Fingal turned onto the busier, much wider High Street and as he looked for number ten, sang,
… he fought big Goliath who lay down and dieth
Little David was small, but Oh my …
It was probably Enya’s teasing him about his height that had brought the song to mind. He stopped, pushed his bike over the curb, across the pavement, leant it against the wall, and went into number ten. John-Joe had said he lived in the front parlour. Fingal knocked on the door and heard an uneven tread and the door opening.
“Doctor O’Reilly,” John-Joe said. “W’at brings you here, sir? Come in. Come in.” His sleeves were rolled up and his forearms covered in soap suds.
Fingal followed into what in the old Georgian house’s glory days had been a spacious front parlour. There was much more room here than in Dympna’s single front. “I knew it was time for you to have been discharged so I thought I’d drop by. See how you were.”
John-Joe held up his arms. “I hate bein’ idle. Ailish is out up O’Connell Street cleaning in Clery’s department store, the chisslers are wit’ the neighbour’s granny. I had for til go to Sir Patrick Dun’s for my last X-ray. Mister Kinnear says he can do no more for me. I’m fixed…”
“I’m glad to hear that,” Fingal said.
John-Joe pulled up his trouser leg. “You can see for yourself it’s not quite straight, but I’m gettin’ about grand. No more crutches. Not even a walking stick. I’m just a bit gimpy.” He laughed then said, “I’ll not be winning any races like your man Jesse Owens at the Olympics in Berlin back in August.”
Fingal could see the deformity and swelling, but for an ankle that had been so badly smashed, Mister Kinnear at Dun’s had done a fine job. And he admired John-Joe for being able to accept his handicap with such seeming good humour.
“I’m home about an hour, but I thought I’d leave the kiddies a while longer and get a bit of peace ’til I get the washin’ done.” He nodded to a galvanised tub full of sudsy water. A corrugated washboard stood at one side. A pile of recently washed clothes was stacked on the shelf where the tub sat. He grabbed a towel and said, “It’s woman’s work, but it gives me something to do. Have a pew, sir. I’ll just dry meself.”
“I will.” Fingal sat on a simple wooden chair, one of four that surrounded a plain wooden table. He noticed how the front bow windows shone and had curtains. An old Welsh dresser against one wall was decorated with Delft plates, and a plaster statuette of the Blessèd Virgin stood on the dresser’s top. At the far end of the room, a double mattress lay on the floor against the wall. It was covered by an eiderdown. Not a typical tenement room by any means, but then John-Joe had had a trade. Fingal fished in his pocket. “Are you still smoking?”
John-Joe shook his head. “The oul’ doh-ray-mi’s a bit tight. I had til quit, but some days I’d still kill for a feckin’ fag.” He limped over and took a chair opposite Fingal.
Fingal left the ten Woodbine where they were in his pocket. “So you’re sure you’re getting around all right on that ankle?” he said.
“I am, Doctor. And God bless you for bein’ dere the day I got banjaxed. I owe you one, sir. Can I get you a cup of tea?” The man’s smile was open, wide.
“It’s our job,” O’Reilly said, warming to the man. “Tea? Not at the moment, but thanks.”
“Dat’s all right. And if you don’t mind me saying, sir, you have a job. Not like some.”
“No luck?” Fingal was glad he’d asked Ma to try to help, but he had no intention of telling John-Joe unless there was something concrete to offer.
“Not yet, sir, and it’s not for want of trying. I applied at Beamish’s and Murphy’s breweries in County Cork, two Dublin distilleries, Jameson and Powers, and Paddy in County Cork, and even Bushmills up in the Wee North.” He sighed. “Not a feckin’ sausage.”
“And you’d’ve been willing to leave Dublin,” Fingal said. “Uproot and go? Even up north?”
“Sir, if I’d the money I’d get on a feckin’ steamer and try America, but, och.” He stared at the tabletop.
“I’m impressed,” Fingal said.
