An Irish Country Love Story (17 page)

Barry inhaled.

“If you're wrong and it's a blood cancer … You said he's sixty-one?”

“Yes.”

“The leukaemias tend to be slow to progress at that age, but you'd be risking delaying the diagnosis and treatment.” He steepled his fingers. “Willing to accept that on behalf of your patient?”

Barry barely hesitated. “I haven't discussed it with him. I'm trying not to worry him unless it's absolutely necessary. If I'm right, we'd be sparing him painful and unpleasant tests, wouldn't we? And a lot of anguish if we can keep him out of hospital. I hope a week, ten days wouldn't be critical if I'm wrong.”

Doctor Nelson drummed his fingers on the desktop, then smiled. “You care about your patients, don't you, Barry, not just their diseases?”

Barry knew he was reddening.

“I suppose if you've been working with Fingal O'Reilly it was bound to rub off. We know all about him through his classmates Charlie Greer and Donald Cromie. They say he was always an old marshmallow hiding under a fake crusty exterior. You could be emulating a much worse model.” He leant forward and looked into Barry's face. “Mind you, I seem to remember the way you looked after a patient with polycythaemia. As a student you went the extra mile for that man. Good for you.”

Barry recalled the man, a Mister Steele from Ballybogy in County Antrim.

Gerry Nelson pointed a finger and for a moment Barry felt like a student again. “And don't ever stop caring. In our trade it can be very easy to focus on the disease and ignore the patient. Don't.” He returned the lab forms. “I'll support your idea. I couldn't get him admitted until next week anyway. It would take a day or two to get the tests done. If you don't mind dropping in on him on your way home tonight you could get treatment of his suspected PA started straightaway. He'll need daily intramuscular injections of one hundred micrograms of B12.”

“I'll see him this evening.”

“His current tests show an absence of reticulocytes.”

Barry struggled to remember his pathology classes, when they had been taught how to examine blood smears. Reticulocytes were immature red blood cells that left the bone marrow where blood was produced. They were easy to see under the microscope because, when stained, a network of intracellular protein became identifiable. They appeared in the blood stream, where they then matured in one day and the network disappeared. Ordinarily they were about 1 percent of all red cells. The percent of reticulocytes could be used to assess bone marrow activity. A low count or their absence was consistent with pernicious anemia, but could be due to other blood disorders, including the leukaemias.

“Re-measure them in ten days. If the count is very high, say forty to fifty percent, then the marrow is working at top speed to make red cells because at last it's getting B12 and you'll have been proven right.”

“And more, Mister Houston will be on the mend,” said Barry.

“He will, but he'll still need daily injections until his complete blood count is normal, then one every four weeks for life.” Doctor Nelson nodded. “But if the count's not up, then it's not PA, so phone my secretary and get him admitted at once. I'll arrange it in advance and we'll do whatever is necessary to make a diagnosis.”

“I will, Gerry.” Barry rose. Using the senior man's name got easier with each repetition. “Thank you for your time and advice.”

“It's been a pleasure. Always is to see our old students doing well. Consult me any time.” He rose, went to a small fridge, and took out a glass bottle containing pink liquid. “You'll need this. Cyanocobalamin. Vitamin B12. I presume you have hypodermics with you?”

“I have.”

Gerry Nelson stretched out his hand, which Barry shook. “Good luck and do let me know how it turns out.”

“I will, and thanks again.” Barry let himself out, closed the office door, and let out a sigh. That had gone even better than he'd hoped for, in more ways than one. Not only had he achieved the outcome he'd wanted for Sonny, it was very gratifying to be accepted as an equal within the medical hierarchy. He glanced at his watch. There was just time to nip over to the pathology department and see his old classmate Harry Sloan, then stop off at Erskine Mayne's bookstore to get a book for Kitty's imminent birthday. And if he caught the four o'clock train to Bangor, picked up Brunhilde and drove to the Houstons', he could still be back at Number One in time for a predinner drink.

*   *   *

“It's quare and decent of you to come out again the day,” Maggie said as she took Barry's coat and ushered him into the living room. “At least the gale's blown over.” She spoke to Sonny, who was sitting, fully dressed, in an armchair before the fire reading a book. “Doctor Laverty's come til see us, dear.”

