A Dublin Student Doctor Page 6

  Fingal’s jaw tightened. He hoped his father meant the luckless student had missed his chance for a tutorial, but knowing Father he was pretty sure that unless a watertight excuse could be produced there was more severe retribution in store.

  “It’s all worked out nicely,” Ma said. “Fingal popped in and now you’re home early.” She fixed her son with a glance. “You were disappointed that Father wasn’t here. Isn’t that right, Fingal?”

  “How are you, Father?” Fingal asked.

  “Well enough,” he said in a clipped voice. “How are you, Fingal?”

  “For goodness’ sake, Connan, you’re not addressing a class. Sit down. Have a cup of coffee,” Ma said. “You sit too, Fingal.”

  Fingal sat.

  Father walked round the table and took a chair beside Ma.

  “I’m well too, Father,” he said.

  “And—um—how are your—um—medical studies going?”

  “Well,” Fingal said, “very well. You know I’ve passed all the exams first go so far. I’m ready for the next one in June.”

  “I would have expected that. And the arts courses?”

  “Fine.” Fingal smiled. “It’s a good thing you and Ma—Mother—taught Lars and me to like reading when we were little. I’m really enjoying them, but I feel a bit of an eejit having to wear a gown to attend classes. It’s so—so mediaeval. I’ll be glad to be rid of the thing when I get my BA.” He glanced at Father trying to gauge his response, hoping for a smile.

  “Tradition should be respected.” Father turned to Ma. “I’ll have that coffee, please, Mary.”

  Fingal took a breath. A word of encouragement would have been appreciated. Fingal watched as Ma rose then he looked back to the spare man opposite. He sat, shoulders braced, back straight. His three-piece, pin-striped suit was perfectly tailored.

  The Victorians, Fingal thought. This restraint, this self-containment. It was how they were reared. And yet his father’s indifference was galling. It gnawed at Fingal. He knew he was breathing too quickly, suspected his blood pressure was rising. He was tempted to forgo breakfast here, there were plenty of cheap cafés, but he shook his head. There was no point making a scene.

  Damn it all, Cook would, as always, serve up a right tightener and Ma would be terribly disappointed if he didn’t eat every scrap. And if Fingal hadn’t realised by now he was never going to please Father, then perhaps it was enough to have pleased one of his parents. He looked at his mother, her lined but still radiant face turned to her husband. Perhaps it was enough.

  7

  Social Comfort, in a Hospital

  The true beginning of Fingal Flahertie O’Reilly’s immersion into clinical medicine started on a crisp Dublin morning. He strode from his digs under a sky that had the washed-out look of late autumn. Brittle brown leaves shared the gutters with fish-and-chip wrappers and discarded cigarette packets.

  When Fingal arrived at the teaching hospital, Charlie Greer was waiting with a group of four other students. Fingal barely had time to bid them good morning when a small man came down the front steps and announced, “Good morning. I am Doctor Micks, deputy professor of materia medica and therapeutics and attending physician here at Sir Patrick Dun’s Hospital.”

  He was slim with a pointed chin and narrow face that made Fingal think of Gladys, the classroom skeleton. Doctor Micks wore wire-rimmed spectacles and a long white coat over the waistcoat and trousers of a grey suit. “I’m here,” he said, “to welcome you to the first day of your six-month clinical clerkship. You will be, as we call it, ‘walking the wards,’ working with general medical inpatients. You’ll attend required outpatient sessions and prescribed lectures. Your surgery training will come later.”

  Fingal fingered the tubing of the stethoscope in his pocket the way an ancient Celt might have fingered a runic talisman. He’d aced Intermediate Part II and collected his BA in June. Ma had come to the graduation ceremony in the Examination Hall to watch him and his friends, including a bemused Bob Beresford, receive their degrees. She’d made an excuse for Father. Said he’d been a bit under the weather. Now that those exams and the courses from June to October were over, the real meat of learning medicine was beginning.

  “I should like to know your names,” Doctor Micks said. “You are, Miss?”

  “Manwell, sir. Hilda Manwell.”

  “And you, Mister?”

  “Fitzpatrick, sir.”

  Pity, Fingal thought, that the man had also picked Sir Patrick Dun’s. Hilda was an unknown. At least the other lads, Bob, Charlie, and Cromie, were here too.

