An Irish Doctor in Love and at Sea (51 page)

“Ouch,” Lorna said as the needle slipped through the skin beneath the middle of the X.

O'Reilly assumed that Doctor Sproule would be putting local anaesthetic into the skin, abdominal wall, and uterine muscle, along the projected path of the sample-taking needle.

“While we're waiting for the freezing to take,” Doctor Whitfield said, “can anyone tell me what level of bilirubin in the fluid is taken as indicating the requirement for further treatment?”

The other trainee doctor, an auburn-haired young woman, said, “Walker and Jennison in 1962 used a level of nought point two mgs percent, sir.”

“Correct. Well done, Stevenson. So do we here at RMH.”

The young woman smiled and O'Reilly pulled out a pen and a small notebook from his jacket pocket and made a note of the number so he'd know in the future.

“We'll have all the results in two days,” Doctor Whitfield said, “and we'll let Doctor O'Reilly know at once, Mrs. Kearney.”

“Can you feel that, Mrs. Kearney?” Doctor Sproule asked as he gently pricked her belly where the local anaesthetic had raised a small wheal.

“No, sir.”

Sproule nodded to himself, put down the hypodermic, and lifted a long, wide-bore needle. “Here we go then,” he said, “and please do your very best to lie absolutely still.” He stabbed the needle vertically through the skin.

O'Reilly watched Lorna's face. She frowned, presumably because while she couldn't feel the sharpness of the needle's point, she would have experienced a feeling of pressure. Then, as the doctor advanced the instrument, her features relaxed.

He attached a ten cc syringe to the needle and pulled on the plunger.

O'Reilly watched in fascination as the barrel filled with an opalescent fluid.

Doctor Sproule detached the syringe, set it on the trolley, and gently withdrew the needle. A dab of collodion over the puncture was quickly covered with a gauze swab. “All done,” he said with a broad smile. “That wasn't too bad, was it?”

If it wasn't, why were there beads of sweat on his forehead? Because, O'Reilly realised, it took courage to thrust a sharp instrument blindly into a pregnant uterus. It would have been entirely possible to stab the baby, its umbilical cord, or the placenta.

“No, sir,” she said, “and thank youse all very much.”

“We're going to keep you here for a few hours,” Doctor Sproule said. “As a precaution.”

O'Reilly remembered what Barry had said about the risks of premature labour following amniocentesis.

“Then we'll send you home in the ambulance. If you're worried about anything, let Doctor O'Reilly know at once.”

“You do that, Lorna,” he said.

“We'll give him your results when they're ready, and we'd like you to come back in two weeks so we can get one more sample, and then we'll be able to let you know exactly what's going to happen.”

She nodded. “Yes, sir,” she said.

“Right,” said Doctor Whitfield. “You students can go back to the clinic, and I'm sure the registrars have work to do.” He turned to O'Reilly. “And if you'll come with me, Doctor O'Reilly? I'll explain all about spectrophotometry and prediction curves and action lines.” He headed for the door and O'Reilly followed, shaking his head in wonder at the enormous advances science was bringing to the art of obstetrics.

*   *   *

“Cup of tea, Doctor O'Reilly?” said Doctor Whitfield.

“Thank you, but no.” O'Reilly glanced quickly round the office from where he sat in a wooden armchair, taking in the overstuffed bookcase shelves, light green walls, filing cabinets, and a big desk covered in papers in front of him. The single window behind the desk where the senior lecturer sat overlooked the lawn and the redbrick main corridor of the Royal Victoria. “And thank you for taking the time to explain, Doctor Whitfield.”

“I enjoy teaching,” he said, “and it's Charley.”

O'Reilly noticed a glass-fronted cabinet in which were arranged an assortment of instruments which he recognised as having been in use back in the '30s for what were called “destructive operations.” With no blood transfusions and no antibiotics, sometimes in cases of obstructed labour it was safer for the mother for her doctor to snap the baby's collarbones or crush its head so it could be delivered vaginally. Caesarean section really had been the court of last appeal. He shuddered and said, pointing to the cabinet, “They were still using those things when I was a student.”

“Part of my museum now,” Charley Whitfield said. “Obstetrics has made great advances in thirty years.”

