An Irish Country Wedding (3 page)

He felt her sag and with his hands under her armpits lowered her to the tile floor. He looked around. Laundry was piled nearby. He grabbed an armful and a plastic basin. Barry made a heap of the clothes, including, he noticed, a pair of his own trousers. “Lie back, Kinky. Put your head there.” He set the bowl beside her.

“Thank you, sir.” Her pinafore was splotched, her lips caked.

Barry dampened a tea towel, squatted beside her, and mopped her face. “Can you tell me what happened?”

She took a shallow breath, then said, “I was grand all together until about twelve thirty. I’d nearly finished getting lunch ready when I got a sharp pain. Mary, Mother of
—
” She clutched her lower belly and moaned. “There it is again.”

“Tell me about the pain,” he said. He took her pulse. The skin was clammy and her pulse rapid.

“It came on like a terrier pouncing on a rat, so, and it gnawed at me and kept on grinding, then it went away. That
—
” She inhaled. “
—
that was a blessèd relief for I was able to serve your luncheon on time, so.”

Kinky, you’re one brave woman, he thought, but asked professionally, “Can you show me where it hurts?”

She pointed to her left groin. “There, sir, and it does be back there now. And it’s coming in spasms.”

Barry glanced at his watch. One thirty-five. He frowned. Her vomiting had suggested the relatively innocuous acute gastroenteritis, often called stomach flu, or “the abdabs” by the locals. But while the disease might cause vomiting, clammy skin, and a fast pulse, it would not cause pain in the place Kinky was describing nor pain that came on so suddenly. “Have you ever had trouble there before?” he asked.

“Not like this. Once in a while if I’ve been lifting things or hoovering I’ll get a bit of a grumbling there, but, och, sure don’t I usually sit a while and then work it off?” She managed a weak smile. “My ma taught us that you should always try to work pain off, so. Not give in to it.”

“And you’ve never mentioned it to Doctor O’Reilly?” He knew Kinky would not voluntarily consult him, Barry. She’d consider Doctor O’Reilly’s assistant much too young.

“Och, Doctor Laverty, dear,” she said, shaking her head. “Sure wasn’t it only a shmall-little ache, and didn’t it always go away, and amn’t I at an age when you must expect such things? Another fourteen years won’t I be seventy and if I’m spared I’ll be playing in overtime then if you believe what the Good Book says about us being given three score years and ten?”

“Go on,” he said, “tell me more about what’s happening now.” Her description of the pain and its situation had given a hint.

“Just a bit before you came, sir, I had another fierce one, a spasm like a hot knife in exactly the same place. I dropped a pan of potatoes. A few minutes later another one came and then
—
” A tear fell. “
—
I embarrassed meself. I threw up, so.” She struggled to sit. “But I’m nearly better now
—
” She coughed. “
—
and soon I’ll clean up.”

Barry couldn’t keep an edge out of his voice. “Kinky Kincaid, you’ll do no such thing.” She gasped and clutched her belly. He heard her stomach give an enormous gurgle. The exact words from A Short Textbook of Surgery sprang to mind.
Borborygmi are sometimes loud enough to be heard by the unaided ear. The sound of turbulent peristalsis coinciding with an attack of colic is valuable evidence of intestinal obstruction. The causes
 
… which may be acute, chronic, or acute-on-chronic, are very numerous
. The site of Kinky’s pain and her previous history of a chronic ache brought on by exertion pointed to a hernia, a weakness in the abdominal muscles containing a sac of peritoneum. Spasms suggested a loop of bowel was trapped there, was being compressed, and causing pain every time a wave of peristalsis, the normal muscle contractions of the digestive tract, ran along the gut. He blew out his breath against partially closed lips. It was a logical explanation, but the other potential causes of obstruction were legion.

She groaned and used the basin. “Dear Lord,” she said, and gasped. “Please can you make it go away, Doctor Laverty? Please. The pain does try a body, so.” There was no strength in her voice.

“I’m sorry, Kinky,” he said, rising to take the full basin away. I only wish I could, he thought, but what I think you need is beyond the capabilities of a country GP. He poured the contents into the sink. He didn’t gag. All those years in the teaching hospital had inured him to many sights and smells. Before he turned on the tap to rinse the mess away he studied it. There was the greenish tinge of bile. That and the onset of pain immediately accompanied by vomiting, which by his guess was happening every three or four minutes, was typical of compression of the small intestine, probably the jejunem, that section of the small bowel immediately between the duodenum and the ileum. He was narrowing the list of possibilities. “I’ll just be a sec,” he called to Kinky as he rinsed the bowl. Blockage lower down the bowel, he thought, usually produced pain that lasted for quite some time before the vomiting started.

