Cissie Sloan grinned back. She’d be in to get her thyroid pills and, he sighed, a good blether. Sonny Houston stood.
“Morning, Sonny,” O’Reilly said, “how’s Maggie?”
“Right as rain,” Sonny said. “She’s home making a plum cake for Brenda and Ian, and seeing to the dogs. We’ve six now. We couldn’t find a home for the last of Missy’s pups, but I saw Colin Brown yesterday. He’s making a good fist of his dog Murphy.”
“Good for Colin,” O’Reilly said, wondering how Donal and the boy were getting on with Bluebird and when Donal was going to race the animal. “And it was kind of you to bring Brenda in.”
“It was really no trouble.” He looked expectantly at her. “If she needs to go to the—”
“Doctor O’Reilly’s for letting me go home,” she said.
“Wonderful. I’m delighted to hear it.” Sonny offered his arm, which she took.
“And don’t forget, Brenda, if you’re worried at all, at all, phone. Either myself or Doctor Bradley”—That provoked a few subdued mutterings among the other patients—“will be out in a flash.”
He barely heard her “Yes, Doctor,” as he said, “Right. Who’s next?”
“Me, sir,” said Cissie, lumbering to her feet. “I need more of them wee thingys Doctor Laverty prescribed. They’re doing me a power of good, so they are. I’m brisk as a bee—” She was still talking on the intake of breath as he closed the surgery door behind her.
16
Skill in Surgery
“Jasus, Doctor, I hope it works. The back’s still feckin’ killin’ me.” Lorcan O’Lunney, the Dublin tugger, shook his head. “I’m like a toad with a broken leg dragging meself and the cart about. Last time I was here some pregnant woman told me to try her granny’s bog onion poultice. And she gave me her granny’s prayer too.” He made a derisive snort. “About as much use as a fart in a high wind.”
He was clearly aggrieved but held out his callused hand to take the prescription. He was the last patient of the Monday morning surgery as Fingal began his fourth week working at the Dublin dispensary. He’d enjoyed the rest of his Saturday after he’d left John-Joe Finnegan at Sir Patrick Dun’s. Thanks to Phelim Corrigan’s flexibility with the on-call schedules, he and Charlie were now bona fide members of the Wanderers Football Club and would have their chances to earn their places on the first fifteen this season, the first step toward that much-longed-for Irish cap. Turned out Phelim had played Gaelic football at the county level in his youth, and despite the prohibition by the Gaelic Athletic Association of its members attending “Garrison” or “English” games like rugby and cricket, he took a keen interest in the fortunes of the Irish Rugby team.
And the evening spent with lovely Kitty? He told himself to stop grinning and concentrate on Lorcan O’Lunney’s aching back. He had to show the sympathy he felt for the man. Fingal took a deep breath, pursed his lips, and said, “It can be miserable, I know.”
What Lorcan needed was a long rest, but Fingal might as well suggest the man take a Mediterranean cruise. Pulling that cart hour after hour, day after day was all that kept a roof over Lorcan’s and his family’s head and put stale bread on their table. “Here,” Fingal said, handing over a scrip’, “Take that to Mister Corcoran, the apothecary. He’ll make you up a strong linament with oil of wintergreen”—it contained a salicylate, as did aspirin—“and he’ll also compound these tablets.” Although Fingal had never seen it used for backache, the Atophan he was prescribing was effective for another joint disease, gout. It was worth a try. “Break one up, mix it with water and baking soda, take the same dose three times a day, and come and see me next week.”
“All right.” Lorcan shrugged, took the paper, clapped a duncher on his balding head, and headed for the door. “I’ll give her a go, but I’m not expectin’ to be yellin’, ‘whoa, hold the fecking’ lights because I’ve had a miracle cure.’ You’d need to go to Lourdes for dat and where’d a man like me get the money for the fare?” He shrugged. “But t’anks anyway, sir, for doin’ yer best.”
He’d barely closed the door when Phelim and Charlie came in.
“Great,” said O’Reilly, rising and lifting a small picnic hamper that Cook filled every morning. “Lunch.” He was aching for today’s cold poached salmon and mayonnaise sandwiches and hard-boiled eggs with a big slice of her Bramley apple pie to follow.
“Will ye wait a minute?” Phelim held up one hand like a policeman on traffic duty then adjusted his toupee. “Charlie’s agreed to do the afternoon visits, Fingal. One of my few paying patients seems to have twisted or ruptured an ovarian cyst. She’s in a lot of pain.”
