An Irish Doctor in Peace and at War Read online

  “And can you cure it, Doctor O’Reilly?”

  “I used to when I had a sick bay where I could admit patients, but now we’ll leave that up to the specialists at the hospital and let them do the curing. Now,” he said, “Doctor Laverty, could you nip up to the hot press and get a blanket so we can keep Rory as comfortable as possible.”

  “I’m feeling a wee bit better,” Rory said. “Them aspirin’s working, so they are.”

  “Good,” said O’Reilly. “Hang on and I’ll start the other part of the test.” He went to collect the sample tube. There was a dark brown-red clot at the bottom and a layer of yellow-coloured fluid, the serum, on top. If there was an increase in the level of globulin, a serum protein, as there would be in cases of visceral leishmaniasis, adding one drop of formalin to one millilitre of serum would render the mixture opaque in about ten minutes.

  He busied himself pouring the serum into a fresh tube and adding the formalin, wrinkling his nose at the pungent fumes of the chemical used to preserve bodies in an anatomy dissection lab. O’Reilly couldn’t ever smell it without in his mind being transported back to Trinity College and sharing lab time with Bob Beresford, Charlie Greer, and Donald Cromie, his closest friends. Those had been great days. The thirtieth class reunion they’d been planning for this year was approaching and there was still planning to be done.

  Barry reappeared with a blanket and busied himself making Rory comfortable.

  “If I’ve to go til Purdysburn, would I have to go now, I mean like right away? Is it an emergency?” He swallowed and O’Reilly had a quick flash of what Rory Auchinleck must have looked like as a little boy. He was frightened and who could blame him.

  “It’s not an emergency, and you’re not in any immediate danger, but the sooner we get those little buggers out of your system, the better.”

  “So you’ll tell my da and Kinky?” He blushed and giggled. “I’m very fond of her, so I am, but I just can never call her Ma.”

  “I hear you,” O’Reilly said, “and I will of course let them know. And I’ll tell them not to worry and that you’re going to get better.”

  Rory snuggled down under his covering, still with a childlike look, but now somewhat more reassured. “Huh,” said Rory, “some welcome home, me getting sick and all. Thanks for the blanket, Doctor Laverty. It’s taking the edge off the chils.”

  O’Reilly stole a look at the tube. The pale yellow serum was a milky colour, so the Formol-gel test was positive. Unfortunately, it wasn’t entirely specific for visceral leishmaniasis, or kala-azar, as the disease was also known, but it gave O’Reilly all he needed to say, “Bingo. It’s the Purdysburn Fever Hospital for you, young fellow, one more test then you’ll have to be given a drug called sodium antimony gluconate intravenously for three to ten days, but it’ll marmalize the invaders.”

  “I’ll be glad til get better.” Rory frowned. “And will you let my platoon officer know too, please, sir?”

  “I have to, in fact; I’ll give your duty officer a call in a minute. I’m not altogether up with military protocol, but I’m sure he’ll agree with what I’m proposing.”

  “Thank you, sir.”

  “Och, you’ll be on your feet in no time,” O’Reilly said, inwardly blessing all the extra experience his time on the old Warspite had given him. Of course by the time he’d been seeing cases of kala-azar in Egypt he was no longer the wet-behind-the-ears young surgeon lieutenant who had joined the ship at Greenock—and got pitched in at the deep end.

  12

  Emptied Some Dull Opiate … and Lethewards Had Sunk

  The ship’s operating room looked to Fingal as if it could have been onshore—if it hadn’t been rolling gently side to side. In here the smell of fuel oil was masked by the odour of disinfectant. The operating table was arranged fore and aft immediately in front of where Fingal stood with Richard Wilcoxson. Above it hung a huge multilensed operating light. A hand basin for scrubbing up was attached to the bulkhead to Fingal’s left and two tiers of shelves stacked with instruments and sterile towels were on the farthest bulkhead. It would have been silent, but for the incessant rumble of machinery in the ship’s bowels, the gentle whirring of an air supply fan in the lobby outside, and the sounds of a man’s voice as Fingal came through the door.

  “Appendix then, sir?”

  “Leading SBA Barker, meet Surgeon Lieutenant O’Reilly. He’s just joined and he’ll be stunning the patient, and yes, it is an appendix.”

