The Irish Connection

I was excited to travel to Ireland. My admission to the Royal College of Physicians and Surgeons in Dublin was confirmed. I was finally going to specialize in Paediatrics!
Leaving my two-year-old with my husband, sister and her paternal grandmother was heartbreaking, but I knew she was well taken care of. And there was always the telephone. My bills were phenomenal, but definitely worth it.

The day I landed in Ireland, was a sunny day. From the time I looked out of the plane’s window, till I reached the bedsit where I was staying, I was visually bombarded with eye-soothing shades of green. Yes, this country was more than adequately named the “Emerald Isle”. And I was there! It was to be my home for the next few months. Fáilte romhat go hÉirinn… Welcome to Ireland!
After a quick shower and a chat with my land lady, I thought I would take advantage of the good weather and go for a walk. Coming from a hot country, the mild weather was a balm to my soul, and I definitely relished it. It was a lovely day, and I wanted to think about the days ahead. Maybe this would be the only time I would get to relax before we got busy with our ward lectures and studies at the college.

While walking down one of Dublin’s many pedestrian zones, a little body literally hurled into me. Looking down I saw that it was a little girl who must have been about eight years old. She had a cherubic face that was framed with beautiful red curls and there was a light dusting of freckles over her nose. Her green eyes twinkled at me mischievously. To my dismay, she was dressed in very shabby clothes, and her tennis shoes had holes where the toes were unsuccessfully trying to merrily stick out.
Seeing me make eye contact with her, she started to beg for some money. I looked at her carefully, and noticed that despite her shabby appearance, she looked well-fed and more or less clean. So instead of giving her money, I asked her where her parents were, and she succinctly told me, as if it was a regular occurrence, that they were both in the nearby pub. They needed money to have more drinks, so she was sent by them to beg in the street. Conversationally, so that she wasn’t scared away, I asked whether she had eaten anything that day. On hearing that she hadn’t, I did give her a few coins, but I told her that the money was  to buy something to eat for herself and not to give to her parents. Little Kathy snatched the money from my hand, and grinned at me over her shoulder, while she happily made her way to a nearby well-known fast-food restaurant. Poor kid, I thought to myself. Not letting the incident mar my pleasure of the lovely day, I walked on and put all thoughts of her and her predicament out of my mind.

Kathy’s name triggered a thought in my mind… I should try to contact Sister Kathleen Mcguire. She was the one nun in my Convent School that I really liked. I had heard that she had moved back to Ireland and was still with her Order of the Presentation Convent. Okay then, once I was back home, I started to look in the phone book and noted down the numbers of the Orders that I thought were relevant…..Have you any idea how many Kathleen Mcguires there are in this land of intrepid wandering nuns? Sadly, unless I wanted to call each and every one of the two thousand and more Kathleen McGuires in the phone book, I wasn’t destined to meet her again.
True to Ireland’s weather unpredictability, I woke up the next day to a wild hurricane. Now how would I be able to go to the college? Would it even be open in these weather conditions? Just to be sure I phoned them. I didn’t want to be thought tardy on my first day.

“Och! We won’t close the college for such a little drizzle.” I was told by the office secretary.
Therefore, being ill equipped for such weather, borrowing an umbrella from my landlady, I literally ran to the shops nearby. Since we hardly needed coats and umbrellas where I lived, I had planned to go shopping that day after class. But I was not counting on Hurricane Charley. Later on, listening to the news I found out that Hurricane Charley had hit  Ireland hard and brought heavy rainfall, strong winds, and widespread flooding. It was responsible for at least 11 deaths. Winds reached 65.2 mph, and rainfall peaked at 280 mm setting a record for the greatest daily rainfall in the country. Wow! Little drizzle? I really thought that I had to take up that issue with the college secretary!

Thankfully the shops were just opening, and I was able to buy a sturdy (hurricane proof) umbrella and a Burberry raincoat. I was lucky that the Irish were friendly, helpful people, and allowed me to shop before they were properly open, otherwise I would have had to slink into class looking like a drowned rat.

Studying in Ireland was different and interesting. The discussions and interactions between the postgraduate students and the professors were exhilarating and eye-opening. There was such a lot to learn. But the most prominent feature that stood out was the attitude of the professors to ante-natal diagnoses of genetic diseases, and the termination of pregnancies even if the unborn foetus had severe or life-threatening deformities. There were many cases documented where the mothers’ health was in jeopardy, with their pregnancies, but the doctors refused to terminate them because of their beliefs. One case was also touted in the newspapers where a 13-year-old was raped and became pregnant. You of course can understand by now what her fate was. She was denied termination by the state and her diocese.

Unbeknownst to me, I brought up the topic in class when we were told that the Celts were genetically more prone to have babies with Spina Bifida or with Down Syndrome. The worrying fact was that children with Spina Bifida have multiple neurological defects ranging from mild to moderate paralysis of the lower limbs to loss of bladder and rectal functions. We noticed that there were sometimes two, or even three children with that condition in the same Irish family. I was puzzled why an antenatal diagnosis wasn’t performed and the mother given the option of a therapeutic abortion rather than let a child come into the world with severe deformities. More often than not they were not able to have a good quality of life or even take basic care of themselves. In addition to that, why weren’t the families properly counseled on family planning if there were risks?  To my knowledge, I didn’t say anything new. That was taught in all of the textbooks around the world, so hearing this being refuted in Ireland was puzzling. But why did I feel as if I had said the wrong thing?