  “And you?” he asked, nodding at Fingal.

  “O’Reilly, sir.”

  “O’Reilly? You, and I believe Mister Greer there, you play rugby for Trinity, do you not?” He smiled. “I am led to believe that one or both of you might be capped for your country.”

  Fingal blushed and glanced at Charlie, who said, “If it’s anybody it’ll be O’Reilly, sir.”

  “As long as it doesn’t interfere with your studies, I wish you both the best of luck. Your success will add lustre to Trinity and to Sir Patrick Dun’s.”

  Fingal swallowed. That had been generous of Charlie and it wasn’t true. Greer was the better player.

  Doctor Micks turned to Bob.

  “Beresford, sir.”

  “And you?”

  “Cromie, sir.”

  “Thank you. Now, before I take you to the wards, I think it’s important that you, as new junior medical staff—”

  Fingal grinned. They were only students, but it was courteous to be treated like doctors.

  “—know something of the history of Sir Patrick Dun’s.”

  Fitzpatrick’s hand shot up. He was so excited he was waving his hand. Fingal could picture him asking, “Me, sir. Me, sir. Pick me. Please, please.”

  “Yes, Mister Fitzpatrick?” Doctor Micks frowned. “You have a question?”

  “No, sir.” He adjusted the pair of gold-framed pince-nez. “I’ve read about Sir Patrick.”

  Fingal looked over at Charlie, who raised his eyes to the heavens. Fingal shook his head and inwardly cringed. This sucking up to teachers was taboo.

  Fitzpatrick was tripping over his words. “He was born in Aberdeen, in Scotland in 1642. He treated King William of Orange for a shoulder wound on the day before the Battle of the Boyne. When he died, he left most of his fortune to found another medical school in Dublin. Some of that money went to building a hospital on Lower Exchange Street in 1792. The staff and patients moved here to Grand Canal Street in 1816.”

  A year after Waterloo, Fingal thought, and the victor of that scrap, Lord Wellington, had been born in Dublin. There was a dirty great monument to him in Phoenix Park.

  “I see you’ve done your research, Mister Fitzpatrick,” said Doctor Micks, and continued, “As you students will be spending the better part of two years with us in various departments I think it is important you understand your surroundings and develop a deep sense of pride in this institution.” He pointed up. “Can anyone translate that gilt inscription on the arch beneath the clock?”

  Fingal peered up and read, Nosocomium Patr. Dun. Eq. Aurat. MDCCCXIV. In full he knew it would be “Nosocomium Patricii Dun Equitis Aurati” and the date.

  To Fingal’s delight, Doctor Micks avoided Fitzpatrick and pointed at Charlie, who manfully translated, “The Hospital of Sir Patrick Dun, Knight, 1814.”

  “Well done, young Greer. That’s the year this part of the building was completed, before it was opened, two years later.” He removed his spectacles, polished, and replaced them. “But we must not dwell on the past,” he said, “I want to bring you up to date with more recent developments.”

  Fingal leant forward.

  “Since the original two wings on each side of this arch were built, one for men and one for women, Sir Patrick’s has expanded. The upper floor of the east wing to my left became, and still is, a fever ward with twenty-six beds and a separate entrance. New operating rooms wer
e built in 1898 and replaced in 1916.”

  The year of the Easter Rising, Fingal thought, and he knew that wounded rebels and British soldiers were treated here during the battle at the nearby Mount Street Bridge, which spanned the Grand Canal. One of the leaders had eventually come to Sir Patrick’s and asked to be taken to British headquarters to arrange the surrender of the rebels.

  Doctor Micks continued, “Those operating rooms were replaced again in 1924, this time in the rear of the building. There are student rooms when you are living in the hospital for the required periods of residence.”

  Fingal was looking forward to that. Every month spent practically gratis in the hospital was a saving of rent money.

  Doctor Micks continued, “That structure in front of the east wing is the outpatients’ department.” He smiled. “It was opened last year. Thirty thousand patients a year are seen there, so you’ll have plenty of opportunities to learn. And there is a home for student nurses on Lower Mount Street.”

  Fingal saw Charlie’s grin. Perhaps Doctor Micks had seen it too. He continued, “The lady superintendent, Miss Northey, keeps a very close eye on her young ladies, so be warned.”

