She was formal now. “I’ll bleep Mister Strachan. He’ll be looking after your Mrs. Galvin on behalf of Mister Bingham. You can give Mister Strachan the X-rays.”

  “Thank you, Sister,” Barry said.

  “One of my nurses will be along to do the admitting paperwork, and I’d like you to put on a nightie, dear, and get into bed.”

  “Yes, Sister.”

  In a short time, Anne Galvin’s chart held the required information—name, age, address, phone number, next of kin, religion—and the bed in the single-bedded side ward, usually reserved for patients who needed to be isolated, held Anne Galvin.

  Barry sat on a plain chair beside the bed.

  The door opened and Alan Strachan came in. “Doctor Laverty,” he said, and smiled.

  “Mister Strachan,” Barry said. If Anne had not been there, it would have been “Alan” and “Barry.” They had worked together in 1964 when Alan had been halfway through his general surgical training. He had passed those exams and now was specialising further. “This is Mrs. Galvin and here are”—Barry handed over the envelope—“today’s X-rays and the ones taken on the twenty-fifth of last month.”

  “Thank you.” He set the envelope on the end of the bed.

  Barry listened and watched as his friend took a detailed history and carried out a thorough physical examination, including much work with a stethoscope all over her chest. He paid particular attention to the hollows above her collarbones. Barry knew he was looking for enlargement of the scalene lymph nodes, a common site of metastasis, or spread, of lung cancer.

  “Right, Mrs. Galvin,” said Mister Strachan. “Doctor Laverty and I are going to look at your pictures.”

  “Thank you, sir,” she said. The look she gave Barry would have melted tungsten steel.

  “I’ll come back and explain to you soon, Anne,” he said, dreading what he was pretty sure he was going to have to tell her. He followed Alan out and into the adjacent ward office where the surgeon had already switched on a wall-mounted viewing box. He slipped the plates side by side under the retaining clips with practised ease. “There’s sweet FA in her history except for the recent bleed and I can find nothing else by examining her. No abnormal chest sounds. No consolidation, no finger clubbing when the fingertips are thickened in severe pulmonary disease. Not a sausage,” Alan said, then scrutinised both X-rays over and over, making a series of noncommittal grunts. He stepped back. Shook his head. “I’ll be damned. Take a gander at that, Barry.” He stepped off to one side so Barry could get a good look.

  “See. The first plate seems to be clear as a bell. Emphysema. Healed TB. What Teddy reported was gold in the bank. You and Doctor O’Reilly have nothing to feel sorry about. That X-ray showed nothing amiss. Then this. Look.” He pointed with his index finger at the recent film.

  Barry leant forward. He had no difficulty recognising structures in varying shades of grey: the clavicles at the top, the spine running from top to bottom, the curved ribs encasing the chest cavity, and off to the left the great triangular shadow of the heart. The ringed cartilages of the central trachea, the windpipe, ran down into the chest before diving into the right and left main stem bronchi, each of which in turn branched into a veritable tree descending and ascending into the tissues of the lungs.

  “See?” Alan said. “That small blurry darkness on the wall sticking into the inside of the first right upper lobe bronchus just after the main division? That little dark devil is what’s bleeding.”

  Barry stared at the thing. “Cancer?” he asked, thinking about the Greek word karkinos, the crab, because as they spread through the tissues, some cancers looked like crabs’ claws. “Are you certain?” He knew that, like Anne earlier, he was grasping at straws, hoping beyond hope that his friend was wrong.

  “No, I’m not certain,” said Alan, “but we’re going to have to be sure one way or the other. I’ll schedule a bronchoscopy and biopsy as soon as I can get her into the operating theatre.”

  Barry felt his shoulders slump. “Alan, how the hell could that thing blow up so quickly? Bad chest thirty days ago. Recurrence but clear X-ray last week. Cancers don’t develop that fast from nothing, do they?”

  Alan shook his head. “No, they don’t. It’ll have been growing for years. But from her history, the first really solid clue was her frank bleeding today.”

  Barry felt some shame that, despite his deep concern for Anne, he could still feel relief that he was not responsible for getting the diagnosis wrong at first.

  “And X-rays are not infallible. The first one failed to pick the lesion up.” He peered at it again. “It’s a small one. It may be curable.”

  Barry knew his friend was offering words of comfort. Lung cancer, particularly in a woman so relatively young, was nearly universally lethal. “Thanks, Alan.” Barry stepped back from the box. “If you don’t mind, I’ll go and break the news. It may be a little easier coming from me.”

