Dr Garrett FitzGerald

Dr Garrett FitzGerald recalls one particular medical colleague whose prodigious memory allowed him to soak up information and take an unconventional route through the education system.

I used to meet my colleague at European congresses in various cities. He rarely went into the live sessions. “Tried it a few times to no avail, so I gave it up,” he said.

We went way back. We attended the same second-level school and college. He graduated in medicine with flying colours. Our latest meeting took place at our umpteenth international conference in Barcelona. He was wandering around the commercial exhibition, going from stand to stand, gathering complementary printouts from prestigious journals, inspecting the latest scanners and gizmos, sometimes sitting and reading, now and again interrogating a guy who was selling stuff.

I recalled him in his early years as giddy and sort of feckless, a restless Jack-in-the box, all transmit and no receive. A nice guy, but with a tendency to blurt out the wrong thing at the wrong time.

“I have no idea why I would say some of those things. People were really turned off. I’m a bit better now but it can still happen. Then I’ll spend weeks regretting it. The truth is that a lot of people regard me as a person without the gravitas appropriate to my station.” He laughed at this.

We relaxed with a coffee, watching with amusement as ‘delegates’ bagged whatever freebies were in the offing; we saw an anxious woman who had acquired five umbrellas which unapologetically advertised metered-dose-inhalers. I encouraged my man a little further and he responded.

“Do you know that I never lasted more than five minutes in a lecture hall?” he asked. “And I’d always have to stay to the end. There were four hours of lectures every afternoon and I never learned anything from even one. That was every weekday for years. All the guy would have to do is talk for two minutes and I would fade away, no matter how I tried not to. In the early years at college, attendance was compulsory. In the later years, I never attended a single one. I’m living proof that these lectures aren’t necessary at all. For me, they were soul destroying.”

Kindly clerics
In school, he was always in trouble — never paying the slightest attention, often interrupting, always fidgety. The kindly clerics with long dresses knew how to cure him; they beat the hell out of him day-in, day-out, and they came to despise him. The feeling became irreversibly mutual in no time.

He was taken aside regularly for a dressing down. His school reports spoke of a boy of bad behaviour and low character without redeeming features. His father wondered about it all because the academic part of the reports always showed high marks in every subject, top 5 per cent persistently. The teachers suspected cheating of the first water, which plunged his perceived ‘character’ to an even more infernal nadir.

“For many decades,” he continued, “I believed it myself. I just knew that I wasn’t the full package. Yet I was greatly interested in the subjects to which I just couldn’t pay attention. But, I also knew that I had something the other lads didn’t have; I could concentrate greatly on the written word and learn the whole shagging lot in a very short time. In medical school, I could study effectively for 10 or 11 hours a day for weeks on end. So, I had no problem at all with examinations; pissed up, never failed even one. Sometimes, the examining lecturer would have never seen me before. And, I had a prodigious memory, particularly for clinical detail.”

Holmes, I presume
I knew that he had always been very sharp at the job. He could zone in on the patient’s problem and dissect its constituents a la Sherlock Holmes.

“In a one-to-one situation, I could concentrate deeply and think, evaluate and conclude almost effortlessly. As a more senior medical student, I haunted the hospital corridors at night. I loved it. Next morning there would be a teaching session in the lecture hall in the hospital, maybe even on a patient I had seen the previous evening, and I’d be awol before the guy had finished saying bonjour. When at all possible, I dropped those sessions as a total waste of time.”

That conversation took place in 1989. I remember that he wondered aloud if they would ever discover the illness he had suffered from. It hadn’t gone away, you know, but it had eased slightly over the years. He kept on trying.

“Yesterday, I went to what they call a ‘Plenary Session’ on hypersensitivity pneumonitis, given by the main man brought over from the States. There were fifteen-hundred doctors in the hall. After three minutes, that had dropped to fourteen hundred and ninety-nine. I came out here and picked up a load of reprints on the subject and had it all pat before the lecture was half-way through.

“I hope the schools nowadays are convinced that beating the bejaysus out of fellas like me is therapeutically sub-optimal. Maybe they don’t still regard my kind of student as belonging to the untermenschen. If I met some of those guys in the street, I’d feel justified if there were a few shots fired!”

I assured him, over-genuinely, that someday, someone would name his syndrome. I headed off.

He called after me, in volume enough for the world and his mother to hear: “Are you still beating the wife, you hoor?”

‘Man with no musical training amazes concert-goers’

Dr Garrett FitzGerald recalls being asked for the unusual medical advice of how best to become a world-renowned pianist with Acquired Savant Syndrome.

Dr Garrett FitzGerald

It is a well-known fact that there are two distinct classes of persons; the feckless — a majority — and those who have a plan. Persons of the latter subspecies generally keep their heads down and are not easily identifiable in the street, particularly from the side-view. They rarely divulge details of what they are about. They seem to think along Zen lines: ‘Those who know do not say and those who say do not know.’

Do nothing

Those who have a plan can be further subdivided into those who have a plan and do nothing about it, such as governments, and those who have a plan and stick to it. The stickers rule the world. Whether the plan is a good one or not is beside the point, so long as there is a plan. The best laid plans of mice and men often gang awry.

Only if you are a good history-taker will you have a chance of elucidating their innermost secrets. In the days when pre-scan clinical time was allotted to history-taking and physical examination — anybody remember those? — a doctor could get a privileged glimpse into the workings of the well-planned mind. One recalled occasion beats Banagher.

“I am on the lookout for a grand piano, doc,” the man said during an exhaustive review-of-systems, taking his cue from a question about visual acuity. I almost swept on to syncope and tinnitus but something in his gaze held me. “For?”, I asked. “And a swimming pool with a shallow end no deeper than two-foot five-inches. You see,” he added by way of elucidation, “I took lessons with a Ms O’Brien when I was a youngfella, but I didn’t pay her any heed at all. I’ve always regretted it.”

Here he wept silently, nasal stuff flowing down onto the table. Fortunately, the next patient hadn’t arrived or my man would have been shown a radiology card there and then.

Plan B

By now I had noted the shortest route to the door and slipped my feet onto the starting blocks under my chair. I was on the point of implementing Plan B when he reached for the arse pocket, sliding from it and placing in front of me a cutting from a magazine. He arranged it the way one would present, in the Egyptian hinterlands, a crumbly papyrus of the hitherto-unknown Gospel of the Magdalena. The photograph showed a man playing a piano, one eye on the conductor. In the background was a full house in a huge auditorium. The heading read: ‘Man with no musical training amazes concert-goers.’

There are occasions when one realises with great certainty that it is not one’s turn to speak. Rather, a silent raising of a maximum of one eyebrow should be the order of the day. Sudden moves could be fatally misinterpreted. Unless one is on a train — and an Archbishop — where one could pull the excommunication cord, if tactically positioned beside it, stillness gives the best chance.

My man wiped himself slowly. “I’m fed up with all this recession and business going down the tubes,” he said. “I had to find a way out. I think I’ve found it at last.” Enthusiasm of gaze, if not outright mania, was switched on and shone on the world.

The right note

Derek Amato, the man in the magazine, had fallen into the shallow end of a swimming pool, suffering a blow to the head. On recovering full consciousness, he could see geometric patterns of black-and-white musical notes which easily transferred to his fingers and onto the ivories. Within a short period of time, the 35-year-old from Denver felt compelled to sit at a piano. Here he could play like an old pro, despite never having met a piano in his past life. Within a short time he could play eight different musical instruments. Since, he has released a couple of albums in which he plays his own compositions.

He attended  a ‘savantism expert’ at the Mayo Clinic, who recognised his case as that of the Acquired Savant Syndrome. My man wanted the same; he had even contacted the American to learn what part of the head had been impacted in the accident and had shaved the corresponding spot on his own left parietal area.

“Doc, I’ve a bit of a problem with my plan. I have the price of the piano, but I don’t think I can rise to the pool — and anyway, I’d need planning permission which could take years, seeing as I live in a second floor apartment in the middle of the town.

“What would you advise yourself, doc?”

Unfortunately, Waterford’s savantism expert was on holidays that week and the neighbouring one had been admitted to his own unit about two years previously — said to be ‘doing well’.

The savant side of the brain was called for. Engaged in low gear, it came up with the solution in no time. In the exhaustive history-taking exercise, it had emerged that my man — 74-years old — disported himself at the playing of junior hurling in South Tipp. The very next week, he was to line out against the Swan.

The inspired advice was that he should just continue hurling but without a helmet.

With big ‘hits’ and shuddering tackles ever on the increase, Dr Garrett FitzGerald believes it might be time for the governing bodies of rugby to think anew in order to protect its players.

There is something elemental about rugby. In Thomond Park, home of the Brave and the Faithful, one never comes away with the impression that the home team are ‘minding’ themselves. In the Heineken Cup games, nothing of mind or body is left on the field. Usually, no more than one or two players — preferably from the visiting team — have to leave the field with injuries sustained/inflicted.

Since rugby became a professional sport in 1995, injuries of all degrees of severity have doubled. The most feared is spinal damage and resulting paralysis, once the exclusive domain of front-row forwards in the scrum, but now just as likely to happen as the result of the tackle. In the UK  each year, there are 1,200 instances of all-cause spinal injury with paralysis going to spinal injury units; 11 per cent of these from sport, 4.5 per cent from rugby.

There are 40,000 people in the UK living with paralysis. Translating these figures crudely to Ireland, there would be approximately 10 new cases of spinal injury with paralysis — 2.4 from rugby; 2,700 persons living with paralysis, 310 from sport, 65 from rugby injuries. The caveat in such translation would be the higher prevalence of rugby players in the UK. I have been unable to find figures from Ireland. Perhaps a reader could enlighten me?

A survey in the 2006/2007 season on a single weekend found that 33 per cent of all professional English Premiership players were currently ‘out’ with injury; an astonishing rate of attrition.

Strength in depth is extremely important for success. This playing season, Leinster were for months without Seán O’Brien, Brian O’Driscoll, and Rob Kearney — three players of world stature — through serious injury. Munster recently lost David Wallace, Jerry Flannery and Denis Leamy permanently, Paul O’Connell hasn’t had more than a handful of games in the past year, and Felix Jones, Keith Earls and Conor Murray are in and out. Stephen Ferris of Ulster has been unable to play for several months. One could make up the bones of a good Lions XV from these guys alone.

Reasons for the increase would include overtraining, higher intensity of play and the fact that the ball is ‘in play’ for longer periods than formerly.

