gravely ill patient lay on his side in his bed with the curtains drawn for privacy.
'You're going to feel a boring pain in your lower back now, Mr Morell,' he'd warned as he positioned his patient.
'Go ahead, doctor, do whatever you have to do.'
Morell had sounded weak and resigned. Gone was the strength of voice that had ordered men around building sites. He'd been a foreman and site inspector for years, a tall, burly man with hands like shovels.
Clancy had scrubbed to sterile standards, then donned surgical gloves and face mask and carefully swabbed Morell's lower back with antiseptic. He'd glided his trained fingers along the patient's back and upper pelvis, feeling for bony landmarks. Finally satisfied, he'd mentally marked the entry point and quickly injected local anaesthetic. The long point of the needle had dispersed the anaesthetic along most of the skin and immediate underneath tissue, down to bone. Next Clancy had slowly inserted the sharp-pointed, stainless-steel wide bore trochar until its tip met Harold Morell's pelvic bone.
'Okay now, Mr Morell, steady yourself.'
He'd sensed the older man stiffen in the bed. Slowly and delicately the trochar was turned until it bored through solid bone.
'Jesus Christ,' Morell had grunted through gritted teeth.
By the time he'd felt the pain it was all over. The trochar had passed right through bone and into marrow. Soft, treacly liquid had seeped out to be collected and analysed. It was this same marrow Clancy was now inspecting. There was virtually no evidence of the early forms of the white cells. Having few white cells in peripheral blood, that which could be drawn from a vein, was bad enough. But no sign of regeneration of white cells in marrow, the power house of blood formation, was even more ominous.
'Agranulocytosis, no doubt about it,' Clancy murmured to himself.
Agranulocytosis was the medical term for an almost total lack of white cells in peripheral blood and bone marrow. Some doctors preferred the alternative label, neutropaenia, for the same condition. Clancy always opted for the longer version. He thought it sounded grander.
He picked up a Dictaphone and began recording his findings. As he spoke he flicked the pages of Harold Morell's in-patient chart. Morell was a sixty-one-year-old male with a seven-year history of angina, a condition of narrowing of the inside bore of the arteries around his heart such that it became momentarily deprived of sufficient blood from time to time. When this happened Morell had experienced pain and a sensation of tightening in the chest. He'd been admitted to the Mercy Hospital for tests, then further investigations and finally a coronary angiogram. Here a special dye had been injected into Morell's heart arteries to highlight their calibre and detect any sign of narrowing.
Clancy looked at the entries in the chart, noting the procedures that had been performed by cardiologist Linda Speer. He studied her findings: 'Stress ECG showed ST depression in the inferolateral leads. While not diagnostic these changes suggest underlying ischaemia.' Next came the coronary angiogram result: 'Immediately after injection of the right coronary artery the patient experienced acute cardiac pain with ST elevation. Treated in the usual way with atropine, nitrglycerine and sub-lingual nifedipine. The pain settled after about six minutes. Critical coronary artery disease found involving principally the mid portion of the left anterior descending artery and mid portion of the right coronary artery. There is 50% stenosis in the proximal portion of the circumflex artery. Left ventriculography confirmed normal left ventricular function.' Then her final recommendation: 7 have discussed this patient with Mr Marks with a view to coronary artery bypass.'
Morell had been sent home to await a suitable slot on the cardiac surgery operating programme but became suddenly unwell with unstable angina within a week and readmitted as an emergency. Clancy
'You're going to feel a boring pain in your lower back now, Mr Morell,' he'd warned as he positioned his patient.
'Go ahead, doctor, do whatever you have to do.'
Morell had sounded weak and resigned. Gone was the strength of voice that had ordered men around building sites. He'd been a foreman and site inspector for years, a tall, burly man with hands like shovels.
Clancy had scrubbed to sterile standards, then donned surgical gloves and face mask and carefully swabbed Morell's lower back with antiseptic. He'd glided his trained fingers along the patient's back and upper pelvis, feeling for bony landmarks. Finally satisfied, he'd mentally marked the entry point and quickly injected local anaesthetic. The long point of the needle had dispersed the anaesthetic along most of the skin and immediate underneath tissue, down to bone. Next Clancy had slowly inserted the sharp-pointed, stainless-steel wide bore trochar until its tip met Harold Morell's pelvic bone.
'Okay now, Mr Morell, steady yourself.'
He'd sensed the older man stiffen in the bed. Slowly and delicately the trochar was turned until it bored through solid bone.
'Jesus Christ,' Morell had grunted through gritted teeth.
By the time he'd felt the pain it was all over. The trochar had passed right through bone and into marrow. Soft, treacly liquid had seeped out to be collected and analysed. It was this same marrow Clancy was now inspecting. There was virtually no evidence of the early forms of the white cells. Having few white cells in peripheral blood, that which could be drawn from a vein, was bad enough. But no sign of regeneration of white cells in marrow, the power house of blood formation, was even more ominous.
'Agranulocytosis, no doubt about it,' Clancy murmured to himself.
Agranulocytosis was the medical term for an almost total lack of white cells in peripheral blood and bone marrow. Some doctors preferred the alternative label, neutropaenia, for the same condition. Clancy always opted for the longer version. He thought it sounded grander.
He picked up a Dictaphone and began recording his findings. As he spoke he flicked the pages of Harold Morell's in-patient chart. Morell was a sixty-one-year-old male with a seven-year history of angina, a condition of narrowing of the inside bore of the arteries around his heart such that it became momentarily deprived of sufficient blood from time to time. When this happened Morell had experienced pain and a sensation of tightening in the chest. He'd been admitted to the Mercy Hospital for tests, then further investigations and finally a coronary angiogram. Here a special dye had been injected into Morell's heart arteries to highlight their calibre and detect any sign of narrowing.
Clancy looked at the entries in the chart, noting the procedures that had been performed by cardiologist Linda Speer. He studied her findings: 'Stress ECG showed ST depression in the inferolateral leads. While not diagnostic these changes suggest underlying ischaemia.' Next came the coronary angiogram result: 'Immediately after injection of the right coronary artery the patient experienced acute cardiac pain with ST elevation. Treated in the usual way with atropine, nitrglycerine and sub-lingual nifedipine. The pain settled after about six minutes. Critical coronary artery disease found involving principally the mid portion of the left anterior descending artery and mid portion of the right coronary artery. There is 50% stenosis in the proximal portion of the circumflex artery. Left ventriculography confirmed normal left ventricular function.' Then her final recommendation: 7 have discussed this patient with Mr Marks with a view to coronary artery bypass.'
Morell had been sent home to await a suitable slot on the cardiac surgery operating programme but became suddenly unwell with unstable angina within a week and readmitted as an emergency. Clancy
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