What a rotten job you've got

He was a large man with gynaecomastia and he was covered in bruises. The day before his general practitioner had sent him up to hospital for a full blood count. The phlebotomist he saw had taken enough blood for a clotting screen and this had revealed disseminated intravascular coagulation. He had been admitted urgently to the ward on which I was house officer. There my efforts to obtain more blood were failing as each vein I tried ballooned and bled into his skin. I sweated, he contained his irritation, and finally there were a few more millilitres.

With some relief I stood near the door, talking in general terms about further tests. “What do you think's the cause of this blood not clotting then?” he asked. He had been diagnosed 17 years before with …