It is obvious to watchers that there has been a very notable increase in the size and bulk of players. There are wingers and centres over six feet five inches and 16 stones in weight. Centre play has evolved to the use of at least one who is there for his battering-ram capability.

The number of big ‘hits’ and shuddering tackles seems to increase every year. The combination of augmented defence play, hits and player size can only mean that injuries will continue to increase. Recent research has pointed to a total number of sub-concussive head impacts being at least as important in the genesis of long-term brain injury as less frequent obviously concussive hits.

In summary, more play, more games, more hits and bigger players bring about a worrying situation. We can look forward to the situation deteriorating further.

Watching a fiercely contested pool game in the Heineken Cup always makes me fret somewhat for the long-term health of greats like the marvellous ‘Drico’. It is incumbent on the medical people to keep a very close watching brief on these developments. The fans just love the gladiatorial  aspect of the game, so appeals to make changes to reduce the physicality of the sport will not come from them.

With the present astonishing state of fitness amongst the professional players, rugby may be going the way of golf; the new equipment and stronger players, most of whom now drive the ball 320 yards and use 8 irons for 180 yard ‘pitches’, have all but destroyed many of the legendary courses of times past. The courses are too short for the modern player; now most of the par-4s are a three iron and lob wedge, and many have driveable greens. Jack Nicklaus has long advocated changing the golf ball to shorten the distance it can travel.

Perhaps, in professional rugby, the pitch is now too small for supremely fit athletes who have the energy to partake continuously in arrayed defences which are most difficult to break down. There are only two options to produce a more free-flowing rugby where line breaks are not a rare exception; enlarge the pitch or reduce the number of players. It is unlikely that the field at Lansdowne will be allowed to extend to Sandymount beach or Thomond take over King John’s Castle, so one is left with the option of, perhaps, a thirteen- or fourteen-man game.

In such scenarios, there would be less need for bulk amongst the backs. Centres with the ability to send opponents the wrong way rather than crash into them would make a welcome return. Injuries may then lessen in the short-term.

We have no idea what may be ‘coming down the tracks’ in long-term injury-induced disabilities and ‘wear-and-tear’ disorders of the musculo-skeletal system. Most important of all, we don’t know what, if any, brain function sequelae will result from this era of the big men and the big hits.

Dr Garrett FitzGerald

Government plans to unilaterally downgrade regional hospitals are fatally flawed and will compromise local health services, illustrates Dr Garrett FitzGerald.

‘Save our Hospital’ campaigns are usually good indicators that ‘our hospital’ will not be ‘saved. The most organised and vocal groups of recent years were in favour of Monaghan, Ennis and Roscommon hospitals.

Navan is the current one to watch, for those who pay heed to these things. The result is always the same — closure/downgrading. The local TDs join in the protests but are helpless, particularly if they belong to the party which is pushing the agenda.

Crystal clear

Statistics are given by the hospital’s supporters whereby it becomes crystal clear that patients will die in ambulances on the way to the nearest not-yet-downgraded hospital.

All protest falls on deaf ears. Once the suggestion emerges that the local hospital is being considered for ‘rationalisation’, the writing is on the wall. The only question remaining is the date.

Master plan

Since the late 1980s, governments and departments have learned that they can do anything they wish to — except take medical cards from the over-70s. Even in that instance, they hadn’t the balls to hold the course; they would have succeeded.

I hadn’t realised what the master plan is until now. There is to be one hospital only in the great Republic. I hope they have selected the St James’s site to allow for all treatments from cradle to grave in a co-located way.

For the first time, there is a regional hospital on the chopping block. A group of incredibly expert experts, led by an expert obstetrician from Cork, is set to report to Minister James Reilly that Waterford Regional Hospital is to be granted hind-tit status to the Cork set-up.

Clonmel is to change its hind-tit feed from Waterford to Cork. Wexford and Kilkenny are to become sources of nourishment for a couple of Dublin hospitals.

The Wexford feedback suggests that they are not too pleased down by Slaneyside. Kilkenny is divided on the issue. Some people there have always had a ‘thing’ about Waterford — the ABW syndrome.

New notion

This latest move will establish the new notion that an area of near a half-million people no longer requires a regional hospital. Farewell Limerick and Drogheda — get your campaigns going. On second thoughts, should you bother? These campaigns don’t work. The campaigns tend to concentrate on two factors; job losses and deaths-on-the road to God-knows-where.

For instance, the regional hospital is by far the biggest single employer in the whole of the South-Eastern region, but decisions about rationalisation of hospitals are not made on the grounds of hospitals being employment agencies.

The deaths-on-the-road argument has spectacularly failed in every one of the past instances.

My experience in dealings with the Department tell me that any talk of death is shrugged off as ‘shroud-waving’ and cuts no ice at all in Hawkins House. The motto over the hall door should read: Death, where is thy sting?

Take your pick, but leave St James’s alone

A fatalistic feeling

Nonetheless, there will be a major mobilisation of opinion in Waterford, if not in the other parts of the region. Mass meetings will be held. Over all of the best efforts will be a fatalistic feeling of the inevitability of failure.

Democracy has yet to catch on in Ireland. People will then have to adapt to any new situation which is cast down from on high. To hell or to Cork.

If there is another lesson to be learned, it is that Dublin calls all the shots. Logic doesn’t come into it. The South East does not require a regional hospital for its half-million people and Dublin requires no less than six of them for a population less than three times that. Were logic — and fairness — to be applied, then Dublin would require, at most, two super-regional hospitals; not one for every 230,000 people. I would respectfully — and logically — suggest that three should go at the same time as Waterford.

Take your pick, but leave St James’s alone. Round 1 might see the downgrading of Blanchardstown and St Vincent’s. Next round, as Limerick bows to Galway, drop the Mater and Tallaght.

As Drogheda bites the dust, farewell Beaumont. Rationalisation gets there in the end; only James’s will stand as the great world-class basilica.

The eyes of Ireland should then descend on Cork and Galway. If you set your cruise control at 134km/hour on the motorways, you can be in James’s inside of two hours from Cork or Galway.

So why in blazes do they need fancy hospitals in these backward places? It takes much longer to get from the peripheries of most other downgraded counties to the nearest hind-tit outfit.

It is worth mentioning the way the Machiavellian minds of our governors work in relation to pre-downgrading. Waterford has seen the arrival of a coronary angiographic suite in the past few years.

Here you can have a quick angio followed by immediate stenting. It is important for the locals to know that only two cardiologists carry the load, so that there is a very limited service. Out-of-hours/weekend stuff hit the high road to Dublin.

When the talk of long-planned downgrading comes up, the governors will use, by way of persuasion, the argument that there will be a 24/7 availability of stenting for South-Easterners in Cork; ergo, yez are much better off. I would have erroneously read this message to mean that, instead of a part-time stent service in Waterford, yez’ll now have none at all.

I should be downgraded.

Dr Garrett FitzGerald

Recalling his own 81-hour weekend shifts, Dr Garrett FitzGerald says news of NCHDs dying by suicide must compel the Minister for Health to address their working conditions.

I confess here and now that I am somewhat mad. I am extremely fortunate to share this state of being with most people I know. Please write in to our Editor if you claim 100 per cent sanity and he, with help from his 20-to-80 per cent sane medical columnists, will have you declared quite mad.

We’re not talking sectioning here, mind. Just 20 points or so up or down on the percentile chart would cover most of us. Even allowing for an upbringing dominated by an extreme degree of communal piety, an education delivered by male celibates wearing frocks, and a dubious collection of genes, I can say without doubt that some of my adventures as a junior doctor accelerated my progression into the ranks of the mad monks.

The interview board in a Dublin hospital for my first SHO job were all set for Poker. One very benign gentleman asked if I would be willing to work one night and one weekend in three. Having made such inroads with my assenting yessir, a more ascetic fellow pushed home the advantage by asking whether I would work two out of three, butter unmelting in the mouth.

As the alternative was to emigrate instantly, what choice did they give me? We’re talking an easy week of only 91 hours followed by two less easy weeks of 133 hours each.

Disorder of the urine

An easy week was 91 hours — ‘less easy’ weeks were 133 hours

A substantial percentage of our patients were diabetic. In those days, diabetes was predominantly a disorder of the urine. Blood glucose levels at night or weekend by technicians was out of the question; one could be called up before the Lord High Nun who always had a perfect unbeaten record; she had the advantage of having an invisible bird perched on a shoulder — all the while whispering seven gifts into her ear.

Even the consultant would have a mandatory session with her to receive second-hand these infallible though inaudible promptings. It would be explained to each medic that, however exalted one’s station in medical life, the hospital would endure without our assistance.

So, in a situation where a blood level was critical, we could betake ourselves to the biochemistry laboratory and set up the ingredients for the Folin and Wu method of blood glucose estimation. Pipettes and an alarm clock played a big part in the manufacture of the analytical pancake. I never managed the ‘Eight minutes in a boiling bath’ bit to the degree of perfection required. My first few attempts resulted in levels not before nor since described in any mammal, always incompatible with life.

As the donors were still living at the time, I blamed the clock rather than make a pronouncement of laboratory death. My later attempts were not attempted.

Outpatients began at 8.30am on Monday and Wednesday, 2pm on Friday. Four-and-a-half hours was standard. Consultant ward rounds were at 8.30 on Tuesdays, Thursdays and Fridays and a ‘consolidation’ ward round was held (the Registrar and me) on every day of the week. We varied between 50 and 60 inpatient beds. ‘Last urine’ rounds were commenced at 12.30 midnight. This required attention to every diabetic in every ward in the hospital. The morning’s insulin could not be prescribed until the final midnight void had been tested.

81-hour shifts

I often waited until 2 or 3am for the golden liquid to be excreted. Had I prescribed without waiting for it, I could pack my bag for Manorhamilton or Saskatoon. The weekend ‘on’ shift was from 8am Friday to 5pm Monday — 81 hours. Fortunately, this only happened 35 weekends in a year.

Meantime, Mrs Columnist was advancing into the later stages of almost-parthenogenesis. She resided (rarely, we resided) in a flat over a butcher’s shop in Dorset Street. We had a span old car, which had to be parked on a hill with a brick anterolateral to the dextrorotated front wheel. She boasted betimes that she was married to a monk; a great novelty in those days. I asked her to be diplomatic about it, seeing as Archbishop John Charles McQuaid lived around the corner on Clonliffe Road.

My next job had a one-in-four rota. I felt guilty all the time. I was the portrayed civil servant or a dosser. The transition was nearly too much. I got to know my eldest son’s name and would swear I’d nearly have recognised him in the street. In truth, I never got back to the state of near-full shillingness. At best, I have occasionally scaled to the heights of 17 and sixpence in the mental pound (82 cent/euro).

