Pic: Getty Images

Dr Garrett FitzGerald pays solemn homage to his most charming late great-aunt Bea and an Ireland of old, both of which were, all to soon, no more.

Due to a grievous, if welcome, error on the part of the celestial department of justice, there is still breath in my body. Longevity, a sweet non-optional extra in one’s family history, works both ways and gives little guarantee; while many of our crowd had to be put down for a finish, there were plenty too who went early. One such was my grandmother’s sister, Bridget ‘Bea’ Higgins.

‘Holy relic’
‘Bea’ was born in 1875 in Ballaghaderreen, then in Co Mayo. According to family tradition, she was somewhat delicate, most charming, and very ‘holy’. Some described her as a ‘saint’. A cousin recalls a story about Bea; a representative of the Sisters of Charity was said to have come to the house soon after Bea’s funeral and asked the family to treasure Bea’s sputum mug as a ‘holy relic’. I await the details of the certificate but assume that it will indicate a respiratory illness, probably the ubiquitous tuberculosis, consistent with the time and place that were in it. The words (The Dying Girl) of Richard d’Alton Williams (1822-1862) — poet, medico and consumptive — strike a note:
‘They brought her to the city
And she faded slowly there
Consumption has no pity
For blue eyes and golden hair.’

Poor Bea had been ‘ailing’ for some months before her passing. The Western People report of her funeral in November 1896 speaks to us 21st Century dwellers of the infamous foreign country — the past — where ‘they do things differently’:

“Deceased, who had been ailing for some months died on Monday last, 2nd inst. at 8 o’clock am, fortified by the rites of holy Catholic Church.

“The clergy were named. The bishop of Achonry, his lordship Most Rev Dr Lyster, officiated.

Children of Mary
“The deceased was a member of the Sodality of the Children of Mary and the ceremonies in the Cathedral, on that account, were most impressive.

“The coffin, which was covered with a blue pall, was borne into the Cathedral and placed on a catafalque before the altar.

“As the ceremonies commenced the young ladies of the Sodality of the Children of Mary, numbering about 100, ranged (sic) themselves around the catafalque, draped in long-flowing white veils and holding lighted candles in their hands. After the close of the solemn function her remains were reverently borne to the family burial place in the old chapel yard, followed by the Children of Mary in procession … and a vast number of mourners and sympathisers from the town and surrounding districts.

“While the funeral was passing through the town all the business places were closed up. It may be remarked that this was the first occasion on which the funeral of a member of the Sodality of the Children of Mary was carried out with such Impressive solemnity.

“Too much praise cannot be given to the good Sisters of Charity, who during her illness, and up to the last moment, were most attentive and paid her frequent visits, which were a great source of consolation to her parents in their trouble. RIP.”

Bea had a great send-off indeed. Nowadays, the antimicrobials would possibly have ensured her place in the upper reaches of the great ages attained by her siblings — her sister, my grandmother, passed on in her 99th year, 79 years later.

Even in the 1950s, the Children of Mary were still going strong and seen in huge religious processions in my home town; light blue veils and a matching uniform, droves of them (some ‘young ladies’ in their 70s) making their way down the main drag in Tipperary, the ‘faithful’’ cast down on their knees on the footpaths at either side, the shops closed for the duration, holy statues in many of the display windows, papal flags hanging from first-floor windows, irreverent traffic diverted by the guards out the back road to ‘the Junction’, and ahead, swarms of surpliced clergymen, the monstrance shielded by its four-poster canopy, which was usually tilted to the Bansha side — because there was always a fella with a bad hip holding one of the four.

And, not least amongst my childhood observations, the censoring righteous ‘tut-tuts’ for the seen-to-be inadequately reverential.

In my teaching hospital in the 1960s, the same Sisters of Charity were still very much in the ascendancy of importance relative to ordinary persons. The populace still generally accepted that religious immortals existed on a higher plane.

Old Mother Ireland
The past has a habit of receding at an imperceptible pace, however. Then, almost suddenly, decades later, you notice that the past is no more. So it has gone; the piety epidemic, the shoals of surplices, the most reverend titles, the deference, the processions, “the impressive solemnity”, the closed shops — have all dwindled and blown away into the great grey yonder of Mother Ireland.

Only the stories and the old newspapers remind us of a time that has very definitely had its day in the sun.

For Bridget ‘Bea’ Higgins 1875-1896, great-aunt, resident of the past. Ar dheis Dé go raibh a h-anam dílis.

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Not content with a string of obscenities like the rest of us when we hit a bad shot, or hurling the club into the Atlantic, Rory McIlroy is golf’s true good guy, says Dr Garrett FitzGerald.

Wee Mac can astonish you. He can throw birdies at his card same as if he was shelling peas. He can win majors by record margins.

He could chip Titleists into a washing machine when he was only two-months old. I believe there is an early pregnancy ultrasound in the archives which records a huge golf-brain at 14-weeks’ gestation. He has just become Europe’s top golfer again while spending half the year in a plaster. Then he goes and spoils it all.

The sad occasion was in Dubai very recently. He’s two shots ahead of the field with two to play and arrives at the tee box on the 17th, a par three. The beautiful swing as per usual and the ball goes miles astray and into the water, which almost surrounds the green.

The crowd is silent. Rory is shown with his club around his neck in the full follow-through position, taking in the enormity of this disaster. Thousands, nay millions, are witnesses to what happened next. He said it!

The Editor has given me full permission to repeat it here — in this upstanding medical (and family!) weekly. Rory said, out loud and clearly: “Oh my goodness!”

I kid you not, dear reader. Incredible, unlikely, never happened, you can’t be serious, pull the other one, I hear you say. “Oh my goodness”— hereinafter OMG.

How many golfers out there have been in tight matches with normal people (or even doctors) when something similar occurred? Millions. How many have heard such an expletive in similar circumstance? I thought so — no one.

Next question: please answer honestly or incur a two-shot penalty. Did you ever shout the OMG thing when your shot went astray or nowhere? Right again; ‘no’ is correct. Have you ever whispered it? Have you ever thought it or even seen a player think it?

Silence, head-shakes, none-of-the-above. Does your committee have sanctions for such verbal outrage or is it too unimaginable for your local blazers?

PIc: Getty Images

The people I play with would be rightly ashamed if it were reported that they had made the OMG utterance. Apart from the historic, perhaps creed- or class-based, distaste for such verbals around here, there is the pragmatic aspect of what happens next when the ball is heading for the water, bushes, car park, suburban garden, clubhouse bar or wildlife enclosure nearby.

It has long been established that there are only two shots in golf; ‘good shot’ and the other. There is no need for verbal intervention when the shot is good.

The other requires a firm calling out to. The expressions used, which have been known to alter the flight and path of the ball, are usually delivered loudly, immediately and succinctly, with a minimum of one key word and a maximum of three.

The one ‘key’ word is always present and is the active ingredient in ball-flight intervention. Some attest to miraculous results. A case of hyperbolics probably, but solid outcomes are often sworn to.

It can be heard all over the course. Players at other holes, who may not be having a great day of it, are consoled and heartened at its hearing; “at least I am not alone” being the attendant thought. In the Rules of Golf as issued by the Royal and Ancient with the USGA, the ball-call described is NOT ‘an outside agency’ so one can assume that its use is legal and even clandestinely encouraged.

The recommended expression is less pious ejaculation than a tried and true formula for golfing success. The ‘key’ word likely has its origins in armies of old, particularly amongst squaddies from a nearby island, possibly related to non-golfing recreational activities. Whatever its pedigree or provenance, it is nowadays firmly established in the wide world of golf.

Like many quality items these days, cheap imitations are freely available out there and can be found in the more upmarket pitch-and-putt clubs favoured by clergymen, men of little faith. But, take it from one who knows, the simulations are inferior and do not do the job required.

Recently, I had the good fortune to play a course in the county of Mayo. On the fourth fairway, my opponent shanked (I have composed a Limerick about it). His ball headed for the nearest hazard, an oil-rich roaring ocean. He shouted “Feck it anaways!”. As expected, his ball paid no heed at all.

