During the operation Piers was not in peak condition, having eaten `the strongest Balti you've got' not eight hours previously

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Indy Lifestyle Online
Every now and then, we doctors congregate in secluded hostelries to exchange anecdotes over a sensible amount of industrial-strength cider.

This is about as close as the profession gets to counselling itself, and is far less embarrassing than Alcoholics Anonymous. The aim of the session is to upstage the previous anecdote by something even more unnecessary, until somebody's conscience kicks in and forces us all to conclude that laughing at misfortune really isn't the thing to do.

Modesty and the features editor forbid me to share the later anecdotes with you, but the second one - which I pray is apocryphal - will give you a flavour of the darker side of medicine.

Piers and Toby are allegedly two third-year students from a medical school that still accepts people called Piers and Toby (so no clues there, then.) They're bloody good men, top-notch chaps, and belong to a wider clique entertainingly known as "The Damage Boys". The DBs have a long history of amusing japes - eg drinking Bloody Marys made with real blood (their own) and catheterising themselves, connecting the ends and peeing into each other's bladders - you get the picture. Piers and Toby are at the forefront of all this, having earned a place in med school history by remaining inside a portable toilet while it cleaned itself. The floor opened and they fell through into a shit pit. Bloody Marys all round.

Despite this anarchic behaviour, P and T remain deeply respectful of authority figures and as frightened as the next medical student of malignant consultants. One such surgeon, with a reputation for bad breath and even worse references, works in a district general hospital where our heroic duo are learning surgery. This involves cowering at the back of busy clinics and ward rounds, staring at your feet, and trying to summon up the courage to ask a question while simultaneously praying you won't be asked one you don't know. But the greatest fear of all is being called on to assist when the great man does his operations.

The pitfalls of your first theatre experience are legion. If you're last in the changing room, the only greens left are either 22in around the waist, or 44in and without a draw-string. No one tells you where the hats and masks are, and the only pair of boots left have the name of your consultant written on the side. If you do manage to scrape together a costume, you've then got to scrub your hands for at least twice as long as the boss, dry them, put on a gown and a pair of gloves (without getting balloons in the fingertips) and all under the gaze of a hawk-eyed Sister desperate for you to desterilise yourself so you have to start all over again. If you are deemed clean, you must then approach the table and hold on to a wound retractor for about seven hours, while praying that your glasses won't tumble off into the wound.

Piers was first into the bear-pit, assisting at a laparoscopic something- or-other (trying to remove an unfeasibly large organ through an unfeasibly small keyhole incision). Some surgeons are very good at it, but this one wasn't. Piers was not in peak condition, having eaten "the strongest Balti you've got" not eight hours previously. As the operation finally drew to a close, his bowel protested in a silent but none the less evocative way. "I smell faeces," sniffed the consultant. "So do I," sniffed the senior registrar. "Damn," said the consultant. "We must have perforated the bowel. I'll have to open him up."

What should Piers do? On the one hand he has a duty to protect the patient; on the other, he needs to pass his surgery assessment. In a culture where fouling the air is frowned upon, a simple admission could mean the end of a promising career. But the patient was promised a tiny incision and an overnight stay, and could now wake up with a 7in wound and a month off work. Perforation of the bowel is a serious, often fatal, condition. If you suspect it you have to reach for the scalpel.

By this stage I was engrossed in the anecdote, desperate to find a solution that would preserve both livelihoods. My colleague, who heard it from a friend of a friend (but they're both doctors, so it must be true), claims that the real Piers kept mum and the patient underwent an unnecessary bowel exploration. That's when I knew he was lying. Today's medical students are the academic elite, the top 0.1 per cent of the nation's intelligentsia, and fiercely dedicated to patient welfare. No real-life Piers would accept such a limp cop-out. He'd lean forward, taking care not to desterilise himself, and whisper in the consultant's ear, "I think it was Sister." There is only one thing you need to know to survive in medicine: if in doubt, blame it on the nursesn

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