  “Hello, Barker,” Fingal said, looking at a wiry, auburn-haired lad of about twenty-five. His eyes above his mask were green. The left one had a slight squint.

  “Hello, Doc. Pleased to meet you, and welcome to Warspite.”

  “Thank you,” Fingal said. “Londoner?” The man must have been born somewhere within the sound of Bow Bells. His accent was pure Cockney.

  Wilcoxson said, “You should hear Barker and his oppo using—”

  “Sorry, sir,” O’Reilly said. “Oppo? I’ve forgotten.”

  Wilcoxson smiled. “Goes right back to the days of tarry pigtails. Sailors paired off to help each other tie theirs so each had, in the parlance of the time, an opposite number, shortened to oppo.”

  “Oh, right.”

  “But Barker here would probably call Sick Bay Petty Officer Fletcher his old china—china plate. It means mate. You should hear the pair of Cockneys using rhyming slang. You’d think they were yammering away in Greek.”

  “I’ll teach you some if you like, Doc,” Barker said.

  “Like up the apples—apples and pears—stairs, but that’s all I know. A foreign language is always useful in the navy and I’m always happy to learn something new,” Fingal said, but his smile faded. Something new, like giving an anaesthetic for an open abdominal operation. Something he’d never done before. He had to tell Wilcoxson. He couldn’t pretend he knew what he was doing, could he? He was well aware that in some of the best hospitals in Britain and Ireland, it was quite common for medical students and even porters to be pressed into service as anaesthetists—with the surgeon, if necessary, providing helpful hints.

  “I’ve finished setting up the instruments, sir,” Barker said.

  Fingal saw an instrument table covered in a white sterile towel standing near the operating table. All the necessary scalpels, forceps, clamps and needle drivers, ligatures, sutures, the tools of the surgeon’s trade, would be under it.

  “I’ve your gowns and gloves beside the wash-hand basin. Just a couple of things more to do.”

  “Thank you, Barker. When you’ve finished, go and give Paddy a hand bringing the patient in.”

  “Righty-ho.”

  “Have you any preference for the anaesthetic you’re going to use, Fingal?” Richard Wilcoxson asked as he started to scrub.

  Fingal hesitated. He’d rather not be giving one at all, but needs must when the devil drives. He wasn’t the first junior doctor to give an anaesthetic without knowing quite what he was doing. He realized he had to. Fingal cleared his throat. “Would ether be all right?”

  “Of course, my boy.” His senior smiled. “And we do have a Boyle’s machine.”

  Fingal was familiar in principle with the apparatus that carried cylinders of oxygen, nitrous oxide, and a device for vapourising ether. It had been introduced in 1917 and steadily improved by such additions as a soda lime container to remove the carbon dioxide that the patient exhaled and a rebreathing circuit. In practice he’d not the faintest idea which knob to twiddle or even what the proportion of gases should be. He vaguely remembered one doctor’s unhelpful guidance at Sir Patrick Dun’s, where there had been no specialist anaesthetists on the faculty. “You start with nitrous oxide and let the patient breathe freely until he turns blue.” Fingal shuddered. He could remember nothing more and had no wish to suffocate a patient to sleep—or to death. He’d not use the Boyle’s machine. He preferred something simpler, but it was comforting to know a supply of oxygen was handy on the machine if he needed it.

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p; “Or would you like to use chloroform? We have a Vernon Harcourt apparatus.”

  Fingal remembered his senior in Dublin, Doctor Phelim Corrigan, draping the device round his neck so he could anaesthetise a wealthy young woman in her own home for the removal of an ovarian cyst. But Fingal had never actually used such equipment himself. He’d better stick to the tried and true—well, occasionally tried. The last time had been in ’35 for a five-minute procedure, the removal of a large sebaceous cyst if memory served, in the surgical outpatients at Sir Patrick Dun’s Hospital. He took a deep breath. “I think I’ll use an open Schimmelbusch mask, Richard, if you don’t mind. It’s really the only thing I’ve used before.”

  Clearly Richard Wilcoxson was unconcerned. “Sounds fine to me,” he said, “and don’t be afraid to ask for advice.”

  That was a comfort. “I’ll not.”

  “All shipshape and Bristol fashion now, sir,” said Barker. “I’ll nip off and get Paddy and the patient.”