  Charlie’s eyes narrowed. Fingal could almost hear him plotting how to bamboozle the redoubtable Miss Northey. Trust Charlie.

  “The X-ray department is getting overstretched so the Board of Governors is applying for money from the Irish Hospitals Sweepstakes Fund for a new one. The massage department is next door to the lecture theatre, in which I’m sure, Mister Greer, you’ll enjoy the weekly compulsory lectures delivered in Latin.”

  Charlie groaned.

  “Now,” said Doctor Micks, “that’s enough about the place, unless there are questions?”

  Fitzpatrick held up his hand.

  “Yes, Mister Fitzpatrick?”

  “Is it true, sir, that there’s a memorial in the front hall, a brass table engraved with the names of the thirty staff and students of Sir Patrick’s who fell in the Great War?”

  “It is,” Doctor Micks said.

  Fingal shook his head. And it’s true about you, Fitzpatrick. You’re one of those people who only ever ask a question if they already know the answer.

  “So,” said Doctor Micks. “No more questions?”

  Silence.

  “Right. Follow me and we’ll go and make ward rounds. Doctor Pilkington, the house physician, will be joining us.”

  Fingal trooped after the rest, through the front doors, past the War Memorial, and to the right of the splendidly named Grand Staircase.

  “This,” said Doctor Micks, holding open a door, “is Saint Patrick’s Ward.”

  Fingal’s nose was assailed by hospital smells. A low continuous moaning came from behind screens around a bed halfway up. Elsewhere someone was snoring, deeply and rhythmically. Nurses, their voices low and soothing, went about their duties.

  Inside the door, a young man in a long white coat waited. Two student nurses, a staff nurse, and the ward sister accompanied him. She wore a neck-to-ankle white apron over a floor-length blue dress. A white starched fall, a headdress that was bound across her forehead below the hairline, drooped in folds at the back and sides like the head adornments of a pharaoh.

  “Good morning, Doctor Pilkington, Sister Daly, ladies,” Doctor Micks said.

  The nurses bobbed, Doctor Pilkington said, “Good morning, sir,” as did Sister Daly. Her accent was pure County Cork. She smiled, then her green-eyed gaze fell for a moment on the six students. She might, Fingal thought, be inspecting something she’d found on the sole of her shoe that wasn’t to her liking. “Everything’s ready. Shall we start?” she asked.

  “Please.”

  Fingal looked around as he followed the entourage. He noticed that the walls were painted black. Someone called Nathaniel Hone had been resposible for the colour scheme, apparently believing that walls so coloured were easier to keep clean. High arched windows provided a great deal of light, and on good days were opened to admit fresh air. Light and air, it was believed, were two things critical to patients’ recovery. In the children’s ward, that recovery was helped along with liberal helpings of Bird’s custard.

  Along each side, beds were arranged with military precision, heads to the wall, feet to the central walkway. Every bed had a cane-backed chair at its foot and the case notes clipped to the bed-head. The twenty-five beds to each side were all occupied by men, some recovering from operations, others with medical conditions that did not require surgery.

  Fingal recognised the painting hanging over a fireplace, a scene depicting Saint Patrick preaching to Oisín, a warrior from Irish mythology.

  They arrived at a bed inside an oxygen tent. As the group arranged itself on either side of the foot of the bed, doctors to the right, nurses to the left, Fingal noticed a plaque on the wall. OTC COMMEMORATION BED. Endowed by citizens of Dublin in recognition of the gallant defence of Trinity College. Easter 1916. Dublin’s history was never far away.

  Through a wide celluloid window in the canvas Fingal could make out a man of about thirty propped up on pillows. The inflowing oxygen hissed and a fan whirred extracting carbon dioxide. Sister nodded to a student nurse who opened the zipper that gave access to the bed, and folded the material back. The man’s cheeks were dusky, his breathing jerky and shallow, his head was turned to one side, and his eyes were closed. The jugular vein, running from his collarbone to the angle of his jaw, was distended.

