Free Bleeding Hearts by Ian Rankin Page A

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