Kieran Murphy writes: How will you ever know someone else? The cask that houses their brain may be familiar to you, but their consciousness and preoccupations will always only be glimpsed. Their nuances, doubts, and ambitions will never be transparent.
In 1986, when I was an intern at Jervis Street hospital in Dublin, Eoin O’Brien was an intimidating character. As a cardiology consultant, with a Talmudic beard, clad in his Donegal Tweed suits and with a well-known relationship with the Nobel prize-winning author Samuel Beckett, we treated him with a mixture of awe and respect.
I bought his wonderful autobiography as soon as it was published. It has now become a dog-eared, highlighted and annotated copy. If we are lucky, a book may have one great sentence that makes it all worth while. This book has many and they give deep insight into the complex, gifted, creative person that is Eoin O’Brien. Here are two quotations he cites. He describes a friend with frustrated talent as ‘a spark that fell short of the fire’. Or on Beckett: ‘You cannot explain genius, it’s better to just enjoy it.’
I now understand how much I had underestimated him when I was his intern thirty-eight years ago. Reading the book, I now realise that the old man that I was clerking was only forty-two years old, twenty years younger than I am now. In our rotating internship we worked for him for three months. ET, as we called him, had surreal clinical abilities. This was a time of cardiology before Grüntzig developed angioplasty, Palmaz the stent, or Topol had introduced TPA for acute MI. It was all about ward rounds, the bedside exam, the pulse, and auscultation. We hunted for Corrigan’s collapsing pulse and the diastolic murmur of aortic regurgitation and the opening snap of mitral stenosis with our black Littman stethoscopes.
The book does not describe adequately the huge clinical impact Eoin has had on medicine globally. In today’s academic terms he is a clinician scientist. He has trained over a thousand interns, house officers and registrars. He has interacted with approximately 8,000 medical students at the Royal College of Surgeons in Ireland. In Pubmed and Google Scholar, online archives of academic peer-reviewed literature, his scientific publications have been cited over 86,364 times by other scientists. His H-Index, a metric of his global scientific impact, is 113. Most winners of the Nobel prize for medicine have a H-Index in the forty range. None of this is mentioned in his book. Alone this would be a remarkable achievement for a career. To place this in context, my number of citations is 7,892, and my H index is forty-seven, placing me in the top 1% of scientists. Eoin would be somewhere in the 0.001%. To achieve that from Jervis Street hospital and Beaumont in Ireland of the ’70s, ’80s, and ’90s took remarkable drive.
Eoin secured his first job as a consultant at The Charitable Infirmary, Jervis Street, in 1975. He created the cardiac critical care unit there from the ground up. The Jerv was an anchor of the community around Moore Street, Capel Street and Abbey Street. The infirmary opened its doors to patients in 1786. The former city home of the Earl of Charlemont, this Victorian building had eight floors, each with a thirty-six-bed public ward measuring 136 feet by 30 feet with 20-foot-high ceilings. There was also a six-bed private ward on each floor, for priests, nuns and wealthy private patients. There were two elevators, two stairwells, wooden floors, antiquated plumbing, and no ventilation other than huge windows that I never saw open. The high-intensity beds for the sick patients were clustered around the head nurse’s desk. There were 300 beds in total, unless we were full and cots had to be added on busy on-call nights. If you have seen the early-twentieth-century medical television series The Knick, starring Clive Owen as a surgeon, you know what Jervis Street looked like. The hospital opened at a time when antisepsis was an unproven and radical new concept. In the 1880s, surgeons still saw their bloodstained clothes and unwashed hands as signs of their prowess.
One hundred years later, in July 1986, I was a surgical intern at ‘the Jerv’, which looked after Dublin’s inner-city patients. For the most part they worked around Moore Street, near the fruit and vegetable market where my mum and I went every Saturday for the week’s food as I was growing up. When Eoin and I met recently, we realised we remembered the very same stall owner, a lady with huge overgrowth of her lower lip from a congenital hemangioma. He captures the spirit of this great hospital in his beautiful book The Charitable infirmary: A Farewell Tribute, published in 1987. The photographs capture the good will in the building. The fabulous porters who really ran the place, and made sure you were alright if they thought you were decent. Father Greenan with his bicycle, in the elevator at odd hours. The doctors’ residence where we stayed on call, and in which good and bad decisions, on a professional and personal basis, were made. Differences of opinion were reconciled across the road after work in The Ritz bar. Sadly, when The Jerv was moved to Beaumont hospital, that spirit, and culture of medicine, was lost.
In his biography, Eoin does not mention how generous he was in helping many interns, house officers, and registrars launch scientific careers by facilitating our first publications in the British Medical Journal, where he was a significant contributor under the editor, Stephen Lock. He helped me publish my first paper ever in the Christmas edition of the BMJ on my experience working with Tibetan refugees. He understood that papers in strategic journals are like visas in your passport that open doors for your career and allow you to control the decisions you want to make. His global perspective and insight were very rare in Ireland in the ’80s. It was not a time of mentorship in medicine. It was more a culture of nepotism and service. Perhaps his behaviour was influenced by the great mentors that he had been fortunate enough to meet during his training in Birmingham in cardiology, or at Beckett’s side in smoky bars in le Marais in Paris.
