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A doctor's fight to aid the poor

Stricken by pain and disability since birth after his mother was given thalidomide while she was pregnant, Dr Austin O'Carroll has since dedicated his medical career to assisting the homeless, drug addicts and prostitutes of the inner city. Encouraged by an upbringing of tough love, discovers Emily Hourican, he gained the strength to do battle for others

Dr Austin O'Carroll's surgery is in a rundown Georgian building on the corner of Mountjoy Street, in the shadow of the Black Church. Inside it is slightly shabby and overcrowded, with some surprisingly good art on the walls. The waiting room has a sculpture by Kathleen O'Brien, made up of spoons and watches. His own office carries a series of photos by Veronica Nicholson called Roadkill, done in bright, saturated colours, showing dead animals carefully arranged with sprigs of various wildflowers. There is also a vaguely Aztec-seeming stone pig, with a cigar sticking out of its mouth; "it's a capitalist pig," laughs Austin. When he first moved into the surgery, there were problems with stolen purses and prescriptions. As he was putting up the art, he was warned that it too would probably be stolen. Not only was it not, but the rest of the thievery gradually petered out too. "I think if you treat people with respect, they return it," is Austin's simple assessment.

In the basement is a methadone clinic, and O'Carroll and his team also dispense the heroin substitute to some of their own patients. It's not exactly the Jewish mother's dream of "my son the doctor ... " I suggest. "No," he readily agrees, "but I absolutely love this job. I couldn't see myself working in any kind of Southside, Harley Street-type practice. That's just not for me." His voice is low and gravelly, deep and reassuring, and he has a warm, steady charisma.

His people are the poor of the inner city, the homeless, the drug addicts and prostitutes, and he has, through dedication, humanity and great clarity of purpose, brought about some impressive changes in their circumstances. His work is all the more remarkable when you consider the challenges he has to face within his own life.

Austin O'Carroll is one of 15 inspirational people profiled in a new book, Give Me Irish Heroes, by author and adventurer Ian McKeever. Austin was born in 1962, in Blackrock, one of six children. His father, from Dublin, was a civil servant, his mother was from Limerick. Two of his nephews are Ross and Rory O'Carroll, who play for Dublin and Kilmacud Crokes.

Austin was one of some 10,000 babies worldwide affected by thalidomide, the so-called "miracle drug" given for morning sickness to pregnant women in the Fifties and early Sixties. He is one of 32 adults in Ireland living with the consequences of this drug, which resulted in serious birth abnormalities. The foetal damage he suffered has resulted in foreshortened legs; he is powerfully built and should probably stand at six foot. In reality, he reaches about five foot, robbed of his natural stature.

As a child, he walked with callipers, went through many operations, and spent long stretches of time in Crumlin Children's Hospital, alone and in pain. He recalls staring out the window and being able to see nothing except the tops of buses as they passed by the hedge at the bottom of the hospital grounds. "One day I counted 43 buses," he recalls now. Back then, the attitude to pain relief was different, more regimented, and so there would be long periods of time when he would be given nothing to alleviate it. "The pain would wax and wane," he says now, matter-of-factly. "You coped. As a child, you didn't know any different." His memories are a shadowy mix of injections, pain and being on his own, of suffering the consequences of a medical profession that was institutionalised and often dehumanising. No wonder that today he practises what he calls "narrative-based medicine" and has a passion for communication, which he teaches to trainee doctors.

Remarkably, Austin grew up largely unaware that he was any different to other children. "You've never had it any other way," he says now. "That's your normality." This sense of himself was instigated and reinforced by his parents, in particular his mother, to the point where they didn't even tell him what was wrong with him. "I always thought I'd broken my legs," he says. "I always thought the callipers were what stopped me growing, and that when I took them off, I'd catch up. I think I was around 11 or 12 when I realised this wasn't going to happen." He says it with a laugh, but wryly all the same.

Looking back, does he think his parents should have been more upfront with him? "It's very hard to say what they should have done, all I can say is what they did do, and I think it worked for me. It may not have worked for somebody else." His mother, Maureen, who sounds a remarkable, if slightly alarming woman, simply refused to treat Austin any differently, or to smooth life's path artificially in any way. He recalls her passing him by one day when he was involved in a scrap after school, in which he was definitely coming off worst. "Fight back!" she shouted at him, walking on.

What does he make of this now? "You can say, why didn't she protect me? But my instinct now, particularly with children, is, you need to protect them if they're being overwhelmed, but if they're not being overwhelmed ... Even when the surgeon would say to me, 'you've had an operation, you can't play football or you'll have to have another operation,' I'd go home, and I'd go off to the football pitch, and my mum would give out, but she'd never actually stop me. And I was re-operated on three or four times, which strictly speaking was wrong, but ... " and he shrugs a little. "I think it's an instinct that probably runs through the family," he adds. "My instinct, too, is to promote independence. The danger with being protective is that you then start treating them differently, and you encourage them to think of themselves as different."

I wonder at the personality of a mother who could behave like this, but Austin is easy with it. "I think she worried hugely about me, and still does. She's not physically affectionate, but she's not cold. She's very warm. But she's a fighter, and she wanted to instill that instinct into us. She came from a background where there was a lot of poverty and she had to fight her way out of that."

He remembers being put into a rehabilitation centre in Dun Laoghaire, to be assessed with other thalidomide children. "I remember feeling 'these people are weird'. And I remember thinking eventually, 'Hold on, if they're weird, I must be as well.'" He recalls hating having to go there, not wishing to be confronted by this alternative version of his reality.

