Sebastian asked, “Peely-wally? I don’t think I’ve—”
Barry hid his smile. “It means under the weather. Brought over by the Lowland Scots farmers in the seventeenth century during the Plantation, the settlement of Ulster by Protestants to replace the native Catholic Irish.”
“Aye, and we’re suffering for it til this day,” Mister Johnson said.
Barry nodded and waited while Sebastian collected the routine medical historical information, none of which was particularly dramatic.
“So, what exactly brings you to us today?”
“I’m just not at myself. I’m tetchy, I’ve the shakes.” He held out his hand and Barry could see the tremor.
“I’m sweating, and I get the heart palpitations.”
“And when did this start?”
“About four weeks ago, but it’s getting worse, so it is.”
Sebastian asked, “Have you noticed any muscle weakness?”
“Only in my right calf, but the doctors at Newtonards Hospital said that was til be expected after not using it til the sprain healed.”
Sebastian nodded. “Are you swallowing a lot?”
“No, sir.”
Barry had already begun to formulate a diagnosis and, judging by the last two questions, so had Sebastian.
“Right,” said Sebastian, “time to take a look at you. Nip over to that couch. Jacket and shirt off. Loosen your pants waistband please and hop up on it.”
In very short order Mister Johnson was ready and Sebastian was behind the curtain.
Barry heard him say, “I’m going to call out my findings to Doctor Laverty. Don’t let any doctor talk scare you. I’ll explain when I’ve finished, and you’ve got your clothes on again. Now I’m going to look at your eyes.”
If those were the first organs Sebastian wanted to examine then his working diagnosis had to be the same as Barry’s.
“They are not protruding, nor staring, nor are the pupils dilated. Look down, please. No lid lag.”
A phenomenon where the upper lid lagged behind the globe and exposed the white of the eye. The absence of those eye signs, Barry thought, cast some doubt on his original working diagnosis, but Sebastian hadn’t finished his examination yet.
“Look up, please.”
“I can’t look up far, Doctor.”
“That’s fine. Now I’m going to take your pulse and listen to your heart.” Pause. “A hundred and ten and very forceful but no auricular fibrillation. Mister Johnson’s skin is warm and a bit sweaty, his hair is silky. Mister Johnson, I’m going to examine your neck and I’d like Doctor Laverty to do so too.”
“All right.”
Barry rose and joined them. Sebastian had moved behind his patient, who was sitting up with his head bent forward. Both of Sebastian’s hands were gently palpating the front of the neck. He nodded to himself, put his stethoscope in his ears, listened over the neck, nodded again, and said, “Swallow, please. Thank you.” He turned. “Doctor Laverty?” And inclined his head to the patient.
“Sorry to do this to you a second time.” Barry’s fingertips immediately felt a swelling, which in part was beneath the strap muscles of the neck. The gland he was feeling, the thyroid, was enlarged, with scattered dense lumps. When Barry put his stethoscope over the organ, he heard a distinct continuous murmuring sound. A bruit. “Thank you. Please get dressed and come and join us.”
Both doctors took their seats.
Sebastian said, “Thyrotoxicosis with a nodular goitre.”
“Well done,” said Barry. “I agree. Now you explain it to Mister Johnson, and what you propose to do.” Funny coincidence, Barry thought, that Cissie Sloan, who suffered from a deficiency of thyroid hormones, should be in the waiting room.
Mister Johnson reappeared and took his seat. He looked expectantly at Sebastian.
“Sir, all of us have a gland in our necks called the thyroid. Its job is to produce a substance called thyroxine. Thyroxine’s job is to go around in the bloodstream and talk to parts of your body. It’s like a messenger from an officer ordering soldiers about.”
Mister Johnson nodded. “I understand.”
“Sometimes the officer sends too many orders and the soldiers work like slaves to obey, but the end result is that the patient—you—starts to notice differences. For example, a normal heart rate is somewhere between seventy-two and eighty-two. Yours is a hundred and ten.”