On the 13th, my tee-shot gained the afferent limb of Boston. I got the non-OMG word out at great decibelity. The wild Atlantic wind gathered itself up to its full height in response and hurled the yellow Srixon to the green. QED.

In Dubai, Rory sank a marvellous putt for bogey on seventeen, then went on to win. Such heroics would not have been necessary had he used the full weaponry at his disposal. Instead, he put himself under serious pressure by the useless and disproven OMG method.

Augusta in April should be in for a surprise, in the unlikely event of his hitting a bad shot.

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With a return Royal visit on the cards this Christmas to Mullinahone for the ‘special’ waters, Dr Garrett FitzGerald examines the further fall-out from the Windsor family’s continued longevity.

Big nights coming up over the Christmas in Mullinahone! Charles is coming back for treatment soon.

Philly and Lillabet are after telling Charles he better take a break after making a pork-miceál of himself again. They have asked the dwindled Dwight of the dwarf Dwyer-Dwans to have the special waters ready and hoped that they would steep the lad’s head in it q.i.d. while he is on leave over here. Cameron has asked Enda to close the ports here — after yer man arrives.

I suppose everyone has seen Seoirsín’s interview where he insisted that the Syrian war is a result of climate change. Most of my acquaintances found that the watching experience was stunning and left them with mouths in the ‘O sign’ position. It is consensus that, perhaps, chez Charlie, the wheel may be turning but the hamster is in big trouble.

Whereas the prince will be given the usual céad míle fáilte and invited to deliver his annual lecture during Christmas week (this year entitled ‘The Role of the Ozone Layer in the Losing of All-Irelands’), there are worries amongst the elders that the parents mightn’t visit again; people might get the idea that they are related to the misfortunate cawbogue.

No worries — dispatches from the Palace indicate that Philly is all for coming. “Bring it on, youssir!” said the nonagenarian. “When I’m standing next to my boy Numpty, how good will I look meself? Answer me that!”

Dwight, the youngest (born c 1434) and most stunted of the Dwyer-Dwans, during an interview on a high stool on Tipp FM, pulled no punches about the princely nature of the challenge facing the clinic. This hoor would require very close man-marking and many oodles of the ‘special’ waters. There was an element of water-boarding about it, he joked.

The therapist would have to conduct the irrigations around the foot in yer man’s mouth.

There was always a case to be made for optimism in facing these obstacles. As an example he noted a recent success in the instance of a clergyman from back beyond Upperchurch.

Only three days into therapy, the holy man had abandoned his conviction that he would attain great success as a single-sex wedding-planner in Tehran.

As we speak, there is a long line of carts — loaded with churns of ‘special’ water — causing traffic mayhem on the roads from Killenaule, Grangemockler and Fethard. Opportunistic horticulturalists along the main routes are having a field-day scooping the horse manure into sacks.

Pic: Getty Images

Whatever about local effects of the royal visit, there is great concern internationally about his proposed treatment. EU leaders have already been in touch with regulatory agencies including the Irish Medicines Board, HIQA, the European Medicines Agency, the HSE, the Harry Potter Foundation, the EU Commission and representatives from Tír na nÓg.

There is great alarm about the likelihood of side-effects of the Dwyer-Dwan waters. Experts in Trinity point out that there is already anecdotal evidence that immersion, when combined with the use of grey enamel baths, might extend old age ‘well beyond a joke’.

In support of this worrying claim, they point to some obvious hints; the already unreasonable and bizarre longevity of the owners of Buckingham Palace, the average age — around 581 years — of the dwarf Dwyer-Dwan family (it was noted that this family, albeit tiny in stature nowadays, was well above the average height of the population back in the 1400s when most of the current family were gossoons — local folklore has it that the crossbar was tied on at only four foot eight inches for both hurling and football matches back then).

Finally, it has been put about that the local population don’t get up before 12 in the day and they have their dinner soon after that.

Investigators are to arrive in droves and airplanes as soon as the Gardaí give the word that the churn lines have eased.

Clever commentators are saying that all this regulatory stuff is a smokescreen to hide a more serious agenda. The Boston Globe has leaked a story that the big worry is that Seoirsín will benefit most and will go on and on and on living. (His favourite song is ‘My Heart Will Go On’ from Titanic).

Paddy Power is giving lousy odds against him becoming king between 2065 and 2090. The plan, it seems, is that Willie too will take the waters annually at Mullinahone, ascending to the throne of Sussex, about 50 years after the second coming.

Little Georgie will succeed him as King of Whitehall when the earth is 18 degrees warmer.

At present, the only forlornish hope is that global warming will, at some yet unspecified time, inactivate the effective ingredients of the Dwyer-Dwan immersions.

Check in here at IMT for breaking news in the story — in a few hundred years.

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Dr Garrett FitzGerald is unhappy that our usually favourite Martian, whose views on Earth’s problems are pin-point accurate and listened to by most in terrestrial power, is being ignored when it comes to our ED crisis.

In the recent allocation of national resources, the HSE will receive €13 billion for 2016. Apart from the fact that this will not be enough to ‘stand still’ next year, one is expected to accept that this measure reflects some sort of prudent management of public resources and of the health service. The thinking goes along these lines (and has done for decades); here’s what we are giving this year, so come up with a service that will cost €13 billion. Use of forward or creative thinking remains outlawed. Same old.

Naturally, one can reasonably conclude that the service will do nothing new, will not shorten waiting lists, will not solve the quarter-century-old ED crime, and will not attract staff — adequate in number and quality. The prescription is for continuing chaos and disaffection.

Politicians will make great health-related promises come election time. The HSE will whine a bit, then knuckle down to business as usual. The next minister will declare that the ED problem is unacceptable and launch a 20-point strategy, or 30 or 50 or 100 — old traditions die hard. All solutions will be on the table except the one that would work. If you wish to find parallels to the outcome of this type of management in the private sector, you need go no further than Stubb’s.

The ED problem (most of the other problems are sons and daughters of the ED problem) has its origins in the budgets of 1986/1987 and will have a coincidental 30th anniversary with the 1916 Rising’s 100th.

Back in the late 80s and early 90s, the residential capacity of the service was reduced without major immediate ill effect; because, for our needs, we had too many beds. The success of this capacity reduction changed the mind-set of the health masters.

They began to imagine a future where everything was possible in their philosophy and would relentlessly pursue the capacity-reduction obsession to the gates of hellish EDs. At some stage in the process — the mid-90s — the bed-closing mania reached runaway mode, and began to backfire. In winter, especially in flu times, the creaks appeared.

Pic: Getty Images

Welcome to Trolleyland
In a short few years, a new and terrible beauty was born – Trolleyland. Blame was sought and apportioned anywhere and everywhere, except where it belonged. The shrinks have a word for this state of mind: denial. This latter condition is contagious and may explain why all remedies other than the solution have been employed over the years with varying high degrees of failure.

There is in our tradition a frequent call made on one fellow to give his opinion on all conundra pertaining to the running of earthly matters. His overview is accepted as peerless. He is, of course, the Visiting Martian (the VM).

Everybody knows what he thinks. He never gets it wrong. In the instance of EDs, he says that the capacity has been cut too much and the health service cannot be fixed until capacity has been restored. When the capacity reaches the correct level, the ED problem vanishes and Trolleyland is no more. The VM refers to such level as the ‘steady state’.

On all matters of importance and even trivia, cute politicians and cuter public servants always know what the VM thinks and says.

Such insight is the very key to their survival in the success game. I do not feel ashamed when I say that reliance on the VM (I know him simply as Mr Green) helped me through many a difficult clinical pancake in my time. The Force is always with him.

Please imagine for a moment a world without Trolleyland. Imagine civilization breaking out in the health services. Go further with the mind’s eye to conjure up pictures of humane conditions, an absence of chaos, medical and nursing staff who do not wish to be somewhere else, applications pouring in for hospital posts, decent carer-patient ratios, decency itself. The possibilities are endless.

A little Green?
For the strangest and possibly contageousest reasons, successive ministers, administrators and even some medical directors have concluded that Mr Green has got it wrong; only in this one matter, mind you. They are great followers of the VM in all other domains of their cortices.