“And you sent her to hospital? Don’t see why that should hold up lunch,” Fingal said as he opened the hamper and lifted out a sandwich wrapped in greaseproof paper. A woman as sick as that needed surgery.
“I did not.” Phelim reached over, removed the sandwich from Fingal’s hand, and returned it to the hamper. “I asked Doctor Andrew Davidson, a gynaecologist from the Rotunda, to make a domiciliary visit. He came straight out and agreed with my diagnosis. He’s sent for his team and they’re setting up her bedroom as an operating theatre. It’ll take an hour to sterilize everything, longer to set up the portable operating table and get everything ready. He’s going to operate as soon as it is. I’ll give the anaesthetic. I’ve come back to get my gear. You’ll assist Doctor Davidson. Clear?”
“Yes, yes, of course.” Fingal looked longingly at the sandwich but had to admit it would be an interesting way to spend the afternoon. He knew that surgery was often carried out in wealthy patients’ own homes, but he’d never seen it done. He felt a momentary twinge of nerves and then relaxed. Surgical assisting had been part of the routine of his student days and he’d discovered that he had a talent for it.
“One thing,” Phelim said. “You and I, Fingal, when we get our fees we’ll pool them and divide by three. No reason Charlie should be left out.”
“That’s very generous, Phelim,” Charlie said.
“No, it is not,” Phelim said. “But it is fair. It’ll be the same when it’s Charlie’s turn to come with me. Now, leave yer posh grub behind, Fingal, and follow me. Ye’ll not starve. If I can do without my rasher sandwiches you can do without your poached salmon.”
Fingal followed his senior colleague along a corridor to a storeroom and waited as Phelim picked up a walnut carrying case and a bottle labelled CHLOROFORM. “Right,” he said, “off. And in case ye’re wondering where I got patients like these, I’ve known Jane Carson since she was a little girl in Roscommon. Her father was a resident magistrate. She married a toff, but not too far up from her class. Her husband Robin’s a director of more Dublin companies than ye could count on yer fingers and toes.”
* * *
Phelim parked near the junction with Baggot Street on Mount Street Upper. At its far end Fingal could see the pillared portico and domed cupola that gave Saint Stephen’s Church the nickname the Pepper Cannister. The thoroughfare was as broad and sunlit as Aungier Place was narrow and dark. This part of Dublin had been developed in the 1770s and ’80s. Fingal could imagine top-hatted coachmen driving the barouche-landaus and coaches of the gentry, each carrying ladies with lace bonnets and parasols while young bucks trotted on prancing thoroughbreds. It was a street on which the characters in a Jane Austen novel would not have been out of place—except for their English accents.
He and Phelim crossed a wide pavement to the red sandstone arched doorway of a four-storey terrace house. When his senior colleague knocked on the glossy black door, a uniformed maid answered. They were expected. “Mister Carson will receive yiz, Doctors,” she said. “Follow me.”
Fingal found himself in a spacious drawing room. The Regency striped fabric of armchairs and a love seat made him wonder if the furniture was indeed of the period. Most likely.
“Robin,” Phelim said, “meet my partner, Doctor O’Reilly. He’ll be assisting.”
The tall man, well dressed
in a morning suit and highly polished shoes, offered a hand and said, “Thank you for coming, Doctor.”
Fingal guessed he was in his mid-twenties. “How do you do, sir.” They shook. Fingal knew that the Carsons were one of the remaining families of the Anglican Ascendancy, the landowners who were more English than Irish and who had been the aristocracy before the Potato Famine and the subsequent land wars. Their old family seat had been out in Mayo, not far from Roscommon, where Phelim had said Mister Carson’s wife had come from. “You two will take care of my Jane, won’t you? And Doctor Davidson—he’s the Master of the Rotunda, isn’t he? So he must be good.” There was a quaver in Carson’s voice and rightly so, Fingal thought. Major abdominal surgery was not risk-free.
“Try ye not to worry, Robin. I’m sure she’ll do very well,” Phelim said. “And if ye’ll excuse us, Doctor O’Reilly and I should go up. But we’ll come and explain when it’s all over.”
“Of course. I’d appreciate that.” Robin Carson tugged on a nearby satin bell pull, there was a faint jangling in the distance, and soon the maid reappeared and bobbed.