Mister Johnson smiled. “So that’s why I get the palpitations?”
“Exactly.”
“Boys-a-boys.”
“Too much thyroxine speeds up a lot of body functions. It’s no wonder you sweat and feel too warm. But it can be fixed.”
“Dead on. Can you fix it right now?”
Sebastian shook his head. “I’m sorry. We’ll still need to do some laboratory tests, and we can’t do them here. I’ll have to send you to a specialist at the Royal Victoria. Professor Desmond Montgomery.”
Mister Johnson smiled again. “Oh, aye. There’s some good luck. Him and me’s the same Christian name, so we do.”
“Indeed, you do. He’ll order some special tests. There are quite a few, but none of them hurt more than getting a blood test. Once he has the results, he’ll see you again, explain what’s going on, and pick a treatment for you.”
Mister Johnson frowned. “You mean there’s more than one treatment.”
Sebastian nodded. “Most of the time it’ll be one of three anti-thyroid drugs that slows down the production of thyroxine. A few research centres in English hospitals are testing—” He hesitated, and Barry knew Sebastian was deciding whether or not to say “radioactive”—“specially treated iodine, but it’s not available in Belfast yet.”
“I see.”
“And sometimes removal of the gland is recommended.”
“An operation, like?” He put a hand to his neck. “I don’t much fancy getting my throat cut.”
Sebastian smiled. “Generally, surgery is only called for with huge swellings, we call them goitres, ones behind the breastbone, or if the patient is experiencing a lot of what we call ‘pressure symptoms’ on their gullet or windpipe and have difficulty swallowing or breathing, and you’re not, are you?”
Mister Johnson shook his head.
“Then I don’t think there’s much risk of you having to have an operation.”
“Dead on.”
And there wasn’t in this case, unless the specialist had reason to suspect the presence of malignant changes in the thyroid gland. Sebastian had left that possibility out of his explanation and Barry applauded that.
“I’ll get a letter off and they’ll send you a letter back with an appointment time and date. I’m afraid there’s not much us GPs can do to make life easier for you in the meantime, but I’ll mark my request urgent.”
“Thanks a million, Doc.”
“Have you any questions for us?”
Mister Johnson rose. “No, sir, but I have this. I’m sorry I didn’t know you was here, Doctor Carson, but this here’s”—he gave the package to Barry—“a brace of geese to say thanks to you, sir, and Doctor O’Reilly for helping me out from under thon tractor.”
“Thank you, Mister Johnson,” Barry said, “on behalf of us both. That’s very kind of you. Doctor O’Reilly’s housekeeper is an excellent cook and so is my wife. They’ll do your geese proud.”
Desmond Johnson donned his flat cap and dipped his head in acknowledgment to the two men. “I’d best be off. Thanks, again, Doctors.”
Barry watched Mister Johnson leave. “My compliments, Sebastian. Your diagnosis was spot on, in my opinion. A bit more teaching—it was more likely to be a nodular goitre because?”
“Because diffuse goitres are more common before age thirty-five and cardiac symptoms are not pronounced but eye signs are. Nodular ones occur after thirty-five and cardiac symptoms are prevalent, but eye signs are not.”
“Good man.” Barry grinned. “I also want to compliment you on your explanations.”
“I learned that lesson the hard way too. Particularly with country patients. I thought your not using the specific was kind.” His voice became serious. “I also like the way you didn’t mention the possibility of malignancy when you explained the indications for surgery. Well done.”
“Better he blames me if it turns out to be the case—which is very unlikely—than put the fear of God, almost certainly unnecessarily, in the man for a couple of weeks.”
“I agree,” Barry said. “Now, while you’re writing your referral letter, I’ll take the geese to Kinky. Then I’ll bring in the next customer.” He hefted the parcel. The pair of geese were heavy and fleshy. They would make two wonderful meals. “There are some distinct advantages to rural practice.”
“I’m beginning to see that. I could get to like it very easily.”