“I know,” said O'Reilly. “That's why I'm here. I'm trying to catch up. And it's Fingal.”

“Fair enough, Fingal. And you'd like to understand how we manage Rhesus isoimmunisation?”

“Please. I do understand it's a juggling act between leaving the baby in utero until it's mature enough to survive outside and not leaving it too long and letting the anaemia and bilirubin from the broken-down red cells threaten its life or mental capacity. We saw all those things in the '30s.”

“I think we're getting better at it,” Charley said. “Initially, all we had to go on was the level of antibodies in the bloodstream and the bilirubin level in the amniotic fluid, but recently, in 1961, a New Zealander, Doctor Liley, took things a step further.” Charley Whitfield handed O'Reilly a sheet of graph paper. “This is his prediction graph.”

O'Reilly saw that the bottom axis was marked “wavelength” and the vertical one “optical density.” A straight line ran at an angle of forty-five degrees from the bottom left-hand corner to halfway up the right margin. Above the straight line, a higher curve rose and fell from halfway up to the end.

“When we put a fluid into a spectrophotometer,” Charley said, “it will absorb or let light through, and how much it does of either depends on the wavelength of the light being used. Look at the bottom left.”

O'Reilly did.

“At a wavelength of seven hundred—”

The figure was clearly marked.

“—nearly all the light gets through, but at three hundred and fifty, look at the right margin, a lot of light is being absorbed.”

“I see that,” O'Reilly said. “So the shorter the wavelength, the harder it is for the light to get through?”

“That's right, and of course the density of the fluid affects absorption too.”

“Water might let a lot through, but milk is more opaque so it would absorb more?”

“Exactly. Now, that straight line on this graph represents the behaviour of normal amniotic fluid and, quite simply, the shorter the wavelength of the light used, the more of it is absorbed.”

“Makes sense.”

“The curve above the line is the light absorption qualities of amniotic fluid containing bilirubin.”

“So after,” O'Reilly followed the lower axis with an index finger, “five hundred and fifty, the bilirubin starts absorbing more light?”

“Correct, and Doctor Liley found he could correlate the height of the bilirubin curve above the straight line at a wavelength of four hundred and fifty with the severity of the disease and the likely outcome for the baby.”

“That's bloody amazing,” said O'Reilly.

“It gets better,” said Charley, handing O'Reilly a second sheet of graph paper. “The vertical axis is marked in units reflecting the values measured from the straight line to the top of the bilirubin curve on the Liley graph. The bottom is the weeks' duration of the pregnancy.”

“So you'll plot Lorna's result at thirty-three weeks on this chart?”

“Exactly, and plot it again at thirty-five. The graph is divided by these straight lines sloping down across it, dividing it into lower, middle, and upper zones, and the two top ones are further divided into mild/moderate, moderate/severe, and severe/gross. Depending on the trend revealed by the two measurements, we can predict the probable severity of affectation and pick a date for delivery or, and it's still pretty experimental, actually do a blood transfusion into the baby while it's still in the mother.”

O'Reilly shook his head. “Whoever comes up with these ideas?”

“The spectrophotometry and intrauterine transfusion were Liley's.” Charley Whitfield blushed, hesitated, then said, “Actually the action graph, the second one, was my notion, Fingal.”

“More power to your wheel,” O'Reilly said. “I admire you research lads.”

“We have our place, but it's the doctors like you, in the trenches day and daily, that do the work.”

O'Reilly shrugged. “My best friend at Trinity was in bacteriological research.”

“What's he doing now?”

O'Reilly sighed. “He's dead. He was in the army. Singapore.” Bob Beresford. He missed him still.

“I'm sorry to hear that,” said Charley. “Your friend will have been buried in Kranji Cemetery. It's a very moving place to visit.”

“You've been there?”

“I have. I did a spell in the army in Malta and Singapore after the war.” He smiled. “I much prefer civvy street.”

“Me too,” said O'Reilly, rising and extending a hand, which was taken and shaken. “Thank you for taking the trouble to explain about Rhesus. I'll look forward to hearing Lorna's results.”

“Young Sproule will phone you.” He began to rise.

