An Irish Country Christmas Part 32

"Will you come with me please, Miss Moloney?" Barry turned and walked back to the surgery, a.s.suming that his patient was following. He wasn't looking forward to this consultation. When he'd first met her in August, Miss Moloney had struck him as acerbic and rude. She'd certainly terrorized her shop a.s.sistants, Helen Hewitt and Mary Dunleavy. And when he'd tried to suggest she might not be so ruthless with her girls, she had told him in no uncertain terms to mind his own business.

O'Reilly had once remarked that not all doctors and patients were perfect fits. He'd suggested that if Barry felt antipathy to anyone, it would be better for them both if he advised the customer to seek medical advice elsewhere. Perhaps he should consider that in this case. Of course, between Ballybucklebo and the Kinnegar, Miss Moloney's choices were a bit limited.

Barry wondered if Miss Moloney's acidity and Doctor Fitzpatrick's arrogance would make for a better match. Then he quickly dismissed the thought. He might not like the woman, but that was no reason to subject her to the dubious doctoring of Ronald Hercules Fitzpatrick. Like her or not, he would do his medical best for her.

"And how are you feeling today?" he asked, as he and Miss Moloney walked down the hall.

"I'm still very tired, Doctor," she said. Her voice, normally sharp and harsh, was quavery. He noticed how pale she looked. "I've no energy. I'm just not at myself at all, and I get short of breath."

He closed the door, waited for her to sit, then took O'Reilly's swivel chair. Barry was comfortable trying to fill, it, at least figuratively; he knew he'd never have the physical bulk to fill it. He turned to the desk and picked up the laboratory report that had been delivered in yesterday's post. "I have your results here."

Miss Moloney shrugged. "I suppose you'd better tell me." She was listless and seemed to be disinterested. She stared at the carpet. "I hope it's nothing serious."

Something in the tone of her voice when she said "serious" belied her apparent lack of interest. Miss Moloney was scared. Barry frowned. He'd like to be able to rea.s.sure her at once, but even though he'd scanned the laboratory values and knew his diagnosis of anaemia was correct, until he knew the underlying cause he was in no position to comfort her.

At least not if he were to be honest. But did he need to be brutally frank? He hadn't been so at her first visit. It wouldn't hurt to prolong the deception a little longer. Barry smiled at her. "You're anaemic, Miss Moloney. Thin-blooded," he said. "That's why you're not 'at yourself.' " He leant forward. "The lab report shows nothing else wrong with your blood. It's just anaemia, and that's not very serious."

"But . . . but there is something wrong . . . with my blood?" She sat hunched in the chair and would not meet his gaze.

Perhaps if he told her she didn't have one of the lethal blood diseases, it would give her more rea.s.surance. He smiled. "Yes, but it's not anything nasty like leukaemia. That also thins the blood."

"Leukaemia? Oh my heavens." This time she looked at Barry intently, and as she did her lip trembled and a tear ran down her cheek.

Good G.o.d, what had he said? Think, man. Say something. "No, no, Miss Moloney. There is no question of leukaemia. You have simple anaemia. I promise," he said, wishing he'd never mentioned the blood cancer.

Her fingers picked aimlessly at the fringe on the patterned wool shawl she wore over her grey coat. She sniffed, wiped her eyes with the back of one hand, and made an effort to sit straight. Then, hauling in a deep breath, she said quietly, "I'm sorry. I shouldn't have got so upset."

"It's all right, Miss Moloney. It really is." Barry looked as deeply as he could into her eyes. This was a very different woman from the termagant he'd met in August. He couldn't help but feel sorry for her. He lifted the report from the desk. "Would you like me to explain all of this to you, Miss Moloney?" he asked, hoping she'd say no. She was in no state to understand terms like "mean corpuscular haemoglobin concentration," "mean corpuscular volume," or "mean corpuscular diameter."

She shook her head. "I trust you, Doctor Laverty."

"Thank you." Barry felt warmed by her words.

"And," she said, "Miss Moloney's very formal. My name is Alice."

"Alice. That's a pretty name."

"Thank you," she said with a little sigh, "but apart from my sister in Millisle, n.o.body uses it anymore." She smiled at him. "I'd like you to, Doctor."

"Of course . . . Alice." And he thought if that wasn't an indication of her accepting him, he didn't know what would be. It pleased him. "Now"-he held the report so she could see-"I won't explain everything because there are all kinds of numbers here, but really only two matter. That one, the haemoglobin, is 12.2. It should be 14.8, and that one of 39 is very low too. It's called the haematocrit. It should be at least 42."

She craned forward to see. "And what do they mean?"