  “We’ll need a mask and ether for Lieutenant O’Reilly. Can you get them before you go?”

  “Righty-ho, sir.” It clearly was second nature to Barker, who immediately went to one of the sets of shelves and took down a contraption that looked as if it might have suited Alexandre Dumas’s Man in the Iron Mask. A fat oval with an outer thin rim surrounding an open space, it had a handle that looked like a duck’s bill at one end. Two thin, convex metal bars, one running north–south, the other east–west, crossed in the middle of the aperture. Barker produced a thick wad of lint sheets. “There’s ten of them there, sir, that’s routine.”

  It dawned on Fingal that Barker and probably the other SBAs knew how to give an anaesthetic. And that possibly Barker was well aware of Fingal’s inexperience. The thought was far more reassuring than humbling. It had ever been thus with senior nurses and junior doctors. No reason it should be any different afloat.

  Barker stretched the lint sheets over the frame and locked them in place with a device that was hinged to the handle and which conformed to the shape of the oval frame. He handed it to Fingal. “There you are, sir. Bob’s your uncle.” He produced a bottle of ether with a glass stopper, “and Fanny’s your aunt.”

  “Thank you, Barker,” Fingal said. Everything indeed was as it ought to be.

  “I’ll be off, then.” Barker left.

  “Tie up my gown, will you, Fingal?” Wilcoxson had already dried his hands on a sterile towel and shrugged into a white gown.

  “Of course.” As Fingal tied the strings at the back, Wilcoxson slipped on a pair of sterile rubber gloves.

  The door opened and O’Rourke and Barker carried the patient in on a stretcher.

  Fingal saw the young man’s wide-open eyes peering round the room.

  “Alley-oop,” said Barker, and the two SBAs loaded Stewart onto the table.

  For a moment Fingal thought he was in a C. S. Forester novel about Nelson’s navy with the victim about to lose a leg at the hands of a barber surgeon. The two attendants were now securing Stewart with leather straps across his chest, arms, and legs. He’d seen it before in Dun’s hospital. The anaesthetic didn’t always put a patient under completely, and a half-awake sailor could thrash about. At least poor Stewart was going to have the benefit of ether, not like Nelson’s men who had to make do with rum and a leather strap to bite down on.

  “How are you feeling, Stewart?” Fingal asked.

  “Not too grand, sir,” the seaman said.

  “We’ll have you fixed in no time,” Fingal said, trying to exude a confidence he did not feel. He was vaguely aware that the two SBAs had removed the stretcher. Paddy O’Rourke, who was to handle the instruments and assist, jobs that would have required a nurse and another doctor onshore, was getting scrubbed, gowned, and gloved. Fingal took a deep breath, looked at the mask, and with the glass stopper halfway into the neck of the ether bottle, started to drip the pungently smelling liquid onto the gauze. “I’m going to start putting you to sleep, Stewart. Don’t be frightened.”

  “Is that laughing gas, sir? I once had that at the dentist. It wasn’t so bad.”

  “No,” said Fingal, “this is ether.” He wished fervently he knew how to use nitrous oxide. Some eighteenth-century chemist, whose name escaped Fingal at the moment, had called it laughing gas—and for good reason. It was a kinder way of putting the patient to sleep. “I’m afraid ether doesn’t smell very nice. Try not to let the pong and the mask bother you and just take deep breaths.” He put the mask over the man’s nose and mouth. Engine Room Artificer Stewart’s gaze never left Fingal’s face. Eventually his eyelids drooped and closed and the man seemed to be unconscious. If Fingal remembered correctly, that was the first stage of anaesthesia. Stewart started to mutter incoherently and Fingal ignored his string of expletives. Stewart began to cough, hold his breath, and for several minutes the ERA struggled against the straps, trying to move his right arm, no doubt in a half-conscious attempt to pull the mask away. Those reactions typified the second stage.

