Now for something completely different Medical Matters Dr Muiris Houston

Welcome to Medical Matters for 2004

Welcome to Medical Matters for 2004. I thought I would start the year on a light note, with some medical anecdotes borrowed from the Lancet. No ageism, sexism or any other ism is implied.

Dr Larry Greenbaum wrote about the need in medicine to establish the right blend of humanity and humility. One day, he and a nurse were trying to cajole a history out of a patient lying on an emergency-room trolley. Unco-operative or comatose, the woman was uninterested in answering questions about her chest pain. "After a few minutes of frustration I rolled my eyes and glanced at the nurse, wondering how to restore my patient's mental status. At just the same time the nurse rolled her eyes at me. Although you might not subscribe to theories of extrasensory perception, the effect the nurse and I had by simultaneously rolling our eyes seemed to magically cause the patient to open her eyes.

"Her mood then changed from flat and somnolent to a level of bellicose irritability that I would have judged impossible just seconds earlier. To my consternation she also found her voice, and her first words were: 'Do you always make faces at your patients?' My status also changed abruptly. My role was suddenly transformed from noble, attending doctor to grovelling servant singing choruses of 'excuse me'."

Less humorous but definitely humbling was the time Greenbaum was looking after an older man left brain damaged after a severe heart attack. The patient, who had long, straggly grey hair, was lying in bed, completely unresponsive. A young woman stood on his left side, tenderly holding his hand, the picture of filial devotion. The doctor, who was unable to offer anything in the way of good news, describes what happened next.

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"I stationed myself solemnly on his right side, wedged uncomfortably between wall and the bed, and I nervously skimmed through the man's heavy chart. Several times I looked back and forth between the patient, the chart, the cardiac monitor and his daughter. I knew that I couldn't do anything to help his anoxic encephalopathy [irreversible brain damage\]. Truthfully, his daughter wasn't paying any attention to me, but I wanted to say something encouraging, positive and hopeful yet realistic.

"The situation seemed to demand that I comment. After sweating over my limited options for five long minutes, I addressed my small audience with an air of physician authority, pronouncing each word slowly and evenly. 'As far as I can tell from the chart, your father is about the same as yesterday.' The young woman continued to caress the hand of the unresponsive man, but she looked up and corrected me. 'This is my boyfriend, not my father.' I don't remember how I replied, but it was probably just a simple 'oh', since talking does not help in every situation."

Feeling a year older this week? Here's a less-than-scientific checklist for ageing. Everything hurts, and what doesn't hurt doesn't work. You feel like the morning after the night before - and you haven't been anywhere. You get winded playing cards. You sit in a rocking chair and can't get it going. Your back goes out more than you do. You sink your teeth into a steak and they stay there. Your knees buckle but your belt won't. The gleam in your eye is from the sun hitting your bifocals. And your little black book contains only names ending in MD.

And just to prove that politicians can laugh at themselves, this medical joke was recounted by a senior politician at a recent social function.

Five surgeons were discussing which was the easiest profession to operate on. The first surgeon declared that librarians were the simplest, as when you opened them up everything was in alphabetical order. The second disagreed and pronounced that electricians posed the least challenge; when you opened them up everything was colour-coded. The third surgeon disagreed with his esteemed colleagues' opinions and was heard to say that accountants were the easiest to operate on, as when you opened them up everything was numbered. The fourth was adamant that they were all wrong and that builders were by far the easiest patients, as they did not mind if the job took longer than you initially thought and never objected if there were a few spare parts left over. The fifth surgeon agreed with none of them, declaring that politicians were by far the easiest to operate on. For when you opened a politician up they had no spine, no stomach and no heart - and, even better, their heads and rear ends were interchangeable.

You can e-mail Dr Muiris Houston at mhouston@irish-times.ie. He regrets he cannot answer individual queries