An Irish Country Christmas (32 page)

He ordered her drink and an orange juice for himself. He’d be driving home soon; he hadn’t really intended to stay for very long, but it had been pleasant to see Jack and Mandy, and Harry. Barry paid for the drinks and carried them over to Peggy. “Here you are,” he said, handing her the vodka and sitting opposite.

“Thank you. You’re a vodka drinker too?”

He shook his head. “Just orange. I’m driving.”

She patted his free hand. “That’s smart, Barry. When I was working in Casualty, I saw enough youngsters smashed to tatters because some eejit thought he could take a lot of drink and still drive.”

“I’ve seen a few myself.”

“How?”

“I’m a GP, assistant to a Doctor O’Reilly in Ballybucklebo, but I did three months in emergency at the Royal when I was a houseman last year.”

She took a pull from her drink. “I must have just missed you. I was there this June, just before I got my R.N.” She looked more closely at him and frowned a little. “Barry Laverty? Laverty? Are you the chap who used to date Brid McCormack?”

“That’s me,” Barry said, remembering Brid’s green eyes and auburn hair, a remembrance made more real by Peggy’s perfume.

“And she married Roger Grant, the surgeon, this September.”

Brid had told him about that in January last year when she’d calmly announced she was going to marry someone else. Now it was December, and it looked as though Patricia was losing interest. There must be something jinxed about women, himself, and the wintertime. He sighed and was surprised to feel Peggy’s hand covering his.

“She’s a very pretty girl. She was a class ahead of me at nursing school.” He looked into her eyes and saw sympathy.

“Och,” he said, shrugging. “ ‘That was in another country; and besides, the wench is dead,’ ” he said, quoting Christopher Marlowe’s
The Jew of Malta
.

Peggy looked at him quizzically. “Brid’s not dead, as far as I know.”

“I know. It just means I’m over her.” The next question would probably be “Are you seeing anybody else?” he thought. He didn’t know how he was going to answer her, being warmed as he was by the increasing pressure of her hand on his.

“It’s not nice to get dumped,” she said. “My boyfriend and I split up six months ago.” She sighed. “You get used to it, but it stings.”

“Do you?” he said, wondering if Patricia dumped him would he
ever get over it. He knew O’Reilly still grieved for his lost wife, but at least he was seeing Kitty now.

“Yes,” she said, “you have to. Life has to go on.”

Barry noticed that her glass was empty. “Would you like another?”

She shook her head and glanced at her watch. “I live in Knock, and I have to get up early tomorrow. My friend drove me here, but she seems to have vanished with your white-haired pal. I don’t suppose you’d like to give me a lift home? It’s on your way to Ballybucklebo.”

Barry finished his orange juice and stood. “I’d be delighted,” he said without hesitation. “Let’s get our coats and I’ll walk you to my car.”

She waited to kiss him until they were far enough away from Bo-stock to be in the dark shadows, away from prying eyes. She kissed him softly at first, then harder, and Barry didn’t mind. He didn’t mind one tiny bit.

The Absent Are Always in the Wrong

“This is the house.” O’Reilly parked the Rover outside 27 Shore Road. “Out,” he said to Kitty, then piled out himself and opened the back door. He grabbed the two heavy maternity bags that minutes earlier he had taken from the kitchen at Number 1. “Can you close this door, Kitty?”

She came around from her side of the car and slammed the door.

“Open the garden gate.”

Above the rhythmic crashing of surf on the nearby beach he heard the squeak of rusty hinges. The low cast-iron gate stood in a three-foot-high brick wall. Kitty hurried to the house, and he followed, leaving the gate open.

All the detached houses along this part of the Shore Road were identical, and although O’Reilly had not visited this one before, several of his patients lived nearby. He moved quickly after Kitty and had no difficulty finding his way along the short path, even though the night was black as pitch.