John-Joe straightened his shoulders, looked straight into Fingal’s eyes, and said levelly, “Doctor, I know most of the men here are out of work, but my da, and him a cooper by trade too, God rest him, he brung us up that if a man married it was his job to provide.”
Which was highly unusual, Fingal thought. He remembered a conversation he’d had with a sixty-year-old female patient. “The men’ve no feckin’ responsibilities,” she’d said with resignation. “The men are the men. Everything has to be done for dem.” And he knew it was how things were in tenement Dublin. “I think your da was right, John-Joe,” Fingal said, and he wondered if he could do anything else. “If you don’t mind me asking, how are you managing?”
John-Joe sighed. “Well, dere’s Ailish’s wages, and the Relief does come on Wednesday, though it breaks her heart to take it. Monday’s not only washday here, it’s trip to uncle day…”
John-Joe smiled. “Him as runs the people’s bank—the pawnbroker.”
“I know,” Fingal said. “I found out about that when I first started working here.”
“I’ve given up the fags and I only have one pint of porter a week, on Saturday.”
Two big sacrifices for a Dubliner, Fingal knew.
“We won’t use a Jew-man, although most folks round here have one.”
Fingal had learnt that there were many of the race who were moneylenders or rag-and-bone men who’d buy used clothing, rags, old bones, just about anything they could resell at a profit. The term was universal in the tenements and not derogatory, and the moneylenders were wholly admired for their scrupulous honesty, lower interest rates than those charged by the native Irish in the same business, and for being forgiving to a fault if a borrower was in truly dire straits. They were an integral and respected part of Dublin tenement society.
“Nah, we’ll not use one,” John-Joe said. Fingal heard a crack in the man’s voice when he continued, “Ailish t’inks I don’t know, but she’s been dippin’ into the diddley club money.”
“Diddley club?”
“Aye, Mrs. O’Higgins runs a shop further up the street. Ailish and some other mas give her a half-penny a week starting in January, den it goes up to a penny, and up to t’ruppence, sometimes as much as a shilling. Mrs. O’Higgins holds the money until early December and gives it back so the mas have a few pounds to get Christmas treats. There’s clubs like ours all over the Liberties and the Coombe.” There was a catch in his voice when he said, “I don’t like to t’ink w’at the chisslers’ll do if we’ve nuttin’ for dem dis year.”
Fingal turned away. He could see how John-Joe’s eyes shone and that a tear was on the verge of falling. He heard the man sniff. When Fingal turned back, John-Joe was sitting rigidly, dry-eyed and taking a deep breath.
“I’m sorry, sir, but it destroys me utterly to t’ink of it.”
“I hear you,” Fingal said, knowing full well that any suggestion of “I’m sorry” would be a further wound to the man’s already tattered pride. He didn’t want sympathy. “John-Joe, please don’t take this the wrong way. Please. What would you say if I was to offer to lend you five pounds at Christmas.”
He recoiled. “By Jasus, I won’t take—”
“Charity? It’s not charity, man. It would be a business transaction, man to man. I’d charge you, as the only interest, a pint in the pub of your choice, to be taken when you’ve got a job and can pay me back.”
John-Joe took a deep breath, exhaled through tight lips. “Are you serious, sir?”
“I am.”
“Dear God.” This time the tears flowed freely. “I’ll take it, sir, but only for Ailish and the kiddies.”
“Good man,” Fingal said. “It’s a promise then. I’ll be round with the money in the first week in December.”
“I don’t know how to say t’anks.” John-Joe’s voice sank to a harsh whisper. “And I wish I
’d not to take your money, sir. I only wish—I wish to Christ I’d a feckin’ job.”
Fingal sat silently thinking how smug he’d felt after seeing wee Jack Dempsey and congratulating himself on what a good job he was doing. What about Lorcan O’Lunney? Have I helped his back with lotions and pills when he doesn’t need medicine. What he needs is to get rid of his bloody cart and have something worthwhile to do. I’m only scratching the surface. Sanitation, clean water, dry houses, proper diets, and jobs—jobs for the menfolk would do more for the people of the tenements than him and all the other 649 dispensary doctors in Ireland put together. For the first time since he’d started at Aungier Place, Fingal wondered if he’d made the right choice. Was he happy fighting a rearguard action one individual case after another? And back at the Dempseys, he’d thought he was willing to accept how powerless G.P.s were against so many diseases. Was he really?