  The staff nurse handed Doctor Pilkington a chart. He glanced at it then started to give the patient’s history. “The patient, Mister KD, aged twenty-nine, of Ash Street in the Liberties, was admitted last night complaining of weakness, shortness of breath, coughing and haemoptysis—”

  Fingal had begun learning the language of medicine early. Patients were never referred to by name when they were being discussed. Only their initials. If a case were to be talked about in a public place, there could be no breach of confidentiality. Haemoptysis was spitting blood, as opposed to haematemesis, vomiting blood.

  “He had no other symptoms. A diagnosis of acute rheumatic fever was made five years ago when he was treated in Doctor Steevens’ Hospital with bed rest, fresh air, and acetylsalycilic acid at a dose of two hundred and forty grains daily—”

  “Aspirin,” Doctor Micks added. “First introduced by MacLagan of Edinburgh in 1874 to treat rheumatic fever—”

  Fitzpatrick interrupted, “But your book, sir, says it has now been proved that salicylates exercise no specific action in rheumatic heart disease.” His grin was oily. “And you recommend only thirty grains daily for relief of symptoms.”

  Fingal looked at Cromie and crossed his eyes.

  Doctor Micks inclined his head. “Thank you, Mister Fitzpatrick. Please carry on, Doctor Pilkington.”

  “He has been admitted on several occasions with congestive heart failure as a consequence of mitral stenosis and aortic incompetence.”

  Doctor Micks turned to Fingal. “Mister O’Reilly, what is rheumatic fever?”

  “An infection with the bacterium beta-haemolytic Streptococcus. Given where Mister KD lives, a damp, filthy, tenement—”

  Doctor Micks sighed. “Mister O’Reilly, we physicians cannot solve the difficulties of the whole world. Just tell me about the disease.”

  Fingal looked at the bed. That was a human being lying there, not just a disease, but he swallowed and continued, “The infection damages the heart valves. The mitral valve is narrowed so it’s difficult for blood to get into the left ventricle—”

  “Which is?” Micks asked Bob.

  “The lower chamber of the left side of the heart that is responsible for pumping blood around the body, sir.”

  “Good. And aortic incompetence, Greer?”

  “There’s a valve between the aorta and the left ventricle. When the ventricle finishes pumping, the aorta contracts to boost the blood along and the valve shuts to prevent backflow. But—”

  “But if the valve is damaged,” Fitzpatrick leapt i
n, “blood goes back into the ventricle, the blood gets dammed in the system, pools in the lungs, and causes congestive heart failure—”

  “Indeed.” Doctor Micks cut him off and spoke again to O’Reilly. “And how is the diagnosis of valvular disease made?”

  “From the previous history of rheumatic fever and by hearing the classic murmurs, sir.” O’Reilly tugged out his stethoscope.

  “Now,” said Doctor Micks, “you’ve got your stethoscope out, O’Reilly, have a listen to his chest. Tell us what you hear.” He nodded and said, “Sister, please.”

  Sister Daly said, “Nurse Kelly. Nurse O’Hallorhan. Please sit the patient forward.”

  A second student nurse joined the first. Together they bent over Mister KD and with their arms supporting his shoulders bent the man at his waist. The one on O’Reilly’s side unbuttoned the pyjama jacket.

  “Please, only describe the murmurs, O’Reilly,” Doctor Micks said.

  O’Reilly looked at the man’s narrow, sallow face, at how he gasped for breath, at the fear in his sunken blue eyes. “You don’t mind if I examine you?” he asked.

  The man weakly shook his head.

  “Get on with it, O’Reilly,” Fitzpatrick hissed. “Don’t waste time.”

  Fingal ignored Fitzpatrick. “Don’t be frightened,” he said to the patient. “I’m not going to hurt you.” He plugged his stethoscope into his ears, placed the bell below the man’s left nipple over the heart, and strained to make sense of what he was hearing. A fifteen-second glance at his watch told Fingal the heart rate was regular and ninety beats per minute. Superimposed on the heart’s lup-dup, lup-dup beats was a bewildering series of clicks and whooshes. He knew he was meant to relate them to the lups and dups, but for the life of him could not. He looked up. “I’m not sure, sir.”

  “You’re an honest man, O’Reilly. Very few people can at the first attempt. It takes practice. We’ll make sure you get plenty.”

  Fitzpatrick, without waiting to be asked, provided a comprehensive description of what should be heard, larding his discussion with terms like opening snaps, diastolic murmurs with presystolic accentuation, and aortic diastolic murmurs.