Exploitation

The hours may not be as gross as they were, but the intensity of the on-call work has trebled in the meantime for today’s young doctors. They are on a hiding to nothing. They too are being exploited and are well on the way to becoming seriously damaged goods. Suicide was not so much an option in my time because of religious brain-washing. Later, Hell or high water, it became a serious alternative for me as I burned out and sank deeply to a multi-factorial depressive-illness nadir.

Some of my close colleagues, even in those days, did away with themselves. I am grateful now that I did not join them.

Young doctors are dying by suicide, working conditions a major precipitating factor. It is an outrage that this is tolerated. End it now, Dr Reilly.

Dr Garrett FitzGerald

Dr Garrett FitzGerald has some practical advice for those destined for Heaven and a humanist steer for those a little bit less certain of their final destination.

It’s been 40 years since the subject of Heaven came up in conversation. Even allowing for the apostasy of droves of the pious community and the abandonment of the little people, one would expect that the raison d’être of the Western world over two millennia would get some mention.

Most of us were taught — nay, mass coerced — into the belief that our short sojourn on this doomed planet was but a trial before achieving the real goal of our existence; long, long, long year after year in Paradise amongst the angels and saints, laughing and gambolling and harping and cavorting away, gleeful at the sight of the bad guys sizzling down below — more joyous altogether if you could pick out a fella who did you a bad turn during your first life.

We would remain for eternity in the presence of the most merciful creator/evolutionist or burn forever and ever and ever. The idea filled Grangegorman in my time, no bother.

In those days, Ireland was heavily under the influence of the mickey-god. It seemed essential that the then-occupants of beforeland and afterland were keen to outlaw pleasure down below. Having made women terribly good looking and men terribly randy, they seemed to regret having created the gonadal system which still prevails — according to all reports.

In many parts of the world, the creator is saved the bother of much policing in this domain as many of the undesirables are eaten, stoned, burned, shunned, hanged, castrated and whatever you’re havin’ yourself by the lads who will get to heaven for their good works. Another plus for Grangegorman’s trade.

Many bright and wonderful people have devoted their whole lives and being to the certainty of Heaven. Once upon a time, our schools and churches and hospitals were monuments to the sacrifices of pious and good people who were hell-bent on getting the eternal reward. It is the same in the Jewish and Muslim traditions; variations of the same theme. Similarly, almost every religion on earth has the afterlife carrot dangling in front of our ass-noses and, of course, the big stick of punishment at the other end.

So, why doesn’t anybody ever mention Heaven? Not once have I heard it discussed on the Six-one News or Tonight with Vincent Browne. I hear they never talk about it in sermons on Sundays. Teachers avoid the subject in primary schools. Their eight-year-old pupils have already fallen down with uncontrollable laughter at the ideas of parthenogenesis, angels, resurrection, ascension into Heaven and so on. Who’s going to try Heaven/Hell in that atmosphere? Two chances.

As a firm believer in evidence-based religion, I remain stunned by the conviction abroad that life is based on the punishment/reward coin, especially amongst a population which never brings up the subject in conversation.

Some of these righteous folk would have me executed for using reason, obviously another mistaken creation by the evolutionist-in-charge. Perhaps, one might be certain of a clear path into the celestial wonderland had one been born sans gonad or cerebral cortex.

For heavenites, the wait is a long one. Look at poor old Tutankhamun. His bodily parts are still with us 3,336 years after his demise. If I were him, provided the righteous people have it spot-on, he should hope that the planet lasts a good while yet; the odds of getting up there are against him big time — he married his sister and pre-dated being saved. Probably wasn’t even baptised right.

The reason-people have come up with the irreligious notion that the earth will die out when the sun dies out, likely to happen in the year 5,400,000,013. Then, the era of afterlife begins in earnest. The gurus have it that body and soul will be reunited then.

Meantime, if the soul makes its journey to Heaven ahead of the body, say 5.4 billion years ahead, what the hell use will be the 70 virgins to a martyr who has nothing to dangle?

Sola fide doctrine
If one needs to believe that there is a Heaven, one should go no further than the Protestants’ sola fide doctrine/guess. In this, you can hurl away at any class of divilment down here, but so long as you have the faith you’ll get there for a finish. One could then realistically hope to dine up there with the likes of Reinhardt Heydrich, Saddam Hussein or Nurse Cadden.

No problem getting a table, although an average wait of 80 millennia would probably not be unusual.

For those who are convinced of an afterlife where body and soul have the big reunion, it is worth thinking in advance about the whereabouts of tissue specimens, which have been removed during one’s lifetime. Heaven without one’s appendix would be unthinkable.

Keep a note of the location of your amputated parts and biopsy specimens taken, just in case the gathering is less than efficient the week the sun becomes unstable. I don’t really know what happens to bits et be sharks, so cannot advise further in the matter.

For me, Noel Purcell sang it as it is:
‘Wouldn’t it be Heaven
To have coffee at eleven
And a stroll
Through Stephen’s Green.
There’s no need to hurry
There’s no need to worry,
You’re a king
And the lady is a queen.
Grafton Street’s a wonderland,
There’s magic in the air,
Diamonds in the lady’s eyes
And gold dust in her hair.
And if you don’t believe me
Come and meet me there
In Dublin on a sunny Summer’s morning.’

Decidedly evidence-based.

Dr Garrett FitzGerald

Another verse of Doris Day’s famous Black Hills of Dakota definitely made Dr Garrett FitzGerald experience a lonesome feelin’ that he had found himself at a patient’s bedside miles away from home.

The fares for the daughters from Australia (plane) and Killarney (bus, pony-and-trap) were pre-paid, as were the wicker casket for his earthly remains, the cremation in Cork, the music to be played as the flames rise higher, the reading of the will, the power of attorney (a Mr Power), the scattering of his ashes on a windy day at the foot of Slievenamon out of a Ming-dynasty Chinese vase from Woodies DIY, and a ‘last word’ epistle to his estranged missus, “God blasht her to Hell!”

Although I was the one who referred him on for surgery, he was not sure if I would be interested to hear about the consequences of my action. He was going to tell me anyway.

It became clear that he didn’t rate his survival chances following his upcoming dissection. His family out to the third cousinship, many of them blessed by degrees of remove, and everyone else in his district knew that he was to ‘go under the knife’. Battalions of Trappists and a megabit of monsignors were already prophylactically employed at the chanting of plainsong, the telling of 15-decade rosaries and many missae solemnis, all by direct debit. In my role of Chief Consolatory Healthcare Provider (CCHP), I offered no comment on the apparent paradox of such a degree of fourth-world insurance in a man with vigorously expressed atheistic convictions.

“I learnt all that stuff with the Brothers when I was a youngfella, doc. But now I know that ‘twas all only a bit of auld gammon. They never could explain to me why it is that I have a pair of tits and a set of muscles down below for wagging a tail I don’t even fecking have! As a scientific man, you probably wonder about that yourself.”

The time to reveal to him that the surgeon in question did not aspire to the lofty heights of a near-100 per cent intra-operative or even peri-operative mortality rate had definitely arrived. However, for the moment, I was unable to interject; it would have been poor medical form to interrupt the strains of The Black Hills of Dakota, which he had taken to eluting quietly though nasally in the intervals between recitations of doomsday arrangements.

Doris Day and Howard Keel in Calamity Jane, 1953 Pic: Courtesy Everett Collection/Rex Features

The lyrics bored

“I’m definitely going to have them play that at the cremation. ‘Twas always my favourite song. Anyone at all knows me would tell you that I could always be counted on to render it at weddings or parties. Jaysus, doc, they don’t make songs like that anymore. Where would you hear music and lyrics the like of it?”

I kept the eyebrows in the neutral position midway between the extremes of descent and ascent, a trick learnt long ago in the Glen of Aherlow.

“Lost my heart in the Black Hills, the Black Hills of Dakota, where the pines are so high that they kiss the sky above. Ha!? Do you know Kitty of Coleraine, doc? I’ll have to have it as well. My mother always sang it after she’d get outside a few small bottles, God rest her.” Dicky Dawkins would surely have been confused at this latter ejaculation in a man who hadn’t darkened church nor meeting with 40 years. “Do you know what daddy’s favourite was? After a few, he was always good for The Cremation of Sam McGee. I don’t know how many verses was in it, but he had ‘em all. A right good time to have it read out, I’d say! Hahahahaha.”

Surgical intervention

I signalled by laevo-index the need for polite interruption, making simultaneous ‘with-you-in-a-sec’ gestures, dialling and then listening for the surgeon’s infallible voice. No reply, probably on the links again. My dominant hand Googled for the complications of the surgical intervention on a slow Internet connection.

“Take me back to the Black Hills, the Black Hills of Dakota, to the beautiful Indian country that I luh-uv” came across the desk, now with mortal passion and upward tweaking of the volume knob. Perhaps a bit of juggling and handstands were in the offing, or worse — such as the 26 verses of Sam McGee.

“Doc, everyone has to face it sooner or later. Only the lucky ones get advance notice.”

A musical interlude from Melvin Udall, singing Always Look on the Bright Side of Life, beamed through the audiovisual parts in my cephalic soft stuff, but jarred harmonically with the next part-aria. “And when I get that lonesome feeling that I’m miles away from home… “, I could sense that I could agree with the lyricist, if not the composer.

Sometimes, one is called upon to administer what is known in the talk-therapist trade as ‘tough love’. In this instance, it was a tragically misplaced therapeutic move. My man was completely floored (thank Darwin) by a direct question which asked for knowledge of his Plan B — in the admittedly unlikely event of his survival.

I pressed home my cruel advantage, while he sat listening to my advice that, if he really wished it, it was not impossible to go on living with a ganglion on his wrist. After a few moments in which dudgeon of the first water was being exhibited unashamedly, he rose up silently and made his dignified exit. Back to the Black Hills, hopefully.

It took 12 weeks to get the tune out of my head. You’d envy the pathologists, all the same.

Pedestrian zone in Varna, Bulgaria Pic: Image Broker/Rex Features

Dr Garrett FitzGerald begins the first of a two-part retelling of his adventures with the World Health Organization, starting

Dr Garrett FitzGerald

with the tricky business of entering Communist Bulgaria without a visa.

My assignment was in Varna on the Black Sea. I got that old Cold War feeling as the plane landed in Vienna. In August 1982, the Iron Curtain was strong as ever. Russians were shooting down capitalist passenger flights for sport. I tried to recall Smiley’s instructions; love freedom, go the extra mile, face the puckout.

