O’Reilly’s chuckle was cut short by a “Doctor O’Reilly” from the hall.
There was something different in Kinky’s voice.
“I think you’d better come to the phone, sir. Now.”
This wasn’t the amused tolerance of a couple of weeks ago when she’d asked him to speak to Donal Donnelly. She was disturbing him in the middle of lunch to speak directly to a patient. Something serious was going on. He left Barry to finish his meal and galloped to the hall where the usually unflappable Kinky stood, hand over the mouthpiece, eyes wide, and saying sotto voce, “It’s that Doctor Fitzpatrick, sir. Something’s very wrong and he won’t tell me what. I do not like the man at all, but he sounded mortal petrified, so.” She offered O’Reilly the receiver.
“Ronald? Fingal here. What’s wrong?”
The man’s voice came over the line. “Fingal, can you come to my surgery at once, please? Please?” The tones were quavering. The man did sound terrified.
“Do you want to tell me what’s up?” O’Reilly said. He lifted his shoulders at Kinky and widened his eyes in question.
“Please just come. I’m—I’m frightened.”
“Leave the front door open. I’m coming,” O’Reilly said and, not waiting for an answer, put the phone down. “Doctor Fitzpatrick’s in some kind of trouble.” O’Reilly called through the dining room door, “Barry, will you make my home visits this afternoon? I have to rush round to Fitzpatrick’s. I’ve no time to explain.”
“Sure,” came back the answer. “Never worry.”
Blessing Barry’s good-natured willingness, O’Reilly grabbed his bag from the surgery and charged through the house and back garden yelling a quick “stay” at Arthur.
He piled into the big Rover, started the engine, slammed the car into gear, let out the clutch—and promptly stalled. “Jasus Murphy,” he said aloud to himself. “Festina lente.”
Once on Ballybucklebo’s Main Street he had no choice but to make haste slowly. Thursday was market day, and even in early November it was a busy time. Cars and carts were parked higgledy-piggledy at the sides of the road, reducing traffic flow to one lane, which was creeping along behind a farmer on a rusty bicycle, and his border collie driving a small herd of Jersey cows up the middle of the road. Attar of cow clap mingled with car exhaust in the sea-misty air. O’Reilly sat pounding his fist on the steering wheel and yelling, “Come on. Come on.” Fortunately, the cattle were going his way and were no respecters of traffic lights. They meandered on through the green, amber, and red, which gave him the chance to turn right onto Station Road and, thirty-mile-an-hour speed limit be damned, roar on to the Kinnegar.
He only wished his Rover had a siren and flashing lights like the police cars driven by TV’s Sergeant Joe Friday of Dragnet. Whatever neurological disorder ailed the man, it must have worsened.
He parked by the seawall on the Kinnegar’s Esplanade, grabbed his bag, piled out, and tore through Fitzpatrick’s hall and on into his surgery.
Ronald Hercules Fitzpatrick sat behind his desk on the raised dais with his elbows on the desktop, his forehead resting on the palms of his hands. He looked up and Fingal saw that beneath the gold pince-nez were tear tracks down the man’s hollow cheeks.
“Fingal,” he said, “thank God you’ve come.” He sniffed, swallowed, and his Adam’s apple bobbed. “It’s my legs,” he said. “My legs.” His voice quavered. “I can hardly move them.” He stared into O’Reilly’s eyes. “Help me. Please.”
“Of course.” Fingal stepped up on the dais and, very sure of the importance of human touch to a man in distress, laid a companionable hand on Fitzpatrick’s shoulder, handed him a hanky, and said, “Here. Blow your nose. You’ll feel better.”
“Thank you.” Fitzpatrick sniffed and honked.
O’Reilly’s mind was racing like one of those newfangled IBM computers. Add weakness of the legs to lack of pain and heat sensation in the hands and almost certainly something ominous was happening in the spinal cord. Probably at the place where it left the brain to run down the spinal column and provide the body with its controlling nervous system that conveyed messages to and from the brain. The range of potential causes was large, and the investigation, diagnosis, and correct treatment—if the causative condition were to be treatable—were far beyond the capabilities of a rural GP.
