John-Joe sighed. “It’s tougher at home. I’ve a plot out at Dolphin’s Barn where I grow some veg. A fellah I know’s looking after it for me.” He forced a smile. “Anyroad, my Ailish and the two weans are managin’. She gets the ‘Relief’ money on Wednesdays and dat pays the rent, the neighbour’s granny looks after our two while Ailish makes a few bob as a cleaner, and she’s always been brilliant on Saturday nights at the nine thirty auctions.”
Fingal frowned. “I’m sorry, I don’t understand.”
“Bless you, sir, and why would you, a toff like yourself?”
Fingal had never exactly thought of himself in those terms, but he supposed in John-Joe’s eyes he would be.
“Every Saturday night at nine thirty the butchers auction off all the meat they couldn’t sell during the week. She gets some not bad leavings. Makes great stews. You might not t’ink much of dem, but och, sure, sir, for the likes of us, when you never get a salmon you’re happy wit’ a herring.”
Fingal smiled.
John-Joe’s face fell. “The trouble is when dey let me out we’ll have another mouth til feed—me—and it’ll be hard looking for a job.”
Fingal wished he could say something comforting, do something practical, but he knew he was powerless. “I wish … well, anyway,” he said, “I’m delighted to see you’re doing well.”
“And t’ank you for comin’ til see me. If you’re working in Aungier, I’ll likely see you round the place, sir.”
“Indeed you might,” said Fingal. “You take care. I have to trot.” He half turned, then remembering, shoved his hand into his jacket pocket and fished out a packet of Woodbine cigarettes. “Here,” he said, giving them to John-Joe and, ignoring the man’s thanks, headed back up the ward only to meet Doctor Micks going the other way.
“O’Reilly,” he said, “what brings you here? I thought you were working in a dispensary.”
“An orthopaedic patient, sir. Pott’s fracture. One of Mister Kinnear’s.” Fingal smiled. “He’s doing well, I’m pleased to say.”
“Good.” Doctor Micks stared down at his highly polished black shoes then straight at Fingal. “I’m so very sorry about your father.”
“It was decent of you to come to the funeral, sir. My mother appreciated it.”
“I wanted to come. Your father was a good man and I enjoyed getting to know him, even under the circumstances. It’s a pity we can’t do more.” He pursed his lips. “Sorry I couldn’t make the interment and graveside service, but Holywood’s a long journey for me from Dublin.”
“It’s all right, sir. We understand. It was my father’s wish to be buried there. He was born there and he wanted to—well, to go home.”
“Yes, of course. Please,” said Doctor Micks, “give my regards to your mother.”
“I will,” said Fingal, and after a moment’s embarrassed silence said, “I’d best be going, sir.” He headed down the ward, angry for the plight of John-Joe Finnegan, sad for his father, and suddenly in need of a comforting cup of tea with Sister Mary Daly.
15
Bring Equal Ease unto My Pain
“I’d’ve come out to the farm to see you, you know, Brenda,” O’Reilly said.
The pale young woman before him had curly auburn hair under a rain-spotted plastic hood and dark eyes behind National Health Service granny glasses. She was clearly having difficulty breathing, and, judging by the way she screwed up her face, each breath hurt. “Och, Doctor, dear,” she said, and grimaced, “I’m not altogether at myself, but I’m not at death’s door neither. There’s no need for anyone to come traipsing out into the Ballybucklebo Hills on a day like the day.”
He heard rain pattering on the surgery window. It hadn’t been the greatest summer, and here in early September yet another disturbance had come in from the Atlantic. Och well. They say in Ireland, “Rain at seven, fair by eleven,” and it was pretty well true. Four hours was about the spacing of the small low-pressure systems that tore across the isle bringing rain squalls—and kept it emerald.
“Not at yourself? You’re not just a bit unwell, Brenda Eakin, you’re sick. I could have come, or seeing it’s my turn in the surgery today, I would have sent Doctor Bradley.”
“Doctor Bradley?” Brenda lowered her voice. “Och, sure, haven’t you seen me ever since I was wee and don’t you know all about me? I’d be daft to swap horses in the middle of a gallop, if you know what I mean, like? I’m happy for til see yourself, so I am.”
