An Irish Country Practice Read online

  Barry reckoned that it was out of character, but why shouldn’t the man celebrate? And two bottles. Could there be someone else in the good doctor’s life? Barry said, “I say good for him, Cissie. Now, I’ve another patient—”

  “I’m away off, sir. If I don’t see yiz through the window, I’ll see yiz through the week.” She chortled at her own humour.

  Good old Cissie. He grinned. She was a decent sort, but best taken in small doses.

  He headed for the surgery and returned with Julie Donnelly, carrying a wicker shopping basket on one arm, its contents covered by a red-checkered cloth.

  Her bump was obvious under her blue woollen pullover. “Great day, so it is,” she said. “I seen Anne Galvin at the grocers there now. She said you’d fixed up her bronchitis and it was so sunny she reckoned she was fit to go out.”

  Barry smiled. Acute bronchitis could resolve very quickly so he was not surprised, but he would pop round anyway on Thursday as planned. “How are you, Julie?”

  “I’m early for my visit, sir,” she said, handing him a plastic specimen bottle, setting her basket on a chair, and without having to be told climbing up onto the examining couch. “I’m twenty-seven weeks now and I know I shouldn’t come in until twenty-eight, but Mister Bishop’s business is slowing down a wee bit so he’s given a wheen of his workers next week off. Me and Donal and Tori’d like to go down to Rasharkin to see my family. We haven’t since Christmas. I hope you don’t mind. He doesn’t get much holidays.”

  So Cissie had been right about Bertie. “I’m glad you’re able to get away. And I don’t mind a bit you coming early.” He thought of how important families were and of Anne Galvin missing hers in America. “You were doing fine three weeks ago. Anything different now?”

  She opened her skirt and adjusted it so he could examine her. “I’m bigger, my back hurts if I stand too long, I have to pee more often, and the bairn’s kicking the living bejasus out of me, but sure I had all that with Tori too.” She rolled up her right sleeve. “Will the cuff fit?”

  “It will.” Barry put on the blood pressure cuff. “One thirty over eighty-five. Up a tad but nothing to worry about.” He was not concerned. Julie had no untoward symptoms. Any pregnancy could go sour at any time, but she was young. Healthy. Granted she’d miscarried her first, but she’d sailed through her second so far, and second, third, and fourth pregnancies were usually the most straightforward. “Let’s see your tummy.”

  She lay on the couch and Barry palpated her abdomen. The fundus, the top of the uterus, might be a bit higher than he would have anticipated, but some women did “carry high.” He could make out a foetal head at the top of the uterus. “The wean’s bottom-first today, but that’s nothing to worry about.” And wouldn’t be unless it persisted until much later in the pregnancy. Only three percent of babies were breech births. “They toss around a lot at this stage.” He found the baby’s back and placed his Pinard stethoscope over the foetal heart. “One hundred and forty-four. Spot on,” he said, straightening up. He moved along the couch and palpated her ankles, pressing in with his thumb. When he removed it there was no remaining pit, so no fluid, oedema, in the tissues. Good. “Everything looks pretty good. I’ll test your urine while you’re getting dressed.”

  He did, with the use of two dipsticks. No sugar. No albumen. So no need to worry about gestational diabetes or pre-eclamptic toxaemia, a combination of high blood pressure, swollen ankles, and albuminuria. It was ill understood, but if untreated could interfere with foetal growth and in severe cases cause fits in the mother. “Fine,” he said.

  “Just need to weigh you.” He glanced at the notes, then at the scales. “Three-pound gain in three weeks? Perfect.” He returned to the desk to fill in her chart. “You are taking your iron, folic acid, cod liver oil, and orange juice?”

  “Aye. I’m not fond of the cod liver oil, but sure if it’s for the wean?” She smiled.

  “Come back in three weeks then,” Barry said.

  She nodded. “I’ll do that.” She removed the cloth from her basket and handed Barry a greaseproof-paper-wrapped parcel. “It’s a wee gift for himself and Mrs. O’Reilly. A cock pheasant. Donal brung it home Saturday. The bird’s plucked and cleaned, like. I know it’s a bit naughty of Donal, but it does help with the housekeeping.”