“Ronald,” O’Reilly said, “I hope you’ll agree, but I don’t think there’s much point in me trying to make a diagnosis. I think it’s time we took you to see Charlie Greer.” He waited.
“Whatever you say, Fingal.”
“Where’s your phone?”
“In the hall.”
“I’ll just be a minute.” O’Reilly left, and after the usual and seemingly interminable delays at the hospital switchboard, he was put through to Ward 21, where the ward clerk who answered the phone soon had the ward sister, Kitty, on the line. “Fingal? What’s the matter?”
Her abrupt question did not surprise him. He rarely phoned her at work. “It’s Ronald. He’s taken a turn for the worse. He’s going to have to be admitted, but he’s agreed to see Charlie. Have you a bed?”
“I’ll find one and I’ll find Mister Greer.” She’d not refer to him as Charlie in front of her staff and junior doctors, who would be on the ward. “He has a clinic this afternoon. I’ll let him know to expect the patient.”
“Grand,” said O’Reilly. “I’ll drive him up myself.” He hung up then realized he’d done so without telling Kitty he loved her. He’d been distracted wondering, with Fitzpatrick having difficulty standing, whether he’d be able to get him into the car. There was only one way to find out. He tried to oxtercog the man, but Ronald’s legs dragging helplessly slowed their progress. “Be damned,” said O’Reilly, and simply picked Fitzpatrick up bodily, surprised at how light such a tall man could be, and carted him out to the backseat of the Rover. Throughout the entire undignified exercise, the man remained as quiet as a scolded child. The car smelled strongly of damp dog, but O’Reilly didn’t care and his passenger didn’t comment. The first priority was to get this sick man up to the Royal.
* * *
“Ronald is not a well man,” Charlie said to Fingal and Kitty as they sat together in his office on Ward 21, the neurosurgery unit in Quinn House, a recent addition to the Royal Victoria Hospital. “My initial physical examination confirms what we anticipated back in Dublin. Loss of pain and heat sensation in his right hand.” Charlie was every inch the senior surgeon in his long white coat with the tools of his trade—a tuning fork and a patella hammer like a small tomahawk with a rubber head—sticking out of one pocket. Kitty looked coolly official in her red senior sister’s uniform dress, white apron, and white triangular headdress called a fall.
“There’s more, now I’ve had a chance to examine him properly. He’s retained the ability to sense light touch, feel the vibrations of the tuning fork, and he can sense position. There’s some wasting of the small muscles of his right hand and his tendon reflexes are gone. And now he’s had this sudden loss of power, some spasticity of his legs, and his Babinski reflex is extensor.”
O’Reilly remembered being taught how to scrape a key along a patient’s sole. All was well if the great toe curled down, but if it went up in extension as it had with Fitzpatrick? He clenched his teeth.
“Taken all together, that says to me in a loud voice, ‘high spinal lesion,’” Charlie said.
“I’m afraid diseases of the nervous system were never my strong suit,” O’Reilly said. “Have you made a differential diagnosis?”
“Aye.” Charlie nodded. “I never really seriously considered Tabes dorsalis.”
O’Reilly understood why Kitty was trying to hide a smile. Despite the gravity of the situation for poor Fitzpatrick, the thought that he, of all people, might be suffering from late-stage syphilis was incongruous enough to be risible.
“And because it causes upset of all sensations and Ronald can feel light touch and vibrations, I’m pretty confident tha
t Tabes is a nonstarter.”
“Good,” said Kitty. “I just can’t picture dear old lugubrious Ronald as a roué.”
“Nor me,” said Charlie. “Those signs are pretty typical of either local compression of the spinal cord or some degenerative nervous disease in an early stage.”
“Degenerative diseases like multiple sclerosis or the one you get with vitamin B12 deficiency?” O’Reilly asked.
“It’s called subacute combined degeneration of the spinal cord,” Charlie said. “Quite a mouthful. I’m tending to think it’s not degenerative, because those conditions are more likely to be more generalised. So I’m thinking either syringomyelia or a space-occupying lesion.”
