An Irish Doctor in Love and at Sea (12 page)

He laughed. “I'll be grand,” he said, “and now's not the time to start quibbling over what to take.”

“Go on, then,” she said, “go and see your patient.”

“I'm fine seeing her by myself, Fingal, really,” Barry said. “I'd like to. I've got the details in my head. Pap test normal at twelve weeks. Everything pretty well normal at her last antenatal visit. Fibroid I found in her last pregnancy was bigger, but asymptomatic. Let's see. Last period, February the twenty-first, due November the twenty-eighth, so she'd be about thirty-two weeks now. And why it should be important I don't know, but I also recall she collects butterflies and moths, and has a brother in Canada in a place called Medicine Hat.”

O'Reilly laughed and nodded. “And I remember your first months here and you being baffled because I could remember my patients without needing to look at their records. It just takes practice. You're growing into the job, Barry. I'm proud of you.”

“Thank you, Fingal.” Barry's smile was broad, but O'Reilly also knew he was getting a look that said: “I'm a full partner now. I don't need you to supervise me.”

“I still think I should come,” he said, giving Kitty a furtive glance. “You don't mind, do you, love?”

“'Course not,” she said, smiling. “The packing can wait. And there's a good police programme on TV. Off you trot.”

He dropped a quick kiss on her head as he walked past.

“My guess is that she probably has red-degeneration of her fibroid,” said Barry, following behind. “But you know as well as I do it could be anything from something wrong with the pregnancy, including the fibroid, to any of the ills of the flesh that can afflict non-pregnant patients and be purely coincidental. But that's what we're here for,” Barry said as they reached the hall. “Puzzling things out.”

“Aye,” said O'Reilly, turning toward the kitchen. “And seeing I'm going to be away for a week it's a good thing you'll know all about her. Now,” he said, crossing the room and opening the back door, “they live out near Maggie Houston's old cottage by the seafront on the way to Bangor … Back into your kennel, sir.”

Arthur Guinness, who had come bounding down the garden, stopped wagging his tail and retreated into his doghouse. By the look in his brown eyes and the way his head drooped O'Reilly knew the big dog was woestruck, but it couldn't be helped. “You've had your walk today and it's still only September, lummox. We'll start bringing you into the kitchen for the night when the weather turns.”

Barry smiled and said, “From what I've seen since I've been here, once you do start, he spends more time in front of the fire upstairs than in the kitchen.”

“Och,” said O'Reilly, opening the back gate. “He's family.” After all, O'Reilly was only talking to Barry, who had never lifted a shotgun. If the real shooting fraternity knew that O'Reilly treated his gundog like a person they'd think the good doctor had gone astray in the head. Country dogs were working animals, not pampered pets.

“Shall we take Brunhilde?” said Barry, heading for his little green Volkswagen beetle.

“In cases of severe pain,” O'Reilly said, “I always want to get there as quickly as possible, so we'll take my Rover.” He wondered why Barry's eyes suddenly uplifted to the heavens. Now the boy was grimacing and seemed to be crossing his fingers. Silly lad. No one knew the roads of County Down like Fingal Flahertie O'Reilly and, cyclists notwithstanding, nobody could navigate the winding narrow ways more skilfully.

*   *   *

“Out.” O'Reilly didn't even wait for the big Rover to stop shuddering on its springs after slamming to a halt. He grabbed his bag and walked the last few paces across a gravel path to the Beggses' bungalow.

Past the building and across Belfast Lough, the sun's burnished disk was starting to slide behind the blue Antrim Hills and pinks, yellows, and scarlet dyed the undersides of low clouds. Beneath them the lough was at peace and yet, as often happened near the sea even on a night as tranquil as this, O'Reilly found himself imagining his old
Warspite
in the fury of an Atlantic gale.

As Barry came and stood at his shoulder, O'Reilly banished the image, pushed a ceramic doorbell, heard a distant
ding-dong,
and waited until the door was opened by Davy Beggs, a short man in a grey V-necked pullover, collarless shirt, moleskin trousers, and tartan carpet slippers.

“Thanks for coming out,” he said, then noticing Barry, “is it bad enough that it's going to take two of youse?”