As Barry trotted along the hall, he knew he was warming more to Sebastian Carson and realized they still hadn’t taken the marquis up on his offer of a day’s fishing. Trout season would be ending on September 30. Another season, wildfowling, was starting today, September the first. Those dates on the calendar heralded age-old seasonal changes all over Ireland. Fingal and Kenny were down on Strangford for opening day and Barry remembered how, back in 1964, he’d taken a girl called Patricia Spence down to Gransha Point for a picnic not far from Lisbane on Strangford Lough and it had rained. The girl was long gone and no longer missed. But Strangford remained. Timeless. Eternal. He wondered how Fingal and Kenny were getting on there?
21
No Man Is Born an Angler
Barry’s car passed under some ancient elms on the rutted lane past Ballybucklebo House. Their asymmetrical leaves looked dispirited and faded so late in the summer. Tree branches scraped the windows until, leaving the small wood behind, he entered a broad meadow. The lane crossed the field heading toward the banks of the Bucklebo River, where weeping willows wandered in a meandering line following the bends in the stream. When the lane petered out, Barry parked, grabbed his gear, took off his shoes, and tugged on a pair of Wellington boots. He slung his creel, shouldered his rod, and walked through the recently mown hay with its scent fragrant in his nostrils. At the bank of the river, the current, sunlight dappling its wavelets, flowed from left to right.
Behind him another car approached, turned—Sebastian’s green Mini Cooper-S. When they had agreed to go fishing together five days ago and had sought the marquis’s permission to do so on this Saturday afternoon, Sebastian had explained that it would suit him better to go straight to the river than meet Barry at the Lavertys’ bungalow.
The Mini parked beside Barry’s Imp, and to his surprise, Sebastian helped a woman out of the passenger’s seat, opened the back door, and handed her what looked like a painter’s easel. He dragged out a folding stool and then produced a fishing rod and creel. The pair walked across the meadow.
“Barry,” he called, when they were close enough to be heard. “I’d like you to meet the mater, Mrs. Ruth Carson. Mother, Doctor Barry Laverty.”
“How do you do, Mrs. Carson?” Barry was soon speaking to a woman whom he guessed to be in her early fifties. She was slim and blue-eyed with a fringe of auburn hair peeping out from under a green silk headscarf.
“How do you do, Doctor Laverty?” She smiled and Barry saw regular white teeth and laugh lines at the corners of her eyes. “I hope you don’t mind me tagging along.”
“Not at all. It’s a pleasure to meet you.”
“Thank you. And you.” Ruth Carson looked over at her son. “Dear Sebastian,” she said. The fondness in her eyes made them sparkle like the sun glinting off the nearby river. “I’m having one of those days, I’m afraid. Since Sebastian’s father died, there are times I just don’t like to be alone. The shock, I suppose, so sudden. A heart attack, you see. I’m afraid I still haven’t quite got my feet under me.”
She stooped to pick a long wand of timothy grass that had escaped the mower and continued speaking, her eyes still on the ground. “My son kindly took me shopping this morning then out to lunch in Bangor at the Dufferin and Ava restaurant, and then invited me to join him this afternoon.” She straightened and indicated her easel. “I’m a keen watercolourist. I can already envisage a lovely landscape here. I promise I won’t get in your way.”
“I’m sure you won’t, Mrs. Carson.” Barry glanced at Sebastian. He was busying himself with his mother’s easel, the very acme of filial duty. Barry thought back to the interview at the inn and looked at Ruth Carson. Was she the reason her son needed time off? Perhaps Barry and Fingal had misjudged their young trainee.
“I’d rather prefer it if you’d call me Ruth. May I call you Barry?”
“Of course.”
“Splendid. Now I shall be perfectly happy to set up my easel here while you boys trot off and annoy the fish. Do give me a hand, will you, Sebastian?”
While Sebastian got his mother settled, Barry realized that it wasn’t only the influence of Harrow that had given Sebastian his upper-crust accent and speech patterns. His mother hadn’t the slightest suggestion, as was prevalent among some top-drawer Ulsterfolk, of letting, in local parlance, the buttermilk show through the cream—when an otherwise perfect Oxbridge accent was marred by the sudden intrusion of Ulster tones or idiom.
