I know that it was when I was sixteen for several reasons; being an atopic kinda guy I'd had plenty of interactions with the medicos, inhalers this, allergies that, but really only knew about what was wrong with me. When I was fifteen, I remember having shingles. Big yellow pustules on my elbow. And I saw a doctor. And they went away. And I had no idea how or why. I just had the scars from scratching the hell out of them. Aged sixteen, I went on 'work experience' to the local hospital with my friend's father.

On day one I showed up, all excited and shiny, in a pair of pants I'd borrowed from my Dad, looking forward to learning about becoming a doctor. First up I was shown how to wash my hands. Then it was explained that the ward we were going to was a 'quiet zone' but that there was a lot of (rightly) worried friends and family and that it was not a place for a young man to muck around.

I was taken to the ICU.

It was precisely at this moment that my 'informal' learning of medicine began. We went into the fishbowl and the doctor told me, quietly and lightheartedly, about the three types of patients on the ward.

Os have their mouths open;
Qs have their tongue out;
Spotted-Qs are very rare. They have flies on their tongue.
The aim is to stop the Os turning into Qs and the Qs into Spotted-Qs.

I remember being shocked and a bit repulsed. And confused. How could this man, who I'd known for years as kind and caring and gentle, express such flippancy about patients, even as a joke.

Now, ten years older, I can see where the doc's humour came from. I can appreciate it's dryness and pithy cynicism without offense. So can most people who watch Scrubs.

But, through my repulsion, I remembered the doctor's words. In fact, whenever someone mentioned the ICU, the O-Q-SpottedQ story would pop into my brain. I even came to think of it as some sort of initiation story, a 'Welcome to the team, kiddo, it's not all Roses here.'

Anyway, over the last week or so I've been trundling though Shem's House of God. Several of my friends are 'saving it' for Intern year. Others told me not to read it whilst on my Internal Medicine Rotation, and I understand why. It's not what I'd call a wholly optimistic book, and whilst I no longer have the sheer naievety as when I first strolled into ICU, aged sixteen in daddypants, I hope that it's a long, long time before I get that cynical about medicine.

But, crikey, I can see how it spelt out the feelings of an entire a generation of doctors. And I can sure as eggs see some of the remaining artefacts of paternalistic medicine each day on the wards. Not just from docs, or nurses or allied health, but from patients who still believe in it.

Anyhoo, just after the Fat Man describes the importance of Finesse in medical care, is the book's only illustration;