The Austrian stopover was for three hours, during which time I needed to get in touch with my contact in Bulgaria. Arrangements had gone well apart from the small detail of a visa. Ireland, in which I had been living in deep cover for years (Monaghan), did not have a Bulgarian consulate at the time. The nearest was in London, where agents had a profound allergy to opening incoming mail.

Efforts to get in touch with our people in Bulgaria had failed. Telegrams were received promptly there, then filed. There was no delivery system, so messages stayed filed. Telephone calls went unanswered. I had come to surmise that there were a lot of Bulgarians who lived stress-free lives, other than those who were guests in the local Lubianka. So, the status of my visa application, sent to London six months earlier — followed by innumerable back-up applications — could not be confirmed by my contact ‘Bela’ in Varna.

Vienna’s airport was justly famous for the price of its beer. In between failed telephone calls to Sofia and Varna, it seemed a good idea to sample instead the local red wine in lenten dosage. The ‘new season’ red was cheap beyond expectations. Its alcohol concentration exceeded one’s wildest dreams. How was I to know that a few days of drinking a glass or two with dinner could achieve irreversible brain damage?

Good night Vienna

The vino was helpful in decision-making when the time came. The people on the other side of the curtain remained uncontactable, all my coins squandered on attempts to reach comrade Bela. The time to choose came; go in without a visa or go home next flight out. The vin rouge won.

Confident in the goodwill of our communist brethren, I deplaned in Sofia at noon. Tactics would be called for. My first encounter was with the man to whom one handed one’s passport.

He trousered, using the Houdini method, the $40US which lay within the plastic cover, did not look for a visa at all, and smiled — possibly for the first time since 1917.

Onwards to the customs desk, at which every one of the 20 officers went slowly through every bag. It looked as if I would be hours late for the connecting flight to an farraige gorm, due to leave at 7.30pm.

Fate intervened. The large clock in the customs hall struck lunch-hour. To a man and woman, the officers stopped instantly and walked away. Three quarters of the newly-arrived passengers were now free to enter Bulgaria, cases filled with American blue-jeans.

Downtown Sofia

There I was, the first ever Premier boy to enter Bulgaria without a visa, sitting tipsily in a taxi to downtown Sofia. Perhaps I might have time to sample the local brew. I soon realised that my passport inspector was probably now the wealthiest man in town; there were no shops, no pubs, no cars, no nothing in Sofia.

There were very few regular people. In the main drag, regiments of lads in military uniforms marched back and forwards, criss-crossed occasionally by more in different uniforms. Loudspeakers blared messages about the glory of the State.

Adorned with posters

All available walls were adorned with posters of slogans about the leaders. Battalions of women troops marched through the adjacent central park, where legions of tug-of-war-experienced mamas leant on hoes and rakes, presumably waiting for autumn to arrive.

Downside was on the way from the vin nouveau and a woeful dreuth was taking possession of the traveller. In a queue extending down a side street, 50 or 60 doom-faced locals made their way to its zenith incredibly slowly; I noted that their watches showed dates but not time.

I spied on the premises to which they aspired, a bar with empty shelves. The customers were being admitted singly, served something, then dispatched outside again. I joined the posterior end. In an hour or so, my turn came.

A Carrick-on-Suir of a face suggested that all the relatives of its wearer had passed on tragically and painfully that morning. She set aside a large jug while she tap-rinsed the tumbler used by the last customer and those who went before.

It was placed on the counter in front of me on a newspaper, which may have carried the death of Hitler. I put iron-curtain shekels on an outstretched hand, from which she removed the Bulgarian equivalent of a tanner.

The business end of the jug — the kind you might find in an abbess’s cell for the nocturnal ablutions — was tilted myopathically towards the glass. Faintly orange liquid, say, one part per million, dripped out until my receptacle reached half empty.

It was apparent that I was to glug this down and move on quickly so the glass could be wetted for the next lucky guy in the queue. It was orange-hinted warm water, 110 millilitres as the crow flies, topped with the combined Sofian respiratory flora.

I asked her ‘how’s tricks’. Impossibly, the face worsened.

To be continued

Dr Garrett FitzGerald

Concluding his peek behind the Iron Curtain on assignment with the WHO, Dr Garrett FitzGerald recalls how a few dollars could always buck Communist protocol.

Varna Airport, Bulgaria: ‘Pleasant in an empty kind of way’ Pic: Action Press/Rex

The bus had a hole in the floor for a better estimation of the speed of the road. The view from the window gave high-rises and fields with more regiments of sturdy, statuesque hoe-women, evidently waiting for the up-coming turnips to make their move. It was all very pleasant in a 14th Century kind of way. I debussed at the terminal for internal flights. The check-in line had men with hats; no sign of Harry Lyme.

The plane had seen better days in the dim, distant past, a strong whiff of the Iveagh Men’s Hostel — indelibly imprinted on olfactory memory at the outpatients in Jervis Street. I got a strong impression that she was burning oil, all but beating Banagher in a thankfully successful pass at becoming airborne.

As terminals go, Varna wasn’t up there with Tokyo, but was pleasant, in an empty kind of way. I looked around for my man-behind-the-Curtain; negatory.

In the lounge, I overheard a conversation between a man named Boris and another. It seems they were bitching about a recently-botched job in Rome. The second man was urged to finish the job this time.

The little noise there was of human traffic spluttered and then quickly died. I sat outside on a bench, watching the last of the travellers and workers move away. Then the lights went out and I was left alone in complete darkness — 2am on a grand summer’s night and not a sound; you wouldn’t get it in the Glen of Aherlow in the sunny long-ago. I thought about bears and wolves and Bram Stoker.

After about an hour of wolverine and ursuline contemplation, the lights of an approaching vehicle made their way slowly towards the building, taxi sign on the roof.  An apologetic man got out and asked me if I was Georgi. I wasn’t until then but decided instantly to give it a try. The €20US convinced him that I was a far better Georgi than the old one. He had me in a hotel in Varna town in jig time.

The man behind the desk failed to understand my not-so-fluent Bulgarian. I tried Romani, Macedonian and Serbo-Croat, but only in sign language, as taught in Ballydesmond. I blurted the name Bela in desperation. His face lit up and he handed me a room key. Too late for breakfast, I handed in the key again. The morning man looked at the number and from the corresponding pigeon-hole behind him extracted my ‘messages’. This neatly folded stack was made up of all the previous telegrams I had sent from the mother country. Deliverance, at last.

Operation weed-killer
Bela and the others arrived to whisk me away in a black saloon. Soon, in the bowels of some secretive building, we investigated why the Bulgarians and Irish were joint world-beaters at drinking weed-killer. Selected agents from Oz, the US, India and Scotland wrote and rewrote the new WHO gospel of Paraquat/Diquat.

There were breaks for tea and lunch, the highlight being the daily cold cucumber soup made on milk — a step too far for a bacon-and-cabbage man. International cuisine was the order of the oft-repeated evening meal; burger and fries a la Black Sea.

A short indigestive walk on the esplanade before some nocturnal re-writing hastened the ageing process all round. There were no coach tours as there was nothing to see and, anyway, they didn’t want you to see it — or so I was told.

After only what seemed to be 10 months but in reality was six days, it was time to return to the Western world. The visa situation was no further on, no mechanisms in existence for that class of thing at all.

Pass-the-pathogen
No sign of Boris (code name ‘Two-mile’) at the airport. Presumably the other fella was on his way to sorting out Red Rabbit in Rome, provided he could get a visa. The good news was that the connection from Sofia to London was almost immediately after the Varna flight. I did not want to expose myself to another pass-the-pathogen in Sofia’s downtown orangerie.

The big question was whether they’d let me out without a visa.

Nervous dispossessions displaced my customary joie-de-vivre and possibly led to temporary ED. Not only were there fellas with hats, but fellas with guns. I circled the emigrant area in despondence. Suddenly, my man was there, back no doubt from a feed of white soup. He had hardly opened his hatch when my Irish passport with its 40 poorly-concealed Uncle Sams appeared before him.

The smile which all but bisected his head followed some hand movements not visible to the naked eye or possibly even on the slow-motion replay. His sheer joy telegraphed to me that I would never have a need for an ingressing or egressing visa as long as there was breath in his body and maybe even a bit longer. He placed the passport on my palm. Both it and I felt lighter.

We crossed the Iron Curtain somewhere around the joining of East and West Germany, though I didn’t get to see it from an aisle seat. A few years later, they got rid of partition. On television, there were scenes of popular mobilisation in communist countries. One night they showed a massive demonstration in Sofia.

I bet you $80US you can’t tell me who was at the head of the parade.

Sweet drinks are the biggest cause of our national expansion Pic: Durand Florence/SIPA/Rex

With the ticking time bomb of obesity about to explode, Dr Garrett FitzGerald believes the Government

Dr Garrett FitzGerald

must declare a policy of ‘zero tolerance’ on the epidemic and can start by banning sugary soft drinks.

The United States has passed the theoretical point of issuing drivers’ licences where the photograph may have to be ‘continued overleaf’ — more lately, also spreading onto page 3. Reality programmes, in which 400kg persons are shown counterpaning emperor-size beds, can be seen every day on the television. Omenta the size of a small family saloon can be seen being carried from operating theatres by many young men of 20 in scrubs.

I only realised the extent of the problem on a relatively recent visit to Semple Stadium. My seat in the covered stand was ‘reserved’. Unfortunately, the busty lads whose seat numbers were either side of mine were unable to confine themselves to one place each, so that my seat was now suffocated under unrelated thighs.

I didn’t insist on my rights. Apart from the prospect of being crushed to death, I didn’t want a row with the two Kilkenny giants at such an early stage; plenty of time for that when we’re eight points up and I am behind them, armed with a stout bottle. I sat on the steps.

The problem is growing in Ireland and throughout Europe. Morbid obesity is increasing here at an alarming rate. We’ll catch up with America in about 15 years. The American experience shows what lies ahead if we do not take the matter seriously.

For the first time in centuries, American citizens are not expected to live as long as their own parents. Obesity prevalence has tripled since 1982. Health spending on obesity-related illness, currently US$150 billion (€114 billion), is expected to reach $300 billion (€228 billion) by 2022. Morbidity and mortality from obesity are expected to overtake deaths and illness from smoking by next year. Half of all blacks will become diabetic.

In the US, children are being brought up as the third generation in their families to have never prepared or cooked their own food.

Grandmothers would not recognise at least 95 per cent of the nearly-edible produce seen on supermarket shelves. Some commentators suggest that, if your gran wouldn’t regard it as food, then it’s taboo for your system.