“You’re all set now, Mother,” Sebastian said as Ruth Carson settled herself on her stool and opened her paint box.
“Indeed I am. Off you trot, boys. I believe in huntin’, shootin’, and fishin’ circles the good-luck wish is ‘tight lines.’”
“It is,” Sebastian said, “and we’ll not be far away. If you need me just shout. Come on, Barry. As I remember, there’s a wide curve upstream. With a long ripple. There’s usually a trout at the tail of the ripple.” He started to walk, and Barry fell into step by his side.
Barry noticed Sebastian’s Hardy split-cane rod and single-action reel. Trust him to have the Rolls-Royce of fishing tackle. Barry said, “On this side downstream of the ripple there’s a still, deep pool shaded by a willow. Trout lurk there too. Do you want the ripple or the pool?”
“I’ll take the pool and move slowly downstream so I can get close to Mother again.”
Barry stopped. “Sebastian?”
He turned to face Barry. “Yes?”
“May I ask you a personal question?”
“Um. Well. Yes, actually.”
“I’ve only known you for a month, but you strike me as a private person, and I don’t want to overstep myself.”
“Perfectly all right.”
Barry inhaled, looked the man in the eye, and said, “Fingal and I have been a bit concerned about you needing a lot of time off. Getting away the minute work’s done.” He glanced downstream to where Mrs. Carson was holding up a paintbrush and squinting over it to establish perspective. “Something your mother just said about not liking to be alone made me wonder. Is it for her sake you’re always rushing off?” He waited.
Sebastian stared at the toes of his Wellingtons before looking directly at Barry. “Yes.” He swallowed. “I know I can trust you, Barry.”
Barry nodded his encouragement.
“My father’s death came as a terrible shock. I think the mater is finally coming around—at least I hope so. But she’s been very needful and somewhat reliant on yours truly. There’s more, but I’d rather not…”
“I understand. Say no more.” Barry used his rod tip to point at the river. “I’ll take leave of you here at the pool and hope the fishing will take your mind off things. Come on. I want to get a fly in the water.”
Barry left his colleague, no, friend—that was closer to the right word now—setti
ng up his rod and line and studying the pool.
Thirty yards farther on, Barry stopped a little upstream from the tail of the ripple, scrutinised it, and decided there was no evidence of any kind of insect hatch or rising trout. Nothing with which to match a specific fly. He reached in his creel, took out an aluminium fly box, selected a Williams Favourite, and replaced the box. The black-bodied fly, with its silver wire rib and black hen’s hackle, often was effective in attracting the fish. He tied it to his fine nylon leader.
Right. Barry stripped a loop of line from the reel, bent his right elbow back, and quickly let the loose line be carried back. He made sure the rod tip was just past the vertical, then, as the line reached its full length, brought the rod tip rapidly forward. The latent energy built up by the weight of the line added extra push and let the fly drift onto the centre of the ripple at the full extent of the line. Borne swiftly downstream by the current line, the leader and fly arced downstream until the fly was brought to a halt. Any waiting trout would be presented with what looked like an appetising morsel that had drifted down to the fish.
No luck.
He retrieved and cast again.
Part of what he loved about fly-fishing was the near-perfect peace of the riverbank interrupted only by the tinkling sound of the water and today, on the Bucklebo River, the occasional bleat from a flock of black-faced ewes on the opposite bank.
He cast again. This kind of fishing, requiring as it did complete concentration, only gave him a split second to decide not to think about the state of Ulster, Sue’s now uneventful and progressing pregnancy, and Sebastian’s cryptic remark that “there’s more but…” before he felt a tug and jigged the rod back to strike the hook deeply into the fish.
The rod tip arced down, and the reel screamed as the line ran out. He made sure the rod’s tip was vertical to ensure the pressure on the line would keep the fish from throwing the hook.
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