  Alan clapped Barry’s shoulder. “I’m truly sorry, Barry. Will you be home this evening?”

  “After seven. I’ve promised to talk to her husband at six.” He could feel his stomach flip over at the thought of telling Guffer Galvin what had happened today.

  “I’ll phone. Let you know when the bronchoscopy’s on. Your mate Harry Sloan, the pathologist, has developed a special interest in lung cancers. I’ll get him to read the slides. That’s the best opinion you’ll get in Ulster. We’ll get on to you with the results as soon as possible.”

  “I’d appreciate that, Alan. Very much.” Barry headed for the door. “If you’ll excuse me?”

  Anne Galvin was sitting up in bed. “It’s not good news, is it, sir?” Her hands, which lay palm down on the blanket, were trembling.

  Barry sat on the bed beside her and took her right hand in both of his. It was clammy. “We don’t know for sure, and Mister Strachan’s the expert. The X-ray shows a wee spot on your right lung…”

  Her eyes widened and her left hand flew to her mouth.

  “Mister Strachan needs to do another test called a bronchoscopy. They’ll put you to sleep…” He regretted the expression, a euphemism for putting a sick animal down, but he ploughed on, “And slip a narrow tube into your windpipe. They’ll take a specimen.”

  “Excuse me, sir, is that what’s called a biopsy? I use til watch Doctor Kildare on BBC until they took the programme off last year.”

  “That’s right, and we’ll not know for sure what’s wrong until we get the results.” He squeezed her hand. “Mister Strachan and I have worked together in the past, Anne. He’s going to get things going as quickly as possible. I’ll see Guffer tonight.”

  “And tell him not til worry too much. Please, sir.” She stared through to his soul. “I’ll tell him and the boys all in good time.”

  Barry was struck with admiration for Anne Galvin’s courage, but also recognised that it was going to take time for the probable gravity of her condition to sink in.

  “It’s like Mister Robinson the minister tells us,” she said. “We’re til hope for the best, but get ready for the worst.” She nodded to herself. “Now, sir. Thank you very, very much. You’ve been dead on bringing me here, and all. Run you away on. And don’t you worry your head about me.” She picked up a Mills & Boon romance from the top of the bedside locker, and Barry was certain she was sparing his feelings by pretending to read.

  “I’ll be in touch,” he said, releasing her hand and standing.

  It wasn’t until the door had been closed behind him that he heard the muffled sounds of a woman in tears.

  30

  Dusty Purlieus of the Law

  Lars O’Reilly opened the door of his big grey house on the shores of Strangford Lough and shook
his brother’s hand. “Finn,” he said, and then hugged Kitty. “Lovely to see you both. Come in. Come in.” He ushered them into the spacious hall and took them through to his lounge, which counted among its decorations a turbulent skyscape that Ma had painted back in Dublin in 1936, the year the boys’ father, Professor O’Reilly, had died of leukaemia.

  O’Reilly thought his brother was starting to show his sixty years. Greying hair. A slight stoop. His neat moustache, which had been dark, was turning pepper and salt. And there was no spring in the man’s step.

  “Sit down. Sit down. What can I get you?” he asked.

  “G and T, please,” Kitty said.

  “Neat Jameson, Finn?”

  “Please.”

  O’Reilly and Kitty sat beside each other in two of four armchairs arranged around a large fireplace. A single purple orchid sat in a small Waterford vase on the mantel. The seating was arranged in such a way that three seats gave panoramic views over Lars’s garden, dominated by a huge horse chestnut tree decked with white candle flowers. A window cleaner was washing the glass of the large greenhouse where Lars cultivated his orchids. Out on the Narrows in their strong tidal current, the little ferry crabbed across to Portaferry from Strangford Town.

  To O’Reilly’s right lay the 820-acre Castleward Estate, originally Carrick na Sheannagh and home of the Earls of Kildare. It had been the seat of the Ward family since 1570 almost to the present day. O’Reilly never ceased to marvel at the comforting sense of permanence such places gave to his country. The estate’s trees were verdant with fresh spring leaves and trimmed lawns ran down to the lough’s far shore. A window was open and O’Reilly, even at that distance, heard borne on a northwesterly breeze the harsh cry of a cock pheasant. A syndicate led by a Mister W. J. McCoubrey of Ballynahinch rented the shooting rights from the new owners, the National Trust.