The door opened to Kitty’s knock, and Miss Hagerty, the district midwife, smart as ever in her blue uniform and starched white apron, was backlit by the hall lights. “I’m very glad you could come, Doctor O’Reilly,” she said. Then she turned and started walking quickly. “The patient’s in the main bedroom upstairs,” she called over her shoulder. “I don’t want to leave her alone for long. Follow me.” He guessed that the husband, like any sensible Ulsterman with a wife in labour, was at the pub, and that was why Miss Hagerty had answered the door.

“This is Sister O’Hallorhan,” he called by way of introduction, as he lugged the heavy bags along a well-carpeted hall and up a broad staircase. Oil paintings of fishermen and landscapes that he recognized as painted by James Humbert Craig hung in ascending order to keep company with anybody climbing the stairs. Craig, a Bangor man, had often painted scenes of Belfast Lough.

O’Reilly could hear a woman moaning, and he saw Miss Hagerty disappear through an open door on the right side of the landing.

He followed, set the bags on the carpet, straightened up, tore off his overcoat and jacket, and flung them into a corner of the room. Rolling up his shirtsleeves, he moved across to stand beside a large double bed. Miss Hagerty stood at the far side. Kitty came in and waited unobtrusively beside the door.

Gertie Gorman, a woman he guessed was in her late twenties, lay on top of a rubber sheet that Miss Hagerty would have placed there to protect the mattress. The bedclothes lay in a heap beside a dressing table. Gertie’s nightie was rucked up just below her breasts. “Hello, Mrs. Gorman,” he said. “I’m Doctor O’Reilly.”

She managed a weak smile. “Thanks for . . .” Her face creased. She gritted her teeth and moaned. O’Reilly glanced at Miss Hagerty and raised one bushy eyebrow.

“She says the pains started about ten hours ago and are coming every three minutes and lasting for a minute. She’s well along.”

He nodded. “How many’s this for her?”

“Number three. The other two were short labours, eight and six hours. And she has small babies, six pounds eight ounces and seven pounds one.”

Be thankful for small mercies, he thought. Second, third, and fourth were the easiest deliveries, the least likely to be complicated. On the other hand, the time of labour usually grew shorter with each successive pregnancy. This time it was longer, and that was worrying, but she was probably close to being ready to deliver. It was time to start to ascertain exactly what was happening and mobilize his forces. “Kitty, could you clear a space on the dressing table and get all the sterile packs out of the bags?”

Kitty went to the dressing table and started moving things from the top.

“Miss Hagerty, I’ll need you to bring me up to date. Is she at term?”

“Thirty-eight weeks,” Miss Hagerty said, “and the pregnancy’s been uncomplicated as far as I know.”

O’Reilly frowned. As far as I know? Usually most of the antenatal care of a woman with an uncomplicated pregnancy was the duty of her midwife.

“When did you see her last?”

“A month ago.”

He heard his voice rise. “A month? In the third trimester?”

Miss Hagerty sucked in her thin cheeks. “Doctor Fitzpatrick was most insistent that he be almost solely responsible for her care.”

O’Reilly shook his head. Stupid. Stupid. An experienced midwife like Miss Hagerty was one of the most sensitive diagnostic tools available. It was the height of arrogance for Fitzpatrick to ignore her expertise.

“But as far as you know there haven’t been any problems?”

“As far as I know. I asked Gertie as soon as I got here, and she said Doctor Fitzpatrick kept telling her everything was fine. No high blood pressure. Good weight gain. The baby was growing and its heart rate was normal.” He heard a disdainful tone in her words. “So as far as I know there were no difficulties before labour . . . at least none that were noticed.”

He frowned. What did that mean? O’Reilly disliked discussing a patient in so impersonal a manner in front of her, but he needed the critical information, and during a contraction she was in no position to hold a conversation anyway. He tried to reassure Gertie by squeezing her hand for a moment, and he was gratified to see her manage a weak smile as the contraction waned. It was time to examine her. He’d pursue Miss Hagerty’s implications later.

“I’m going to examine your tummy,” he said, looking questioningly at Miss Hagerty. He had no difficulty lip-reading the midwife’s silent, “I think it’s a breech.”