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It's a kind of disconnect which he only really confronted once he became involved with the Disability Movement in the Eighties. "I learned an awful lot from that," he says. "One of the things I learned is that the very fact of not thinking of myself as disabled shows how negatively I think of disability."

The majority of teens will agonise over being "different" as they unravel their way in the complex business of dating; so how difficult must this be when the difference is so highly visible? "I did become consciously conscious of myself," he says now. "I had lots of friends, lots of girl friends. I tend to get on better with women. They would have been very comfortable physically with me in terms of affection, but probably in a way like a gay guy. But it was probably my fault too, I wasn't engaging on a sexual level. That's the way I sold myself -- as the fun guy, the caring guy. So I had my first girlfriend only in my mid-20s. It wasn't that I wasn't confident, just that I don't think I sold myself that way."

He met Dorothy, his partner, in the mid-Eighties, and although both were already in relationships at first, after five years of friendship they began a relationship. The couple now have two children, Naoise and Hannah. "We did the Irish version of family planning," Austin laughs. "We never had a conversation about it, we just stopped using contraception."

Hannah, the eldest, was born when Dorothy was 40 and had already had a miscarriage, so it was an especially happy time, with, however, a strong degree of anxiety in the lead-up to the 18-week scan as thalidomide has been shown to be hereditary in laboratory rats.

And yes, the early years were tough. "Before they turned four, I found it hard. Kids are very physical before that. After four, they start to do what they're told more and pay more attention to what you say, so it became much easier." His years of youth work served him well, in that he had already learned to exercise control without moving around, just using his voice.

Did his children ever reach a stage when they realised their father was different? "We told them early on, we said 'my mum took a tablet when I was in her tummy and that's why I'm like this'; and I have also done talks in their school, to the other children and parents, explaining it. What's funny is that my kids notice that other people are different -- for example a friend of ours who suffers from cerebral palsy -- but they don't associate those differences with me. We tend to group all disability together as one, but they don't. It's intriguing."

Honesty is equally a part of the relationship with Dorothy. "I'm a big fan of being absolutely straight, and she's very open and honest as well. There can be times when things are going bad, but we pull it out of each other, the truth about what's going on."

What then are the major flashpoints? "When I'm doing too much, Dorothy will give out that I've lost the balance between family and home. Also, I'm at work talking to people all day. When I come home, I'm all talked out. Dorothy works as an artist, a painter, and doesn't talk to anyone all day, so she's looking forward to conversation, and she can spot when I'm just going through the motions."

Austin went through the mainstream school system, attending first Oatlands College in Stillorgan, where he excelled academically, and then Trinity, where he began by studying law. He was tutored first by Mary Robinson, then, in his second year, by Mary McAleese. It was she who told him to "go for it" when he mentioned his dream of studying medicine, and got him an appointment with the college board, who eventually allowed him to switch.

Why the passion to become a doctor? "I'm sure the fact that I was so often in hospital has some bearing on it," he says. "I worked as a counsellor for a few years and one theory going around was that by becoming a carer, you're sort of on the other side of the gate. When you're cared for, you're the powerless person, so you reverse that."

Or it could be simpler than that. One of his most vivid memories as a teenager is this: "You're trying to be really tough, and not give in to pain, and I remember one day it really hit me and I just collapsed into tears. There was a nurse who came in and just gave me a big hug. Probably the mixture of the embarrassment and the humanity makes me remember." And it may even be what has inspired him to dispense warmth, dignity and help to some of the most vulnerable in society.

These days Austin is the motivating force behind an organisation called Safetynet, providing healthcare to the homeless. The service involves going out to hostels and running a GP clinic on site, and the next step is to equip a bus as a mobile unit to reach street sleepers and prostitutes.

He is also fighting the cause of thalidomide victims in Ireland by engaging with the Government to improve the provisions made in 1975 for those affected by the drug. "There was a financial package, but it wasn't exactly compensation, because the Irish Government wouldn't, and still hasn't, admitted liability. There was an arrangement made -- you got so many points if you had an arm missing, so many if you had a leg missing, and an amount of money was based on that."

In practice, this medieval-sounding system worked out at a lump sum of a few thousand euro per person, and a disability pension of between €16-35 per day. It seems miserly, particularly given that thalidomide was never on sale in the States, for example, because it didn't pass their more stringent drug regulations. Here, it was, as well as being an injustice of shocking proportions, a watershed in terms of regulation. As Austin says: "What happened to us resulted in an awful lot more protection for others."

His own health is steadily deteriorating, and his walking distance has reduced from four or five miles, to just a few hundred yards. After that, the pain is simply too much. When he goes to the airport, he uses a wheelchair. But, ever one to see the bright side, Austin insists: "It doesn't bother me, you just adapt. I get on my bike and cycle. I did a 100 mile-cycle last year for the first time. You change your approach ... I don't take pain relief, because the only time I get pain is when I walk, so I just don't walk any more."

It seems an almost surgically simple, and yet impossibly difficult, solution. "Grief, sadness and anger come with not being able to do what you normally would do," he explains. "But you can't just make everything the same as it was, no matter how much you want to. You have to adapt your lifestyle." And so he continues to cheerfully and patiently adapt his own, and in so doing, encourages society to the same efforts, changing the way we treat our most vulnerable, challenging all of us to greater efforts at humanity and endurance.

Give Me Irish Heroes, by Ian McKeever, a tribute to 15 outstanding Irish people, is available through Tesco, Hughes & Hughes and independent book stores, or can be purchased online at www.givemeheroes.ie. All profits go to Gaisce -- The President's Award, The Chernobyl Children's Project and other deserving charities

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