Additives and processing bring what was once a living chicken to its first reincarnation as an unrecognisable mush of poisonous but sickly-sweet collation; these new-lifers have lots of fat, Es of God knows what provenance, sacks of salt, buckets of sugar cubes, colourings from Persia, monosodium glutamate and yet can proudly boast on the label that the whole thing has ‘low cholesterol’. If you have a high-fat product to sell nowadays, just add a bucket of sugar (fructose-glucose) and your fat concentration is way down; not because there is any less fat — but because the sugar weighs much more. On the shelf you will see the big label stating that the product is ‘LOW FAT,  LOW CHOLESTEROL!!’ Low-fat yogurt, great for the health, is sweeter than mamma’s apple pie.

Have a right feed of these options and you’ll gain weight in no time. Best to follow with a large Big Mac meal with Ronald’s people, including a large Coca Cola (16 cubes of sugar) and a large French fries. Then you’ll get hungry again for same in 75 minutes and grab another one or, if in the wrong place, two Aero and a large Coke. A pizza would be great in a couple of hours, swigged down with a few Magners. You are now calorifically ahead of a middling town in India.

In Ireland, we will eat anything that is quick, anything that is over-sweetened, anything which doesn’t require preparation for cooking, anything which is not recognisably related to tissue which may have previously lived. The gap between the pig in the field and the piggy-man in the kitchen is ever closing.

Despite this dysnutrition, obesity would reduce by 40-60 per cent rapidly were sweetened soft drinks to become unavailable. It is now recognised that sweet drinks, particularly amongst children, are the biggest single cause of our national expansion. The scientists go further in suggesting that the sweet drinks are the single most important entities in giving us massive weight gain, high triglycerides, and too low HDL lipids. The drinks more than anything else will make 40 per cent of us diabetic within the next two decades.

Should you eschew your fructose addiction, you would be back to granny’s cooking of fresh foods without additives within a short few weeks. There are many examples of patients who dropped fructose but ate everything else, who lost stone after stone. The rules are simple; if there is sugar in or added to the dish/drink, don’t! Metabolism returns rapidly to the level where the pancreas can cope and risk factors for vascular disease wane.

Our Government has a major task. First, it must declare that there will be no tolerance for obesity in our country. It should immediately ban all soft drinks which have added sugar; they can be replaced with ‘diet’ and ‘free’ compilations of same drinks. A move to ban all sugar-added/fortified children’s breakfast cereals would be almost as helpful. Sweets and sugar-laden chocolate could be restricted, as in Sweden. These things can be achieved in coerced co-operation with food companies.

Government which continues to sit on its ass in this regard will lose its only chance of engineering a thinner society, a less diabetic population and a vascular-fit constituency.

So, get off your asses and lead for a change!

Waddle they think of next: Buttercup and her new foot Pic: Feathered Angels Waterfowl Sanctuary/Rex Features

Dr Garrett FitzGerald

Inspired by Buttercup the duck’s new prosthetic 3D-printed foot, Dr Garrett FitzGerald dreams up a million and two creations with his new 3D printers that fit the bill perfectly.

Some events, real or imagined, can bring out the Leonardo in you. Up until recently, the 3D printer in the garage was making very mundane things and making very little money for me or the Government.

Of late, the artistic brain had been capable only of efforts worthy of your average schlub. The relentless production of materialistic things such as All-Ireland medals, Krugerand, year-round new Arran Banners, life-size young Dolly Partons and skulls of St Patrick-as-a-boy was both fiscally and supernally depressing. There is a limited market for these items since Anglo-Irish imploded.

Additionally, they have no true artistic or spiritual value. I firmly believe that right and left hemispheres were not working in tandem and can safely blame the penultimate tablet prescription.

Then, a moment of contact with cosmic consciousness. A Lo and Yonder breaks experience, whose intensity approached the radiance of sanctifying grace. Something incorporeal was definitely afoot.

Duck tales

Perusing the latest edition of Life Science in a deep serotoninless moment over tasteless rashers, I read about Buttercup and Minnie. For clarity’s sake, I understood immediately that the same were and still are ducks, really distinct and (apart from one detail) equal in all things. The devil is in that detail.

Buttercup was clearly born from a curate’s egg. Her left foot was deformed and turned backwards which displeased her owner Mike Garey, owner of the Feathered Angels sanctuary for fowl in Bartlett, Tennessee. One presumes that when she attempted locomotion in either forward or reverse gear, no significant progress was made towards the destination of her intended journey and she could, at best, be said to be holding her own.

On the other hand, her companion Minnie, a real moocher, was able to keep her distance, no bother. Sadly, amputation of the bad 12 inches was necessary in Buttercup’s case.

Mike made contact with his local 3D printer, Novacopy of Nashville. Minnie’s left foot was copied digitally, then printed in silicone. Buttercup now wears it, covered with a nylon sock. My spies tell me that she can partake of slow barn dances and the like, but is never going to be able for the Walls of Limerick.

Athletic aspiration may be limited to goalkeeping or, at a maximum, as handy corner-forward on wet days. Apart from such restrictions, a normal-enough existence can be expected until such time as the jars of orange sauce are being taken down from the pantry shelves. It is important to state that the new duck’s foot is yellow. Mike’s gastroenterologist insisted. Now inspired with new-found zealotry and exhibiting a proud and joyous mien, the reinvigorated artistic cells up-top have effected huge changes chez Fitz. Firstly, my designers wrote the programs necessary for our 3D machine to make more of itself.

Within hours, 3D printers were popping out onto the garage floor, half of them soon spitting out worker gnomes (Glen of Aherlow model) who pay their way by loading buckets of Piltown plutonium into the other half of the printers, now engaged around the clock for the requirements of our Israeli customers. One of our machines is in full-time production of what we have named ‘the 50-shades-of-shite flogging device’ requested by a Middle-Eastern open-air purgatentiary. The Tea Party has commissioned hundreds more to be readied for when their latest lunatic gets to the White House in 2016.

Naturally, the income generated is well on the way to solving the national question and a Mr Kenny visited only last week. He made very incisive enquiries about the potential for replacing his cabinet without the use of deadwood as substrate. He has also placed an order for 1,000 blueshirts for next year’s party jamboree.

The shelves are now lined with more spiritual offerings. Replications of out-of-print bestsellers such as Prayer Book for Young Women and Lady Chatterley’s Confession stand alongside busts of inspirational figures like Starry Crowley, Caligula’s horse, Warren Gatland and Father Cleary. Our flagellae are hard to keep in stock, in big demand from people of all religions and none. Even the whipping boys below in Clare are snapping them up.

You can now buy 3D printers on the internet, ranging in price from many thousands to as low as $800. You can produce a one-piece pistol which will fire one bullet at a time. The good news is that the plastic gun is undetectable by extant screening machinery at airports, has no serial number and the remaining piece can be burned after use. The gun, The Liberator, can be made with an entry-level 3D printer. The cost is about €20. The downside is that it often ‘kills at both ends’ with resulting underemployment of hangmen.

My favourite initially was the Choc Creator for making designer chocolates — you can even make little Infants of Prague with it — until I learned that you had to feed it with chocolate; a bit of a snag in any man’s terms. The team is now vigorously engaged in the  purchase of a milch cow, several tonnes of cane sugar and acres of Theobroma cacao.

Spirituality best emanates from a stomach filled with chocolate. The theobromines shoot up the serotonin levels.

Place your orders now.

Dr Garrett FitzGerald laments the passing of his old friend the handkerchief, and remembers with fondness its significant place in history, literature, medicine… and up one’s sleeve.

In the time of Otello’s wife Desdemona, Kleenex had not been invented. This turned out to be bad for her.

In ‘Joe Green’s’ opera Otello, she is set up for a big fall by that bad hoor Iago. The hanky — embroidered with strawberries — which Iago stole, has gone missing and she can’t find it when the husband asks for it to wrap his aching head in. Poor, innocent Cassio ends up with the rag and is wrongly thought to have been conducting hanky-panky with Desdemona. In the end, Otello kills his missus and then himself. A bad-news handkerchief, if ever there was one.

There were also good-news handkerchiefs. Saint Gerard Majella dropped his on the street one day. A fair maiden picked it up to return it to him, but he told her to hang on to it as it might come in handy sometime. Sure enough, she got into real trouble when later she was in labour, roaring with the pain. She sent for the handkerchief and it cured mother and child there and then.

After Gerard’s death, the hankie became a famous relic which was divided into multiple little relics and spread all over Italy. Once-removed relics later abounded; other hankies which had touched the little relics became relics themselves. Miraculous cures were as common as with the original. Gerard and his relics are widely venerated to this day, particularly in Newark and Dundalk.

Both of the examples above represent the extremes of handkerchief folklore and behaviour. My own experience is somewhat in between, but no less exciting. Many of the young fellas I grew up with did not have underpants, yet nearly all had hankies. White was the natural colour, some much whiter than others. The economically advantaged males frequently carried clean ones.

Down the scale, there were grey areas. In CIE linesmen and suchlike, a blackish hue was prevalent. Persons with chronic coughs tended towards yellow and green. Haemoptysis, a common ailment at the time, brought localised scarlet colouration to some, later decaying to russet. Bright red was in vogue after hurling matches in high summer. Hankies tended to become smaller the longer they had been released from the wash.

The kerchiefs of the all-too-infrequent female friends of my youthful days tended to be puny in size, of diverse colours, decorated with embroidered pink flowers and used for near-weeping, attention-seeking and removal of migrating eye-paint and lipstick. A boy who carried such excuse for the real thing would be laughed out of the CBS playground.

The male cloths were usually stored in the trouser pocket of the dominant side. Less commonly, they could be located in the non-dominant sleeve anywhere from the distal ulna to the axilla. Vain persons and gay bookmakers tended to display theirs from the breast pockets of suits of clothes, sometimes matching their dickie-bows.

One came upon recently-laundered, sweet-smelling, jaunty hankies less frequently than the stored, adhering, crinkly and sometimes peripherally-knotted examples — and all varieties in between and far worse.

Bank-robbers tended to keep them on the face. Cowboys kept theirs knotted around their necks in optimal positioning for upward motion during dust storms along the trail.

What use, you could well ask dismissively, the modern balaclava for storing rhinorrhoea or carrying a few Bulls Eyes or other gallon-sweets? How thermally  impractical could a hoodie be for bald men of the mehill saving hay on a hot summer’s day? How could you expect Kleenex to carry sandwiches safely to the night shift without letting onlookers know what was in ‘em?