The Professor with whom we were discussing these cases stopped talking for a beat, and for a fleeting moment, he might have had a frustrated look on his face. He took a deep breath and told us, a class of predominantly International Students, that Ireland was a Roman Catholic country where family planning and abortion for any reason whatsoever was a crime. Therefore, the average Irish family had six or even eight children. If there was a genetic inclination to any medical condition, it was not uncommon to see the disorders emerging in more than one child in the same family. We were shocked. But of course, no one said anything out loud because we realized it was a sore point here and we did not want to hurt the religious and political sensitivities of the Professor and other Irish citizens. We were guests in their country, and we needed to respect their beliefs and laws.

Recently however, it was all over the news. It is only now, in the 21st century that they have permitted abortions in Ireland. That too only during the first twelve weeks of pregnancy. (And I agree to this wholeheartedly. I do think that abortions performed later in the pregnancy are dangerous for the mother as well as the baby.) The authorities and powers that be in Ireland added a codicil that abortions could also be performed  where the pregnant woman’s life or health is at risk. That included also the cases of a fatal or severely debilitating foetal abnormality. This legislation was just implemented on the 1st of January 2019, which had become the law only on the 20th of December 2018. Can you imagine how much heartbreak the families had with their babies till then? It wasn’t unusual to see families in town with more than one sibling having either Down Syndrome or walking on crutches or in wheelchairs due to Spina Bifida.

Let me make it very clear. As a physician, I am an advocate of therapeutic abortions, where either the life of the mothers or the babies are at risk. I would not recommend random abortions, but then that is the prerogative of the person(s) involved. I have no say whatsoever in that matter. Your body, your choice.

Neonatology, a personal favorite, was taught to us at the famous Rotunda Hospital of Dublin. This ancient historical hospital was built with perfectly round “lying in rooms”. The air vents were placed near the floor for proper circulation. The idea was that if there were no corners in the room, the germs that caused post-partum sepsis or puerperal sepsis couldn’t lurk in the corners. I found that quaint and interesting, since the Rotunda Hospital has occupied its present premises since 1757. The concept of germs was very new in that period of time, so this belief was an innovative way of providing a more or less germ-free environment for the mothers. The idea was commendable.

To study the diseases and conditions of older children, we were rotated through the many hospitals in Dublin. One day, while we were heatedly discussing child-abuse, a sore topic with any pediatrician, we were to my surprise introduced to Little Kathy who I had met on my first day in Ireland.
Our teacher showed us that she had multiple bruises on her legs and her back. She looked quite miserable, the poor little girl. Definitely (at first glance) it seemed as if she had had a severe beating leading to the horrific bruising all over her body. Her mother who had consented to let us examine Kathy, was already aware of her diagnosis. To my dismay there were a few indiscreet students who once again started to talk about physical child abuse as a differential diagnosis in front of the mother. Therefore, while listening to the random discussion, she became inconsolable. She kept saying tearfully that her Kathy had fallen down while playing with her brother in the garden. She said that she would never beat her child so cruelly. Well, thankfully she hadn’t. We reassured her and told her that the reason our lecturer had brought Kathy forward as a clinical case for us to examine, was to show us that everything is not always as it seemed. Kathy had developed condition called Idiopathic Thrombocytopenic Purpura. Due to the lack of platelets in her blood, and most probably due to a past viral infection, just like other children with this condition, Kathy bruised easily. The acute form of this illness often follows an infection and spontaneously resolves within two months. A mistaken diagnosis of child abuse could easily be made in this case. To avoid psychological and traumatic implications on the child and the family, a careful diagnosis always had to be made. Especially in places like Ireland where Child Protective Services were quick to isolate the children from their allegedly abusive parents.
Knowing where I had met Kathy initially, I was aware that even though she might not have been physically abused, she was still being used by her parents to beg for their pub visits.

Kathy had recognized me the moment she stepped into our classroom, and she looked at me with pleading eyes. I understood that she didn’t want me to mention how and where we had met. Giving in to her silent plea, I didn’t say anything because I didn’t want to add to her and her mother’s stress, but I did think about it a lot, and wondered whether I should have said something?

My stay in Ireland, the intense hands on as well as the theoretical studies opened my mind, I felt on top of the world! Finally, I graduated with honors.

On the last day of  my exams I was able to pick up my husband and daughter from the airport. We had planned to spend a very nice relaxing month driving through Europe. Stopping when we wanted to and meeting whoever we wanted to.

The food snobbery in France was hilarious and my husband kept telling me to bug the chef by asking for ketchup. I obviously didn’t. I wanted to eat in peace. They were already upset with me because I didn’t sample their wine. My only regret was that I had to cut my visit to the Louvre short because of a cranky toddler… or was it a recalcitrant, (or a not into art) husband?. But on the whole, it was fun and memorable. Meeting my maternal relatives in Switzerland and Austria was also quite enjoyable.

Now the time had come to go home and start serious work. After all, I was now a qualified pediatrician. I was ready to jump in feet first and start looking after the children of the world.