O’Brien’s book beautifully captures Irish medical and artistic life in the 1970s and ’80s as the country emerged from Catholic fundamentalism and embraced the European Union, the migration from shepherd’s pie to nouvelle cuisine. Many of the protagonists in the book lived along the Grand Canal near Baggot Street, where at nighttime there was a red-light district. Having spent his day protecting his patients from us, he spent his evenings protecting the livers and lungs of his literary friends from excess.
His relationship with Beckett is central to the book. In Irish literature there will always be a tension between Joyce and Beckett. Sam was a more normal person, kinder, gentler with a more subtle genius. He entrusted to Eoin the ‘chest’ into which he had thrown his wild thoughts, as contained in his first novel, Dream of Fair to Middling Women, which O’Brien and his friend Édith Fournier curated and published posthumously through Eoin’s own publishing house, Black Cat Press. Beckett wrote the book in 1932 and considered it the work of an immature mind.
As an outstanding physician-scientist Eoin would, if he had published only one non-medical book, have been a rare and successful medical truant. But he published eighteen. His approach to writing The Beckett Country, which places Beckett’s writing in a photographic and geographic context, was the first of its kind. From 1975 to 1986 Eoin cycled around Dublin, Dún Laoghaire, Foxrock, Dalkey and the Wicklow mountains finding the locations mentioned in Beckett’s work. I learned yesterday that the bike was a Dawes 10-speed racing bike with a 27-inch frame. A fine bike. I had one myself.
Here is his email:
Kieran,
It was a wonderful bicycle – 10-speed gears, and all sorts of paraphernalia to help me navigate Beckett’s country – notepad and biro on the front drop handle bars, dynamo lights – front and rear (often worked into the night), mirrors to keep a watch on pursuing traffic (in the days when cyclists were seen as fair game), panier bags to house notes, beer and sandwiches, and I could go on. My bicycle maintenance man, who was quite a character and local wit once said to me – ‘they say a camel was designed by a committee, well, Eoin, your steed is the camel of bicycles.’ I loved that bicycle until some bastard stole it and I was never able to recreate it.
Eoin
The Beckett Country, like the Jervis Street book, captures an Ireland that is long gone. Without the book Beckett’s work exists in an unknown, distant land in writing concerned with the inner self. Because of Eoin’s efforts, those thoughts have been placed on a map. The photographs capture pensive places in range of a good bike, like Upper Loch Bray, the east pier lighthouse in Dún Laoghaire, the south wall Poolbeg lighthouse of Dublin harbour.
Our medical education is now all about focus, learning more about less and less, and perhaps getting a PhD for thinking in ever-decreasing circles. We no longer celebrate the pluripotent mind of a well-read physician who is as comfortable at a scientific meeting as he is in a bawdy cafe. Yet who can communicate with the patient better? Who can get to the core of a patient’s problem whose clinical history is like a short story?
The most striking thing about Eoin’s biography are the friendship. So many friends, for many years. A lot of laughing, perhaps Gauloises or Gitanes and Jameson, great conversations, until dawn, and then breakfasts at Seapoint or Sandycove. Eoin’s emails are a delight and have maintained these friendships. Here is a typical one below:
Best for now from the cold, cold scrotum tightening snot green sea of Sandycove, which is recovering from the Bloomsday invasion of countless eejits, dressed as they thought JJ might have been, and discussing fervently a book they have never read. I joined in, albeit at distance, muttering a student ditty (or a perversion thereof) that irreverently sprang to mind:
Oh, the gulls, they fly high in Sandycove,
Oh, the gulls, they fly high in Sandycove,
Oh, the gulls, they fly high
And they shit right in your eye,
Thank God cows don’t fly in Sandycove.
With these pre-bedtime thoughts, my best to you.
Eoin
A Life in Medicine celebrates the fact that being a physician gives one access to moments that most others will never see. I have treated kings and criminals in the same day. Whether we save lives or fail, we practise in an environment of truth and complete engagement with those around us. CP Snow, in his 1959 Rede lecture, said there were two cultures, and that a scientist can be an artist but an artist cannot be a scientist. Eoin celebrates this both by practising medicine as a liberal art, a natural philosophy, and by being a gifted writer and biographer.
To quote Yeats, “’hink where man’s glory most begins and ends, and say my glory was I had such friends.’ Eoin O’Brien is a polymath, a medical truant, and a loyal, true friend to everyone around him. I heartily recommend his book to all my students and colleagues as a roadmap for a career practising the art of medicine, which differs from, but should always accompany, the science of healing.
A Life in Medicine: From Asclepius to Beckett, by Eoin O’Brien with a foreword by John Banville, is published by Lilliput Press.
16/8/2024