Historians and dermatologists are unanimously agreed that ‘four knots at the corners’ is the optimal anti-skin-cancer prophylactic. In balance it should be said that the cloth cap could equally ensure comfort for the right patella during semi-genuflection at communion time at the back of the chapel. What use the cap for signalling surrender or hoarding gobs/ gobstoppers? Can you clean your rifle with a beanie? Whoever kept dentures in a Stetson?

The presentations of the cloth handkerchief were of inestimable value to classical clinicians. Fresh and not-so-fresh excretions were portable to the surgery. Inspection of the contents of the cloth was often enough to secure the diagnosis, sometimes confirming multi-system disease all in one swoop. Blood, sputum, gum rubbings, urine (desiccated), semen, fossils, chippings from toffee apples, cerumen and seraphim, feathers, teeth, bees; you name it, they were all there.

A missionary father once brought me a sample of pus from a deceased member of the Ngswani tribe enquiring whether Madura could have been afoot. Insects enclosed were often after-the-fact rather than prima facie signs of disease. These great days of diagnostics are sadly no longer with us as the handkerchief sinks into the mists of time. It had a great innings; it was originally invented by King Richard II to stop courtiers from stiffening with nasal starch the sleeves of their tunics.

There is not a single handkerchief chez moi. Instead, there are rolls of white or sickly-blue tissues in kitchen, bathroom and scullery. Apart from nuggets of gold, my trousers pockets are sadly deflated. I dream of the chainsaws working around the clock in the rain-forests and global warming.
When the rhinorrhoea strikes on Tramore strand, I regret the sad passing of an old friend. Nowadays, I have to press on one nostril and propel the stuff off the head into the wind.

Dr Garrett FitzGerald

In medicine, as elsewhere, closing ranks requires not only the coercive power of those at the top, but also the tacit agreement of those further down, says Dr Garrett FitzGerald

The ordeals suffered by those who conscientiously complain are obvious to all

We have always needed whistleblowers, though rarely welcomed them and usually punished them. Coercion, more often than not a testosterone-only product, generally prevents the act of whistleblowing.

Depending on the organisation, army, cult, gang, career, firm — a person usually knows that the consequences of such action may lead to ostracisation, sacking, loss of earnings, becoming discalced, often destroyed, sometimes topped. It has been suggested recently that one of the worst consequences to be feared could entail ‘washing cars in Navan’. It is difficult to find a walk of life where some kind of omertà is unknown, however understated or unspoken.

Apart from recent newsworthy examples, it is difficult to find many successful outcomes for those, usually brave, souls who have ‘spat in the soup’.

The ordeals suffered by those who conscientiously complain are obvious to all.

Journalist Paul Kimmage was vilified for decades following his publication in 1990 of A Rough Ride, an exposé of doping in professional cycling. Even recently — 23 years on — he was held to ridicule at a press conference hosted by Lance Armstrong. The latter told Kimmage on live television that he (PK) was ‘not fit to sit in that chair’.  The ‘feeling’ in the room was that Armstrong was telling it like it was.

The story of those who complained of rape/sexual/physical/emotional abuse by organised religion is still making headlines. It is now common knowledge that some victims have complained that the ordeals suffered in their uphill whistleblowing efforts almost matched those of the original criminal assaults. Many didn’t live to see the fruits of their long campaigns for justice, but rather faded away, mostly regarded as pariahs — or worse in the Irish context, INFORMERS.

A recent poll which found that a substantial minority of doctors would not draw attention to the instance of a colleague who exhibited malpractice/impairment strongly suggests that the culture is alive and well in society.

I was personally imbued in my younger years with the almost unspoken rule that a doctor who brought attention to deficiencies in another doctor was no better than a rat — and should be treated as vermin.

Perhaps many of those who ‘voted’ against whistleblowing realised that, at a key moment in their own lives, they themselves could have reasonably been the object of the whistling. Such motives are a little more understandable and charitable, though hardly enlightened.

The rationalisation for the thinking has always been biblical in origin: “there but for the Grace of God go I.” Boiled down to its essence, it means that you don’t rat on someone because someone may rat on you. Also in biblical tradition, only he who is without sin should cast the first stone.

Other justifications were once called upon; it would do this ‘noble profession’ no good to have the laity knowing too much; it might reduce people’s confidence in doctors generally, etc. The more reasonable idea, that one should be sure of one’s ground before doing serious harm to a colleague, was less frequently emphasised.

Citadels must be defended at all costs and all devices to ensure defence may be (and have been) employed. Because the citadel, corps, firm, profession, church, department, institute, team or club must be sacrosanct, powers of coercion are the outstanding feature of defence. Some use the term esprit de corps. This fine-sounding French phrase may facilitate a multitude of interpretations and outcomes from well-meaning to murderous.

Threats of, and actual, denigration and vilification are the standard tools of the omertà-ensuring trade. If these don’t do the job, then a no-holds-barred escalation usually ensues. There can be only one winner, the citadel. Enrolment or employment into citadels is often preceded by enquiries as to whether the candidate is a ‘team player’ or ‘collegiate’. It is well known that if you have to take on an eejit, a collejit eejit is the best choice. They had plenty of them at Balaclava.

Forward, the Light Brigade!
Was there a man dismay’d?
Not tho’ the soldiers knew
Some one had blunder’d:
Theirs not to make reply,
Theirs not to reason why,
Theirs but to do and die:
Into the valley of Death
Rode the six hundred.

Closing ranks in organisations requires not only the coercive power of those at the top, but also the tacit agreement of those further down. It is the strong support of the latter — petty officers and foot-soldiers — which gives certainty to the real villains at the top.

When one takes on City Hall, one is often taking on the City as well. This multiplies the difficulties for potential ‘rats’. If ‘some one has blunder’d’, best to say nothing and keep saying it.

In negotiations for the original consultants’ common contract a generation ago, the last sticking point was the ‘need’ by the health authorities to silence criticism and to have this ‘need’ enshrined in the final agreement. I warmly recall Finbarr Fitzpatrick and the late John Fielding, backed by every member of their organisation, resisting this ‘gagging clause’ until it was rejected completely.

The health authorities are never quick to learn from battles long ago. Like most faceless organisations who are consumed with the ‘command and control’ paradigm, they are at it again in their efforts to impose a new contract for general practitioners.

This will never, ever happen.

Dr Garrett R FitzGerald

Dr Garrett FitzGerald recounts a meeting with the famed Dr Alfred Oberon Fagan-O’Toole, whose unique take on pain relief has won him many admirers in the nonsmoking, old-world, medical moral majority of Shakespearean enthusiasts.

He was an exemplary boy in his private school. The reverend head-Lar repeated ad vomitum that the boy would do well. I hear they were very disappointed when he failed to ‘join up’ after the Leaving. His lisping teacher of holy math said seriously that Alfred Oberon Fagan-O’Toole had the eye of an archbishop and the bearing of a cardinal. On top of all that, it is rumoured that his mother prayed day and night that he would enter the order so as to guarantee a high place in Heaven for her good self.

Fortunately, his time in medical school did not coincide with mine. Nevertheless, our paths crossed occasionally over the decades. The last time we met at a gathering he looked extremely serious and impressive as always — although it was the opinion of some that his Bo Peep outfit was a little too small at the shoulders. My own view was that it was rather the lavender bonnet which didn’t suit him, but who can lay claims to taste these days? Students of his claimed that he was at his most impressive in the purple and gold of his Swiss Guards outfit — the one with the bells.

As is well known, he is a leading figure in the pain-relief scientific community. The many peer-reviewed organs which serially rejected his clinical communications over many years are now possibly in touch with the error of their ways.

It was, and still is, his main conviction that not all pain merits relief. Initially his ideas were unpopular amongst his colleagues but have recently been gaining substantial traction in the highways and byways of therapeutic life.

Perhaps the turning point was the emergence of his elegant and inspired publication, Absolutism not Absolution — a guide for Healthcare Professionals.

There was a huge attendance at the RDS for the launch of the Society for Medical Fascists.In the promotional literature released that night it was stated, amongst other surely self-evident truths, that from the earliest days of humankind, life was never intended to be ‘a bed of roses’. People have always suffered. The devastation of the Great Hunger cannot all be laid at the feet of the British Crown.

There are, clear to see, two distinct bodies of sufferers; those whose misfortune is fortuitous and those whose suffering may have arisen as a result of their own misguided pathways through life.

The examples given to highlight the latter sort of person include all sorts of deliberate misbehaviours such as drinking, smoking, late nights, riotous living, gluttony, sloth, inattention during classes, hereditary or acquired fecklessness, agnosticism, cynicism — and above all, tolerance.

On the big night, Dr Fagan-O’Toole, whose committee had earlier released the relief-merit scoring system for sufferers, received a prolonged standing ovation after his presidential address, which concluded with exhortations to his ecstatic followers: “Always be mindful, mein herren, that some people were born to lead and others to be led!” and “Pain and anguish are not like Mount Everest; they should not be necessarily taken on just because they are there!”

(Pic: Getty)

e-Cigarettes
In the public domain attention has recently been focused on the Society’s relentless — and apparently successful — campaign to ban electronic cigarettes in the workplace, the beach, restaurants, indoors, outdoors, HSE properties, Ireland and the world. Whereas some organisations have been quoting non-evidence-non-based reasons for their need to ban anything they might dislike, the real honest decent totalitarians in Dr O’Toole-Fagan’s coat-tails have more cogent arguments for the ban, however understated.

In the case of cigarette smokers, no mercy should be shown. If they were to be allowed cease tobacco by switching to a possibly harmless nicotine fix, they would be seen to be getting away with their crimes and avoid needful suffering. Such travesty of natural justice would cause terrible mental distress in the ranks of ordinary intolerants. It would stymie the overwhelming need in one’s betters to dictate to lesser and undeserving mortals. Relief for relief’s sake would make a comeback.

I was fortunate in landing a short interview with the great doctor himself. Our meeting was in a secluded boudoir in the Shelbourne. His secretary had warned me in advance that the strict dress code theme for the occasion was to be based on A Midsummer Night’s Dream. I went as Bottom the Ass and the learned colleague was a radiant Titania.

We covered a wide range of general subjects before getting down to the meat of the evening. It transpired that his favourite episode in history was the Crimean War.

He spoke admiringly of the shouting and roaring of the injured and maimed soldiers, the ‘live’ amputations of whole limbs with leather belts in the mouth to bite down on, the mercy of a couple of quaffs of brandy for the more deserving amputees; himself gallantly in charge of the bottle and the saw. “What a pity,” he said, “that we didn’t have modern anaesthetics then to give to the truly deserving men. The better ones shouldn’t have died like that. That would have been perfect justice.”

