RTÉ producer and competition organiser, Séamus Hosey, says the story casts new light on “the relationship between medicine and literature, and how a medical practitioner depicts from the inside the harrowing and stark world of a cancer ward”.

Duffy, aged 36, now works as a staff clinician at the National Cancer Unit in Bethesda, Washington DC, where he specialises in the treatment of gastrointestinal cancers.

Extract from Orca by Austin Duffy

Winner of the Francis Mac Manus short story competition 2011, (will be broacast in the first of the Mac Manus Season on Monday, June 6th in The Book On One slot at 11.10pm on RTÉ Radio 1).

‘You can’t beat the feeling of coming to the end of a night on-call. When you’ve got to the morning without anyone dying on account of some vacancy in your medical knowledge. It was close though. All evening there’d been calls about Ruairi. His dressing was seeping with blood at the spot on his hip I’d drilled into earlier that day with a large trocar needle, hand-held like a power drill and bevelled, for bone marrow biopsies. My advice over the phone had been simple. Keep with the pressure dressings and watch the blood pressure. Then around eight, Debra called. She’d just started her night shift. You can see it pumping, she said, you’d be as well to come in. I didn’t argue. Sometimes doing marrows you can be unlucky, hit a small artery. Potentially cause a bleed out. Sort of the opposite to an oil-strike, luckwise. Sure enough, when we peeled back the dressings there was a good trickle coming from the spike hole. Took hours to quell it. His blood pressure started to hover low. Vitamin K and clotting factors did the trick eventually. His mother came up to me afterwards and asked, is this normal with cancer? I told her no, it wasn’t.

I turned the corner by the brewery then crossed the footbridge to the North Mall. At that point you can see the river for some length before it bends into grey walls. A complete moon was over where the open sea would be. Most of the light was coming from streetlamps, hunched over the footpath like lanky tulips. They threw my shadow on the water as I walked under them.

I’d only met Ruairi and his mother a few days previous in outpatients. He came referred after noticing a lump on the side of his nose. Looked like a horse kick. He was into horses. When we did a scan of his lungs there were tumours hanging from his bronchial tree like ripe fruit. Tests showed small round blue cell tumour, which, believe it or not, was the technical term. When the pathologist announced it at the multi-disciplinary conference it was the first time I’d ever heard of it.

A very primitive . . . aggressive tumour, the pathologist said, poorly differentiated . . . hasn’t evolved much . . .

Like a great white shark, someone said.

I suppose so, said the pathologist.

Small round blue cells, Like tiny irises. There was a picture shown, projected from the microscope onto the back wall. It certainly didn’t look like a vicious cancer, lit from the inside by immuno-histochemistry like a stained glass window. The pathologist pointed out the characteristic features with a bright red dot, showing clumps of cells, a bit bloated, suspended in serum, not very blue actually. They looked like the frogspawn I’d dip jamjars into as a child, then place on a windowsill and watch day by day as the tadpoles evolved. Sprouting mini-hindlegs, then weeks later released into the grass at the back of our house.

He kept texting on his mobile phone throughout that first outpatient visit. I kept waiting for his mother to tell him to stop. Will it take long? was the only thing he said. As if cancer was school work. I looked at him severely, thought to myself, one of those immortal teenagers, did he not listen to a word I was saying? Had he never heard of cancer? What he really means doctor, his mother said smiling, is will he be long away from the horses? Hopefully not too long, I said. Forget about the fucken horses was what I was thinking. He wanted to be a jockey but had grown too tall. Hoped now to be a trainer. He prefers horses to people you see, said his mother ruffling his hair.

He looked down and away, red-faced, embarrassed, his thumbs still working away on the phone. Mam!! Ah he’s still my wee pet, she said, my wee fella. Mam will you shut up will ya!

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