O'Reilly said, “Don't get up. I'll see myself out.” And as O'Reilly left, the academic doctor was already riffling through a pile of papers. Not O'Reilly's cup of tea, he knew. He much preferred GP work.

He left the RMH and strolled to the car park. Quite a day. It was a great relief that Ronald was really on the mend. And watching the amniocentesis had been fascinating. O'Reilly wondered what kind of a mind thought of using a thing like optical density to predict how a baby was doing? A research worker's, that's whose. Poor old Bob Beresford had been fascinated by his work in microbiology. What discoveries might he have made? O'Reilly shook his head. The war had taken some of the very best. Sad. Very sad.

He got into the big Rover, fired up the engine, and started to head for home to see if Kinky could put dinner off until tomorrow. And then, work and cares of the day be damned, off to the Culloden Hotel and, his grin was vast, to meet Kitty.

 

42

Fretted with Golden Fire

“Not much longer to Wadi Halfa on Egypt-Sudan border.” The now-familiar, accented voice of squadron leader and pilot Ludomil “Effendi” Rayski came tinnily over Fingal's intercom earphones. He was sitting beside Rayski in the nose of the Blenheim bomber, yet, even there, the device was necessary. The constant roaring of the twin air-cooled Mercury engines made ordinary conversation impossible. His oxygen mask had a built-in microphone and smelled of rubber, but at least that stifled the other smells—of sweat and aviation fuel.

To show he understood, Fingal nodded at Rayski.

“After that, one more refuelling stop at Luxor and then to Cairo's Abu Sueir aerodrome. Nearly home for you.”

Nearly home. He wondered how long the word “home” for him would mean the flat at the Terrace in Alverstoke with Deirdre. He would not be sorry to see
Warspite
again, though. He was eager to know how Richard Wilcoxson and the SBAs were getting on, how his old friend Tom Laverty,
Warspite
's navigating officer, was.

Since he'd parted from Deirdre in Southampton Station, the last thirty-two days had been ones of constant travel and an almost persistent ache of missing her. With nothing to do on the cargo ship but sleep, eat, read, and smoke his pipe, there had been little to distract him from his thoughts. She'd be back at work now in the Women's and Children's Hospital on Templemore Avenue, missing him as he was missing her. Elizabeth Blenkinsop had posted a letter he'd written the day before he'd left Haslar telling Deirdre how much he loved her. She'd have to wait for at least a month for the ones he'd written on the ship and mailed in Takoradi where the freighter had docked a week ago and unloaded him and the crated aeroplanes.

He'd been put up in some pretty grim accommodation for two days to await the next flight ferrying aircraft from the coast to Cairo. It cut two months off the time it would have taken to go round the Cape by sea, and Richard had specified he wanted Fingal back by the quickest route once his training was complete. He'd been happy to get away from the hot, humid, smelly Gold Coast, also known as “The White Man's Grave,” so prevalent were the mosquito-borne tropical diseases of malaria, yellow fever, and blackwater fever. And he'd be delighted to leave this noisy, cramped, constantly vibrating aeroplane.

One thing about being up here, though. It certainly wasn't hot and humid. Probably about minus twenty Farenheit outside. He stared through the front Plexiglas windows of the cockpit. Ahead the empty blue sky stretched limitlessly away to where the earth's curvature was hazily visible and appeared to undulate as the aircraft was raised and lowered by the surrounding air currents. Below he could see the Nile, sunlight flashing from its surface, winding its unhurried way to the Delta. Six Hurricane fighters made up the rest of the convoy. He had to turn in his cramped seat to see three echeloned a little astern on each side of the lead bomber.

There was no radio communication between members of the convoy, so the seven planes had to stay in constant visual contact, the fighters conforming to the course of the leader. The Blenheim's flight sergeant navigator, who had the only wireless in the convoy, sat in his station ahead, stepped down from the main cockpit. He was able to get direction bearings from their next landing field on his wireless and alert his pilot about the course corrections to make to get there. From the ground, the formation must look like a mother goose leading her goslings, strange birds with their underbellies painted azure blue and their topsides in camouflage browns, the official colours of Air Chief Marshall Sir Arthur Longmore's Desert Air Force.