He looked at John-Joe’s tear-streaked face. His needs were more immediate. The man had to have work, but he should be comforted at this minute too, Fingal thought, and became all doctor now his own uncertainty was dismissed. John-Joe shouldn’t be left alone. “Tell you what, John-Joe,” Fingal said, rising and putting a hand on the man’s shoulder. “Show me where the makings are”—he could see the kettle near a coke-burning stove—“and I’ll get us that cup of tea.”
24
We Will Pardon Thy Mistake
“Who’s next?” O’Reilly said as he scanned the half-full waiting room. He frowned when he spotted Brenda Eakin and frowned even more when she stood slowly and said, “Me, sir,” in a thin voice. She turned to her husband. “I won’t be long, Ian.” Her left hand clutched the right side of her chest. She was having trouble breathing.
Had she been sick all through the harvest or had she recovered and had a relapse? O’Reilly waited for her to join him in the doorway. She’d neither come back since her last visit a month ago nor had the hospital sent him an X-ray report. Strange. But while O’Reilly was good at following up with his patients, he did expect a certain amount of effort from them on their own behalf. He waited for her to go into the surgery.
The front door opened and Jenny Bradley came in carrying her doctor’s bag. “Just finished this morning’s home visits,” she said, heading for the staircase.
“See you at lunch,” O’Reilly said, then went into the surgery and closed the door. “Right, Brenda,” he said, “let’s get you lying down.” Before he helped her onto the examining couch he moved a T-shaped rod along notched tracks so the hinged upper end of the table was held at forty-five degrees to the horizontal. “There, I think that will be more comfortable for you.”
“Thank you, Doctor. You’re right,” she said. She winced with each indrawing of breath. “It does get worser when I lie flat.”
O’Reilly frowned. He’d thought it would be easier for them to talk if she was sitting up a little but had no idea why the pain would be worse when she was flat.
“And I fainted this morning, so I did.”
Chest pain and fainting? People who had heart attacks could pass out, but whatever had caused what he assumed was her pleural effusion seemed to have recurred, and it was on the right. Heart attack pain was central, and besides she was far too young to be having one. He shook his head. This was puzzling. Most doctors were usually able to hazard an informed guess at the most likely causes of a patient’s complaints within the first thirty seconds of a consultation’s beginning and spend the rest of the questioning and examination following the trail by seeking confirmatory symptoms and signs. But for once in many years, he was completely at a loss. The clues didn’t add up. “Let’s start at the beginning,” he said.
“I hope you aren’t cross with me, sir, but after I seen you last month I did like you said, and in about three days the pain had went away so I didn’t need to come here. I thought I was going to be rightly from then on, but it’s come back, so it has.”
She’d done the same thing last year when he’d diagnosed primary dysmennorrhoea, taken his advice and the pills he’d suggested, and had never come back until she’d developed a new ailment. Country women were a self-sufficient lot. Given the arduousness of life on a farm they had to be.
“Did you go for the X-ray?” If she had it might be a help. He could phone the hospital. Get the report.
She took a shallow breath, gasped, “Ah,” hung her head and said, “No, sir. I’m sorry, but I was well mended so I thought it’d not show anything anyroad.”
“Yep,” he said, “you’re probably right.” If she felt completely better the cause of her illness had probably resolved and nothing would have shown. No help there. He remembered a case he’d seen years ago in Dublin when he was flirting with becoming a specialist obstetrician and gynaecologist. Fainting and shoulder pain could be the clues to a tubal pregnancy, and an old adage of one of his profs that “Every woman is pregant until proved otherwise” had saved O’Reilly and his patient on more than one occasion. “When was your last period?”
“Which one, sir. The one I had last time I come in, or the one that started three days ago right on time?”