O’Reilly pulled off his half-moon spectacles and peered at her. Bertie Bishop’s strong reaction to a woman doctor four days ago and now Brenda. Jenny still had failed to convince some of the practice that she was to be trusted. He tried to persude himself that it was the usual reactionary response of country folk to anything new … “Better the divil you know, that it?” he said, and smiled. But he was concerned. Was it merely because she was new, and young? Barry had taken a while to be accepted. He’d almost forgotten how he’d had to help young Laverty when a patient of his had died and it seemed the whole village had lost faith in him. O’Reilly would help Jenny all he could too, but it was also up to Jenny, who’d been here for more than two months, to keep working hard to allay local suspicions. But she could hardly change her genetic makeup.
After having taken an instant liking to the young woman, he was also becoming increasingly impressed with her clinical acumen. And during the dinner in Ballymena, Barry had expressed no interest in coming back. If he didn’t, Fingal would be happy to work with Jenny Bradley as his partner, if she could fit in here. Worry about it later, he told himself. Get Brenda sorted out first.
“You’re no divil, Doctor O’Reilly. You just—” She gasped. “—only pretend to be as tough as oul Balor.”
In Irish mythology, Balor was the king of the Fomorians, a race of giants. His gaze could turn men to rock. O’Reilly harrumphed. Pretend indeed? She’d not seen him having that little chat with Bertie a couple of days ago. The doctors at the Royal had confirmed O’Reilly’s diagnosis of angina. Bertie had had no more attacks, and as O’Reilly had instructed the good councillor on the subject of manners to all doctors, he’d fixed Bertie with a glare that bloody nearly turned the man into a lump of Mourne granite. Balor? When his ire was up, O’Reilly would have made the ferocious giant look like an edentulous pussycat, but he needn’t dwell on it. The problem of the moment was to get Brenda better.
“Now, let’s be getting you seen to. The last time you were in was last October. For painful periods.” He’d been confident back then that the twenty-six-year-old wife of farmer Ian Eakin was suffering from primary dysmenorrhoea, periods that occurred in ovulatory menstrual cycles and were caused by contractions of the uterine muscles. It was unrelated to any organic disease. The exact cause was not known. It often disappeared after a first baby was born. “You didn’t come back,” he said, “so I imagine the medicine worked?” He’d told her to use a combination of aspirin and paracetamol, which did not require a prescription. They were to be taken four times a day on the first day of her period when the pain was worst and twice a day thereafter until the pain went away as the period diminished.
She rubbed the right side of her chest. “Pretty well. Ever since then the minute my monthlies start, I get a wheen of pills into me like you said til and I’m able til thole the cramps and get on with—” She caught her breath. “Mother of God, that smarted.” She inhaled, but it was shallow. “Like I was saying, it takes me and Ian and a bit of help from young Peter Dobbin til keep the farm going—Peter’s eye’s better by the way. So I’m able for til do my work, so I am. I didn’t need to bother you, sir, and sure don’t most women have cramps anyroad?”
“Sad, but true,” he said. Although there was some evidence that as the repressive strictures of the Victorian era were being cast aside, the numbers were falling, and a good thing too. There was precious little medicine could do. Most approaches were either to treat the symptoms medically with painkillers or resort to dilating the cervix u
nder anaesthesia and curetting, that is scraping out the uterine lining, known as a D and C. Some heroic surgeons removed a plexus of nerves from the pelvis and claimed a 70 percent success rate, but similar results had been reported using psychotherapy.
“The new contraceptive pill does work for painful periods, Brenda.” Because, he knew, it suppressed ovulation, which clearly was a prerequisite for primary dysmenorrhoea to occur.
“Aye, but me and Ian want a family so it’s a no-go, so it’s not,” she said. “Anyroad, I have my monthlies right now. They’re a bit niggly, but…” She screwed up her face. “This thing in my chest, that’s a different kettle of fish.”
“When did it start?”
“This morning about six. I’d just got up and I was feeding the chickens when I took this stabbing in my side every time I breathed in. I have it still. For a wee minute there now I thought I was going til keel over I felt so—” She gasped and said, “Excuse me, sir,” before continuing. “—faint.”