I have been most fortunate in my extra-terrestrial contacts. Mr Green and I frequently discuss these matters, as well as a great diversity of others (you should hear his views on Tipp hurling!).

In his most recent communication, he reminded me about his friend Einstein’s view on not solving problems at the level of thinking which created them.

Then, with visual apparatus downcast and what would pass in his parish for a depressive demeanour, he opined (in his official VM capacity) that we’re in for years more of the same old shite.

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As the Trolleyland cancer spreads, Dr Garrett FitzGerald believes Irish politicians are like car dealers, trying to sell us scrap metal on wheels and telling us it’s the real deal.

Trolleyland, having conquered hospital ward corridors, is now to neutralise the remainder of the hospital. Since the recent nurse-HSE dispute, there is agreement that, in times of hiberno-viral war, the elective functions of the services will be shut down sine die. This is part of an Escalation Policy that, at least in theory, elevates ED needs to a higher level in hospital priority than its long-standing F-minus status. The nurses had been pushed too far.

The deck-chairs have now been switched. A different group of patients (electives) will get a fairer share of the punishment that is being doled out at many venues across the country. Much needed R and R downtime will become available to the medics who languish in operating theatres carrying out non-emergency interventions from long waiting lists. Lots of early morning phone calls (stay where you are boss, we’ll call you) and all manner of things shall be well.

In the 1990s, the half-century-old tradition of admitting all patients who required urgent admission to hospital wards — irrespective of availability of beds, was abandoned in favour of keeping them in ED. The practice of putting up temporary beds in every ward became outlawed. The nurses had been pushed too far. Trolleyland, a terrible beauty, was suckled and reared.

By 2011, partial reversal of this ‘previous’ solution to the crowded ward problem allowed for two or three trolleys to be moved into each ward — as a (partial) new solution to ED chaos. The deck-chairs weren’t switched, but they were put facing in different directions.

Which all brings us to 2016, where the furniture is to be placed in the engine room and the engines shut down. One right can make a wrong.

Underlying all of this ongoing — and worsening — situation lies the dreaded R-word. Reality. Not a word to be trifled with, or taken lightly. It is, as current zeitgeist goes, best denied absolutely.

Yesterday, upon the stair
I met a man who wasn’t there.
He wasn’t there again today,
I wish, I wish he’d go away.

Pic: Getty Images

Non-deniers, of which there are few, say daft things like the following:‘The population has grown. The elderly multiple-afflicted population has increased. The population of survivors of major illnesses such as CVA, cancer and heart disease has enormously increased. General practice does not have the weapons (bloodwork, imaging) or therapeutic armaments (drip, oxygen, IV medications) to provide modern acute care outside the hospital setting. Modern diagnosis and treatments cost a fortune. Current capacity restraints guarantee that the problems are insoluble.’

The bottom line is that we cannot have the Mercedes E-class for the price of a 1980 Lada. Yet, somehow our administrative zeitgeist says “Yes, we can!” There have been notions abroad for a few years now that, if you had cut down on the number of ‘pen-pushers’, given Michael O’Leary the reins, did extra rounds of a Sunday morning, and sent in Martin McGuiness to negotiate the price of the oncology drugs, you’d be able to start up the old world-class waffle again. All, of course, equivalent to valeting the Lada. To quote my late Armagh-born mother-in-law, “me arse and parsley!”

The real conversation around the crime of what is being done to our sick brethren has yet to take place. It has to do with money. The citizens are not really being told, or perhaps are not ready, to contemplate the real deal; they cannot have the Merc unless they pay for it. Successive ministers have evaded the real Merc-Lada debate and pretend that there are solutions in the handbook Machiavellian Aphorisms for Simpletons. Policy is this: show ‘em the Lada and tell ‘em it’s a Mercedes.

Paying for it all would consist of an immense increase in contribution. The real cost is probably something like a 50 per cent increase on today’s spend. Not paying for it gives you the nada-Lada — exactly what you have now, a furniture interchanger’s paradise.

The current Government ran with the universal health insurance delusion for a few years. Then they found out, to their astonishment apparently, that the real cost was off the walls. They dropped it pronto.

It would mean hitting the election doorsteps with proposals for a vast increase in financial charges for every citizen. It would have the same chance as Pol Pot coming to ask for the daughter-of-the-house’s hand in concubinage.

The criminal conversation will not happen this side of the Leitrim three-in-a-row. Get ready for same old. Reality isn’t coming soon to a theatre near you. Bring War and Peace next time you’re in an ED. If you are lucky, you might get to finish it in a non-elective ward.

When I came home last night at three
The man was waiting there for me
But when I looked around the hall
I couldn’t see him there at all.

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When it comes to improving the health service, Dr Garrett FitzGerald believes we have to recognise that extra taxes are required to pay for it — otherwise we all may miss the bus.

It takes the bus two hours to get from Waterford to Dublin, give or take five or seven minutes. There is nobody in the bus office making promises that 60 per cent of the bus will get to Dublin in nine hours and that there are targets to have 75 per cent of the bus reach its destination in six hours by 2027. Neither is anyone saying that entry to the bus station within one calendar year can be achieved for 80 per cent of the passengers.

Parallel to these non-statements, there are no newspaper reports showing that, in fact, the journey took four days or entry to the station was at almost two years.

So, the bus is very different to the health service. Perhaps the bus-man should be in charge of health? Rapid Express is one of our most successful bus outfits. They’ll get you to Dublin. To date, there has been no edict to remove half of the seats from the coaches or to limit the number of passengers to three or four. Or to not employ any drivers. Nor to put in only a tablespoonful of diesel. The punter pays about a tenner each way. Or somebody pays it for him. There is no chance that you will be told that it can all be done for a fiver.

Bus-ted economics
In the Pretend Health Service, bus rules do not apply. Politicians, parties, ministers, candidates and wafflers alike tell you that they’ll get you to Dublin in reasonable time (albeit on a driver-less, seat-less, diesel-deficient, non-existent bus) and it’ll cost you hardly anything at all. To suggest that you might have to pay some extra taxes to do the health equivalent of what Rapid Express does will not get a hearing at all. Health passengers and their people do not have ears for reality.

This is because of the well imagined fact that there is a big money chest of unlimited capacity in Dublin. At times it becomes a little depleted, in which event a race known as ‘Others’ should be made to top it up. This money is then given to the health people by the Government to ensure a timely, modern, no-waiting-lists, instant, luxurious, world-class service. Aspiring TDs make sure that the population understand the veracity of all this. The health service bosses are made to proceed in this fictional universe dictated by the denial/ delusions/ falsehoods of their political masters.

Perhaps the bus-man should be in charge of health? Pic: Getty Images

You know, of course, what happens to the health-bus next; they take off the wheels. They then send out a spokesperson (Darcy?) to sing the old refrain, “Our problems cannot be solved by throwing money at them!” Pat Shortt’s schoolmaster comes to mind: “A right funny man Darcy, a right funny man!”

Magic numbers
Official magical thinking never extends to the magic number. I do not know what this magic number is — perhaps it is 19 billion, maybe 22 billion. It is the number of euro required annually to ensure a health service that is close to requirements and reasonable aspirations. In my simplicity, I think of it as the cost.

The cost is the amount you have to give to get whatever it is you want. If you don’t come up with the cost, they don’t give you the goods. If you give half the cost, you get half the goods. Some non-mathematicians call it ‘reality’.

For many years back, our weird official orthodoxy has been to hold the view that cost has a wide spectrum of meaning. Terms like ‘Ten euro’ or ‘Tuesday’ or ‘Tooth’ are not afforded such rainbow interpretation, yet ‘cost’ is a whatever-you-think-yourself concept in health. It is a thing that dare not speak its name.

Reality checklist
In the recent election campaign, most would-be TDs had a bit about health on the flyers, which came in through our letterboxes.

Not one of these aspirations had any basis in reality. Perhaps each promissory health Garryowen in future elections should state the cost of each measure (e.g. doubling of the mental health budget, expansion of local Emergency Department, extension of free medical cards to population X, etc). Beside these should be noted the extra tax which the voter will be paying for the promised measure.