A breech? Christ Almighty. The risks of serious injury to the
mother and of damage, asphyxia, and even death to the child were much greater when a baby came bottom first.

That would certainly explain the “at least none that were noticed” remark. It was a major responsibility of the attending midwife or physician to identify any abnormal presentations and to arrange for the patient to be transferred to a properly equipped maternity unit. A specialist obstetrician, who could if necessary call on the services of a team, ought to manage the delivery and if necessary do a caesarean section.

O’Reilly hadn’t had to deliver a breech since before the war. His palms started to sweat. Miss Hagerty might be wrong, and if she wasn’t he hoped that labour would be insufficiently advanced so he could get Gertie up to the Royal Maternity Hospital.

He stood facing her and laid his hands on either side of her swollen belly. Through the abdominal wall and the temporarily relaxed uterus, he could make out the smooth, curved contour of the baby’s back lying on its mother’s right side. He followed it upward until he could no longer feel it. He placed one hand on either side of the fundus, the top of the uterus, and moved his hands from side to side. Something solid moved back and forth between his hands. It was, in medical terminology, ballottable. Heads usually were, buttocks less so. He used his right-hand fingers and thumb curled like a claw to grasp the hard round thing, and he was sure it was the baby’s head. He met Miss Hagerty’s gaze and nodded.

Using both hands, one on either side of the lowest part of her belly immediately above the pubic bones, he was able to make out a shape that was deep into the pelvis. It didn’t feel like a head. It was narrower. He nodded at Miss Hagerty again. “Is the fetal heart rate okay?”

“It was one forty just before you arrived.”

Good. That at least was normal.

Before he could carry out any further manoeuvers, he felt the beginning of another contraction. He’d be unable to feel anything but the iron-hard uterine muscles until this contraction passed. Time to get ready to examine the patient vaginally.

“Is the bathroom on the landing?”

“Two doors down along to the right.”

Gertie’s moans pursued him, but had died away by the time O’Reilly returned from scrubbing his hands. While Kitty handed him a sterile towel and opened a packet of rubber gloves as he dried his hands, the moans started again. Then Gertie cried, “I have to push! I have to push!” while Miss Hagerty responded, “Huff, Gertie. Huff.” O’Reilly donned the gloves to the accompaniment of the patient’s short, rapid, shallow breaths. He hoped to God the cervix was fully dilated.

If, as he was almost certain, the baby’s buttocks were coming first, they were narrower than the head and could slip through a partially dilated cervix and descend into the pelvis. There the pressure the buttocks exerted on the muscles of the pelvic floor would give the woman an uncontrollable desire to push.

She might well push the narrower parts of the baby past the cervix and out into the open with no apparent difficulty, but once the neck had passed through the muscular cervical ring, the wider head would become irretrievably stuck. The consequences would be disastrous for both mother and child.

O’Reilly lifted a pair of sponge forceps that Kitty had placed on the dressing table, her makeshift instrument trolley. He chucked a handful of sterile cotton-wool balls into a bowl of dilute Savlon disinfectant and moved to the patient’s side, accompanied by Kitty, who carried the bowl.

“Can you draw up your legs, Gertie?” He waited as Miss Hagerty helped the patient bend her knees and open her thighs. The labia were gaping, and in the opening he could see something smooth and dusky. It was a buttock. Its plum colour was caused by the blood being dammed back in its blood vessels due to the constriction of the pelvic canal. That answered two questions. It definitely was a breech, and there was no time to arrange a transfer. Bloody Fitzpatrick should have made the diagnosis weeks ago. O’Reilly knew Miss Hagerty would have—had she been given the chance.

No time to get tried about that now. He’d deal with it later. Gertie Gorman needed his undivided attention.

“I’m going to give you a wash,” O’Reilly said, loading the forceps
with sodden cotton-wool balls. “Sorry if it’s a bit cold.” She flinched when he started to paint her vulva, inner thighs, and her buttocks with the pale yellow Savlon solution, its fumes tickling his nose. He chucked the forceps back into the basin. “Now you’ll feel me touching you.”