Fingal O'Reilly, Irish Doctor (26 page)

She’d done the same thing last year when he’d diagnosed primary dysmennorrhoea, taken his advice and the pills he’d suggested, and had never come back until she’d developed a new ailment. Country women were a self-sufficient lot. Given the arduousness of life on a farm they had to be.

“Did you go for the X-ray?” If she had it might be a help. He could phone the hospital. Get the report.

She took a shallow breath, gasped, “Ah,” hung her head and said, “No, sir. I’m sorry, but I was well mended so I thought it’d not show anything anyroad.”

“Yep,” he said, “you’re probably right.” If she felt completely better the cause of her illness had probably resolved and nothing would have shown. No help there. He remembered a case he’d seen years ago in Dublin when he was flirting with becoming a specialist obstetrician and gynaecologist. Fainting and shoulder pain could be the clues to a tubal pregnancy, and an old adage of one of his profs that “Every woman is pregant until proved otherwise” had saved O’Reilly and his patient on more than one occasion. “When was your last period?”

“Which one, sir. The one I had last time I come in, or the one that started three days ago right on time?”

“And is it normal?” If she had conceived in the previous cycle it was just possible for her to be having problems with a very early pregnancy fourteen days from conception, and bleeding because of it. But he doubted it very much.

“Same oul’ achy, crampy soreness, but them pills still help.”

“And what else is wrong?” He pursed his lips. He knew he was fishing, hoping she’d say something that would point him in the right direction, but he was at a loss.

“Just—” She stopped in mid-breath, grimaced, then said, “Like last month, a pain here in my chest and it’s hard til breathe, so it is.”

Nothing to help him. Nothing. He’d bet his boots that she had another pleural effusion. But why? “Let’s have a look at your chest,” he said. “Just sit forward, tug your blouse out of your skirt at the back.”

He examined her upper back. Self-same findings as last time including the whispering pectoriloquy. O’Reilly pursed his lips. He was completely foxed. He allowed himself a small smile. Nobody had said doctors had to be right all the time, nor was he ever reticent about admitting when he was stumped. “I’m pretty sure you have fluid round your lung again, Brenda, but I’m damned if I know why.”

“Maybe it’ll just go away again, like last time?” She peered at him through her granny glasses.

“It might, but we need to get to the bottom of it, find out what’s causing it. It’s you for the Royal today.” She needed the opinion of a specialist physician, a discipline he knew was referred to as internal medicine in America. “Can Ian run you up? Or—” Why not? O’Reilly asked himself. “Or I could get a second opinion here. Ask Doctor Bradley to take a shufti at you.”

Brenda frowned. “I dunno. She’s awful young, so she is, and she’s a lady…”

“Doctor,” O’Reilly said. “I understand, but female or not she’s been to medical school much more recently than me, and I’m sure there are new things she knows. What do you say, Brenda? Will we give her a try?”

“Welllllll … if you say so, Doctor O’Reilly, and you’ll be here too, won’t you?”

“Of course. You wait and I’ll be back in a couple of minutes.”

And he was, having interrupted Jenny’s reading of Isaac Asimov’s recent book
The Rest of the Robots.
He explained the complaint and his physical findings on their way downstairs, but not the patient’s reticence about seeing a female physician. Jenny had been particularly interested in the fact that lying down made the chest pain worse.

“Good morning, Mrs. Eakin,” Jenny said, and smiled as they went into the surgery to stand beside the examining couch. “I’m Doctor Bradley.”

“Pleased til meet you, miss,” Brenda Eakin said, not quite looking Jenny in the eye.

“I’d like to ask you about your periods. Is that all right?”

Brenda looked at O’Reilly for reassurance.

He nodded.

“They’re regular?”

“You could set your watch by them.”

“Please tell me about the pains. Doctor O’Reilly says you have cramps.”

“Aye.”

“Do the cramps get easier or worse as the period goes on?”

O’Reilly leant forward. He’d assumed that it had been a routine case of primary dysmenorrhoea, so common was the complaint, and hadn’t paid a great deal of attention to the nature of the cramps.

Brenda sighed. “They get worser until it’s over then they tail off, like.”

Worse? Bugger. O’Reilly’s initial diagnosis had been wrong. In primary dysmenorrhoea—pain caused by uterine contractions with no underlying disease—the pain always eased as the period progressed. He hadn’t considered secondary dysmenorrhoea caused by an underlying condition like inflammation, and particularly the ill-understood endometriosis. In those cases, the pain got worse as the period progressed—and both causes of secondary dysmenorrhoea could delay or inhibit conception. Brenda and Ian had been trying for eighteen months. He took a deep breath. But how did that information help understand her pleural effusion?

