Highly trained sleep walker

Dr Genesis, this week.

Dr Genesis is on nights.

That means 9pm until 10am, seven days in a row.

By night two, at 3am, Dr Genesis is a walking zombie. He had some sleep during the day but anyone who does night shifts will know that you can never really get quite enough. Dr Genesis knows when he ought to rest. His mind gets slow. You would not want him making medical decisions about your loved one.

In obstetrics, there is an on-call room with a bed, clean sheets, a basin and a TV. "You are not at work to sleep!", cry the powers that be who govern the lives of junior doctors. "Correct, my friend", Dr Genesis replies, "I am here to save the lives of sick people". They allow the obstetric doctors to have a room each. Because for a baby or young mother to die would be a catastrophe for the hospital. The press would be damaging. But in general medicine...if someone dies...well...it's probably not going to be someone who'll be missed.

There used to be on-call rooms just across the car park. Dr Genesis would book one in advance and nip over to have a nap during the night. But they have been abolished. You are not allowed to book one.

The refreshing power of a few half hour naps, throughout the night, can work wonders.

Luckily, Dr Genesis knows of a few spare examination rooms in the dark recesses of the hospital. No one will find him napping there.

Still. It is ridiculous. A deliberate attempt to exhaust doctors. Why? What is to be gained?

The pancreas: a mischievous cretin

Someone's pancreas. Not mine.

Metastatic pancreatic cancer.

Nice man. Felt a bit dodgy. A little poorly. Not his usual sprightly 70-odd self. A little breathless. The xray showed a large pleural effusion. Duly drained off by knackered junior doctor. What could cause this effusion? Hmm...let's scan every inch of his body to find out. Oh dear. Pancreatic cancer. And the liver is choc full too.

Now, any doctor/nurse/physio/medical secretary/porter/cleaner/hospital dustman would know enough about this to know the treatment: drive to a nice hotel, charge everything to Visa, twice daily aromatherapy massages, Belgian chocolates on tap and... wait to die. You'll never have to pay the Visa bill. Because you'll be in heaven/nirvana/choose your afterlife by the time the bill comes through the post.

Problem: the loving family don't belong to any of the above employment categories. They want everything. Can't they operate? No. Can't they give chemo? No. Radiotherapy? No. So that's it, is it? You're just going to let him die?

What could I say? I thought about if it were my father. And my family were looking at some kid doctor in his 20s who looked like he'd just left prep school. A doctor who was telling us our father was going to die within months.

Sigh.

Wise old man. Probably thinking about ethics.

First blog. Big day.

First patient: ancient man, advanced dementia. Even the dementia nursing home couldn't cope. Not his usual self. Normally happily demented. Now not so. Agitated, tearing clothes off, not eating. The nurses managed to get some blood off him. Turns out he was in acute renal failure, big style. And still totally demented. What can we do?

Sat down with the family: don't worry, they said. We were expecting this. Let him go. He's had a good life. Served in the war and got the shrapnel to prove it.

No problem, you've picked the right doctor for the job, I said. Dignity is my mot du jour.

Discuss it with my senior, been in the job 7 or 8 years. Let's try some intravenous fluid, catheterise him, check the heart trace, do an arterial blood gas sample (ouch) and repeat the bloods in a few hours, she says.

An interventionalist

Hmm. Ethical day.