Sonny put down the book. “How very kind. Please have a seat.” He indicated a vacant armchair.

Barry sat and glanced at the book's cover. Nancy Mitford's
The Sun King.
“I've never read her. Are you enjoying Louis the Fourteenth's biography?”

“Enormously,” Sonny said. “Mitford writes very well. You should try her. Her
Madame de Pompadour
's great fun.” He gasped a short breath and then said, “But I don't think, Doctor, you came out here to get my recommendations on what to read, did you?”

“No, I haven't,” Barry said, “but I will take your advice about the book. Sorry I hadn't had it earlier. I was in a bookstore this afternoon on my way back from the Royal Victoria Hospital where I'd consulted with a specialist about you. He says he agrees that we can assume you do have the kind of anaemia I think you do.”

“Thon pernicious thing?” Maggie said.

“That's right, anaemia due to B12 lack, so we can start your treatment today and see what happens. We'll do another blood test in ten days. If the test shows what we expect it to, and that would be the return of red blood cell production, then the diagnosis is correct and you'll be on the road to recovery.”

Sonny nodded. “So,” he said, “I am to be an experiment with a sample size of one—me? Is that correct?”

“It is.”

Sonny smiled. “I'll be delighted to participate. What must I do?”

Barry rummaged in his bag and fished out the cyanocobalamin, a prepacked hypodermic, a bottle of methylated spirits, and a cotton wool ball. “If you'd roll up your sleeve to above your shoulder, please.” He soaked the cotton wool in the methylated spirits. The fumes stung his nostrils. In moments he had swabbed the rubber cap of the little bottle and filled the small syringe. “It'll only sting a bit,” he said, swabbing Sonny's exposed shoulder over the large muscle, the deltoid, at its point. The injection took seconds.

Sonny sucked in his breath.

“There,” Barry said. “All done.”

“Thank you, Doctor,” Sonny said. “Not bad at all.”

“I'm afraid you're going to start feeling a bit like a pincushion,” Barry said. “You're going to need daily injections until your blood count is entirely normal. Each one of us will put you on our home visit list so you'll not need to come to the surgery.”

“Thank you, sir,” Maggie said.

“And assuming you are right in your diagnosis, how long will it take to get my counts to become normal again?” Sonny asked.

“About a month,” Barry said, “and then it's once-a-month injections for life.”

“That's not too bad, dear,” Maggie said. She tugged at her nose. “I've a cousin with diabetes. She has to give herself injections twice a day every day.” She cocked her head to one side. “Doctor Laverty, could you mebbe teach Sonny how to do it himself or me to do it for him? Save youse doctors an awful lot of trips?”

“There's an idea,” Barry said, and wondered why if, as he well knew, diabetics could be taught to self-administer their insulin, other patients needing regular jags could not? “It's not usual for PA patients,” he said. “Let me think about that in a couple of weeks. We'll be doing a blood test in ten days and if it's showing the right response we'll mebbe teach Sonny or you, Maggie, to do the injections.”

“That would be grand,” she said, and grinned her toothless grin at Sonny. “And there'll be no
craic
to our friends that I'm always needling you neither.”

Sonny and Barry laughed. That Maggie could joke was a measure of her relief. Barry handed her the bottle of B12. “Pop that in your fridge, but take it out in the morning.”

“I will,” she said.

“I'm sorry,” Barry said, “that we can't fix your nerve damage.”

Sonny nodded. “You did tell me earlier. Pity, but it's not so bad. Bit of pins and needles. Not always being sure where my feet are. I'm not in pain. I can live with it.” He smiled at Maggie. “And don't you be worrying your head either.”

Typical of the man, Barry thought. “That's it then,” he said. “I'll write out your lab forms for Monday week, and then I'll be off.” Barry sat at a table and started filling in the forms. “I suppose there's no word about Jasper?”

Sonny shook his head. “I'm afraid not.” He took a deep breath. “But we keep hoping.”

Maggie stood behind her husband and squeezed his shoulder. “We do, and thanks for asking, Doctor.”

