turned to the operation notes on Morell's chart.
Pre-operative diagnosis: Unstable angina pectoris, recent anterior myocardial infarction within 12 hours, streptokinase therapy. All secondary to three vessel c oronary artery disease.
Operative procedure: U rgent CABG x 3 (LIMA to LAD, VG to RCA3, VG to OM1)
Surgeon: Dan Marks
Anaesthetist: W. Carter
Assistants: N. Dowling and L. Speer
Perfusionist: L. Moloney
Complications: Re-sternotomy for bleeding
Notes:
Harold Morell was admitted with a small anterior infarction where he was given streptokinase with a good result. Operated on later the next day, some 16 hours after admission. Three grafts placed, he has excellent distal vessels. In the immediate post-operative period Mr Morell bled a lot and the operation site was re-explored. Nothing important discovered and the bleeding settled. It may have been due to the t hrombolytic therapy. Post-operative recovery uneventful.
Discharge Drugs: Adizem 120mgs daily: D/N Aspirin 300 mgs daily.
A thought flickered as Clancy read. Linda Speer had assisted at the operation. That was unusual. Cardiac surgeons preferred fellow surgeons during operations, men and women with similar technical skills. Speer was certainly a world-class cardiologist, expert at examining and interpreting cardiographs, heart scans, angiograms and such like. Surgeon she most certainly was not. Clancy mulled this over, then dismissed his reservations as old-fashioned. He recognised more than anything else the notes reflected a straightforward and uncomplicated heart operation.
Harold Morell's pre-, intra- and post-operative treatments and management were excellent, of the highest international standards. Indeed he'd made such good progress he'd been discharged home after six days and scheduled for a follow-up angiogram three months later. Unfortunately he'd had to be readmitted as an emergency only four days previously when a simple throat infection had turned unaccountably life threatening. In the admitting ward, Morell had been feverish, sweating and shivering violently. He'd been prostrate with the illness and almost succumbed but for the timely intervention of intravenous antibiotics. As he'd rallied the treating doctors had started to delve deeper into the illness and discovered his rare and unusual blood disorder. That's when Frank Clancy had been called in.
Clancy flicked to the drugs treatment page in the chart. His lips puckered as he read. Morell was only on a standard anti-anginal tablet, Adizem 120 milligrams once a day, and D/N Aspirin. Clancy knew D/N Aspirin was routinely used in post-operative heart patients, it 'thinned' their blood thus allowing it flow more easily through narrowed arteries. D/N was the manufacturing pharmaceutical company's shorthand for day/night, their product a slow-release aspirin that maintained therapeutic levels in the bloodstream twenty-four hours a day. D/N Aspirin, a USA product, was not in the Mercy Hospital drug formulary but still a recognised and acceptable pharmaceutical agent.
Clancy turned to the daily notes, searching for any other drug regime that might not have been entered into the pharmaceutical therapy pages. There was nothing. An unusual reaction to a treatment drug was the most likely explanation for Harold Morell's sudden and life-threatening blood picture. Yet, puzzled Clancy in the gloom, the medication he's on couldn't cause agranulocytosis. He sat back again, taking his glasses off and pinching the bridge of his nose. He looked aimlessly around the laboratory, as if somehow there might be an explanation for Morell's sudden blood change hiding behind the test tubes.
'Agranulocytosis,' he muttered to himself, 'that's the third case in as many months.' He spun the swivel chair round and around. 'What is going on?'
Clancy glanced at his watch and groaned. He was an hour behind time at least. He knew he'd be home late, his wife glaring at the clock, the dinner probably
Pre-operative diagnosis: Unstable angina pectoris, recent anterior myocardial infarction within 12 hours, streptokinase therapy. All secondary to three vessel c oronary artery disease.
Operative procedure: U rgent CABG x 3 (LIMA to LAD, VG to RCA3, VG to OM1)
Surgeon: Dan Marks
Anaesthetist: W. Carter
Assistants: N. Dowling and L. Speer
Perfusionist: L. Moloney
Complications: Re-sternotomy for bleeding
Notes:
Harold Morell was admitted with a small anterior infarction where he was given streptokinase with a good result. Operated on later the next day, some 16 hours after admission. Three grafts placed, he has excellent distal vessels. In the immediate post-operative period Mr Morell bled a lot and the operation site was re-explored. Nothing important discovered and the bleeding settled. It may have been due to the t hrombolytic therapy. Post-operative recovery uneventful.
Discharge Drugs: Adizem 120mgs daily: D/N Aspirin 300 mgs daily.
A thought flickered as Clancy read. Linda Speer had assisted at the operation. That was unusual. Cardiac surgeons preferred fellow surgeons during operations, men and women with similar technical skills. Speer was certainly a world-class cardiologist, expert at examining and interpreting cardiographs, heart scans, angiograms and such like. Surgeon she most certainly was not. Clancy mulled this over, then dismissed his reservations as old-fashioned. He recognised more than anything else the notes reflected a straightforward and uncomplicated heart operation.
Harold Morell's pre-, intra- and post-operative treatments and management were excellent, of the highest international standards. Indeed he'd made such good progress he'd been discharged home after six days and scheduled for a follow-up angiogram three months later. Unfortunately he'd had to be readmitted as an emergency only four days previously when a simple throat infection had turned unaccountably life threatening. In the admitting ward, Morell had been feverish, sweating and shivering violently. He'd been prostrate with the illness and almost succumbed but for the timely intervention of intravenous antibiotics. As he'd rallied the treating doctors had started to delve deeper into the illness and discovered his rare and unusual blood disorder. That's when Frank Clancy had been called in.
Clancy flicked to the drugs treatment page in the chart. His lips puckered as he read. Morell was only on a standard anti-anginal tablet, Adizem 120 milligrams once a day, and D/N Aspirin. Clancy knew D/N Aspirin was routinely used in post-operative heart patients, it 'thinned' their blood thus allowing it flow more easily through narrowed arteries. D/N was the manufacturing pharmaceutical company's shorthand for day/night, their product a slow-release aspirin that maintained therapeutic levels in the bloodstream twenty-four hours a day. D/N Aspirin, a USA product, was not in the Mercy Hospital drug formulary but still a recognised and acceptable pharmaceutical agent.
Clancy turned to the daily notes, searching for any other drug regime that might not have been entered into the pharmaceutical therapy pages. There was nothing. An unusual reaction to a treatment drug was the most likely explanation for Harold Morell's sudden and life-threatening blood picture. Yet, puzzled Clancy in the gloom, the medication he's on couldn't cause agranulocytosis. He sat back again, taking his glasses off and pinching the bridge of his nose. He looked aimlessly around the laboratory, as if somehow there might be an explanation for Morell's sudden blood change hiding behind the test tubes.
'Agranulocytosis,' he muttered to himself, 'that's the third case in as many months.' He spun the swivel chair round and around. 'What is going on?'
Clancy glanced at his watch and groaned. He was an hour behind time at least. He knew he'd be home late, his wife glaring at the clock, the dinner probably
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