If symptoms

persist. . .

WHEN I walked on to the ward one morning last week I surmised from the exhalations of stale alcohol which greet- ed me that I might have to endure an insult or two before the end of the day. One of the worst things about being a doctor is that you have to pretend that repulsively bad manners are a sign of suffering.

The insult wasn't long in coming. I approached the first bed, which con- tained a patient who, just before his arrival in hospital, had smashed up his common-law wife's flat.

`Good morning,' I said.

`Piss off, will you,' he replied, looking at me with such concentrated malevolence that even I, who am no stranger to the ways of human malice, was taken aback.

I recovered a little, and carefully wrote in the notes 'Piss off, will you,' so that whenever he attended our hospital in future, he could be assured of a frosty, hard-hearted reception.

`How are you feeling?' I continued, turning the other cheek.

`I'm telling you to piss off.'

The patient in the next bed was a truly terrifying specimen, a young man with bulging muscles and receding forehead, with Made in Britain tattooed round his left nipple. This was a redundant piece of information, for on his biceps were tattooed unfurled Union flags, guarded by bulldogs, their snarls revealing rows of fangs. The man's head was shaved, the bristly scalp punctuated with white scars from wounds inflicted by bottles, crow- bars, etc.

He had been admitted to the hospital unconscious. Apparently, he had bought some methadone (the drug used in the treatment of opiate addiction) in a pub and swallowed rather too much of it.

`How much did it cost?' I asked him.

`Five quid.'

`Why did you buy it?'

`How the fuck should I know? I was drunk, wasn't I?'

I changed the subject. I had noticed a large scar across his neck.

'How did you get that?' I asked.

`I cut my froat.'

'Why?'

'I don't know. I had enough, I sup- pose.'

So had I. Truly I had glimpsed the abyss, the abyss of modern life. Poverty is not quite the word for it, conjuring up as it does images of children without food or shoes. Indeed, I thought my patient looked unhealthily healthy.

In the afternoon, I had an outpatient clinic. To raise money, the hospital man- agement has now installed televisions in the waiting area, on which local services are advertised, including those of a faith healer who has succeeded (he says rather pointedly, considering the location) where many have failed. The waiting patients watch the screen as a rabbit watches a stoat.

My first patient was a man whom I remembered as having been exceptional- ly truculent during his last appointment. My recollection proved correct: for my note about him on that occasion read `Fuck off' and nothing else.

I was' relieved to discover that today he was in a better mood. He had thought over his truculence, and had asked for another appointment.

He leant over my desk and looked at his notes, which were open upon it.

'I never said that,' he said.

`Yes, you did,' I replied.

`No I never. I said, "Fuckin"ell".'

`All right, then,' I said, and I crossed out 'Fuck off.' Pursing my lips, I replaced it carefully with `Fuckin"ell'. By all means let us be accurate.

Theodore Dalrymple