"They mean, Alice, that your blood is too thin because you are short of iron. Because your blood is thin, you get short of breath because the blood carries the oxygen you breathe to all of the body."

"I see," she said with a little frown. "Interesting."

Barry took her hand and held it in his palm with the back of hers facing upward. It was chill to his touch. He pointed to her spoon-shaped nails. "That's called koilonychia. It's due to iron lack too."

"I see." She took her hand away. She c.o.c.ked her head to one side. "And why would I be short of iron?"

Barry tried not to frown. This was the bit where his prevaricating about whether she was seriously ill would be put to the test. It pleased him that she was so willing to trust him. He didn't want to lose that trust. He knew he had to be honest now. He took her hand again and bent toward her. "I'm not sure." He met her gaze with his and sensed she was strong enough to deal with uncertainty.

"Oh. Could it be serious?"

Don't lie now, Barry, he told himself. "Yes, Miss Molo . . . I mean Alice . . . yes, it could, but ninety-nine times out of one hundred, it isn't."

"I see." For the second time, she took her hand away and folded it into the other in her lap. "Thank you for being honest, Doctor Laverty. Not every doctor would have been. I know that." Her lip trembled again.

He congratulated himself for judging her correctly. Some physician has hurt her, Barry thought, wondering if she too could be one of Fitzpatrick's victims.

She sat stiffly. "I suppose you do know how to find out what's wrong?"

"Of course."

She pursed her lips. "Then let's get on with it."

"All right. It's not hard. I need to ask you a few questions, examine you today, and perhaps arrange an X-ray."

"What kind of questions?"

Barry put the form back on the desk. "You can be short of iron either because you're not eating enough of it or you're losing blood. My job is to find out which one it is."

Her mouth opened in a silent "o." She frowned, then nodded as if agreeing with herself. "I see. Ask away then."

"Doctor O'Reilly told me he'd treated you for piles once." Barry was pleased he had remembered that detail.

"About three years ago. Nasty things." She curled her lip. "Itchy, very itchy, but Doctor O'Reilly gave me ointment and laxatives, and I've had no trouble since."

"Good." It sounded as if she had been afflicted with external haemorrhoids. Their apparent cure did not exclude the possibility of varicosity of the rectal vessels inside. He'd have a good look when he examined her. "You told me last time you were here that you are fifty-one."

"Yes. I'll be fifty-two in January."

She might not be menopausal yet, might be having heavy periods. Barry was about to ask, but a tiny alarm was telling him to wait, to ask first about matters that would not embarra.s.s her. Older countrywomen, he had learned, could be reticent about discussing "female" symptoms. "Do you like your grub?" She certainly was a skinny woman.

"I like it well enough. I've three square a day, but small portions. I'm not a big eater. I live on my own-well, me and my cat and budgerigar-so I've no one to cook for." Barry could hear the resignation in her voice. Perhaps her loneliness explained why she had been so vicious with her staff of pretty, marriageable young girls. "Seeing it's just me, I can eat what I please," she continued. "I don't like eggs or green vegetables," she said. "I don't eat red meat, but I like fish and chicken."

"I see." So, Barry thought, she didn't eat enough of the three main dietary sources of iron, and what she did eat most likely provided insufficient iron. "And how long have you been using that diet?"

"Since I was a very young woman . . . in India."

"India? I didn't know you'd been there." Miss Alice Moloney, owner of a tiny dress shop in Ballybucklebo, had been to India?

"Oh, yes," she said. "Daddy took the whole family there in nineteen thirty-two. I was ninteen."

This was intriguing. "And what did your father do there?"

"He was with the Indian civil service. In Calcutta. They kept him on after independence in nineteen forty-seven." Her lips trembled again. "My sister and I had been born in Ballybucklebo, and she and I came back to Ireland after . . ."-her hand shook-". . . after he was killed in the Hindu Moslem riots in nineteen forty-eight."

Ulster is not the only place to be racked by religious strife, Barry thought.

She pursed her lips and forced a weak smile. "But it was a wonderful place for a girl to live. We had a huge bungalow, ponies, dances with the handsome young white subalterns in the Indian army . . ."

Barry for a moment wondered why she hadn't married one. Perhaps she had been in love, but her young lieutenant had been posted far away and they had drifted. It could happen. He gritted his teeth; he should know.

She was still reminiscing. "We had summers in the hills, servants galore . . ."

Which might account for the way she had treated Helen and Mary.

She looked away into the middle distance, and Barry wondered if she was seeing the Mandan or scenting the mudflats of the Hugli River. As a boy he'd loved the works of Rudyard Kipling.

"I loved India. Have you ever seen an elephant?"

