I often think about how we keep families out of the resuscitation room in A&E. How the sight of their dying father with a triple-bore central line sticking out of his blood-soaked neck, and his groin betraying the scars of my traumatic practice runs at inserting a femoral arterial line, his chest covered in electrode pads, being used as a coffee table for bits of equipment, and his trousers lying in half on the trolley beneath him . . . how it all might be too disturbing for the relatives.

To be honest, the sound of them in tears outside the door, demanding to be let in, is often the only thing that can bring home what exactly is unfolding before me, and that alone feels like a good enough reason not to let them in, because you don't want to think about that kind of thing when the registrar is barking out instructions and you're trying to get arterial blood gases off quickly enough to impress the anaesthetist so that he'll talk you through the next patient's femoral arterial line (get to do a few yourself, it looks great on the CV).

Gradually, by subterfuge, these episodes are changing me, or at least cleaving off my work persona from the boy next door I imagine I must still be. The process of depersonalisation that starts in casualty is just as real on the wards. You cannot rely on innate charm with patients at three in the morning, and you cannot afford to take it personally when that notoriously unhelpful nurse on 7E starts bouncing up and down and giving you grief about somebody else's blood form.

Sometimes I am astonished to catch myself on autopilot, asking nothing but pertinent questions (I kid you not), smiling away, almost completely unaware of the fact that I am talking to a person and not a box with "query unstable angina" written on its forehead, who may or may not need IV isoket and heparin depending on how highly it scores on the tick list in my head. The rare occasions when I offend or cause distress are the times when I am foolish enough to chance my luck at just being myself.

But the strangest thing is that this hugely effective depersonalisation of the patients, this reinvention of myself as a walking bedside manner, is exactly what I have started to do to myself, as the only way to stave off the powerful inner drive towards self-pity and resentment of the NHS, and how it has ruined my life.

It is a resentment that has cut even deeper over the festive period, when everyone else is at home watching It's a Wonderful Life on the sofa with their mum and dad, and the only way to cope is to make yourself love the job, by buying into the delusory self- sacrificing herd mentality of junior doctors, where nothing outside the hospital matters any more, where you do not expect to have a life, where friends are a thing of the past, where disasters are a challenge and where you have to love your work because to expect anything more from life is to court disappointment. So this is what I have learned this year, more than how to manage myocardial infarction: how to stop the patients from punishing me, how to cope with evil politics on the ward, and how to stop taking it as a personal affront or judgment on my character when a patient gets ill.

So if I grit my teeth hard enough, the festive period (which was anything but) was a delight. The day after Boxing Day A&E was full to boiling, and the casualty sister was sending patients up to the admissions ward (about a million miles away, since you ask) before they had even been seen. Each and every one of them was a social and medical disaster zone, neglected by all and sundry for the entirety of the preceding week, and there was nothing we could do for most of them but admit them to our Gomer Hotel. (Gomer: noun, medical: unloved geriatric patient on his or her last legs for no apparent reason. [abbrev. for Get Out of My Emergency Room].) These people are sent to punish us. Let them come. Our admissions list, previously an index of pain, went on to a fifth page, and we loved it.

I have become a medic. I have put my blinkers on, drawn up my galoshes, and waded into the bloodbath before me. The patients over the four-day-long Christmas holiday were underhydrated and grossly mismanaged, dry as a crisp: it wasn't my fault, but, better than that, it was a great opportunity to practise my central line technique.