“And is the pain in the middle of your tummy?”

Barbara shook her head. “Mostly on the right.”

“Thank you, Mrs. Eakin,” Jenny said. It was only a hint of a smile before her face went expressionless, but it was enough to tell O’Reilly that she was sure she’d solved the problem. “I think,” she said, “I can spare you another examination.”

Which was considerate, and Jenny had been, given the clinical findings.

“Could I have a word with you in the hall, please, Doctor O’Reilly?”

O’Reilly smiled. A professional thing to do, because Jenny was going to have to correct him and didn’t want to do so in front of the patient. “Not at all,” he said, turning to Brenda. “You remember I told you last year you’d the kind of period cramps that a lot of women get? Nothing unusual?”

“Yes, Doctor.” She looked at him.

“I may have been wrong…”

She looked at Jenny.

“And I’m going to ask Doctor Bradley to explain.” He watched Jenny’s face. He’d certainly taken her by surprise, but hadn’t he promised that he’d do everything he could to help her gain the patients’ respect? Damn it all, he wasn’t infallible and hadn’t he had a father who’d taught, “If you’re wrong, admit it?” “Go ahead, Doctor,” he said.

Jenny nodded. “Mrs. Eakin. I believe I know exactly why you’ve got painful periods and why you’ve got the fluid in your chest.”

O’Reilly frowned. Was she thinking there was a correlation between the two? If there was, it was something he’d never heard of.

“I believe you have a condition called endometriosis.”

“Is that a cancer?” O’Reilly saw how Brenda’s eyes widened as she expressed the usual, but unspoken fear of every patient. She was paying rapt attention.

“I promise you it’s not,” Jenny said. “It’s a women’s disease. When we have periods…”

Nice, thought O’Reilly. A subtle hint of “us women together.”

“… the lining of the womb bleeds and is shed. Some women develop islands of the special womb lining outside their womb, but inside their tummies. The lining is called endometrium, ‘endo’ for inner, and ‘metrium’ for of the womb. The condition you have is called endometriosis. When it’s period time, the tissue that shouldn’t be in there bleeds too. It causes pain like yours down below and in some extremely rare cases when the woman lies down, the blood runs up from her pelvis and gets into her chest and that hurts too.”

So that’s why that symptom had been Jenny’s initial clue, and one that had eluded him.

“When pelvic endometriosis causes pleural involvement it’s always right-sided, just like yours, Mrs. Eakin.” Jenny turned to O’Reilly as she said, “And I only know about it because I saw a case two and a half years ago in the Royal. Mister Gavin Boyd, who has been a specialist for years, said it was the first case of endometriosis causing haematothorax he’d ever had and that most doctors had never even heard of it.”

Graciously done to ease any wounds to my reputation, O’Reilly thought, and she was right, he had never heard of the condition.

“We all make mistakes, Doctor O’Reilly. There’ll be no side taken,” Brenda said.

In other words, she wasn’t going to blame him.

She looked at Jenny. “I tell you, I was quare and disappointed to be took sick so soon after I thought I was better, but if I did have to see a doctor I think I’m powerful lucky you’re here, Doctor Bradley. I’ll be happy til see you any time, so I will.”

You don’t know how lucky, O’Reilly thought. He would have sent Brenda to a specialist physician and no internist would even have heard of haematothorax caused by endometriosis, which was a condition that fell within the purview of the gynaecologists. It could have taken forever to sort her out.

“I don’t need to examine you because it’s usually impossible to feel endometriosis. We have to look at it,” Jenny said.

“And would that mean an operation?”

“In a way. If Doctor O’Reilly agrees I’d like us to send you to Dundonald Hospital.”

Why the hospital on the outskirts of Belfast on the way to Newtownards? O’Reilly wondered.

“The specialist there, Mister Matt Neely, sent one of his staff to Oldham, a place in England, to learn a new technique from a Mister Patrick Steptoe.”

This too, was news to O’Reilly.

