i thought that by the time i was a doctor i would have acquired certain 'doctorly' attributes - such as a high tolerance for other people's nonsense, and a certain generousity of spirit - but i'm still the same lousy person. i still get grumpy from missing meals, annoyed by cry-babies (particularly strapping young men who whine when you stick a tiny needle in them), and invariably feel emotionally and physically drained at the end of a 13-hour shift. i get through only one in two on-calls without ending up in tears at some point. sometimes it seems that being 'professional' means everyone else is allowed to be rude and unfair to you and you just have to absorb it all.

in order to cope with the prospect of having to do it all over again, i run the day's events over in my head, milking them for the 'good bits' - patients who've made me smile, and things i've learned. yesterday's favourite patient has got to be Mrs. D, an 89-year old retired nurse who had come in again with a prolapsed rectum. As she lay on her side with my gloved hand between the cheeks of her bottom, she said "i checked what day it was, in case you asked - they always ask me what day it is when i come to hospital." i had to smile. 'what day is it?' is one of the questions in the mini-mental test.

Mr. G was delirious with pain from a bladder distended nearly up to his chest. i inserted a catheter, which promptly yielded a litre and a half of urine - as much as most people produce in 24 hours. "Do you mind if I quote Shakespeare?" he said. I was quite startled to hear him speak as the only sound from him since his arrival in A&E had been a constant unintelligible groaning. "Nope, go ahead." "For this relief, good thanks." he grinned - as far as he was able to grin with his top dentures missing.

the most intriguing patient of the day was Mr. K, a middle-aged man with an unplaceable accent. he was pale and drawn and doubled up with pain when i found him. i wrote him up for some pethidine. "i've had 6 laparotomies in total", he said, "it all started when i got stabbed in Warsaw last october." Even though he claimed to be an engineer, he used lots of medical terms like 'laparotomy' and 'venous cut-down' and his story was either extremely tragic - or just poorly made up. I always work (on principle) with the patient's word as truth, but the consultant, Mr. A, didn't believe the man for one minute. the abdominal x-ray did, however show that he had drunk some contrast medium recently, which fitted with his claim to have had a CT scan in Poland last saturday... we admitted him and instructed the nurses to monitor his blood pressure closely - an excuse for checking on him hourly. it's all very bizarre.

Just as i was about to leave (45 minutes after i should have gone), i was bleeped by one of the wards. "Mr. L's family would like to talk to a doctor," said the nurse, "they want to know what the biopsy results showed." This was a patient i had done lots of running around for - i had organised an urgent CT scan, phoned the histology secretaries twice for the biopsy results, badgered the bed manager to get him moved to a surgical ward, and persuaded the social work department that they needed to get involved. after 11 hours on my feet in A&E, i was tired and not in the right frame of mind to be sympathetic. but somehow i gathered the last remnants of something - perhaps it is the very stuff a doctor is meant to have. i asked the nurse to put the patient's daughter on the phone. "they took 3 small tissue samples from his stomach, and none of them showed any cancerous changes. now this doesn't rule out gastric cancer, but it does make it more unlikely, and it means that all the tests we've done do not seem to point to cancer as the diagnosis. Mr. M has referred your father on to Mr. A, another surgeon who specialises in diseases of the stomach, so he is under the care of the best team to treat the problem." what i really meant was, "we don't know if your father has cancer or not because none of the tests has actually shown anything. and ask to speak to Mr. A's house officer next time." but she seemed to buy it. "thank you doctor."

one of the more bizarre things about about working at the weekend is that you look forward to Monday. Monday, when everyone else will be back so I don't get bleeped every 5 minutes by 4 different wards AND have to see all the surgical patients in A&E. Monday, when I get off work at 5 instead of 9pm. When the ratio of anxious relatives to doctors is not something like 50:1 - that '1' being me.
having said that, speaking to relatives and explaining things was one of the more enjoyable tasks over the weekend - people seem fairly grateful to be told anything - even if I had never met the patient before saturday and was making half of it up.
saturday was madly busy, but sunday merely seemed to drag interminably - talking to and examining patients, sticking people with needles, inserting catheters - until all the white-haired men and paper-skinned women blended together. Rubber tubes up shrivelled penises, a finger in stool-packed rectum, fungating breast cancers - by the end of it you simply cannot look at a naked body the same way again.