The day before everything went wrong had started off just like any other one. There had been no signs, no solitary magpie or black cat crossing her path to warn of what was to come. Helena O’Herlihy had got up that morning like she always did and gone to the Cara Family Practice in Rathmines where she worked as a GP. She had had a steady stream of patients that day; she had seen an elderly patient suffering with gout and she had prescribed antibiotics for a toddler with a chest infection, but when her patient Julie Carroll, a young mother of two, had broken down in front of her during her check-up following a recent miscarriage, something had erupted inside Helena. Something she had managed to keep suppressed and hidden for a long time. Helena hadn’t even realised she was crying until Julie reached across her desk and handed Helena one of her own tissues from the box she kept there for her patients.
Helena had always prided herself on her professionalism. They had been trained in medical school on the importance of remaining sympathetic but detached from their patients’ problems; it had been drilled into them that they must keep a professional distance and up until today she had always managed to achieve that. As a GP, she had seen lots of her patients break down in front of her over the years, but it wasn’t meant to be the other way around – it wasn’t a two-way street. Of course there had been times when she had shed a tear when a patient had died or when a child in her care had been diagnosed with a serious illness, but it had always been in private, behind the closed door of her surgery. She had never let the mask slip in public before, but Julie’s pain had mirrored the emptiness inside her own heart as she herself grappled with the recent losses of her own much-wanted pregnancies.
As soon as she had taken the tissue proffered by Julie, Helena had realised a line had been crossed and had quickly pulled herself together. She began issuing harried apologies and mumbling things like, ‘I don’t know what came over me…’ Julie had made sure she was all right, before standing up to leave, and Helena had mumbled more awkward apologies as she saw her to the door.
A few minutes later, there was a knock on her surgery door. ‘Is everything okay, Helena?’ Mairéad, their receptionist, had asked, as she came into the room. ‘I saw Julie Carroll on the way out and she mentioned I should check on you?’
Helena was mortified when words deserted her as, once more, she was engulfed by tears.
‘Oh, love, what it is?’ Mairéad, a kind but efficient woman, had quickly closed the door behind her, before wrapping her arms around her in a motherly fashion, while Helena sobbed heartily onto her shoulder.
When Mairéad had suggested that Helena should take the rest of the day off, Helena hadn’t even put up a fight. She had gone home and climbed into bed. It was after nine when her husband, James, had arrived home and he hadn’t noticed there was anything out of the ordinary. He had left her alone and gone to sleep in the spare room. They had been avoiding each other lately anyway.
That had been yesterday and as Helena got up that morning and dressed for work, she already felt a lot better. She felt fortified by the dawn of a new day, if a little embarrassed by her outpouring the previous day, but it was out of her system now and she resolved never to let it happen again. She made a mental note to call Julie Carroll first thing to apologise for being so unprofessional.
She was the first one in the practice that morning and was just going through the backlog of paperwork which had piled up from her early departure the day before, when there was a knock on the door.
‘Come in,’ Helena called.
The door opened and she saw the friendly face of Ken, a fellow GP and the practice owner.
‘May I come in?’ he asked hesitantly. He was in his mid-fifties and dressed in his usual uniform of a tweed jacket over a shirt and tie. Helena guessed he had been dressing like that since he had been in college. He was a kind man, if a little socially awkward.
‘Of course,’ she said. ‘Take a seat.’
He came in and sat on the chair at the end of her desk, the same chair that Julie had sat in the day before. He crossed his legs awkwardly and was fidgeting with the end of his tie, rolling the fabric up like a Swiss roll before unfurling it down again.
‘Mairéad mentioned what happened yesterday…’ he began. ‘Are you okay?’
‘I’m very sorry about that,’ she cut across him straight away, wanting to end this conversation fast. She knew her colleagues would have had to fit in her appointments into their already overworked day and she felt awful for leaving them in the lurch. ‘It never should have happened. I don’t know what came over me, but don’t worry, I’m going to ring Julie Carroll first thing this morning to apologise—’
‘I’ve already spoken to Julie…’ he admitted, rubbing his salt-and-pepper beard now. ‘She was very understanding. She was worried for you.’
Helena felt herself bristle. She lifted a pile of paperwork and straightened the bottom edges against the desk. ‘Well, I will call her anyway,’ she insisted.
Ken cleared his throat before speaking again. ‘I… em… think you should take a little time off, Helena.’ The words were uttered so quietly that she wasn’t sure if she heard him right.
‘Sorry?’
‘I know you’re going through some… um… difficult… personal issues.’ He took off his glasses and began cleaning them on his woollen pullover.
He knew about the miscarriages, of course; she had had to tell him as she had needed time off to recover, not just physically but emotionally too. But he didn’t know that the fertility clinic that they had been attending for the last two and a half years had recently told Helena and James that they were unlikely to ever have a child of their own.
She should have known from the way their fertility specialist, Dr Bedford, wouldn’t meet her eye when she had taken a seat across the desk from him that morning that it wasn’t going to be good news. She had noticed him shift a little in his chair and her stomach had clenched as she’d waited for him to speak.