Such an honest approach would send out the missing message; if you want a really good service it will cost money and the money will have to be raised by taxation. Location of the would-be TD on the political spectrum will then dictate whether it’s to be you or ‘the other fella’ who will cough it up. But someone must pay for it.

The magic amount necessary to bridge the gap between the shambles we have now (1980 Lada) and a decent service will necessarily all be additional spending (and therefore new tax). It is my contention that this magic number is somewhere between €5 billion (newish VW) and €9 billion (basic Merc). Each year the price will go up.

Meantime, the service continues to be in the hands of fiscal spacers.

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While researching his family tree, Dr Garrett FitzGerald discovered some unusual annotations in the baptism entries for the 1850s, recording the christening of many a Winny, George, Cecily or Gyles with a particular, frowned-upon parentage.

During my very brief period of obstetric training as a medical student, in the closing days of the piety epidemic and in the reign of John Charles, a serious hush would descend on all gathered in the event of an ‘unmarried birth’.

It was something that the kindest amongst the carers pretended to ignore. A wise midwife from Mayo advised that we should “say nothing for a fortnight and then say it again”.

Yet, in those days, one could not avoid becoming immersed in the pervading air that took possession of the place, with its allusions of British soldiers, Henry VIII, mortal sin, loose morals, sailor’s itch — not to mention a hyper-alerted wariness of old and pallid treponemes. No need for HIQA in those days to ensure Pontius-Pilate-level hand-washing.

By then, sin, guilt and shame mixed with anglophobic anglophilia had almost irreparably mangled the Irish cortex. Luckily, I did not attend any of the even more celestially connected maternity units, whose righteous-intolerant joie-de-vivre was piped in directly from the Italian side.

Magdalene laundries
The handmaidens in the punish-the-penitent, baby-for-sale laundries would have been alerted long before the breaking of the waters. All going well, a terrible bastard was born. Statues in the maternity wards wept blood. Such was the manner of things in the past, the most foreign of all countries. This is the place wherein I now often dwell, as one learns from an interest in genealogy.

It was a trip to the ancestral 1850s that triggered the above memories of childbirth in the 1960s. I had been looking for a Mr O’Callaghan’s birth in the records of Lattin-Cullen in Co Tipperary, poring over the handwritten baptism entries of the time, but he failed me by being born somewhere else — a rare feature in the life of Lattinos of the time.

Nothing for it then except to fine-comb the books of surrounding parishes. So I started in my home parish of Tipperary, commencing with an estimated year of 1852.

Tipp of the iceberg
For fear of denigrating my fellow Tippmen, I will almost desist from stating how many births were proudly declared to be ‘Illegitimate’ (not ‘against the head’), usually only written ‘Illeg’, which I had charitably taken to mean that the baby was unable to read.

This sinotation was most clearly displayed in the record, leaving no doubt where the child came outa.

Cecilia was one of the ‘names’ printed in the baptismal records

Garrison town
In fairness to the Premier men and women, it must be said that, 1. Tipperary was a garrison town, and 2. Many of the ‘sinners’ had smuggled the child for baptism into Tipp from quare places in Co Limerick, such as Doon, Oola, Galbally and Pallasgreen.

I presume that they arrived in dead of night in boxes hidden under blankets on ass-and-carts or, in the case of the elites, pony-and-traps.

Chances of eternal spiritual surveillance were diminished from the word ‘go’ for these unread babies; they got only one sponsor rather than the customary godfather + godmother combination; it was usually the sacristan who had to do the ‘dirty work’ year after year.

Records exist for Tipp parish dating from 1793. In the beginning, no comment was made on the baby’s relative right to exist but, as the years went on, it somehow became necessary to demonstrate their ‘lessness’.

Up to 1856, a short entry (‘Illeg’) beside the name sufficed. Not enough for some, it seems. In March 1856, the ‘illeg’ tag was dropped but the sin babies were now to be otherwise labelled.

They were christened either Winny or George — almost every one of them! Ongoing from June of that year, each Winny or George entry was given back its ‘illeg’ label — to be sure to be sure. Between March 1856 and August 1857, there were 21 Winny and 15 George christenings (from a total of approx 350 births).

A change of heart followed in September 1857 and the Winny/George hegemony was abandoned. It was replaced with Cecily (or Cecilia)/ Gyles (or Giles)! Between late 1857 and March 1862, there were 148 Cecily or Gyles entries from a total of 163 ‘illeg’ births.

The puny (15) remainder were given more usual names such as Mary, John, Pat and Bridget. The ‘illeg’ rate from 1856 to 1862 was approximately 12.5 per cent (248 of 2,008 approx).

Some class of edict from above came to pass in 1862. Cecily and Gyles abruptly ended. The last Gyles was born again on 20 February, 1862 and the last of the Cecilys on 10 March, 1862.

Normal service resumed; plain ‘illeg’ with plain names became the restored order of the day. I have yet to figure out the reason for the use of Winny, George, Cecily and Gyles. I would be grateful for my reader’s input. In some parish records that I have examined in my peregrinations, the labelling is less legalistic; the term ‘illeg’ is simply replaced by ‘bastard’. The past is definitely a country where things are done differently.

At the heel of the hunt, I didn’t find my man O’Callaghan’s birth entry in Tipp. It gives me great pleasure to announce that he married into a farm of land in Emly and his happy and mostly legitimate marriage is recorded, without any asbergers thrown, in the Emly parish records.

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With the meteorologists running out of letters to name the storms of 2016, Dr Garrett FitzGerald recounts the events of the ‘Night of the Big Wind’ in 1839, and its unusual ill-effects on one of his Mayo ancestors.

There is a big wind out as I write. Storm Jake, they call it. It would blow a harrier off his prey.

They started with Abigail in the autumn and are working their way up the alphabet via Barney, Clodagh, Desmond, Eva, Frank, Gertrude, Henry, Imogen, and now Jake. Puts one in mind of the man from Upperchurch who had 14 poetic children back in the anovulant-free 1930s:

Barry, Larry, Mick and Harry,
Davy, Tim and Dan.
Sarah, Jinny, Nora, Winny,
Mary, Kate and Ann.

The storms will pass. One or two days of the east wind in April and the ground will be cracking. Lads and lassies will come out to play in the near-zero temperatures and old lads will delight in the great “stretch in the evenings”. Only last week in Tramore, there were two days back-to-back during which there was no rain. You would have sworn that it was the August bank holiday.

In case one hadn’t noticed the almost blue sky, people were anxious to tell one about it triumphantly with levators palpebrae well drawn back. In my shuffle along the promenade, the good news was imparted to me on dozens of occasions by people I never saw before (outside the therapeutic setting). By the time I made it to the lifeguard’s hut, I knew grand day better than my six times tables. I regretted that I did not have equally hot tidings for barter, such as the Fall of Mafeking or the Japanese surrender aboard the Missouri.

The climate-change experts tell us that this weather pattern is here to stay and will worsen considerably. It seems that we’re gonna need a bigger alphabet; 26 storms will be a thing of nothing in future years, a mere warm-up to the real weather action.

We are in pre-emptive mode down here as usual. The Déise School of Climactic Linguistics, in cooperation with Waterford Whispers, is now offering night classes in Khmer, a language with 74 difficult characters in its alphabet. I am told that already there have been 74 difficult characters sent from the Déise to Cambodia to learn the tongue. The principal of the college believes it is the coming language.

It is already well established that endless wet dark days have made a contribution to our rapid evolution into the modern master race. You only have to listen to the news to appreciate how bad things are in the places where there is almost uninterrupted sunshine.

There are, however, some historical and clinical pointers to climate disturbance having undesirable effects on the head.

Admittedly we get SAD, depression, morbid jealousy, cabin-fever, flooding and flying slates but, on the whole, nothing serious. The real effects on the head are more subtle and diabolic.

The Night of the Big Wind, January 6, 1839, will be described in future chronicles as little more than a freshish breeze.