“Normally your gynaecologist would have to open you right up to diagnose and remove the out-of-place endometrium and cure you,” Jenny said, “but Mister Steptoe has been working on techniques developed in France by a Doctor Raoul Palmer and in Germany by a doctor Hans Frangenheim. The gynaecologist makes a tiny cut below your belly button and puts a telescope in your tummy—”

“Honest to God?” Brenda’s eyes were wide. “A telescope? That’s powerful, so it is.” She even managed a weak smile. “Will they see any stars?”

“No stars,” Jenny said, and chuckled, “but if they see bits of endometriosis, they’ll make another tiny incision and put in an electric probe and cauterise the abnormal bits to get rid of them. So instead of being in hospital for weeks after a big operation, you’ll be out in one day. Once the cause is gone, your chest will heal up in no time.”

“I never heard the like,” Brenda said. “Wait ’til I tell Ian, and wait ’til I tell my granny. Thanks ever so much, Doctor Bradley, and thank you too, sir. You’re still my doctor, but I know if you ever get stuck you’ve a one here with a right head on her shoulders, so she has.”

O’Reilly knew Brenda’s granny, Edie Carmichael. She was the best friend of Cissie Sloan’s grandmother. Which meant that three days from now Doctor Jenny Bradley’s stock would be blue chip in Ballybucklebo and the townland—and it would be even more difficult to let her go if Barry wanted to come back.

25

Ev’n Do as Other Widows

“You look very well this morning, Ma,” Fingal said when she came down to join him in the dining room for breakfast. Today, Saturday, was one week short of three months since Father’s death. She had worn nothing but black since then, Bridgit and Cook had put on black armbands, and Fingal a black tie. Convention decreed the uniform of mourning, but its duration was no longer a dismal four years for widows. He rose, pulled out her chair, and saw her comfortably seated.

She glanced at her lavender blouse and grey skirt. “I miss your father dreadfully, Fingal, but I am not going to parade my grief in public by staying in widow’s weeds forever. These colours have been acceptable as half-mourning since Victoria’s reign and I don’t intend to be in them for more than a month. By Armistice Day, I shall be back to my usual clothes.”

“I’m delighted to hear it,” he said. “I miss him too,” and Fingal did, “but I agree. Grief should be a family matter.”

She rang a small bell. “Now,” she said, clearly considering the subject closed, “what are your plans for today?”

He hesitated. He knew that if she’d any news for him she would have told him at once, but he couldn’t help himself. He had to ask on behalf of John-Joe Finnegan. “I don’t suppose you’ve had any luck yet?”

“With finding work for your friend?” She shook her head. “I’m sorry,” she said. “I have tried. You’re like me, Fingal. You take the plight of those less fortunate to heart too much.”

Bridgit appeared, carrying a tray. “Here’s breakfast. Sideboard as usual?”

“Please, Bridgit,” Ma said, and rose.

“Nice til see you out of black, Mrs. O’Reilly,” Bridgit said, “and what I have here’ll cheer you up even more. Porridge, kippers, and toast and marmalade.” Bridgit started unloading the tray and putting the covered plates of kippers on a warmer.

“Thank you, and please thank Cook,” Ma said. “And, Bridgit?”

“Yes, Mrs. O’Reilly?”

“Both you and Cook can take off the armbands. Thank you for wearing them, I know you both miss the professor.” Ma smiled. “We all have to be moving on, all of us have to start cheering up, don’t we?”

“Yes, we do, Mrs. O’Reilly, thank you, and we will, so we will.” Bridgit left.

A brace of kippers was just what Fingal needed to start his day. Ma having found a job prospect for John-Joe would have been an even better way. Damn. Ma was right. He did take his patients’ problems to heart. And he knew he was too old to believe that no matter what the problem was, Mummy could fix it, but he had hoped.

“These are very difficult times, Fingal,” Ma said, starting to serve. “Why in heaven’s name, with the whole world trying to recover from the Wall Street Crash of ’29, would our dear ‘president of the executive council’
…”
Fingal heard the tinge of sarcasm at the cumbersome term that really meant prime minister. “Why Mister de Valera in his infinite wisdom would start a trade war with Great Britain, I’ll never know. Talk about a mouse taking on an elephant. That was in ’31, and it has only got worse, as you know. Particularly among the farmers. And it’s thrown even more people out of work. I asked the rest of the folks I know, but I’m afraid no one can help. I’ll be speaking to Mister John Jackson when he gets back from the Continent next month. He has a shoemaking factory out at Chapelizod, but I’d be none too hopeful that he has any work either. I am sorry.” She handed him a plate of porridge. “Please start.”