She took it off. “It’s absolutely beautiful.”
“That’s the ring you want?” O’Reilly asked.
“Yes, please. It’s exactly what I had in mind.”
“You don’t want to look at any others?”
She shook her head.
“We’ll take it,” O’Reilly said.
“Just a minute, Fingal.” Kitty spoke to the assistant. “May I borrow your loupe?”
“Certainly.” He gave her a monocular magnifying eyepiece, which Kitty screwed into her right eye socket.
What the hell now? O’Reilly wondered.
She scrutinised the ring. “There’s a tiny flaw in the stone,” she said, handing the loupe and the ring to the man.
He examined the diamond. “Modom is right. I do apologise. Shall I—?”
“No need. I love the ring. We’ll take it.” She looked him in the eye. “But I’m sure you’ll adjust the price.”
“Of course.”
“Good,” she said. “Now, I’ll wait outside while you take care of paying, dear.” She lifted her glove and left.
Typical. O’Reilly had been going to suggest she go. He didn’t want her to know what he paid.
“I’ll box and wrap it, sir.”
“Please. And the bill.”
“Of course, and there will be a twenty percent discount because of the flaw.”
“Thank you.”
“And if sir doesn’t mind me saying, he is a very fortunate man.” The assistant looked at the door through which Kitty had vanished to a jangling of bells. “Your fiancée is a remarkable and very beautiful lady.”
“I know,” said O’Reilly, trying not to sound smug. “By God, I do know.”
He paid, took his little parcel, thanked the assistant, and left.
Kitty linked her arm through his. “Thank you, darling. Thank you.”
“Not yet,” said O’Reilly. “We’re going to Mooney’s on Corn Market. It’s not far. You can thank me after I’ve given it to you properly, you’ve put it on, and I’ve toasted you with a pint of black velvet.”
“Black velvet?”
“Guinness and champagne. You’ll love it.” He set off at a brisk pace. “I’m buying lunch too.”
“Sounds wonderful.”
They crossed Royal Avenue and headed along Castle Place. “By the way,” he said, “are you free this weekend?”
“I am.”
“I’d like you to come down, show your ring to Barry and Kinky,” he said, “the rest of the crew at Number One, Main Street, Ballybucklebo.”
“I’d love to.”
“Great.” He pushed open the door to Mooney’s Pub. “I know the barmen here,” he said.
The place was packed, smoky, and noisy. “Black velvet. Two pints, Andy,” O’Reilly roared in his quarter-deck voice, “menus, and a dozen oysters on the half shell to start with. My belly thinks my bloody throat’s cut.”
2
And Strangled in the Guts
What on earth was that clattering? Barry Laverty—Doctor Barry Laverty—was enjoying a cup of tea after lunch, but now he frowned and listened. Probably that demented cat Lady Macbeth knocking something over. He rose from the table wondering how O’Reilly was doing up in Belfast with Kitty. He’d been like a child going on a school outing, so impatient he hadn’t even eaten a proper breakfast, which for O’Reilly was unheard of unless there was an emergency. And it would have to have been a life-threatening one at that for the big man to forgo his vittles.
The clattering stopped, but now he could hear retching. A patient must have come into the house unannounced.
Barry crossed the hall and looked into the surgery. Empty. He hurried to the waiting room, but although the plain wood chairs and God-awful rose-patterned wallpaper were there, the room was deserted.
More sounds of retching were followed by a moan, and this time Barry knew where they were coming from—the kitchen. He ran to the back of the house and flung open the door. The room was warm and the stench of vomit smothered the cooking aromas. A saucepan lay on the floor with peeled and diced potatoes forming a small archipelago in a pool of spilled water. Mrs. Maureen “Kinky” Kincaid, Doctor O’Reilly’s housekeeper, stood clutching the edges of the sink. Her silver chignon was in disarray, tears streamed down her cheeks. “Ohhh Lord Jasus,” she gasped.
“Kinky, are you—” he began, then stopped. “Are you all right?” would be a bloody silly thing to ask, almost as stupid as “What’s the matter?” He was a doctor, but it didn’t take one to see that Kinky Kincaid was not well. He took a breath, resolved to behave like the doctor he was and sort out what needed to be done without wasting time mouthing platitudes. He moved to her and put an arm round her shoulders. “It’s all right,” he said. “It’s all right. Let’s get you sitting down.”