The calm after the storm — Killala Bay, Co Mayo. Pic: Getty Images

First reports came from Mayo where the steeple of the Church of Ireland in Castlebar was blown down. Bad news soon followed; the whole of the Catholic church in Derrytrasna near Portadown was thrown to the ground. Possibly as many as 300 Irish people lost their lives during the storm.

My cousins were not unaffected by the night. Ancestors of mine came from Kilmovee, Co Mayo, including a deceased-in-law-to-be, Father Robert Hepburn, parish priest.

Friar stuck
Nearby was the historic Dominican Abbey of Urlár, which had suffered dissolution (which the monks ignored) in the early 17th Century. The friars continued their ministrations from the Abbey until 1698 at which juncture they had to abandon their 14th-Century abode and go ‘underground’. Despite officialdom’s suppression, friars stayed ministering in the locality right up to the 1830s. These few men had been ordained in Rome and had secretly made their way home. They were the only spiritual (and probably physical) aid and were kept busy by the demands of their large Catholic flock.

After Emancipation, the Roman Catholic Church formed a more secular administration with priests of the Diocese of Achonry taking control of the parishes in parts of Mayo. Such new men were instructed to inform the faithful that ‘us new lads’ were taking over and to not bother themselves with the use of friars. This was understandably lead-balloon country chez the friars.

Possibly the last of the friars was Father Sharkey. He was called upon on the morning after the Night of the Big Wind to administer to a family in the district, taking with him a local man Jack Rush to see to the horse. It is recorded that Sharkey told Rush that the friar had spent the previous night outdoors ‘ twixt lake and abbey’ shouting at the wind, “Séid, a Dhiabhal, séid!” (Blow, Devil, blow!).

Having successfully attended to the sick call, Father Sharkey came by the house of Father Hepburn, saying to Mr Rush, “There’s a man in here and I’ll make him keep his tongue off me.”

Details of the ministrations to Robert Hepburn are not known, but the previously healthy parish priest spent the remaining five years of his life confined to bed and died a young man in 1844.

Whatever else can be said about the bad weather to come, one should be cognisant of ill-effects on the head.

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While a certain sartorial look was once expected among the professional classes in Dublin during his former UCD days, Dr Garrett FitzGerald recalls the quite different ‘uniform’ on taking up his registrar post in Galway.

Those who know about things are in accord concerning the slippery sartorial slope, which seems to be unending. Proof of this is seen in the dearth of references to ‘one’s tailor’ in the newspapers.

Men of substance in the literature of our far-off schooldays were always in debt to their tailors.

One was nobody at all if their suit didn’t come from a firm who could boast appointment to the queen, much like Benson & Hedges cigarettes.

Professional men were expected to announce their importance through the medium of their clothing.

Even my hometown boasted three busy tailors who could assemble a suit-of-clothes for you in six or eight weeks.

One such firm would have the coat ready for fitting within a fortnight, but there could be some irritating delay in the trousering department; this was explained by the tendency of the leg man to take contemplative leave about once a year — an ailment that usually reached its denouement on discharge by the good monks.

I was fitted in stages for such a staggered suit to coincide with my arrival at UCD to be made a doctor out of.

Three-piece was the order of the day amongst the established and aspirant professional classes in our capital city. Stylistic elegance of the hierarchy ascended from initial dowdiness through succeeding medical school years. By the time we hit the hospitals, one could have no fears for the livelihood of Maurice Abrahams and some slightly lesser but equally expensive bespoke clothiers. By observing senior colleagues, it became apparent to one that the road to success in Fitzwilliam Square was festooned with many or all of the essential components, such as a grey/navy pin-stripe suit with waistcoat highlighted by a rugby club/old school/medical school or royal college tie — many of which bore testimony to the specialty and religion, even the denomination, of the wearer.

Shirts were white or blue — the latter a preponderance in my own hospital. Socks frequently came in understated, unstriped silk from Silberry’s of Dame Street, while shoes, which bided their off-days in serried ranks of shoe-treed glory in Leeson Park’s or Killiney’s finest mansions, were mostly sourced from the outer coatings of now-extinct animals.

Overcoats came in three main varieties; the charcoal cashmere, the camel-hair, and the sheepskin — reserved for weekend Rugby matches. The flat cap was nowhere to be seen amongst doctors outside of places like Cork and Longford. An odd surgeon wore a papahka to denote his White Russian leanings and always requested that matron hand him his ‘astrakhan’ when leaving the hospital for lunch at his club on the Green.

Pic: Getty Images

My late mother, God love her, brought me to an off-the-peg draper in Dublin on my 21st birthday. A sheepskin coat — three sizes too big — was purchased and the rest is history. I was on my way!

Dr Leopardstown
At the conclusion of an obstetrics lecture in the college, it was the unusual habit of one teacher to ask questions of the students and on one occasion while I was snuggled into the coat, he directed the query at me and addressed me as ‘Leopardstown’. Surely I had arrived!

It was a good career move to land a registrar job in the professorial firm in Galway. The only question remaining after such trivia as organising a dwelling, schools for the children, a bank loan and a car was what one should wear.

At the time, most people were aware of the Galway shawl and the Aran crois glimpsed on postcards and in Pathé newsreels. Instinct informed one that coming as Dublin doctor/London undertaker might not be the thing.

Fisherman’s clogs
Questions romped through the cortex, evoking bookmaker’s answers. The Galway doctors were unlikely to be wearing fishing-fly decorated green hats with the hair growing up though them. They surely wouldn’t wear fisherman’s clogs. They would not have thick homespun and homemade trousers suspended with the crois, with the fly buttons on the outside. No, they could be wearing thorn-proof tweed suits and Viyella shirts like the vet students in Dublin, and maybe the odd racing hat and thick-rimmed glasses. Brown boots laced with tar-augmented oakum to counteract the Atlantic mist would be the banker. I hocked my fob and watch and stopped polishing the shoes a month before departing.

After all, I wasn’t going to Cork, where I would have expected to concentrate on road-bowling apparel and sailing gear for Crossers. I also conjured up images of flat caps and whippets to include those colleagues with more rural origins. How wrong were the postcards and the newsreels!

The only bit they got right was the absence of pin-stripe suits. You wouldn’t necessarily be able to pick out a colleague in the street. They were delightfully normal. Travel broadened the mind and allowed me to shed the uniform.

In any event, Bri-Nylon had arrived. Drip-dry, you could wash the suit in the sink, squeeze it out, roll it in a towel, and put it back on immediately.

And you could charge your car battery with it.

Who needed a tailor?

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The conditions of the Irish health service have meant nurses said goodbye to the days of Florence Nightingales many moons ago, and find themselves instead battling against the lure of foreign but better lands, says Dr Garrett FitzGerald

In the public press, particularly in the “comments” sections, administrators are a bunch of hoodlums holding everything back, while the doctors and others at the coalface are wonderful entirely.

Top of the eulogy pile, nurses get the best lauds of all. They are Florence Nightingales, striving might and main to heal the sick and comfort the afflicted against all the odds in desperate conditions, and are underpaid, abused, saintly, devoted, and driven by vocation.

Some of this is true. On the other hand, most nurses I meet are extremely displeased with their lot and have had a more than adequate bellyful of the vocation stuff. They are not Florries in the real sense. Most do not see themselves as devoted missionaries.

They are well trained nurses and willing to go the extra yards at times because of the nature of their work and their persons. If they were the full Florrie, they would have stuck around. Those whose life circumstances permit are nurses in Australia, Canada, Britain and other countries.

Many of those remaining did not go away because they have family and commitments here. Otherwise, they too would have left the native shore. Many have become resigned to a job that is often chaotic, disorganised, overwhelming, depressing and without any glimmer of light. They tell me every day how lucky I am to be ‘out of it’. The most hoped-for state of being is retirement. Meantime, many are condemned to endless years of nursing in Irish hospitals.

Pic: Getty Images

The Florrie element
The Florrie element in a nurse’s make-up is a small part of the whole. They are normal citizens going about their lives, picking up the dwindling pay packet at the end of the week.