  “I’m sure Doctor and Mrs. O’Reilly will be delighted,” Barry said, accepting the parcel.

  “You won’t tell no one, Doctor?” Julie said.

  “Not a soul,” Barry said, understanding how with a family like the Donnellys money was always tight, “and you do know you’ll be getting a maternity grant of sixteen pounds when you deliver, and another three pounds seven and six a week for eighteen weeks starting eleven weeks before you’re due.”

  “That’s dead on, so it is.” She lowered her voice. “Mister Bishop’s been generous. The week off’s with pay, but…” She pursed her lips. “Donal and I worry a bit about the future of the boss’s business.”

  So did Barry, but he said, “Mister Bertie Bishop’s been around here for a long time. I’m sure it’ll only be temporary. Donal and the lads’ll be back to work in no time.”

  “I’m sure you’re right, sir.”

  Barry rose and showed her to the door. He wandered back to the kitchen. The door was shut, but he knew why.

  “Just a minute.” Kinky’s voice came through the door when he knocked.

  He heard a couple of yips then, “Come in.”

  Kinky stood with her back to the range, cuddling a wriggling Kenny. Barry shut the door. It kept the pup in and Lady Macbeth out.

  Kinky set him on the floor and he immediately ran over to Barry to be petted.

  Barry handed Kinky the parcel. “A gift from the Donnellys. A pheasant. Donal got it Saturday.” He bent and patted Kenny’s head.

  “Grand, so,” Kinky said. “Three days old? They’ll be just right tomorrow night roasted. Sage-and-onion stuffing, roast potatoes, and red cabbage.” She shook her head. “But they do be out of season.” She tutted. “I know Donal’s no dozer, but if he’s not careful he’s going to get caught and summonsed, and I do hear the new resident magistrate is tough. Very tough.”

  “Donal?” Barry said. “I think he’s big enough and ugly enough to look after himself.”

  “Well, I do hope so,” Kinky said, “for it would be a stiff fine, and him with another mouth to feed soon.”

  And for a moment Barry wondered if Kinky’s winnings might be going to be needed very close to home.

  7

  Teach Me To Feel Another’s Woe

  “Please have a seat, Doctor O’Reilly.” The young secretary in the outer office of the department of general practice whipped off her glasses and offered him a wide and open smile. “Would you like some tea? Coffee?”

  “Thank you, but I’m fine.” He reckoned she was about twenty-five, with fair hair and blue eyes. Her accent definitely came more from the roomy mansions of Malone Road than the tenements of the Shankill. Bernard Shaw’s Professor Higgins would have enjoyed Belfast, so different were the tones of the upper-and lower-class districts.

  “Professor Irwin, I’m afraid, is running a bit late. He’s meeting with the dean but had the dean’s secretary phone me and ask me to explain and apologise.”

  “That’s perfectly all right,” O’Reilly said, and smiled. Although he hated unpunctuality, there was no need to take it out on this young woman, and George Irwin had at least had the courtesy to apologise. “I can wait. Don’t let me hold you up.”

  “Thank you, sir. I’m sure he won’t be long, and I do have a lot to do.” She returned her pair of gold-framed spectacles to the bridge of her button nose and began typing furiously.

  O’Reilly sat for a while listening to the clatter of the keys, the ting and clack of the carriage return. Twice she stopped to answer the phone. He glanced at his watch. His appointment was for eleven and it was already ten past. He had arranged to meet two of his closest friends from his student days a
t Trinity College Dublin, now surgeons who worked here. Charlie Greer and Sir Donald Cromie would be waiting for him at noon in O’Kane’s Oak Bar on Grosvenor Road opposite the gates to the hospital. He didn’t want to be late.

  The outer door flew open and a man of medium height wearing a black academic gown dashed in.

  He thrust out his hand. “Doctor O’Reilly? George Irwin. Sorry I’m late. Do come in. Molly, coffee and biscuits, please.”

  O’Reilly stood and shook hands.

