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opportunity of learning, from first hand experience, when tospeak out and when to keep silent. In other words, doctorsand nurses, rather than philosophers or experts in ethics.

Provided, of course, that we are at least as concerned for thewelfare of patients as are the rest of society. Which is not forus to judge. But even Bernard Shaw, in the famous preface toThe Doctor’s Dilemma, observed that "doctors, if no betterthan other men, are certainly no worse".

REFERENCES

1. Phillips M, Dawson J. Doctors Dilemmas: medical ethics and contemporary science.Brighton, England: Harvester Press. 1985. Pp 230. £7.95.

2. Faulder C. Whose body is it? The troubling issue of informed consent. London: ViragoPress. 1985. See Lancet 1985; ii: 75.

3. Brewin TB. The cancer patient: communication and morale. Br Med J 1977; ii:

1623-27.4. Joyce CRB, Caple G, Mason M, Reynolds E, Matthews JA. Quantitative study of

doctor-patient communications. Quart J Med 1969; 38: 183-94.5. Cushner T. A conversation with Norman Cousins. Lancet 1980; ii: 527-28

In England Now

"Is he all right?" I asked the casualty sister. "Nothing to worryabout," she replied. "Only a few stratches and surface abrasions. Ithink it is his dignity more than anything else." "Oh well," I said."No doubt I will hear all about it when I visit him tonight."To be fair, it was his concern for the patients that was at the root

of things. One of our topmost wards has had for years a strangecontraption as a fire escape. This is a canvas affair, wound round aturntable, situated below a large window. In an emergency thewindow is thrown open, a handle is pulled, and the end of the canvasis precipitated out into the open. Being hollow it forms a chute.A few days ago it occurred to Giles to test it. A porter was stationed

at ground level and the machinery set in motion. Giles entered theescape fearlessly feet first and elbows out. Unfortunately he stuckhalf-way down. His muffled cries for help galvanised the staff intoaction. A junior doctor, with experience of pot-holing, was lowereddown, head first, attached to a rope, to push from above. A muscularmale nurse, who had climbed in the Cairngorms, made the ascentfrom below. The resultant struggle, as seen from the outside, was afascinating portrayal of fabric peristalsis. Sister Tutor made thisvery point to such young nurses as were within the crowd. That ishow the bowel attempts to rid itself of a bolus, were her very words.And, indeed, odds and ends were being evacuated from the distalend of the tube, such as a stethoscope, a piece of trouser leg, afragment of white coat, and a shoe. These, together with the noisesemitted as advice was proffered and rejected, made the comparisonquite apt.Eventually, the bolus was discharged, red, dishevelled, out of

breath and out of sorts. It is said he kissed the ground, Vatican style,before he was hustled off to the accident and emergencydepartment, but that is open to doubt. He was almost recoveredwhen I saw him that evening. "You know," I said in admiration."You are the stuff that medical martyrs and heroes are made of."Giles looked doubtfully pleased.

* * *

UP here our microclimate has escaped from the control of theWeather Centre, and orders its own affairs. A television forecast of"sunny periods" now guarantees a day of 10/l0ths sullen greycover, and "a few clouds developing by evening" translates as "apersistent downpour beginning at dawn and lasting all day".

It was therefore a shock to find that our annual Highland Gamesfell on a decent day-the only one we had had in the past eightweeks. The sun shone on the bulging muscles of the heavies, on thelassies dancing nimbly on a strangely dry platform, and on thepipers who rang the unexpectedly visible welkin. After theconcluding ceremony the mobile bank and the Army recruiting vandrove away unassisted, instead of having to be winched out to safety,as had been universally predicted.

All this was very satisfying, but I had another reason forcontentment, for my grandchildren were otherwise occupied, and inconsequence I was spared the annual loss of face which attends myrefusal to take a ride in any of the giant mechanisms-Rotors,Octopuses, Racers, and the like-which lurk among the sideshows.When I was a boy I rollercoasted with the best, but advancing

years took toll of the cells in my vestibular apparatus, and I came torealise that thrills of the kind that my dependants would have me

sample are not worth the aftermath. My family image began todisintegrate because I would not embark on the scenic railway in theTivoli Gardens in Copenhagen, and for many years thereafter mynegative attitude (maintained against frightful odds) was aninexhaustible source of adverse comment. The matter was finallysettled in Disneyland, where, despite minatory notices about peoplewith heart conditions or nervous dispositions, I was dared by mydaughter to enter the Magic Mountain, in which sensorydeprivation and fearsome G-forces induced in me both pity andterror. The resultant vertigo put me out of action for two days, andsince then it has been accepted by the Fl generation that poor oldDad isn’t fit for this sort of thing. This viewpoint has unfortunatelyproved difficult to instil into the F2 generation, and it is prettyuniversally felt that Grandpa is something of a fraidie-cat.But this year at the Games there were no reproaches. I was able to

remain upright throughout the day, and enjoyed the calmer and lessadventurous attractions. No doubt next year will again bring theusual ruthless criticisms of my inadequacy.

* * *

I LEARNED a lot in the RAMC. Amongst other things, awarenessof time and sleep. Time in the Service is not the same as that incivilian life. If reveille is for 7 am, the alarms will sound at 6.30;lights out, scheduled for 11 pm, extinguish themselves at 10.45.One hour’s duty consists of 1 hour and 15 minutes; a half-hour breaktakes 25 minutes. To this day I arrive at stations and airports at leastan hour before I should. On the credit side, I have yet to miss a trainor an aeroplane.Sleep interested me greatly. My problem was not how to induce it,

a subject which has exercised many minds, but quite the contrary.The legendary bedsteads, iron, folding flat, which have beencompared unfavourably with park benches, pebble beaches, andprison blocks gave us no trouble whatsoever. There was no need tocount the days to demobilisation before drifting off to happyoblivion. Sleep was virtually instantaneous as soon as our head hitthe unyielding pillow.No, our difficulty was in trying to rise from the sybaritic comfort

of sandpaper-like sheets, rough-hewn blankets, and the overlay of aBritish warm. The nearby cacophany of our sergeant banging anempty pail with a poker, whilst shouting dire imprecations at ourstaff, did nothing but induce a desperate desire for more sleep. Eventhe banging door and the lugubrious comments of the duty privateconcerning the weather, as he brought us in a cup of tea, failed todispel the delicious need to drift back again into the arms ofMorpheus.

I often think of those halcyon days as I lie awake on my expensiveorthopaedic mattress, covered by a costly duvet which leaves myfeet cold. And when sleep eventually comes, it is banished,immediately, by the merest twittering ofa solitary sparrow. It wouldbe nice to return to the half-light of those distant mornings when theorderly sergeant banged on a bucket with an iron bar.

* * *

REFLEXOLOGY is the ancient art of foot massage. I had heard thatpeople derived immense benefit from this strange practice, so I waseager to visit a trainee reflexologist I had heard of, who needed to"do" 100 pairs of feet before he could qualify to charge patients. Iwas asked to lie down and place my carefully scrubbed feet on apillow. He asked me whether I had anything wrong with me and itsuddenly occurred to me that I ought to mention my athlete’s foot. Ispent an enjoyable hour having my neck massaged!