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Just don't make me laugh or I may wet myself

The joke is on Copperfield when one of the games he plays to get through surgery without going mad goes horribly wrong.

The joke is on Copperfield when one of the games he plays to get through surgery without going mad goes horribly wrong.

'Doesn't it drive you mad,' my non-medical friends ask, 'seeing moaning patients all day long?' And I switch on my caring-sharing face, remember my patient-centred vocational training and, with the serene bedside manner of Dr Kildare himself, reply: 'Yes, it drives me totally nuts.'

That's why I invent little games to play during the consultation. These distractions prevent the average surgery from doing my head in.

So, for example, I'll see if I can get through the whole session without examining a patient, or issuing a sick note, or saying the word 'virus' (tricky).

Anyway, today I notice that my pre-surgery dose of caffeine has hit my bladder unusually quickly. By my fifth patient, I'm at that niggly stage where I'm not busting for a pee, but I'm not comfortable, either.

So naturally I decide that today's mission is a game of endurance: to reach the end of surgery without a loo break. This is a high-risk strategy, given that I have a history of incontinence. Indeed, the last occasion I wet myself was quite spectacular, as I was standing on a busy street. Mind you, I was aged four at the time, and a big dog had just barked at me.

Extra urgency

The point is, the loo's quite a way from my consulting room and, frankly, I can't be arsed to move. Besides, I figure that my slowly distending bladder will add some urgency to the consultations, thereby speeding things up. Which is good.

Patients six through to nine are uncomfortable. Numbers 10 through to 13 actually quite painful. By 14 or 15, I decide that next time I'll wear incontinence pads. Or simply catheterise myself before the first punter.

But patient number 16 is the last one, and I remain dry and determined. Then she opens her mouth.

'It's a bit embarrassing, doctor,' she begins, misinterpreting my strained silence as an invitation to continue. 'The thing is, when I laugh or cough I, er…' Oh God.

I know what's coming. This is cruel. She might as well have turned the taps on.

I clamp my knees together and hold my breath - '... well, I'm afraid I leak'.

OK. Calm. Breathe. I can get through this. 'I think I have a prolapse,' she continues. 'So I'd like you to examine me.'

Now alarm bells are going off. I try desperate measures. No, she doesn't want to book a further appointment. No, she doesn't want a female doctor. No, she doesn't just want to forget all about it. She wants it sorted, now.

With the situation at Code Red, I consider asking her if she needs the loo before the examination on the basis that, if she declines, I could say: 'Well, I do.' But in the end, I decide to risk getting on with it. In, out, a few seconds, job done. Hopefully.

Gingerly, I rise to my feet. Good. I stagger over. Still good. I get to work. Suddenly, my intravesical pressure increases. I explain, in a high-pitched voice, that it's normal practice for doctors to hop from foot to foot during these examinations.

Moments later, we're done. Joy. Relief. She's getting dressed as I explain I'll refer her to the local prolapsologist. I'm seconds from success. Then, outside, a big dog barks…

Dr Tony Copperfield is a GP in Essex. You can email him at tony


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