  The professor’s silver hair was parted to the left, with short sideburns coming halfway down beside large ears. Thick eyebrows arched over dark eyes. He strode to his inner office.

  O’Reilly followed him into the small room. A functional Formica-topped table sat serving as a desk in front of a window. The tabletop was overflowing with books and manuscripts, an in-and-out tray, and a telephone. A bookcase occupying one wall was stuffed with medical texts and bound issues of The Journal of the College of General Practitioners arranged by year of publication. On another he noticed Professor Irwin’s framed diplomas: his medical degree, his Member of the College of General Practitioners certificate, and the crest of the Royal College of General Practitioners with its motto, Cum Scientia Caritas. O’Reilly had no trouble translating. Science with compassion. Latin had been one prerequisite for admission to medical school, both at Trinity—where in O’Reilly’s day one lecture a week had been delivered in that language—and here at Queen’s University.

  The professor pulled off his gown. “Bloody archaic tradition,” he said, hanging it on a hook behind the door. “Have a pew.” He indicated a small sofa with dark linen-covered cushions in front of his desk.

  “Thank you for coming, Doctor. And thank you, Molly.” He cleared room on his desktop, then sat down behind it. “Pop it there.” The secretary set down a small tray. Coffee, cups, milk, sugar, and McVitie’s chocolate digestive biscuits. “Help yourself.”

  O’Reilly took half a cup of coffee, with milk and sugar, and two biscuits. He had a soft spot for chocolate digestives.

  “Molly knows my habits,” the professor said as she left and closed the door. “She keeps a pot of coffee on the go.” He raised his cup as might a man raise his glass in a pub. “Now. To business, and I’m George, by the way. Do you prefer Doctor O’Reilly or Fingal?”

  Here was a courteous and probably humble man. Many professors were jealous of their rank and would never have dreamed of asking lesser mortals their preference. “Fingal’s fine.” O’Reilly sat back and crossed his tweed-covered legs. He was interested to hear what the man was going to say, but had decided on the day he’d opened his letter not to make any firm commitments until he’d had time to think, to talk it over with Kitty, then with his partner and associates.

  “Let me give you some history. This is a brand-new department. The National Health Service was brought in in 1948—”

  “Don’t I know it?” said O’Reilly. “Don’t I work in it?”

  “Of course you do, Fingal. I wasn’t thinking. So you well know the effect it’s had.”

  “I do. I used to get paid by the patient’s fee for service. Well-to-do people like the local gentry or successful business owners paid directly. The marquis paid for his servants or folks had work-related insurance. Colleagues got ‘professional courtesy’—free treatment. Now the ministry pays me so much a head every year for each patient registered with my practice, whether I never see them or have them in once a week. The change hasn’t affected me much, but I hear it’s really altered things for doctors in the city. I don’t know the details though. I haven’t paid much attention to the financial aspects of medicine, I’m afraid.”

  George Irwin laughed. “Then you’re a lucky man. There certainly has been a change. The private, fee-paying patients like your marquis have vanished for the GP. Everyone has taken advantage of the Health Service’s low premiums and apparently ‘free’ medical services from GPs. That’s cost a lot of city GPs money. There’s private insurance and lots of the wealthy do pay premiums, but the companies only cover specialist care and hospital costs.”

  O’Reilly frowned. “I thought specialists like Charlie Greer got a salary for looking after folks in hospital and the state-insured folks weren’t charged.”

  “True, but if you were having an operation, would you like to go on a waiting list and recover in a twenty-six-bed ward or have your operation that week and recover in a private room like today’s private patients do?”

  “I know my friends Charlie and Cromie, fair play to them, do work in the private Musgrave and Clark clinic for patients who have extra private insurance.”

  “The specialists are doing very well, but a lot of GPs have started feeling hard done by. No more private patients. And because they think of the service as ‘free’”—he emphasised the word—“patients don’t put up with a cold until it gets better. Now they demand to be seen, insist on a home visit, and often in the middle of the night. I think the lack of respect is more galling for many than the drop in income.”

  “Most country patients aren’t like that, thank the Lord,” O’Reilly said.

