Really useful engine.

It had been bugging me for weeks. Ever since his first presentation as I ran through the first of many monotonous consent forms. So practised now at the list of anaesthetic risks that I can actually be thinking of something else completely as I prattle them off, interjecting occasionally to emphasise the rarity and to mention the modifiable risk factors. I had been admitting him, running through the presenting complaint, the medical history, the surgical history, the social history, the smoking history and it niggled away. In that way that something you just can't pinpoint rankles.

He went home after that presentation with the mystery unsolved. No matter how hard I thought about it I couldn't work out what it was that his voice reminded me of. I would have conversations later about his surgery to remove half his liver and the chances that this surgery would be curative for his metastatic cancer. It would bug me as we bargained and rationed his blood tests because of his needle phobia.

I'd walk away from his bed after ward round as we discussed management trying to work out where it came from. But it wasn't until I had the conversation with him about the abandoned surgery and the massive problem we'd found intra-operatively that I realised where it came from, and I had the uncomfortable desire to laugh as I realised his voice was a perfect match to Ringo Starr's narration of Thomas the Tank Engine.

It was Thomas and James that I conversed with for the next few mornings, as we sorted things out, organised for the oncologists to drop by. Sorted more things out, and I made excuses to drop by and see how he was doing. Such is the nature of dealing with favourite patients. And it tickled me always, his accent, reminding me of whistling, cheerful, cheek engines.

But when I went in to see him this morning it had finally dawned on him, the reality of his situation, of his shitty prognosis, of the mind that is young but a body that is literally crumbling. And he voiced what I'd known since the beginning, that he was going to die, and it was not going to be far off in the future. It was bright outside, one of the first days to truly brighten up the world after a week of mist and drizzly Winter rain and I knew something was wrong as soon as I saw him brooding in his chair, the curtains drawn around, shutting out the light.

I asked what was wrong, and he told me, simply, that he was pissed off. And he was, with every right to be, pissed off. Impotently with a body that he can't fix, that will give out, and in his Fat Controller's voice he lamented to me that he'd just had enough. His bright blue eyes not meeting mine. His affect defeated, his body slumped in his chair.

And it felt so wrong. As wrong as it always does, when you're privy to the worst moments in someone's life. But more wrong too. We'd been chums for the last few weeks, there's always been a twinkle in the eye, as if laughing over some secret joke, a jollying along in what was undeniably a shitty situation. He lost his humour, and in watching him, I lost another crumbling part of my faith in the rightness of things, magical thinking dying its slow uncomfortable death.

And tonight I said goodbye as he got ready to go home to his family. Joking about breaking out of hospital to start living again, even though we both knew he was going home to die. Feeling that keen of emotion behind my sternum as the tears glistened in his eyes as they met mine. Feeling beyond useless and struggling as my cheeks flushed red against the urge to hug him to me, like he was my grandfather instead of yet another patient that I cared too much about. Failing yet again to be objective and indifferent.

Trudging home in shoes that pinched in the dark, thinking of his Ringo Starr accent and my inability to not care before determinedly wiping the death out of my body and replacing it with violent life instead. Filling myself with it until I forgot another day where I held hands and wiped sweat away while listening with my stethoscope, pushing cannulas into arms with a calm skill that would amaze even myself 6 months ago.

Standing in the shower, washing the rancid sweat of a heavy day from my body and feeling the numbness swamp. Paying my indemnity insurance and swigging ice cold vodka that clings to my lips and my teeth. Feeling that prickle of consciousness that comes when I need to escape.

And wishing I didn't understand death like I do.