Barry brought the basin back and squatted beside her. “Kinky,” he said, “if you were anybody else I’d have to ask you a lot of personal questions, then examine you thoroughly. Last year Doctor O’Reilly taught me only to do the minimum to make a diagnosis if it spares the patient pain or embarrassment. He said when he was a student he’d learnt that from a surgeon in Dublin.”

“Thank you.” Her words caught in her throat. “But if you need to examine me, you fire away, sir. I’d not be any more ashamed than I already am for being so weak.”

He felt a prickling behind his eyelids. “Kinky,” he said. “Kinky, you mustn’t be ashamed. You didn’t bring this on.” He stood. “Please, you just lie there. I’ll be right back, but I have to make a phone call.”

“Go ahead. I’ll be grand if you leave me the basin. I’d not want to make any more mess on the floor.” Her breathing came in gasps. “But don’t be too long.” Her voice dropped to a whisper and she looked him straight in the eye. “I’m mortal afraid, sir.”

He pursed his lips and squeezed her hand. “We’ll get you well soon. Don’t be afraid. I’ll be straight back. I promise.” He rose, went to the hall phone, called the Royal Victoria Hospital switchboard, and waited for an answer.

As he did, drumming his fingers on the wall, he couldn’t help thinking how it was this having to refer difficult cases to specialists that made him question whether he was really cut out to be a rural GP.

“Royal Victoria Hospital.”

“Doctor Laverty here. Can you get me Doctor Jack Mills please.
It’s urgent.” Again Barry waited. Stop being so bloody selfish, he
thought. You’ve more important things to worry about than whether you’ve made the right choice to go and try obstetrics and gynaecology. Important things like Kinky Kincaid being sick.

“Barry?” Jack’s Antrim accent was clear. “What’s up?”

“It’s Kinky.”

Jack laughed. “Hey bye, I like the sound of that, but what is? Ursula Andress in a white bikini in
Doctor No?
Or maybe Honor
Blackman as Pussy Galore in
Goldfinger
. Remember when we
used to watch her in
The Avengers
on telly in the students’ mess? All dressed in that black leath
—
”

“Jack. Jack, be serious.” Despite his concerns, Barry found himself smiling at his old friend. “I’m talking about our housekeeper, Mrs. Kincaid.”

“Oh. That Kinky? Och, I am sorry. Is she sick?”

“Violent abdominal pain, and I do mean violent, of recent onset, concurrent bilious vomiting, previous history of groin aches
—
”

“Physical findings?”

“Clammy skin and tachycardia and that’s all I know. Come on, Jack. Kinky’s fed you often enough when you’ve come down here. You know how she looks after O’Reilly and me. It would be like examining my own mother.”

“Fair enough. You don’t need to anyway. It sounds like a strangulated hernia. Probably needs surgery,” Jack said. “Shoot her up to us and we’ll take care of examining her and doing any tests.”

“I thought it might be a hernia,” Barry said, “but getting her to you in a rush is tricky.” It was gratifying to have his probable diagnosis confirmed by his friend who now had ten months of surgical training under his belt. Barry was happy to have the specialists take care of Kinky. She was family. It was the other referrals he’d had to make that were frustrating him.

“How soon can you get her to the Royal?” Jack asked.

With bowel obstructions, the sooner the constriction was removed the less was the likelihood of complications like gangrene of the bowel, perforation, peritonitis. Barry owed it to Kinky to
move quickly, but— “I could run her up myself,” he said, “but
O’Reilly’s not back from Belfast and if I do there’ll be no one here if there’s another emergency in the practice. She usually looks af
ter the shop when the boss and I are both out. Makes not-so-
urgent patients wait, gets an ambulance for the really sick ones and sends them to casualty.”

“Not to worry. You’re at home?”

“I am.”

“I’ll get an ambulance down pronto.”

“Fine.” Barry heard a distant low moan. “Jack, she’s having a lot of pain. Morphine?”

“Better not, I’m afraid. Understanding the pain, where it’s felt,
what makes it worse, what relieves it, it’s all part of making the fi
nal
diagnosis in folks with acute bellies. Painkillers muddy the wa
ters. We’ve known that since fourth year, Barry.”

“I know. I just thought
—
” He bit off the words. He’d made the serious mistake of letting his concern for this special patient override what must be done. He also knew he hated to see Kinky suffering.