She was Barry's patient. O'Reilly waited.

“Not at all, Mister Beggs,” Barry said. “I've been looking after Irene's pregnancy and you know I delivered your last, wee Vera. Doctor O'Reilly came out to keep me company, that's all.”

“And,” Barry really didn't need any moral support, but the next statement wouldn't hurt, O'Reilly thought, “Doctor Laverty has had an extra year of training in midwifery at the Waveney Hospital.”

“Right enough? So I hear.”

O'Reilly nodded. “Now perhaps we might see the patient?”

“Aye, certainly. Come on, on in. She's on the bed, so she is.” He stepped aside to let them in, closed the door, and led them along a hall. In what must be a lounge to the right, a TV blared. O'Reilly recognised the Ulster tones of a character, Bert Lynch, played by James Ellis from Belfast in a popular series,
Z-Cars,
the police programme Kitty was probably watching back at Number One.

“In thonder, Doctors,” Mister Beggs said, opening a door and standing aside.

The room was well lit, had the inevitable female perfumes of powder and face cream, but over them hung the acrid smell of vomit. Beside a ceramic baking bowl on the bedside table stood a brilliant blue butterfly mounted and behind glass in a glossy black frame.

“Here's your doctors, love,” Mister Beggs said. “I'll leave youse all in peace.”

O'Reilly hung back and let Barry approach the bed.

“Hello, Irene,” he said. “Not feeling so hot?”

The fair-haired young woman lying on the bed shook her head and moaned softly.

O'Reilly could see a faint sheen on her forehead, her eyes were listless, and her lips were caked. A tear track was drying on her left cheek.

Barry hitched himself onto the side of the bed. He took her pulse while saying, “Tell me what happened.”

“We'd just finished our tea—Davy got us a nice bit of haddock from your man Hall Campbell…”

O'Reilly well remembered Irene Beggs. She could be as loquacious as Cissie Sloan. He crossed his arms and waited to see how Barry might handle the torrent of words.

“… him that runs the boat with Jimmy Scott, and—” She screwed up her face and took a series of deep breaths before saying, “Then I took this pain right here.” She pointed to the front of her distended belly and clutched it with both hands. “Next thing I knew I'd to run til the jakes, for I'd to boke in the toilet bowl. Twice. That's when Davy phoned youse.”

So far the symptoms fitted with their original suspicions, although sudden bleeding behind the placenta, called
abruptio placentae
or accidental haemorrhage, a condition potentially lethal to mother and child, could present that way. Barry would have to make sure it wasn't the case.

“And did the pain move anywhere else?” Barry said. “Or does it come in regular waves like labour pains?”

“I'm not in labour,” she said. “I know what that's like … at least them pains give you a rest.”

Although something going wrong with a fibroid could precipitate the premature onset of contractions, it didn't seem to have done so here.

“And since it come on it's not moved an inch, so it's not. I wish it would go away.”

Just about any other non-pregnancy-related condition would hurt elsewhere. Appendicitis in the right lower belly, twisting or rupture of an ovarian cyst in one side or the other, kidney troubles high under the ribs at the back, serious illnesses of the bowel all over the abdomen and usually crampy.

“It's dead chronic, so it is.” She whimpered. “Could youse maybe give me something for the pain, like?”

“Perhaps when I've finished examining you,” Barry said. “Now, have you felt cold? Taken the shivers?”

“No,” she said, “but I feel hot and sweaty.”

Barry looked at O'Reilly. “She has a temperature and her pulse is up. Have you a sphygmo in your bag?”

“Aye.” O'Reilly fished out the blood pressure measuring device.

Barry asked, “Have you noticed any bleeding down below?”

“Not a drop. Just this God-awful pain.” She looked at Barry and touched his sleeve. “Do you think my baby's all right, Doctor?”

“Pretty sure. I'll know for sure when I've finished.” Barry started to take Irene's blood pressure. “Let's see how your blood pressure is.”

No bleeding. Labour was often preceded by some loss of blood, the so-called show, and often some blood was lost in cases of
abruptio,
but in them the real damage was caused by the blood trapped behind the placenta, and the blood didn't always escape to the outside world.
Abruptio
couldn't be excluded yet.