“Please show the doctors the way.”
Fingal followed Phelim into the wide hall and up two flights of deeply carpeted stairs. “In dere please, sirs. Doctor Davidson and his nurses are waitin’.”
Fingal followed Phelim into a room where the curtains were drawn back and every light was burning brightly. Surgeons needed to see what they were doing. He noticed at once that most of the furniture had been moved out, and saw the patient, an auburn-haired young woman, lying under a blanket on a portable operating table. She appeared to be very drowsy and had probably been given a dose of chloral hydrate as a sedative, although a larger one than Phelim had prescribed for the teething Aidan Curran.
Phelim went over to her, laid a hand on her shoulder, and when she slowly turned her head to him and blinked, he said, “Soon be over now, Jane, and we’ll have you tucked up in your own bed.” He nodded to a single bed against one wall. Fingal could see the bumps of hot water bottles under the blankets. The patient would be popped in there postoperatively.
Two uniformed nurses bustled about, preparing towels and basins of water.
A tall man in pinstripe trousers, their braces crossed over his shirt, was washing his hands, his sleeves rolled up above the elbows. “Ah, Doctor Corrigan. And young Doctor O’Reilly. I recall you from your time in the Rotunda. You had a good pair of hands in surgery.”
“Thank you, sir.” He remembered Doctor Davidson’s report about an outbreak of puerperal sepsis, childbed fever, at the Rotunda Hospital in 1935. The senior man was presently investigating the bacteriostatic properties of a new medicine, red prontosil, in that disease. Prontosil, an aniline dye, was the subject of Bob Beresford and Professor Bigger’s research in the laboratory too.
Fingal’s nose was assailed by the smells of the antiseptics perchloride of mercury, carbolic acid, and absolute alcohol. In one corner of the room, a cylindrical drum standing on three feet gurgled and hissed. A steam gauge on top indicated ten pounds of pressure. Fingal had never seen one but guessed it was a portable steam sterilizer for their overalls, masks, gloves, instruments, and towels.
He watched while Phelim opened the walnut case and withdrew a device with a face mask attached to a thick rubber tube. A similar tube on the other side was attached to a glass bottle which Phelim was filling with chloroform. Fingal recognised it as a Vernon Harcourt apparatus for controlling the rate of flow of chloroform vapour. The fluid level rose in the glass. Two beads, one blue, one red, floated in the liquid, and by noting their level, Phelim would decide if the patient was getting too much or too little chloroform. He used a strap to hang the device round his neck. “I’m ready,” he said.
“Come and scrub, Doctor O’Reilly,” Doctor Davidson said. “Doctor Corrigan, please start the anaesthetic.”
Fingal washed his hands in three successive basins, carbolic soap and water, clear water for rinsing, and biniodide of mercury 1/1,000 solution. A nurse, herself already dressed antiseptically, helped them into their sterile masks, overalls, and gloves.
“She’s under,” Phelim said. “Pulse is fine, respiration’s regular.”
Fingal was impressed. The little doctor sounded so unconcerned he might have been reading a weather forecast, and yet he had the patient’s life in his hands.
“Thank you.” Doctor Davidson moved to the right side of the operating table. The patient was hidden beneath sterilized towels. An exposed strip of abdominal skin glistened. Fingal knew that Doctor Davidson preferred to use absolute alcohol to sterilize the skin.
Fingal took up his position on the patient’s right, facing Doctor Davidson and the nurse who would hand the surgeon his instruments.
Phelim sat on a wooden kitchen chair at the patient’s head, holding the rubber mask over her nose and mouth. “Ye may start anytime,” he said.
“Good. Scalpel.”
Doctor Davidson made a midline incision from umbilicus to pubic symphysis, and Fingal mopped away blood and used artery forceps to clamp bleeding vessels for Doctor Davidson to ligate with silkworm gut. He talked as he worked. “First chap to remove an ovary was Ephraim McDowell in 1809 in a log cabin in Kentucky. No anaesthesia and the patient was making her own bed by the fifth day. Tough folks, the old hillbillies.”
Fingal saw the smile behind the mask when the gynaecologist continued, “I’m glad we have you and your chloroform, Phelim.” Fingal knew that titles were often dropped in operating rooms once the patient was asleep. “I’d not have the guts to operate with the patient conscious.”