“We’ve made an informed guess that it’s a hernia,” Jack said, “but at her age, what, fifty, fifty-five? You could get those symptoms from a lot more things. Crohn’s disease, ulcerative colitis
—
”

“I know, I know,” said Barry. “You can spare me the list, Jack. Just tell the ambulance to be quick and ask one of the attendants to keep her company on the drive up to Belfast. She’s in a lot of pain, and she’ll be terrified. She shouldn’t be left alone.”

“Done, mate,” Jack said, “and I’ll talk to my boss, Sir Donald Cromie, at once. He’s here in outpatients. He teaches that severe belly pain is either ‘watching sick,’ meaning you can observe them, try nonsurgical treatment, and perhaps they’ll get better, or ‘opening sick,’ which means immediate surgery is indicated. And I’m sorry, Barry, but even sight unseen, your Kinky sounds pretty ‘opening sick’ to me. If he agrees, he’ll see her the minute she arrives on the ward. Save a bit of time.”

“Thanks.” Barry was going to say good-bye, but remembered, “One last thing. Kinky’s hundreds of miles away from her family in County Cork. She’ll be all on her own at the hospital. I’ll have to let her folks know, but I’ll wait ’til I hear for sure what’s going on. Will you give me a call when you’ve seen her?”

“Sure.”

“Thanks, Jack,” Barry said. “I’d better go back and see how she’s doing.” And it won’t be well, he thought, but at least I can offer her a bit of comfort while we wait.

3

“Plain Cooking” Cannot Be Entrusted to “Plain Cooks”

“What? You’ve sent Kinky to the Royal?” O’Reilly still had one arm in his wet raincoat as water from an April shower dripped onto the hall carpet. It was forty-five minutes since the ambulance had left. The house had felt hollow and empty to Barry without the stoic Corkwoman in her kitchen. He welcomed O’Reilly’s expansive presence now, even if he wasn’t taking the news in exemplary fashion.

“Blue blazes. A bowel obstruction? Holy thundering Jasus, poor Kinky.”

“I’m sorry, Fingal.” His senior’s nose tip had blanched, a sure sign the man was furious.

“No need for you to bloody well apologise.” He hung up his coat so forcibly that Barry thought the coat-peg might be torn off the wall. “You didn’t make her sick.”

Barry said, “I wasn’t apologising, Fingal. When I said ‘sorry’ I was expressing regret that Kinky’s sick, not accepting blame for anything.”

“I know,” O’Reilly said. “I know, and I’m not angry with you, Barry. It’s not your fault. You’ve got her in good hands, and I understand why you didn’t take her to Belfast yourself. You could have panicked, but you didn’t. Mind you, I’m not surprised you did the right thing. You’ve learnt a lot since you came to work here. I trust you, son. Implicitly.”

“Thank you, Fingal.” And he’s right. I could have panicked,
Barry thought. Seeing Kinky so sick and feeling helpless was
scary, and I didn’t let it beat me. Being scared by illness in others wasn’t an emotion allowed to doctors.

O’Reilly continued, “I’m fit to be tied because she’s sick. Poor woman. Kinky’s had her share of grief.”

“I know.” Barry swallowed. “She asked me to pack a bag for her and put a stuffed toy bunny in it. I never knew she had one. She called it her
gorria mór
.”

“Irish for ‘big hare,’” said O’Reilly. “I suppose it’s a comfort to her for some reason. None of our business.”

But Barry knew the reason. He’d gone to her tidy room and
seen her gallery of faded photographs—family, friends, a farm
house. On her bedside table a book lay open to where a rosebud had been pressed between the pages, and done so long ago, judging by its dryness. Next to it, two sepia-coloured pictures shared a silver frame. In one, a grinning young man with long dark hair parted to one side sat in a small boat, holding two salmon. In the other, coatless, shirtsleeves rolled up, he stood on a road between blackthorn hedges, right arm hanging low, ready to loft a “bullet”—a road bowling cannonball. The inscription was fading, but Barry could read it.
To Maureen from your
gorria mór,
with all my love
. It must have been the man’s pet name. The lump in Barry’s throat had nearly choked him. Maureen “Kinky” Kincaid, née O’Hanlon, had indeed had her “share of grief.” He understood now why she’d wanted the toy, but decided O’Reilly was right. It was Kinky’s business alone. No need to explain even to him. “She should be at the Royal by now,” Barry said. “I wish we knew what’s happening. My pal Jack Mills is going to admit her.”