‘Helena and James,’ he had begun, ‘I’m sorry but there is no easy way to tell you this.’
Icy sweat had broken out across her neck and her heart had started to hammer. James had reached across from his chair, his palm finding hers; it had felt clammy, like her own.
‘Considering Helena’s most recent miscarriage, I don’t think it’s in your best interests to continue treatment. Your body has been unable to sustain a pregnancy to date and I think you really need to consider other…’ he’d stopped for a beat, ‘…avenues if you want to have a child.’
Helena had felt as though she was sinking through the floor. She hadn’t been expecting that news coming to the clinic that morning. The losses of the last few years had been devastating, but she was slowly picking herself up again, like she had done so many times before, and she was ready once more to board that gruelling IVF train that would give them their much-awaited for baby.
‘So what do we do now then?’ she’d heard James ask, but she knew what Dr Bedford was saying. She was bracing herself for the impact.
Dr Bedford had continued, ‘After six miscarriages, most of them quite early on in the first trimester, I suspect a hyperactive immune system is the reason your body can’t sustain a pregnancy – your body is essentially attacking your own baby.’
‘Surely there has to be something we can try? You must have something to stop it happening?’ James had asked, and the desperate note in his voice had nearly finished her off completely.
‘As you know, we have already tried immunosuppressant medication, which I had hoped would be successful, but unfortunately not…’ He had paused and placed his hands flat on his desk. ‘I am conscious of your age, Helena. At forty-three, time isn’t on your side,’ he’d said bluntly. ‘All things considered, I think the best option for you both to have a child is through either surrogacy or adoption.’ His gaze had switched between the two of them. ‘I’m sorry, I know that’s not the news you were hoping to hear today.’ He’d exhaled sharply, making a little whistling sound through his teeth as if relieved that he had now said the words he had been preparing himself for, but Helena had felt winded, like he had just reached across his desk and assaulted her. A little rush of vomit had made its way up her throat. She’d pulled her hand away from James’s and balled it into a fist on her lap.
Dr Bedford had continued then, explaining about how he could put them in touch with a surrogacy clinic abroad, but Helena hadn’t been listening. All she had heard were the words that she would never be pregnant. She would never carry her own child, she would never share her body with another, nourishing them until the time came to meet one another. She would never get to hold her baby as it curled its tiny fingers around hers and breathe in its newborn scent. It would never happen for them.
But I’ve been so good! she wanted to rage and rail. She’d done everything Dr Bedford had told her to do. She had given up coffee, forgoing her much-loved morning latte, she had tried meditation, acupuncture and reflexology, she had injected herself and taken so many drugs… but maybe she had missed some crucial step? Maybe if she had relaxed more… she’d always found it difficult… but, god, it was hard to relax when all your dreams were hanging in the balance. She knew life wasn’t fair, but she really believed that, on some level, karma would see her right. If she was a good person on balance and played by life’s rules, then it would all work out for them. But Dr Bedford’s crushing words had told her that there wasn’t a happy ever after for them and there never would be. As he had talked, she could taste the metallic tang of her own tears as they fell down her face.
They had returned home from the appointment both stunned by what they had been told. To be turned away as a lost cause really emphasised just how hopeless their situation was. Over the years in her job as a GP, she had met patients facing the same crushing news as they were, but it was fair to say that nothing could have ever prepared her for the awful finality of their own personal prognosis.
What Ken also didn’t know was that she had had a huge argument with James when she had discovered that he had contacted a surrogacy clinic in Ukraine ‘to get the ball rolling’. James couldn’t understand why she was so angry. In his eyes, he was helping the situation by being proactive; he reasoned that the next logical step if they wanted to have a child of their own was to use a surrogate, but to her, he was being completely insensitive. She couldn’t believe he was able to think about going down that road yet, while she was still grieving the fact that she would never carry her own baby. That she would never feel those first fluttery kicks as graceful as butterfly wings or the firm roundness of her baby growing strong inside her tummy.
She felt like a failure; carrying a baby was one of the most fundamental tasks of womanhood and she would never understand why her body couldn’t do what generations of women had done before her. James didn’t seem to understand the depths of her grief and so they had barely spoken to one another in three weeks. It was too hard to see her pain mirrored in his eyes. He was better off without her anyway. It was her fault that he would never be a father. His tests had all come back fine – he had joked about how his swimmers were the Michael Phelps of the sperm world – she was the only obstacle standing in his way of fatherhood.
It was a cruel irony that he was so good with children. Whenever they would go to the birthday parties of their nieces and nephews or their friends’ children, James was the one tearing around the garden with the children, while the adults looked on, balancing paper plates of canapés and sipping wine; he was always the biggest child of them all. Then they would plaster a smile on their face as they posed beside the birthday child for a photograph and nobody would ever guess the pain they held inside their hearts as she wondered when it might be their turn. When was she going to be the one standing taking a photo of her child blowing out candles on their birthday cake? Helena didn’t know how they would move forward from here, or even if they could. The chasm between them seemed too much.