Some face each day as if on the way to the guillotine. Some cannot take any more of it. Sick-days are frequent. Their daily working lives are almost polar opposites of how they envisioned life when they qualified. Many hate being a nurse in Ireland.

So, it is best to dispense with the Florrie nonsense. Yes, most are efficient, kind and thoughtful and the thanks they get from grateful patients and relatives is helpful, as is the reward of each job well done. But at the end of the day, there is too much downside.

There is too much disorder, hassle, bossiness, professional bureaucracy, workload, restrictions and negativity. And out there in the main world which they inhabit after work, there is free-floating anger and rage about the health services. They endure this every day.

Some older RC readers will recall the advice about invisible stuff that aids the spirit in its journey to the life of eternal bliss in Heavenland. There was sanctifying grace and then there was the (lower case) actual grace. See how a major RC website describes the difference:

Grace of God
“… there is a difference between actual grace and sanctifying grace. An easy way to understand actual grace is to remember that it enables us to act. It is the strength that God gives us to act according to his will. Sanctifying grace is a state in which God allows us to share in his life and love. When we speak of being in the state of grace, we mean the state of sanctifying grace. There is no mortal sin in us. This grace comes to us first in baptism and then in the other sacraments.”

To draw a parallel, nurses may get touches of the really good sanctifying stuff in the cortex, but this is far outweighed by the need to cope actually with their everyday lives. The Florrie bit is only a trickle in the flood of actuality. It’s not enough to balance the package. So it is too for many other grades and specialty of health workers.

There has been a healthcare recruitment fair in Dublin recently. Countries all over the globe were here to entice our nurses, doctors, technicians and therapists to foreign lands with sweet offers on pay, conditions and lifestyle. Warm feedback was given to those enquiring by ex-pat nurses and others. The overwhelming message was a call to a reasonably normal life attended by a satisfying professional one. Skype and Viber could at least attenuate the ‘miss me mammy’ bit.

Fare thee well
I hear the interest in the fair was phenomenal. One can understand. Many are signed up already. Fare thee well, my lovely Dinah, a thousand times adieu.

Apart altogether from the grave chronic failure of our health system itself, it does us no credit that many of our carers work in such a sorry mess and in such a state of mind. New beginnings will be extremely hard to find.

The Florrie factor won’t change anything. Very few will come home to work the Irish mission. Efforts to re-entice nurses back are already in failure.

Sadly, our own version of Disney World is to blame; we have created the perfect Mickey Mouse health service.

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Debunking the big lie that money can’t solve the problems in the health service, Dr Garrett FitzGerald laments the fact that we have yet another government planning for Mercedes while using Lada money

The problems in Health can not be solved by throwing money at them.” It’s now three decades since this (or similar) outpouring became the official line of ministers, politicians, departments, CEOs of health agencies, finance experts, economists — and lots of eejits too.

There has been a sort of three-monkey embargo on utterances, which go contrary to this semi-official shibboleth. I studied for a diploma in management for doctors in the mid-90s; a suggestion that more money should be invested into health services was the equivalent of chickens voting for Colonel Sanders.

The no-no idea pervaded the atmosphere. All problems could — and should — be solved by preventative care and efficiencies of management. Worse, most of the lecturers believed this concentrated dose of crap.

Behind the semi-official curtain of illogicality and falsehood, the powers that be have managed to confuse the politicians and management — and themselves. The medical Maginot line must be held or all is lost. The barrier erected has stymied all progress and is responsible for the deteriorating services over the past 30 years.

First, the big lie. There is a word too many in the main slogan. The word is ‘not’. If one changes the first sentence in this article to “The problems in Health can be solved by throwing money at them”, we have arrived at Truth.

I cannot name one deficit in the service that cannot be solved by money. Money is the magic ingredient that gets you more doctors and nurses, more hospital beds, more extended-care places, more home helps, more therapists, more effective EDs, more equipment and better managers.

Money is the ONLY thing that can do all of the above. Reorganisation (same monkeys, different cages) of personnel, names and administrative lines does very little, if anything, by contrast.

We are in the age of the 1980-Lada health service. Switching Mickey Mouse men around the factory floor will not send out a 2016-Mercedes Benz from the delivery end of the assembly line. Money can.

Our health services’ biggest problem is a shortage of money.Once one has accepted this fundamental truth, moving on is possible. At present, there can be no movement and future plans (the latest is a 10-year plan to build on 30 years of failure) are firmly founded on the big lie.

‘We are in the age of the 1980-Lada health service’. Pic: Getty Images

The latest reorganisational vista brings with it the false notion that things are going to get fixed. They have been switching the deckchairs in Britain for 50 years and they are nearly as bad as we are. Our main organisational contribution has been to copy every mistake the Brits make, but we do it 10 years later than they do.

In some countries there are solutions for regimes that have managed to persist with failure against all the odds; the most notorious but effective is the firing squad. No such easy solution is available here. It is highly unlikely that the same mindset and the same minds that contain it can adapt to the radically different requirements of a successful about-turn. Old dogs do not learn new tricks.

The record speaks for itself. It loudly trumpets abject failure. EDs are chaotic and worsening. Waiting lists for consultations are the longest since the dawn of time. Procedural waiting lists are now in the realm of nightmare. The public do not have any confidence in the system. The staff are abroad. The delusion of the big lie pervades and corrupts all thinking and all attempts at solution.

The plans call for more of the straitjacket cerebration. The theme-song is simple; it speaks to the ultimate delusion, which insists that you can have the Mercedes for the price of the Lada. Future direction is based on this erroneous paradigm. Which brings us back to the solution. Money.

Health Disneyland
Perhaps it is time to state the unthinkable; there is not enough money to give you all the Merc, folks. For too long, it has been the mantra to pretend that, in our Health Disneyland, reorganisation of deck-chairs will somehow succeed — where only money can. Pack-shuffling and money have equal status in such a fantasy land. Our masters have dwelt in this denial place for many decades and, worse, plan to stay there into the next 30 years of ever-increasing failure.

It is now time to break into reality before the next in a succession of lie-based grand-plans gets legs. Perhaps the new Minister for Health should have it pointed out to him that the most recent acceleration of failure (2008-present) was caused by a lack of money, not by a deficiency of pack-shuffling. He is already committing himself to the latter. Can he be stopped before the next failure decade? Doubtful.

We seem to be in the unrelenting grip of the flat-earthers. They are planning for Mercedes using Lada money.

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Having taken the Oregon Trail in ’66 after graduation, Dr Garrett FitzGerald recalls the welcome and encouragement of the late Dr ‘Buck’ Shields — an inspirational role model for any doctor in the making

It was the time just before medical gods began the slow descent into mortal form. One bad look from the professor, it was believed, and you may start saving the fare to the new world.

Students in the teaching hospitals perceived that it was a near-fatal career error to cross the main man or, in some cases, the head nun. Each hospital had its own gods and each god was unquestionably a superior god to the god in the hospital down the road.

About one-quarter of my graduating class of 1967 boarded planes for the United States and Canada in the final week of June, and most were never seen again. They did not fancy the stifling atmosphere that they perceived at home.

Many had tasted the other life already as they had carried out ‘externships’ as final year students in US hospitals during the previous summer. Large contingents went to Texas and Michigan. The Americans had their own agenda of course; they wished to attract as many Irish interns as possible the following year.

The Oregon Trail
Five of us went to Portland, Oregon — specifically to St Vincent Hospital. We did a two-month stint, one in Surgery, the other in Medicine. We were interns in all but name and performed the usual duties, with the exception of prescribing.

I started with Surgery. Nothing could have prepared me for the experience. Dr Miller, the residents’ (we resided in the hospital grounds just above the nuns!) go-to man, assigned me to Dr A. B. Shields.

‘Buck’ Shields waited for us in the doctors’ alcove of the cafeteria that first morning. “Hi Irish!” he called out. “You guys are the Black Irish. My people are the White Irish, right?” His grandfather James Shields had left County Down in the mid-19th-Century and had settled as a farmer in Kansas.

Buck got his MD from Kansas in 1940 and moved to Portland for his internship.