“I'm sorry,” Barry said, and completed the requisition for the blood work, including a reticulocyte count. “Here,” he said, “and I'll arrange for the ambulance again too.” He stood.

“I'll see you out, sir,” Maggie said, and after Sonny and Barry had said their good-byes he followed her into the hall. It was going to be very satisfying if he were proven right in about ten days' time. If he wasn't, and he'd deliberately avoided talking about the implications so as not to worry the Houstons, it was going to be difficult having to tell them. But, damn it all, it was a risk worth taking.

 

14

He Has a Fever

O'Reilly watched Kitty examine several grapefruit before selecting three and putting them in his shopping basket to keep half a dozen carrots and a fresh cauliflower company. He felt the increased weight on his left arm.

“Morning, Doctor and Mrs. O'Reilly,” Aggie Arbuthnot said. “Helping out with the shopping, sir?”

“That I am,” he said. “Mrs. O'Reilly calls me Bob. It's short for ‘beast of burden.'”

Aggie laughed. “You're a quare gag, sir, so you are, but it is about time men started giving their missusses a hand. Fair play til you. When my Henry, God love him, was alive he was a great one for helping round the place.” She wandered off in the direction of a table where ranks of onions rubbed shoulders with paper bags of mushrooms lying beside rows of cucumbers. Lennon's greengrocers was well stocked and O'Reilly marvelled at the out-of-season fresh fruit and vegetables. They would have been flown in from places like Israel and the U.S.A. This shopping for grub was all foreign to him. Kinky had taken care of all that before he'd married. Now Kitty liked to do some herself if she was off duty.

As part of his plan to get her to slow down from her nursing, O'Reilly had come along to keep her company. He intended to turn the routine Saturday morning chore into an outing by surprising her with a trip to Culloden for lunch, which was why they'd come in the Rover rather than enjoying the short walk from Number One. The treat would also be a diversionary tactic. Kitty had been muttering about popping into Alice Moloney's shop to look at some new bolts of material and he was damn sure she did not intend having a dress made.

“That's about it unless you fancy some artichokes.”

“No, thanks. I've never quite understood the appeal of the artichoke. There seems to be so much work to eat them for so little reward. “He joined her at the back of a short queue.

Connie Brown had son Colin by the hand and was waiting in line behind Cissie Sloan. Colin's best friend Murphy the mongrel was on a leash, sitting obediently at his feet. Colin and Donal Donnelly had trained the pup well.

On the far side of the scrubbed wooden counter, Mister Lennon, the owner, was totting up Cissie's bill, licking the end of a pencil as he did the addition on a small slip of paper. Like all workers in village specialist shops—grocers, butchers, fishmongers, bakers, greengrocers, newsagents—he wore a long, lightweight linen coat. He also had a barely controlled look of irritation on his face as he tried to tot up the bill while Cissie rambled on—and on.

“… anyroad, I says til her, says I, ‘Is that a fact?' Says she til me, ‘In soul it is. I would not of had've believed it if I had not of would've been there and seen it for myself—'”

“That's be seven shillings and ninepence ha'penny, Mrs. Sloan.” The grocer let out a sigh, and sticking the pencil behind his ear, opened the cash register with a loud
ting
.

O'Reilly watched a look close to surprise cross Cissie's face as if only now had it dawned on her that she'd be expected to pay. Then the ritual, strange to O'Reilly, began. She rummaged in her handbag like an archaeologist sifting through mounds of pot shards in a midden and muttering to herself until finally she found her change purse. “Seven and ninepence ha'penny?”

“Correct,” said Mister Lennon, his eyes behind thick-lensed spectacles raised in supplication.

“There's a two-bob bit, and another one, that's four shillings.” Methodically and ponderously she counted out coin after coin. O'Reilly chuckled. It's a good thing they weren't in a rush.

Kitty was hunkered down beside Colin, looking at his face. “Fingal? I don't think young Colin's very well. I just patted his head and he's on fire.”

“I didn't think he was at himself yesterday. He was restless and a bit drowsy, and had a wee cough and a runny nose,” Connie said. “I kept him home from school.”