“I’m sorry, sir,” she said, and hiccupped, “but I’ve been taken over all funny, so, and I haven’t finished getting tea ready for himself and you. And him with no breakfast.” She dragged in a deep breath and shuddered. “I’ll be grand if I could sit down for a shmall-little minute, so.”
“Don’t worry about tea,” Barry said. Typical of Kinky to be thinking about “her doctors” and their next meal rather than herself. He knew he should get her into the surgery and onto the examining couch, or onto her own bed, but Kinky was what her fellow County Cork people would describe as “a powerful woman” and that did not imply slimness. He wasn’t strong enough to oxter-cog her to the surgery or to her quarters in the next room. “Let’s get you sitting down, Kinky Kincaid.” He turned his head away as her shoulders shook and she threw up. “Sorry, sir,” she said, and wiped her mouth with the back of her hand.
He felt her sag and with his hands under her armpits lowered her to the tile floor. He looked around. Laundry was piled nearby. He grabbed an armful and a plastic basin. Barry made a heap of the clothes, including, he noticed, a pair of his own trousers. “Lie back, Kinky. Put your head there.” He set the bowl beside her.
“Thank you, sir.” Her pinafore was splotched, her lips caked.
Barry dampened a tea towel, squatted beside her, and mopped her face. “Can you tell me what happened?”
She took a shallow breath, then said, “I was grand all together until about twelve thirty. I’d nearly finished getting lunch ready when I got a sharp pain. Mary, Mother of—” She clutched her lower belly and moaned. “There it is again.”
“Tell me about the pain,” he said. He took her pulse. The skin was clammy and her pulse rapid.
“It came on like a terrier pouncing on a rat, so, and it gnawed at me and kept on grinding, then it went away. That—” She inhaled. “—that was a blessèd relief for I was able to serve your luncheon on time, so.”
Kinky, you’re one brave woman, he thought, but asked professionally, “Can you show me where it hurts?”
She pointed to her left groin. “There, sir, and it does be back there now. And it’s coming in spasms.”
Barry glanced at his watch. One thirty-five. He frowned. Her vomiting had suggested the relatively innocuous acute gastroenteritis, often called stomach flu, or “the abdabs” by the locals. But while the disease might cause vomiting, clammy skin, and a fast pulse, it would not cause pain in the place Kinky was describing nor pain that came on so suddenly. “Have you ever had trouble there before?” he asked.
“Not like this. Once in a while if I’ve been lifting things or hoovering I’ll get a bit of a grumbling there, but, och, sure don’t I usually sit a while and then work it off?” She managed a weak smile. “My ma taught us that you should always try to work pain off, so. Not give in to it.”
“And you’ve never mentioned it to Doctor O’Reilly?” He knew Kinky would not voluntarily consult him, Barry. She’d consider Doctor O’Reilly’s assistant much too young.
“Och, Doctor Laverty, dear,” she said, shaking her head. “Sure wasn’t it only a shmall-little ache, and didn’t it always go away, and amn’t I at an age when you must e
xpect such things? Another fourteen years won’t I be seventy and if I’m spared I’ll be playing in overtime then if you believe what the Good Book says about us being given three score years and ten?”
“Go on,” he said, “tell me more about what’s happening now.” Her description of the pain and its situation had given a hint.
“Just a bit before you came, sir, I had another fierce one, a spasm like a hot knife in exactly the same place. I dropped a pan of potatoes. A few minutes later another one came and then—” A tear fell. “—I embarrassed meself. I threw up, so.” She struggled to sit. “But I’m nearly better now—” She coughed. “—and soon I’ll clean up.”
Barry couldn’t keep an edge out of his voice. “Kinky Kincaid, you’ll do no such thing.” She gasped and clutched her belly. He heard her stomach give an enormous gurgle. The exact words from A Short Textbook of Surgery sprang to mind. Borborygmi are sometimes loud enough to be heard by the unaided ear. The sound of turbulent peristalsis coinciding with an attack of colic is valuable evidence of intestinal obstruction. The causes … which may be acute, chronic, or acute-on-chronic, are very numerous. The site of Kinky’s pain and her previous history of a chronic ache brought on by exertion pointed to a hernia, a weakness in the abdominal muscles containing a sac of peritoneum. Spasms suggested a loop of bowel was trapped there, was being compressed, and causing pain every time a wave of peristalsis, the normal muscle contractions of the digestive tract, ran along the gut. He blew out his breath against partially closed lips. It was a logical explanation, but the other potential causes of obstruction were legion.