  The struggling stopped and Stewart’s breathing became slow and perfectly regular. His eyeballs, which Fingal had observed by lifting the upper lid, had stopped rolling about in their sockets and were steady in central positions. This was plane one of the third stage, or what was known as “surgical anaesthesia.” There were three more ever-deepening planes and it was Fingal’s job to juggle between them so that the patient felt no pain but did not descend into the fourth stage that followed, namely the cessation of breathing, cardiac failure, and death. Never in his short medical career had the clichéd “Their life is in your hands” been so horribly true. He knew he was sweating. “I think you can start, Richard.” Fingal crossed his fingers. Painting the belly with more antiseptic solution and draping him with sterile towels shouldn’t cause any response, and when it didn’t Fingal felt himself relax—a little.

  “I’m making the incision,” Richard said.

  The patient twitched and held his breath. Fingal saw the man’s eyes start to move.

  “Needs to be deeper, Fingal,” Richard said. “Belly’s rigid as a rock. I need more muscle relaxation.”

  “Right.” Fingal, who had himself jumped when the patient did, dropped more ether on the gauze. But how much was enough and how much was too much? He waited. The respiratory rate stabilised, the eyes stopped moving.

  “That’s better. Off we go.”

  Fingal was too busy keeping watch over ERA Stewart—it helped Fingal to think of the patient by name, not simply as “the patient”—to be able to pay much attention to how the surgery was progressing. He was able to guess from the exchange between surgeon and assistant.

  “Clip that skin bleeder.”

  “Got it.”

  “Hold up the peritoneum so I can cut it. Thanks.” They had nearly entered the abdominal cavity.

  Concurrent with Stewart’s eyes starting to move came, “Damn it, Fingal, take him down some more. He’s all tensed up again. Put more ether on the gauze.” Richard’s voice softened. “You’re doing fine, lad.”

  Fingal could understand the surgeon’s irritation, and was grateful for the advice and support. It was well nigh impossible to operate if the abdominal muscles were rigid. He dropped ether onto the gauze.

  “Better. Lord, would you look at that?”

  Fingal peered along the table to where Paddy was holding up the appendix prior to Richard ligating its base and cutting it free. The normally pink, wormlike structure was a horrible bluey-green, infected, and gangrenous. “Better an empty house than a bad tenant,” Fingal said, feeling less stressed now that the critical part of the operation had been completed and all that remained was to close the incision. Perhaps he could start letting the anaesthetic wear off?

  Not quite. As Richard reached the stage where he was starting to sew up the skin, Stewart began to moan and try to thrash. Fingal was glad of the leather restraining straps. “Hang on, please,” he said, dropping more ether, then, “okay, carry on.” He lifted the right upper eyelid. C
hrist, the pupil was dilated and the breathing was becoming shallow. Fingal ripped the mask away. The lips had a blue tinge. Cyanosis. He’d overdosed the man, who now desperately needed oxygen. “Quick, Barker. Bring over the Boyle’s machine. Turn on the oxygen.”

  “Everything all right, Fingal?” Richard asked. “I’m putting in the last stitch now.”

  “He’s gone a bit deep,” Fingal said. A bit? He was damn nearly dead.

  “Here, sir.” Barker had shoved over the trolley with flow meters and gas cylinders. He offered Fingal a rubber mask connected to the machine by two corrugated rubber hoses. “I’ve got the oxygen on full blast.” There was no flippancy now.

  “Thank you.” Fingal clapped the mask over Stewart’s nose and mouth. Thank you? Fingal could have kissed the Cockney. God bless him. Fingal hadn’t a clue which knurled wheel controlled the flow of oxygen.

  “Finished,” Richard said. “You can wake him up now.”

  And because the man’s pupils were now normal sized, his respiration slow and deep and regular, Fingal knew it was true, he could let Stewart wake up, but he nearly wouldn’t have been able to. The Duke of Wellington’s remark about Waterloo being “A damn near-run thing” certainly had applied today.

  Already Richard Wilcoxson had stripped off his gloves. “Undo my strings, Barker, there’s a good lad.” He shrugged off the gown. “You happy enough with him, Fingal?”

  Stewart’s eyes were rolling and he moved his head from side to side. His breathing was regular and his pulse was—a hundred. “He should be all right now,” Fingal said, handing the mask back to Barker, “but he may throw up so please keep an eye on him.”

  “I will, sir.”

  “Good,” Richard said. “All right, Paddy, you and Barker know what to do. Take him along to the isolation ward. Make sure he does wake up all right. Keep him on his side in case he vomits. Give him a quarter of a grain of morphine and repeat the dose six hourly.”