‘Here we are again, Mrs Bridewell,’ Hughes yelled at her, as they prepared to hoist her into the ambulance. ‘Soon have you home.’
‘Is it worth the trip?’ Hoffer muttered to himself. He turned away from the ambulance, but Hughes called to him. The driver was already getting into his seat and starting the engine. Hughes had an arm on the back door, ready to close it.
‘I meant it about the cardiac. You really should lose some weight. We could do our backs in rolling you on to the stretcher.’
‘You’re all heart, pal!’ Hoffer called, but he called it to a slammed door as the ambulance revved away. He walked back up the hill to Emergency. The same nurse he’d spoken to was still there. She didn’t look like she’d been pining.
‘Just one more thing,’ Hoffer said, raising a crooked index finger. ‘Who do I speak to about haemophilia?’
‘It means love of blood, literally.’
Dr Jacobs was a small man with one of those English-actor voices that make American women wet their drawers. It was like Jeremy Irons was behind the scenes somewhere and Jacobs was his dummy. He also had the hairiest arms Hoffer had seen outside a zoo, and he only had ten minutes to spare. He was explaining what the word haemophilia meant.
‘That’s very interesting,’ said Hoffer. ‘But see, the man we’re dealing with here, he’s a hired killer, a gunman. He also uses explosives. Does that sound like a suitable occupation for a haemophiliac?’
‘No, it doesn’t. Well, that’s to say, not for a severe haemophiliac. You see, there are three broad levels of haemophilia. You can be severe, moderate, or mild. Most registered haemophiliacs in the UK are severe — that is, they show less than two percent factor activity.’
‘What’s factor activity?’
‘Haemophiliacs, Mr Hoffer, suffer from a clotting deficiency in the blood. Clotting is a complex event, involving thirteen different factors. If one thing happens, then another happens, and we get a knock-on effect. When all thirteen things have happened, we get blood clotting. But haemophiliacs lack one of the factors, so the knock-on can’t happen and clotting can’t take place. Most haemophiliacs suffer from a factor eight deficiency, some from a factor nine deficiency. There are a few even rarer conditions, but those are the main two. Factor eight deficiency is termed Haemophilia A, and factor nine Haemophilia B. Are you with me so far?’
‘Reading you like braille.’
Dr Jacobs leaned back in his black leather chair. He had a small cluttered office, all textbooks and test results and piles of unanswered mail. His white coat was hanging up behind the door, and there were a lot of framed certificates on the walls. His arms were folded so he could run his hands over his monkey arms. Hair sprouted from the collar of his shirt. Naked, Hoffer bet you could use him as a fireside rug.
‘Severe haemophiliacs,’ the doctor said, ‘make up over a third of all haemophilia cases. They can suffer spontaneous internal bleeds, usually into soft tissues, joints and muscles. As children, they’re advised to stay away from contact sports. We try to make them get a good education, so they can get desk jobs rather than manual ones.’
‘They don’t go into the armed forces then?’
Dr Jacobs smiled. ‘The armed forces and the police won’t recruit from haemophiliacs.’
Hoffer frowned. If there was one thing he’d been sure of, it was that the D-Man had been either a soldier or a cop. ‘No exceptions?’
‘None.’
‘Not even if they’ve got the milder form?’
Jacobs shook his head. ‘Something wrong?’ he said.
Hoffer had been tugging at his ears. ‘Flying does things to my ears,’ he said. ‘Say, can you help? Maybe take a look?’
‘I’m a haematologist, Mr Hoffer, not ENT.’
‘But you can prescribe drugs, right? Some painkillers maybe?’
‘Consult a GP, Mr Hoffer.’
‘I can pay.’
‘I’m sure you can. Did you catch your cold on the plane?’
‘Huh?’ Hoffer sniffed so much these days, he was hardly aware of it. He blew his nose and reminded himself to buy more paper handkerchiefs. Damned nose was always itchy too. ‘It’s this lousy weather,’ he said.
The doctor looked surprised and glanced out of his window. It was another beautiful day outside. He looked back at Hoffer.
‘The police have already asked me about this assassin. It seems from what I hear that he does possess some knowledge of haemophilia, but as I told them, I just can’t visualise a severe haemophiliac being an assassin. He told the ambulanceman that he was one per cent. I think he was lying. I mean... well, this is guesswork.’
‘No, go on.’ Hoffer stuck his shred of handkerchief back in his pocket.
‘Well, it seems to me that these weapons he uses, they would have a recoil.’
‘Believe it.’
‘You see, any recoil might start a severe haemophiliac bleeding. It wouldn’t be long before he’d start to suffer problems with his shoulder. After which he wouldn’t make much of a marksman at all.’
‘What about a moderate sufferer?’
‘Even with a moderate sufferer, there would be dangers. No, if this man suffers from haemophilia, then he is a mild case.’
‘But he’d still know about the disease, right?’
‘Oh, yes. But he’d also be able to injure himself without needing medical aid afterwards. Simple pressure on the cut would be enough to stop it.’
Hoffer chewed this over. ‘Would he be registered?’
‘Almost certainly.’
‘I don’t suppose those records...?’
Jacobs was shaking his head. ‘If the police wish to apply to see them, then of course there might be a chance, especially if it’s a case of catching a murderer.’
‘Yes, of course. Dr Jacobs, how many mild sufferers are there?’
‘In the UK?’ Hoffer nodded. ‘About fifteen hundred.’
‘Out of how many?’
‘Roughly six and a half thousand.’
‘And how many of those fifteen hundred can we discount?’
‘What?’
‘You know, how many are kids, how many are pensioners, how many are women? It’s got to bring the number down.’
Jacobs was smiling. ‘I have some pamphlets here you should read, Mr Hoffer.’ He opened a desk drawer, hunting for them.
‘What? Did I say something funny?’
‘No, it’s just that haemophilia affects only men. It’s passed on from the mother, not the father, but it is only passed on to the sons.’
Hoffer read the pamphlets as he sat in the bar of the Allington Hotel.
He found it all unbelievable. How could a mother do that to her son? Unbelievable. The women in the family could carry the disease, but they almost never suffered from it. And if they passed it on to their daughters, the daughters could fight it. It was all down to chromosomes. A boy got his mother’s X and his father’s Y, while a girl got two X chromosomes, one from each parent. The bad genetic information was all in the X chromosome. A man with haemophilia passed his bad X to his daughter, but the good X she got from her mother cancelled the bad X out. So she became a carrier but not a sufferer. Each female had two X chromosomes, while males had an X and a Y. So boys had a fifty-fifty chance of getting the bad X passed on to them from their mothers. And they couldn’t override it because they didn’t have another good X chromosome, they had a lousy Y which wasn’t any use in the battle.
There was other stuff, all about Queen Victoria and the Russian royal family and Rasputin. Queen Victoria had been a carrier. There didn’t have to be a history of haemophilia in the family either, the thing could just spontaneously occur. And a mild haemophiliac might never know they had the disease till it came time for a surgical operation or tooth extraction. The more Hoffer read, the more he wondered about going for a blood test. He had always bruised easily, and one time he’d been spitting blood for days after a visit to his dentist. Maybe he was a haemophiliac. He wouldn’t put anything past his mother.