O’Reilly saw Kitty flinch and knew why. Syringomyelia was an ill-understood condition where there was degeneration of the grey matter, the actual nerve cells of the spinal cord, the cells that relayed messages like pain and feelings of heat and cold to where they were interpreted by the brain and experienced by the conscious mind. The degeneration led to the formation of a cystic structure filled with cerebrospinal fluid, the so-called syrinx, which as cells died could expand up and down the spinal cord. It was incurable, although it was believed that radiation might slow down its progress. “Space-occupying lesion” was a euphemism for “tumour,” and O’Reilly knew that there was quite a list to pick from. Some were benign. Most were not.
“So,” said O’Reilly, “what happens next? Tests?”
“Aye,” Charlie said. “I’ll tell you both what they are and, Kitty, will you please make the arrangements?”
“I will,” she said.
“He’ll need some blood work, most important a haemoglobin assessment and, if it’s low, an examination of a smear of the cells to exclude or identify B12-deficiency anaemia that could be associated with subacute degeneration. And even if he is a friend, I’d be remiss not to ask for a Wasserman to exclude syphilis.”
Kitty ticked off the boxes on a lab requisition form.
“From my perspective, I have to establish if there is indeed cord compression, so he’ll need a spinal X-ray. And a chest X-ray. If there is a space-occupying lesion, it may be a secondary from a lung cancer.”
O’Reilly flinched. That would be a death sentence. “Ronald never smoked cigarettes as far as I know,” he said. The link between smoking and lung cancer had been recognised in 1929 by German physician Fritz Lickint.
“Two years ago, the American surgeon general recommended that cigarette smokers quit,” Kitty said. “The news was all over the BBC. I don’t think anyone here paid a blind bit of attention.”
“Lung cancer can affect nonsmokers too,” Charlie said, “but I’m not unduly concerned about Ronald. Just being thorough. It’s more a question of determining if there is such a lesion, and if so, is it inside or outside the cord? That means a myelogram, I’m afraid.”
O’Reilly shuddered. He vividly recalled how his last patient who had required the test had received an injection of a radio opaque dye into the spinal canal so X-rays could follow its progress along the canal as the patient was tilted on a special table. John Cowan, a local labourer, had described it as having green fire poured along his back. Poor Ronald.
“I’ll speak to the radiologist myself,” Kitty said. “Make sure it’s done by a consultant, not a trainee.” Her gaze met O’Reilly’s and she pursed her lips and rapidly shook her head.
He could tell she too was cringing at the thought of what the poor man must endure. But that was Sister Kitty O’Reilly. Skilful, efficient, and with a heart like a duck-down pillow when it came to her patients.
“I’ll try to get them organised for tomorrow, before the weekend. Doctor McIlrath in that department owes me a favour.”
“Thank you, Kitty. Do your best,” Charlie said, and rose. “Now if you’ll excuse me, I’ll go and try to explain to Fitzpatrick. It won’t take long, then I’ll have to get back to outpatients. I’ll pop in before I go home, Kitty. See what you’ve got organised.”
“Thanks, Charlie,” O’Reilly said. “Thanks a lot.” He hesitated. “Can I come with you?”
“Sure.”
Together they went to a one-bed ward where Ronald Fitzpatrick lay propped up on pillows, reading.
“Fingal’s come with me, Ronald,” Charlie said, stating the obvious. “He’s concerned for you and he wants to understand as much as possible so he can try to help you.”
Fitzpatrick looked over his gold pince-nez at Fingal. “I appreciate it, Fingal, I truly do.”
O’Reilly smiled and lowered his head.
“I’m not going to wrap it up, Doctor Fitzpatrick,” Charlie said. “I’ve examined you, made a differential diagnosis, and ordered some tests. Sister O’Reilly is arranging those now. You’ll need some blood work and some X-rays.”
“I see,” Fitzpatrick said. “If you remember from Sir Patrick Dun’s, I was quite good at internal medicine.”
O’Reilly did remember. The man should have won the gold medal in that subject but for a careless error. In fact, he’d never understand why Fitzpatrick had gone into general practice. He had seemed destined for some kind of specialization.
“I know that you are the expert, Mister Greer, but if I may hazard a guess? I suppose very few doctors would fall ill without trying to make the diagnosis themselves.”
Charlie smiled and said, “True. Go ahead.”
“You’re trying to decide between syringomyelia…” There was a catch in his voice. “I’ve been terrified that’s what it might be ever since I picked up that hot teapot in Davy Byrnes. Or it might be a tumour.”