Nor me, Fingal thought, and shuddered. He wondered if the senior man’s banter was carefully planned to camouflage the butterflies he must be feeling inside. Slicing open a fellow human was not a natural thing to do.
“My pleasure,” Phelim said. “And ye may be wrong, Andrew. There’s some evidence that a Robert Houston of Glasgow successfully removed an ovarian tumour in 1701. I study medical history. Ye can learn a lot from it.”
Something else Fingal had not known about Phelim Corrigan.
“Anyhow, young O’Reilly, now we have her open,” Doctor Davidson said, “if you could retract?”
Fingal lifted a stainless steel instrument with a long narrow handle and a broad deep blade mounted at ninety degrees. He put the blade into the nearest side of the wound and pulled, then did the same with the far side, thus giving the surgeon better access to the abdominal and pelvic cavities.
“Keep it like that.” Doctor Davidson slipped his right hand inside and slowly brought out the ovary. A healthy ovary should be about the size of a walnut, but Fingal could see how this one was as big as a small orange. The Fallopian tube that ran on top of the diseased organ was distorted. Both were a dusky red due to an obvious twisting of the ligament that suspended the ovary from the corner of the uterus. Torsion. Phelim had been right in his diagnosis.
“Now, young O’Reilly, if you were me, what would you do?” Doctor Davidson asked.
“The safest and easiest thing would be to remove the tube and ovary, sir.” God, it was like being back in class.
“That’s right, but watch.” Doctor Davidson rotated the organ and relieved the twist in the stem. Immediately the colour began to improve. “I think,” he said, “we can preserve this ovary and tube. She’s no kiddies—yet.”
Fingal watched as his senior split the ovarian tissue, which although fully intact had been turned from a solid organ into a sheet and compressed into a thin envelope by the tumour growing inside. The effect was rather like the thinning of the rubber of a child’s ballon when it was inflated by air. What had once been a solid, healthy ovary was now no more than an outer thin skin covering the tumour beneath. The technique was first to dissect the skin from the underlying cyst. Doctor Davidson gradually worked the blunt handle of his scalpel between the ovarian tissue and the cyst until it was completely free, then dropped the mass into a stainless steel dish. In what seemed like no time,
he had placed rows of sutures and reconstructed the ovary. “It’s amazing,” he said, “how that ovarian tissue will reconstitute itself in a couple of months.”
Only a tiny amount of blood seeped from the repaired ovarian incision. “Now,” he said, and pushed his hand gently inside the pelvic cavity. “Uterus feels normal. Other ovary and tube fine. Let’s put this back.” Fingal watched as the now untwisted and repaired ovary and its tube were replaced in the pelvis. “Retractors out.”
Fingal complied.
“Closing in a minute, Phelim,” Doctor Davidson said. “You can start bringing her back.” He leant over the dish containing the tumour and sliced into it. “Look at that,” he said as oily sebaceous material oozed out. Strands of hair appeared. “Dermoid cyst. Benign. No worry about cancer.” He started to sew, closing the peritoneum first. As he worked, he said to Fingal, “Interesting tumours. Nobody is sure how they grow, but they often have identifiable structures in them, like hair or teeth.” He laughed. “My old prof, Doctor Henry Wilson, used to tell us students that the diagnostic sign for a dermoid cyst in a patient was to put an ice pack over the lower abdomen, then listen with your stethoscope. If you heard—”
“Teeth chattering because of the cold,” Phelim said, “ye knew what ye’d got.”
Fingal, who had heard the same old joke when he was studying gynaecology, thought it politic to manage a small laugh.
“Will you close the skin, O’Reilly?” Doctor Davidson arched his back. “My back’s killing me.”
“Yes, sir.” Fingal frowned. In the teaching hospitals, juniors were usually left with the routine job of closing wounds, but this was a private patient. He wasn’t sure if it was a sign of Doctor Davidson’s faith in his assistant’s technique or simply that the man’s back really was hurting from bending over the patient. Davidson would be able to stand more comfortably when his only task was cutting the ends of Fingal’s stitches. Fingal felt a twinge in his own lumbar regions. He looked at the consultant, still arched, teeth bared in a grimace of pain. Just like poor old Lorcan O’Lunney. For a mischievious moment, Fingal wondered about suggesting a bog onion poultice. He bent to his work, stitching and knotting as carefully as he could so Jane Carson would be left with as unobtrusive a scar as possible. “Finished, sir,” Fingal said.