She groaned and used the basin. “Dear Lord,” she said, and gasped. “Please can you make it go away, Doctor Laverty? Please. The pain does try a body, so.” There was no strength in her voice.
“I’m sorry, Kinky,” he said, rising to take the full basin away. I only wish I could, he thought, but what I think you need is beyond the capabilities of a country GP. He poured the contents into the sink. He didn’t gag. All those years in the teaching hospital had inured him to many sights and smells. Before he turned on the tap to rinse the mess away he studied it. There was the greenish tinge of bile. That and the onset of pain immediately accompanied by vomiting, which by his guess was happening every three or four minutes, was typical of compression of the small intestine, probably the jejunem, that section of the small bowel immediately between the duodenum and the ileum. He was narrowing the list of possibilities. “I’ll just be a sec,” he called to Kinky as he rinsed the bowl. Blockage lower down the bowel, he thought, usually produced pain that lasted for quite some time before the vomiting started.
Barry brought the basin back and squatted beside her. “Kinky,” he said, “if you were anybody else I’d have to ask you a lot of personal questions, then examine you thoroughly. Last year Doctor O’Reilly taught me only to do the minimum to make a diagnosis if it spares the patient pain or embarrassment. He said when he was a student he’d learnt that from a surgeon in Dublin.”
“Thank you.” Her words caught in her throat. “But if you need to examine me, you fire away, sir. I’d not be any more ashamed than I already am for being so weak.”
He felt a prickling behind his eyelids. “Kinky,” he said. “Kinky, you mustn’t be ashamed. You didn’t bring this on.” He stood. “Please, you just lie there. I’ll be right back, but I have to make a phone call.”
“Go ahead. I’ll be grand if you leave me the basin. I’d not want to make any more mess on the floor.” Her breathing came in gasps. “But don’t be too long.” Her voice dropped to a whisper and she looked him straight in the eye. “I’m mortal afraid, sir.”
He pursed his lips and squeezed her hand. “We’ll get you well soon. Don’t be afraid. I’ll be straight back. I promise.” He rose, went to the hall phone, called the Royal Victoria Hospital switchboard, and waited for an answer.
As he did, drumming his fingers on the wall, he couldn’t help thinking how it was this having to refer difficult cases to specialists that made him question whether he was really cut out to be a rural GP.
“Royal Victoria Hospital.”
“Doctor Laverty here. Can you get me Doctor Jack Mills please. It’s urgent.” Again Barry waited. Stop being so bloody selfish, he thought. You’ve more important things to worry about than whether you’ve made the right choice to go and try obstetrics and gynaecology. Important things like Kinky Kincaid being sick.
“Barry?” Jack’s Antrim accent was clear. “What’s up?”
“It’s Kinky.”
Jack laughed. “Hey bye, I like the sound of that, but what is? Ursula Andress in a white bikini in Doctor No? Or maybe Honor Blackman as Pussy Galore in Goldfinger. Remember when we used to watch her in The Avengers on telly in the students’ mess? All dressed in that black leath—”
“Jack. Jack, be serious.” Despite his concerns, Barry found himself smiling at his old friend. “I’m talking about our housekeeper, Mrs. Kincaid.”
“Oh. That Kinky? Och, I am sorry. Is she sick?”
“Violent abdominal pain, and I do mean violent, of recent onset, concurrent bilious vomiting, previous history of groin aches—”
“Physical findings?”
“Clammy skin and tachycardia and that’s all I know. Come on, Jack. Kinky’s fed you often enough when you’ve come down here. You know how she looks after O’Reilly and me. It would be like examining my own mother.”
“Fair enough. You don’t need to anyway. It sounds like a strangulated hernia. Probably needs surgery,” Jack said. “Shoot her up to us and we’ll take care of examining her and doing any tests.”
