problem?'
'No.'
'Anything to do with cardiology?' Speer's stare was now boring into him.
'No.'
'Well, what the hell are you doing here?' she snapped, the cultured accent now turned hard. 'I've a mountain of work to do.' She waved a gold-bangled arm across a pile of charts.
'Well, you see,' Clancy tried again, 'the patient started out in this department and…'
'Where is he now?' Speer snarled in exasperation. 'Don't tell me he's down in the dermatology wards. I know nothing about skin diseases.'
Clancy lifted the chart onto the paper she was working at. 'No,' he said quietly, 'he's in my department, in haematology. He's seriously ill. He's got agranulocytosis.'
Speer squinted at the chart for no more than a minute. 'He's deficient in white cells, right?' she asked.
'Yes. In his case deficient in both peripheral blood and bone marrow.'
'That's a haematology problem, though, isn't it, Dr Clancy?' Speer was beginning her dismissal mode.
'Yes.'
'And you're the haematologist, right?'
'Yes.'
'Well,' she closed over the folder and handed it back to Clancy, 'shouldn't you be back with your patient?'
Clancy refused the implied dismissal. 'I need to know why Morell has developed this,' he said calmly, eyes fixed on Speer. 'And I need to know why there have been three such rare blood disorders in this hospital in as many months.'
'You're the haematologist, Dr Clancy, with the greatest respect that is your job.'
'Indeed it is, Dr Speer, no one knows that more than me.' Clancy decided to treat Speer with the same contempt he was getting. 'But what's puzzling about these cases is they were all in this cardiac unit for one procedure or another about four weeks before their blood disorders set in. I was just wondering about any link? That's what a haematologist is supposed to do. Look for causes as well as treat.'
Speer lifted Harold Morell's chart as if it was a piece of dog dirt and flicked through until she reached the pages dealing with in-patient stay and cardiac procedures. She dropped it and returned to her paperwork.
'His cardiac procedures were standard. Routine stress ECG, followed by angiogram, followed by triple bypass surgery. His post-operative phase was completely uneventful.' She picked up another chart and began turning its dog-eared pages. 'What happens to these patients after they leave here is none of my business.'
For a moment Clancy was stunned. The dismissive manner in which Speer was treating his query was bad enough, but her total indifference to the patient's final outcome shocked.
'I find that attitude quite extraordinary,' he said, barely able to control, himself. He'd heard about her legendary coolness, her attitude towards patients, looking on them as merely interesting pieces of pathology which she could work on and turn around. 'But,' he continued bitterly, 'to think you can dump your patients out of this department,' he pointed towards the outside offices, hands shaking with rage, 'and then not want to follow them up is quite extraordinary.'
Speer continued at her paperwork. 'Think what you want. That's your problem, not mine.'
Clancy was not to be outdone. 'Well, it's more than just my problem, Dr Speer, a great deal more.'
Speer turned around slowly.
'The other two patients, a Mary Hyland and a James Murphy,' Clancy was reading from a slip of paper he'd pulled from a side pocket, 'both developed a sudden and dramatic and fatal agranulocytosis within six weeks of being discharged from this great cardiac unit.' He couldn't keep the anger out of his voice. 'I'm wondering this: what therapy were they on? What drugs, cardiac or otherwise, were prescribed that could have shocked their peripheral blood and bone marrow so violently?'
Linda Speer listened without blinking. 'Apart from drug therapies, what else can cause agranulocytosis?' she asked.
'Radiation or cytotoxic or antimetabolite therapy,' Clancy rattled off quickly, 'severe infections or sometimes associated blood disorders such
'No.'
'Anything to do with cardiology?' Speer's stare was now boring into him.
'No.'
'Well, what the hell are you doing here?' she snapped, the cultured accent now turned hard. 'I've a mountain of work to do.' She waved a gold-bangled arm across a pile of charts.
'Well, you see,' Clancy tried again, 'the patient started out in this department and…'
'Where is he now?' Speer snarled in exasperation. 'Don't tell me he's down in the dermatology wards. I know nothing about skin diseases.'
Clancy lifted the chart onto the paper she was working at. 'No,' he said quietly, 'he's in my department, in haematology. He's seriously ill. He's got agranulocytosis.'
Speer squinted at the chart for no more than a minute. 'He's deficient in white cells, right?' she asked.
'Yes. In his case deficient in both peripheral blood and bone marrow.'
'That's a haematology problem, though, isn't it, Dr Clancy?' Speer was beginning her dismissal mode.
'Yes.'
'And you're the haematologist, right?'
'Yes.'
'Well,' she closed over the folder and handed it back to Clancy, 'shouldn't you be back with your patient?'
Clancy refused the implied dismissal. 'I need to know why Morell has developed this,' he said calmly, eyes fixed on Speer. 'And I need to know why there have been three such rare blood disorders in this hospital in as many months.'
'You're the haematologist, Dr Clancy, with the greatest respect that is your job.'
'Indeed it is, Dr Speer, no one knows that more than me.' Clancy decided to treat Speer with the same contempt he was getting. 'But what's puzzling about these cases is they were all in this cardiac unit for one procedure or another about four weeks before their blood disorders set in. I was just wondering about any link? That's what a haematologist is supposed to do. Look for causes as well as treat.'
Speer lifted Harold Morell's chart as if it was a piece of dog dirt and flicked through until she reached the pages dealing with in-patient stay and cardiac procedures. She dropped it and returned to her paperwork.
'His cardiac procedures were standard. Routine stress ECG, followed by angiogram, followed by triple bypass surgery. His post-operative phase was completely uneventful.' She picked up another chart and began turning its dog-eared pages. 'What happens to these patients after they leave here is none of my business.'
For a moment Clancy was stunned. The dismissive manner in which Speer was treating his query was bad enough, but her total indifference to the patient's final outcome shocked.
'I find that attitude quite extraordinary,' he said, barely able to control, himself. He'd heard about her legendary coolness, her attitude towards patients, looking on them as merely interesting pieces of pathology which she could work on and turn around. 'But,' he continued bitterly, 'to think you can dump your patients out of this department,' he pointed towards the outside offices, hands shaking with rage, 'and then not want to follow them up is quite extraordinary.'
Speer continued at her paperwork. 'Think what you want. That's your problem, not mine.'
Clancy was not to be outdone. 'Well, it's more than just my problem, Dr Speer, a great deal more.'
Speer turned around slowly.
'The other two patients, a Mary Hyland and a James Murphy,' Clancy was reading from a slip of paper he'd pulled from a side pocket, 'both developed a sudden and dramatic and fatal agranulocytosis within six weeks of being discharged from this great cardiac unit.' He couldn't keep the anger out of his voice. 'I'm wondering this: what therapy were they on? What drugs, cardiac or otherwise, were prescribed that could have shocked their peripheral blood and bone marrow so violently?'
Linda Speer listened without blinking. 'Apart from drug therapies, what else can cause agranulocytosis?' she asked.
'Radiation or cytotoxic or antimetabolite therapy,' Clancy rattled off quickly, 'severe infections or sometimes associated blood disorders such
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