I revealed it to him that he was an imaginary character and that there was nobody remotely like him in reality. He agreed entirely. Tatiana adjusted her pantaloons and addressed the fairies.

“I may not be real now, but my spirit is abroad!”

Dr Garrett R FitzGerald

With the sports injury experts in a spin, Dr Garrett FitzGerald comes up with a novel solution to the penalties of Cork’s Anthony Nash, involving some traditional chainmail dress from our Norman ancestors.

The Institute of Orthopaedics and Sports Injuries has issued reports on two important matters related to the game of hurling. The report on the nomenclature of blunt injury passed without any great fanfare or animosity.

Shortly after the release of the second document (known now as the ‘Blasted Penalties Report’) there occurred, in the foyer of the conference hotel, serious scuffling in which several noted ‘not-Cork’-minded consultants received dunts, fongs, belts, digs, nudges, slugs, sogs, wallops and flamms, as well as some other as yet unnamed non-penetrating methods of assaults upon their persons. There was apparently frequent use of the name of a famous German golfer. Gardaí called to the scene made no comment, but recorded everything.

It is believed by those who are obviously biased in these things that the Cork-minded, more upmarket specialists, were responsible. Unfortunately, many of these, who were photographed during the altercation by the Examiner, have also been able to prove beyond all doubt that they were on a cruise liner off Montserrat at the time.

Whatever the truth of the event, it is also noteworthy that the limelight, during and after the deliberations which produced both reports, was occupied by one man who (genuinely) wasn’t there. This innocent party is none other than Anthony Nash, goalkeeper-bádóir of the Cork senior hurling team.

Nash happens to have almost perfected the art of scoring goals from penalties, taking after and now surpassing techniques used by the late great Christy Ring. The ball is placed in the centre of the 20 metre line. It is lifted by the hurley (come on) into the air and struck with great force in the direction of the goal and three trembling, borborygmal defenders. In his heyday, it was said that Ringy connected with the ball about 16 yards out.

Goal-line glory
Anthony has brought the skill to a divine level. Lifting the ball, he can whoosh it upwards and forwards to an arcing, unprecedented proximity to the goal-line. I am told by a man who is not known for hyperbole or truth that Anthony, after the ‘whoosh’, walks slowly forwards for a few leisurely paces, sits into an armchair, lights a cigar, has a read of de paper and rings home to know if there’s any messages ‘wantin’.

Sometime later, as gravity exerts itself on the sliothar, he slopes forwards to meet it with the bás at a distance of about 10 yards from the now nigh-incontinent defenders. If the near-side umpire is not felled by the missile, he is already in the act of reaching for the green flag.

Everybody who is from anywhere other than Cork wants the practice stopped. In Cork itself, rules are rules, boy. It is important to understand that the latter approach is based on geographic principles. The following scéal clarifies everything.

A man of my acquaintance who says he doesn’t make a big deal about being a Corkman, has a huge framed map of Ireland in pride of place over his mantelpiece. The country is coloured blue apart from Cork county which is very red. Only three words appear on the artwork; the red zone is labelled ‘Cork’ and the rest ‘Not Cork’. What else is there to be said?

The ortho/sports doctors, anti-Cork obviously, want the practice ended in the interests of defender safety/survival. Nobody mentioned the lads in the first rows in the stand behind the goal. The argument that a defender with a soft head or body has no business standing in the goal was rejected.

As usual, this columnist has the solution. One needs to look no further than the ancestors of Anthony himself. His (four-times) great grandfather Maurice ‘Múinte’ FitzGerald, resident of Co Limerick in the mid-1700s, was descended from Norman invaders.

Arriving in Waterford in 1171, they were equipped with iron helmets, visors, chainmail and iron shields. Now is the hour when our hurlers must be afforded the same armour — as JBM himself would say, “in all fairness!”

The other matter which did not lead to thumping was the report on the nomenclature of blunt injuries. Again, this concerned Anthony Nash. After Cork and Clare drew the All-Ireland final last year, Cork manager JBM complained of impedance of Anthony on his journeys from his own goal to the opposite 20-metre line when penalties were awarded to Cork.

Dunt know
To the defence of the Claremen came their manager Davy Fitzgerald, another Norman. Much ado about nothing, was his verdict. He said there might have been reason for the Cork manager to crib had Anthony received ‘a big dunt’ on his peregrinations, but nothing like that had happened.

This comment put the ortho/sports lads into a spin; ‘dunt’ is not mentioned in the medical literature. A meeting was called and a non-controversial report issued. I will explain what a dunt is — amárach.

Windsor Castle, where many Irish were treated to a banquet. Pic: Jchambers/Getty

Following the successful visit of President Michael D Higgins to Britain, Dr Garrett FitzGerald investigates what might be the Irish secret behind the Royal’s longevity.

I hear Philly is worn out after the big week over in England. He was looking good, if a little disoriented at times. Reports suggest it may all have been too much for the poor divil to take in during the visitation of Michael D.

Of course, he didn’t put a foot wrong in front of the cameras, but in the private quarters asked herself to remind him who in the blazes was the ‘little chap’.

A counsellor in the privvy let it out that Philly was actually astonished to hear the fellow was the president of the Irish Republic. “Are you absolutely sure of that, Betsy?”

Our informant came to understand that Philly was under the impression all the week that the chap was poor misguided Uncle Davy come back to make up.

David was crowned Edward VIII but ran off with a gamey wan from America, who had been a few times around the houses, and left throne and Empire after him.

Philly was, like herself, a bit relieved at the same time; he half suspected there was something afoot when so many Irish were invited to the banquet in Windsor.

He realised he had been saved the embarrassment which might have followed had he known it was all a shindig for Paddies. At a previous Hibernian affair he had not-so-wisely opined that he had been surprised to find two Irishmen in the same room without a fight breaking out.

(That comment is not as famous as the one he once made on receiving at the Palace an ambassador-cum-wife of a prominent equatorial African country who were flamboyantly festooned in flowing flowery native dress: “Ah, ready for bed are we?”).

There was indeed much relief all round at the end of the Higgins visit that the royal old fellow hadn’t put his foot in it. His son Cathal helped out a bit by engaging our president in some discussions about the nature of poetry; many of the latest ditties don’t even rhyme, making it damnably difficult to remember them, and  dammit, that Heaney chap only managed to find the right word about ten times in his whole life, yet they gave him top prize for it!

Our Health boys were there too, not so much to record the tenuousness of Philly’s galactic interconnection, but to find out why the royals are living so long. They got no clues at the banquet where there were lashings and leavings of any kind of groodles and gargle you could imagine. In fairness, there were no rashers or porther to be seen; possibly a clue. O’Connell’s mother-in-law fish from the English Market in Cork wasn’t served. A report to Minister Reilly logically points to an unknown aetiology; ‘idiopathic longevity’ as explanation rings too clichéd and cop-outy.

The long-term prognostication from the Chief Petty Officer serves to warn the Government that the favoured descendants are unlikely to make king: Cathal, Liam agus Seoirsín.

He concludes that the Queen has probably got another four decades in her. The spectre of her presenting Sam Maguire on a return visit to Croker may not be the ridiculous fiction it’s cracked up to be.

The Hawkins House lads watched every move of the royals during the visit and unsurprisingly came up with the zilch number again. Top-up payments were denied all round.

There is a man who knows the answer. He does not want to be identified as he already knows who he is. People have become more accepted in their communities by not listening to him high nor holy.

He once revealed himself to an abbess on the Tipp-Waterford frontier. All he would say, over and over, when interviewed by detectives, was “Ask Dwarf Dwyer-Dwan.” Theirin lies the key.

Not a league away from the town of Mullinahone is a meandering boreen which features at its distal end the unassuming dwelling of the dwarf Dwyer-Dwans. The house is within two Irish miles of the one where Cathal and Camilla honeymooned, yet this latter couple know nothing of the old dears’ visits.

The little woman-of-the-house has been secret hostess to Philly and his missus twice a year since the end of the Emergency. The grub, although tasty enough, is neither here nor there. Jugs of stout are placed on the table at each meal, but rarely drained.

The secret is in the baths. Each evening the royals strip off and sit into two grey enamel baths. Mrs Dwyer-Dwan then pours the liquid over their heads making sure to leave no parts unwetted. The dwarf Dwyer-Dwans themselves are very, very, very old; in their long-forgotten prime their full four-eight height was the average adult height of the time. They have never missed their evening bath.

What’s in the water has never been said.

Dr Garrett R FitzGerald

Dr Garrett FitzGerald believes the health service — like most walks of life — would benefit enormously by having women take over the controls and bring balance for the benefit of patients.

In the Spring sunshine, I visited a newly-found relative at his rural farmhouse. A single man of advancing years, he finds himself unable to keep up with his once-passionate gardening hobby and the overgrowth is in the early stages of its inevitable and relentless takeover.

Inside the farmhouse, the relics of auld decency. Spartan is an understatement; a home frozen in time, 1940s at the latest, some detail going back more than 160 years. In the parlour, formalised by the solid dark furnishings of the early 20th century, I visualised better days with, perhaps, the excitement of a ‘station’ with the neighbours in and the smell and sound of any amount of sizzling rashers, the priest’s hat in the hall. Or the sound of the fiddle and the bosca on St Patrick’s Night.

I didn’t need to consult the family tree to know that it was a long time back since a woman’s hand had made the house a home.

My cousin had succeeded as householder to two bachelors whose mother was born in 1856. She was the last ‘woman of the house’. Her demise more than 60/70 years ago would have brought a halt to the kinder hand of gender balance on the place. My single cousin, his uncles before him and the premises, had been on the road less travelled since then. In the hidden Ireland, there are still far too many people on that road.

Pic: AlexRaths/Getty

Masculine medicine
This stark demonstration of the result of lack of the feminine set me thinking about some unexamined aspects of my career. As a hospital doctor since the 1960s, I had never really thought about the masculine/feminine balance of the job; male/female was different, and I saw and welcomed the gradual acceptance of what is now dominantly a profession for woman doctors. My daughter is one (and as good at her job as any male), something which was rare and strange when I qualified. The fact that some specialties are almost closed to women, even in 2014, is a subject for another day.