“I thought it might be a hernia,” Barry said, “but getting her to you in a rush is tricky.” It was gratifying to have his probable diagnosis confirmed by his friend who now had ten months of surgical training under his belt. Barry was happy to have the specialists take care of Kinky. She was family. It was the other referrals he’d had to make that were frustrating him.
“How soon can you get her to the Royal?” Jack asked.
With bowel obstructions, the sooner the constriction was removed the less was the likelihood of complications like gangrene of the bowel, perforation, peritonitis. Barry owed it to Kinky to move quickly, but— “I could run her up myself,” he said, “but O’Reilly’s not back from Belfast and if I do there’ll be no one here if there’s another emergency in the practice. She usually looks after the shop when the boss and I are both out. Makes not-so-urgent patients wait, gets an ambulance for the really sick ones and sends them to casualty.”
“Not to worry. You’re at home?”
“I am.”
“I’ll get an ambulance down pronto.”
“Fine.” Barry heard a distant low moan. “Jack, she’s having a lot of pain. Morphine?”
“Better not, I’m afraid. Understanding the pain, where it’s felt, what makes it worse, what relieves it, it’s all part of making the final diagnosis in folks with acute bellies. Painkillers muddy the waters. We’ve known that since fourth year, Barry.”
“I know. I just thought—” He bit off the words. He’d made the serious mistake of letting his concern for this special patient override what must be done. He also knew he hated to see Kinky suffering.
“We’ve made an informed guess that it’s a hernia,” Jack said, “but at her age, what, fifty, fifty-five? You could get those symptoms from a lot more things. Crohn’s disease, ulcerative colitis—”
“I know, I know,” said Barry. “You can spare me the list, Jack. Just tell the ambulance to be quick and ask one of the attendants to keep her company on the drive up to Belfast. She’s in a lot of pain, and she’ll be terrified. She shouldn’t be left alone.”
“Done, mate,” Jack said, “and I’ll talk to my boss, Sir Donald Cromie, at once. He’s here in outpatients. He teaches that severe belly pain is either ‘watching sick,’ meaning you can observe them, try nonsurgical treatment, and perhaps they’ll get better, or ‘opening sick,’ whic
h means immediate surgery is indicated. And I’m sorry, Barry, but even sight unseen, your Kinky sounds pretty ‘opening sick’ to me. If he agrees, he’ll see her the minute she arrives on the ward. Save a bit of time.”
“Thanks.” Barry was going to say good-bye, but remembered, “One last thing. Kinky’s hundreds of miles away from her family in County Cork. She’ll be all on her own at the hospital. I’ll have to let her folks know, but I’ll wait ’til I hear for sure what’s going on. Will you give me a call when you’ve seen her?”
“Sure.”
“Thanks, Jack,” Barry said. “I’d better go back and see how she’s doing.” And it won’t be well, he thought, but at least I can offer her a bit of comfort while we wait.
3
“Plain Cooking” Cannot Be Entrusted to “Plain Cooks”
“What? You’ve sent Kinky to the Royal?” O’Reilly still had one arm in his wet raincoat as water from an April shower dripped onto the hall carpet. It was forty-five minutes since the ambulance had left. The house had felt hollow and empty to Barry without the stoic Corkwoman in her kitchen. He welcomed O’Reilly’s expansive presence now, even if he wasn’t taking the news in exemplary fashion.
“Blue blazes. A bowel obstruction? Holy thundering Jasus, poor Kinky.”
“I’m sorry, Fingal.” His senior’s nose tip had blanched, a sure sign the man was furious.
“No need for you to bloody well apologise.” He hung up his coat so forcibly that Barry thought the coat-peg might be torn off the wall. “You didn’t make her sick.”
Barry said, “I wasn’t apologising, Fingal. When I said ‘sorry’ I was expressing regret that Kinky’s sick, not accepting blame for anything.”
“I know,” O’Reilly said. “I know, and I’m not angry with you, Barry. It’s not your fault. You’ve got her in good hands, and I understand why you didn’t take her to Belfast yourself. You could have panicked, but you didn’t. Mind you, I’m not surprised you did the right thing. You’ve learnt a lot since you came to work here. I trust you, son. Implicitly.”