“I see.” In fact he didn’t, not precisely anyway. Her symptoms sounded as if she had irritation of the pleura, the double membrane that sheathes the lungs. There were a number of causes. “Did you hit your chest on anything?”
She shook her head.
That ruled out traumatic haematothorax, blood between the pleural layers caused by a blow. “I remember giving you a TB test in 1946 when you were seven.”
“And it come up in a red bump and you said that meant I was immune til TB.”
It did, so one obvious cause was excluded. O’Reilly never saw a patient with chest troubles without remembering the high rate of TB in the tenements in the 1930s. Many people were infected as children, were unaware and shook off the disease, leaving them immune for life. Her red lump had been a positive immune response to the Mantoux test. Other causes? She was far too young for lung cancer. “You’ve no pains in your legs?”
“No, sir. If I didn’t have this pain in my chest, I’d be going round like a liltie.”
Not long ago Barry had been worried about Aggie Arbuthnot’s deep venous phlebothrombosis, but it didn’t sound as if Brenda could have had a pulmonary embolism from such a source. He was narrowing his suspicions. “And you were perfectly all right up until this morning?”
“Fit as a flea, sir.”
Heart failure, nephrotic syndrome, a severe kidney disease, and cirrhosis of the liver could all cause fluid to enter the pleural cavities, but such patients would all have been very ill for a long time and both sides of the chest would be affected.
“Do you feel hot or are you having chills?”
She pursed her lips, grimaced, and shook her head.
She certainly looked pale and sweaty. He leant forward and put the back of his hand on her forehead. A bit damp, but he was confident she wasn’t running a fever. “Have you a bad cough?”
“No, sir.”
It didn’t look as if she had pneumonia, either viral or bacterial. O’Reilly blew out his breath through semi-closed lips. He was coming to the end of the possibilities he knew. “Better have a look at you, love,” he said, rose from the swivel chair, and helped her onto the examining couch.
By the time he had finished a thorough examination, the only unusual thing he had been able to find was a small area of dullness to percussion over the base of her right lung in the same place that she was feeling the pain. He’d been unable to pick up any sounds with his stethoscope of breath entering the lung there, but immediately above the dull part of the lung he had noted a strange phenomenon. When he’d asked Brenda to whisper “Ninety-nine,” he’d heard the words through his earpieces as if she was speaking directly into his ear. The effect—with the musical name of whispering pectoriloquy—was often heard over a lung that was badly inflamed. It could also appear immediately above a collection of fluid in the pleural cavity.
He stuffed the stethoscope back in his jacket pocket. “Put your clothes on, Brenda,” he said, stepping outside the screens, “then I’ll try to explain.” If he could.
O’Reilly was frowning and scratching his head when she called, “I’m all dressed now, Doctor.”
When he went back she was lying down, doing up the last button of her amber blouse.
“You have a small collection of fluid round the bottom of your right lung,” he said. “It’s a kind of pleurisy.” Most folks knew what that was.
“Pleurisy?” she said. Her eyes widened. “Is it serious, like?” Her voice trembled. “When I was wee, my auntie Norma died of pneumonia and you was our new doctor then, sir, after Doctor Flanagan passed away. You told my da that his sister had pleurisy as well.”
O’Reilly nodded. He could picture the woman even now, twenty years later. And despite all he’d seen in his younger days in Dublin, regardless of having had to deal for six years with the carnage of naval warfare, he’d been saddened by her death. Norma McCausland had been a bright and high-spirited young woman—and much too young to die. No wonder Brenda was frightened now. “I remember Norma well, Brenda. It was 1946, and I’d only been here a few months. We knew about penicillin, but it was just after the war and I couldn’t get my hands on any.”
“She was awful nice, so she was.”
“I know, but what happened to her isn’t going to happen to you. In the first place, I can promise you you don’t have pneumonia.”
“Are you sure?”
“Positive.”
She smiled. “Thank God for that.”
