Patients are like wild animals: you can never show fear, or they will attack. I'm tempted to believe that we have a habit of over-complicating things, not just to patients, but to each other, in order to bolster some illusory sense of control.
On some level, even to the most educated and involved patient, we routinely lie in our mannerisms and attitudes, because medicine just isn't a precise business, and if you took a moment to be honest with yourself, you would admit that you find it hard to cope with that, especially when mortality is hitting you for the first time, and especially in A&E.
You don't want me standing over you in casualty thinking out loud: "Buggered if I know, but you can't die too quickly as long as I hit you with some oxygen and keep your circulation moving."
You want nurses and doctors dashing in and out of the cubicle, barking out coded instructions with thinly veiled urgency: you want the machine that goes ping, you want to be seen the moment you walk in the door, and you want it all to happen to the soundtrack of a drum and bass remix of the Casualty theme tune.
What you get, of course, after waiting for several hours in a crowded waiting room full of screaming toddlers and haemorrhagic tramps, is a junior doctor like me. And once I've ascertained that you're not on the verge of death, while you are sizing me up for the haggard-looking teenager I appear to be (I promise you, I'm 24 and I work well under pressure), I'm trying to work out what kind of doctor you want me to be, because most of the time, it's harder than diagnosing your (frankly rather pedestrian) angina attacks.
The stakes are high. I've had patients, who were either demented or plain belligerent, just clam up on me: I swear, I was so friendly and charming, they just stopped taking me seriously, and waited for the real doctor to arrive. I may feel the same way myself sometimes, but believe me, those real doctors can take a very long time to answer their bleeps.
I know I can't expect it to be any other way. I don't expect you to tick the box marked "authoritarian medical practitioner please" any more than I expect you to fall out of the ambulance with Subdural Haematoma Scan My Head Please written on your T-shirt.
But what I don't like is when it gets complicated and you uppity, over-educated Guardian readers start off all bitchy about me not telling you exactly what diagnostic options are passing through my head and then start demanding a more precise logical explanation of exactly why your 97-year-old mother fell off the commode this morning when the best I can come up with is that her house is a mess, the telephone cable is spangled across the room at ankle height, she can't see without her specs, and her children should do the honourable thing and either stick her in a home or let her move in with them in their flash central London pied à terre.
Am I ranting? My humblest apologies. Just try to remember that if you're going to die on the doorstep, we'll save you if anyone can, and if you're not, then we're doing just fine, Holby City histrionics or not. This is a teaching hospital for God's sake: we spew out doctors faster than you spew up blood. This is as good as it gets.
On a more important note, I'd like to share with you my research findings on the transmissibility and infective nature of body odour. My interest was first aroused when the groins on one particular geriatrics ward started smelling the same as that of Mr P, a relatively new arrival to our surreal little salon, by which I mean that he had been festering in an acute medical bed at risk of hospital-acquired infections while social services quietly ignored him for a trifling three weeks.
Body odours, it seems, are the result of a peculiar interplay between the nutrients secreted in your body's natural juices, and the microbes that feed on them. Just as different species of bacteria and fungi have furnished the French with a wide variety of cheeses from the same kind of milk, so a different selection of invisible helpers are apparently at work in the armpits, gussets and insoles of us all. This is an area in which I have recently become something of a connoisseur.
At first the aroma of condensed egg white and vinegar was confined to the other gentlemen sharing his bay, whose sores had been tended by the same team of nurses. Within a week it had spread throughout the male end of the ward, and recently we have been detecting it on the surgical wards three floors below.
And now, this morning, as I sit in my towel waiting for the doctor with whom I share a bathroom to finish his interminable shower, I cannot ignore the heady, familiar aroma which fills my nostrils. It is not a chain of events on which I wish to dwell.