Women make up the vast majority of healthcare and hospital staff. Yet, the power resides with the men. So, are masculine design, operation and attitude still calling the shots? Are the buildings ‘buildings for men’ by men? Is there a harshness about our health institutions which could never happen if ordinary women were empowered decision-makers? We’re not talking frilly curtains here, but much more important domains of the care-giving environment. Is there a balance somewhere between — which would be to the benefit of the patients? I strongly believe there is. Androgyny was never more needed.

Edifice complex
I recall sitting around a board-room table 30 years ago. There were ‘experts’ there to advance the commissioning of a new hospital. All of them were men, the rest women. Health Board officials of the first water, Department men kicking for touch, architects in silk suits and various specialties of doctors. We all did a wonderful job, creating a great monument to past practice.

At the time, I thought it was all very correct, which goes to show that I was, like many of those around the table, marching to an off-beam drummer and lacking insight. Our paraclete came from the cloud of unknowing. At best, we radiated inspired mediocrity. At worst, a covenant of philistinism.

Had we had a gender balance (not obsequious ‘yes women’ anxious to please the CEO!), I have no doubt that the result would have been spectacularly better. Most of the women should ideally have come from non-admin, non-medical and non-nursing walks of life. One half-reasonable woman would have attenuated the product, the way it turned out.

The building itself is male and masculine, all starkness and angles, small windows;
very like those flour-mill edifices of the 19th century. The administration was a masculine entity. The professional staff  — who did very little of the deciding — were dominantly masculine in output. The Department of Health has always been a masculine behemoth, living again the structures and attitudes of the Roman Empire. Fine for wartime lyrics but sh!+€ for melody.

Female balance
Worldwide, the masculine dominance is evident. Great buildings are phallic. The Vatican has masculine structures yet the choreography is feminine — gay colours and men in frocks, suspicious androgyny in a male-only institution. But the respect for the female doesn’t get exported. Of all the famous landmarks, the Taj Mahal strikes the balance.

There is too much of the masculine in our lives, our surroundings and our attitude. Without the feminine, the world is a harder and sadder place. Sans delay, we should hand over the HSE, the Department and the Cabinet table to the women, and take it from there.

Could I rephrase this? The men should desert these institutions and not stop the women from taking them over.

Pic: Roger De Marfà/Getty

Dr Garrett FitzGerald writes a glowing obituary on his late lamented professor, who was obsessed with bringing ‘balance’ to an uneven, one-sided world. 

To sleep, perchance to dream in the first private oneirology clinic in the country. Aye, there’s the rub for Dr Garrett FitzGerald, who muses on his friend’s latest attempt to reinvent himself.

My colleague is getting middling long in the tooth but has recently reinvented himself professionally. He came originally from a then undiscovered part of the West of Ireland to the ‘uni’ for medical school. John Charles was archbishop at the time. Cosmos sat what in those days was termed ‘the long course’ to graduate proudly in his late thirties. He held the distinction of having been both an immature and a mature student in his time.

Every few years, he moved up into the next school year, usually soon after the dean wrote to advise him by registered post that he was on his last chance. At the heel of the reel, they gave him the degrees — some say it was because the professors’ fathers had been his classmates. He has always been insistent that the extra time given over to thinking out the subjects was to prove invaluable; very few pathologists could boast that they had already studied pathology for seven years before entering the bottom rung of the specialty.

Recently — well, 14 years ago — he had to retire from his public role, having reached the age of 65 well before his time. He felt, he shared with me, restless and unfulfilled. I had been a classmate of his for one year as had a whole generation of students. Naturally, he knew everybody who graduated from our school over a short half-century.

New life

His latest move to the Southeast from the Northwest after so few years upset him considerably. He had been accustomed to rain every day and now had to adapt to every second day. But, having trained himself to taking the long view on time’s unerring path, he settled into his new life here within a decade.

His new venture opened last week. It is the only private oneirology clinic in the land. It is already attracting acres of off-beam customers. Consultations, which can take up to three days, do not come cheap. He has already requested the HSE to help him find some juniors from the subcontinent on the next recruitment/enlistment safari.

The clinic will be on the cutting edge of dream induction and  interpretation in Ireland. There is a well advanced plan to link up with a local chancer who is to finance the latest Functional MRI and PET equipment. Each mark who attends will be provided with complimentary essential pieces such as state-of-the-art hollowed-out chess bishops and weighted dice to help with TILD  (Totemic Induced Lucid Dreaming).

For those who are sadly unfamiliar with the technique, he (eyes protruding forward, unblinking, scary) showed me an extract from his patient advice literature. It is of course self-explanatory.

Pic: Ingram Publishing/Getty

Lucid reverie

“With TILD, you can use more advanced techniques like summoning your totem. Some people imbue their totems with the power to change their dreams when they find themselves in lucid reverie. However, this can be a difficult technique. You might not always find that you enter a dream state with your totem on your dream body, and summoning a dream object is an advanced dream control technique that you might have to work on for a while!”

I wished him well in providing this badly needed service. He just coughed when I wondered if the under-sixes would get it free. He had become, I felt, less altruistic in recent days. He mused dejectedly that not one of his thousands of clients had ever paid him for their autopsies; a good point in all fairness.

We moved the subject to simpler dreamy generalities. He was in no doubt that he would always recommend pre-treatment with Stilton, mustard, salmon and dark chocolate. Supplements with 5HT and Vitamin B6 are extremely useful. Peyote has the advantage that sleep isn’t a necessary accompaniment of the ensuing dreamscape, but it won’t grow in Kilmacthomas.

I recalled for him my seven-year relationship with mirtazapine. It had been the saving of my dotage, but the dreams, man, the dreams! He spoke at great length about serious serotonin.

There was little else to say apart from the traditional well-wishing and felicitations. Then it occurred to me that he might just help me sort out a matter for a good friend; originally a Limerick man in long-term exile in Waterford.

On the eve of his retirement, he had a very vivid dream. No less a person than Jesus stood before him and asked him whazzup. My friend responded that he didn’t know what to do with his remaining above-ground days. Jesus told him he should return to Limerick which, needless to say, put the Fear of God into him!

“Will you come with me, Lord?” he asked. Jesus said, “I’ll come with you as far as Bansha.”

I asked my oneiropathologist what he made of all that.

“‘Tis hard to know,” he said.

Dr Garrett R FitzGerald

With Waterford set to become a Model Four hospital under the latest reconfiguration, Dr Garrett FitzGerald looks at why local politics never allowed WRH to live up to its ‘regional’ status — and why people are right to be sceptical about the latest plans.

A regional hospital without a region is one way of looking at it. The non-believers of Minister Reilly’s plans for our hospital here might seem to be unnecessarily pessimistic. They lined up last week to un-welcome Dr Reilly but had to abandon their protest because the man had tonsillitis and didn’t travel.

The sign at the entrance which had for years, somewhat misleadingly, proclaimed ‘Waterford Regional Hospital’ had been taken down. With fanfare the new order was to be launched with a bigger sign indicating that the place is ‘University Hospital Waterford’  — or similar fiction.

This grandiosity didn’t get to see the light of day. Beidh lá eile. Meantime, it is an unnamed hospital. It is a teaching hospital of the RCSI. Scratch that; this week’s advertisement to recruit a replacement vascular surgeon tells us that it is a teaching hospital of UCC. Tomorrow, who knows?

Prof John Higgins

Tomorrow there will be no HSE, the great invention of only a decade ago. Tomorrow is the key. Tomorrow, with a clear view of yesterday, is the reason for the unbelief and the protests. Déise view or déjà vu; take your choice.

Superficially, plans for reorganisation are well worked out and logical. They are genuine and well meaning. Prof John Higgins and his team are talented and fair and the UCC lads enthusiastic beyond expectations. It’s hard to find a flaw in the blueprint for the new set-up. Waterford is to be a Model Four hospital, same as CUH. The whole shebang will be administered by a new board. All wonderful, but behind all boards ‘there be dragons’.

Model ‘T’ Four
Why do the population here believe it’s more likely to become a Model ‘T’ Four? They remember that WRH was also supposed to be a ‘regional’ hospital in the past. Never happened. It took 40 years of games for it to have never more than half-happened. I heard Prof Higgins comment on radio that Waterford ‘Regional’ never really had the degree of support (including doctors) or investment necessary to bring it up to the level that would have put it on an equal footing with other regional hospitals.

The original FitzGerald Report favoured Kilkenny — correctly — as the logical place to put a hospital for the Southeast. Late in the day, the plans switched to Waterford. Kilkenny got, instead, the headquarters of the SEHB.

The county jerseys came out of the drawers bigtime. The geographic distribution of elected/appointed members of the SEHB ensured that the Waterford representatives always comprised a minority. Any ‘upgrading’ of Waterford was seen by politicians, some medics and population as a ‘downgrading’ of Wexford, Kilkenny/Carlow and South Tipperary hospital services. Diktats from Hawkins House held sway in forcing the building of a new hospital in Waterford in the late 1980s and early 1990s. Piece by piece, and uphill, there were a few half-hearted ‘regional’ specialties allocated to it; but by and large, the other hospitals held their ground. To many, Waterford was a threat rather than a boon. Waterford never really made it beyond grade school level.

Kilkenny HQ
The siting of headquarters in Kilkenny was crucial. The administration’s real decision-makers lived there, brought up their families there, sent their children to the local schools and thus became part of that very tightly-knit and admirable community. It would not surprise anyone if they were at times slow to make decisions which would make at least symbolic tarring and feathering a realistic consideration.

Politicians who might have considered voting a Wexford or South Tipp service into Waterford (on rational clinical grounds) may as well have gone the hairy Carey route.

Some clinicians have never boarded the ‘regional’ hospital train. Their wishes have possibly come true; four hind-tit outfits rather than three plus a regional centre. The future was fine so long as it wasn’t at Waterford.

So, don’t be too hard on the unbelievers. They know the score. Usually, the doctors are the first to detect which way the wind is blowing. Medics will not apply to crew a straw-bottomed ship. They are now very wary of making their careers in WRH/UHW. Several are moving out. They are not reassured by the soothing guarantees from Dublin and Cork. They see with their eyes the current dismantling. They too know the dark places where the dragons lurk.

We are to remain a major cancer centre. We are promised that our cardiac intervention lab will be open 24/7 instead of office hours only. The people who brought you this latter contempt will still be in charge of  health services including any boards which are set up. The believers are convinced that the dragons will disappear under the new dispensation. The unbelievers say ‘pull the other wan, boy!’

In the medium term, things will seem good. The long term is another kettle. The unbelievers feel/know in their waters that when fiscal push comes to fiscal shove, the mother breast in Cork will dispense cream to Cork and skim to the Déise. They have been on this merry-go-round before.