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The Daily Rhino
Sunday, April 20, 2008

Incendiary views
I WAS on the wireless today. It's not the first time - I was on Anita Rani's show on the BBC Asian Network talking all about porn, but that's another story. Today I made it, interviewed by Eddie Mair on iPM. Like most people, I despise hearing my voice, but it could have been worse. I was asked to comment as a piece I wrote for the paper about a year and a half ago was picked up. The topic under discussion was ash cash.

No sooner than one British establishment featured the DR, another did. Now I've
really made it. The great Dr Crippen talked about ash cash too, which is why I thought I'd write this quick note.

The passage quoted on Dr Crippen's and iPM's blogs is tongue-in-cheek and I take any accusation of being insensitive on the chin, for it is deserved. But the passage should be taken in context, so do please read the rest.

Dr Crippen does indeed make the exact same point I did in the extended interview, hospital doctors who deal with death on a daily basis utilise coping strategies that are insensitive. When we talk about getting your ash cash from the ash point, or make jokes about celestial transfers to the big ward in the sky, it is merely a way of distancing ourselves from the fact someone has snuffed it. Crippo's right, we don't develop the same relationships with our patients that a GP might (well, polyclinics will see an end to that).

"I wish I was young again so that it could all be fun and “ash cash”, but I am no longer young. My skin is no longer Rhino-thick for now I understand what I am doing, and how important it is that I do it properly." [Link]

I enjoyed reading some time back that the venerable NHS Blog Doc describes himself as a curmudgeonly git, as this is how most of my friends would refer to me. Whilst I have maturing to do before I reach Crippenesque gravitas, it does not mean that youth eschews pathos.

Sure we joke and pick up our ash cash cheques, but I think we all spend a quiet moment contemplating the elapsed life we are signing off into the flames. In its great early days,
Scrubs occasionally featured some great lines. JD looks at his first dead patient and says "he looked exactly the same, only completely different."

Moments like this, and fumbling awkwardly for a pacemaker across a cold corpse, are the experiences that stay with you and shape your development in medicine. But they're put away and covered by tasteless jokes at the pub. Just the way, I feel, it should be.

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I suppose it makes sense that doctors ought to be complacent.
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