“I’m afraid so,” Charlie said.
Fitzpatrick smiled. Clearly his satisfaction with making the correct diagnosis had momentarily overridden his fear. “I suppose I’ll need a myelogram?”
Charlie nodded.
Fitzpatrick swallowed and his Adam’s apple bobbed. “I shall try to be brave,” he said.
“Good for you, Ronald,” O’Reilly said, marvelling at how well the man seemed to be taking the news of what must be done, what might be found. “I’ll make you a promise. Kitty’ll let me know when the test results are in and I’ll pop up and see you.” Let you cry your heart out with another human being if the news is bad and you need to, he thought.
“Thank you, Fingal. I’d appreciate that. I shall try to stay positive.” He forced a tiny smile. “I’ve been reading this. It was in my pocket.” He handed a slim volume to O’Reilly. The Power of Positive Thinking. “I’m trying to practice what Doctor Peale preaches.”
O’Reilly opened the book at random, his eyes drawn to a passage the gist of which was not to imagine obstacles, but despise them, shrink them. “Difficulties … must be seen for only what they are and not inflated by fear.” Probably good advice for a man in Ronald Fitzpatrick’s situation.
“I have a favour to ask, Fingal.”
“Fire away.”
“Could you and your young friends look after my practice—just for a while? Until I’m back on my feet?”
Not having a clue exactly how running the man’s practice was going to be done, O’Reilly nevertheless said, “Of course. You’ll not need to worry about it.”
“Then,” said Fitzpatrick, “that’s settled. It is a great weight off my mind. Thank you, Mister Greer. Thank you, Fingal. May I have my book? Thank you.” He began to read then said, “I’m sure you are both very busy men.” Obviously, they were being dismissed and the man must want to be alone to grapple with his thoughts.
“I’ll be seeing you tomorrow,” Charlie said. “I’ve left you a sleeping pill, Ronald. Try to get a good night’s sleep.” He led O’Reilly out of the room. “He’s an odd fish,” Charlie said, clasping his hands behind his back and heading down the corridor toward the outpatient department, O’Reilly in step beside him. “For weeks, maybe even months, he’s been so terrified he’s been denying the truth to himself. Now that’s no longer an option, he seems to be quite reconciled. He’s an odd fish all right, but you have t
o admire his pluck.”
“I know you’ll do your best for him, old friend,” O’Reilly said.
Charlie shrugged. “It’s what they pay me for, you know. Doing my job.”
His friend was a highly skilled technician in a field where many of his patients, despite his best efforts, were incurable. O’Reilly knew from long experience with the breed Homo surgicus that Mister Charlie Greer had been forced to develop what looked to be a cynical carapace. Inside, though, he knew, Charlie was concerned that he’d had to order a horrible test for his patient and even more concerned because of his deep understanding of how devastating the results might be.
22
Let’s Have a Wedding
The Reverend John Wilfred Evans, B.A., stood in front of the altar and beneath the ornate baldacchino in Haslar hospital’s Church of Saint Luke, built in 1762. Behind him hung a painting of the Restoration of Sight to Bartimaeus. The healer was Jesus Christ. “All ye that are married or intend to take the holy estate of matrimony upon you…”
Fingal tried to listen, but it was a particularly dry and lengthy part of the service and his mind kept wandering to how he had come to be standing here, neat and starched in his dress uniform complete with his brand-new lieutenant-commander’s insignia and sword. That which had seemed impossible a month ago, his wedding to Deirdre Mawhinney, was now almost complete. Fingal tried once again to concentrate on the chaplain’s instructions about the duties of husband and wife, the final act of the Anglican service before the benediction and dismissal. He stole a sidelong glance at his bride. She stood to his left, the veil of her white headdress, now that the vows had been exchanged, thrown back. She was gazing intently at Reverend Evans, but soon sensing his eyes on her, she turned slowly and smiled.
Twice in his life Fingal had come close to experiencing feelings of ecstasy; the day he’d passed his finals and had become Doctor O’Reilly, and the day he’d put on the green shirt with shamrocks on the left breast to play rugby football for his country. But the sensation in his chest when he saw Deirdre’s smile reduced those events to the humdrum.