Thus began a wonderful summer. Buck encouraged us in every way — always eschewing the tut-tut stuff and the cutting eye, instead bringing a great warmth and humanity to our early medical lives.

He brought us along gently in the operating room, the wards and the clinics. His interaction with patients was simply gracious. In our early searching, it was never far from our minds that here was a role model for, at least, the kind of doctor-person we would wish to become with time. It was liberation! There were long hours in surgery but my attention never lapsed. Every day was a learning day. We learned so much.

Providence St Vincent Hospital, with Dr ‘Buck’ Shields inset

Buck’s hereditary ‘céad míle fáilte’ attitude never lessened or wavered towards us no matter how average our performance fell to at times. There were no judgements, just quiet-word correction and then ‘move on’.

On our first weekend in the job, Buck invited us to his home. His wife Alice had steaming corns-on-the-cob (and a great meat and potatoes course) ready and we shamelessly guzzled at them with the butter dripping off our faces and running down the legs of the table. My old taste-cortex still records this as the greatest culinary experience of my life — and I’ve had a feed in Fouquet’s! The Shields family gave us a day of days, never to be forgotten.

On July 12, we were paged to come to the cafeteria — urgently! Rushing down, we found Buck surrounded by orange bunting — with a small tricolour in the middle of the table and a smile wider than Crater Lake. “We are celebrating being Irish today,” he said.

Buck took a few hours off every Wednesday. Not once in the two months did he allow us (Liam McDonnell and I) put our hands in our pockets as we two failed to become golfers at his club and at Meriwether. He supplied green fees, clubs, balls, tees, and bought us a couple of beers afterwards.

I recall finding my ball in very long grass and suggesting that it was unplayable. He was having none of it. “Hit the damn ball out of that grass,” he roared. “Why, it’s no more than pecker-high to a tall injun!” — the same can-do he showed in his medical practice and in his life.

Before we knew it, it was time to go home. It was difficult to leave Portland and the family Shields behind, but that’s what you do when you are 22. The long road with no turn.

Fifty years have passed. I lost all contact with the Portland episode, yet often wondered about the obvious questions. Recently, interest in genealogy gave me the facility to search.

An obituary for Buck appeared on my screen a few weeks back, complete with photograph which almost melted me. The great news is that he lived to be 99 years old, passing on at his home in Portland in 2013. He was as generous and humorous to the end. My great regret is that I never got to thank him. When I come back next time, it’ll be very close to the top of my to-do list.

Ar dheis Dé go raibh sé.

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Dr Garrett FitzGerald

Donald Trump’s colourful ascent to the US presidency has the experts at the Cortical Institute in the South East scratching their collective eggheads, says Dr Garrett FitzGerald

Hey Mr Tangerine man, play a song for me,
In the jingle jangle morning I’ll come following you.

The jingle-jangle morning has arrived. The Americans have voted to come following him and the Donald is the head man now, as prophesised by The Simpsons. He is to make America grate again. He is to march into the sunset with his auld pal, Vlad Putin.

One of the sharpest minds in the Cortical Institute here has brought our attention to the possibility that there is something isotopic going on chez Trump. This researcher quoted passages from the most prestigious anecdotal literature, the most appealing authored by Pauline Kael of The New Yorker. Writing about former screen idol Robert Redford, she said: “He has turned almost alarmingly blond — he’s gone past platinum, he must be plutonium.”

I need not tell you the stunning effect such allusion had on the assembled eggheads, the day that was in it; the day they elected the Orange Man to the most powerful office on the planet.

Our lateral thinkers were already a step ahead. The brightest sparks among them had consulted an even brighter one during the campaign for information on the medical causes of orange skin-and-hair. At the time, I gave them a modest if biased reply, favouring gems from my pioneering work on selenium toxicity with xanthotrichotic overtones.

But, back then, I hadn’t known about ‘my pal Vlad’. Those of us who had been keeping an eye on Russia have our reservations. We are particularly mindful of the lad with the umbrella, who discharged from it a plutonium-encapsulated ricin pudding into the thigh of Bulgarian dissident, Georgi Markov on Waterloo Bridge in 1978.

We recall also the polonium-210-laced cup of tea — at the Millennium Hotel — that terminated one Alexander Litvinenko in 2006. Vlad the Lad is still mentioned in reports of these events. Therefore, we have our suspicions that it may already be too late to urge caution in The Donald’s courting of said Vladimir.

By coincidence, CPD had us working on XRT (xanthorubrotrichosis). Very timely. It is easy to rule out the usual causes of progressive citricality in this case. Had he been using excess selenium, the hair would have fallen out by now. The Donald does not drink water from a well that has too much iron. Nor does he use low-quality shampoos in his golf resort in Donaldbeg. He does not disport himself at marching on the 12th. There are few oompa-loompas in the family background.

That leaves us with only one possibility; the humble isotope. Now, let us take a leap into ‘conundrum 2016’. Pal of the Vlad plus orangeism?

Elemental, my dear Watson.

The prognosis will depend on two factors; dose and portal of entry — too late to build a wall. What a paradox we have when the lad who is thought to want to make America white again is himself turning more orange by the day. And we know that orange is the new black.

Isotoupées
Our scientists are burning a lot of nuclear fuel in a race to be first to identify the culprit isotoupée. They are particularly interested in any substance which may cause Donald’s Dyad; shortening of the fingers and endowment of the member.

There are signs already that the radioactive agent employed is having its way on internal tissues. ‘Mashed-potato Brain’ has been a notable feature of published cases to date and it seems this one will be no different.

The Tangerine Man is astonishingly playing a new song for us and given the thumbs-up to Obamacare. The Mexican Wall has given way to a little bit of fencing here and there. It is even being reported that California has been given the all-clear to release the remaining Japanese Americans interned in 1942.

There is unending post-election good news: waterboarding is to be confined to Muslims who are in custody rather than those at airports or shopping malls; Hilary Clinton is now a wonderful woman; a few Mexicans have already been convicted of not raping — even once. The volte-face gets better: slavery will not be reintroduced until after the Superbowl and pet cats may no longer be snatched at in the locker room.

‘Duck Donald’
It is a tribute to the success of the American Dream that there are more presidents who have not been assassinated/nearly assassinated than presidents who have. The old anxieties, however, returned lately when some cortex at a Trump rally shouted “Gun!” Screaming dyslectically, “Duck Donald”, the Gauleiters whisked the candidate away in a show of conditioned plumbophobia. There have been too many assassinations.

Nobody wants to see any more of that stuff.

The sombre men and women of our Cortical Institute agree with this latter sentiment. They are not, however, hopeful. It is their clinical opinion that such an event has already taken place. They urge the employment of confirmatory Geiger counters in the interest of peaceful transition.

The post The jingle-jangle morning appeared first on Irish Medical Times.

Dr Garrett FitzGerald

Facing into a winter crisis yet again, health workers must decide whether to allow yet another government to makes pigs and dogs of our nearest and dearest on the sickest days of their lives, says Dr Garrett FitzGerald

There is something seriously wrong with Planet Ireland. Winter came again as it has at this time of year every year for eons. Influenza came again as it has at this time of year every year for eons. People get sick in the cold weather each year as they have been doing since Africa and South America split off.

It is difficult to believe that, apparently against all the odds, all these things have happened again this year as have happened every year since time immemorial. How astonishingly grotesque, unbelievable, bizarre and unprecedented the world has become.

The time has surely come to pursue the destruction of our health services with renewed vigour. Simple chaos is not sufficient unto the day. The chaos of last year, or the one before, or the one before that was just not chaotic enough.

There have been no official statements from the Equinocopric and Taurocopric Councils of Ireland, whose finest protégées have been appointed ministers for health over several decades. The current minister appears to be no different from his many predecessors, having publicly revealed his difficulty with distinguishing his donkey from a hole in the ground; an understandable confusion given the astounding coalescence of events depicted above.

His department is trotting out the usual lapsed doctor to explain to the great unwashed the tried and true strategies for dealing with influenza. They always slip in the delusional statement that Ireland’s health spending is off the charts. The bull is clearly being taken by the horns.