"Well, yes, there was one called Sarah in the Dublin Zoo in Phoenix Park. And I've seen them at the circus."

She snorted. "Poor creatures. I meant a ceremonial animal splendidly caparisoned, with a howdah on its back and a mahout-that's the driver-sitting just behind its head."

"I'm afraid not. I've not been very far from Ireland." Not even as far as Cambridge.

"You must travel, young man. Find out about other peoples. I thought the Hindus were fascinating." She giggled. "You'll probably think it's silly, but I even learned a bit of yoga. I used to be able to sit in the lotus position."

"I don't see anything silly about it."

"Thank you. There's a lot the East could teach the West. I've read a lot of Vedic philosophy in their texts, the Upanishads . . ."

Barry was embarra.s.sed, not by her confession, but by how badly, after two very short encounters, he had misjudged Alice Moloney.

"And I found the idea of not eating meat very appealing. Even to this day I can't eat beef. Cows are sacred in India, you know. As I said, I'm not a big fan of green vegetables, but I do eat carrots and parsnips."

"I see." It was almost certainly the answer. How interesting, India. Vegetarianism. It certainly added up. Barry was tempted to call a halt there and then, but to do so would be to neglect his responsibility to her.

She could be losing blood either from heavy periods or, more ominously, from one of a number of disorders of the stomach and bowel-disorders that included cancer. He ploughed on. "Have you been having an upset tummy? Pain when you eat or after you eat? Have you thrown up any blood?" All symptoms of gastritis or an ulcer in the stomach or duodenum.

"No." She shook her head. "Nothing like that."

"Have you noticed any pain in your lower belly, change in your bowel habits, diarrhea, any black motions, any red blood?" Black stools, called melaena, were a sign of stomach or bowel bleeding high in the system. Red blood would come from lower. Piles, diverticulitis, ulcerative colitis, Crohn's disease, benign polyps, and more worryingly, cancer of the bowel could all produce those symptoms.

"I've no pains, and I don't think there's anything wrong with my motions. Mind you, I don't look very often."

"Not many people do, but I have to ask." Her answers still didn't rule out a condition that was painless, like an early cancer.

"I understand, Doctor. What else do you want to know?"

Barry swallowed, coughed, and then asked, "What about your periods?"

She shrugged. "They were never heavy, if that's what you mean. They stopped about three years ago . . . good riddance to bad rubbish, if you ask me." She leant forward and put a hand on Barry's knee. "Now I have the hot flushes."

Barry did not want to complicate matters at this visit, so he made a mental note to have a chat with her about using small doses of ethinyl oestradiol to control her flushes. At the moment, however, her anaemia took priority. He looked straight at her and said, "If you've had no trouble with your periods, and they're not coming anymore, we can't blame them for you losing blood. That leaves only two possible causes for your iron deficiency."

"And what are they?"

"My best guess is that you're not eating the right things."

"I suppose."

He didn't want to worry her, yet he didn't like to be dishonest. "You could have something in your bowel."

She looked him straight in the eye. "Like cancer?"

It was something in her voice that made him ask, "You really do worry about cancer, don't you, Alice?"

"I should. I have good reason to."

Barry waited. She'd tell him if she wanted to.

"The word is that you're in love, Doctor."

He wanted to deny it, but he could already feel the heat in his face. And this interview seemed to be all about telling the truth. "I am." b.l.o.o.d.y rumour mill. He loved Ballybucklebo, but there were some disadvantages to living here.

"I was once." The same dreamy look she'd had when she spoke of India flitted across her face. "He was a captain with Skinner's Horse. It was a famous cavalry regiment." The look faded, and her eyes glinted as she said, "His doctors lied to him."

"I'm sorry."

"They did. They told us he'd get better." She took a very deep breath. "He died."

"I am truly sorry, Alice." What a trite thing to say.

"Do you know what he died of?"

Barry shook his head.

"Leukaemia."

"My G.o.d." No wonder she'd reacted the way she had done. And no wonder she was concerned about cancer. Thank the Lord he'd been honest, and he would be honest again right now.

"Alice, I can't tell you that you don't have cancer. Not until all the tests are done, and for starters I'll need to examine you, feel your tummy for lumps, and do a rectal examination."

She curled her lip. "I hate those, but I suppose it's necessary."

"I'm afraid it is."

She rose, left her shawl and coat on the chair, and headed for the screened examining table. "We'd better get it over with."

Barry examined her abdominally and rectally without finding anything. By the time he had stripped off his rubber glove, washed his hands, and written a prescription for ferrous sulphate, Alice Moloney was already dressed and standing by the chair. Barry also stood.

"Well, Doctor Laverty?"