Mad angry

Rich, a male Filipino nurse, is clearly insane. Despite plenty of evidence to the contrary, he's chosen me, basically a medical student with a staff discount in the canteen, as his personal icon of clinical excellence. A ward-based Dr Quinn Medicine Woman or Karl Kennedy.

He's also got a touching faith in our drugs' ability to cure any medical complaint. Sometimes his enthusiasm for the chemical cosh oversteps the mark. Take Mr Harris, a middle-aged firebrand who was getting frustrated that he didn't feel any better despite the improvements in his blood tests. When Mr Harris got cross with one of the nurses serving him lunch, Rich asked me to prescribe an anti-psychotic.

With a hopeful look in his eyes, Rich handed me a syringe he'd already prepared, with the immortal words: "Haloperidol, doctor?"

I looked at Mr Harris, by this point fiercely attacking his mashed potatoes, and decided that a powerful sedative may not be necessary.

Making sense of emotions like anger and fear - mundane events in the real world - is actually quite difficult in hospital. Arguments can come from personality clashes, but can also be the first sign of an acute delirium. It's the same with new symptoms: aches and pains that most people don't bother to mention to the GP take on a new, possibly frightening significance when they're already in hospital for something else.

I left Mr Harris to enjoy the rest of his lunch in peace. Even if he did have something serious going on, it certainly wasn't spoiling his appetite. It wasn't a trouble-free decision though: I think I may not be Rich's number 1 medic any more. He asked another junior doctor to prescribe the teatime sedatives.