Even after thirty-four years in medicine O’Reilly still marvelled at the absolute faith of most of his patients in his pronouncements. “And in the second place, if you do develop a fever and it starts to look like pneumonia, we’ve antibiotics galore. Fix you in no time flat.” Not quite true if the cause was a virus, but there was no need to worry her. “But we will have to get to the bottom of it,” he said. “You’ll need a chest X-ray.”
“Now? Like today?”
“I’ll send you to Bangor Hospital. They can do it there. Could Ian run you down?”
She sat up and took a breath. He could see how she was trying not to show that it hurt. “Doctor O’Reilly, could it maybe wait for a few days? Please?”
O’Reilly was sure he knew why she was asking. She was a farmer’s wife and it was September. “Harvest?”
“That’s right. Ian and Peter are at it from dawn ’til dusk. They should have it in in another few days, but they need me too, so they do.” She pointed at the window. “Now the rain’s stopped Ian’ll be reaping the barley and Peter’ll be driving the lorry that catches the grain that’s been threshed out.” She smiled. “Ian reckons it’ll be a wheeker crop, so it will—if he can get it in time. And there’s no time to waste.” O’Reilly heard the urgency in her voice. “He rented a new CLAAS Herkule combine harvester, one with a self-cleaning rotary screen.”
“A rotary screen?”
“Aye. It’s a new whigmaleery, you know. Stops grain dust from clogging the radiator so the engines never overheat like they used to and you can keep reaping nonstop. It’s hard, dry, dusty work, so it is, with all that chaff in the air, and they need me for to feed them, make cups of tea because they eat on the run, bring them plenty of water. And the cows need milking.” He saw the pleading in her deep brown eyes. “Please, sir. I always wrap a hanky round my face when I’m near the combine. Keeps the dust out.”
“Give me a minute,” he said. He couldn’t understand why she had this small pleural effusion and an X-ray might give some answers. But the truth was, it probably wouldn’t help him decide on any different treatment than he could offer today. “Brenda,” he said, “I’d like to get an X-ray—”
“But—”
He held up a hand. “I’m pretty sure one of two things will happen. Either the accumulation of fluid will get absorbed and you’ll start feeling better soon, or it might just get bigger, in which case, it’s the Royal Victoria for you.” To have the fluid removed, he thought, but kept the thought to himself. “You have a phone?”
“
Aye.”
“If you can stick the pain and promise, and I mean promise, to call me the minute the pain gets worse or you’re having more trouble breathing—” He made a rapid calculation. “—I can be at your farm in fifteen minutes.”
“Oh, thank you, sir,” she said. “I promise. Honest to God. Cross my heart.”
“And,” he helped her down, “go on using the painkillers I gave you even after your monthlies are over. They’ll help the pain in your chest a bit. Have you enough?”
“Aye. I bought a clatter last month to do me for six months.”
“Good,” he said. “Now, try not to overdo it.” And take a short trip to the moon while you’re at it, he thought, knowing from experience how tough and hardworking Ulster farmers’ wives were. “Get as much rest as possible, and try to keep warm. Lots of fluids.”
“Yes, Doctor.”
“Sit down for a minute,” he said as he helped her to a chair. “How are you getting home?”
“Mister and Mrs. Houston live not far away. Sonny’s a real gentleman. He give me a lift in his motorcar, you know, and he’s waiting for me, so he is, in the waiting room.”
As she spoke, he sat at his desk and filled in an X-ray requisition form. “If you get worse,” he said, rising and giving it to her, “you’ll not need this. The hospital doctors will see to it. But if you’re getting better, and I’m fairly sure you will, the minute the harvest’s over I want you in Bangor Hospital for a chest X-ray, then come in and see me the next day.” O’Reilly wasn’t quite sure what it might show if the fluid had gone, but it was better to be safe than sorry. “Right,” he said, rising. He offered his arm.
“I can manage, sir,” she said, and he knew she was trying to prove to him, and probably to herself, that she could cope unaided.
In the waiting room, all eyes turned toward him. He nodded a greeting to the other patients and as always admired the roses on the wallpaper. He wondered why Kitty thought they were gaudy. That’s what she’d said the day Colin Brown had an infected foot.