  “I’m glad to hear it. But if that’s not enough,” George said, “the paperwork has increased. Letters for sick leave. Physical examinations before certain government employment. I’ll not go on. You know about it as well as I do.”

  “I hate filling out forms,” O’Reilly growled.

  “And of course there’s the financial pressure.”

  Now that’s never bothered me, thought O’Reilly. Even before the National Health Service and its guaranteed payment per patient on his list he had been happy to collect what fees he could. He’d charge the marquis or Bertie and Flo Bishop lots, but see the likes of Maggie MacCorkle for free, take payment in kind, a couple stone of spuds, a goose, a string of plaice. He remembered Seamus Galvin, before he’d emigrated, arriving at the door with a brace of lobsters. O’Reilly’d always believed doctors were meant to look after people first and worry about money later.

  George continued. “We decided it was time to become specialists in our own right, the equals of consultants, not simply triage officers sending the patients to the right consultant. To do so we needed our own college. I was on the steering committee. Foundation memberships were offered in 1953 to those doctors who met a set of criteria. Within six weeks more than one thousand, six hundred had joined.”

  “I got a letter, but I didn’t apply,” said O’Reilly. “I’m not very political. I told you I hate filling in forms, and surely to God after thirty-one years since qualification, no one’s going to take away my licence, are they?”

  George laughed. “No, Fingal, they’re not. I hear from your friends and some other GPs that you are a first-class physician.”

  O’Reilly cleared his throat, grunted, and looked down. He didn’t need to be told that he bloody well knew his job. And flattery always made him cringe. He supposed it was his Victorian upbringing.

  George Irwin shook his head. His voice was firm. “Charlie Greer warned me you might shrink from praise, and Charlie’s known you since 1931. I admire modesty, but I don’t hand out credit unless I believe it’s due. Your reputation is solid.” He fixed O’Reilly with a steely stare. “And I want your help.”

  Polite George Irwin might be, but O’Reilly realised the man was determined and did not like being contradicted, even if only by a grunt.

  “We got our Royal Arms in ’62 so we are recognised as being on a par with the other royal colleges: physic, surgery, and obstetrics and gynaecology. We moved our headquarters to Kensington in London and now we’re going a step farther. All across the United Kingdom of Great Britain and Northern Ireland, we’re going to start insisting on formal training in university faculties for new GPs. Our department is the fifth to be established.”

  O’Reilly noted the man did not say “my.” In that one word he had defined his position. Academic medicine, O’Reilly knew, was full of little Caesars building their empires, polishing
their reputations, regarding their department as a private fiefdom. Clearly George Irwin was not one of them. Cromie had said as much when O’Reilly had phoned his old friend to enquire about the new professor. Charlie had assured O’Reilly that George Irwin was a good head.

  “And I’d like to have you a part of it.” He sat back in his chair and steepled his fingers. “Tell me, Fingal. Do you think GP as a specialty is a good idea?”

  That caught O’Reilly off guard. He inhaled, pulled out his pipe. Lighting up always gave him time to think. He saw George’s look of disapproval and shoved the briar back in his jacket pocket. “When I got your letter, I automatically said to my wife, ‘That’s the end of old GPs like me,’ and I’m not sure what I actually meant. I’ve done my job my way for a long time. I’m not used to change, and yet in the last couple of years I’ve taken on associates, seen less of my patients, have more time off. My own general practice is changing. Medicine has changed enormously in the last thirty years. I’ve tried to keep up.” He hesitated, working out the rest of his answer.

  George sat back in his chair and said nothing.

  O’Reilly frowned. “I think you and your colleagues will be steering a narrow course. On one hand there’s resentment about the way today’s GP can be regarded as second class by some of the more arrogant specialists. I understand that, but if the only reason for a college and extra training is to salve your collective amour propre, no, I’m not in favour.” He inhaled.

  “Please go on,” George said.

  “But if at the heart of your endeavours you want to make better GPs, who to the best of their ability look after their patients with … what’s your motto, ‘Science and compassion’? Then, yes. I’d fully support that.” He grinned. “Do that—improve our services to our patients—and the respect is bound to follow.”