In moments Barry was able to remove his stethoscope and say, “One twenty over eighty. Perfectly normal. Same as it was at your last antenatal visit.”

That made
abruptio placenta
much more unlikely. It was almost always accompanied by signs of shock, which included a rapid pulse and low blood pressure.

“That's a good sign, then, Doctor?”

“It is,” said Barry. “Now, let's have a look.” As she undid her skirt's waistband, Barry was rapidly looking under one of her eyelids to get a rough appreciation of her haemoglobin level, sniffing her breath. “Put out your tongue.” He nodded and said, “Bit dirty.”

O'Reilly saw her stiffen and frown.

Barry smiled at Irene. “And I'm not calling you dirty, Irene. What I think ails you makes your tongue look furry.”

“Oh,” she said, and visibly relaxed.

Good lad, O'Reilly thought. Don't neglect the patient's feelings.

“Can you pull up your blouse, please?”

Barry stood up and faced her.

O'Reilly couldn't quite see what was going on, but he knew that Barry would first feel the abdominal muscles. In cases of
abruptio,
they would be rigid.

“Tummy's nice and soft,” Barry said, and O'Reilly relaxed. It wasn't what he had been worried about. He rummaged in his bag and produced a foetal stethoscope. “You'll need this.” He handed it to Barry and waited. Eventually Barry finished, turned to O'Reilly, grinned, and winked. “No sign of abruption,” he said, and by his wink, O'Reilly knew Barry was relieved too. “And the pain is localised to the fibroid.” He turned back to Irene and said, “All finished, and now I know for certain your wee one's fine.”

Good lad. It was the first and foremost worry of every unwell pregnant woman.

“Right size, right place, and the wee heart's rattling away.”

“That's a quare relief,” she said.

“You're not quite well, but it's not something to worry about, and I'm going to explain what's wrong. Do you want us to get Davy in to listen?”

“Not at all,” she said. “Men only know how til make babies.” For a moment a smile broke through her constant grimace. “My Davy's dead on at that, so he is.”

O'Reilly smiled.

“There's only one problem, and it's sore I know, but probably not serious. There's a bump on the front of your womb. It's called a fibroid.”

“A fireball? That's ferocious. My cousin Biddy, her what lives in Clougher, had fireballs, and she needed one of them 'ectomies, you know. I'm not sure what kind. Will I need one?”

“No. I promise. And in case you're worried, it's not cancer.”

“That's all right then.”

“You've had the fibroid for some time. Your womb is a big muscle, you see, and sometimes a part of it starts growing into a big bump.”

“Like an oak apple on an oak tree?”

“Exactly, although oak galls are caused by a kind of wasp. No one knows what causes fibroids, but sometimes, particularly when a woman is pregnant, the fibroid outgrows its blood supply and dies. We call that condition red degeneration. But it's only the bump that's dying. Unfortunately, in doing so it causes pain.”

“Pain? You can say that again, sir.” She clutched her tummy.

“Can I have a quarter of morphine, please, Doctor O'Reilly?”

“Aye.” O'Reilly prepared the injection.

“Usually with good nursing, a light diet, and regular painkillers, women get better in no more than ten days, but I'm afraid we're going to have to admit you to the Royal Maternity.”

“But can't I stay—”

Barry shook his head. “We simply don't have the nurses available for round-the-clock care at home, Irene.”

“If you say so, sir. And I want that injection now. Will youse explain til Davy? He'll have for til get my other cousin who lives in the Kinnegar til take care of wee Bert and Vera.”

The Kinnegar. O'Reilly thought of Ronald, picturing him changing the dressings on his burnt hands, then gave Barry a prepared hypodermic and a cotton wool ball soaked in methylated spirits. The fumes stung his nose.

“All right, Irene. I'll give you your jag now, then we'll explain to Davy and arrange for you to go to hospital.”

She yelped once as the needle went home.

“Right, Doctor O'Reilly,” Barry said as they left the bedroom to make the arrangements, “I think we're just about done here and then we'll head for home, and please remember we are not going to be rushing to a fire, nor are we likely to be pursued by wolves. No need to break the sound barrier.”