“And is it normal?” If she had conceived in the previous cycle it was just possible for her to be having problems with a very early pregnancy fourteen days from conception, and bleeding because of it. But he doubted it very much.
“Same oul’ achy, crampy soreness, but them pills still help.”
“And what else is wrong?” He pursed his lips. He knew he was fishing, hoping she’d say something that would point him in the right direction, but he was at a loss.
“Just—” She stopped in mid-breath, grimaced, then said, “Like last month, a pain here in my chest and it’s hard til breathe, so it is.”
Nothing to help him. Nothing. He’d bet his boots that she had another pleural effusion. But why? “Let’s have a look at your chest,” he said. “Just sit forward, tug your blouse out of your skirt at the back.”
He examined her upper back. Self-same findings as last time including the whispering pectoriloquy. O’Reilly pursed his lips. He was completely foxed. He allowed himself a small smile. Nobody had said doctors had to be right all the time, nor was he ever reticent about admitting when he was stumped. “I’m pretty sure you have fluid round your lung again, Brenda, but I’m damned if I know why.”
“Maybe it’ll just go away again, like last time?” She peered at him through her granny glasses.
“It might, but we need to get to the bottom of it, find out what’s causing it. It’s you for the Royal today.” She needed the opinion of a specialist physician, a discipline he knew was referred to as internal medicine in America. “Can Ian run you up? Or—” Why not? O’Reilly asked himself. “Or I could get a second opinion here. Ask Doctor Bradley to take a shufti at you.”
Brenda frowned. “I dunno. She’s awful young, so she is, and she’s a lady…”
“Doctor,” O’Reilly said. “I understand, but female or not she’s been to medical school much more recently than me, and I’m sure there are new things she knows. What do you say, Brenda? Will we give her a try?”
“Welllllll … if you say so, Doctor O’Reilly, and you’ll be here too, won’t you?”
“Of course. You wait and I’ll be back in a couple of minutes.”
And he was, having interrupted Jenny’s reading of Isaac Asimov’s recent book The Rest of the Robots. He explained the complaint and his physical findings on their way downstairs, but not the patient’s reticence about seeing a female physician. Jenny had been particularly interested in the fact that lying down made the chest pain worse.
“Good morning, Mrs. Eakin,” Jenny said, and smiled as they went into the surgery to stand beside the examining couch. “I’m Doctor Bradley.”
“Pleased til meet you, miss,” Brenda Eakin said, not quite looking Jenny in the eye.
“I’d like to ask you about your periods. Is that all right?”
Brenda looked at O’Reilly for reassurance.
He nodded.
“They’re regular?”
“You could set your watch by them.”
“Please tell me about the pains. Doctor O’Reilly says you have cramps.”
“Aye.”
“Do the cramps get easier or worse as the period goes on?”
O’Reilly leant forward. He’d assumed that it had been a routine case of primary dysmenorrhoea, so common was the complaint, and hadn’t paid a great deal of attention to the nature of the cramps.
Brenda sighed. “They get worser until it’s over then they tail off, like.”
Worse? Bugger. O’Reilly’s initial diagnosis had been wrong. In primary dysmenorrhoea—pain caused by uterine contractions with no underlying disease—the pain always eased as the period progressed. He hadn’t considered secondary dysmenorrhoea caused by an underlying condition like inflammation, and particularly the ill-understood endometriosis. In those cases, the pain got worse as the period progressed—and both causes of secondary dysmenorrhoea could delay or inhibit conception. Brenda and Ian had been trying for eighteen months. He took a deep breath. But how did that information help understand her pleural effusion?
“And is the pain in the middle of your tummy?”
Barbara shook her head. “Mostly on the right.”
“Thank you, Mrs. Eakin,” Jenny said. It was only a hint of a smile before her face went expressionless, but it was enough to tell O’Reilly that she was sure she’d solved the problem. “I think,” she said, “I can spare you another examination.”
Which was considerate, and Jenny had been, given the clinical findings.