The chancellor of Makeup University, in a carefully worded statement, has simply commented: “You couldn’t make this up.” Extrapolating from an interview given anonymously by a nameless but imaginary whistleblower at the college, one can conclude that all is not well there. Only recently there was a dispute as to whether their advice to the minister to express unbridled ignorance went far enough. Apparently, some more conservative voices urged that he should deny that there was any problem at all with the health service. They were able to quote many precedents.

ED expansion
Meantime, at the coalface, the pens and stalls are overflowing and multitudes of subhumans are thrown on portable mangers and lie in unofficial dens and nooks. Outside the EDs, transports are queued up, waiting to dispose of their limitless supply of Roscreas.

At Limerick, the ED has extended into the approaching roadways and car park. It is feared in some quarters that the current strain of influenza will have an unacceptably low mortality rate, compounding the problems (and potential for unjustified criticism) for the masters. One daft nurse has imagined that she has intercepted an official email from management urging chaplains to pray for a high rate of fourth-world transfer.

Full capacity
Our television screens are full of the latest batch of ED consultants (who were in medical school when I first began writing about these winter crimes against the citizen) who are unanimously explaining that there is a capacity problem, as did their now long-retired predecessors year after year, crisis after crisis. Regrettably, they are pissing into the wind.

Their analysis is correct and their solution is spot-on. Unfortunately, many of them have not yet come to realise that every option is on the table except the solution. Many will be drawn (as I was for a while) into false dawns, task forces, think tanks, working groups, talk-shops, winter initiatives and other taurocoprolalic dead-ends in the HSE and the Department in the expectancy of imminent action.

My advice to these colleagues is to eschew all such spiderwebs. The origins of the current disaster were blueprinted in 1977, seriously augmented in 1988, and had the coup-de-grâce applied in 1994. It’s been relentlessly downhill since then. The authorities have been making the same mistakes with increasing confidence for three decades.

Caged animals
There is a mindset abroad that is not for turning without radical measures. There have been many organisational and structural changes with one chilling outcome; same monkeys, different cages. The net result on the service side is that our people are treated no better than animals.

The charade will have to stop sometime. Yet it will only stop if it is made to stop. Health workers are facilitating its continuation by not using their immense power to bring it to an end.

They are the only people who can bring the ignorant masters to heel. Leadership is required.

It is worth noting that the current state of our health services is and has been government policy for more than three decades. There is an official gutless, callous and ignorant disregard for the citizens. Our choice is whether to continue to allow policies that makes pigs and dogs of our nearest and dearest on the sickest days of their lives.

The solution will cost money; lots of it.

The post Against all the odds appeared first on Irish Medical Times.

Dr Garrett FitzGerald

Dr Garrett FitzGerald recalls a 14-month residency in the Children’s Sanatorium in Foynes, Co Limerick, and how not making a sound, eating up all one’s food and staying in bed 24 hours a day made one the model patient

As the clock ticks on towards final curtain time, the cortex increasingly recalls details of the receding past. I have recently had revealed to me a memory of one day as a three-year-old, such delight having been hidden in some part of the intracranial maelstrom this three score and 13 summers.

The past is coming into play. I can clearly remember seeing matches I didn’t attend, valorous deeds achieved against all the odds, a burning wish to die for the ‘faith’, a clear understanding of the universe and, in my junior doctor days, hearing the seventh heart sound.

I can smell the material of my ‘sloppy joe’ T-shirt and the coarseness of the S-shaped metal fastener of my blue and white elastic belt. My mother later read somewhere that belts constricted the abdomen and ensured that a decent deep breath could not be taken, so galleasses were provided from that day on, the belts retiring to new life in catapultion.

The idyllic childhood of fighting, arguing, crying, stone-throwing and general dysfunction had to come to an end, as these things do. I was issued with an invitation to enter, as a long-term resident, the Children’s Sanatorium in Foynes, Co Limerick. This came as a surprise as I had suffered no symptoms of any kind.

Thus began 14 months of the most tediously boring period of my life. I did not know why I was there — then or later. It became slowly apparent that the treatment for whatever the condition might be was to have me remain in a bed for more than a year. Of equal importance, it appeared, was the requirement to not upset the nursing staff.

A really good patient was one who did not make a sound, who ate up his plain food and stayed in bed 24 hours per day like a proper six-year-old. Being caught out of bed was punished by confiscation of the lower half of the pyjamas. I therefore lived bare-assed for a full year.

The hospital wards consisted of two rows of beds along the walls, a couple of statuary jujus in the corners, and a communal potty in the middle of the floor for excreting both ways publicly.

Nurse Cruella de Vil
The staff existed in another universe, adjacent to our pound but out of sight. Visits from the nurses, apart from scolding duties and shaming sessions were uncommon and we rarely saw the doctor. There were a few legendary senior nurses who put the fear of God into staff and patients alike, and who make Cruella de Vil seem like the Good Fairy.

Only once during my first year did I see the outside corridor; that was the morning I was supposed to go for ‘clearance’.

Clearance was where you had what the inmates called ‘the ether mask’ put on your face and you woke up back in your bed (still sans pantaloon) without a tooth in your head. I was returned to the ward with some hard tissue still in situ.

There were no medications given (or available for the condition) apart from a very brief period of a daily dose of liquid PAS. There were a couple of lads in the ward stone-deaf from streptomycin, but I never got those jabs. Cold air from the adjacent verandas, nominal confinement to bed, shaming, bare bums and evacuation in public were evidently the keys to cure.

In a year or so, my absent symptoms seemed to become more absent, because I was declared to be fit to attend mass (a mighty boost for a seven-year old) and attend daily at the hospital’s school.

Happily, I had already been schooled in the ward by lads, aged five to 16, from Gurran na mBrathar, who ‘learned’ me the facts of life and made an irreversible iconoclast of me.

It was a boy named Jamesy Kelleher of that parish who taught me fluency in all the bad language I needed for a lifetime. I was, in later teenage life, blackballed every year by peers in my Jesuitical madrassa from becoming a member of the sodalities of the Holy Angels and other ethereal beings because of my coarse, venial sin-laden lingo. Kelleher (bless him!) introduced me to the simile in my early incarceration days when he opined that Sister X had a face as crooked as a wizard’s mickey, like.

He also taught me well known ditties from the Cork tradition, such as “Oh didn’t I laugh, ha-ha-ha, to see my life so bad”.

Rescue remedy
Fourteen months on, I could take no more. I wrote to my mother saying she could come for me the following Wednesday. She telephoned the doctor whose attention I now had at last. He woke me up to give me a furious dressing down as was only right in dealings with criminals, sinners and children in early-1950s Ireland. He threatened me with incarceration for another lifetime. The lachrymals delivered; QED.

Then, mirabile dictu, he said I could go home on Wednesday. I got my pyjama bottoms on Tuesday night. Next day, I sat into the front passenger seat of the Ford Prefect and my mother gave her the wellington all the way to Tipp.

The post The good old days… appeared first on Irish Medical Times.

The solution to the inevitable slide of the acute services has finally been put on the table, but does the ‘Golden Rule’ still hold sway, wonders Dr Garrett FitzGerald

This story continues at Minister for Health’s unexpected contact with reality

Or just read more coverage at Irish Medical Times

Now on the other side, Dr Garrett FitzGerald recounts bravely facing the ordeal that was his pre-med year, notwithstanding the air of gloom that abounded

This story continues at Not being Ted McGrath

Or just read more coverage at Irish Medical Times

Dr Garrett FitzGerald recalls the revered professors of old, then thought of as super humans, and how questioning them was considered the equivalent of challenging a ‘god’

This story continues at The heady days of the Herr Professor

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Dr Garrett FitzGerald appears – as if back from the dead – to write for Irish Medical Times once more.

The post The return of the prodigal son was greeted with a great celebration! appeared first on Irish Medical Times.

Writing from the other side of his medical profession, Dr Garrett FitzGerald meditates upon the life-to-come beyond death and finds he is not as enlightened on the afterlife as Groucho Marx

The post Considerations of what lies beyond appeared first on Irish Medical Times.