A Dublin Student Doctor by Patrick Taylor Page A

out. Not enough oxygen was getting to his brain because for some reason even less blood was being pumped by the damaged heart. Why? Why?
    Fingal raced down the ward, pulling out his stethoscope. Perhaps atrial fibrillation had started. It was common in patients who had had rheumatic fever. The heart’s electrical control system broke down and the muscles in the atria, the upper chambers of the heart that collected blood from the body and lungs, started working asynchronously. That meant each individual muscle fibre would contract as often as four hundred times per minute instead of the whole chamber at a rate of eighty beats per minute. That electrical chaos stimulated the ventricles irregularly and their ability to pump blood suffered.
    Screens had been closed round the bed. He pulled one aside. Sister stood at the bedside. The oxygen tent was unzipped. She was taking Mister KD’s pulse and looking at her watch.
    Fingal saw how much more dusky the man’s face had become. His lips were blue. His breathing was shallow and irregular. The great strap muscles of his neck stood rigidly every time he struggled to inhale through flared nostrils. He did not respond when Fingal spoke to him.
    “He’s fibrillating,” Sister said.
    “Thank you, Sister,” O’Reilly said. “Can I listen to his chest?”
    She opened the man’s pyjamas. Fingal clapped his stethoscope over the heart and tried to count the beats, but the great muscle was wildly out of control, contracting rapidly, irregularly, and with hardly any ability to circulate blood to the lungs and brain. He could hear no air going into the lung bases, and higher up the chest there was clear evidence of fluid. Sister was right. The fibrillation and failure were going to kill the man if they couldn’t be reversed. And quickly. Clearly the dose of digitalis was not enough. Should he be given more? Fingal remembered Doctor Micks’s measured tones. “If any symptoms of overdosage are produced, sudden death is a possibility as the late stages of digitalis poisoning may be passed through very rapidly.”
    “How much digitalis has he had, Sister?” Fingal heard the uncertainty in his tone.
    She lifted the chart. As she did, Fingal noticed that Nurse O’Hallorhan had come behind the screens. Her eyes were wide and a hand covered her mouth. If he was worried, she, as a first-year nurse, must be terrified.
    “A total of twelve ccs since he was admitted last night.” Sister’s voice was calm.
    “And it takes a whole day to get rid of about one cc, so he’ll not have metabolised much,” he said.
    Sister nodded.
    Fingal took a deep breath and looked at the man battling to breathe, listened to his wheezing gasps and the hissing of the oxygen. His eyes were open, pleading.
    Standing here doing nothing, hoping to hell Geoff Pilkington would materialise, wasn’t going to help Mister KD, but giving him more digitalis might kill him. Fingal exhaled and remembered one of Father’s adages, “Never be ashamed to ask advice from an expert.” “Sister Daly,” he said, lowering his voice so the patient couldn’t hear, “I’m very green. You must have seen hundreds of cases. Do you think more digitalis would kill him?”
    “Mister O’Reilly, I don’t know. You can never be sure—”
    You’re going to have to decide, Fingal. He could feel his own pulse hammering.
    “—but, I think for a case like this, Doctor Micks would use quinidine sulphate, particularly as this patient has had digitalis already. He’d start with two grains to see how the patient tolerated the medicine.”
    He could have kissed her. “Could you not have given it yourself?” he asked.
    “Only doctors and senior students under supervision can order medicines.”
    Fingal snorted. “That’s ridiculous. With all your experience?”
    She smiled and said, “Och, sure don’t we know it does be ridiculous—but it’s the rules, so.”
    “Can I prescribe it?”
    “Only under supervision.” She looked