‘But what about my patients?’ Helena argued to Ken. ‘I can’t walk out on them! The practice is busy enough as it is.’ How dare he suggest that she wasn’t up to doing her job! She was a good doctor. Her job was all she had left right now.
‘Come on, Helena, you know better than anyone how important it is to take care of our emotional well-being. Sometimes, as GPs, we spend so much time caring for others, that we forget to look after ourselves. This job can be very demanding if you’re going through something in your personal life. Your health and well-being has to come first. We can get a locum to cover you.’
‘I’m sorry—’ Tears pushed forward once more and she tried to blink them away before Ken would notice. Damn it anyway, she cursed herself. Why couldn’t she just hold it together? All the drugs and hormones in her body had turned her into a mess. She was mortified when he reached for a tissue from the same box that Julie had done the day before and handed it to her.
‘Everything will be okay, just take a month out and give yourself time to get better,’ Ken advised.
‘A month?’
‘It’s for the best, Helena. You can’t give your patients the best care if you’re not taking care of yourself first.’
Helena blinked back tears. ‘I-I’m a good doctor, Ken… I know I made a mistake yesterday, but I’m good at my job,’ she pleaded.
‘It wasn’t just yesterday…’ He paused and wouldn’t meet her eyes. ‘There was that issue with the prescription for Mrs Redmond last week too…’
Helena had prescribed the wrong dosage level for an elderly patient. Luckily, it had been picked up by the pharmacist, who had phoned the practice to double-check whether it was an error, but Helena knew it could have been so much worse.
She realised then that she didn’t have a choice. The decision had already been made for her. Ken was right. She was a liability to the practice in her current state. When she wasn’t breaking down in front of her patients, she was distracted and, lately, her brain was fuzzy and slow, her head was too full of grief to concentrate on anything. What if she made another mistake? One that wasn’t discovered in time. Or if she misdiagnosed someone or missed a crucial symptom – for the sake of her patients she needed to get herself together.
‘What will you tell people?’ she asked quietly, resigned to her fate.
‘We’ll just say that you need some personal time – they don’t need to know anything more than that.’
She nodded, too upset to speak. How had she let this happen? Her personal life had seeped into her professional life like liquid soaking through tissue paper.
‘I respect and admire you greatly and I know your patients do too,’ Ken continued. ‘You are a much-valued member of the team here and I want you back feeling better. Okay?’
‘Okay,’ she sniffed as she dabbed the tissue at her nose.
Ken stood up then and left her alone.
As Helena gathered up her belongings, she took a moment to look around her office at all she was leaving behind. How had it come to this? She carried her GP bag in one hand and hooked her laptop bag over her shoulder, before she made her way out the back exit of the practice without saying goodbye to anyone. She got into her car and drove home to their red-bricked Victorian semi-detached house on Abbeville Road in Rathgar. She and James had bought it soon after they had got engaged. This house with its original fireplaces and timber sash windows where children scooted past on the leafy streets outside had seemed like the perfect family home. As soon as she had set foot inside it, she had already imagined laughter ringing between its walls. The house had a generous rear garden for this part of Dublin and was shaded with a large oak tree. They had had a whole future planned here – they would lie in bed together imagining what their children might look like. They both wanted at least two. She pictured James tying a rope swing over the boughs for them to play on, and maybe building them a little timber playhouse down the end of the garden, which she would paint in the softest shade of apple green. She had already visualised the nursery decorated in pale greys with a delicate canopy draped over the cot, but it had never transpired.
Helena put her key in the lock and let herself into her empty house which was now the shell of her broken dreams. How had her life come to this? She and James had never been more distant and now she had been deemed unfit to do the job that she adored. She pushed the door closed behind her and slid down along it with her back until she reached the floor. She stayed sitting on the black and white chequered tiles of her hallway until she lost all sense of time and when the doorbell rang suddenly, she jolted.
She picked herself back up again and through the stained-glass panes of the door, she could see the outline of a dark-clothed man.
‘Hello?’ she said, pulling the door back and quickly composing herself. It took her a few moments to register that he was dressed in a Garda uniform and a white squad car with blue lights on the roof was parked behind hers in the driveway. Her mind felt as though it was trudging through concrete as she tried to work out what was going on. Perhaps he had followed her home – maybe she had broken the speed limit, or run a red light… She barely remembered the drive, her head had been in a spin and her eyes blurred with tears. Immediately her heart was racing and blood filled her ears.
‘Are you Helena O’Herlihy? Married to James O’Herlihy?’ he began.
‘Y-yes, I am.’
‘I’m Garda Lorcan Murray from Donnybrook Garda Station.’
‘Uh-huh,’ she said, wishing he would just hurry up and tell her what this was about.
‘I’m very sorry to tell you that your husband James has been involved in a serious road traffic accident on the Coast Road earlier.’
‘James?’ she repeated, buying her brain time to process what he was telling her, even though she had heard what he said.
‘He’s been taken to Dublin City Hospital by ambulance,’ the Garda continued.
‘Is he okay?’ The voice that came out didn’t sound like her own.
‘Unfortunately I don’t have that information, Mrs O’Herlihy, but you need to get to the hospital urgently.’